Reducing Suicide Rates: Need for Public Health and Population Interventions.

Recent studies from India have challenged the fact that the majority of the people who die by suicide have severe mental illness; they have demonstrated its frequent links to environmental stress, social, cultural, economic, and political correlates. Suicide, a complex phenomenon, is a final common pathway for a variety of causal etiologies. Nevertheless, psychiatry continues to argue for curative solutions based on the reductionistic biomedical model, rather than support public health measures to manage the larger sociocultural, economic, and political context. While psychiatry and curative medicine help many people in distress, specific mental health interventions are unlikely to impact secular trends in the rates of suicide. The reduction of population rates of suicide requires a range of public health measures.

INTRODUCTION

Suicide has been recognized as a major public health problem affecting all nations in general and low- and middle-income countries in particular.[1] It has an adverse impact on individuals, families, communities, and on society as a whole.[2] The WHO Mental Health Action Plan 2013 − 2020[3] foregrounds the prevention of suicide and has included indicators that measure progress.

CORRELATES, FOCUS, AND INADEQUACIES

Research has identified a diverse group of risk factors for suicide. The results have been used to argue for specific preventive strategies. However, part perceptions, which highlight particular correlates, argue for specific solutions while ignoring others, are partial responses to a complex, multidimensional problem. Psychiatry continues to focus on the individual when the need is for a change in contexts, environments, and populations. The issues are briefly highlighted in Table 1.

Table 1

Isolated research findings, individual treatments, public health strategies

NEED FOR A COMPREHENSIVE APPROACH

Suicide, behavior, is a final common pathway for a variety of factors: predisposing, precipitating, and perpetuating causes.[2] Nevertheless, each of the risk factors and condition associated with suicide is neither necessary nor sufficient for suicide. Consequently, there are no single or simple solutions to preventing suicide. While interventions have shown a reduction in method-specific or site-specific rates, there is no firm evidence to suggest an overall reduction in suicide. A national strategy encompassing diverse approaches needs to be in place to achieve any degree of success.[22] Multi-sectoral and comprehensive approaches are required. On the other hand, medicalizing suicide or reducing it to a psychiatric label will prove inadequate for reducing population rates.

SUICIDE AND PUBLIC HEALTH

The poor health status of populations in the poorest countries is related to chronic poverty working through a lack of basic needs and access to health services, social discrimination, economic insecurity, and political exclusion.[2] Suicide is also associated with many of these sociodemographic, cultural, and economic correlates and demands comprehensive population-based strategies.[22] Many of the risk factors associated with suicide require a social security net provided by the state. Without a social security net many vulnerable individual face significant socioeconomic distress, which can easily propel them toward the option of suicide. The egalitarian society promised in the Indian constitution requires the provision of basic needs such as clean water, nutrition, housing, health care, education, and employment. In addition, it should provide gender justice and protect against social exclusion. Without such public health approaches, suicide prevention would remain on paper with the medical and psychiatric approaches currently advocated completely inadequate for the task of reducing suicide rates. Multidimensional problems like suicide require large-scale public health interventions to reduce suicide rates of populations.[2]

CONCLUSION

Many risk factors associated with suicide are neither necessary nor sufficient for death making the search for single and direct solutions impossible.[2] Nevertheless, experts tend to identify causal mechanisms operating in a minority of suicides and suggest single and simplistic solutions to manage the complex individual and social phenomenon of suicide. They rarely push for comprehensive national responses. Comprehensive solutions demand a package of macroeconomic policies that reduce the impact of free-markets, schemes which meet basic human needs and rights, psychosocial interventions that organize local support within communities, an essential pesticide list that excludes lethal compounds, gender justice, universal primary health care, legal and social protection for the vulnerable and increasing awareness and education through mass media.[2]

Financial support and sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.