Toronto Public Health report urges action to prevent suicides

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Suicide far surpasses homicides and traffic accidents as a leading cause of death in Toronto, according to a new report by Toronto Public Health that assessed the ways people end their own lives and offered recommendations to prevent further fatalities.

The report, titled Suicide Prevention in Toronto and presented at a board of health meeting on Monday, showed an average of 220 people die by suicide in the city each year – a toll that is four times higher than the number of homicides and three times the number of deaths by motor vehicle accidents. Among its recommendations, Toronto Public Health called for installing barriers to prevent people from jumping onto subway tracks, restricting the availability of over-the-counter drugs commonly used in overdoses, such as acetaminophen, and promoting community and school-based programs that build skills in problem-solving, coping and conflict resolution.

"[Suicide] is, I think, one of the most important but least talked about population health issues," David McKeown, the city's medical health officer, told the board, noting that restricting access to the common means of suicide has proven effective in preventing deaths.

Based on coroner's data, most suicides occur at home. Hanging, jumping or falling from heights and overdoses were the most common means, accounting for nearly 75 per cent of suicides in the city between 1998 and 2011. Collisions with subways, trains and cars were also responsible for more than 7 per cent of deaths. The Toronto Transit Commission records an average of 23 suicide attempts and fatalities on its subway system each year, which the report noted could be prevented with the installation of doors along the platform edge.

While the recommendation to provide funding for such barriers is one of the report's most tangible solutions, it is contentious.

The report pointed out that the TTC board approved the installation of platform edge doors in 2010, but that they remain unfunded. Councillor Joe Mihevc, chair of the board of health, noted the cost of installing platform edge doors is estimated at $5-million to $10-million a subway station.

Speaking to reporters ahead of the board meeting, councillor Glenn De Baeremaeker said it is a solution the city cannot afford.

"If we were to put that project first, we would have to cancel any new buses, any new streetcars, any new subways. In fact, we'd have to cancel the Scarborough subway line just to get that platform protection in place," Mr. De Baeremaeker said, adding that while it has the support of TTC commissioners, this is "one of the many things the city needs to do but doesn't have the money to do as of this time."

But, while addressing the board, Mr. Mihevc noted that along with saving lives, the doors would increase transit efficiency by between 20 and 35 per cent.

"If you do the math and you count there are 31 stops on the Yonge-University line, for that $300-million, you actually do a lot of good on suicide prevention and you squeeze a heck of a lot of efficiency out of an existing asset," Mr. Mihevc said.

Converting the subway system on the Yonge-University line to automatic train control, or driverless trains, is already about 75 per cent complete, Mr. Mihevc said. But once these trains enter the station, they are currently required to move slowly to ensure safety. But Mr. Mihevc noted that if platform edge doors are put in place, these trains can enter the station at a much greater speed, stopping on a dime when the train doors line up with the platform doors. This would reduce the headway time from 2 minutes and 30 seconds to 1 minute and 40 seconds, reducing the time it takes for a train to pull into the station, and allowing more vehicles to run at a time.

In an address to the board, Toronto resident Lindsay Hill put a face to the report's statistics. She recalled standing on a Toronto subway platform contemplating ending her life in 2007 – but stopped herself when she realized she did not want her son growing up not knowing his mother.

"Unless you have been in that situation, and unless you can hear what it's like to have that moment when you think there's no other option available to you, you can't understand that it is a moment that comes upon you as the opportunity is presented," Ms. Hill said. "If you are prevented from accessing that opportunity, your life will be saved at that moment. For many people, it's that simple."

Dr. McKeown emphasized subway barriers are only one part of a comprehensive suicide prevention approach.

"Eliminating or reducing access to the means of suicide is a very important measure, but it's not the only thing we need to do," he said. "We need to identify people who are at risk, we need to identify them earlier. … All of these things work together."