Suicide prevention – it is everybody’s business

To mark the launch of BMC Psychiatry’s new section on Causes, treatment and prevention of suicide, Section Editor Ute Lewitzka discusses the importance of suicide prevention.

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On September 4th 2014, the World Health Organization (WHO) launched the report ‘Preventing Suicide: A Global Imperative’, the first-ever global report on suicide prevention. It provides not only detailed information about statistics, epidemiology, causes of suicide, and so on, but also aims to guide countries in developing and implementing national suicide prevention programs taking into account the different stages a country is at.

Why do we need to focus on preventing suicide globally?

More than 800,000 people die by suicide every year – around one person every 40 seconds. Suicide occurs all over the world and can take place at almost any age. Globally, suicide rates are highest in people aged 70 years and over. In some countries, however, the highest rates are found among the young. Worryingly, suicide is the second leading cause of death in 15-29 year olds globally.

For every suicide there are many more people who attempt suicide every year. As well as the obvious impact this has for an individual and their friends, and families, this also has a societal cost. It is estimated that non-fatal injuries due to self-harm cost an estimated $2 billion annually for medical care in the US. An even higher financial burden is caused by indirect costs, such as lost wages and productivity.

A prior suicide attempt is the single most important risk factor for suicide in the general population. It is well-known that 75% of global suicides occur in low- and middle-income countries. Globally, the most common methods to commit suicide are by ingestion of pesticides, hanging, or firearms.

People with mental disorders are particularly at risk, but we also know that many suicides happen spontaneously in moments of crisis due to life events or stressful situations.

Research has investigated risk factors such as sex, age, marital status, chronic painful illnesses, access to lethal means, and prolonged stress factors, and their importance in the origin of suicidal ideation/behavior. Media reporting about suicides also plays an enormous role.

On the otherhand, not that much is known about protective influences; especially important seems to be research regarding individual resilience and strengths in relation to suicide.

What is the current global status of suicide prevention?

Mental disorders and suicide are still stigmatized. Many people who are thinking about suicide are not seeking help, and overall the prevention of suicide has not been adequately addressed due to a lack of awareness of this topic as an important public health problem. Worldwide only 28 countries are known to have national suicide prevention strategies.

Undoubtedly, the most important message for everyone is: suicides are preventable.

Ongoing education of the medical community to recognize and treat mental diseases such as depression is one key factor within any prevention strategy. Also important are system-wide suicide prevention approaches, but they need to be enforced continuously, otherwise the effect might disappear.

Other approaches such as web-based and anonymous screening tools could help to find individuals who are experiencing symptoms of depression. The user then will be connected to an online counselor who could offer personalized support.

Many different sectors of the health system and the education system, but no less importantly the political system, play an important role. For example, it is important to strengthen training on suicide risk assessment and intervention, not only for general practitioners but also for non-health professionals, teachers, journalists, and so on.

As suicide is a very complex phenomenon, suicide prevention requires collaboration, and different integrated and comprehensive approaches.

It is also important to mention special follow-up care for people who attempt suicide. As prior suicide attempts are a strong predictor for a suicide, taking care of those who attempt suicide is a fundamental requirement.

There are many different institutions, associations, programs, and initiatives around the world working intensively for suicide prevention. As suicide is a very complex phenomenon, suicide prevention requires collaboration, and different integrated and comprehensive approaches. With that in mind it is very important that the WHO recognized suicide as a public health priority.

With the above mentioned WHO report, another step in raising awareness was achieved. Now every country needs to make suicide prevention a high priority on the health agenda. Financial, personal, and material support at different political and business levels is necessary to improve research into the origins, influences, and therapeutic opportunities associated with suicide. And more than that, to help implement those findings into daily clinical routine for all professionals who work with people at risk.

WHO member states have committed themselves to working towards the global target of reducing suicide rates in their countries by 10% by 2020 – as recorded in the WHO Mental Health Action Plan.

Various challenges in developing and implementing suicide prevention programs were also detected. Several countries have to deal with criminalization of suicide (still 25!), no or insufficient resources or no independent data or evaluations.

As the title of this blog is ‘Suicide prevention– it is everybody’s business’ I would like to encourage every reader to think about a little piece of engagement of their own: there are so many opportunities of which the most important one is: “Talk about it!”


The new section in BMC Psychiatry will cover all aspects of a wide range of suicidality, considering studies of suicidal behavior, its causes and effects but also its prevention and intervention approaches. Research which investigates psychological and sociological as well as neurobiological, genetic and pharmacological aspects of suicidal behavior are also of great interest.

The section also incorporates topics such as assessment and risk-management approaches, ethical issues in intervention research, and cross-cultural risk factors for suicide, as well as the needs of those bereaved by suicide.

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wmnka1990@gmail.com

As nobody is immune to stress, pain, loss and poor adjustment to changes in life situations , I share the view that , suicide is everybody’s business. Thanks for this open resource to share views on such a fundamental topic.

My views are informed from a place in front line services and” Inner community voluntary work on promotion of awareness of need to look after mental health and identification of markers of ill health”.

in front line services suicide claims come in different packages, explained in different languages, mannerism and behaviours and at different stages of consciousness.

The histrionic nature of a certain age group, the selective manner of choice of words to explain the potential of risk of suicide or deliberate self harm and the elusive and rather guarded manner the person seeking help (or even made to seek help) do present.
I sometimes wonder when I do ask self or peers, what training or experience path have we obtained, walked to say that we are competent enough to enable those at risk access the right or helpful services after our initial assessment.

Do we have enough time in for example Emergency Departments to meet the minimum standards (what are they?) of a risk assessment for suicide?
But we do it anyway and I strongly believe we do prevent premature death due to suicide.
There is a need to develop a knowledge base in constructing a model or framework of training or operational framework, standardise it with room for flexibility to improvement with new knowledge and experiences by both services users and clinicians/researchers.

Solutions:
What works is (from experience of hands on from users who verbalise the risk on first contact and by end of an hour or two session feel safer) is mostly a simple but important tool of listening and asking the right questions. of course not in all cases but a good number of them usually with less or no biological causes but more of psycho-social triggers.

Positioning brief solution focused and psycho–education approaches in acute services where people at risk present can contribute to better outcomes at those services.
Psychiatric liaison services are proving to be a good resource that works collaboratively and integratively with other services points to prevent and contribute knowledge and awareness of risk factors and management options to other stakeholders in service provision.

William Masembe Nkata (PLNS).

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RoseAnnie

A lovely & important blog. Really critical, I think, for doctors to remember that suicides don’t just “happen”. Real live human beings take action to end their own lives because they can’t bear to carry on, at a point when it feels there is no way out of a terrible situation. It is not always necessarily a matter of wanting to die but often, rather, a matter of seeing no feasible way to go on living.

“Suicide prevention” alone isn’t enough to help turn things around. We need to help people in desperate situations reach a point where life feels worth living again.

Psychiatrists can’t change the world around their patients, but they can make a difference on the front-line by listening and responding with compassion to each individual they meet at a time of darkness.

When life gets tough we all need a helping hand. In the darkest times of life, when our own hope is depleted, it can make a huge difference if someone reaches out and lends us a bit of their own strength to tide us over until our own is restored.

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