Governments around the world have been urged to shift suicide prevention efforts from being the responsibility of health portfolios to a whole-of-government approach, according to an important series of papers published this week.
The series, ‘A public health approach to suicide prevention’, published in The Lancet Public Health, argues that the narrative around suicide prevention needs to change so that it is seen as more than a mental health issue, and also involving social factors, such as poverty, debt, addictions, homelessness, abuse, discrimination and social isolation.
Governments should take a Suicide Prevention in All Policies approach, with national suicide prevention strategies signed off by prime ministers or their equivalent or by specially appointed ministers with cross-sectoral responsibility, the series says.
It also calls for action on the commercial determinants of suicide by deterring the use of products or services that heighten suicide risk – such as by limiting the consumption of alcohol or availability of gambling – and restricting access to means used for suicide, such as bans on highly toxic pesticides and restrictions on gun ownership.
Publication of the series is timely, coinciding with World Suicide Prevention Day on 10 September, and in Australia the National Suicide Prevention Office’s release of a consultation draft, ‘Advice on the National Suicide Prevention Strategy’. (Deadline for submissions is 27 October).
While the series is not directly cited in the draft strategy, one of its key authors, Professor Jane Pirkis from the University of Melbourne, has provided input, in her role as Scientific Advisor to the National Suicide Prevention Office.
The draft strategy acknowledges the importance of addressing the social determinants of health, recommends that all government policies be explicitly considered for their potential impact on suicide, and advises that “accountability for suicide prevention should rest with the highest level within a government”.
“Given the federated system of government in Australia, a whole-of-governments approach is needed to establish accountability across portfolios and across all levels of government – the Australian Government, state and territory governments, and local government,” it says.
Embedding suicide prevention considerations into policy development as routine practice across governments may require capability building within government portfolios to ensure policymakers understand the relationship between suicide and their policy areas, it says.
The document also highlights work underway on the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the Gayaa Dhuwi (Proud Spirit) Declaration Implementation Framework and Plan.
A step change
In the article, Preventing suicide: a call to action, Professor Keith Hawton, from the University of Oxford, and Pirkis say the public health approach to suicide prevention outlined by The Lancet series “represents a step change in the way decision makers should think about suicide and its prevention”.
“In the past, the emphasis has been on clinical solutions, delivered by psychiatrists, psychologists, social workers, mental health nurses, and other professionals who make up the mental health workforce,” they write.
“Suicidal thoughts and behaviours have been predominantly regarded as symptoms of mental illnesses that should be treated with pharmacological or psychological therapies.
“We are not denying the importance of these clinical strategies, and absolutely agree that they are crucial for people who present to services in a suicidal crisis. However, we contend that they will inevitably only reach those who are already at the point of crisis.
“A more comprehensive public health approach is required to prevent those who might be at risk of suicide because of their circumstances from reaching this point.”
Population-wide suicide prevention policies discussed in the series include wellbeing budgets, policies that buffer financial hardship, and policies that have an impact on cultural and societal values – for example, by addressing racism.
The series profiles successful interventions, such as conditional cash transfer programs in Brazil and Indonesia that mitigate the effects of poverty for households, and which have been associated with significant reductions in suicide.
It also describes a Scottish suicide prevention strategy, Creating Hope Together, which has an explicit emphasis on addressing the upstream causes of suicide, by targeting poverty, debt, addictions, homelessness, trauma, and social isolation.
The series urges that people with lived experience of suicide are “front and centre” in all policy, practice, and research and evaluations.
• Croakey is keen to hear from readers who have feedback on the draft strategy as well as The Lancet Public Health series. If you are planning to make a submission to the consultation, please let us know.
Declaration by Croakey: Suicide Prevention Australia has contracted Croakey Professional Services to contribute to a report on suicide prevention research.
Services
Lifeline
13 11 14
Lifeline.org.au
Suicide Call Back Service
1300 659 467
Suicidecallbackservice.org.au
Defence Member and Family Helpline
1800 624 608
MensLine Australia
1300 789 978
Mensline.org.au
ReachOut
au.reachout.com
Aboriginal and Torres Strait Islander peoples
13 YARN (13 92 76)
healthinfonet.ecu.edu.au
LGBTIQ+ community
1800 184 527
Qlife.org.au
Kids Helpline
1800 551 800
Kidshelpline.com.au
Head to Health
Headtohealth.gov.au
headspace
1800 650 890
headspace.org.au/
Open Arms
1800 011 046
openarms.gov.au
Culturally and linguistically diverse communities
embracementalhealth.org.au
Beyond Blue
1300 224 636
Beyondblue.org.au
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