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WORLD SUICIDE PREVENTION DAY

Preventing Suicides

POONAM KHETRAPAL SINGH
EVERY 40 seconds, a person commits suicide somewhere in the world. The impact on families, friends and communities is devastating and far-reaching. Suicides accounted for over 800 000 deaths in 2012 alone, according to a new global report of the World Health Organization. The estimated suicide rate is the highest in WHO's South-East Asia Region as compared to other WHO regions. As suicide is a sensitive issue—and even illegal in some countries—many cases go unreported.
Suicide characteristics differ based on a country's economic status. The age-standardized rate of suicide is somewhat higher in high-income countries than in low- and middle-income countries (LMIC) (12.7 versus 11.2 per 100 000 people). However, given the much larger proportion of the global population that resides in LMICs, they account for the bulk of deaths, with 75.5% of all global suicides occurring in these countries. 39% of the suicides in LMICs are reported from WHO's South-East Asia Region which has 11 countries and is home to a quarter of the global population.
Overall, more men commit suicide than women, but again there are variations based on the economic status of the country. In richer countries, three times more men commit suicide than women, but in low- and middleincome countries this ratio is 1.5 men to each woman. In most countries, suicide rates are highest in people 70 years and over, but young people aged 15-29 are also particularly vulnerable.
Pesticide self-poisoning is the most common method of suicide, resulting in one third of all deaths, most of which occur in LMICs. In high-income countries, on the other hand, hanging and firearms are more common methods.
The prevalence, characteristics and methods of suicidal behaviour vary widely between different communities, in different demographic groups and over time. Consequently, up-to-date surveillance of suicides and suicide attempts is an essential component of national and local suicide prevention efforts. This task is much more difficult than it appears. Obtaining high-quality actionable data is difficult in view of suicides being stigmatized or illegal in many countries. Until this changes—until countries and communities recognize suicide as a public health danger and provide support to those attempting suicide—we will be on the losing side of the fight to prevent suicides.
Governments play a pivotal role in this fight. The first step in this battle is to create a national strategy, stating a dear commitment to suidde prevention. Currently, only 28 countries have such a strategy. Ensuring collaboration between multiple stakeholders and sectors—public and private—is essential.
Countries must restrict access to the most common means of suicide. In India and Sri Lanka, restricting access to pesticides locally through locked storage facilities has been effective in lowering suidde rates. Evidence from Australia, Canada, New Zealand, the United States and several European countries suggests that restricting access to firearms has been associated with a drop in firearm suidde rates.
Responsible media reporting has been shown to decrease suidde rates. This indudes educating the public about suicide, risk factors and where to seek help; avoiding sensationalism and glamourization; and avoiding detailed descriptions of suicidal acts. Governments can help media with these efforts by releasing public service announcements that raise awareness, identifying and treating mental and substance use disorders as early as possible, and ensuring those vulnerable to suicide receive the care they need before it is too late.
Worldwide, the prevention of suidde has not been adequately addressed due to lack of awareness of suidde as a major problem and the taboo in many sodeties to openly discuss it. In fact, only a few countries have included prevention of suicide among their priorities. It is dear that suidde prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multiseaoral approach, induding both health and non-health seaors, e.g. education, labour, police, justice, religion, law, politics and the media.
Suicide prevention is a cornerstone of WHO's Mental Health Action Plan, adopted by the World Health Assembly in May 2013. The plan calls on countries to reduce their rates of suidde by 10% by 2020.
WHO's new report, ‘Suicide prevention: a global public imperative," is a call to aaion to make suidde prevention a higher priority on the global public health agenda. World Suidde Prevention Day, observed each year on 10 September is a global opportunity to raise awareness and promote joint action to protea those who are vulnerable to suicide.
The writer Is the Regional Director of World Health Organization, South-East Asia Region.