Authors: European Brain Council and GAMIAN-Europe

As World Mental Health Day 2019 is focusing on suicide prevention, we consider how societal and policy changes can help to build a compassionate, empathetic and ultimately effective response to suicidality.

Suicide should be a public health priority. Every 40 seconds, someone dies due to suicide. It is predicted that for every adult who dies by suicide, a further 20 attempt to do so.

There are various causes associated with suicidality, which can include many social, psychological and cultural factors. Some of these are isolation, stigma associated with seeking help for mental health, experiences of trauma, abuse or discrimination, and even inappropriate media reporting.

Changing the conversation about suicide

Suicide is the most devastating outcome of depression, and suicide prevention is thus fundamental to depression care. But all too often, the risks of suicide are only broached with people suffering from mental health issues after they have attempted suicide. Instead of a reactive approach to preventing further attempts, services should focus on understanding the root causes of why someone contemplates suicide to begin with, and working with that person to try to address these causes in an appropriate way. Mental health problems are already subject to stigma, and it can be extremely difficult for a person to acknowledge that they are dealing with thoughts of suicide – especially to their loved ones. Encouraging dialogue around suicide is, therefore, essential.

Campaigns like Speech can Save are changing the way suicide is being talked about. Rather than focusing on the act of suicide, it encourages people who have attempted suicide to talk about the thoughts that can lead to suicidal ideation. The campaign asserts the importance of acknowledging people’s triggers for suicidality and allowing them to speak about them openly, with their families and loved ones as well as with health and social care professionals.

The campaign also notes the importance of not creating or reaffirming associations of certain places with suicide – for example, it avoided placing awareness posters or hotline numbers near bridges or railway crossings. Just as different factors can affect a person’s depression, a variety of external factors can contribute to suicidality. Recognising this complexity is a key step to encouraging more open dialogue about suicidality.

Creating accountability for suicide prevention

As societies, we must take joint responsibility for suicide prevention – at a personal level, within our health and social care systems, and in policy.

At a personal level, we need to strip away the taboo around discussing suicide. Empathy is key – this includes reaching out to loved ones and friends and empowering them to speak about their feelings, thus enabling them to seek help and empathise with themselves.

The highest risk of death due to suicide is among those people who have already attempted suicide previously – but this group of people may find it particularly difficult to seek help. Programmes like the Attempted Suicide Short Intervention Program in Finland, which was based on a model developed in Switzerland, help people who have attempted suicide learn to empathise with themselves by revisiting the reasons behind their attempt and identifying their triggers. This programme also brings in the person’s loved ones to open up conversations about why they contemplated and attempted suicide, and how they will manage those feelings if they arise again.

Healthcare professionals can also play an important role in suicide prevention by incorporating preventive measures into primary care. There are tools available that can act as primary screening measures, such as the Suicide Prevention Toolkit for Primary Care Practices. A study in the US found that up to 45% of people who died by suicide had visited their primary care physician within a month before their death. Healthcare professionals should be adequately trained, equipped and supported to identify and help people who are experiencing suicidality.

At a policy level, governments should take accountability for suicide prevention within their populations by implementing targeted national strategies. Across the world, only 38 countries have a national suicide prevention strategy, and just a few include suicide prevention among their top health priorities. Cross-sectoral policies can help to identify all possible causes of suicide, meaning that all sectors are accountable for the progress of the strategies rather than only the department of health.

The gravity of suicide is not lost on anyone. It is permanent, irrevocable and devastating. It cuts short a person’s life and leaves their loved ones bereft – and also exacerbates the risk of suicide for their loved ones. A single approach is not enough for suicide prevention; multi-layered and cross-sectoral efforts are needed. Empathy and accountability must be embedded at all levels of care for depression in order to prevent suicide.