When trying to decrease suicide most countries focus on identifying high risk groups and developing targeted approaches.
Within a country different groups have different rates of suicide. Men have higher risks of suicide than women (apart from in China), married people have lower rates than those who are unmarried and those with mental health and addictions problems are at higher risk than others.
In Canada, where I work, different Provinces have different rates of suicide with French speaking Quebec having the highest suicide rate. But Aboriginal, First Nations and Inuit groups have the highest rates of suicide and studies have shown that this is linked to their level of cultural and economic autonomy.
The WHO has identified key factors they think are important at a community level to identify at risk groups. Those who experience natural disaster, or war may be at increased risk of suicide. Those who migrate, or have to acculturate are at risk, as are those who are discriminated against in society, including, the LGBT and transgender populations and groups that are stigmatized or bullied because both trauma and abuse are linked to suicide. All of these may also be associated with social isolation and a perceived lack of social support.
The WHO have produced a comprehensive way of thinking through suicide prevention strategies in a country.
They start with general or universal prevention strategies for all; these would include decreasing access to the means of suicide, decreasing harmful drinking as many suicides occur when people are drunk, and increasing access to good healthcare – which includes training individuals about how to link people to care.
Targeted strategies would aim to increase awareness that suicide is preventable and increase access to support and care in vulnerable or at risk populations. Help lines have been found to be very effective.
Lastly specific strategies would include those at ultra-high risk, like those receiving treatment for depression, or other mental health or substance misuse problems, or those leaving care or going into prison. Training people who come into contact with these groups has also proved effective.
When these have all been put together as a strategy they can have real impact.
For instance, Quebec cut its suicide rates from 26.5 deaths by suicide per 100, 000 to 14.6 per 100, 000 between 1999 and 2009.
The rate in youth 15-19 from 21.3 per 100,000 in 1999 to 5.8 per 100,000 in 2009.
The comprehensive plan included a provincial hotline, suicide prevention centres in every region of the province, better mental health treatment and follow-up for people who attempt, the installation of barriers on key bridges and railway trestles, and improved training for staff at youth protection agencies.
But the highest rates of suicide in Quebec, and in Canada are in the Aboriginal population. Their rates did not decrease despite the prevention plan.
The Aboriginal, First Nations and Inuit populations of Canada have some of the highest suicide rates in the world.
They are a group that have suffered huge social change, they have been colonized, they have had their land taken from them and a variety of strategies have been deployed to strip them of their identity over generations.
As a population they have “loss events” on a huge scale. In addition they have high rates of poverty, poorer access to housing, education and healthcare. Their high suicide rates a completely predictable from a sociological perspective.
Deploying targeted suicide prevention strategies alone are like putting a bandaid on a gaping wound.
This is a population that has been systematically discriminated against and needs a systematic approach to improve their situation. Effective suicide prevention may only be achieved by fundamental upstream efforts to mitigate their loss.