The need for smarter tools to guide suicide prevention

To the Editor

Page et al. (2018) state suicide is ‘a significant public health problem’. But what does that mean? The World Health Organization (WHO) defines ‘health’ using ‘well-being’, (complete physical, mental and social well-being) which is in turn defined in terms of ‘good health’, and around we go again. We do know ‘health’ generally involves doctors, nurses and sundry ‘health professionals’. Nor is ‘public health’ clearly defined—the words ‘health of the population as a whole’ are used. We do know that certain public health activities prevent large sections of the population suffering infectious diseases. Page et al. (2018) also tell us that the suicide-prevention strategies currently employed in Australia are not working and need to be adjusted.

Suicide has been known throughout history, in every ethnic/religious group and geographical region. It is a human behavior, an escape from distress which is otherwise inescapable (Baechler, 1979). Thus, suicide is considered a problem by communities and a solution by individuals.

Different countries have different suicide rates and their relative positions on ranking scales remain much the same. This informs that culture—the beliefs and behavioral responses to circumstances—is profoundly important (Durkheim, 1952).

It is likely that while there is distress, there will be suicide.

It may be possible to reduce some risk factors, such as minimizing access to means, which may have a small effect. Some risk factors such as a family history of suicide are unalterable (of course, their impact may be mitigated by psychotherapy). Influential events occur throughout the lives of the individuals, and it is probable that many of the more easily mutable risk factors are more recent but less potent.

Suicide is better conceptualized as a sociocultural than a public health issue. Instead of developing new public health strategies, we might take a fresh view. Hefty reductions in the suicide rate of regions will only come with cultural change—altering the attitudes and behavior of the population. Encouraging males to be less self-reliant and readier to speak about their problems would be a small part—but that would involve a re-casting of the national stereotype/character (which may or may not be acceptable). Two things are clear, however, (1) such changes will not be delivered by additional Emergency Room staff, and (2) any change will be slow, and as for the person trying to lose weight, looking at the scales (annual statistics) every day (year) will be not be constructive.