Self-injury rates indicate Canadian mental health services are inadequate.

enter hospitals each day following suicide attempts or self-inflicted injuries, a number that could be greatly reduced through improved community-based intervention strategies and greater awareness of groups most at risk for self-harm, according to the Canadian Institute for Heath Information (CIHI). About 17 482 Canadians were admitted to hospitals for overnight stays as a result of self-inflicted injuries in 2009– 2010, CIHI says in a new report, Health Indicators 2011, (http://secure.cihi.ca/ci hiweb/products/health_indicators_2011 _en.pdf). “One of the surprising things about self-injury indicators is that 70% of those admitted to hospitals have a mental health diagnosis, which means that 30% don’t,” says Kira Leeb, CIHI’s director of health system performance. “What does that mean? Are we underdiagnosing the mental health component? The other aspect is that mental health is a continuum, and it’s quite possible to self-injure without having a clinical diagnosis of mental illness.” The highest rate of hospitalization for self-injury, at 140 per 100 000 people, was among women aged 15–19, with poisoning being the primary cause (85%), followed by cutting (10%) and strangulation (2%). The rate for men in that category was more than 50% lower, though, overall, men were more than three times as likely to commit suicide than women (16 per 100 000 v. 5 per 100 000). Although suicide accounts for 4000 deaths per year in Canada, placing it among the top 10 causes of death in the country, Canada lacks a national strategy for suicide prevention and efforts to create one have been mired in jurisdictional wrangling (www.cmaj.ca/lookup /doi/10.1503/cmaj.109-3724). “The problem is breakdown in community support,” says Richard Ramsay, president of LivingWorks, an international suicide intervention training company based in Calgary, Alberta. “We have to find ways that don’t involve sending people off to a stranger for help. You need to strengthen where they came from rather than sending them to a new regime of care.” The CIHI report also indicates that rates of hospitalization due to selfinjury vary from province to province. The provinces with the lowest rates, all below 60 per 100 000, are Prince Edward Island (55 per 100 000) and Ontario and Manitoba, which both have rates of 58 per 100 000. New Brunswick, as well as Newfoundland and Labrador, have the highest rates, each at 81 per 100 000. Because of complex societal and health care issues, the rates in the territories were substantially higher than in the provinces, ranging from 192 per 100 000 in the Yukon to 379 per 100 000 in Nunavut. Overall, rates of self-injury and suicide have been declining in Canada. It has been estimated, the report notes, that hospitalization due to self-injury has decreased by 16% over the past decade, and suicides have dropped by News CMAJ