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Suicide is a major cause of premature death in Canada that has no bounds in age, gender, background or geography. Approximately 4,000 Canadians die by suicide every year, making it the ninth leading cause of death in the country.
Given that suicide is a complex issue that may involve any combination of factors including psychological, biological, social, cultural, spiritual and economic, it has no single prevention solution. Despite these complexities, there is hope that suicide can be prevented when collective efforts are harnessed to raise awareness, promote mental health and well-being and mitigate risk factors related to suicide. Footnote 2
In 2015, the Prime Minister tasked both the Minister of National Defence and the Minister of Veterans Affairs to collaboratively develop a CAF-VAC Joint Suicide Prevention Strategy. Published in October 2017, the CAF SPAP is the CAF’s fulfillment of the Prime Minister’s direction. Furthermore, DND and the CAF have identified suicide prevention as a critical priority and a cornerstone to the Department’s commitment to the well-being of military members, as iterated in SSE.
The Strategy “defines the context for action, describes the goals upon which actions are focused, and shows the many programs, projects, and initiatives now underway to help reduce risks, build resilience in [the] CAF and Veteran communities, and prevent suicide among [its] military members and Veterans.”
The Strategy has garnered support from national health agencies and independent groups such as the Canadian Psychological Association and the Canadian Mental Health Association, and was lauded for its holistic approach to suicide prevention. Footnote 3 Footnote 4
The SPAP is underpinned by the existing Federal Framework for Suicide Prevention, the Surgeon General’s Mental Health Strategy and the Report of the Mental Health Expert Panel on Suicide Prevention in the CAF. In 2016, the Panel reviewed suicide prevention in civilian and military populations, and issued 11 recommendations for action which are listed in
Annex B. 1.1.1 CAF Suicide Prevention Action Plan & Realignment
The CAF-VAC Joint Suicide Prevention Strategy includes over 160 CAF and VAC initiatives dedicated to reducing the risk of suicidality and enhancing health and wellness protective factors. Of these, 95 initiatives fall under the responsibility of the CAF, forming the CAF SPAP. These initiatives span seven lines of efforts, and cover different areas that contribute to suicide prevention such as Communicating, Engaging and Educating members. While CAF initiatives across these lines of effort are in various stages of development and completion, 55 are complete and already in operation. Given the many interdependencies between suicide prevention and total wellness, 62 of the 95 initiatives will be incorporated into the new Total Health and Wellness Strategy (THWS). The seven lines and their respective statuses are detailed in
Annex C. 1.1.2 Total Health and Wellness Strategy
The health and wellness of personnel is crucial to having operationally ready units and effective support staff across the Defence team. SSE dedicates nearly $200 million in funds to creating a THWS in support of Defence Team members. The broad goals of the THWS are to develop an overarching strategy that considers psychosocial well-being in the workplace, the personal dimensions of health, and the physical work environment in order to improve individuals’ quality of living, life and job satisfaction, and engagement at work. Over 200 programs and services under the THWS will benefit the entire Defence Team.
At the time of audit, the THWS was under development and scheduled for release in FY 2020/21. The strategy development team visited bases and wings across the country and consulted with health and wellness service providers as well as military and civilian Defence Team members to inform strategy development. As a significant contributing factor to total health and wellness, the CAF SPAP will ultimately be included as a key initiative under the umbrella of the THWS.
1.1.3 Key Stakeholders
Military Personnel Command
Reporting directly to the Chief of the Defence Staff (CDS), Military Personnel Command (MILPERSCOM) is responsible for military personnel management including, but not limited to, recruitment, education, health services, casualty support and career transition. MILPERSCOM is responsible, with the support of other Level One (L1) organizations, for the development of the CAF Suicide Prevention Strategy.
Key organizations under MILPERSCOM involved in implementing initiatives within the CAF SPAP include:
Director General Morale and Welfare Services
Director General Military Personnel Research and Analysis
Director Strategic Force Development
(DSFD) Footnote 5
DSFD is responsible for the coordination, monitoring and reporting on strategy development and implementation.
The original 95 CAF SPAP initiatives fell under the responsibilities of various L1 organizations including MILPERSCOM, the Canadian Army, the Royal Canadian Navy, the Royal Canadian Air Force, Assistant Deputy Minister (Public Affairs) (ADM(PA)) and Vice Chief of the Defence Staff (VCDS). These organizations were responsible for supporting the development and implementation of the CAF SPAP, as well as for providing status and performance updates to MILPERSCOM and to share lessons learned and best practices.
Since the approved realignment in 2018 toward the THWS, MILPERSCOM is now responsible for the implementation of 30 of the 33 SPAP initiatives. The remaining three initiatives belong to ADM(PA) and VCDS.
CAF-VAC Joint Steering Committee
The CAF-VAC Joint Steering Committee is a strategic decision-making body co-chaired by the Commander MILPERSCOM and the Deputy Minister (DM) of VAC.
The Committee serves as a venue for consultation on important joint issues and initiatives, including the CAF-VAC Joint Suicide Prevention Strategy, which have significant impacts on both organizations. The Committee meets at regular intervals—approximately three or four times annually. Joint priorities are managed by joint working groups with specific mandates, deliverables and timelines. Progress is reported on a quarterly and annual basis, and includes updates on the delivery of joint priorities. The annual report is circulated across both organizations, to the CDS, the Minister of National Defence, and the Minister of Veterans Affairs. Footnote 6 1.1.4 Tools and Process
CAF SPAP Implementation and Performance Trackers
To facilitate information gathering and reporting, and to provide an overview of the assigned initiatives, DSFD has developed two tracking tools: an Implementation Tracker and a Performance Tracker.
The Implementation Tracker is used to track progress of initiatives, as they are being developed and implemented.
The Performance Tracker is used to track implemented initiatives, focusing on outcomes and performance metrics to determine whether programs are meeting their objectives.
Information in both systems is self-reported for individual initiatives.
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Suicide is a complex, society-wide issue that has no single solution. To fulfill its commitment of continuously improving its approach of providing appropriate support, care and services to ensure the total health and well-being of CAF members, the CAF developed a SPAP to mitigate suicide risks in the military community. Successful and timely implementation of the numerous initiatives within the SPAP is critical to building a resilient armed forces, and ensuring appropriate care and support are provided to those in need.
Given the importance of suicide prevention, the audit was included in the ADM (RS) Risk-based Audit Plan for FYs 2019/20 to 2021/22.
1.3 Objective and Audit Criteria
The objective of the audit was to provide assurance that the CAF has an effective framework to monitor the implementation of programs and services to support suicide prevention.
The criteria used for this audit was the following:
DND/CAF has a governance process to monitor and provide oversight on the development and implementation of the CAF SPAP.
Communication and coordination are carried out to ensure development and implementation of the CAF SPAP.
DND/CAF has established a performance measurement framework to monitor progress and results.
The assessment against the audit criteria can be found in
1.4 Scope and Methodology
The scope of this audit included the review of the tools and processes in place to develop and implement the CAF SPAP, including the Implementation and Performance Trackers and a selection of initiatives under the SPAP from January 2017 to May 2019. Scope exclusions and the complete listing of audit methodology are outlined in
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2.0 Findings and Recommendations
There is a governance process in place. Some policies and procedures require updating. ARA could be improved for key stakeholders to guide reporting of initiatives in SPAP implementation.
We expected to find:
Policies and procedures are updated and relevant;
ARA are clearly defined and communicated;
Effective monitoring function is in place; and,
Key information is accurate and complete to support decision making.
2.1.1 Policy and Procedures
Suicide prevention in the CAF is supported and guided by multiple policies and strategies. This includes
Canadian Forces Administrative Order (CFAO) 19-44 Suicide Prevention and Defence Administrative Orders and Directive 5017-0 Mental Health, both of which have not seen significant updates since their publication in 1996 and 2000, respectively. CFAO 19-44 Suicide Prevention includes the responsibilities, measures and procedures for suicide prevention, intervention and post-intervention. Due to the evolution of prevention efforts and policies in the CAF, roles of some key stakeholders, such as Chaplains, are not defined. As well, several supplementary directives and procedures have either been cancelled or not referenced within other policy, limiting the overall usefulness of these documents.