For many Canadians, accessing care during a mental health crisis is difficult. Seeking help for suicidal ideation can mean shouldering the cost of private therapy, or, in an emergency, waiting for hours in the ER—where not all hopsital staff are able to provide adequately sensitive support. 

For queer and trans people, mental health struggles are common, and the barriers to care are particularly high. As the PTP Pink Paper on Health found, 40 percent of LGBTQ2S+ individuals reported a diagnosed mental health condition (twice the rate of their cis straight peers). But less than 30 percent of respondents were satisfied with the mental healthcare services they’d accessed in the past. 
 

Many mental health professionals are not adequately trained to understand or support the needs of queer and trans patients, and this knowledge gap can lead to care that’s ineffective and, at times, even harmful if patients experience homophobia, transphobia or medical discrimination at the hands of providers. So queer people often become the first line of care in their own communities. 
 

A Nova Scotian mental health organization is working to help strengthen that first line by offering suicide awareness training specifically for queer and trans participants.

Next month, Marisa DiCosta, a nurse and community outreach coordinator at Healthy Minds Cooperative, will be guiding 15 Nova Scotians through safeTALK, a suicide-alertness program offered across Canada. 

The program is built on the knowledge that most of us will, throughout the course of our lives, know someone who is struggling with thoughts of suicide, often silently. With the practical skills learned in the training, anyone can have the power to notice, reach out and connect their community members with appropriate options for help—options which often need to look different for queer and trans people. 
 

“There’s still a big separation between community and clinical that needs to be bridged,” DiCosta says. 
 

The four-hour training, which is geared toward the general public rather than healthcare professionals, will teach participants how to recognize signs that someone may be thinking about suicide, and how to engage in a supportive conversation about it. It will also address how to connect people to appropriate help and resources. 
 

DiCosta says the training is designed to be accessible for the everyday person, and is meant to help participants to direct others to mental healthcare services, as opposed to intervening themselves. “You don’t have to be a professional, you don’t have to be super mental health literate,” he says. “You just have to be a person who cares and wants to ensure the safety of the person that you’re supporting.”

By hosting a training specifically for LGBTQ2S+ participants, DiCosta hopes to ground the program in queer and trans inclusivity and community care—all while recognizing the unique experiences and mental health challenges we face. For example, the session will address the nuances of what might lead someone who is queer or trans to feel suicidal. “We’re experiencing trauma sometimes on a day-to-day basis,” they say. “Just having to be yourself in this society is inherently traumatic for queer folks.” 
 

There are many contributing factors to poor mental health, such as a lack of access to gender-affirming care or ostracization from one’s family. Poor mental health can also stem from “not feeling like you’re living your life authentically and not knowing how to do that,” says Seana Jewer, community engagement lead with Roots of Hope at Nova Scotia Health, which also focuses on community suicide prevention and support. 

 

But LGBTQ2S+ communities can—and always have—supported one another. When a friend, peer, colleague or family member engages with someone who is feeling disconnected, the impact can be profound. “So many people have helped [others] when they were thinking about suicide, but never were aware of that,” says Jewer.
 

With safeTALK, DiCosta hopes people can feel more confident taking an active intervention role: learning how to notice when someone is perhaps feeling suicidal, and understanding how to ask them about it or what to do next. 

It was a friend stepping in and sticking around what saved DiCosta’s life when they were feeling suicidal. 
 

“I had a friend who knew that something wasn’t right and asked me about it over Facebook Messenger. I was honest with them about how I was feeling. For the next week or so after taking me to hospital, she would call and check in with me every single day…...”

“It was that level of care that really saved my life, that got me back on track.” 
 

DiCosta says that the SafeTALK program is largely designed to guide people through how to notice patterns in people they’re already close to. For example, they might see differences in the way that people are showing up: a co-worker might start coming into work less frequently, or a friend might seem especially lethargic or disengaged. On the more extreme end, a loved one may write uncharacteristic letters saying how much others mean to them, or may express that living is just not worth it anymore. These behavioural changes might not immediately indicate a crisis, says DiCosta, but they are a sign to pay closer attention. 
 

SafeTALK also walks participants through how to engage when these situations arise. This starts with having a frank conversation about whether or not the person you’re caring for is experiencing thoughts of suicide. While it’s a difficult question to ask, DiCosta says that the query can feel like a relief for someone who is struggling but not wanting to bring it up. 
 

And just asking is not enough, Jewer adds: it’s also important to listen to the person’s answer. Jewer recommends refraining from immediately trying to problem-solve. Instead, she suggests giving people plenty of room to share why they’re feeling disconnected from life.
 

“When somebody is thinking about suicide, they’re not in the mindset necessarily to be thinking of more options. Offering solutions too early can feel like trying to solve someone’s problems and diminish the weight of the struggle.”
 

And not everyone will need to visit the ER, Jewer says. Thinking of suicide is not always a high-level crisis—the earlier someone can share that they’re experiencing ideation, the sooner and easier it is to support them through it. 
 

Still, the program covers how to connect people to sources able to provide suicide prevention support, whether that’s a mental health professional or a person who has taken additional training. In some scenarios, this can mean calling a mental health crisis line, heading to a hospital or calling emergency services, but DiCosta notes that for LGBTQ2S+ folks, those options aren’t always safe. The person they’re connected to for care and support “could have no knowledge whatsoever about the queer community,” he says. “It’s like luck of the draw.” 
 

DiCosta’s lived experience with suicidal ideation—as well as the lived experiences of queer and trans participants—will shape the recommendations offered in the sessions. DiCosta hopes the group can share personal experiences with local programs that were queer-friendly—or not. He also hopes that despite the barriers, anyone who does the training will walk away feeling confident to help connect someone to safety when necessary. 

Because institutional supports are not guaranteed to be LGBTQ2S+-friendly, both DiCosta and Jewer stress the importance of connection to community throughout the entire process. 
 

“The thing that really keeps people going is social connection,” says DiCosta. 
 

By working to help members of the queer community feel more comfortable talking about suicide with someone they love, DiCosta says, “more people will, hopefully, continue to live.”