Suicide Prevention

Death by suicide is now, in many coutries, a leading cause of death for working age adults. This is partly because of improvements in road safety and treatments for other illness - especially infections and cancers in younger people. However, it still carries a sense of stigma and uncertainty that make it somehow different to other ways of dying.

And it causes great anxiety...

The prevention of suicide is something that carries great emotion - with some saying that 100% are preventable - despite the fact that over half of people who die this way have no recent mental health contacts. We can also tend to micro-manage the more obviously risky cases, enacting an obsession with risk assessment and simplistic measures to seal over risk.

But perhaps we need to think more broadly...

New Zealand, where I live, has just published a draft suicide preventon strategy [temporary link]. Some have criticised it with being too broad, but actually I think they have it right. Prevention needs to start at the level of the population and not the individual. You don't reduce lung cancer by shouting 'stop smoking' at the person on chemotherapy who has smoked for 60 years. What are the things we can do as a society to reduce suicide overall?

The stragegy contains the grahics below which emphasise both the multiple ways we can intervene, and the cumulative effect this has. We need to act at a number of levels to affect different numbers of people:

reduction matrix

And we need to continue to focus outwards on mental HEALTH [the broad horizon, in Maori cultual terms] in order to impact the darker core. If we can all improve our mental health by 5%, suicide will reduce by much more becuase the whole pyramid has shifted down.
core

Some things that this might look like [from the strategy] are:

  • education
  • family and whanau support
  • health and social services
  • housing
  • income support
  • promoting [cultural] development
  • mental health and wellbeing
  • public health
  • workplace health and safety
  • disability issues
  • promoting youth development
  • employment and skills development
  • alcohol and other drug use
  • crime and reoffending
  • family and sexual violence
  • stigma and discrimination
  • child abuse and neglect

If we can get these right, suicide will reduce!

But what about those who seem risky?

It is easy to focus on this way with your eyes focussed on the horizon, looking at the whole population rather than the person. However it is people who we keen on coming across. When we meet someone who says they are thinking of suicide, it is hard to stand back and work on these percentage population gains.

There are two ways to respond to this. The first is that, from a church or community perspective, we should always err on the side of caution and get people to seek help. This may look like supporting them to attend their GP, or it may [in the most extreme cases] look like calling and ambulance or event the police.

However, when you get to meet these 'experts', it can seem odd when they take the second sort of approach - which seems on the face of it to be flaunting the risk. They may not admit the person to hospital, they may seem to take things less seriously that you are. They seem to asking people to take risks and not to reduce them.

To understand this, we have to think about how people develop - for example, when teaching a kid to ride a bike you have to remove the stablisers at some stage. If we see suicide as a response to trauma [which it often is], and so a result of arrested and interuped psychological development; then the way to reduce suicidal behaviour in the long term is to encourage people to develop psychologicaly, to grow coping skills and resiliance. And you can't do this by always reducing the risk, always taking on all the responsibility.

If you really want to understand more of the theory behind this approach, then this is a good article to read [not free]. However, for most of us it is enough to know that mental health services have reasons for doing what they do, and we may need to meet them halfway.

Suicide is a terrible thing, but the answers are not always what we might think - instead we need to focus on things that improve mental health overall, and work with the experts when the rubber hits the road.
 

Rob Waller, 13/05/2017
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