Suicide Awareness Isn’t Enough for Prevention

Today is World Mental Health Day (the 27th annual), and this year’s focus is on mental health promotion and suicide prevention. Suicide awareness is a big part of this.

The message from the president of the World Federation for Mental Health, which organizes World Mental Health Day, states:

“The object of making suicide prevention the theme of World Mental Health Day in 2019 is to attract the attention of governments so that the issue might be given priority in public health agendas around the world.”

The WFMH’s campaign materials for this year’s World Mental Health Day note several key goals in order to reduce suicides:

• prevention of mental illness
• promotion of good health
• reduction in the stigma associated with mental illness
• improved access to evidence-based mental health care

WFMH recommendations to reduce suicide

The WFMH document lists the following recommendations:

• improve mental health literacy to promote help-seeking
• train community providers to recognize suicidality
• ensure hospitals have the training and manpower to identify people who are at risk of suicide
• increased government funding of suicide research and prevention measures
• develop better tools for suicide risk rating and management planning
• include psychological first aid in all first aid courses (you can read about mental health first aid here)
• try to change mental health diagnostic systems to consider suicide more explicitly
• collection of suicide prevention indicators and suicide rates as part of mental health performance indicators
• develop a global strategy for stigma reduction around suicide

Sounds good, doesn’t it? None of it helps me, though.

What the recommendations don’t address

For one, it really doesn’t address the reasons why I would not be willing to go into hospital. You want to make sure people won’t seek treatment again? Give them a couple of bad ER/inpatient experiences, and that should be enough to do it. These recommendations also don’t change the fact that I have a mental illness that causes suicidal thinking, and there is no available treatment that fully controls my illness.

All the prevention talk is great, but when you’re dealing with chronic mental illness, unless there’s treatment available, people can talk their fancy talk all they want and there are still going to be people dying. If the alternative choices aren’t good, bad options start to look like the only options.

The importance of mental illness treatment

So now that I’ve got that little rant out of the way, this is what’s on my top 3 wish list for suicide prevention:

• the availability of better treatments – too many people have treatment-resistant illnesses and are not responding well enough to their current treatment regimens
• improved access to treatment – long waiting lists can cost lives
• treatment needs to be acceptable, which at least in part requires a serious attitude adjustment in emergency departments and inpatient psych units

Stigma is alive and well in the places where people really should be going when in suicidal crisis, and that keeps people from seeking help. Based on my past experiences, hospitalization is not an acceptable option, and that’s a serious problem. It’s also a serious problem when stigma means that some people (such as those with borderline personality disorder) are deemed not suicidal enough to warrant attention.

Crisis lines are essential, but for people with serious mental illness they can only do so much. So often, the message that gets shared the loudest is that people should be willing to talk about it, and crisis lines are the right place to turn. Sure, for some people, they are the right place to turn. For others, they’re a temporary bandaid solution, and for some people, they don’t do much of anything. That’s okay, but it means that suicide prevention efforts can’t just be a one-trick pony.

Can suicide be 100% preventable?

There are a variety of organizations that promote a zero suicide goal. One example is the Zero Suicide Alliance, which is based in the UK and offers free suicide prevention training. There’s a Suicide Is Preventable website, which belongs to Know The Signs, an organization based in California.

While it would certainly be nice if suicide could be fully preventable, I have strong doubts as to whether it’s actually realistic. I’m also concerned that saying suicide is 100% preventable suggests that when there is a completed suicide, or even a suicide attempt, somebody has dropped the ball and failed to prevent it. And I just don’t think it’s that simple.

For suicide to ever be 100% preventable, the stars would need to align 100% of the time in terms of there being available, accessible, and acceptable treatments to address the issues that suicidal individuals are facing. With so many people having hospital horror stories from hell, I think we’ve got a long way to go.

So what can we do?

So, do I think suicide will ever be entirely preventable? Sadly, no.  What I think is important, though, is that suicide prevention campaigns target the multiple factors that play a role in suicide rather than focusing solely on awareness. We also need to ensure that better options are available to make living easier, so that no one feels that suicide is the only choice.