Suicide prevention

Suicide prevention is an umbrella term for the collective efforts of local citizen organizations, mental health practitioners and related professionals to reduce the incidence of suicide.

Such efforts include preventive and proactive measures within the realms of medicine and mental health, as well as public health and other fields – since protective factors such as social support and connectedness, as well as environmental risk factors such as access to lethal means, appear to play significant roles in the prevention of suicide, suicide should not be viewed solely as a medical or mental health issue.

In the U.S., suicide prevention efforts are guided by the National Strategy for Suicide Prevention, published by the Department of Health and Human Services in 2001. Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population.

The Best Practices Registry (BPR) For Suicide Prevention is a registry of various suicide intervention programs maintained by the American Association of Suicide Prevention. The programs are divided, with those in Section I listing evidence-based programs: interventions which have been subjected to indepth review and for which evidence has demonstrated positive outcomes. Section III programs have been subjected to review.



Strategies
As a suicide prevention initiative, this sign promotes a special telephone available on the bridge that connects to a crisis hotline.
A telephone connected to a crisis hotline at Niagara Falls State Park

In recognition of the need for comprehensive approaches to suicide prevention, various strategies have been put forth in the last decade.

In 2001, the U.S. Department of Health and Human Services, under the direction of the Surgeon General, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal behavior throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual).The document also outlines 11 specific objectives, listed below :

Promote awareness that suicide is a public health problem that is preventable
Develop broad-based support for suicide prevention
Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services
Develop and implement community-based suicide prevention programs
Promote efforts to reduce access to lethal means and methods of self-harm
Implement training for recognition of at-risk behavior and delivery of effective treatment
Develop and promote effective clinical and professional practices
Increase access to and community linkages with mental health and substance abuse services
Improve reporting and portrayals of suicidal behavior, mental illness and substance abuse in the entertainment and news media
Promote and support research on suicide and suicide prevention
Improve and expand surveillance systems


Specific strategies

Various specific suicide prevention strategies have been used:

Selection and training of volunteer citizen groups offering confidential referral services.
Promoting mental resilience through optimism and connectedness.
Education about suicide, including risk factors, warning signs and the availability of help.
Increasing the proficiency of health and welfare services at responding to people in need. This includes better training for health professionals and employing crisis counseling organizations.
Reducing domestic violence and substance abuse are long-term strategies to reduce many mental health problems.
Reducing access to convenient means of suicide (e.g. toxic substances, handguns).
Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g. aspirin.
Interventions targeted at high-risk groups.
Research. (see below)

It has also been suggested that news media can help prevent suicide by linking suicide with negative outcomes such as pain for the suicide and his survivors, conveying that the majority of people choose something other than suicide in order to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.


The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents. There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be valid for use among adolescents and young adults. There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview. The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually commit suicide. Asking about or screening for suicide does not appear to increase the risk.

In approximately 75 percent of completed suicides the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who completed suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening.



Lethal means reduction

Means reduction, reducing the odds that a suicide attempter will use highly lethal means, is an important component of suicide prevention.

For years, researchers and health policy planners have theorized and demonstrated that restricting lethal means helps reduce suicide rates. One of the most famous historical examples of this is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning.
A photo illustration produced by the Defense Media Agency on suicide prevention

In the United States, numerous studies have concluded that firearm access is associated with increased suicide risk. Because guns are quick and more lethal than other suicide means (about 85% of attempts with a firearm are fatal, a much higher case fatality rate than for other methods), they are often a major driver of suicide rates.



Treatment

There are various treatment modalities to reduce the risk of suicide by addressing the underlying conditions causing suicidal ideation, including, depending on case history, medical pharmacological and psychotherapeutic talk therapies.

The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms, upwards of 50% may have an undiagnosed medical condition which if not causing is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and if necessary medical testing which may include neuroimaging to diagnose and treat any such medical conditions or medication side effects may reduce the risk of suicidal ideation as a result of psychiatric symptoms, most often including depression, which are present in up to 90-95% of cases.

Recent research has shown that Lithium has been effective with lowering the risk of suicide in those with bipolar disorder to the same levels as the general population. Lithium has also proven effective in lowering the suicide risk in those with unipolar depression as well.

There are multiple evidence-based psychotherapeutic talk therapies available to reduce suicidal ideation such as dialectical behaviour therapy (DBT) for which multiple studies have reported varying degrees of clinical effectiveness in reducing suicidality. Benefits include a reduction in self-harm behaviours and suicidal ideations. Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.
Respect of self esteem

World Health Organization states that "worldwide, suicide is among the top five causes of mortality in the 15-to 19-years age group and in many countries it makes first or second as a cause of death among both boys and girls in this age group." and recommends "strengthening student's self-esteem" to protect children and adolescents against mental distress and dependency, and enables them to cope adequately with difficult and stressful life situations. and "prevention bullying and violence at school" that specific skills should be available in the education system to prevent bullying and violence in and around the school promises in order create a safe environment free of intolerance. and as well "to de-stigmatize mental illness"




Support groups, even forums

Many non-profit organizations exist, such as the American Foundation for Suicide Prevention in the United States, which serve as crisis hotlines. In addition, some groups such as To Write Love on Her Arms have been promoted using social media to reach more people.



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