A scoping literature review and stakeholder consultations
By: Kyrra Rauch, Donna Epp, and Candice Waddell-Henowitch
The Public Health Agency of Canada (PHAC), in association with the Mental Health Commission of Canada (MHCC), conducted a literature review and stakeholder consultations on suicide in 2018. Many priority populations did not have a voice in those discussions, including rural and remote communities. The Centre for Critical Studies of Rural Mental Health (CCSRMH) was contracted by the PHAC to conduct an in-depth scoping review on suicide in rural/remote communities followed by stakeholder consultations in rural communities.
Six stakeholder consultations were held across Canada in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Newfoundland with a total of 47 stakeholders participating. Stakeholders had a variety of reasons for attending but most prevalent were professional interest, desire to learn, and having lived/personal experience of suicide. Lived experience was defined as having experience of suicidal ideation, suicide attempts, or having lost someone to suicide; 72% of stakeholders reported having such experience. Main themes of stigma, service accessibility, and lived experience emerged from both the literature and the consultations.
Stigma is reported as being ever-present in rural communities, having an influence on willingness to access mental health support, to communicate with others about mental illness, and suicide risk. Stigma is frequently tied to masculine ‘norms’ experienced by rural men. These ‘norms’ have been said to reinforce the ‘I’m strong, I’m stoic’ attitude that can prevent men from reaching out for support due to fear of ‘perceived weakness’. The other large facet of stigma is rural anonymity. Residents of rural communities expect that everyone knows everyone’s ‘business’, which leads to apprehension when considering seeking support due to fear of judgement.
Rural anonymity extends to service usage. This lack of confidentiality may cause people not to seek services, adding to the suicide risk. As well, mental health services in rural communities are limited. Services that are available tend to have high wait times for professional support, short-term support when they do get access, and the service providers may not understand rural culture as a result of travelling from urban centres.
There is a lack of research on lived experience of suicide in rural communities. The qualitative research that does exist focuses only on men and farmers. Stakeholders echo that men are difficult to reach. Stakeholders did, however, highlight the need for research on different populations as well as geographical areas that had a scarcity of research (Saskatchewan, Atlantic Canada, the Territories). As one of the stakeholders stated:
“Firstly, the most voiceless people are the people that are dead, they can’t speak to us, … so sadly we’re the closest to a voice that these people are having, and I don’t know what the answer is. I mean, I guess that the best thing, like I said, is try to find someone that’s been there, that’s somehow crawled out of it, and maybe they can offer some solutions.”
A number of main recommendations overlapped from both the stakeholders and the literature. A need for more Canadian research on suicidality in rural communities overall is needed but particularly qualitative research focusing on those with lived experience of suicide. A need for increased services that are rural-specific was emphasized. Last, when it comes to what we can all do to help reduce the stigma surrounding mental health and suicide, stakeholders said the best way to do this is to talk about it! Therefore starting, and continuing conversations around mental health and suicide without judgement is an easy step for all of us to take.
Kyrra Rauch, Research Assistant, Centre for Critical Studies of Rural Mental Health (CCSRMH), Brandon University
Donna Epp, Research Facilitator, CCSRMH, Brandon University
Candice Waddell-Henowitch, Associate Professor, Department of Psychiatric Nursing, Brandon University, Founding Member CCSRMH
To learn more about the Centre for Critical Studies of Rural Mental Health go to https://www.centreforruralmentalhealth.com/