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Suicide Prevention as Harm Reduction: Crisis Centre of BC Presentation to the Special Committee on Health

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On July 6th, 2022 Stacy Ashton, executive director of the Crisis Centre of BC, presented to the BC Select Standing Committee on Health on the topic of effective strategies to address the toxic drug crisis. 

The Select Standing Committee on Health is a non-partisan group of MLAs tasked with examining the Province’s urgent and ongoing illicit drug toxicity and overdose crisis. The Committee is holding a series of hearings to consult with those on the frontlines: emergency response providers, mental health and addictions service providers and substance use peer and advocacy groups.

The Crisis Centre’s presentation tackled the intersection of crisis line work, substance abuse, and suicide prevention. The presentation culminated in three calls to action for the Provincial Government toward effective response to the crisis:

  • Embed suicide prevention into the Province’s response to the toxic overdose crisis as part of a Zero Suicide plan
  • Fund models that free up money for prevention and treatment by utilizing least coercive, least costly, and most effective crisis intervention strategies
  • Recognize crisis line volunteers as our next generation of emergency crisis responders and create career pathways to address staffing shortages

Nearly 15 per cent of the calls received by the Crisis Centre involve substance use as either the primary issue for the caller or a contributing factor to their current crisis. Over the past year, the Centre has witnessed an 8.5 per cent increase in calls related to opioid use and a doubling of opioid-related calls where suicide is a factor.

People are reaching out for help, but our health care system is missing opportunities to save lives. Almost three quarters of people who died by overdose in BC had seen a health care professional within three months of their death¹ and Vancouver Coastal Health found that 21 percent of those who attempt suicide do so within a week of seeing a health care professional².

Myths and misunderstandings about the nature of suicidal thinking impact health policy. Health care professionals are rarely trained to talk openly about suicide with clients or patients.  Suicide screening tools fail to take into account the deep ambivalence that is part of suicidal thinking. Clinical counseling attached to primary care networks often exclude individuals experiencing suicidal thoughts or behaviour.  Policy and procedure that actively discourage people from talking about suicidal feelings leaves them trapped in completely treatable isolation and despair.

Substance users who do disclose suicidal ideation or behaviour are faced with an uncertainty about their freedom; fully disclosing suicidality risks a wellness check from police, a trip to the hospital, and possible involuntary commitment. These coercive and restrictive approaches further traumatize people who are already in crisis. That trauma escalates their distress, fear, and pain, and makes stabilization more difficult.

We have the opportunity to create a province-wide crisis response system that leans into community resources to address the current toxic overdose crisis and transforms how we care for those who use substances and those at risk for suicide. The system would integrate community-based resources – such as crisis lines, mobile crisis response teams, and stabilization centres – to provide coordinated, non-coercive, wrap-around intervention and care for people in crisis.

People should only have to call one number when they’re in crisis. Currently, conversations are taking place to explore adding a fourth option to 9-1-1: dispatch to mental health crisis response. The coordination of emergency response services will be a crucial first step toward the creation of the crisis response system. The Province can enact an untapped funding source, the 9-1-1 wireless levy, to fund this change. 911 levies are collected by cell and landline providers in 6 provinces and territories: Quebec, Alberta, Nova Scotia, New Brunswick, Saskatchewan, Prince Edward Island, and the Northwest Territories. BC is one of the few provinces leaving this reliable and non-controversial funding mechanism on the table, at an estimated value of $58 million per year.

The presentation outlines a clear path forward, and the Crisis Centre of BC is ready and willing to work collaboratively with the Provincial Government and other stakeholders to stop the toxic drug overdose crisis and improve crisis care systems for British Columbians. 

Crisis lines are available across British Columbia 24 hours a day, seven days a week. If you or someone you know needs help, call us:

  • 1-800-SUICIDE
  • 310-6789 (mental health crisis line)

¹BC Coroners Service. BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths. Government of British Columbia, 2022. https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf

²Daly, Patricia. Chief Medical Health Officer Report: Response to the Opioid Overdose Crisis in Vancouver Coastal Health. Vancouver Coastal Health, 2018. http://www.vch.ca/Documents/CMHO-report.pdf