National Strategies for the Reduction and Prevention of Suicide

Abstract

An increasing number of countries are developing national strategies to reduce and prevent suicide. However, while the large volume of information from psychiatric, epidemiological, genetic, and biological research now gives a generally coherent and consistent picture about the risk factors and causal pathways for suicidal behavior, there is relatively little evidence-based information - at either a program level, or at the level of a national strategy - about the types of interventions that successfully reduce or prevent suicidal behavior. Against this background, it is timely to outline, albeit briefly, the small body of evidence about programs and strategies that show effectiveness, or promise of effectiveness, in reducing or preventing suicide. It is useful to review these programs using the Institute of Medicine's model of universal, selective, and indicated (USI) interventions (Mrazek & Haggerty, 1994). Within this framework, universal programs target the general population, selective programs address high-risk subgroups within the total population, and indicated programs address high-risk individuals. Research evidence supports a range of programs targeted at the general population. These include those which focus upon restricting access to means of suicide. Reducing access to particular means of suicide has been shown to reduce suicides by that specific method, and sometimes, to reduce total suicide rates. These findings span a range of means including: detoxification of domestic gas; various levels of restriction of access to guns; reduction in the pack size of analgesics, and installing barriers at jumping sites. Programs which attempt to improve mental health literacy may contribute to suicide prevention by changing public recognition and attitudes toward mental illnesses. This approach is exemplified by a program in Germany which focuses on increasing awareness about depression (Althaus, Schmidtke et al., 2003). To date, evaluation suggests improvements in public attitudes and knowledge about depression.