SYMBIOSIS COLLEGE OF NURSING

MENtaL hEaLth NURSING

PROJECT ON
SUICIDE

\ SUBMITTED TO, SUBMITTED BY

DR. SHEELA UPENDRA MS. KAJAL MORE
DEPUTY DIRECTOR SECOND YEAR M.SC NURSING
AND PROFESSOR SCON, PUNE
SCON, PUNE

SUBMIttED ON: 27/05/2024

 SELECTION OF TOPIC:

Selecting a suicide-related topic for a project in mental health nursing provides an opportunity
to explore a specific aspect of suicide prevention, assessment, intervention, or support within
the context of nursing practice. Here are a few potential topics to consider:

1. The Role of Mental Health Nurses in Suicide Prevention: This topic could focus on the
specific responsibilities and interventions that mental health nurses undertake to prevent
suicide, including risk assessment, crisis intervention, safety planning, and follow-up care.

2. Effectiveness of Suicide Prevention Programs in Mental Health Settings: Investigate the

effectiveness of various suicide prevention programs implemented within mental health
settings, such as psychoeducation groups, crisis hotlines, peer support programs, or post-
discharge follow-up interventions.

3. Cultural Considerations in Suicide Risk Assessment and Intervention: Explore how

cultural factors influence the expression of suicidal behaviour, help-seeking behaviours, and
responses to suicide prevention efforts, and discuss strategies for providing culturally
competent care to diverse populations.

4. Suicide Risk Assessment Tools and Protocols for Mental Health Nurses: Examine different
suicide risk assessment tools and protocols used by mental health nurses, evaluate their validity
and reliability, and discuss best practices for conducting comprehensive suicide risk
assessments in clinical practice.

5. Family and Peer Support in Suicide Prevention: Investigate the role of family members,
peers, and other support networks in suicide prevention, including their potential impact on risk
and protective factors, and explore ways in which mental health nurses can engage and involve
these support systems in the care of individuals at risk of suicide.

6. Ethical and Legal Considerations in Suicide Prevention: Discuss ethical dilemmas and legal
considerations that mental health nurses may encounter when working with individuals at risk
of suicide, such as confidentiality issues, involuntary hospitalization, and duty to warn
obligations.
7. Postvention Strategies for Mental Health Nurses: Explore postvention strategies aimed at
supporting individuals, families, and communities in the aftermath of a suicide attempt or
death, and discuss the role of mental health nurses in providing immediate and long-term
support to those affected by suicide loss.

8. Innovative Approaches to Suicide Prevention in Mental Health Nursing: Investigate

innovative approaches and technologies used by mental health nurses to enhance suicide
prevention efforts, such as mobile health applications, telepsychiatry, or social media outreach
initiatives.

Selecting a topic that aligns with your interests, expertise, and the needs of your target audience
can enhance the relevance and impact of your project in mental health nursing. Additionally,
consider consulting with faculty members, mentors, or peers for guidance and support
throughout the project development process.
 OBJECTIVES:

• Introduce the topic

• Define the terms of suicide.
• Enlist the epidemiology of suicide and suicide attempts
• Explain the methods of suicide
• Explain the intervention of suicide.
• Describe the risk factors of suicide.
• Describe the policy achievements.
• Enlist the components of suicide prevention.
• Explain the activities of responding countries without a national.
• Enumerate the strategy of suicide prevention.
 INTRODUCTION

❖ Each suicide is a personal tragedy that prematurely takes the life of an individual and
has a continuing ripple effect, dramatically affecting the lives of families, friends and communities.
Every year, more than 800 000 people die by suicide – one person every 40 seconds. It is a
public health issue that affects communities, provinces and entire countries.

❖ In May 2013, the Sixty-sixth World Health Assembly formally adopted the first-ever
Mental Health Action Plan of the World Health Organization (WHO). The action plan calls on all
WHO Member States to demonstrate their increased commitment to mental health by achieving
specific targets. Suicide prevention is an integral component of the Mental Health Action Plan,
with the goal of reducing the rate of suicide in countries by 10% by 2020.

❖ Stigma, particularly surrounding mental disorders and suicide, means

many people are prevented from seeking help. Raising community awareness and breaking down
taboos are important for countries making efforts to preventsuicide. We have solutions to a lot of
these issues, and there is a strong enough knowledge base to enable us to act.
 TERMS

• Suicide:

suicide is the act of deliberately killing oneself.

▪ Suicide Attempt:

suicide attempt is used to mean any non-fatal suicidal behaviour and refers to intentional self-
inflicted poisoning, injury or self-harm which may or may not have a fatal intent or outcome.

▪ Suicidal behaviour:

It refers to a range of behaviours that include thinking about suicide (or ideation), planning for
suicide, attempting suicide and suicide itself. The inclusion of ideation in suicidal behaviour is
a complex issue about which there is meaningful ongoing academic dialogue. The decision to
include ideation in suicidal behaviour was made for the purpose of simplicity since the
diversity of research sources included in this report are not consistent in their positions on
ideation.

GLOBAL EPIDEMIOLOGY OF SUICIDE AND SUICIDE ATTEMPTS

▪ The prevalence, characteristics and methods of suicidal behaviour vary widely between
different communities, in different demographic groups and over time. Consequently, up-to-
date surveillance of suicides and suicide attempts is an essential component of national and
local suicide prevention efforts. Suicide is stigmatized (or illegal) in many countries. As a
result, obtaining high-quality actionable data about suicidal behaviour is
difficult, particularly in countries that do not have good vital registration systems (that register
suicide deaths) or good data-collection systems on
the provision of hospital services (that register medically treated suicideattempts). Developing
and implementing appropriate suicide prevention programmes for a community or
country requires both an understanding of the limitations of the available data and a
commitment to improving data quality to more accurately reflect the effectiveness of
specific interventions.
 SUICIDE RATES BY AGE
With regard to age, suicide rates are lowest in persons under 15 years of age and highest in those
aged 70 years or older for both men and women in almost all regions of the world, although the
age-by-sex patterns in suicide rates between the ages of 15 and 70 years vary by region. In some
regions suicide rates increase steadily with age while in others there is a peak in suicide rates in
young adults that subsides in middle age. In some regions the age pattern in males and females is
similar while in other regions it is quite different. The major differences between high-income
countries and LMICs are that young adults and elderly women in LMICs have much higher
suicide rates than their counterparts in high-income countries, while middle-aged men in high-
income countries have much higher suicide rates than middle-aged men in LMICs. As is true of
the overall suicide rates, the variability in suicide rates by age in different countries is even greater
than the variability by region.

METHODS OF SUICIDE
Unfortunately, national-level data on the methods used in suicide are quite limited. The ICD-10
includes X-codes that record the external causes of death, including the method of suicide, but
many countries do not collect this information. Between 2005 and 2011 only 76 of the 194 WHO
member states reported data on methods of suicide in the WHO mortality database. These
countries account for about 28% of all global suicides, so the methods used in 72% of global
suicides are unclear. As expected, the coverage is much better for high-income countries than for
laics. In high-income countries, hanging accounts for 50% of the suicides, and firearms are the
second most common method, accounting for 18% of suicides. The relatively high proportion of
suicides by firearms in high-income countries is primarily driven by high-income countries in the
Americas where firearms account for 46% of all suicides; in other high-income countries firearms
account for only 4.5% of all suicides.
 HEALTH SYSTEM AND SOCIETAL RISK FACTORS
Taboo, stigma, shame and guilt obscure suicidal behaviour. By proactively addressing these, supportive
health systems and societies can help prevent suicide. Some of the key risk factors related to the areas of
health systems and society are presented below.
Barriers to accessing health care Suicide risk increases significantly with comorbidity, so timely and
effective access to health care is essential to reducing the risk of suicide. However, health systems in many
countries are complex or limited in resources; navigating these systems is a challenge for people with low
health literacy in general and low mental health literacy in particular. Stigma associated with seeking help
for suicide attempts and mental disorders further compounds the difficulty, leading to inappropriate access
to care and to higher suicide risk.
INTERVENTIONS
❖ Evidence-based interventions for suicide prevention are organized in atheoretical framework that
distinguishes between universal, selective and indicated interventions (29, 30). Figure 7 links these
interventions to corresponding risk factors. These linkages are not finite, and in reality, should be
context-driven. The interventions are of three kinds:

❖ Universal prevention strategies (Universal) are designed to reach an

entire population in an effort to maximize health and minimize suicide risk byremoving barriers to
care and increasing access to help,
strengthening protective processes such as social support and altering the physicalenvironment.

❖ Selective prevention strategies (Selective) target vulnerable groups within population based on
characteristics such as age, sex, occupational status or family history. While individuals may not
currently express suicidal behaviours, they may be at an elevated level of biological,
psychological or socioeconomic risk.

Indicated prevention strategies

(Indicated) target specific vulnerable individuals within the population − e.g. those displaying early
signs of suicide potential or who have made a suicide attempt.
Given the multiple factors involved and the many pathways that lead to suicidal behaviour, suicide
prevention efforts require a broad multisectoral approach that addresses the various population and
risk groups and contexts throughout the life course.
Access to means
: Access to the means of suicide is a major risk factor for suicide. Direct access or proximity
to means (including pesticides, firearms, heights, railway tracks, poisons, medications, sources of
carbon monoxide such as car exhausts or charcoal, and other hypoxic and poisonous gases)
increases the risk of suicide. The availability of and preference for specific means of suicide also
depend on geographical and cultural contexts.
Inappropriate media reporting and social media use:
Inappropriate media reporting practices can sensationalize and glamourize suicide and increase the
risk of “copycat” suicides (imitation of suicides) among vulnerable people. Media practices are
inappropriate when they gratuitously cover celebrity suicides, report unusual methods of suicide or
suicide clusters, show pictures or information about the method used, or normalize suicide as an
acceptable response to crisis or adversity.
Exposure to models of suicide has been shown to increase the risk of suicidal behaviour in
vulnerable individuals. There are increasing concerns about the supplementary role that the Internet
and social media are playing in suicide communications. The Internet is now a leading source of
information about suicide and contains readily accessible sites that can be inappropriate in their
portrayal of suicide. Internet sites and social media have been implicated in both inciting and
facilitating suicidal behaviour. Private individuals can also readily broadcast uncensored suicidal
acts and information which can be easily accessed through both media.
Stigma associated with help-seeking behaviour:
Stigma against seeking help for suicidal behaviours, problems of mental health or substance abuse,
or other emotional stressors continues to exist in many societies and can bea substantial barrier to
people receiving help that they need. Stigma can also discourage the friends and families of
vulnerable people from providing them with the support they might need or even from
acknowledging their situation. Stigma plays a key role in the resistance to change and
implementation of suicide prevention responses.

RELEVANT INTERVENTIONS FOR HEALTH SYSTEM AND SOCIETAL RISK

FACTORS
❖ Mental health policies in 2013, WHO launched the comprehensive mental health Action
Plan 2013− 2020

❖ The plan encourages countries to work towards their own mental health policies with a
focus on four key objectives:
 1. Strengthen effective leadership and governance for mental health.
2.Provide comprehensive, integrated and responsive mental health and social care services in
community-based settings.
3. Implement strategies for promotion and prevention in mental health.
4. Strengthen informationsystems, evidence and research for mental health.
The suicide rate is an indicator and its decrease is a target in the action plan.

COMMUNITY AND RELATIONSHIP RISK FACTORS

Disaster, war and conflict:
Experiences of natural disaster, war and civil conflict can increase the risk of suicide because of
the destructive impacts they have on social well-being, health, housing, employment and
financial security. Paradoxically, suicide rates may decline during and immediately after a disaster or
conflict, but this varies between different groups
of people. The immediate decline may be due to the emergent needs forintensified social
cohesion. Overall, there seems to be no clear direction in suicide mortality following natural
disasters as different studies show different patterns.
Stresses of acculturation and dislocation:
Suicide is prevalent among indigenous peoples: native American Indians in the USA, First
Nations animist in Canada, Australian aboriginals, and aboriginal Maori in New Zealand all
have rates of suicide that are much higher than those of the rest of the population. This is
especially true for young people, and young males in particular, who constitute some of the
most vulnerable groups in the world. Suicidal behaviour is also increased among native and
Aboriginal communities undergoing transition. Among indigenous groups, territorial, political
and economic autonomy are often infringed and native culture and language negated. These
circumstances can generate feelings of depression, isolation and discrimination, accompanied
by resentment and mistrust of state-affiliated social and health-care services, especially if these
services are not delivered in culturally appropriate ways.
Discrimination:
• Discrimination against subgroups within the population may be ongoing, endemic
and systemic. This can lead to the continued experience of stressful life events such as
loss of freedom, rejection, stigmatization and violence that may evoke suicidal
behaviour.
• Some examples of linkages between discrimination and suicide include:
 • People who are imprisoned or detained.

• People who identify themselves as lesbian, gay, bisexual, transgender and intersex

• People
who areaffected by bullying, cyberbullying and peer victimization • Refugees,
asylum-seekers and migrants.
Trauma or abuse:

Trauma or abuse increases emotional stresses and may trigger depression and suicidal behaviours
in people who are already vulnerable. Psychosocial stressors associated with suicide can arise from
different types of traumas (including torture, particularly in asylum-seekers and refugees),
disciplinary or legal crises, financial problems, academic or work-related problems, and bullying.
In addition, young people who have experienced childhood and family adversity (physical violence,
sexual or emotional abuse, neglect, maltreatment, family violence, parental separation or divorce,
institutional or welfare care) have a much higher risk of suicide than others. The effects of adverse
childhood factors tend to be interrelated and correlated, and act cumulatively to increase risks of
mental disorder and suicide.
Sense of isolation and lack of social support:
Isolation occurs when a person feels disconnected from his or her closest social circle: partners,
family members, peers, friends and significant others. Isolation is often coupled with depression
and feelings of loneliness and despair. A sense of isolation can often occur when a person has a
negative life event or other psychological stress and fails to share this with someone close.
Compounded with other factors, this can lead to an increase in risk for suicidal behaviour –
particularly for older persons living alone since social isolation and loneliness are important
contributing factors for suicide.

Suicidal behaviour often occurs as a response to personal psychological stress

in a social context where sources of support are lacking and may reflect wider absence of well-
being and cohesion. Social cohesion is the fabric
that binds people at multiple levels in a society – individuals, families, schools, neighbourhoods,
local communities, cultural groups and society as a whole. People who share close, personal and
enduring relationships and values typically have a sense of purpose, security and connectedness.
Relationship conflict, discord or loss:
Relationship conflict (e.g. Separation), discord (e.g. child custody disputes) or loss (e.g. death of
a partner) can cause grief and situational psychological stress, and are allassociated with
increased risk of suicide. Unhealthy relationships can
also be a risk factor. Violence, including sexual violence, against women is acommon occurrence
and is often committed by an intimate partner.
Intimate partner violence is associated with an increase in suicide attempts andsuicide risk.
Globally 35% of women have experienced physical and/or sexual violence by an intimate partner
or sexual violence by a non-partner.
RELEVANT INTERVENTIONS FOR COMMUNITY ANDRELATIONSHIP RISK
FACTORS
• Interventions for vulnerable groups:
A number of vulnerable groups have been identified as having a higher risk of suicide. While
rigorous evaluation is lacking, some examples of targeted interventions are included below.
• Persons who have experienced abuse, trauma, conflict or disaster:
On the basis of evidence from studies that have investigated these relationships, interventions
should be targeted at groups that are most vulnerable following conflict or a severe natural
disaster. Policy-makers should encourage preservation of existing social ties in affected
communities.
• Refugees and migrants:
Risk factors vary between groups, so it may be more effective to develop interventions tailored
to specific cultural groups rather than treating all immigrants as if they are the same.
• Indigenous peoples:
A review of intervention strategies in Australia, Canada, New Zealand and the USA found that
community prevention initiatives, gatekeeper training (see next page) and culturally tailored
educational interventions were effective in reducing feelings of hopelessness and suicidal
vulnerability. Most effective were interventions with high levels of local control and
involvement of the indigenous community to ensure that the interventions were culturally
relevant.
➢ Prisoners:
A review of risk factors among prisoners in Australia, Europe, New Zealand and the USA showed
that prevention interventions should aim to improve mental health, decrease alcohol and substance
abuse, and avoid placing vulnerable individuals in isolated accommodation. All individuals should
also be screened for current or past suicidal behaviours.
 ➢ Lesbian, gay, bisexual, transgender and intersex (LGBTI) persons
: Efforts to reduce the suicide risk among LGBTI persons should focus on addressing risk factors
such as mental disorders, substance abuse, stigma, prejudice, and individual
and institutional discrimination.

➢ Postvention support for those bereaved or affected by suicide:

Intervention efforts for individuals bereaved or affected by suicide are implemented in order to
support the grieving process and reduce the possibility of imitative.
suicidal behaviour. These interventions may comprise school-based, family-focused orcommunity-
based postventions. Outreach to family and friends after a suicide hassled to an increase in the use of
support groups and bereavement support groups, reducing immediate emotional distress such as
depression, anxiety and despair.

Gatekeeper training:
❖ Individuals at risk of suicide rarely seek help. Nevertheless, they may exhibit risk factors
and behaviours that identify them as vulnerable. A “gatekeeper” is anyone who is in a
position to identify whether someone may be contemplating suicide. Key potential
gatekeepers include
❖ Primary, mental and emergency health providers;
❖ • Teachers and other school staff;
❖ •Community leaders;
❖ • Police officers, firefighters and other first responders;
❖ Military officers;
❖ • Social welfare workers;
❖ • Spiritual and religious leaders or traditionalhealers;
❖ • Human resource staff and managers.

Crisis helplines:
▪ Crisis helplines are public call centres which people can turn to when othersocial support
or professional care is unavailable or not preferred. Helplines can be in placefor the wider
population or may target certain vulnerable groups. The latter can beadvantageous if peer
support is likely to be helpful.
▪ Helplines in the USA have been shown to be effective in engaging seriously suicidal
individuals and in reducing suicide risk among callers during the call session and
subsequent weeks. A study of telephone and chat helpline services in Belgium suggests
that these strategies might also be cost-effective for suicide prevention. Helplines have
proved to be a useful and widely implemented best practice. However, despite reducing
suicide risk, the lack of evaluation means that there is no conclusive association with
reducing suicide rates.
INDIVIDUAL RISK FACTORS
✓ Risk of suicide can be influenced by individual vulnerability or resilience.
Individual risk factors relate to the likelihood of a person developing suicidal
behaviours.
✓ Previous suicide attempt:
By far the strongest indicator for future suicide risk is one or more prior suicide
attempts. Even one year after a suicide attempt, risk of suicide and premature death
from other causes remains high.
✓ Mental disorders:
In high-income countries, mental disorders are presenting up to 90% of people who
die by suicide, and among the 10% without clear diagnoses, psychiatric symptoms
resemble those of people who die by suicide. However, mental disorders seem to be
less prevalent (around 60%) among those who die by suicide in some Asian countries,
as shown in studies from China and India.
Harmful use of alcohol and other substances:
All substance uses disorders increase the risk of suicide. Alcohol and other substance
use disorders are found in 25−50% of all suicides, and suicide risk is further increased
if alcohol or substance use is comorbid with other psychiatric disorders. Of all deaths
from suicide, 22% can be attributed to the use of alcohol, which means that every fifth
suicide would not occur if alcohol were not consumed in the population. Dependence
on other substances, including cannabis, heroin or nicotine, is also a risk factor
for suicide.
➢ Job or financial loss:
Losing a job, home foreclosure and financial uncertainty lead to an increase in the risk
of suicide through comorbidity with other risk factors such as depression, anxiety,
violence and the harmful use of alcohol. Consequently, economic recessions, as they
relate to cases of individual adversity through job or financial loss, can be associated
with individual suicide risk.
 ➢ Hopelessness:
Hopelessness, as a cognitive aspect of psychological functioning, has often been used
as an indicator of suicidal risk when coupled with mental disorders or prior suicide
attempts. The three major aspects of hopelessness relate to a person`s feelings about the
future, loss of motivation and expectations. Hopelessness can often be understood by
the presence of thoughts such as “things will never get better” and “I do not seething’s
improving”, and in most cases is accompanied by depression.

▪ Chronic pain and illness:

Chronic pain and illness are important risk factors for suicidal behaviour. Suicidal
behaviour has been found to be 2−3 times higher in those with chronic pain compared to
the general population. All illnesses that are associated with pain, physical disability,
neurodevelopmental impairment and distress increase the risk of suicide. These include
cancer, diabetes and HIV/AIDS.

▪ Family history of suicide:

Suicide by a family or community member can beat particularly disruptive influence on a
person`s life. Losing someone close to you is devastating for most people; in addition to
grief, the nature of the death can cause stress, guilt, shame, anger, anxiety and distress to
family members and loved ones. Family dynamics may change, usual sources of support
may be disrupted, and stigma can hinder help-seeking and inhibit others from offering
support. Suicide of a family member or loved one may lower the threshold of suicide for
someone grieving. For all these reasons, those who are affected or bereaved by suicide have
themselves an increased risk of suicide or mental disorder.
Relevant interventions for individual risk factors.

❖ Follow-up and community support:

Recently discharged patients often lack social support and can feel isolated once they leave
care. Follow-upend community support have been effective in reducing suicide deaths and
attempts among patients who have been recently discharged. Repeated follow-ups are a
recommended low-cost intervention that is easy to implement; existing treatment staff,
including trained non-specialized health workers, can implement the intervention and
require few resources Todo so. This is particularly useful in low- and middle-income
countries.
 Assessment and management of suicidal behaviours:
It is important to develop effective strategies for the assessment and management of
suicidal behaviours. WHO’s GAP Intervention Guide recommends assessingcomprehensi
vely everyone presenting with thoughts, plans or acts of self-harm/suicide. The guide also
recommends asking any person over 10 years of age who experiences any of the other
priority conditions, chronic pain or acute emotional distress, about his or her thoughts,
plans or acts of self-harm/suicide. A careful assessment should be carried out through
clinical interviews and should be corroborated by collateral information.
Assessment and management of mental and substance use disorders
Training health workers in the assessment and management of mental and substance use
disorders is a key way forward in suicide prevention. A large number of those who die by
suicide have had contact with primary healthcare providers within the month prior to
the suicide. Educating primary health care workers to recognize depression and other
mental and substance use disorders and performing detailed evaluations of suicide risk are
important for preventing suicide. Training should take place continuously or repeatedly
over years and should involve the majority of health workers in a region or country.

WHAT PROTECTS PEOPLE FROM THE RISKS OF SUICIDE?

In contrast to risk factors, protective factors guard people against the risk of suicide. While
many interventions are geared towards the reduction of risk factors in suicide prevention, it is
equally important to consider and strengthen factors that have been shown to increase resilience
and connectedness and that protect against suicidal behaviour.
❖ Strong personal relationships:
The risk of suicidal behaviour increases when people suffer from relationship conflict, loss or
discord. Conversely, the cultivation and maintenance of healthy close relationships can
increase individual resilience and act as a protective factor against the risk of suicide. The
individual`s closest social circle – partners, family
members, peers, friends and significant others – have the most influence and can besupportive
in times of crisis. Friends and family can be a significant source of social, emotional and
financial support, and can buffer the impact of external stressors.
Religious or spiritual beliefs:
When considering religious or spiritual beliefs as conferring protection against suicide, it is
important to be cautious. Faith itself may be a protective factor since it typically provides a
structured belief system and can advocate for behaviour that can be considered physically and
mentally beneficial. However, many religious and cultural beliefs
and behaviours may have also contributed towards stigma related to suicide dueto their moral
stances on suicide which can discourage help-
seeking behaviours. The protective value of religion and spirituality may arise from providing
access to a socially cohesive and supportive community with ashared set of values. Many
religious groups also prohibit suicide risk factors such as alcohol use. However, the social
practices of certain religions have also encouraged self-immolation by fire among specific
groups such as South Asian women who have lost their husbands. Therefore, while religion
and spiritual beliefs may offer some protection against suicide, this depends on specific
cultural and contextual practices and interpretations.

Lifestyle practice of positive coping strategies and well-being:

Subjective personal well-being and effective positive coping
strategies protect against suicide. Well-being is shaped in part by personality traitswhich
determine vulnerability for and resilience against stress and trauma. Emotional stability, an
optimistic outlook and a developed self-identity assist in coping with life’s difficulties. Good
self-esteem, self-efficacy and effective problem solving-skills, which include the ability to
seek help when needed, can mitigate the impact of stressors and childhood adversities.
Willingness to seek help for mental health problems may in particular be determined by
personal attitudes.

WHAT IS KNOWN AND WHAT HAS BEEN ACHIEVED

❖ Recognition of multicausality:
The interplay of biological, psychological, social, environmental and cultural factors in the
determinism of
suicidal behaviours is now well recognized. The contribution of comorbidity (e.g. mood and
alcohol use disorders) in increasing the risk of suicide has become evident to researchers and
clinicians alike.
 ❖ Identification of risk and protective factors:
Many risks and protective factors for suicidal behaviours have been identified through
epidemiological research both in the general population and in vulnerable groups. There has
been an increase in knowledge about psychological factors and several cognitive mechanisms
related to suicidal behaviour, such as feelings of hopelessness, cognitive rigidity, feelings of
entrapment, impaired decision-making, impulsivity and the protective role of social support and
good coping skills
Recognition of cultural differences:
Cultural variability in suicide risk factors has become apparent. This is especially evident in the
less relevant role of mental disorders in countries such as China and India. There is increasing
recognition that psychosocial and cultural/traditional factors
can play a very important role in suicide. However, culture can also be a protective factor; for i
nstance, cultural continuity (i.e. the preservation oftraditional identities) has been established as
an important protective factor among First Nations and indigenous communities in North
America.
POLICY ACHIEVEMENTS

❖ National suicide prevention strategies:

In recent decades, and particularly since 2000, a number of national suicide prevention strategies
have been developed. There are 28 countries known to have national strategies demonstrating
commitments to suicide prevention.
❖ World Suicide Prevention Day:
International recognition of suicide as a major public health problem culminated in the creation
of World Suicide Prevention Day on 10 September 2003. This observance − held on the same
date every year − is organized by the International Association for Suicide Prevention (IASP)
and has been cosponsored by WHO. This day has spurred campaigns both nationally and locally
and has contributed to raising awareness and reducing stigma around the world.
Education about suicide and its prevention:
At the academic level, many suicide research units have been created, as well as graduate
and postgraduate courses. During the past 15 years the delivery of training packages on suicide
prevention has also become widespread, with specificmodules for different settings such as
schools, military environments and prisons.
 PRACTICE ACHIEVEMENTS
❖ Utilization of non-specialized health professionals:
Guidelines have been developed that expand the capacity of the primary health care sector to
improve management and assessment of suicidal behaviours by involving on-specialized health
workers. This has been an important factor in low-and middle-income countries where resources
are limited.
❖ Self-help groups:
Establishment of self-help groups for survivors, both of suicide attempts and for those bereaved
by suicide, has substantially increased since 2000.
❖ Trained volunteers:
Trained volunteers who provide online and telephone counselling are a valuable source of
emotional help for individuals in crisis. Crisis helplines, in particular, have gained international
recognition for their important contribution in supporting people during suicidal crises.

COMPONENTS OR SUICIDE PREVENTION

When discussing suicide prevention, it's essential to understand the various components that
play a role in addressing and reducing suicidal ideation and behaviors. Here are some critical
components:

1. Mental Health Education: Promoting mental health literacy can help individuals recognize
the signs of distress in themselves and others, reducing stigma and encouraging help-seeking
behaviours.

2. Access to Mental Health Services: Ensuring that mental health services are available,
accessible, and affordable to all individuals, regardless of their socioeconomic status, is crucial
for early intervention and support.
3. Crisis Intervention: Establishing crisis hotlines, text lines, and online chat services staffed
by trained professionals can provide immediate support to individuals in distress and help them
navigate through crises.

4. Community Support: Building supportive communities where individuals feel connected

and valued can serve as a protective factor against suicide. This includes support groups, peer
support programs, and community outreach initiatives.

5. Risk Assessment and Intervention: Training healthcare professionals, educators, and other
frontline workers to recognize the warning signs of suicide and intervene appropriately can save
lives.

6. Addressing Root Causes: Addressing underlying factors such as poverty, trauma, substance
abuse, and discrimination can help reduce the risk of suicide by tackling the root causes of
distress.

7. Promotion of Coping Skills: Teaching coping skills, resilience-building techniques, and

stress management strategies can empower individuals to better manage life's challenges and
setbacks.

8. Collaboration Across Sectors: Collaboration between government agencies, healthcare

providers, educational institutions, employers, and community organizations is essential for
implementing comprehensive suicide prevention efforts.

9. Research and Evaluation: Investing in research to better understand the risk factors,
protective factors, and effective interventions for suicide prevention is critical for improving
outcomes and saving lives.

10. Reducing Access to Means: Implementing strategies to reduce access to lethal means of
suicide, such as firearms and medications, can help prevent impulsive suicide attempts.

By addressing these components comprehensively, communities can work towards reducing

the incidence of suicide and providing support to those in need.
ACTIVITIES OF RESPONDING COUNTRIES WITHOUT A NATIONAL
If a country doesn't have a national suicide prevention plan or strategy in place, there are
still various activities that responding entities within that country may undertake to
address the issue of suicide. Here are some potential activities.

1. Awareness Campaigns: Organizations, advocacy groups, or concerned individuals

can organize public awareness campaigns to educate the population about the warning
signs of suicide, available support services, and the importance of seeking help.

2. Training and Capacity Building: Providing training to healthcare professionals,

educators, community leaders, and other frontline workers on suicide prevention, risk
assessment, and intervention techniques can help build capacity within the community to
respond effectively to suicidal crises.

3. Establishing Support Networks: Creating support networks or peer support groups

for individuals affected by suicide, such as survivors of suicide loss or those struggling
with suicidal thoughts, can provide much-needed emotional support and reduce feelings
of isolation.

4. Promoting Mental Health Services: Advocating for improved access to mental

health services and encouraging individuals to seek help from mental health professionals
can be crucial in addressing underlying mental health issues contributing to suicide risk.

5. Data Collection and Surveillance: Collecting data on suicide rates, risk factors, and
trends can help identify high-risk populations and prioritize interventions. This may
involve collaborating with research institutions or utilizing existing data sources such as
healthcare records and death certificates.

6. Engaging Communities: Engaging with communities to identify culturally

appropriate approaches to suicide prevention and mental health promotion can help tailor
interventions to the specific needs and preferences of diverse populations.

7. Collaboration with International Organizations: Partnering with international

organizations, such as the World Health Organization (WHO) or non-governmental
organizations (NGOs) specializing in mental health and suicide prevention, can provide
access to resources, expertise, and best practices.
 8. Policy Advocacy: Advocating for the development and implementation of national
suicide prevention policies or legislation can help create a supportive environment for
suicide prevention efforts and allocate resources towards effective interventions.

9. Addressing Social Determinants: Working to address social determinants of

health, such as poverty, unemployment, social isolation, and discrimination, can help
reduce the underlying risk factors associated with suicide.

10. Promoting Resilience and Coping Skills: Providing education and resources to
promote resilience, coping skills, and emotional well-being can empower individuals to
better manage stressors and adversities, reducing their vulnerability to suicide.

While a national suicide prevention plan provides a structured framework for addressing
suicide at a systemic level, these activities can still make a meaningful difference in
preventing suicide and supporting those affected by it in countries without such plans.

STRATEGY ON SUICIDE PREVENTION

Developing a comprehensive strategy on suicide prevention involves a multi-faceted
approach that addresses various aspects of mental health, social support, and public
policy. Here's a framework for creating a strategy on suicide prevention:

1. Research and Data Collection: Start by gathering comprehensive data on suicide rates,
risk factors, and trends within the population. This data will provide insights into the
scope of the problem and help identify high-risk groups and areas where interventions
are most needed.

2. Awareness and Education: Launch public awareness campaigns to reduce stigma

surrounding mental health issues and suicide, and to educate the public about the
warning signs of suicide, available resources, and the importance of seeking help.

3. Access to Mental Health Services: Ensure that mental health services are accessible,
affordable, and of high quality. This includes increasing the availability of mental health
professionals, expanding telehealth options, and integrating mental health services into
primary care settings.

4. Crisis Intervention: Establish crisis hotlines, text lines, and online chat services staffed
by trained professionals to provide immediate support to individuals in crisis and
connect them with appropriate resources and interventions.
5. Training and Capacity Building: Provide training to healthcare professionals,
educators, community leaders, and other frontline workers on suicide prevention, risk
assessment, and intervention techniques. This will help build capacity within the
community to identify and respond to suicidal behaviour effectively.

6. Support Networks and Peer Support: Create support networks and peer support
groups for individuals affected by suicide, such as survivors of suicide loss or those
struggling with suicidal thoughts. Peer support can provide invaluable emotional
support and reduce feelings of isolation.

7. Risk Assessment and Management: Develop protocols for assessing suicide risk in
various settings, such as healthcare facilities, schools, and workplaces, and
implementing evidence-based interventions to manage that risk effectively.

8. Collaboration and Coordination: Foster collaboration between government agencies,

healthcare providers, educational institutions, employers, community organizations, and
international partners to coordinate efforts and share resources in suicide prevention.

9. Policy Development and Advocacy: Advocate for the development and

implementation of national suicide prevention policies and legislation that prioritize
mental health, allocate resources to suicide prevention efforts, and promote the
integration of mental health services into broader healthcare systems.

10. Evaluation and Monitoring: Regularly evaluate the effectiveness of suicide prevention
efforts, using both quantitative and qualitative measures, and adjust strategies as needed
based on the latest research and data.

11. Addressing Social Determinants: Recognize and address the social determinants of
health, such as poverty, unemployment, social isolation, and discrimination, which can
contribute to suicide risk. Implement strategies to address these underlying factors and
promote social and economic equity.

By integrating these components into a comprehensive strategy, countries can work

towards reducing the incidence of suicide, promoting mental health and well-being, and
providing support to those affected by suicide.
 SUMMARY
Suicide is the act of intentionally taking one's own life. It is a complex phenomenon influenced
by various biological, psychological, social, and environmental factors. Suicide is a significant
public health concern worldwide, with millions of people dying by suicide each year. It affects
individuals of all ages, genders, and backgrounds, although certain populations may be at
higher risk, such as individuals with mental illness, LGBTQ+ individuals, veterans, and those
experiencing socioeconomic adversity.
Risk factors for suicide include mental illness (such as depression, bipolar disorder, and
schizophrenia), substance abuse, previous suicide attempts, chronic pain or illness, trauma or
abuse, social isolation, relationship problems, financial difficulties, and access to lethal means.
Suicide has profound emotional, social, and economic consequences for individuals, families,
and communities. It can lead to grief, guilt, and trauma among survivors of suicide loss, as well
as significant economic costs associated with healthcare expenses, lost productivity, and legal
proceedings.
Preventing suicide requires a comprehensive approach that addresses multiple factors
contributing to suicide risk. This includes promoting mental health and well-being, reducing
stigma surrounding mental illness and suicide, increasing access to mental health services,
implementing crisis intervention strategies, training healthcare professionals and frontline
workers in suicide prevention, addressing social determinants of health, and fostering
collaboration between government agencies, healthcare providers, community organizations,
and international partners.
 CONCLUSION
suicide is a deeply concerning and complex issue that has significant impacts on individuals,
families, and communities worldwide. It is a multifaceted phenomenon influenced by a variety of
biological, psychological, social, and environmental factors. Despite its devastating consequences,
suicide is preventable with the implementation of comprehensive strategies that address its root
causes and risk factors.

Efforts to prevent suicide must include promoting mental health awareness, reducing stigma
surrounding mental illness and help-seeking behaviours, enhancing access to mental health
services, and implementing crisis intervention measures. Additionally, addressing social
determinants of health such as poverty, unemployment, and social isolation is crucial in mitigating
suicide risk.

Collaboration between government agencies, healthcare providers, community organizations, and

international partners is essential for developing and implementing effective suicide prevention
initiatives. By working together to prioritize mental health, increase support systems, and
empower individuals to seek help, we can make significant strides in reducing the incidence of
suicide and saving lives. Every individual has value and deserves support, compassion, and access
to resources to prevent suicide and promote mental well-being.
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