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LEADING BY EXAMPLE:
MAY 2019 OTTAWA
WORKSHOP ON
COMMUNITY-BASED
SUICIDE PREVENTION IN
CANADIAN VETERANS
AND PUBLIC SAFETY
PERSONNEL
CIMVHR TECHNICAL REPORT
November 2019
James M. Thompson MD, Medical Research Consultant
Madelaine Meehan MPA, Project Manager
Alexandra Heber MD, Chief Psychiatrist, Veterans Aairs Canada
Stéphanie Bélanger CD, PhD, Associate Scientic Director
Haley Sweet, Research Assistant
David Pedlar PhD, Scientic Director
LEADING BY EXAMPLE: MAY 2019 OTTAWA WORKSHOP ON COMMUNITY-BASED SUICIDE PREVENTION IN CANADIAN VETERANS AND PUBLIC SAFETY PERSONNEL
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TABLE OF CONTENTS
Executive Summary ...................................................................................................................................... 2
Résumé ........................................................................................................................................................ 5
Introduction ................................................................................................................................................. 8
Presentations ..............................................................................................................................................11
Welcome and Introduction .................................................................................................................................. 12
Dr. David Pedlar, Canadian Institute for Military and Veteran Health Research
Dr. Alexandra Heber, Veterans Aairs Canada
Opening Prayer .................................................................................................................................................. 12
Mr. Bob Thibeau, Aboriginal Veterans Autochtones
Developing, Testing, and Disseminating Community-Based Upstream Interventions to Prevent the Onset
or Exacerbation of Suicide Risk: Focusing on the Need for Evidence, Safety, and Participant Engagement ................ 13
Dr. Marnin J. Heisel PhD, C.Psych, Department of Psychiatry at Western University, London, Ontario
Panel: Mental Health at the Community Level and the Power of Social Media ........................................................ 14
Ms. Sherry Lachine MSc (Appl Psych), Owner of Broadmind
Mr. Brian Harding, Co-Founder of Send Up the Count
Mr. Paul Hale, President of the PPCLI Association
Moderator: Mr. Glynne Hines
Falling Forward: How do I Know if it is Working? ................................................................................................... 14
Dr. Daniel F. Perkins PhD, The Clearinghouse for Military Family Readiness, Pennsylvania State University
Panel: Making it Work – Ottawa Tri-Service Peer Support ...................................................................................... 17
Sgt. Brent MacIntyre, Ottawa Police Service
Paramedic Lorraine Downey, Ottawa Paramedic Service
Fireghter Scott Patey, Ottawa Fire Service
Moderator Ms. Valerie Testa, Ottawa Hospital Research Institute
Knowledge Translation in Action ......................................................................................................................... 18
Dr. Sidney H. Kennedy, University of Toronto and St. Michael’s Hospital
Round Table Discussions: Gathering Evidence and Collaborating .................................................................... 19
Theme 1: Supporting the evolution of community-based suicide prevention activities........................................................................20
Theme 2: Supporting an evidence-based culture in community-based suicide prevention .................................................................. 21
Emerging Picture of Community-Based Suicide Prevention ........................................................................... 23
Summary and Way Forward ......................................................................................................................... 25
Acknowledgements .................................................................................................................................... 27
Appendices ................................................................................................................................................. 28
Appendix 1: Glossary ........................................................................................................................................................................... 29
Appendix 2: Workshop Participant Survey ........................................................................................................................................... 29
References ................................................................................................................................................. 31
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EXECUTIVE SUMMARY
Suicide is a major tragedy that touches the lives of many in the military, Veteran (former military), and public safety
personnel (PSP) communities. The fundamental, compelling need to help others is a common motivation among
grassroots community-based suicide prevention activities. Eective suicide prevention requires comprehensive and
integrated engagement across society.
Although professional health care in clinical facilities is important, suicide prevention also requires engagement in “the
community”, meaning outside health care facilities and government agencies. Community-based, peer-based suicide
prevention activities take place both “downstream” when people become suicidal and need professional help or when
survivors struggle after a suicide occurs, and “upstream” before the onset of suicidal ideation or behaviour. Examples
of upstream suicide prevention include easing the socioeconomic, health, and disability stressors that are common
precedents in suicide.
At the rst community-based suicide prevention round table hosted by the Canadian Institute for Military and Veteran
Health Research (CIMVHR) in May 2018, there was a desire from participants for a subsequent meeting to share
community-based suicide prevention approaches (Meehan et al., 2018). In response to that call, CIMVHR hosted an
invitational Leading by Example workshop in Ottawa in May 2019 to share ideas for community engagement in suicide
prevention for these important populations. CIMVHR invited Veteran peer support groups, public safety personnel, non-
governmental organizations (NGOs) and government service providers, including the Canadian Armed Forces (CAF) and
Veterans Aairs Canada (VAC). Academics supporting community suicide prevention were also invited. Chatham House
rules were instituted to provide a secure atmosphere and to encourage participation.
This report documents the proceedings of the May 2019 Leading by Example workshop. The goal of the workshop was
to foster whole-of-community engagement in suicide prevention for Canadian military Veterans and public safety
personnel. The objectives were to:
1. Create a platform for community groups to work together in suicide prevention;
2. Develop suicide prevention capacity by sharing promising suicide prevention tactics and strategies; and
3. Share ways to gather evidence for the eectiveness of community-based suicide prevention activities.
The workshop began with a series of presentations.
Dr. Marnin Heisel, Director of Research and Associate Professor from Western University, described the development and
validation of a community-based suicide prevention program for men in retirement transition called Meaning-Centered
Men’s Groups (MCMG). He discussed principles for the development of community-based suicide prevention.
Mr. Glynne Hines moderated a panel on mental health at the community level and the power of social media. Ms. Sherry
Lachine, owner of Broadmind, spoke of the need for Mental Health First Aid (MHFA) training and the Applied Suicide
Intervention Skills Training (ASIST) course for training in preventing suicides and increasing mental health literacy. Mr.
Brian Harding, co-founder of Send up the Count, described their social media network utilizing Facebook to reach
over 11,000 members, seven days a week and 24 hours a day, managed by volunteers, crowdsourcing empathy in an
unstructured way. Mr. Paul Hale from the Princess Patricia’s Canadian Light Infantry (PPCLI) Association described their
suicide prevention training program, emphasizing the need for peer social support.
Dr. Daniel Perkins, Principal Investigator and Scientist at the Clearinghouse for Military Family Readiness at Pennsylvania
State University, explained that “falling forward” means that stumbling forward is better than standing still and doing
nothing, emphasizing that it is important to evaluate where we are going, to ensure that we progress eectively. He
reviewed approaches that community-based suicide prevention initiatives can use to gather and evaluate evidence of
eectiveness and safety.
Ms. Valerie Testa, Clinical Research Program Manager at the Ottawa Hospital Research Institute, Clinical Epidemiology
Program, moderated a panel on tri-service peer support. Sgt. Brent MacIntyre from the Ottawa Police Service, Paramedic
Lorraine Downey from the Ottawa Paramedic Service and Fireghter Scott Patey from the Ottawa Fire Service described
the suicide prevention activities in each of their services. They explained how the three services are combining eorts to
share resources and ideas.
Dr. Sidney Kennedy, Professor of Psychiatry at the University of Toronto and the Arthur Sommer Rotenberg Chair in
Suicide and Depression Studies at the University of Toronto and St. Michael’s Hospital, explained the importance of
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connecting with the community to prevent suicides, using several examples from their team’s work. He emphasized the
importance of academic research, knowledge translation and outreach education so that research can inform policy and
improve programs. He gave a number of real-world examples from their team’s work.
Notes from the rich round table discussions were condensed by the authors into two over-arching themes with sub-
themes:
1. Supporting the evolution of community-based suicide prevention activities.
a. Resourcing community groups
b. Promoting the development of national guidelines for community-based suicide prevention activities
c. Improving communication about program eectiveness (ecacy and safety)
d. Providing training for community caregivers
e. Exploring community-based suicide prevention initiatives
f. Encouraging wellness activities
g. Promoting a “no wrong door” policy
h. Promoting open communication about suicide prevention
i. Normalizing talk about suicide
2. Promoting an evidence-based culture in community-based suicide prevention.
a. Promoting the idea of “falling forward” in research-based program evaluation, meaning getting started and
learning as we go
b. Developing knowledge translation activities
c. Encouraging data collection
d. Identifying research questions for program evaluation and research
e. Meeting challenges in data collection and analysis
f. Promoting the development of standard denitions
g. Accounting for lived experience and identities
h. Supporting program evaluation by community groups
i. Providing training for researchers from these communities
Little is known about the extent of community-based suicide prevention in the Veteran and PSP populations. There
appeared to be four general types:
1. Informal peer support: Military personnel, Veterans, and PSPs helping suicidal peers with none to limited special
training, oversight, or formal relationships with other agencies. For example, the work of the PPCLI Association and
the Send Up the Count initiative.
2. Organized peer support: Individuals with special training, access to guidelines, management oversight structure,
and formal relationships with other agencies. For example, the Operational Stress Injury Social Support (OSISS)
program supported by the CAF and VAC.
3. Suicide prevention embedded in service organizations: Dedicated sta positions in services that support wellness,
peer support, and other suicide prevention / intervention activities within a service organization (e.g. police, re, or
paramedic). For example, the services described by representatives of the Tri-Service team, a collaboration of the
Ottawa Police Service, the Ottawa Paramedic Service, and the Ottawa Fire Service.
4. Community-based “upstream” suicide prevention programs delivered by health care professionals. For example, the
programs described by Dr. Heisel and Dr. Kennedy in their presentations.
Community-based peer support group suicide prevention in the Canadian Veteran and PSP communities is under way
across the country. Peer support groups are working hard to meet a need that they live with among their colleagues,
troop-mates, and friends. As this workshop made clear, these groups welcome assistance with developing evidence to
nd the best ways to do their work.
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While identifying suicidal individuals and helping them get to professional care remains an important priority, it is clear
from listening to the participants at the workshop that community-based suicide prevention is much more complex.
For example, community-based suicide prevention also includes “upstream” prevention, to help people from becoming
suicidal in the rst place. When assisting a peer with suicidal thoughts, community caregivers require more options than
just “call 911” or “send them to the Emergency Department”, although those options also play a role. Managers need to
understand that “prevent suicides” realistically does not mean “prevent all suicides”.
With respect to the three workshop objectives, participants clearly appreciated the opportunity to hear what others
were doing. They called for further development of mechanisms to enable them to learn about and collaborate with
other community-based suicide prevention initiatives. Participants agreed that the workshop allowed them to share
their suicide prevention approaches and to learn from others. They made a number of suggestions for promoting the
development of community-based suicide prevention activities. Evidence is needed regarding the extent, nature, and
eectiveness (ecacy and safety) of community-based suicide prevention eorts in the Canadian Veteran and PSP
communities. Participants responded positively to Dr. Perkins’ idea that it is better to be “falling forward” than standing
still, meaning that it is better to begin collecting any program evaluation data than not get started. Participants identied
a number of challenges and opportunities to participating in evidence-gathering to inform program evaluation.
Three main points arose from the workshop: (1) community-based suicide prevention peer support groups can “fall
forward” one step at a time toward evaluating their eorts with sound evidence; (2) there is a need for evidence-
based guidelines to support the evolution of community-based suicide prevention for peer caregivers, and (3) suicide
prevention research knowledge has to be more transparent and widely available.
This workshop highlighted a wide range of roles for researchers in supporting the development of community-based
peer group suicide prevention. Clearly, much work remains to be done to generate evidence mapping the extent and
needs of community-based suicide prevention initiatives in the Veteran and PSP communities. Although the focus
was on Veterans and public safety personnel, the ndings of this workshop will be of interest to agencies managing
suicide prevention in the serving military population. Researchers can assist in integrating these groups into a whole-
of-community public health approach. Researchers can play key roles in helping community-based peer groups with
data collection and program evaluation. They can enable easy, transparent access by community-based peer groups to
research ndings to promote evolution from an evidence-informed to an evidence-based culture. Finally, researchers can
play important roles in assisting with the establishment of a national initiative to develop evidence-based guidelines for
best practices in community-based program evaluation and suicide prevention.
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RÉSUMÉ
Le suicide est une grande tragédie qui touche la vie de bien des militaires et vétérans (anciens combattants) et de bien
des membres du personnel de la sécurité publique (PSP). Le besoin fondamental et impérieux d’aider les autres est une
motivation commune dans les activités locales de prévention du suicide sur le plan de la collectivité. Une prévention
ecace du suicide exige une participation globale et intégrée de l’ensemble de la société.
Même si les soins de santé professionnels dispensés dans des établissements cliniques sont importants, la prévention
du suicide exige aussi une participation au sein de « la collectivité », c’est à dire hors des établissements de santé et des
organismes gouvernementaux. Des activités d’égal à égal de prévention du suicide au sein de la collectivité ont lieu à la
fois « en amont », lorsqu’une personne devient suicidaire et a besoin d’une aide professionnelle ou lorsque des survivants
éprouvent des problèmes après un suicide, et « en aval », avant l’apparition d’une pensée ou d’un comportement
suicidaire. Les mesures visant à atténuer les facteurs de stress d’ordre socioéconomique ou liés à la santé ou à un
handicap, qui précèdent souvent un suicide, sont des exemples de prévention du suicide en aval.
Au cours de la première table ronde sur la prévention du suicide au niveau de la collectivité tenue par l’Institut canadien
de recherche sur la santé des militaires et des vétérans (ICRSMV) en mai 2018, les participants ont dit souhaiter une
réunion ultérieure pour partager des méthodes de prévention du suicide sur le plan de la collectivité (Meehan et
al., 2018). L’ICRSMV a en conséquence tenu à Ottawa, en mai 2019, un atelier sur invitation, Leading by Example, pour
échanger des idées sur la participation de la collectivité à la prévention du suicide pour ces groupes importants. L’ICRSMV
a invité des groupes de soutien des vétérans par les pairs, du personnel de la sécurité publique, des organisations non
gouvernementales (ONG) et des fournisseurs de services gouvernementaux, notamment les Forces armées canadiennes
(FAC) et Anciens Combattants Canada (ACC). Des universitaires s’intéressant à la prévention du suicide sur le plan de la
collectivité ont aussi été invités. Les règles de Chatham House ont été appliquées pour mettre en place une atmosphère
favorable et encourager la participation.
Le présent rapport documente les délibérations de l’atelier de mai 2019, qui avait pour but de favoriser une participation
de l’ensemble de la collectivité à la prévention du suicide touchant les militaires, les vétérans et le personnel de la sécurité
publique du Canada. Les objectifs étaient les suivants :
1. créer une plateforme permettant aux groupes de la collectivité de travailler de concert en matière de prévention du
suicide;
2. mettre sur pied une capacité de prévention du suicide en partageant des tactiques et des stratégies prometteuses à
cet égard;
3. partager des manières de recueillir des données probantes pour assurer l’ecacité des activités de prévention au
niveau de la collectivité.
L’atelier a commencé par une série de présentations.
Marnin Heisel, PhD, qui est directeur de la recherche et professeur agrégé à The University of Western Ontario, a décrit
l’élaboration et la validation d’un programme, appelé Meaning-Centered Men’s Groups (MCMG, ou groupes d’hommes
mettant l’accent sur le sens), de prévention du suicide au niveau de la collectivité s’adressant aux hommes en situation de
transition à la retraite. Il a parlé des principes de l’élaboration de mesures appropriées.
Glynne Hines a animé la réunion d’un groupe d’experts de la santé mentale au niveau de la collectivité et du pouvoir
des médias sociaux. Sherry Lachine, qui est propriétaire de Broadmind, a, concernant la formation destinée à prévenir
le suicide et à accroître la connaissance de la santé mentale, parlé du besoin d’une formation en premiers soins en santé
mentale (PSSM) et du cours de formation appliquée en techniques d’intervention face au suicide. Brian Harding, qui est
cofondateur de Send Up the Count, a décrit son réseau de médias sociaux, qui utilise Facebook pour rejoindre plus de 11
000 membres, sept jours par semaine et 24 heures par jour, et qui est géré par des bénévoles pour externaliser l’empathie
d’une manière non structurée. Paul Hale, de la Princess Patricia’s Canadian Light Infantry (PPCLI) Association, a décrit le
programme de formation en prévention du suicide de l’Association, qui souligne le besoin du soutien social assuré par
des pairs.
Daniel Perkins, PhD, qui est chercheur principal et scientique au Clearinghouse for Military Family Readiness de
Pennsylvania State University, a expliqué que « progresser » signie qu’il vaut mieux trébucher que rester immobile et
ne rien faire; il souligne qu’il est important d’évaluer notre orientation pour être sûrs que nous progressons d’une façon
ecace. Il a parlé de méthodes que les initiatives de prévention du suicide au niveau de la collectivité peuvent utiliser
pour recueillir des données sur l’ecacité et la sécurité et les évaluer.
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Valerie Testa,qui gère le programme de recherche clinique à l’Institut de recherche de l’Hôpital d’Ottawa et le
programme d’épidémiologie clinique, a animé la réunion d’un groupe d’experts de trois services sur le soutien par les
pairs. Le sergent Brent MacIntyre, du Service de police d’Ottawa, l’ambulancière paramédicale Lorraine Downey, du
Service paramédic d’Ottawa, et le pompier Scott Patey, du Service des incendies d’Ottawa, ont décrit les activités de
prévention du suicide de leur service. Ils ont expliqué la façon dont les trois services unissent leurs eorts pour partager
des ressources et des idées.
Sidney Kennedy, M.D., professeur de psychiatrie à University of Toronto et titulaire de la « Arthur Sommer Rotenberg
Chair in Suicide and Depression Studies » à University of Toronto et à St. Michael’s Hospital, a expliqué qu’il est important
d’établir des liens avec la collectivité pour prévenir le suicide; il a donné plusieurs exemples des travaux de son équipe.
Il a souligné l’importance de la recherche universitaire, du transfert des connaissances et de la sensibilisation pour que
la recherche puisse éclairer les politiques et améliorer les programmes. Il a encore une fois donné quelques exemples
concrets des travaux de son équipe.
Les auteurs ont condensé les notes recueillies au cours des discussions étoées en table ronde sous deux thèmes majeurs
incluant des sous-thèmes.
1. Soutenir l’évolution des activités de prévention du suicide au niveau de la collectivité
a. Doter les groupes de la collectivité en ressources.
b. Promouvoir l’élaboration de lignes directrices nationales applicables aux activités de prévention du suicide
au niveau de la collectivité.
c. Améliorer la communication concernant l’ecacité du programme (ecacité théorique et sécurité).
d. Former les personnes soignantes de la collectivité.
e. Étudier à fond les initiatives de prévention du suicide au niveau de la collectivité.
f. Encourager les activités de mieux-être.
g. Promouvoir une politique d’ouverture selon laquelle « il n’y a pas de mauvaise porte ».
h. Promouvoir une communication ouverte sur la prévention du suicide.
i. Normaliser le fait de parler du suicide.
2. Promouvoir une culture fondée sur des données probantes dans la prévention du suicide au niveau de la
collectivité
a. Promouvoir le concept de progrès dans l’évaluation des programmes fondés sur la recherche, qui consiste à
lancer le processus et à tirer des enseignements à mesure que nous l’exécutons.
b. Concevoir des activités de transfert des connaissances.
c. Encourager la collecte de données.
d. Déterminer les questions posées dans la recherche en vue de l’évaluation des programmes et de la
recherche.
e. Relever les dés associés à la collecte et à l’analyse des données.
f. Promouvoir l’élaboration de dénitions normalisées.
g. Rendre compte des expériences vécues et des identités.
h. Soutenir l’évaluation des programmes par les groupes de la collectivité.
i. Former les chercheurs de ces communautés.
L’ampleur de la prévention du suicide sur le plan de la collectivité auprès des groupes de vétérans et du personnel de la
sécurité publique est peu connue. Il semble exister quatre grands types d’activités.
1. Soutien par les pairs informel : Des militaires, des vétérans et des membres du personnel de la sécurité publique aident les
pairs suicidaires sans avoir suivi une formation spéciale, sans supervision et sans liens formels avec d’autres organismes,
ou presque. Le travail de l’Association du PPCLI et celui de l’initiative Send Up the Count en sont des exemples.
2. Soutien par les pairs organisé : Personnes qui ont suivi une formation spéciale, qui disposent de lignes directrices,
qui ont accès à une structure de supervision de la gestion et qui ont des liens formels avec d’autres organismes.
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Le Programme de soutien social aux blessés de stress opérationnel (SSBSO) soutenu par les FAC et ACC en est un
exemple.
3. Prévention du suicide intégrée à des organismes de services : Postes consultatifs particuliers de l’administration qui
soutiennent le mieux-être, le soutien par les pairs et d’autres activités de prévention du suicide ou d’intervention
au sein d’un organisme de services (service de police, service des incendies ou service paramédical, par exemple).
Mentionnons par exemple les services décrits par des représentants de l’équipe des trois services, qui regroupe le
Service de police d’Ottawa, le Service paramédic d’Ottawa et le Service des incendies d’Ottawa.
4. Programmes de prévention du suicide « en aval » au sein de la collectivité relevant de professionnels de la santé : Les
programmes décrits par M. Heisel et le docteur Kennedy dans leurs présentations en sont des exemples.
Des programmes de prévention du suicide réalisés au sein de la collectivité par des groupes de soutien par les pairs
auprès des vétérans et du personnel de la sécurité publique du Canada sont en cours dans l’ensemble du pays. Ces
groupes travaillent d’arrache-pied pour respecter le fait qu’ils doivent vivre parmi leurs collègues, leurs compagnons
d’armes et leurs amis. Comme cet atelier l’a clairement indiqué, ces groupes apprécient qu’on les aide à recueillir des
données probantes an de les conseiller sur les meilleures manières de faire leur travail.
S’il reste important d’identier les personnes aux tendances suicidaires et de les aider à obtenir des soins professionnels,
lorsqu’on écoute les personnes qui ont participé à l’atelier, il est clair que la prévention du suicide sur le plan de la
collectivité est beaucoup plus complexe. Cette tâche inclut aussi par exemple une prévention « en aval » pour mieux,
avant tout, empêcher les personnes de devenir suicidaires. Quand elles aident un pair qui a des pensées suicidaires,
les personnes soignantes de la collectivité doivent avoir d’autres que choix que simplement leur dire « signalez le 911
» ou « envoyez les à l’urgence », même si ces choix font aussi partie des mesures possibles. Les gestionnaires doivent
comprendre que, si l’on est réaliste, « prévenir les suicides » ne signie pas « prévenir tous les suicides ».
En ce qui concerne les trois objectifs de l’atelier, les participants ont manifestement été heureux de pouvoir avoir de
l’information sur ce que d’autres font. Ils ont demandé que les mécanismes leur permettant d’en savoir plus sur d’autres
initiatives de prévention du suicide sur le plan de la collectivité et d’y collaborer soient améliorés. Les participants étaient
d’accord avec le fait que l’atelier leur a permis de partager leurs méthodes de prévention du suicide et d’apprendre
des autres. Ils ont suggéré des manières de promouvoir l’élaboration d’activités de prévention du suicide au sein de la
collectivité. Il faut recueillir des données probantes concernant l’envergure, la nature et l’ecacité (ecacité théorique
et sécurité) des eorts de prévention du suicide au niveau de la collectivité menés auprès des vétérans et du personnel
de la sécurité publique du Canada. Les participants ont répondu de manière positive à l’idée de M. Perkins selon laquelle
il vaut mieux « progresser » que rester immobile, c’est à dire qu’il vaut mieux commencer à recueillir des données
d’évaluation des programmes, quelles qu’elles soient, que de ne rien entreprendre. Les participants ont mentionné des
dés et des occasions de participation touchant la collecte d’information en vue d’éclairer l’évaluation des programmes.
L’atelier a fait ressortir trois grands points : (1) les groupes de soutien par les pairs qui font de la prévention du suicide au
niveau de la collectivité peuvent « progresser » une étape à la fois en vue d’évaluer les eorts qu’ils font au moyen de
données solides; (2) des lignes directrices fondées sur des données probantes sont nécessaires pour soutenir l’évolution
de la prévention du suicide au niveau de la collectivité dans le cas des personnes soignantes qui sont des pairs et (3)
les connaissances découlant de la recherche en matière de prévention du suicide doivent être plus transparentes et
largement diusées.
Cet atelier a mis en évidence un large éventail de rôles que les chercheurs peuvent jouer en appui de l’élaboration de
programmes de prévention du suicide réalisés au niveau de la collectivité par des groupes de soutien par les pairs. Il reste
manifestement beaucoup de travail à faire pour mettre en correspondance des données sur l’envergure et les besoins
des initiatives de prévention du suicide au niveau de la collectivité auprès des vétérans et du personnel de la sécurité
publique. Même si l’atelier mettait l’accent sur les vétérans et le personnel de la sécurité publique, ses conclusions vont
intéresser les organismes qui gèrent la prévention du suicide chez les militaires actifs. Les chercheurs peuvent aider à
intégrer ces groupes à une approche globale de santé publique. Ils peuvent jouer des rôles clés en aidant les groupes de
soutien par les pairs au niveau de la collectivité à recueillir des données et à évaluer les programmes. Ils peuvent donner
aux groupes de soutien par les pairs au niveau de la collectivité un accès transparent et facile aux conclusions de la
recherche an de promouvoir le passage d’une culture éclairée par des données probantes à une culture fondée sur les
données. Les chercheurs peuvent enn jouer des rôles importants en aidant à mettre en œuvre une initiative nationale
visant à élaborer des lignes directrices fondées sur des données probantes applicables aux pratiques exemplaires
concernant l’évaluation des programmes et la prévention du suicide au sein de la collectivité.
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INTRODUCTION
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INTRODUCTION
Suicide is a major tragedy that touches many in the military, Veteran (former military), and public safety personnel (PSP)
communities. The fundamental, compelling need to help others is a common motivation among grassroots, peer-based
suicide prevention initiatives developing in the Veteran and PSP communities. While whole-of-community engagement
in suicide prevention is widely recommended (Hegerl et al., 2009; Public Health Agency of Canada, 2016; Canadian
Armed Forces and Veterans Aairs Canada, 2017), eective suicide prevention requires comprehensive and integrated
engagement across society, including engagement with special communities (World Health Organization, 2012; Public
Health Agency of Canada, 2016; Caine et al., 2018).
“In the community” refers to initiatives that take place outside clinics and hospitals. Community-based suicide prevention
activities complement professional services in health care facilities across the suicide prevention continuum (Public Health
Agency of Canada, 2016). Community-based suicide prevention takes place both “upstream”, before people become
suicidal (prevention) and “downstream”, when people become suicidal and require professional help (intervention) or when
survivors struggle after a suicide occurs (postvention). An example of upstream suicide prevention includes easing the
socioeconomic diculties that are common precedents in suicide (Caine et al., 2018; Thompson et al., 2019.)
While Canadian health care systems have organized approaches to suicide prevention, community engagement in
suicide prevention has been relatively spontaneous and less organized. Community-based initiatives have varying
levels of training and oversight. Church groups established some of the rst Canadian crisis lines in the 1960s due to a
community mental health movement (Leenaars, 2000). Since then, and parallel to the gradual shift in cultural awareness
of suicide, there has been a growth of largely undocumented community-based suicide prevention activity. However,
the evidence for community-based suicide prevention activities is limited. Additionally, there are few resources and
guidelines available to community organizations. (Isaac et al., 2010; World Health Organization, 2012; Caine et al., 2018).
Veterans and PSP peers are increasingly engaged in suicide prevention within their own communities, particularly
since (1) the increased awareness of suicide in military Veterans (Simkus et al., 2017), and (2) new research on the extent
of suicidality in public safety personnel (Carleton et al., 2018). The Canadian Armed Forces systematically promotes
command-wide suicide prevention and awareness in serving military personnel (Sareen et al., 2018; Canadian Armed
Forces, 2019). However, the nature and extent of Canadian community-based suicide prevention eorts for Veterans
and PSP remains undocumented. Eorts to provide resources and guidance for community-based suicide prevention
initiatives have remained isolated, dispersed, and largely uncoordinated in the Veteran and PSP communities.
Evidence for the eectiveness of suicide prevention approaches remains incomplete (Zalsman et al. 2016, Caine et
al., 2018). Although limited, the evidence to support community-based suicide prevention eorts is growing. For
example, the US Air Force community-based suicide prevention program reduced the relative risk of suicide in serving
members by 33% (Knox et al., 2003). “Gatekeepers” are people in positions to help identify suicidal members and get
them to professional health care. A 2016 study found that gatekeeper training for police ocers improved knowledge
and attitudes, but evidence that the approach actually prevents suicides remains to be developed (Hegerl et al., 2009;
Arensman et al., 2016; Kohls et al., 2017). In Canada, a 12-year suicide prevention program in Montreal’s police service was
associated with a 79% reduction in the suicide rate, although the specic contribution of the suicide prevention program
was unclear (Mishara and Martin, 2012). Sareen et al. (2013) found in a small study that ASIST training of First Nations
reserve people in Canada was not associated with a signicant impact and, furthermore, showed a concerning trend
(not statistically signicant owing to small sample size) toward higher suicidal ideation than a comparison group who
underwent a resilience retreat. The signicance of this nding is uncertain.
The Canadian Federal Framework for Suicide Prevention called for “the regular, systematic collection, analysis and
dissemination of suicide-related surveillance data as well as the generation of evidence through research activities. Data
and research should provide a comprehensive description of suicide and help community members, decision makers and
planners develop and implement interventions that reach the right groups of people at the right time” (Public Health
Agency of Canada, 2016). Data collection and analysis can be daunting for community groups with limited resources and
research capacity.
The Canadian Institute for Military and Veteran Health Research (CIMVHR) is ideally placed to assist in supporting whole-
of-community suicide prevention for Canadian Veterans and PSP. At the rst community-based suicide prevention round
table hosted by CIMVHR in May 2018, there was a desire for a subsequent meeting to share ways that community groups
can engage in suicide prevention, with more representation by members of the Veteran community (Meehan et al., 2018).
In response to that call, CIMVHR hosted a by-invitation Leading by Example workshop in May 2019 in Ottawa to explore
community engagement in suicide prevention for these important populations. CIMVHR invited Veteran peer support
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groups, public safety personnel, non-governmental organizations (NGOs) and government service providers, including
the Canadian Armed Forces and Veterans Aairs Canada. Academics supporting community suicide prevention were also
invited. Chatham House rules were instituted to provide a secure atmosphere and to encourage participation.
This report documents the proceedings of the May 2019 Leading by Example workshop. The goal of the workshop was
to promote whole-of-community engagement in suicide prevention for Canadian Veterans and PSP. Although the focus
was on Veterans and public safety personnel, it was anticipated that the ndings of this workshop would be of interest to
agencies managing suicide prevention in the serving military population. The CAF sent participants to the workshop. The
workshop objectives were to:
1. Start a platform for community groups to work together in suicide prevention;
2. Develop suicide prevention capacity by sharing promising suicide prevention tactics and strategies; and
3. Share ways to gather evidence for the eectiveness (ecacy and safety) of community-based suicide prevention
activities.
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PRESENTATIONS
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Welcome and Introduction
Dr. David Pedlar, Canadian Institute for Military and Veteran Health Research
CIMVHR was formed in 2010 to fulll a need for Canadian research that addresses the health of those who serve, and have
served, Canada. A decade later, CIMVHR represents a network of 45 Canadian universities, 12 global aliates, and over
1700 researchers that focus on health research as it relates to military personnel, Veterans, and their families. CIMVHR
plays a facilitating role in bringing expertise and resources together and facilitating arms-length research through
directed research funding. The institute engages and collaborates with relevant stakeholders including academia,
government, industry, philanthropy, and Veteran and military communities. CIMVHR is well known for its annual Forum,
a conference dedicated to health research for our military personnel, Veterans, and their families. This year’s event will be
the 10th of its kind and it is estimated there will be nearly 700 people in attendance. Forum is a wonderful opportunity to
join the whole community and discuss key topics like suicide prevention.
CIMVHR continues to focus on emerging issues in military, Veteran, and family health research. Suicide prevention is a
priority for the populations served by the institute. This event is a follow-up to the work done at last year’s workshop. The
goal of the workshop was to focus on a whole-of-community approach for suicide prevention, to learn what we can all
do to prevent suicide.
Over the last couple of years, CIMVHR has become more aware of the potential to share information across populations.
CIMVHR extends a special welcome to the rst responders and public safety personnel in attendance. On behalf of the entire
team at CIMVHR, we welcome them in the sharing of information with a population that experiences similar problems.
Workshop participants were encouraged to share information openly and freely. Participants were advised of the
intention to exercise Chatham House Results: participants were free to use the information received but should not
identify the speaker(s) nor their aliation, nor that of any other participant, without permission.
Dr. Alexandra Heber, Veterans Aairs Canada
Dr. Heber pointed out that while mental health problems are beginning to be discussed more openly, suicide stigma
is being addressed more slowly. She noted that the ripple eects of suicide are far-reaching, with negative eects on
survivors. It is important to nd ways to connect with people who have been aected by suicide. Suicide prevention
requires multiple approaches across whole communities. Often people don’t know how they can help to prevent
suicides. When they do engage with suicide prevention, they wonder how to understand what works best and what
doesn’t work so well. Dr. Heber concluded by pointing out the three objectives for the workshop:
1. Start a platform for community groups to work together in suicide prevention;
2. Develop suicide prevention capacity by sharing promising suicide prevention tactics and strategies; and
3. Share ways to gather evidence for the eectiveness of community-based suicide prevention activities.
Opening Prayer
Mr. Bob Thibeau, Aboriginal Veterans Autochtones
Mr. Thibeau thanked the Algonquin First Nation for the use of their land for this meeting. In the custom of these peoples,
he gave a formal welcome to that land, which is unceded territory. The welcome to the territory of those First peoples
who were settled here for many hundreds of years prior to discovery, exploration and colonization recognizes, that in this
case, the Algonquin First Nation were the guardian of the land, water, plants, and animals and that they respected those
things given to them from Creator. They respected everything on Mother Earth.
Mr. Thibeau explained that the prayer speaks to all peoples from all nations and that he presented it in a way that
recognized the reason we were attending this meeting. He explained that suicide is not seen as a normal way to leave
Mother Earth. In their culture, Creator will decide when one’s work here is complete and all those things that one was set
to do through their Vision quest has been done. A person is called by the Creator and the person’s ancestors to move to
the spirit world to once again meet with those who were called before you. Traditional teachings are that should one take
their own life they cannot reach the Spirit World and will wander aimlessly. Creator bestows on us a mission or journey
on the Red Road. We may, at times, falter but we do get back on track. We continue our work teaching and working with
each other until the time comes and we are called to join those who passed before us.
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Developing, Testing, and Disseminating Community-Based Upstream Interventions to Prevent the Onset or Exacerbation
of Suicide Risk: Focusing on the Need for Evidence, Safety, and Participant Engagement
Dr. Marnin J. Heisel PhD, C.Psych, Department of Psychiatry at Western University, London, Ontario
Dr. Heisel’s team established a community-based program in London, Ontario called Meaning-Centered Men’s Groups
(MCMG) for men in transition to retirement, funded by Movember Canada. He pointed out that major life transitions are a
good time to engage people in suicide prevention, because they tend to feel unsettled and are more open to new ideas.
The program’s aim is to build camaraderie, focusing on Meaning in Life (MIL), to enhance psychological resiliency and
well-being, with the ultimate goal of preventing the onset or worsening of suicide risk. He noted that research indicates
that MIL and the related constructs Purpose in Life (PIL) and Reasons for Living (RFL) are associated with well-being
and appear to protect against suicide risk. The MCMG groups are held in community settings, not health care settings,
and are led by a two-person team, consisting of one mental health professional and one community-based social
support worker. The program was designed as an “upstream” preventive intervention to be implemented prior to the
development or progression of suicidal feelings, upstream of the need for intervention or postvention.
Dr. Heisel shared the “AT EASE” acronym (Ascertain need, Theory, Evidence, Assessment, Safety and Engage relevant
stakeholders) to summarize an approach to community-based suicide prevention. He spoke of the need for interventions
for post-retirement men, pointing out that there are few resources focused explicitly on this particular high-risk group.
Suicide rates are highest in men, and, among men, are highest in those 65-70 years of age and older. Retirement, loss
of work and employment, and cultural expectations about masculine identity and behavior can contribute to a sense
of personal failure, helplessness, depression, and, in extreme circumstances, to elevated suicide risk. He believes that
we can achieve results by focusing suicide prevention initiatives on high-risk groups including middle-aged and older
men, citing Rose’s Theorem: “A large number of people at small risk may give rise to more cases of disease than the small
number who are at a high risk.”
The MCMG program therefore is a “selected” primary prevention service for a subpopulation with elevated risk (the
growing population of men in retirement transition), rather than being an “indicated” service for those at imminent
risk of suicide, or a “universal” program targeting whole populations. He also characterized the MCMG program as a
“community initiative” rather than a “public health” program or “clinical” service, although it can be seen as having
elements of these as well (public health-due to its outreach and engagement approach for a vulnerable population;
clinical-as it involves clinical risk assessment and a mental health provider’s involvement).
Dr. Heisel explained that “suicide prevention is everyone’s business” and that everybody has a role to play in it, but
that individual roles dier, whether as an interventionist, researcher, administrator, policy maker, manager supporting
care and research, advocate, care provider, or concerned citizen. He discussed the themes for enhancing community
engagement in research discussed by Ahmed and Palermo (2010):
• Strong partnerships between researchers and community stakeholders;
• Equitable sharing of power and responsibility;
• Openness to diverse perspectives;
• Clear and relevant research goals;
• Research resulting in mutual benet for partners;
• Opportunity for capacity building for all partners;
• Equal respect;
• Continuous communication;
• Transparent monitoring and evaluation;
• Policies for ownership/dissemination of results;
• Translation of ndings into policies,
• Interventions, or programs; and
• Eorts to sustain the relationship and research outcomes after the project ends.
Dr. Heisel emphasized the importance of safety when working with individuals at risk of suicide in a group-based setting
and noted that proper training is essential to ensure the safety of participants. Dr. Heisel outlined evidence from his
study, indicating that the MCMG group meaning-centered group approach is an eective intervention in enhancing MIL
and well-being. He and his colleagues found a signicant dierence in the reduction of suicidal thoughts over the course
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of the intervention between men in the MCMG groups compared to wait-list controls.
His team’s future work includes adapting the MCMG approach for Canadian Veterans transitioning from military to civilian
life, their families, and Veterans organizations.
Panel: Mental Health at the Community Level and the Power of Social Media
Ms. Sherry Lachine MSc (Appl Psych), Owner of Broadmind
Mr. Brian Harding, Co-Founder of Send Up the Count
Mr. Paul Hale, President of the PPCLI Association
Moderator: Mr. Glynne Hines
Ms. Lachine spoke of the need for Mental Health First Aid (MHFA) training. The MFHA course teaches people how to
provide help to a person with mental distress. The course teaches recognition of common mental health illnesses
and problems, increases condence in providing help to others, improves social response to psychological trauma,
improves understanding of resources and gaps, and plays a role in reducing stigma to normalize talk about suicide. Since
2007, more than 250,000 Canadians have been trained in MHFA courses. The Mental Health First Aid for the Veteran
Community (MHFA-V) is a version of the MHFA course that was adapted to the Veteran community by the Mental
Health Commission of Canada on contract to Veterans Aairs Canada. The program is being expanded to 149 Veteran
communities across Canada. Ms. Lachine discussed the barriers that prevent people from immediately accessing services,
pointing out that crisis lines have time limitations, and all operate dierently. Ms. Lachine described the Applied Suicide
Intervention Skills Training (ASIST) course for training in preventing suicides and increasing mental health literacy.
Mr. Harding described Send Up the Count, a social media network that utilizes Facebook to reach over 11,000 members, 24
hours a day and seven days a week. The group’s moderators are all volunteers. They focus on mental health and suicide
to serve military members, Veterans, rst responders, and their family members, doing a lot of defusing situations. He
explained that Send Up the Count is easily accessible using any device connected to the internet and is available at times
when other resources are not. The group’s members “crowdsource empathy” in an unstructured way. Recognizing that
they are not mental health experts, the group’s suicide prevention work is primarily focused on providing peer support,
diusing and managing crises in real time, and connecting individuals with additional supports as needed. Additionally,
following up with individuals after the crisis is extremely important. Although no two military careers are the same, Send
up the Count is a reservoir of shared experiences, allowing mutual trust between members.
Mr. Hale explained that the Princess Patricia’s Canadian Light Infantry (PPCLI) Association is a volunteer organization
comprised of 13 branches across Canada. The association includes serving and released members. The association
developed an approach to suicide prevention following the loss of a member in January of 2016. He emphasized that the
volunteers are trained in MHFA-V and ASIST and are not health care professionals. They provide information and referral
services for retired or released PPCLI members and their families. Mr. Hale described the association’s suicide prevention
work as focused on raising awareness of issues around mental health and suicide prevention and referring those in
need of assistance to the appropriate specialists. He said the association has noticed that the biggest problem among
distressed members appears to be lack of social support. The association has helped many in the Veteran community. Mr.
Hale spoke of the need to address suicide as the complicated issue that it is and believes that the association is setting
the example for others to follow. Moving forward, they would like to collect data and evaluate the eectiveness of their
approach to suicide prevention.
During the question period, there was discussion about how community volunteers ask where they can send people who
are in crisis. A participant said that community volunteers need better options for helping people than only calling 911
or sending them to an emergency department. It was noted, for example, that Ottawa has a mobile crisis response team,
and that VETS Canada has drop-in and support centres.
Falling Forward: How do I Know if it is Working?
Dr. Daniel F. Perkins PhD, The Clearinghouse for Military Family Readiness, Pennsylvania State University
Dr. Perkins explained that “falling forward” means that stumbling forward is better than standing still and doing nothing.
It is important to evaluate where we are going, to ensure that we progress eectively. In other words, it is better to start
collecting and looking at data about what a program is doing than to not collect any data while waiting for a better
way to evaluate the program. “Falling forward” means moving in the right direction in assessing whether a program is
eective.
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The Clearinghouse for Military Family Readiness at Pennsylvania State University (https://militaryfamilies.psu.edu/) works
to advance the health and well-being of military families through applied research, program evaluation, implementation
support, and learning and curriculum development. The organization has evaluated over 12,000 programs and services
to ensure the welfare of military families. Along the way, they have evolved a clear understanding of how to develop
evidence for programs.
Dr. Perkins dened two main approaches to use of evidence in program development:
1. Evidence-informed (also called research-based, or research-informed): programs or services developed from
experience, theory, or a logic model.
2. Evidence-based: rigorous evaluation of a program or service that tests its eectiveness as well as being based on
experience, other research studies, theory, and logic models.
He said that not every program can or should be evidence-based, but every program at least should be informed
through evaluation. For example, the rationale for an opioid prescription take-back program is obvious: it gets opioid
doses out of homes and o the streets. The program still needs to be evaluated to see if the drop-o points are in the
right place, or to see if everybody knows the drop-o points are available.
The Clearinghouse draws from scientic theory, practitioner wisdom, available evidence, case studies, and logic models
to assess programs. Program evaluation is used to:
1. Do no harm (most important).
2. Determine eectiveness.
3. Assess merits of alternative programs.
4. Determine the reasons for successes and failures.
5. Make data-informed decisions.
6. Learn from experience.
7. Rene, revise, update or track a program.
8. Justify programs that are useful or end programs that aren’t working.
The quality of evidence determines how condent you can be that a program or service is doing what it should be.
Programs should be at the very least evidence-informed, using a variety of research designs to measure eectiveness.
Rigorous data collection and a comparison group are needed to fully evaluate the impact of a program or service.
Dr. Perkins emphasized the importance of starting with a logic model to guide a program or service while “falling
forward”. Logic models are simply frameworks for working out the logical relationships between resource investments,
output activities, and results (Figure 1). Logic models are a starting point in understanding whether program inputs and
outputs have the desired outcomes. Logic models use a common approach for integrating planning, implementation,
evaluation, and reporting. Figure 2 shows a logic model for a family vacation. Logic models can grow in complexity as the
service learns more about itself using dierent types of evaluation (Figure 3). Dr. Perkins pointed out an online resource
for creating logic models at https://cyfar.org/.
INPUTS OUTPUTS OUTCOMES
LOGIC MODEL: SIMPLEST FORM
Figure 1: Simplest form of a logic model (© Clearinghouse for Military Readiness)
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Family members
learn about
each other;
family bonds;
family has a
good time
Inputs Outputs Outcomes
Family Members
Budget
Car
Camping Equipment
Drive to state park
Set up camp
Cook, play, talk,
laugh, hike
NEEDS/ASSET ASSESSMENT
What are the characteristics,
needs, priorities of target
population?
What are potential barriers/
facilitators?
What is most appropriate to do?
PROCESS EVALUATION
How is program implemented?
Are activities delivered
as intended? Fidelity of
implementation?
Are participants being reached
as intended?
What are participant reactions?
OUTCOME EVALUATION
To what extent are desired
changes occurring? Goals met?
Who is beneting/not
beneting? How?
What seems to work? Not work?
What are unintended outcomes?
IMPACT EVALUATION
To what extent can changes be
attributed to the program?
What are the net eects?
What are nal consequences?
Is program worth resources it
costs?
Figure 2: Logic model for a holiday vacation (© Clearinghouse for Military Readiness)
TYPES OF EVALUATION
Figure 3: Logic model and common types of evaluation (© Clearinghouse for Military Readiness)
NEEDS PROCESS OUTCOMES IMPACT
INPUTS OUTPUTS OUTCOMES – IMPACT
ASSUMPTIONS EXTERNAL
FACTORS
SATISFACTION
Activities Participation Short Term Medium Term Long Term
S
I
T
U
A
T
I
O
N
P
R
I
O
R
I
T
I
E
S
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In its Continuum of Evidence (https://militaryfamilies.psu.edu/programs-review/understanding-the-continuum-of-
evidence/), the Clearinghouse for Military Family Readiness uses colour codes to classify programs into four levels of
evidence: green for eective, yellow for promising, gray for unclear and red for ineective, using four types of evidence
criteria:
• Signicance of eect, ranging from robust statistical evidence to failure to demonstrate a benecial eect.
• Sustained eect, ranging from eect lasting more than 2 years from program start or 1 year from program end to no
sustained eect.
• Successful external replication, ranging from evidence of eectiveness in at least one other rigorous study to no
replication.
• Study design, ranging from evidence of eectiveness in randomized controlled design or well-match
quasiexperimental design to evidence of ineectiveness in experimental or quasiexperimental design.
Dr. Perkins ended with his list of lessons learned from his years of evidence evaluation:
1. Create a logic model and review it regularly.
2. Do not fall in love with your program, rather your mission!
3. Liking does not equal eectiveness!
4. Be clear what your goals and desired outcomes are, and do not be distracted.
5. Pay attention to evaluation results, do not ignore or deny them.
6. Collect data at the most rigorous level you can.
7. Use data to improve what you are doing!
Panel: Making it Work – Ottawa Tri-Service Peer Support
Sgt. Brent MacIntyre, Ottawa Police Service
Paramedic Lorraine Downey, Ottawa Paramedic Service
Fireghter Scott Patey, Ottawa Fire Service
Moderator Ms. Valerie Testa, Ottawa Hospital Research Institute
Sgt. MacIntyre, Ms. Downey, and Mr. Patey have broad perspectives on suicide prevention through their careers as public
safety personnel (PSP) and now as peer support coordinators for their respective services. In 2015, the First Responder
Mental Health Network Collaboration (FRMHNC) was established and gave rise to the Tri-Service team, a collaboration of
the Ottawa Police Service, the Ottawa Paramedic Service and the Ottawa Fire Service.
They pointed out that each of the three services has dierent levels of organizational, nancial, and peer support
resources. They noted that they are shifting from the reactive (intervention and postvention) to the proactive
(prevention) phase of suicide prevention by promoting social support events and other wellness activities.
Sgt. MacIntyre discussed how the Tri-Service team provides education for their sta. He noted that all Ottawa Police
Service members receive Road to Mental Readiness (R2MR) training. During First Responder Week in October, the
Tri-Service team runs sessions for clinicians to provide education on the clinical challenges unique to caring for rst
responders. The team runs evening events for the families of reghters.
Ms. Downey described how the Tri-Service team shares resources between the peer support coordinators in each service,
engages in suicide prevention sessions, conducts cross training between teams, holds regular meetings, and has unied
Tri-Service representation at all events. The Tri-Service coordinators acknowledge the importance of taking care of each
other.
Mr. Scott Patey spoke of the importance of connecting with their organization members. A link on the peer support
website directs members to the resource portal and provides a space for members to access relevant information.
Additionally, the Tri-Service team sought out a document of commitment from the management acknowledging that
organizational support exists within the three services. There has also been value in recognizing the three management
teams coming together.
Ms. Downey described a signicant paradigm shift from reactive approach to a proactive approach in preventing
suicides. Moving forward, the peer support coordinators will focus on intervening before people are broken.
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Knowledge Translation in Action
Dr. Sidney H. Kennedy, University of Toronto and St. Michael’s Hospital
Dr. Kennedy explained the importance of connecting with the community to prevent suicides, using several examples
from their team’s work. Figure 4 shows the relationship and overlap in knowledge translation (KT) activities: academic
research, outreach education, and community engagement.
He spoke of how telling stories is a method of KT. He said that often we remember a story told during a presentation
more vividly than the presentation’s content, that the story accesses the content.
The Canadian Biomarker Integration Network in Depression (CAN-BIND) program held a series of public lectures on
suicide awareness in partnership with community groups. Their goal was to make researchers’ ndings available to the
community by telling stories of hope and recovery.
The Canadian Network for Mood and Anxiety Treatment (CANMAT) learned from an advisory group community member
about the importance of providing information to community members in a way that made sense to them. As a result,
they engaged people with lived experience to develop CHOICE-D, an easy-to-read lay version of the CANMAT depression
management guidelines. The objective was to help non-experts understand evidence-based treatments for managing
depression. CHOICE-D is a free resource that makes technical details about depression available in an accessible guide.
The guide details information about clinical symptoms, treatment options, suggestions for making health care provider
appointments more meaningful, and suggests supports and self-management tools. The guide has been translated into
French and Mandarin. Dr. Kennedy spoke of the need for accessible information written in common language: CHOICE-D
was written by individuals with lived depression for individuals with lived depression and their families under guidance
from Dr. Sagar Parikh.
The Storybook Project connects with the community through the arts and aims to help suicide survivors and those
who have lost a loved one heal through writing about suicide loss. The project shares personal experience with suicide
in short stories to empower those touched by suicide through creativity and educate the public. Its goals are to spread
awareness of suicide and mental health issues, decrease suicide stigma, encourage conversation, remind people they are
not alone, and help to encourage personal healing through creativity.
Dr. Kennedy emphasized the importance of academic research, knowledge translation, and outreach education so that
research can inform policy and improve programs. Their team worked with the Whitesh River First Nations community
to run wellness events to reduce self-harm and prevent suicides in Indigenous youth. The outreach program started with
community connecting, then used research methods to develop a formalized suicide prevention program.
ACADEMIC
RESEARCH
OUTREACH
EDUCATION
COMMUNITY
ENGAGEMENT
Figure 4: Collaborations in knowledge translation activities (© Dr. Sidney H. Kennedy)
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ROUND TABLE
DISCUSSIONS:
GATHERING
EVIDENCE AND
COLLABORATING
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This section summarizes comments made by participants during the round table discussions following the presentations.
Participants sat in tables of at least six people, with representation across sectors in each group. Each table discussed the
following two questions and then presented their ideas to the workshop audience.
1. How can we measure evidence and ensure eectiveness of suicide prevention programs and interventions?
2. How can we coordinate collaboration and communication to share best practices between organizations?
Two primary themes emerged from the collective comments and perspectives:
1. Supporting the evolution of community-based suicide prevention activities; and
2. Promoting an evidence-based culture in community-based suicide prevention.
Theme 1: Supporting the evolution of community-based suicide prevention activities
Resourcing community groups
• Local community-based groups require dedicated funding and stang to develop and maintain suicide prevention
activities.
• It is necessary for senior management to be aware, engaged, and supportive of suicide prevention work within their
organization. Support sta in helping managers to understand that not all suicides can be prevented, and the goal of
suicide prevention is suicide reduction or intervention.
Promoting the development of national guidelines for community-based suicide prevention activities
• There are no standards and guidelines for community-based suicide prevention activities. Promote national and
regional development of guidelines, standards, and denitions to establish a common way of speaking about
community-based suicide prevention.
• A federal-level working group is needed to make connections to provinces and territories, municipalities, and
communities. Utilize existing working groups and steering committees to connect communities across the country.
• Collaborate with other community-based suicide prevention activities and scale well-developed models for peer
support programs across organizations and regions.
• Link to the Federal Framework for Suicide Prevention (Government of Canada, 2016).
Improving communication about program eectiveness (ecacy and safety)
• Improve communication though cost-eective means between pockets of best practices found across the
country through workshops, tours of best practice examples, working groups, webinars, teleconference calls, and
symposiums.
• Add practical knowledge translation and program evaluation components to research meetings.
• Produce and distribute articles that pass along appropriate knowledge.
Providing training for community caregivers
• There is a need for formal training for community peer supporters.
• Training programs for peer supporters need to be evaluated for eectiveness and updated periodically.
• Ensure there is a support system for peer supporters as caregiver support is often lacking in this population.
• Find ways to work around competition between agencies and business entities to enable sharing of ideas and
resources.
Exploring community-based suicide prevention initiatives
• Find out what community-based suicide activities are going on in the Veteran and PSP communities, for example
through research studies and surveys.
• Identify gaps in community-based activities. Use this information to drive collaboration and make improvements in
areas with gaps.
• Explore the development of identity-specic and culturally-specic suicide prevention activities (e.g. indigenous
populations, women, regional cultures).
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Encouraging wellness activities
• Encourage wellness activities that promote good well-being, such as learning to manage personal nances and other
life skills.
Promoting a “no wrong door” policy
• Individuals should not be turned away from a suicide prevention resource owing to the community they come from,
their identity, or the uniform they wear.
Promoting open communication about suicide prevention
• Engage more Canadians in conversations about mental health and suicide prevention.
• Improve awareness of available resources, programs, and services in the community.
• Investigate alternatives to “call 911” or “send them to the emergency department” when helping a person with
thoughts of suicide.
Normalizing talk about suicide
• It is important to normalize discussions about suicide. The language used to describe suicide and suicide prevention
needs to make sense across various populations and demographics. Consider examples from other public health
initiatives, such as smoking cessation programs.
• Shift the perception of suicide by using respectful and dignied language to express suicide. Examples include shifting
from “commit suicide” to “die by suicide”, and from “suicide prevention” to “life promotion” or “well-being promotion”.
Theme 2: Supporting an evidence-based culture in community-based suicide prevention
Promoting the idea of “falling forward” in research-based program evaluation, meaning getting started and
learning as we go
• Encourage community-based groups to develop logic models, start collecting, and use research data for program
evaluation.
• Develop logic model templates and evaluation kits that can be adapted to t local situations.
• Establish an “evidence-informed” culture and encourage evolution to a research “evidence-based” culture.
Developing research knowledge translation activities
• Research ndings need to be transparent and freely available in lay language. Mechanisms for open and free sharing
of research knowledge are essential in advancing suicide prevention work.
Encouraging data collection
• Help groups to begin or develop data collection. Foster participation in whole-of-community data collection.
• Collect both qualitative and quantitative data. Anecdotal evidence also has value.
• Collect data on safety issues as well as ecacy – eectiveness refers to both.
• Provide solutions to the unique ethical challenges in collecting suicide data.
Identifying research questions for program evaluation and research
• Participants identied a number of questions to ask in program evaluation and research:
°Who is doing community-based suicide prevention in the Canadian Veteran and PSP communities?
°How many individuals in the community need suicide prevention?
°How many individuals attempt suicide?
°How many contacts does the group make?
°How much exposure to occupational stress is there in the organization, and what are the stressors? How many
individuals are aected, and to what degree?
°Is there an increase in the number of people needing help?
°How many are sent to hospital or mental health services versus other options?
°How many courses did the group run, and how many individuals attended?
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°How do men and women dier?
°Are members of the target community aware of the program?
°Does our training method for community caregivers work?
°What is the evidence for MHFA and ASIST?
°Does what we are doing work?
Meeting challenges in data collection and analysis
• Develop a national suicide prevention database, fed by data collection from local community groups.
• How can we know when a suicide has been prevented?
• Identify appropriate metrics for data collection. Participants suggested a number of areas where metrics are needed:
°Measuring suicide prevention/reduction;
°Measuring rates of suicide attempts, ideation, and death by suicide;
°Percentage of people in an organization with relevant training (e.g., MHFA-V, ASIST);
°Number of referrals to mental health professionals in an organization;
°Number of people sent to the hospital for mental health reasons in an organization; and
°Dierences between minority groups, demographics, organizational factors (e.g., stigma, harassment, exposure
to operational stress).
Promoting the development of standard denitions
• Standardize denitions for terms pertaining to suicide prevention, including “suicide” and “suicide attempt”. Dene
terms such as “best practice” and “intervention” as they relate to suicide prevention.
Accounting for lived experience and identities
• When collecting data, conducting data analyses, and doing program evaluation it is important to involve individuals
with lived experience.
• It is important to account for all identities, including minorities.
Supporting program evaluation by community groups
• Community groups can have diculty knowing how to go about program evaluation.
• There was a desire for national coordination for knowledge translation, data collection, training, hosting meetings,
developing logic models, and program evaluation using a Clearinghouse model.
• Make resources available to deal with the unique ethical problems of collecting suicide prevention data.
• Engage not-for-prot organizations to assist with promoting an evidence-based culture.
• Providing training for researchers from these communities
• There was a desire for more formal training in evidence gathering and analysis. Support community workers in
obtaining advanced research education.
EMERGING
PICTURE OF
COMMUNITY-
BASED SUICIDE
PREVENTION
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Little is known about the extent of community-based suicide prevention actively developing across Canada in the
Veteran and PSP populations. From the discussion, there appeared to be four general types of community-based suicide
prevention activities:
1. Informal peer support: Military personnel, Veterans, and PSPs helping suicidal peers with none to limited special
training, oversight, or formal relationships with other agencies. For example, the work of the PPCLI Association and
the Send Up the Count initiative.
2. Organized peer support: Individuals with special training, access to guidelines, management oversight structure,
and formal relationships with other agencies. For example, the OSISS program supported by the CAF and VAC.
3. Suicide prevention embedded in service organizations: Dedicated sta positions in services that support
wellness, peer support, and other suicide prevention / intervention activities within a service organization. For
example, the services described by representatives of the Tri-Service team, a collaboration of the Ottawa Police
Service, the Ottawa Paramedic Service and the Ottawa Fire Service.
4. Community-based “upstream” suicide prevention programs delivered by health care professionals. For
example, the programs described by Dr. Heisel and Dr. Kennedy in their presentations.
SUMMARY
AND WAY
FORWARD
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Community-based peer support group suicide prevention in the Canadian military Veteran and PSP communities have
been developing across the country for many years. Peer support groups are working hard to meet a need that they
live with among their colleagues, troop-mates, and friends. As this workshop made clear, peer support groups welcome
assistance with developing evidence to nd the best ways to do their work.
In providing practical suggestions for developing a comprehensive, whole-of-community approach to suicide
prevention, Caine et al. (2018) concluded,
“Suicide prevention eorts have tended to be one-by-one initiatives rather than comprehensive eorts that bring
together communities, state agencies, health systems and diverse stakeholders to work in a synergistic fashion that
pushes forward multiple eorts simultaneously. Suicide is not a singular problem, or a specic medical diagnosis.
Rather it serves as a nal common pathway for an array of elements reecting personal, family, community and
societal stresses and turmoil—typically expressed one individual at a time. While the nal moments of action—
killing oneself—predominantly have drawn past attention from medical and mental health professionals, it is timely
to integrate the person level with what can be done in both health systems and beyond their walls across entire
communities, and far upstream, so that it is possible to alter life trajectories.”
Community-based suicide prevention in the Canadian Veteran and PSP communities is evolving rapidly beyond the
simplistic “gatekeeper training” commonly recommended in existing suicide prevention recommendations. While
identifying suicidal individuals and helping them get to professional care remains an important priority, it is clear from
listening to the participants at the workshop that community-based suicide prevention is much more complex. For
example, community-based suicide prevention also includes “upstream” prevention, to help people from becoming
suicidal in the rst place. When assisting a peer with suicidal thoughts, community caregivers require more options than
just “call 911” or “send them to the Emergency Department”, although those options also play a role. Managers need to
understand that “prevent suicides” realistically does not mean “prevent all suicides”.
The rst objective of this workshop was to start a platform for Veteran and PSP community groups to work together
in suicide prevention. Participants clearly appreciated the opportunity to hear what others were doing. They called for
further development of mechanisms to enable them to learn about and collaborate with other community-based suicide
prevention initiatives.
The second objective was to develop suicide prevention capacity by sharing promising suicide prevention tactics and
strategies. Based on the workshop discussions, community-based activities are at an early stage of development in the
Canadian Veteran and PSP communities. Participants agreed that the workshop allowed them to share their suicide
prevention approaches, and to learn from others. They made a number of suggestions for promoting the development
of community-based suicide prevention activities.
The third objective was to share ways to gather evidence for the eectiveness (ecacy and safety) of community-based
suicide prevention activities. Evidence is needed regarding the extent, nature, and eectiveness (ecacy and safety) of
community-based suicide prevention eorts in the Canadian Veteran and PSP communities. Participants acknowledged
the importance of starting data collection. Participants responded positively to Dr. Perkins’ idea that it is better to be
“falling forward” than standing still, meaning that it is better to begin collecting any program evaluation data than not
get started. Participants identied a number of challenges and opportunities to participating in evidence-gathering to
inform program evaluation.
Next Steps
Three main points arose from the workshop: (1) community-based suicide prevention peer groups can “fall forward” one
step at a time toward evaluating their eorts with sound evidence, (2) there is a need for evidence-based guidelines to
support the evolution of community-based suicide prevention for peer supporters, and (3) suicide prevention research
knowledge has to be more transparent and widely available. Although the focus was on Veterans and public safety
personnel, the ndings of this workshop will be of interest to agencies managing suicide prevention in the serving
military population.
This workshop highlighted a wide range of roles for researchers in supporting the development of community-based
peer group suicide prevention. Clearly, much work remains to be done to generate evidence mapping the extent
and needs of community-based suicide prevention initiatives in the serving military, Veteran, and PSP communities.
Researchers can assist in integrating those groups into a whole-of-community public health approach. Researchers can
play key roles in helping community-based peer groups with data collection and program evaluation. They can enable
easy, transparent access by community-based peer groups to research ndings to promote evolution from an evidence-
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informed to an evidence-based culture. Finally, researchers can play important roles in assisting with the establishment
of a national initiative to develop evidence-based guidelines for best practices in community-based program evaluation
and suicide prevention.
ACKNOWLEDGEMENTS
The progress of this work is a reection of the dedication by all of the individuals who participated in and contributed to
the workshop. We are grateful to Veterans Aairs Canada, Mr. Paul Hale of the PPCLI Association, and Mr. Glynne Hines for
assisting with the planning of the workshop. We thank all the presenters for sharing their work: Dr. Marnin J. Heisel, Ms.
Sherry Lachine, Mr. Brian Harding, Mr. Paul Hale, Dr. Daniel F. Perkins, Sgt. Brent MacIntyre, Paramedic Lorraine Downey,
Fireghter Scott Patey, and Dr. Sidney H. Kennedy.
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APPENDICES
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Appendix 1: Glossary
ASIST – Applied Suicide Intervention Skills Training
CAF – Canadian Armed Forces
CAN-BIND – Canadian Biomarker Integration Network in Depression
CANMATS – Canadian Network for Mood and Anxiety Treatments
FRMHNC – First Responder Mental Health Network Collaboration
KT – Knowledge translation
MCMG – Meaning-Centered Men’s Groups
MHFA-V – Mental Health First Aid Veteran Community Course
MOU – Memorandum of Understanding
NGOs – Non-governmental organizations
OSISS - Operational Stress Injury Social Support
PPCLI – Princess Patricia’s Canadian Light Infantry
PSP – Public safety personnel
R2MR – Road to Mental Readiness
VAC – Veterans Aairs Canada
Appendix 2: Workshop Participant Survey
Workshop attendees included Veterans, public safety personnel, peer or volunteer support groups, policy makers,
program developers, service providers and clinicians, and academics. Twenty-eight participants completed the
evaluation form was sent electronically after the workshop:
• 86% felt that the presentations met their expectations.
• 96% thought that the presentations were relevant to their interests.
• When asked “How might you incorporate what you learned today in your job or daily life?”, 71% of respondents
hoped to adapt the knowledge to a specic context, 65% of respondents hoped to help family members,
friends, or colleagues, 67% hoped to inuence or develop policies, 73% hoped to inform the development of
strategic initiatives, 73% hoped to increase public/professional awareness, and 73% hoped to aect change at an
organizational level.
• The majority of respondents thought that the format of the workshop was appropriate and eective.
• When asked to provide suggestions to improve the workshop format there was a desire for additional time for the
breakout sessions and for longer question and answer periods following the presentations.
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