Five ways to re­duce sui­cide

The Guardian (Charlottetown) - - OPINION - BY JI­TEN­DER SA­REEN AND CARA KATZ

“We have learned that in­di­vid­u­als dy­ing by ei­ther sui­cide or ac­ci­dent share many risk fac­tors.”

Cana­dian rates of sui­cide and at­tempted sui­cide have re­mained largely un­changed over the last sev­eral decades. But we have seen in­creas­ing rates of sui­cide in the Cana­dian mil­i­tary re­cently, af­ter sta­ble rates for decades.

Over 40,000 Cana­dian sol­diers were de­ployed in Afghanistan, so there has been an un­der­stand­able con­cern about men­tal health prob­lems and sui­cides among mil­i­tary per­son­nel and veter­ans. Both the min­is­ter of De­fence and min­is­ter of Veter­ans Affairs have rightly made sui­cide preven­tion a top pri­or­ity.

The prob­lem of sui­cide is not lim­ited to the mil­i­tary in Canada; in­dige­nous pop­u­la­tions, es­pe­cially in north­ern re­mote com­mu­ni­ties, have high rates of sui­cide.

We need a uni­fied ap­proach across pro­vin­cial and fed­eral sec­tors to re­duce sui­cides in the mil­i­tary, among veter­ans and civil­ians. Here are five promis­ing ev­i­dence-based strate­gies for sui­cide preven­tion.

1. Im­ple­ment a na­tional de­lib­er­ate self-harm registry

The sin­gle most im­por­tant pre­dic­tor of fu­ture sui­cide at­tempts is a his­tory of self-harm. It is im­por­tant to de­velop a con­fi­den­tial na­tional registry of peo­ple with self-harm be­hav­iour, in or­der to record ac­cu­rate data, and tar­get and mea­sure ways to re­duce the risk of fu­ture at­tempts. A sim­i­lar registry ex­ists in Ire­land.

2. In­vest in anti-sui­ci­dal psy­cho­log­i­cal treat­ment

For pa­tients who at­tempt sui­cide, cur­rent prac­tices and pro­grams fo­cus on treat­ing the un­der­ly­ing men­tal health prob­lem and/or ad­dic­tion. Re­cent work chal­lenges this by show­ing that there is also a need for psy­cho­log­i­cal in­ter­ven­tions that di­rectly ad­dress sui­ci­dal be­hav­iour. Two treat­ments ap­pear to re­duce sui­cide at­tempts among peo­ple with a his­tory of self-harm — cog­ni­tive be­hav­iour ther­apy and di­alec­ti­cal be­hav­iour ther­apy.

Both fo­cus on un­der­stand­ing the causes of sui­ci­dal thoughts, im­prov­ing cop­ing skills in man­ag­ing dis­tress­ing emo­tions and de­vel­op­ing care­ful plans to re­duce fu­ture at­tempts. Strong na­tional in­vest­ments are needed to make th­ese ther­a­pies avail­able for peo­ple with a his­tory of self­harm.

3. Re­duc­ing ac­cess to lethal means

This pro­vides the great­est ev­i­dence for sui­cide preven­tion. Sui­cide is of­ten an im­pul­sive act. Ac­cess to firearms is a fac­tor in half of the com­pleted sui­cides in the United States.

In the Swiss mil­i­tary, when ac­cess to guns was re­duced, al­most 80 per cent of peo­ple were de­terred from sui­cide. Al­though firearm-re­lated deaths are less com­mon in Canada, 20 per cent of male sui­cides in Canada are re­lated to firearms.

In the U.K., lim­it­ing pack sizes of Tylenol per bot­tle also re­duced sui­cide. In Canada, pre­scrip­tion med­i­ca­tions, es­pe­cially opi­oids, anti-anx­i­ety and an­tide­pres­sant med­i­ca­tions are com­mon causes of both in­ten­tional and un­in­ten­tional deaths. Lim­it­ing ac­cess to large quan­ti­ties of pre­scrip­tion and over-the­counter med­i­ca­tions for peo­ple with a his­tory of self-harm may re­duce sui­cides and ac­ci­den­tal deaths.

4. Ac­ci­den­tal deaths and un­de­ter­mined deaths need to be tracked with sui­cide deaths

Ac­ci­den­tal or un­de­ter­mined deaths look like sui­cides. We know that sui­cide rates around the world are widely un­der­es­ti­mated, per­haps by 30 per cent or more. It is of­ten dif­fi­cult to de­ter­mine the na­ture of a death, and whether it is defini­tively a sui­cide or an ac­ci­dent. Of­ten, the coro­ner clas­si­fies the death as un­de­ter­mined.

Ev­i­dence in­di­cates that some mech­a­nisms of sui­cide are more likely to lead to the un­de­ter­mined clas­si­fi­ca­tion. In the U.K., in­jury deaths of un­de­ter­mined in­tent are rou­tinely in­cluded in sui­cide sta­tis­tics for this rea­son.

5. Sui­cide preven­tion strat­egy should in­clude in­jury preven­tion

We have learned that in­di­vid­u­als dy­ing by ei­ther sui­cide or ac­ci­dent share many risk fac­tors. They in­clude those who are male, of younger age, un­mar­ried, hav­ing lower education and in­come, be­ing im­pul­sive, or suf­fer­ing men­tal health prob­lems and ad­dic­tions.

Gen­er­ally speak­ing, preven­tion ef­forts for ac­ci­den­tal in­juries and sui­cide are dis­tinct. But given the shared vul­ner­a­bil­ity of th­ese pop­u­la­tions, along with the find­ing that many of the ac­ci­den­tal or un­de­ter­mined deaths may be mis­clas­si­fied sui­cide deaths, a broader ap­proach to sui­cide preven­tion must in­clude in­jury preven­tion.

If we re­ally want to change the rates of sui­cide in Canada, we need to look at ar­eas of medicine that have suc­cess­fully re­duced mor­tal­ity. For ex­am­ple, HIV preven­tion and can­cer preven­tion have cre­ated na­tional reg­istries and in­vested heav­ily in in­no­va­tive preven­tion pro­grams that specif­i­cally tar­get th­ese deadly dis­eases.

We need a con­certed na­tional ef­fort that uses ev­i­dence-based strate­gies to tar­get sui­ci­dal be­hav­iour.

Ji­ten­der Sa­reen is a pro­fes­sor of psy­chi­a­try at the Univer­sity of Man­i­toba; Cara Katz is a ju­nior re­searcher with the Man­i­toba Pop­u­la­tion Men­tal Health

Re­search Group. Troy Me­dia

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