Suicide prevention requires more than just a clinical-psychiatric framework. It also needs to address social injustice, as evidenced by the fact that many suicide risk factors are responses to societal unrest.
Examples include the high rates of suicide among men in midlife and older white men, LGBTQ individuals and those experiencing incarceration. These conditions can be addressed by advocacy.
Suicide is a complex social problem affecting many societal sectors, including health care, criminal justice, and education. Advocate like Catherine Cerulli New York call for a systems approach to suicide prevention, recognizing that it is not a mental health issue or solely a medical matter and involves many risk factors that are influenced by unjust socioeconomic conditions and negative attitudes. A social justice framework can contribute to this system-wide effort by encouraging a critical analysis of the insidious impact of social injustice on suicide and how it is normalized, stigmatized, and judged. A social justice approach can also support a culture of compassion, human dignity, and inclusion and reduce the barriers to disclosure, communication, and help-seeking behaviors. For example, in states with a shortage of available mental health services, police officers are often the first to respond to people in crisis. This can result in violent encounters, with people who may be coping with untreated mental illness being arrested and jailed, further contributing to their distress.
Across the various participant groups, the community was described as a range of things: people at the ground level, gatekeepers and those at the frontline of suicide prevention; a broad social perspective encompassing groups of individuals sharing common values, beliefs, lifestyles and norms. The participants also spoke about community as a means of implementing, co-designing, collaborating, and forming a crucial part of program planning and delivery. Moreover, community was seen as a way to foster a sense of belonging and support for those who might be suicidal. This was highlighted by a participant who works at the policy development/research level, who described how communities could be supported to address adverse social determinants of health through programs and other initiatives. These initiatives must be flexible, allowing each community to decide what is best for them. This was echoed by another participant who is involved with community-level service provision, who said that programs need to be tailored to local needs and able to be adapted for individual communities.
Healthcare systems are where most people who commit suicide first seek medical help. This is why physicians and other health professionals must know how to screen for, assess and manage suicidal patients. Credible screening and assessment tools should be incorporated into all healthcare settings and a protocol for identifying at-risk patients and their referral to specialty care. Patients should also receive regular safety planning and counseling, and access to lethal means of self-harm should be restricted. Many healthcare systems are working to implement Zero Suicide, an aspirational goal that aims for all suicide deaths to be preventable. This includes integrating mental health into primary care and other general medical settings, improving payment for behavioral health services, and training medical staff in identifying and managing patients at risk for suicide.
In addition to teaching students about the warning signs of suicide, schools should also provide information and resources for students who are at risk. Students should know how and where to get help, including a list of community providers specializing in mental health and suicide prevention. Many youths at risk of suicide are struggling with a combination of factors, including a history of depression or other mental illness; childhood maltreatment; bullying and isolation; academic failure or losses (i.e., the breakup of a friendship); physical health challenges such as chronic illness; and a lack of hope and connections. Upstream universal prevention programs have been shown to reduce adolescent emotional problems and suicidal behaviors over time, particularly among marginalized youth. School-based interventions have increased student help-seeking and connection with adults for at-risk peers. NYSED guidance documents on social-emotional learning and the comprehensive school health model include tools for implementing these prevention strategies.