The need to prevent suicide by hanging in Australia

To the Editor

A recent article by Jorm (2019), ‘Lack of impact of past efforts to prevent suicide in Australia: please explain’, plotted the total suicide rate between 1991 and 2016 and 17 national suicide prevention initiatives, concluding that ‘past efforts appear to have made no discernable difference’. However, an examination of suicide data broken down by sex and suicide methods suggests that changes in the gun laws did have a modest and lasting effect on the rate of suicide by men.

Jorm’s plot shows a rise in suicide after the ‘gun buyback’ of 1996. In fact, the buyback occurred over late 1996 and early 1997 and was followed by a fall in suicides in the following year. Moreover, the 1996 National Firearms Agreement introduced regulations for registration and safe storage that took some years to take effect and may have contributed to the further decline in firearm suicide and total suicide in subsequent years (Large & Nielsson, 2010; ABS 2018). The extent and effect of the reduction in firearm suicides is mainly evident in men (Figure 1) as firearm suicide was never a common method among women (Figure 2).

Figure 1.

Rates and methods of suicide by men in Australia 1988–2018.

Figure 2.

Rates and methods of suicide by women in Australia 1988–2018.

The main limitation of any analysis of national initiatives is that there is no way of knowing what the suicide rate might otherwise have been. However, an examination of methods and gender goes some way towards answering Jorm’s question ‘why have past suicide preventions efforts not worked?’ In 1996, there were three common methods of male suicide: hanging, shooting and various forms of poisoning. Today hanging is the most common method of both male and female suicide, accounting for over 1800 deaths annually. There has probably been some reduction in suicide because of firearm regulation, changes in the availability of medications and the removal of carbon monoxide from vehicle exhaust. These measures have probably worked because they limit the proximal, or efficient, causes of suicide. To date, no serious consideration has been given to measures that might limit hanging. The wide availability of both ties and hanging points makes it impossible to completely remove this means of committing suicide. However, the shear number of deaths by hanging would justify initiatives to make hanging less convenient, for example, reducing hanging points in new buildings, requiring rope to be sold face-to-face (like tobacco) and encouraging the disposal of unnecessary rope. A community awareness campaign that highlighted the catastrophic effects of failed hanging and suicide in general might also help.