A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Suicide Prevention in an International Context.

Suicide Prevention Across Countries and Continents: Lessons Learned

News, Announcements, and IASP

Background: National suicide prevention strategies support development of suicide prevention activities and their evaluation. Aims: To describe components included in national suicide prevention strategies and analyze the potential contribution of individual components to reduce suicide rates. Method: We conducted a narrative review and statistical analysis of national suicide prevention strategies. The narrative review was based on a framework of 12 components and included 29 countries (14 lower middle-income countries [LMICs] and 15 high-income countries [HICs]) with a national suicide prevention strategy. The statistical analyses covered suicide mortality data for 24 countries with a national strategy (9 LMICs and 15 HICs). Results: The number of components adopted in national strategies ranged from 4 to 11, and training and education were included in 96.5% of strategies. Estimated period effects for total suicide rates in individual countries ranged from a significant decrease in the yearly suicide rate (RR = 0.80; 95% CI 0.69-0.93) to a significant increase (RR = 1.12; 95% CI 1.05-1.19). There were no changes in suicide mortality associated with individual components of national strategies. Limitations: The limitations of existing suicide mortality data apply to our study. Conclusion: Further detailed evaluations will help identify the specific contribution of individual components to the impact national strategies. Until then, countries should be encouraged to implement and evaluate comprehensive national suicide prevention strategies.

News, Announcements, and IASP

BackgroundSuicide prevention policy in Australia is in a period of reform. The National Suicide Prevention Office is leading the development of a new National Suicide Prevention Strategy (Strategy). Stakeholder input is a critical element in the development of the new Strategy. This article describes key informant views about government-led suicide prevention efforts in Australia obtained as part of an environmental scan conducted as one input to inform the Strategy development process.MethodsWe interviewed 24 key informants in November and December 2022. Key informants were purposively recruited to ensure representation from cross-jurisdiction government departments/agencies, peak bodies and leaders in the suicide prevention sector, people with lived experience of suicide, and suicide prevention researchers. We enquired about successes, challenges, and opportunities. NVivo was used to conduct thematic analysis.ResultsKey themes identified as successes in Australia’s suicide prevention efforts included: leadership and funding for programs, services, and research; valuing the collective lived experience voice; moving towards a whole-of-government/system approach; and high community and political suicide (prevention) awareness. Key themes emerging as challenges in the sector were: defining the suicide prevention sector, limitations in the service system, workforce issues, and building the evidence base. Key themes mentioned as opportunities for improving suicide prevention efforts were: leveraging the current unprecedented awareness and desire for collaboration among multiple stakeholder groups; adopting wellness rather than crisis-driven models of care; including lived experience and co-design in all stages and aspects of policy planning, service development, and evaluation; and investing in data, research, and evaluation.ConclusionsKey informants from across the suicide prevention sector in Australia identified a range of issues for consideration in the development of Australia’s new National Suicide Prevention Strategy which are also relevant for suicide prevention policy and program development in other high-income countries. Key issues include the need for concerted efforts to define and build the capacity of the suicide prevention sector, implement and monitor a whole-of-government approach that includes wellness models of care and lived experience, and bolster the evidence base. These efforts require effective leadership and resourcing.

A population-based analysis of suicidality and its correlates: findings from the National Mental Health Survey of India, 2015–16

A National Suicide Prevention Strategy for Canadians--From Research to Policy and Practice.

Suicide is a global phenomenon. It is estimated that 0.5–1.2 million people worldwide die by suicide each year. Taking into account the global epidemiologic data concerning suicide and the economic impact of this phenomenon on diverse societies, this review aims to examine national suicide prevention strategies. Recognition of suicide as an international public health problem, increased reporting by countries on suicide rates to the WHO, and recognition of the costs (associated with suicide) to society have been crucial influences on the establishment of national strategies. Past reviews on national suicide prevention strategies highlight the fact that those countries with established national strategies share a number of themes relating to intervention. These are grounded in international guidance on suicide prevention and accepted epidemiologic and treatment-based research. This paper highlights comparative rates of suicide around the world, explores the economic implications of suicide and the nature of specific established national strategies for prevention. This paper highlights the urgency for the development of national suicide prevention strategies in all countries. Clearly, countries can learn from each other and integrate established, shared themes. It is argued that nations need to move towards nation-specified prevention strategies with effective structures for research, monitoring, and evaluation. This has been seen in countries such as Finland and New Zealand, where strategies have been effective in building inter-agency working and so benefiting different stake-holders.

Back to table of contents Previous article Next article Government NewsFull AccessMore Efforts Needed to Curb Suicide Rate Among TeenagersChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:19 Oct 2001https://doi.org/10.1176/pn.36.20.0002Saddened by the suicides of two teenagers last year in his hometown of East Haddam, Conn., Sen. Christopher Dodd (D) channeled his concern into a fact-gathering mission by holding a hearing on teen suicide in their memory in September.Dodd, who chairs the Senate Subcommittee on Children and Families, said the number of teenagers who commit suicide is staggering. For young people aged 15 to 24, suicide is the third-leading cause of death, following unintentional injury and homicide.“Unbelievably, more than 1.2 million American teenagers attempt to end their lives each year. This is unacceptable,” said Dodd.That teen suicide was the topic of a congressional hearing is also due to the efforts of Surgeon General David Satcher, M.D., to raise the visibility of suicide as a public health problem that disproportionately affects the young and the elderly. Satcher issued a report on suicide, “A Call to Action to Prevent Suicide,” in 1999 (Psychiatric News, September 3, 1999) and the National Strategy for Suicide Prevention earlier this year (Psychiatric News, June 11).Satcher emphasized that 90 percent of all suicides are related to mental health and substance abuse problems. “We know that effective treatments exist for these disorders and conditions, but the stigma surrounding these disorders prevents many persons, including teens, from seeking assistance.”In addition, the stigma surrounding suicide makes it harder for teenagers to talk about their problems especially with adults, who might help them obtain treatment, said Satcher.He noted that 1 in 10 children and adolescents has a mental health problem, but only 1 in 20 receives help.Having access to mental health treatment is critical for teenagers contemplating suicide, but the lack of parity in health insurance often creates barriers to access, which is tragic, said Sen. Paul Wellstone (D-Minn) at the hearing. He is the coauthor of S 543, the Mental Health Equitable Treatment Act, which was passed by the Senate Health, Education, Pensions, and Labor Committee in September, but at press time its companion measure in the House still languished in committee. The delay reduces the likelihood that Congress will pass parity legislation this year.Wellstone helped ensure the inclusion of suicide prevention programs in the Children’s Health Act of 2000 by appropriating $75 million for them and continues to advocate for appropriation of these funds this year, according to a press release.Satcher testified that progress is being made to educate the public about suicide and mental illness. He mentioned several prevention efforts by federal, state, and private organizations:• About 28 states have implemented some form of suicide prevention strategies in the last five years.• The Centers for Disease Control and Prevention (CDC) has developed a Web site on the National Strategy for Suicide Prevention, which provides information on federal, state, and local efforts; funding resources; and youth suicide.• The CDC is evaluating the effectiveness of suicide prevention hot lines.• The National Mental Health Awareness Campaign launched its Signs for Life Teen Suicide Prevention Program in September to help teenagers, parents, and teachers identify the warning signs of depression and reduce the chances of its leading to suicide.Satcher also made several recommendations to the subcommittee on how to strengthen efforts to prevent suicide among teenagers. States need federal technical assistance and funding to develop suicide-prevention programs that are coordinated with multiple agencies including education, mental health and public health, and justice.“We also need to provide support to communities so they can identify and implement programs that are proven to work,” said Satcher. “Schools have designed programs that are not evidence based or have implemented proven programs in ways that they were not designed.”John Mann, M.D., a professor of psychiatry at Columbia University College of Physicians and Surgeons and an expert on teen suicide, told Psychiatric News that the United States is lagging behind countries like Australia and New Zealand that have implemented national suicide education and prevention campaigns.“We have not made a serious investment in suicide research and prevention. We need a network of treatment research centers to evaluate which treatments are effective,” said Mann.The CDC National Strategy for Suicide Prevention Web site can be accessed at www.mentalhealth.org/suicideprevention. ▪ ISSUES NewArchived

BackgroundGatekeeper training programs are essential public health strategies for suicide prevention. With the rapid digitization of health education, evaluating the effectiveness of online gatekeeper training relative to traditional face-to-face training has become increasingly important.ObjectivesThis study compared the effectiveness of online and face-to-face formats of the standardized Suicide CARE 2.0 gatekeeper training in enhancing suicide prevention knowledge, attitudes, behaviors, and preparedness among community mental health workers in South Korea. We tested the non-inferiority of the online format in improving key outcomes.MethodsA quasi-experimental, two-group pre–post design was employed with 99 participants (51 face-to-face, 48 online) recruited from community mental health centers. Participants were randomly assigned to either the online or face-to-face gatekeeper training group using a computerized randomization tool (www.randomizer.org). Both groups received identical content delivered by the same instructor. Outcomes assessed included self-perceived knowledge, factual knowledge, preparedness to help, attitudes toward suicide, and suicide prevention behaviors. Analyses included paired t-tests and ANCOVA, with effect sizes (Cohen’s d, partial η²) and 95% confidence intervals reported.ResultsBoth groups significantly improved all five domains. The online group showed greater improvements in self-perceived knowledge, preparedness, and behaviors (p < 0.001), while the face-to-face group demonstrated larger gains in factual knowledge (p = 0.017). Effect sizes supported the practical relevance of these findings. Both groups exhibited positive shifts in attitudes, with the online group showing more pronounced changes in avoidant attitudes and readiness to intervene. However, changes in deeply entrenched beliefs, such as the normalization of suicide, were limited.ConclusionOnline gatekeeper training is a feasible and effective alternative to face-to-face instruction, particularly in settings with limited resources or during emergencies. While each format offers distinct advantages, hybrid models may yield the most comprehensive benefits. These findings support the inclusion of scalable online training in national suicide prevention strategies. Suicide prevention, gatekeeper training, Suicide CARE, online education, face-to-face education, and community mental health.

The national suicide prevention strategy in India: context and considerations for urgent action

Suicide is recognized as a global phenomenon and many countries now have national suicide prevention strategies. International guidance on suicide prevention and accepted epidemiological and treatment-based research underpins healthcare policy relating to suicide reduction. There has been an established comprehensive strategy in England since 2002. However, the rate of suicide continues to be a concern and nurses hold a key role in the implementation of national, regional and local policy into practice. The aim of this paper is to consider the current implications of the national suicide prevention strategy in England for nursing. This discussion paper draws upon both empirical evidence-based literature, governmental guidance and policy-related documentation. The national suicide prevention strategy for England currently continues to have a multifaceted impact on the nursing profession. This ranges from clinical practice issues such as risk assessment through to broader public health responsibilities. If nurses and allied health professionals are to be effective in their role within suicide prevention, they will need to be supported in building awareness of the wider context of the national policy. In particular, this will mean working effectively and collaboratively with the voluntary sector, service users and other non-medical agencies.

Suicide continues to be a major problem worldwide. Persons with a lived experience are being actively involved in suicide research and reports suggest that co-production of suicide research with persons with a lived experience significantly improves its quality and appropriateness. The aims of this paper are (i) To identify challenges to Australian suicide prevention strategies and interventions and (ii) To offer recommendations to address these challenges. This perspective article is a co-production between an experienced mental health researcher and a person with a lived experience of suicidality, who has worked as a suicide prevention worker and has held leadership positions in government and non-government suicide prevention programs. Challenges to Australian suicide prevention strategies and interventions include: the careless reporting of suicide in the media, the continuing stigma in seeking help, stigma as a barrier to gatekeeper training, the entry point of suicide prevention services and care of those with suicidal ideation/attempt. Recommendations include: that media must consider the responsible reporting of suicide as a duty of care; that the community response to help-seeking for suicide needs to be one of compassion; that gatekeeper training should be expanded to be universally accessible and messaging in suicide prevention training programs must pay attention to its rationale; that services for those with suicide ideation and attempt must commence with providing a safe space and empathetic support by peer workers and that continuing care after suicidal attempt must be informed by the individual's needs and include informal and family carers, as well as other community agencies. Stigma related to suicide continues to be a major barrier to help seeking and suicide prevention training. The approach to suicide prevention and intervention services needs to focus on stigma reduction, responsible reporting by media and a person-centred approach to care. The perspectives identified here are by no means comprehensive but are merely our observations that we believe, need attention. These perspectives have implications for the early identification and assistance of those at risk of suicide in the community as well as for suicide intervention services. These perspectives have implications for policies related to public health education including the expansion of gatekeeper training, journalism and media, as well as national and state suicide prevention strategies. Further research might focus on suicide related stigma reduction measures within communities, improved suicide intervention services, and continuation of care following suicide attempts.

Finland is a country of only a little over 5 million people, the same number as some of the larger cities in the world. However, its contribution to suicide prevention has been, and continues to be, out of proportion to its population. This brief review, written from the perspective of the other side of the world in Australia, and with the assistance of some knowledge of the history of the International Association for Suicide Prevention (IASP), as well as data retrieved from the PubMed data base of the National Library of Medicine, aims to give credit to Finland’s remarkable achievement. During the nineteenth century Finland was thought to have a relatively low suicide rate compared to other European Countries (Goldney & Schioldann, 2002). However, by the mid twentieth century this rate had risen to be one of the highest, and this led to clinical academics such as Professor Kalle Achte focusing on the reasons for the rise. He was an early contributor to suicide research, publishing no fewer than eight articles during the 1960s, and his early involvement with IASP led to the 9th IASP Congress being held in Helsinki in 1977. Professor Achte was to become President of IASP between 1985 and 1989. Others had also been involved. In 1967 the Finnish Association for Mental Health established a committee to examine suicide prevention possibilities, and the Helsinki Suicide Prevention Center was opened in 1970. Then, in 1974 and 1975, the Finnish Yrjo Jahnson Foundation sponsored seminars on suicide research and prevention, which led to significant research activities that were subsequently presented at the 1977 Helsinki IASP meeting. The proceedings of the seminars were reported by Achte and Lonnqvist (1976), and represent an excellent overview of the state of suicide prevention at that time. In 1985 Finland was the first country to establish a research-based comprehensive national program for suicide prevention (Kerkhof, 1999). The suicide rate continued to increase until 1990, but fell 20% between 1991 and 1996, and then dropped to about 9% below the initial rate. Finland promoted broad involvement and integration of public health and social services in the community, and was arguably the first country in which information guide books about suicide prevention were distributed to different groups, such as teachers and the clergy. Finland’s model has become a blueprint for many other countries. The research phase was integral to the overall planning, part of which involved a detailed psychological autopsy study of 1397 people who died by suicide, from which many publications have emerged. The breadth of the research can be gauged by the project plan outlined by Lonnqvist et al. (1995), which had three distinct areas of focus. The first was a series of studies on suicide per se, including suicide in adolescents and younger adults, in persons with schizophrenia or alcoholism, with physical illness, and in both psychiatric and in general hospitals, as well as an examination of different methods of suicide. The second area was a series of studies on attempted suicide, examining the role of mental disorders and issues such as gender differences and unemployment. The third area was the establishment of a prospective study of suicidal behavior in adolescents with mental disorders. The results of this research-based national program are well demonstrated by examining the number of publications on suicide from Finland using the PubMed data base. There was only one publication in the 1950s, then 15 in the 1960s, 26 in the 1970s, and 34 in the 1980s, before an enormous increase with 160 in the 1990s, and a further 58 in the next 4 years to the end of 2003. In considering the individual contributors to this research, at least eight authors have published more than 10 papers, with three, Drs Henriksson, Isometsa, and Lonnqvist each publishing over 50, and with Dr. Lonnqvist contributing 108. Indeed, it could be argued that Dr. Lonnqvist has been the most influential suicide researcher, both in terms of his own publications and in his sponsorship and