A response from the Ministry of Health on suicide bereavement and support services in BC

In light of the fact that today is World Health Day with the focus on depression, I would like to share the response I received from the Ministry of Health regarding a letter that a group of suicide survivors, including myself, addressed to BC’s Minister of Health, various levels of the Canadian government and relevant organizations. The letter (below) basically was about making sure that SAFER, a suicide education and support service, is provided to all British Columbians. Its services, particularly bereavement counseling, has been reduced/limited to only residents of Vancouver.

It’s not a very encouraging response from the Ministry of Health regarding broadening suicide support and grief services outside Vancouver. On top of that, the link in the letter to find local services doesn’t work when I tried the online mapping tool. Also I think they don’t get that suicide bereavement support isn’t the same as “normal” bereavement support services due to the stigma around suicide and various issues related to it.

With the Prime Minister committing “$5 billion over the next ten years to support mental health initiatives“, I hope that part of this goes to suicide prevention and support/bereavement services particularly for person-to-person support… online resources and tools are not enough!


20 February 2017

Honourable Terry Lake

Minister of Health

PO Box 9050 Stn Prov Govt

Victoria, BC V8W 9E2

Subject: SAFER – a unique and essential service for all British Columbians

Dear Minister,

We are writing to show our support and request that SAFER (Suicide Attempt Follow-up Education & Research) continues to be provided for all British Columbians.

We have been using the grief counselling services at SAFER since the death of our loved ones by suicide. For many of us, we felt lost and unsure about how to handle our grief, as well as the challenges to our mental health after such a tragic event.

Understanding, processing and accepting the grief from a death is already difficult as it is. Death attributed to suicide is even more challenging given the unique context and stigma associated with it. When we found SAFER, we were relieved to discover that BC has such a unique and essential service. Early on, many of us were reluctant to accept or even discuss our loved one’s death. With SAFER, it was a live-saver to be able to talk and receive counselling about surviving suicide and the grief in a safe and supportive environment. SAFER continues to help us to understand, accept, and move through the feelings, emotions, and conditions surrounding grief from suicide.

Unfortunately from our understanding, due to resources and organizational restructuring, SAFER has now limited their services and outreach geographically to only residents of Vancouver. Most of us do not live in Vancouver, but in other parts of the Lower Mainland. In addition to only servicing people living in Vancouver, it has come to our attention that SAFER counselling is limited to one year following intake and people have been turned away from this essential service.

While an average of 10 Canadians die from suicide every day, the loved ones, family members, friends, coworkers etc. who have to live with the grief number much more. SAFER provides a safe and accepting place for survivors to process this grief. It also provides essential services such as counselling and education to help people living with mental health issues, thoughts of suicide and those who have to live through suicide death.

We hope that SAFER will be able receive the support and resources it needs to continue and expand its services for all British Columbians.

We look forward to your response.


4 April 2017

Dear Mr. Fung et al:

Thank you for your letter of February 20, 2017, requesting that the Suicide Attempt Follow-up Education and Research (SAFER) program expand to become available to all British Columbia residents. The Honourable Terry Lake, Minister of Health, has asked me to respond on his behalf and I apologize for the delay.

Firstly, I would like to acknowledge the loss of your loved ones. I understand that the grief following the suicide death of a loved one can be complicated and affects everybody differently.

While the supports provided by SAFER are well respected, we at the Ministry of Health also understand that health services need to be provided as close to home as possible in order to be accessible for all British Columbians. The Ministry is working with the health authorities to provide services to people within or near their communities through a model of primary care homes linked to specialized community care services. In alignment with this model, the health authorities have been reviewing their services. This has resulted in the redesign of some programs, including the changes made by Vancouver Coastal Health to SAFER.

As you are aware, the SAFER services are now focused on Vancouver area residents only. If needed, clients may review their needs with the SAFER program and plan their transition to other services after one year. These changes were made in order for the SAFER program to continue to provide core services and meet the demands of Vancouver area residents. To support the focus on Vancouver area residents only, the SAFER program refers people from outside of their catchment area to local services available in the person’s community.

SAFER continues to offer education and clinical expertise supports to the health authorities. In many communities throughout the province, there are suicide-specific bereavement support services, while in other communities people attend general bereavement support services or participate in individual counselling. Approximately 90 local mental health centres operated by the health authorities provide access to mental health treatment and counselling services and, if required, connect families to local community support services. You can locate these services through our online map tool, found at http://www2.gov.bc.ca/gov/content/health/managing-your-health/mental-health-substance-use/find-services-near-you.

Recently the government announced a mental health digital hub, which has been developed to help British Columbians find the services and supports closest to them. This new resource focuses on better integration and access to services by bringing together over 6,000 services from over 450 providers throughout the province. Information about mental health services in various communities, including grief support services, can be accessed through this hub at http://www2.gov.bc.ca/gov/content/mental-health-support-in-bc.

The Ministry recognizes that the SAFER program provides a specialised and unique service for Vancouver residents bereaved due to a suicide death. People in other areas of the province may go through their family physician or the local mental health centre for assessment and treatment if the impact of the suicide death has resulted in significant mental health and/or substance use problems. Referral to local community based bereavement support services may also be provided if appropriate.

In addition, the Ministry is currently working with all of the health authorities to review and improve services for people at risk of suicide and their families, including reviews of suicide prevention, intervention and follow-up support services.

Thank you once again for writing to share your support for the SAFER program. Input and experience like yours is highly valued as we strive to continuously improve our health care system and ensure that all British Columbians receive the standard of care they deserve. I appreciate the opportunity to respond.

Sincerely,

Robin Pascoe

A/Director

pc:

Honourable Terry Lake

Honourable Justin Trudeau, Prime Minister of Canada

Honourable Jane Philpott, Minister of Health, Canada

Honourable Christy Clark, Premier

Michael Marchbank, President and CEO, Fraser Health Authority

Mary Ackenhusen, President and CEO, Vancouver Coastal Health

Laura Case, Chief Operating Officer, Vancouver Coastal Health

Global Citizenship in the 21st Century. No pressure, right?

It’s really great to hear that York House School, one of the most prestigious private schools in Vancouver, puts resources towards supporting students by also emphasizing personal/mental health for students. Last year I had a great time sharing my experience with the inner workings of the United Nations with the School’s model UN class. So I was happy to give another talk when the counseling team recently invited me to speak to sixty Grade 12 students about how I got into the UN and the unconventional way that my life has taken. The purpose of the talk was to support the students’ personal health and planning and to highlight that there are alternative paths after high school.

“Global Citizenship in the 21st Century” was the topic and it’s quite broad… so it made sense that I would talk about my UN experience…. but I also wanted to share my experience and views on how becoming a “global citizen” isn’t necessarily a fixed path. While I’ve enjoyed the work I’ve done internationally, the most valuable thing that I’ve learned from these experiences isn’t so much the traveling and living abroad, but to be open, curious, understanding and respectful of the people and the environment. Honestly there are people I know who’ve not really traveled much and who are more “global” in their outlook… while there are some people I’ve met during my travels who are not as “global” in perspective as you might think.

My last year of high school.
My last year of high school.

I never thought of being a “global citizen” when I was about to graduate from high school (and I still don’t). I didn’t really have an idea of what I wanted to do after grade 12. I figured going to University was the thing to do since everyone else was doing it.

It's really to easy to give advice, but sometimes it should be taken with a grain of salt. Banana Man - taken on the island of Kyushu, Japan.
It’s really easy to give advice and direction, but sometimes it should be taken with a grain of salt. Banana Man – taken on the island of Kyushu, Japan.

There’s a lot of pressure (and advice) to start thinking about and doing something about your career and/or life when it’s time to graduate high school. From the sounds of it, the current generation of students needs to be “well rounded”, with lots of volunteering and academic experiences under their belt, in order to be considered for university. I’m all for balancing high school and extra curricular/volunteering activities, but I don’t think it should be what defines whether or not you can go to university. That’s too much pressure, physically and mentally, on students… instead, why not make it mandatory that after high school university-bound students are ask to take, say, six months off and do something with this time? And as part of university admissions to ask applicants what they did with these six months and why…

My resume a couple years ago when I thought it would be interesting to map out my work, education, and volunteer background.
My resume from a couple of years ago when I thought it would be interesting to map out my work, education, and volunteer background.

Part of the process of being a global citizen is to figure out who you are, what you like and/or don’t like. And that means trying things and exploring your possibilities. It’s not possible to have all the answers from just books alone, there’s a lot that can be learned and that can help a person grow through experience. It shouldn’t be forced, but rather do things that you want to do rather than what is expected of you… All this helps not only to build up a resume but also helps with personal growth and development. It’s something I’ve kept in mind and it’s led me to spend time in the Arctic, work for a car company in Japan, join the United Nations in Asia and Europe, and even earn my Masters degree while living and working in Bangkok.

One of the best parts of going to the University of Victoria was the relaxing and welcoming atmosphere.
One of the best parts of going to the University of Victoria was the relaxing and welcoming atmosphere.

I was interested and had the opportunity to go to University. Is it the place that will help you find a job after? Not really. It’s called ‘higher education’ after all. Yes, having a university degree opens doors, but it shouldn’t be the main purpose of going to secure a job afterwards. A lot of people try to finish as fast as they can… after 4 years and then what? Work? My advice is to embrace the culture and environment for as long as you think you can or need to… it’s a great place to explore who you are, meet people with different ideas, and learn things. It’s a big jump from high school to university in terms of life experience so what’s the rush of getting it over with?

Where's Waldo... um... where's Vincent in this photo taken at Ueno station during the cherry blossom season in Tokyo.
Where’s Waldo… um… where’s Vincent? Taken at Ueno station during the cherry blossom season in Tokyo.

There’s no perfect way of doing things in life. I’ve learned that the hard way. It was interesting to see the student’s faces when I told them that it took me seven years to finish my undergraduate degree, which included dropping out of university. Burn out is a part of life and that’s ok. It’s an opportunity to learn from and experience these kind of challenges in life. I was fed up with university and so I decided to take time off… and it was one of the best decisions I’ve made. Not only did I realize the trials and tribulations of a working life, but I learned that I wanted to do more and see the world… which led me to taking a couple years off to live and work in the Arctic and Japan. Again… I would have never expected that coming out of high school.

Making the world a more peaceful, stable, and healthy place requires a mix of people, cultures and skill sets... as long as you're into working with others and believe in partnerships and collaboration.
Making the world a more peaceful, stable, safer, and healthier place requires a mix of people, cultures and skill sets… as long as you’re willing to work with others and believe in partnerships and collaboration.

Relationships are as important as the stuff you learn from books. So while the UN is famously known for “global citizenship”, making the world a more peaceful, stable, safer and healthier place also requires patience, understanding, and acceptance. Book smarts helps you understand the world, but it’s relationships that helps to change it. While I got my foot in the door with the UN with academics and life experiences, it’s the relationships that I’ve nurtured that has helped me continue working on and staying connected with global issues.

Priorities change your life and life changes your priorities.
Priorities change your life and life changes your priorities.

Life’s a journey. Having set plans and ideas about what to do with life is great, but you also have to be ready for those unexpected twists and turns. There will be times when you feel in control, and other times when things just feel out of control. Priorities change in life and it’s important to grow and adjust with them.

So what does it mean to be a “global citizen”? It isn’t about how much one has traveled, but, rather, their perspective, outlook, and curiosity in understanding the world around them, whether it’s in one’s own community or in some village in a developing country. That means being open to exploration, discovery, learning, and empathy… and using those experiences to grow as a person and to give back to society in a meaningful way.

The best support can come from the most unexpected place

Having people around for both the good and bad times is so underrated… and for this I am thankful on this Thanksgiving day for the friends and family near and far who’ve been there when I needed it most these past couple of years.

One of the most peculiar things I have found in times of trauma, crisis or grief is you never know who will be in your support system when you need it most. And you never know what that support will be… it might be just having a shoulder to cry on, an ear to listen, an invitation to do something, words of wisdom, a hand to help, or a hug for comfort. Sometimes the best support can come from the most unexpected place during an unforeseen situation.

Coincidentally, today is also World Mental Health Day with the theme of “psychological first aid“. When terrible things happen, not only should people be able to provide first aid, but also be able to reach out with a helping hand to those who are affected and provide much-needed psychological support. Empathy and psychological first aid is definitely useful… we will at some point in our lives be at the receiving or supporting end of a trauma, crisis or grief.

General health care never consists of physical first aid alone.

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Suicide does not discriminate.

Today is World Suicide Prevention Day… and by the time I finish writing this post, more people will have died by suicide. According to the World Health Organization, suicide kills one person every 40 seconds. That’s on average about 800,000 people a year – and for every person who dies by suicide, many more people attempt suicide every year.

Source: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
Source: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/

It’s a staggering figure and a significant one that demands more attention. It happens to the rich and poor… young and old… the mentally stable and ill. Suicide does not discriminate. While we typically think suicide is linked to mental health issues (i.e. depression and alcohol use), many suicides also happen impulsively in moments of crisis and life stresses such as financial problems, relationship break-up or chronic pain and illness. Suicide rates are also high amongst people who experience discrimination, such as refugees, migrants, indigenous peoples, LGBTI persons, and prisoners.

Talking about suicide is no joke. There’s a fine line between joking about it and to actually thinking about self-harm and suicide. And if this leads to an attempt, then it’s definitely time to pay attention before it’s too late. The Canadian Mental Health Association has an easy way to remember the warning signs:

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There are plenty of resources about suicide prevention and education. Ones that I’ve found useful in Canada include:

I found these resources useful because they focus on providing information about preventing and understanding suicide, as well as helping me process my experience with a suicide death. One of the best things when I moved back to Vancouver was to find that there’s a specific suicide support service called SAFER (Suicide Attempt Follow-up, Education and Research). Not only is SAFER a community-based outpatient service that provides counseling for people who are feeling suicidal, it provides free counseling for people bereaved by a suicide death.

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From a public health policy perspective, suicide is a complex issue and so prevention requires coordination and collaboration between various health and non-health sectors – WHO’s recommendations for prevention and control includes:

  • Reducing access to the means of suicide (e.g. pesticides, firearms, certain medications)
  • Reporting by media in a responsible way
  • Introducing alcohol policies to reduce the harmful use of alcohol
  • Early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress
  • Training of non-specialized health workers in the assessment and management of suicidal behaviour
  • Follow-up care for people who attempted suicide and provision of community support

Suicide prevention is a good goal… in the meantime many people have to deal with the aftermath. I found the below video really helpful to connect with what I am going through, and also to share with people who want an insight into the grief from suicide.

Ride Don’t Hide

Living with grief definitely affects my mental health and it’s made me realize that despite the “norm”, everyone at some point suffers from a mental health issue. It’s pretty easy to think about our physical health and take steps to keep in shape – like exercising, watching what we eat, or even wearing sunscreen to protect our skin. According to the Canadian Mental Health Association (CMHA), safeguarding our mental health is just as important.

Many of us don’t consciously make an effort to stay mentally healthy. Mental health isn’t just about mental illness, its about feeling good about who you are, having balance in your life and in your thinking, and responding constructively to life’s highs and lows. Everyone should practice good mental health.

Because my grief is linked to mental health, I jumped at the chance to volunteer for the Ride Don’t Hide movement to support and raise awareness about why mental health is so important.

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My family and I teamed up to be route marshals for an important segment of the 60km route of the event. This “hair-pin” turn off the No. 2 Road Bridge in Richmond was a tricky one because the cyclists needed to come off the bridge and immediately turn onto a small bike path that led them to a residential area just across from the Vancouver International Airport. Of the 1200 cyclists that registered for the event, half of them (around 600) passed our post.

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As the crew for the No. 2 Road Bridge and Dover Park, we cheered riders on and directed riders to keep to the route… I even had to help someone fix their bike chain! All in all, waking up early to volunteer for a couple hours on a Sunday morning was really rewarding – the sunny weather definitely made the day much more enjoyable!

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The Ride Don’t Hide movement began on 1 August 2010, as Vancouver teacher and newspaper columnist Michael Schratter cycled 40,000 km, crossing six continents and 33 countries. In addition to raising funds for CMHA, Michael’s mission was to circumnavigate the world, sharing stories with people in different countries, to bring awareness to the stigma surrounding mental illness.

Here are some interesting stats about mental health in Canada:

  • 1 in 10 Canadians will suffer from a mental illness in their lifetime.
  • 1 in 7 Canadian women experience depression in their lifetime.
  • 1 in 8 Canadians experience a mood disorder like depression in their lifetime.
  • About 1.2 million Canadian children and youth experience a mental illness, but less than 20% receive help.

One of the world’s largest events about maternal mental illness

The more I get involved in postpartum and mental health issues, the more I see that there are lots of awareness-raising events about them (at least in Vancouver). After the interview with CBC, I was pleasantly surprised when I was contacted to join this year’s “Climb Out of the Darkness” events in British Columbia.

I supported the Vancouver event (Facebook page) and joined the walk organized by Kristen Walker, an instructor at the University of British Columbia, who decided to raise awareness about postpartum issues after the death of someone she knew and their family suffering from postpartum psychosis.

Kristen Walker being filmed by CBC welcoming participants of the Vancouver event
Kristen Walker being filmed by CBC welcoming participants of the Vancouver event

Climb Out of the Darkness is one of the world’s largest events raising awareness of maternal mental illness, like postpartum depression. It is held on or near the longest day of the year to shine the most light on this issue by getting people to join together to climb mountains and hike trails to symbolize the rise out of the darkness of maternal mental illness into the light of hope and recovery.

In addition to fundraising more than $3000 to support postpartum support services, the Vancouver event also brought together around forty people who braved the rain and cold to come out for the morning walk. It was also great to see CBC interviewing people and covering the event.

I'm just to the right of the white umbrella on the left side of the photo (Credit: Ciara McDaniel)
I’m just to the right of the white umbrella on the left side of the photo (Credit: Ciara McDaniel)

The turnout was great and it was nice to see that there was this grassroots support for postpartum issues. But definitely more is needed to raise awareness and get people to talk about and share their experiences. The statistics are too real to ignore.

Virtually all women can develop mental disorders during pregnancy and in the first year after deliver.

According to the World Health Organization, virtually all women can develop mental disorders during pregnancy and in the first year after deliver – about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression, and this is even higher for developing countries (15.6% during pregnancy and 19.8% after child birth).

Despite the emphasis in society on the postpartum challenges and struggles women and mothers face, this is also an issue for men whether it’s suffering from similar depression or having to support their partners. More dads need to be involved and speak out about their experience.

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