September 10 is World Suicide Prevention Day. For most of the people reading this blog, the conversation about suicide doesn't happen in our work as often as it should - even though our work touches it constantly.

Long-duration disability claims involve real people in real distress. Some of those people are navigating periods of significant clinical risk. The assessment, claims management, and legal processes we participate in are not separate from suicide prevention. Done well, they contribute to it. Done badly, they can compound the burden.

This piece is a measured look at what the evidence tells us, where assessment can help, and where it cannot.

What the data tells us

Suicide is one of Canada's leading causes of death for working-age adults. Statistics Canada data consistently identifies suicide as among the top causes of death for Canadians aged 15 to 64. Men die by suicide at roughly three times the rate of women.

Several risk factors are well-established in the clinical literature. Mental health conditions - particularly major depression - are among the strongest individual risk factors. Substance use disorder, particularly when co-occurring with depression, is consistently identified as a significant amplifier of risk (CCSA, 2024). Chronic pain, especially when poorly controlled, has been associated with elevated suicide risk in multiple Canadian and international studies.

Each of these factors is over-represented in long-duration disability claims, by definition. The files most likely to involve significant suicide risk are the files most case managers are already concerned about: long mental health files, files with co-occurring substance use, files involving chronic pain that hasn't responded to treatment, files where examinees describe hopelessness about their future.

Where assessment can help

Independent medical assessment is not a clinical intervention. It does not treat suicidal distress, and it should not be confused with the role of treating clinicians or crisis services.

But assessment can do meaningful things in a long-duration file:

• It can identify when the clinical picture has changed and the treating system needs to be re-engaged. A skilled assessor noticing escalating risk and flagging it to the appropriate parties is a real contribution.
• It can support files moving forward in a way that reduces the experience of adversarial limbo, which is itself a risk factor in long-duration claims.
• It can ensure return-to-work and treatment planning are realistic and sustainable, rather than ambitious in ways that set up failure and increased distress.
• It can document the clinical picture in a way that supports thoughtful claims decisions, rather than reflexive ones.

Where assessment can't help - and what does

Assessment is not crisis care. It does not replace treatment. And it cannot, by itself, change the trajectory of a file in crisis.

The work of suicide prevention sits with treating clinicians, crisis services, families, supportive workplaces, and community. The role of assessment is to support that ecosystem, not to substitute for it.

What also helps, structurally:

• Non-adversarial, non-stigmatizing claims management. The experience of a file is part of the clinical environment a examinee lives in.
• Timely decision-making. Long limbo periods compound distress.
• Pathways to treating clinicians and crisis services that are accessible and culturally appropriate.
• Workplaces that are equipped to support, not just to assess.

What case managers, employers, and legal teams can do

• Treat the human reality of distress as part of the file, not a side note
• Know the resources - 9-8-8 in Canada is the suicide crisis helpline (call or text), available 24/7
• Recognize when a examinee is describing crisis-level distress and respond by connecting to clinical and crisis services, not by gathering more medical evidence
• Build assessment requests that ask about risk and protective factors transparently, so the resulting report supports informed claim decisions

World Suicide Prevention Day is a moment to acknowledge what the people on the other side of every file are navigating - and what role the systems we work in can play in supporting them.

At SOMA, our assessments are designed to support files moving forward thoughtfully, with attention to the clinical reality of the examinees whose lives are involved. If your team is managing files where the clinical picture or the human picture has become difficult, reach out at referrals@somamedical.com.

If you are in crisis, or worried about someone close to you, call or text 9-8-8 (Suicide Crisis Helpline). It is free, confidential, and available 24/7 across Canada.

Sources: Statistics Canada - Leading causes of death; Centre for Suicide Prevention - fact sheets on substance use and suicide; Canadian Centre on Substance Use and Addiction - Intersections of Substance Use and Suicide (2024); 9-8-8 Suicide Crisis Helpline (988.ca), operated nationally by CAMH.