A few weeks ago, I posted about differences in suicide rates throughout the world, and received a thoughtful response from Andrew Grimes, a psychologist who has worked for many years in Japan. Mr. Grimes offered his perspective on why Japan's suicide numbers are so high, and what it might take to impact the suicide rate.

I thought of Mr. Grimes when at a briefing by Jerry Reed, the executive director of the organization with which I work and an executive committee member of the International Association of Suicide Prevention (IASP). IASP recently held their World Congress in Montevideo, Uruguay.

I was intrigued by how different nations approach suicide. In the U.S., where we have a National Strategy for Suicide Prevention, we've been able to take both a mental health approach to intervening and responding to suicide as well as a public health approach to suicide prevention. For nations that do not have such plans or the political will supporting planning and prevention, the suicide prevention picture looks quite different.

For example, Sri Lankan villagers go from house to house encouraging folks to put lockboxes on their pesticides, as that is the lethal means of choice in that country.

In Pakistan, there is no bereavement support for survivors of suicide, as suicide is so stigmatized as to be seen as unacceptable.

Other countries have been able to make policy change to influence suicide outcomes. Denmark saw a 50% drop in suicides after prescription rules for dispensing barbiturates were changed. Now, new classes of less lethal medication are prescribed for the same conditions.

What impressed me about the nations that have been able to engage in suicide prevention was their focus on determining the most lethal means and reducing access - in Sri Lanka, it's pesticides, while in Denmark, it's barbiturates. The deep cultural and national resonance that these approaches have is so critical to reducing suicide.

These approaches also move beyond seeing suicide prevention as something that needs to be done individual-by-individual, akin to trying to throw each starfish on the beach back into the ocean. What would be some possible approaches the U.S. could take that would address lethal means?

Copyright 2009 Elana Premack Sandler, All Rights Reserved

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