IASP 31st World Congress highlights from Sue Murray, Zero Suicide Institute of Australasia

The specific areas of interest for ZSIA are the Zero Suicide Healthcare which supports healthcare systems understand and more effectively manage those who are vulnerable to suicidality.

In addition, ZSIA advocates for mental health reform that offers pathways to care that are matched to the needs of the individual and not merely attending hospital emergency departments when requiring mental ill-health crisis care.

Despite the wide range of topics that were on offer across the conference, there were two areas that I think had very important implications for Australia and the future for suicide prevention.

National real-time data systems

Unless we understand the myriad of components that contribute to the complexity of suicide it is very difficult to design programs and services that will enable us to meet the Sustainable Development Goal of reducing suicides by 30% by 2030.

This session highlighted some of the challenges that come with establishing national data systems. The more successful approaches were in countries where a national data repository has been established rather than the state based registries that operate in some states of Australia.

Evaluation of national strategies

The session that discussed the analysis of national strategies and their implementation was truly enlightening. The World Health Organization (WHO) has identified 12 components that should be included in a national strategy and while 118 member countries are signed up to the UN Sustainable Development Goals with a 30% reduction in suicides by 2030 the analysis shown in the presentation showed a great deal of diversity and very little hope that this goal will be achieved. In fact, only 28 countries had a national strategy that could be included in the analysis.

In Australia, 11 of the 12 components recommended by WHO are included. Psychotherapy is not addressed and this is the case in all but five of the countries. Stigma and crisis interventions were other components that were not well covered within the 28 national strategies that were analysed.

It was concluded that the emphasis for countries like Australia, which has almost all components covered, should be on evaluation and improvement particularly using data for effectiveness, efficiency and sustainability.

The session on Preventing Female Suicide and Self-Harm offered for me a key insight that relates directly to my work with the Zero Suicide Institute of Australasia. While I agree the focus on men is important, due to numbers and rates, this session reinforced the importance of work Suicide Prevention Australia began back in 2015 with the release of a discussion paper on Women and Suicide Prevention.

The increase in presentation to hospitals and health services by women with suicidal behaviour means we must ensure that the health system is well equipped to appropriately receive, manage, treat and transition all those who present to the health system.

I am constantly reminded of smoking control when programs and services were designed to reduce smoking among men. In Australia by the early 1990s, the outcome of this concentrated effort was that 92% of young women aged 18-24 years were regular smokers.

We must make sure this does not happen in suicide prevention by neglecting program design for women and girls.

The challenges faced by low and middle income countries (LMIC) were truly heartbreaking:

• Unlike high-income countries the ratio of suicides among men and women is almost on par with one another

• Methods of suicide vary greatly to high income countries and are highly correlated with the social determinants of health of poverty and lack of education
• Responses by LMIC countries to the call to develop national suicide prevention strategies are mediocre at best.

On a more encouraging note it is worth noting that Brazil achieved 61% lower suicide risk when a $17 per month allowance was provided to families to help address poverty and the payment was contingent upon children attending school…..a small investment with a big impact.