Confronting the problem of suicide
BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY
World Suicide Prevention Day – Tuesday September 10th – has provided an opportunity for reflection on this sad phenomenon.
A million people suicide each year, with rates varying by country. The World Health Organisation and other agencies estimate that about 3,000 Australians suicide each year. In the WHO’s ranking, we come 51st of 183 (starting with the worst) countries. Worldwide, men account for three in four suicides, but women make more attempts.
The figures are often speculative: deaths from suicide may be coded to heart disease or other more socially acceptable causes. For example, where suicide is illegal, such as in Malaysia, Syria, Lebanon, the Bahamas, Kenya and Papua New Guinea, reported rates might be low. Deaths are not certified in many countries.
Although we might expect suicide to follow lines of economic advantage, the figures are mixed. Wealth is no insulator.
Historically and socially, several factors have been important determinants. An example cited in Wikipedia is of a Japanese Samurai who intentionally ends life (Seppuku) to preserve honour. “Indian, Japanese, and other widows sometimes participate in an end of life ritual after the death of a husband, although Westernised populations have abandoned this practice. Some perceive self-immolation as an altruistic or worthy suicide.” Recall suicide bombers and the Kamikaze pilots.
These variations are important when wondering how in our society we might mitigate or prevent suicide. This is not a simple problem, as is borne out by the complex web of services constructed to assist those considering suicide to identify alternative pathways to relief of their stress. It is not as though nothing has been done in recent years, especially for young people. We should remember this reality when considering new preventive strategies.
As with all psychiatric disorders, diagnosis and prognostication depend heavily on clinical information. This makes the identification of, and assistance to, people who might be on the brink of suicide very difficult.
If you go into a coronary care ward and measure everyone’s cholesterol, the mean will be as it is in the general community. So, it is not of much use, except when extremely high, for predicting potential cardiac events. Precision medicine might one day provide a better approach, but, for the moment, predicting which individual will have a heart attack (or take their life) is imprecise. While a strong link exists between depression and suicide, not every person who suicides is depressed, nor does every depressed person contemplate suicide.
In recent decades, service development for mental illness has moved forward with clear plans and stronger investment. Indisputably, much remains to be done; there are still big holes in the fabric of care.
And indeed, much more could be done. The multifaceted work of the Suicide Prevention Hub in Australia https://suicidepreventionhub.org.au/programs through several evidence-based programs that develop skills in recognition and support are to be welcomed. Work by Ernest Hunter, a public health researcher, Jo Robinson and Anton Clifford provide analyses of what research has revealed about suicide prevention in Australia, including among Indigenous communities, many of whose younger members experience the ennui of future uselessness in mainstream Australian society. Christine Morgan, the chief executive of the National Mental Health Commission, has been appointed to the new role of National Suicide Prevention Adviser, reporting directly to the Prime Minister.
We should, while remaining cognisant of the complexity and multiple factors contributing to suicide, strongly support these efforts. Much remains to be learned and applied.
Lifeline Australia – 13 11 14
Published: 09 Sep 2019