Preventing Suicide - SPINZ

S u i c i d e P r e v e n t i o n I n f o r m a t i o n N e w Z e a l a n d
Table 3. Activities that raise concerns
NAME OF ACTIVITY TYPE OF PREVENTION NATURE OF IMPACT
Info sheet
3
School-based
suicide awareness
programmes
Unsafe public health
messages and unsafe media
reporting of suicide
Fictional suicides (drama,
film, television, print)
Summary:
No one approach is proven to reduce suicide
substantially on its own. However some actions are
promising, especially as part of a comprehensive
approach. Other strategies, even when they seem
to be helping people, may not be a good use of
resources and may even do harm to some people.
For these reasons finding out what is effective in
suicide prevention is important. You are encouraged
to contact SPINZ if you would like to discuss new
information or what this means for you and for your
community.
Early intervention;
Group focus
Population focus
Population focus
References:
Beautrais, A. L., Collings, S. C. D., Ehrhardt, P., & Henare, K. (2005).
Suicide Prevention: A review of evidence of risk and protective factors,
and points of effective intervention. Wellington: Ministry of Health.
Collings, S., Beautrais, A. (2005). Suicide Prevention in New Zealand:
a contemporary perspective - social explanations for suicide in New
Zealand. Wellington: Ministry of Health.
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003).
Youth suicide risk and preventive interventions: a review of the past
10 years. Journal of the Academy of Child and Adolescent Psychiatry,
42(4), 386-405.
Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D.,
Haas, A., et al. (2005). Suicide prevention strategies: a systematic
review. Journal of the American Medical Association (JAMA), 294(16),
2064-2074.
New Zealand Youth Suicide Prevention Strategy: Youth suicide prevention
in schools: a practical guide. (2003). Wellington: Ministry of Youth
Affairs.
Some findings show modest
increases in help-seeking behaviour,
others show an increase in
risk among vulnerable young
people. These programmes are
not recommended as there is not
sufficient evidence that these
programmes are safe
Media and public health messages
need to be done with care
Some findings show a link with
actual suicides
If you are concerned about somebody who might be unsafe now, call Youthline (0800 37 66 33)
or Lifeline (0800 54 33 54). In an emergency, call 111.
www.spinz.org.nz
Preventing Suicide - What makes a difference?
• Proving that a suicide
prevention activity works is
not easy.
• How can we tell if a suicide
prevention activity is actually
reducing suicide?
Individual suicides and suicide rates
are influenced by a wide range of
factors. Consequently it is difficult to
show the impact of any one specific
prevention activity. It is also difficult
to measure the impact of particular
suicide prevention activities because
suicide is actually a statistically rare
event. A very large sample of people
is needed to be involved in any study.
For example, the suicide rate in New
Zealand in 2003 was approximately 1
for every 8,700 people. This presents a
daunting research assignment.
It is generally accepted in health
research that experiments termed
‘randomised controlled trials’ give
the strongest evidence for any health
intervention. Randomised controlled
trials compare two groups (chosen
randomly and monitored in the same
way) where only one group receives the
intervention. A range of ethical and
statistical factors add complications to
this type of study in the area of suicide
prevention research. To date, randomised
controlled trials have primarily been
used in suicide prevention research for
studying the impact of psychological
therapies - such as cognitive behaviour
therapy (see table 1 inside).
Due to the limitations outlined above,
other types of research studies are
also used when trying to determine if
prevention activities make a positive
difference.
These research methods include:
• observation of groups over time
• surveys
• key informant interviews and
opinions of key workers in the area
of interest.
While there is limited evidence on the
effect of suicide prevention activities
on suicide rates, there are studies that
show a positive impact on some of the
risk factors that contribute to suicide
(see Table 2 inside).
Consequently we need to use what
information is available to make our
best call on:
• what activities are most likely to
work
• those that may work
• those that could (or in fact have
been shown to) cause harm
(see Table 3 inside).
2007 SPINZ is a part of the Mental Health Foundation of New Zealand

A programme is most likely to be safe and make a positive difference if it is aligned with research evidence
that shows this type of activity is effective. This is an important consideration with suicide prevention
because of the potential to do harm.
SPINZ has used the evidence from recent extensive reviews of the research literature to compile a summary
of what the international evidence shows us as at January 2006.
Note on Tables: Activities / interventions generally fit along a continuum from promoting
wellbeing and healthy development to early identification through to clinical services.
Activities / interventions are aimed at individuals, groups, or whole populations.
Table 2. Activities which have some evidence of effectiveness
Population Focus
NAME OF ACTIVITY TYPE OF PREVENTION NATURE OF IMPACT
Media education and guidelines Reducing risk Can limit suicide contagion (e.g. copycat
suicides)
Public awareness of depression/mental
health literacy (e.g. destigmatisation of
mental illness, depression recognition
programmes)
Promoting wellbeing
May increase help-seeking
Improving the control of alcohol Reducing risk May reduce problem alcohol use which is
a risk factor for suicide
Whanau, hapu, iwi, taitamariki
development
Promoting wellbeing
Recognises international best practice
and also subscribes to unique Maori
values, processes and social institutions
Telephone hotlines and crisis centres Early identification Some impact on risk factors
Table 1. Activities with good evidence of effectiveness
NAME OF ACTIVITY
Psychological therapies
(e.g. Cognitive Behavioural
Therapy, Problem Solving
Therapy, Dialectic Behavioural
Therapy, Interpersonal
Psychotherapy)
Restriction of access to
means (e.g. control of
guns and toxic substances,
removing hanging points
in prisons or mental health
inpatient units)
TYPE OF PREVENTION
Clinical services;
Individual focus
Reducing risk;
Population focus
NATURE OF IMPACT
Reduction in depression and
some reductions in suicidal
behaviour among specific
high risk groups
Reduction in suicide
attempts using that means
and sometimes reduction in
total suicides
Group Focus
Internet/computer based tools Promoting wellbeing May improve help-seeking skills
Interventions which strengthen families
and individuals (e.g. decreasing family
violence, child abuse, improving opportunities,
improving problem solving & social skills,
building resiliency or protective factors)
Skills training (e.g. improving individuals or
groups problem solving and coping skills)
Targeted programmes (e.g. programmes
that target substance abuse, depressive
symptoms, anxiety & conduct disorders)
Befriending, mentoring or volunteer
support programmes
Screening programmes - screening young
people or groups who are at increased risk
(such as those in social welfare care) for
depression or suicide risk
Reducing risk;
Promoting wellbeing
Promoting wellbeing
Early identification;
Reducing risk
Early intervention
Early identification
This may limit risk factors or the impact
of risk factors
Some reduction in risk factors
Often some improvement regarding
targeted risk factor
Where the programmes are well run there
can be some impact on risk factors
Can identify high-risk individuals. Needs
to be a quality screening programme,
with follow up for those who need it
Postvention (support after a suicide) Reducing risk May decrease depressive symptoms
amongst bereaved family. Addresses
potential risks within affected people
Education of doctors and
other health professionals
in recognition and treatment
of depression
Gatekeeper training (e.g.
training of caregivers,
military or prison personnel,
school staff, pastors or others
in recognising warning signs,
getting assessment and
treatment)
Early identification
Early identification
Increases recognition and
treatment of depression with
some reductions in suicide
Where gatekeepers are able
to identify risk and facilitate
access to treatment this
can be effective and is a
promising strategy to reduce
suicide
Individual Focus
Co-ordinated follow up programmes
Programmes which focus on pro-active,
regular, co-ordinated follow-up of people
who are at increased risk, e.g. managed care,
collaborative case management or wrap around
programmes for those with depression, those
whom have attempted suicide, or who have
recently been discharged from psychiatric care
Primary health care and mental health
care - programmes that make it easier for
people to access or use primary health care
or mental health care; provide training for
staff and implement systems for recognising
and treating depression and other mental
health problems and assessing & managing
suicide risk
Clinical
Clinical
Can monitor and address current suicidal
risk & promote wellbeing; likely to be an
important strategy in reducing suicides
Increase opportunity for early detection
and management of suicide risk factors;
likely to be an important strategy in
reducing suicide
Psychopharmacological interventions
(e.g. medications for depression and other
specific mental illnesses)
Clinical
Effective in treating the specific
disorders, this may be an important
strategy for reducing suicide