By Sean O’Malley
For the better part of a year while doing research for a study just published in the Canadian Journal of Psychiatry, Dr. Juveria Zaheer, Clinician Scientist in CAMH’S Institute for Mental Health Policy Research, would spend every Monday at the Office of the Chief Coroner of Ontario.
That is where the files were located for the 1,565 people in Ontario who were reported to have died by suicide over a six-year period between 2003 and 2009. In approximately one-third of those case files a suicide note was referenced, and in almost 300 cases either a copy or a transcription of the note itself was included.
Juveria read every one of them.
“As a qualitative researcher interested in suicide prevention, I was hoping to understand the perspectives of those who have died by suicide and to allow their narratives to inform the way we provide care to people who are suffering,” says Juveria. “Their personal accounts are so valuable and meaningful.”
Because the files could not be removed from the office, she transcribed each one of them to share with the research team. She says that spending so much time immersed in the last written expressions of so many people who died by suicide made a lasting impression on her.
“It was a really powerful and humbling experience. Having the experience of bearing witness to people’s tremendous suffering helped me to be more present and empathic with the patients I see.”
It is estimated that up to 90 per cent of people who die by suicide have an underlying mental illness. But it is also true that most people who experience suicidal thoughts do not die by suicide. For Juveria, who is currently on maternity leave from CAMH with her seven-month-old daughter, reading the suicide notes reinforced the importance of having an open and transparent dialogue with patients about any suicidal thoughts they may be having.
“There is no evidence that asking about suicide introduces or worsens suicidal thoughts in a clinical setting. In fact, in some studies people have said that being asked about suicide makes them feel cared about. It helps destigmatize suicidal thoughts.”
As a psychiatrist at CAMH’s Emergency Department, Juveria knows better than most what it is like to deal with people in the midst of a mental health crisis. But that experience has also taught her that even for people who come to her feeling like there is nothing left to live for, recovery is possible.
“I see people on the very worst days of their lives,” she says. “Sometimes I have the gift of seeing them later and they say ‘I feel differently than I did on that awful day. I remember what it felt like to be suicidal, but I feel happy now. I have hope.’”
For Juveria, it really is all about trying to save one life at a time.
“The worst outcome for us as a profession is to lose a patient to suicide. What the notes taught me is that there is value in meeting the person where they’re at. All we want to do as psychiatrists is to help people feel safe and reduce their suffering and distress.”