By: Dr. Christine Sloss, Ph.d, C.Psych
We, at Broadview Psychology, have long worked with individuals with mental health issues and who have struggled for a period of time with suicidal thoughts, urges and behaviour. We make it our mission, through DBT, to help these individuals to live and to build lives worth living. And I can say from experience that all of our DBT clients have been successful in choosing to live, and in creating a better life for themselves. By learning to be mindful, accepting and validating of their emotions, most clients are then able to cope effectively with their emotions and mental health issues and act according to their values and life goals. DBT does not promise freedom from discomfort, but it does provide a way of dealing with intense emotions and pain that helps reduce suffering.
Many of you have likely read in the news about the proposed expansion of MAID (Medical Assistance in Dying) to include individuals experiencing mental health issues. We are deeply concerned about this possibility for a number of reasons.
- Suicidality is not permanent. Individuals who are suicidal may have difficulty in remembering a time when they were not suicidal, and may not be able to imagine a time when they might feel better and not be suicidal. Their moods will dictate what they pay attention to and what they remember, and so they will struggle to access alternative perspectives. And yet, we know from research and clinical experience that suicidal thoughts and urges are not permanent and may come and go with various triggers and changing circumstances/moods. An extensive review of the literature also found that the vast majority of people (at least 9/10) who attempt suicide do NOT later go on to kill themselves, even when their initial attempt was serious and potentially fatal. We would not want our clients or others to make permanent decisions about ending their lives when they are in a period of depressed mood and/or suicidal thinking, and when this state is likely to pass.
- Suicidality is a symptom. Suicidality is a symptom of mental health difficulties and adverse life circumstances. Suicidality is not a condition in and of itself. It is a symptom of many mental health difficulties, and of negative life events, stressors and interpersonal conflicts. Suicidality is not the problem, and MAID is not the solution. We should, instead, be trying to help people to manage mental health issues, cope with adversity, improve the conditions of their lives, and enhance their relationships. This is necessary for everyone, but particularly those who are more marginalized in society.
- Psychological treatments work. Individuals who have mental health issues and who receive effective and empirically based treatment (e.g. DBT, CAMS, CBT) do experience reductions in their symptoms, including their suicidality and suicidal behaviour. We have learned that these treatments can have a significant impact on individuals because they do not just address the suicidality, but they also target the problems that are sustaining or driving the suicidality. Since we have the means of helping people who are suicidal, it is crucial that we focus on increasing these effective treatment programs, rather than using our limited societal resources for MAID. We need to ensure that whenever clients are struggling with suicidality, they can obtain access to these effective treatments, even if they have had access to such a program in the past. Some clients need help and treatment at multiple points in their lives.
- Commitment to living is crucial. Clients in DBT agree to stay alive during treatment, and in doing so, they give themselves and the program the opportunity to work. Clients need to be fully committed to learning ways of coping without suicidal behaviour. If they continue to turn their minds toward their exit or backup plan whenever they are struggling, they will not acquire and rely on new ways of dealing with their emotions and situation. Clients who keep telling themselves that they can turn to MAID will be less motivated to change and less likely to benefit from the treatment that they are receiving.
- Reduced access to means prevents suicide. When easy methods of suicide are not available, rates of suicide are lower in a community or population. Consequently, when we work with suicidal individuals, we try to remove someone’s access to suicidal means. If MAID becomes readily available and socially supported, clients will be more likely to choose to kill themselves, rather than find alternative solutions to their mental health and life difficulties.
- Connection prevents suicide. We know from research that clients who are suicidal often feel lonely and alienated. We are also aware that social support and connection are key to preventing suicidality. Unfortunately, recent developments over the last three years due to the pandemic have eroded a sense of community and belonging for many in our society. MAID does nothing to tackle this disconnection, and may only contribute to greater loneliness and grief among those left behind. We should strive to create healthy communities and families within which we can support our members who are struggling at different points in their lives.
We believe that individuals who have mental health issues deserve compassion, connection, hope, and effective treatment. All of us at Broadview Psychology will continue to promote effective treatment, not MAID. We will help our clients to tackle the problems underlying their suicidal thoughts and urges, and to build lives worth living.