Suicide Prevention Month 2021: What Actions Do We Need To Take As A Nation and As Individuals To Prevent Suicide?

Suicide is a global public health issue that claims the lives of nearly 800,000 people each year, with one death occurring every 40 seconds. For every suicide death, there are approximately 20 other attempts. While most suicides (79%) occur in low- and middle-income countries with limited resources for identification and management, suicide cuts across every socio-demographic level and can affect anyone. It remains the second leading cause of death in 15-29-year-olds. Suicide rates differ between regions and countries, as well as between males and females. There are 9.0 suicide deaths per 100,000 population in Southeast Asia; 10.5 deaths per 100,000 population in Europe and 11.4 suicide deaths per 100,000 population in Africa. In Africa, Nigeria has the second-highest suicide rate, trailing South Africa, with over 7000 suicides. Other African countries with high suicide death rates include Ethiopia, Mozambique and Kenya. Suicide rates in males are higher than in females around the world. In Nigeria, males account for 72% of reported suicide deaths, while females account for 27% [1].

Suicide is a sensitive topic, and it is likely under-reported due to various factors such as stigma. People who need help are unable to do so because of the stigma associated with it. A suicide attempt is a crucial risk factor for subsequent suicide. Other risk factors include a history of trauma or abuse, acute emotional distress, lack of social support, major physical or chronic illnesses, alcohol or drug abuse, job or financial losses, or separation from a partner. In many cases, a combination of these factors increases the possibility of suicidal thoughts [2]. Suicide has a significant impact on the survivors left behind, such as spouses, family, friends, and peers. Oftentimes, they are left without assistance.

Before we address what can be done to prevent suicide, let’s take a look at the progress made on suicide prevention so far. In 2013, the WHO Mental Health Action Plan 2013–2020 describes suicide prevention as an important priority for achieving the global goal of lowering the global suicide rate by 10% [3]. Following this plan, the World Health Organization encourages and supports countries in developing multisectoral suicide prevention strategies. These strategies are a combination of population-based actions and an emphasis on equity and interventions aimed at high-risk groups and individuals. An example is the restriction of access to pesticides, a commonly used and high-lethal method of suicide. Pesticide-related deaths account for a significant portion of the global suicide rates [4]. In collaboration with other relevant parties, the World Health Organization identified the need to review and recommend improved pesticide regulatory policies [5], [6]. Another indicator is the improvement in healthcare systems’ capability to respond effectively to individuals in emotional distress or at risk of suicide. And increased efforts to raise public awareness, such as Scotland’s national suicide prevention campaign, Choose Life [7]. While it is safe to say that there have been improvements globally, there is still much work to be done.

Given the gravity of the public health problem of suicidal behaviours, governments need to develop a comprehensive suicide prevention strategy and allocate resources to achieve both immediate and long-term outcomes [8]. Nigeria, like many other African countries, lacks a suicide prevention strategy which is essential for progress. A ban was placed on some pesticides in 2019 due to the high rate of pesticide-related suicide deaths. However, we still need a comprehensive strategy to achieve significant improvement. A national suicide prevention strategy provides leadership and direction on the most effective evidence-based suicide prevention interventions. It identifies key stakeholders and assigns specific responsibilities to them, while also proposing a robust monitoring and evaluation framework.

One of the Sustainable Development Goals (SDGs) established in 2015 is to ensure healthy lives and promote well-being for all ages. The following are some activities and approaches to achieving the goals.

• Improving early identification of suicide risk in healthcare settings [8].
• Supporting the establishment of an integrated data collection system that will allow for identifying at-risk groups, individuals, and situations [8].
• Maintaining a comprehensive training programme for identified gatekeepers e.g. police, educators and mental health professionals [9].
• Increasing access to supportive and rehabilitative services for those at risk for, or affected by, suicidal behaviours, as well as raising public awareness about mental health and suicidal behaviour [10].

Suicide is avoidable and rarely occurs without warning. Even if you are not a health professional, you may be able to recognize when someone requires assistance and assist them in obtaining it. Never ignore warning signs; instead, find an appropriate time and a quiet place to discuss the issue with the person, and let them know you are there to listen. Encourage the individual to seek help from a professional, such as a doctor, mental health professional, or counsellor. If you believe the individual is in immediate danger, do not leave them alone. Seek professional assistance from emergency services or a healthcare provider [11] [12].

Suicide is a persisting tragedy that cannot be ignored. Suicide prevention is important not only for individuals and families but also for society, the healthcare system, and the economy. As a result, we must all work together to put an end to this tragedy.

References

[1.] Suicide worldwide in 2019: global health estimates. World Health Organization, 2021

[2.] https://www.who.int/news-room/fact-sheets/detail/suicide

[3.] Mental health atlas. World Health Organization, 2018

[4.] Safer Access to Pesticides: Community Interventions. World Health Organization, 2006

[5.]. https://www.who.int/news/item/17-12-2020-new-study-highlights-cost-effectiveness-of-bans-on-pesticides-as-a-suicide-prevention-strategy

[6.] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30493-9/fulltext

[7.] National suicide prevention strategies: progress, examples and indicators. World Health Organization, 2018

[8.] Public health action for the prevention of suicide: a framework. World Health Organization, 2012

[9.] Preventing Suicide: a community engagement toolkit. World Health Organization, 2018

[10.] https://www.cdc.gov/suicide/prevention/index.html

[11.] Preventing Suicide: A Technical Package of Policies, Programs, and Practices. Center for Disease Control, 2017

[12.] https://www.who.int/health-topics/suicide/campaign-materials-handouts

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