(This is the second post in this series; my first post discusses the most popular current theory of suicide as well as some statistics on it, and my third post discusses some assumptions made by suicide prevention initiatives)
In the lead-up to WSPD 2019, I’ve seen many videos aimed at individuals who currently feel suicidal, encouraging them not to act on that feeling. But that can’t be the full story for such a large goal as preventing suicide. So, my question for today is; what does “suicide prevention” actually mean? What areas does it cover, and how does it work?
According to Wikipedia, suicide prevention is “the collective efforts of citizen organisations, health professionals and related professionals to reduce the incidence of suicide”. This is centred on direct intervention, and accompanied by four supporting parts: treating depression, improving people’s coping strategies, reducing risk factors for suicide, and giving people hope.
Direct intervention covers multiple ideas, so let’s break it down further. The first part of intervention is direct conversations about suicide and suicidal feelings. This can mean conversations in person or over the phone, and conversations which happen with medical professionals or support lines.
The second part is screening tests which aim to assess people’s current level of suicidal feelings or their risk of suicide. These are mostly carried out in general doctor’s appointments, to identify people who wouldn’t naturally mention their feelings to their doctor.
The third part is means reduction – environmental changes which reduce people’s access to lethal environments and means. One example of means reduction is adding fences to high bridges to prevent them from being climbed. Another is adding interventions to known suicide spots, such as placing signs which encourage people to contact support lines and to not act on their feelings.
The final part is social reduction, which can quickly be described as “everything else possible”. Social reduction includes community programs; education about suicide and risk factors; training for health services staff; resilience programs for at-risk people; in-school wellness programs; reducing the maximum purchasable amounts of over-the-counter medications; reducing substance abuse and domestic violence; and influencing how the news reports on suicide.
The supporting ideas focus more on helping individuals who are either currently suicidal or at high risk of feeling suicidal in future. The first idea, treating depression, is able to rely on evidence about what kinds of therapy and medication may be effective for people. However, coping strategies and personal risk factors are often part of receiving psychotherapy, and there is comparatively less research on whether therapy can reduce suicide rates specifically.
Current research suggests that DBT (Dialectical Behaviour Therapy), a form of therapy usually given to people with Borderline Personality Disorder, may be effective for reducing suicidal feelings in people without the condition as well. A tailored version of Cognitive Behavioural Theory specifically for suicidal adolescents has also shown some positive results. More generally, the results of a long-term Danish study suggest that talk therapy of any kind may slightly reduce the chances of people self-harming or attempting suicide. Medication is currently less favoured in terms of reducing suicidal feelings or actions. The only medication which currently appears promising is Lithium, which is already known to reduce the suicide risk for people with bipolar disorder closer to that of the general population.
Combining direct intervention and the other aspects of suicide prevention creates a sprawling collection of ideas and strategies which seems to cover almost every part of life and society, such as medicine, public health, the law, and education. (With one notable exception- employment is never mentioned in the description.)
Because suicide prevention covers so many areas, it can be difficult to work out which initiatives will be most useful in any one environment. Also, accurately researching suicide risk factors or suicide prevention initiatives is complex. As such a small percentage of the general population completes suicide, most studies cannot recruit enough participants to reliably find meaningful changes in suicide rates.
In the next post in this series I’ll be looking at what assumptions this approach to suicide prevention makes about suicide and its risk factors, and what evidence supports those assumptions.