Suicide rates and mental health disorder prevention

To the Editor

In his interesting article published recently in the Journal (Jorm, 2014), Professor Jorm proposed that we should be developing a national strategy for the prevention of mental disorders based upon the observation that increases in mental health services have not resulted in an improvement in the mental health of the Australian population. The observation that alterations in mental health service provision do not seem to have translated into improved clinical outcomes is certainly disturbing, if not puzzling, and warrants considerable attention and should be the focus of ongoing research (Jorm and Malhi, 2013).

However, Professor Jorm uses the example of suicide prevention as the main support for the argument that we have reached a time where public health measures can be shown to impact in a positive way on mental health at a population level. From the information provided in the article, however, it does not appear that there is sufficient evidence for an impact of the National Suicide Prevention Strategy on suicide rates: certainly not sufficient evidence on which to base major changes in mental health policy and funding allocation.

The problem with Professor Jorm’s conclusion is apparent from Figure 3 in his article. Although there has been a significant reduction in male suicide rates since the institution of the National Suicide Prevention Strategy, there have been at least two equivalent reductions in suicide rates: one in the 1960s and one from 1930 through to the mid-1940s. These have been of similar to greater magnitude. Clearly, suicide rates at a population level can be affected by a range of sociocultural factors as well as potentially by clinical factors such as the widespread use of antidepressant medications that has occurred on a similar timeline to the fall in suicide rates seen over the last 15 to 20 years.

In this context, the statement that there is a ‘striking’ coincidence between the reduction in suicide rates seen and the institution of the National Suicide Prevention Strategy seems rather questionable and certainly not an observation on which it would seem prudent to base substantial changes in mental health policy.

This by no means suggests that we should not consider the role of mental health prevention approaches (Whiteford et al., 2013). However, we need to look harder to establish evidence that they are effective to ensure any substantial redistribution in mental health funding is done in a manner that follows, rather than precedes, the gathering of evidence.