Backgrounder / December 4, 2014 / Project number: BG - 14.031
Suicide is a public health issue for all Canadians including Canadian Armed Forces (CAF) members. Suicide is the second leading cause of death for those aged 15 to 34 in the Canadian general population.
Every suicide is a tragedy, including the loss of any of our soldiers. Each loss is painful and heartbreaking, therefore, the health care needs of military personnel are a priority for the Government of Canada and the CAF. The CAF recognizes the sacrifices military personnel and their families make in the service of their country. Senior leaders are committed to ensuring military personnel receive a high standard of health care and support.
The CAF’s extensive mental illness awareness and suicide prevention measures consist of clinical and non-clinical interventions by generalist and specialist clinicians, mental health education, and suicide awareness information. Every day great efforts are made to identify people at risk for mental health problems and to provide them with the assistance that they require but it is important to note that not all people who complete or attempt suicide can be identified in advance.
Even with a strong health care system, it is essential that all military personnel, like all Canadians, recognize mental health issues as they develop and progress. We each have a role to play in identifying and assisting those affected by mental illness. Once we are collectively educated and able to recognize the onset of mental illness, we can help our friends, colleagues and family members by encouraging care.
The CAF remains committed to reducing the barriers that may interfere with obtaining timely mental care. Stigma is one of these barriers. Through dialogue, training and leadership, we can create a culture in which care seeking is encouraged and facilitated. The CAF has made great strides with respect to these barriers, but the work is not complete—both in the CAF and in society at large.
The CAF monitors the rates and trends of suicide and other mental health issues in its population in order to gain more understanding of underlying issues and mitigate risks.
Within 72 hours of a death, the police of authority will typically receive an initial indication from the independent civilian coroner on whether the death was the result of foul play, an accident, or a suicide. This, along with information such as police reports and medical records, is used by the CAF in making an informed, professional decision to conduct a Medical Professional Technical Suicide Review and a Board of Inquiry into a suspected suicide.
|Calendar Year||Regular Force Males||Regular Force Females||Reserve Force Males2|
|2014 (to September 30)||12||0||3|
1 It is important to note that the suicide statistics for any given year may be subject to change depending on the results of the investigation into the sudden death. The following table contains the most accurate statistics based on the information available at the time of publication.
While these statistics are provided to give a complete picture of the number of suicides in the CAF over the past 10 years, only a sub-section of these (male Regular Force) are used to determine suicide rates and to compare to a similar age-gender group. This is because Regular Force female numbers tend to be too small to be statistically analyzed with any degree of accuracy while the Reserve Force suicide numbers are more difficult to track and confirm as members are often embedded in local communities where they receive their health care. Additionally, Reserve Force members often have limited contact with their home unit.
Suicide attempts are taken seriously by the CAF. The chain of command, including the Chief of the Defence Staff, is alerted to possible attempted suicides through a variety of mechanisms, including unit significant incident reports and reports from military police or third-party authorities. Any and each attempt reported to the chain of command is recorded and monitored to ensure we are doing all we can in support of the member, ensuring that the health care team and the chain of command are working together to ensure the best possible outcome for the ongoing safety and care of the member.
The reporting route of an attempted suicide can depend on the first responder, and it should be noted that for privacy and patient confidentiality reasons, the doctors within Canadian Forces Health Services (CFHS) do not divulge attempted suicides to the Chain of Command or otherwise unless the patient provides consent to release that information. The intent of the reporting is not to try to determine rates of attempted suicide but rather is used by CFHS to formally review care provided to members to ensure the member is receiving the best possible care and help better understand suicidal behaviour. Further, there is no common medical definition of 'suicide attempt' and attempts may range from calls for help to self-injury and other motivations. Thus, reporting a set number of reported suicide attempts does not represent the complexity of the issue.
The figures in Table B originate with the Directorate of Force Health Protection, and are based on the information collected by the Administrative Investigation Support Centre. These figures include male Regular Force personnel only.
The values in Table B are calculated at a rate per 100 000, like those provided by Statistics Canada. Consistent with accepted research methodology, the CAF compares and monitors the numbers over a five-year period in order to determine if fluctuations are random or statistically significant.
|Year||Number of Male Reg Force Personnel||Number of Suicides Among Male Reg Force Personnel||Male Reg Force Suicide Rate Per 100,000 Population|
|5 year period(2005-2009)||275 606||50||19|
|5 year period(2000-2004)||263 323||51||19|
|5 year period(1995-1999)||281 533||56||20|
3. In 2011, there were 21 suicide deaths in male Regular Force personnel. While this number is higher than previous years, it is important to note that suicide numbers vary from year to year and as is the case for any statistic, a variation can either be due to random patterns or indicate the beginning of a trend. In this case, the subsequent reversal to more conservative numbers in 2012 and 2013 suggests a random variation.
Suicide rates among currently serving male Regular Force CAF personnel, as demonstrated above, are no different than those among a similar demographic of the Canadian population and there has been no statistically significant change observed in the suicide rates in the CAF since 1995.
Each suicide in the CAF is investigated. The Canadian Forces National Investigation Service (CFNIS) investigates all sudden deaths which occur within their jurisdiction. The CFNIS gathers evidence and works with the coroner who then determines the cause of death. CFNIS investigations are conducted in accordance with Canadian police standards. Sudden deaths outside of CFNIS jurisdiction are investigated by local police authorities.
When Canadian Forces Health Services (CFHS) is made aware of a suspected suicide, an initial medical record review is conducted. The responsible civilian coroner’s office is responsible for determining the official cause of death.
For each completed suicide (often before confirmation from a coroner is received by the CAF) CFHS will initiate a Medical Professional Technical Suicide Review a few days to a week following the death. This review is an in-depth medical review conducted by a two-person team (typically composed of a General Duty Medical Officer and a psychiatrist). These clinicians interview family, friends, colleagues, the chain of command, and health care providers in order to gain an understanding of the circumstances surrounding the death. Lessons learned can be used to improve the CAF suicide prevention program or other health services programs. To date, numerous such reviews have been completed and the findings have provided greater insight into suicide in the CAF and how to enhance the already high-quality mental healthcare provided by the CAF.
A Board of Inquiry is also normally convened in cases where the cause of death is suspected to be from self-inflicted means. Normally, the motivating factors that led to the event are among the issues examined during this process.
In the case of an emergency, CAF members in crisis can see a primary care physician on a 'walk-in' basis, without an appointment, at one of the CAF medical clinics during normal business hours. All primary care physicians have been trained in suicide assessment, management, and prevention. Members may also go to a civilian healthcare centre during quiet hours or they may call 911 (for an acute emergency) or 1-800-268-7708 to reach the Member Assistance Program, 24 hours a day, from anywhere in the world, and receive a confidential referral for help.
The friends and family of someone in need of help can also contact emergency services, who will either bring the suicidal member to the base clinic during working hours, or to the local hospital emergency department after hours. Military and civilian police, as well as emergency services personnel, are trained in mental health crises and in helping and managing the suicidal person.
In addition to the primary care services and mental health clinics available on all wings and bases, CAF members with mental health concerns and their families currently have access to a range of CAF and Veterans Affairs Canada services and programs including:
CFHS has several programs aimed at preventing or mitigating the effects of stress. Educational programs are delivered to various levels of leadership and cover all aspects of a member’s career. Through the Road to Mental Readiness program, the Directorate of Mental Health Training and Education Section has developed an evidenced-based mental health curriculum that has been integrated in CAF career courses. Since 2009, over 56 000 CAF members have received some form of mental health training and education. For more information on these courses and other mental health education and awareness programs, please visit the Post-Traumatic Stress Disorder Backgrounder.
The CAF health promotion program, Strengthening the Forces, offers mental fitness and suicide awareness and education training based on the A.C.E. (Ask, Care, Escort) model. At the leadership level, a one-day course called Mental Fitness and Suicide Awareness helps prepare supervisors to promote mental fitness and to mitigate the incidence of mental health injuries, including deliberate self-harm and suicide, within the military community. In addition to the supervisor’s course, a Mental Fitness and Suicide Awareness full-day course is available to all CAF members and their families.
Half-day mental fitness awareness sessions and briefings are also available on all bases and wings. This training takes place under the CAF’s larger health promotion umbrella, responsible for promoting healthy living and an addiction-free lifestyle, preventing injury and illness through education, and skill building activities which include stress management, anger management, and effective communication. For more information, please visit the Strengthening the Forces website.
Over the past 10 years, the CAF has put significant effort into conducting research and enhancing the care provided to members. The goal of the Directorate of Mental Health is to continue to enhance its research capability and conduct world leading research. The research, performed entirely within CFHS or with partners from academia or amongst our allies, will help us to better understand, identify, and treat mental health conditions.
As part of the CAF leadership’s commitment to improve and enhance the care and support services currently available to members, the CAF will continue to monitor suicide rates and other trends that may lend insight into the overall mental health and general well-being of its population.
The Canadian Forces Expert Panel on Suicide Prevention, held in Halifax in September 2009, found that the CAF has a strong suicide prevention program in place that compares most favourably to those of its North Atlantic Treaty Organization (NATO) partners and closest allies.
The panel also found that the CAF has implemented, or are in the process of implementing, nearly all of the suicide prevention strategies most consistently identified in civilian scientific literature. These strategies include, but are not limited to, education/awareness programs, screening, pharmacotherapy and psychotherapy, resilience training and systematic efforts to overcome barriers to mental health care. In addition, the panel expressed agreement that the CAF’s approach also targets additional factors that are more specific to military organizations.
Since the panel, the CAF has established the Medical Professional Technical Suicide Review process and implemented a patient follow-up protocol for missed mental health appointments as tangible ways to help prevent suicide, which are consistent with mental health best practices.
The CAF has also become involved in initiatives that promote responsible media reporting of suicides. CAF mental health experts have shared guidelines on responsible reporting and have been made available to discuss the complexities of suicide.
Click here to read the Panel’s full report on Suicide Prevention
As a transparent and public organization, the Directorate of Force Health Protection regularly conducts analyses to examine suicide rates and the relationship between suicide and deployment. This report uses suicide rates for male Regular Force members to compare to the Canadian population using standardized mortality ratios.
The last report, published in March 2013, concluded that suicide rates in the CAF did not increase over time, and after age standardization, they were lower than those in the Canadian population. No consistent relationship has been established between deployment and the risk of suicide in the CAF at this time. It was noted however, that higher suicide rates in certain commands were consistent with a heavy operational tempo, combat exposure, and resulting mental health concerns. All military personnel undergo a mental health screening as part of their pre-deployment medical assessment. Deploying personnel also undergo a psychosocial screening by either a chaplain or a mental health professional.
Click here to read the latest version of the Suicide Report. An updated report, containing numbers from 1995-2013, will be available in the coming months.
The Canadian Forces Cancer and Mortality Study is a collaborative effort between CFHS, Veterans Affairs Canada and Statistics Canada. All CAF members who joined the Regular Force from January 1, 1972 to December 31, 2006 were included in this study. The initial mortality results released in spring 2011 looked at both serving and former CAF members. The results showed that the risk of suicide within this group was comparable to the Canadian population. However, when considering the population of former CAF personnel alone, men in this group had a higher risk of suicide compared to the Canadian population. Further analysis identified the following associated risk factors: service before 1986, shorter period of service (less than 10 years), former Non‑Commissioned Member rank, and release for involuntary or medical reasons.
For more information and initial mortality results, please visit Canadian Forces Cancer and Mortality Study.
Evidence has demonstrated that there is an increased prevalence of suicidal behaviour in populations where those at risk have experienced the suicide death of a friend, colleague, family member, or someone they can closely identify with. In the CAF, this is of particular concern because of the shared experiences of individuals in the population (i.e. CAF personnel live in close quarters and have similar occupational experiences). If a suicide occurs in the CAF population, there is the risk that others will relate to the deceased individual and this could in turn, lead to an increase in suicidal behaviour.
We encourage dialogue about mental health and suicide, but we also acknowledge the unintended negative impact these discussions can have on the health of personnel at risk of suicidal behaviour. This risk needs to be considered when details surrounding a suicide-related event are communicated both internally and externally.
In particular, there is concern among health professionals that irresponsible media reporting of suicide will lead to contagion. In other words, the concern is that more suicides will occur as a result of media coverage. The World Health Organization reports that the review of over 50 investigations has shown that “media reporting of suicide can lead to imitative suicidal behaviours.”
For more information on responsible media reporting on suicide, please visit:
Suicide is a tragedy and an important public health concern. Significant investment and commitment has been made to ensure the CAF have the health, education and awareness programs required to help identify people at risk for mental health problems and to provide them with assistance.
Caring for CAF members and their families will remain a priority. The CAF has provided leadership in the area of mental health and remain committed to working with its partners to ensure that our personnel, with their families, who are called to sacrifice so much in service to their country, receive quality care and support. The CAF continues to assess its capabilities and adjust its resources to assure they are meeting the increasing complexities and demands associated with caring for our own.
But we can’t do it alone. We each have a role to serve in identifying and assisting those affected by mental health concerns. Often, peers and family members are the first to notice behavioural changes, and when we do, we must not be afraid to act - do not underestimate the impact you can have.