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As we mark World Suicide Prevention Day, Dr Fiona Pienaar, Senior Clinical Adviser at Mental Health Innovations, explores the extent of the global challenge, the complex nature of suicide and the importance of connectedness in suicide prevention.

Each year on 10th September, organisations around the world come together to raise awareness of suicide. Every World Suicide Prevention Day has a different theme that highlights a certain aspect of suicide prevention, with this year’s focus on creating hope through action.

The first step in suicide prevention is understanding the scale and impact of the challenge. Monitoring suicide statistics helps us gain an insight into who is most at risk and where efforts to prevent suicide can most effectively be targeted.

Suicide is a serious global public health crisis, with over 700,000 people taking their own life each year; equating to approximately 1 person every 40 seconds (WHO, 2021). In addition to this tragic loss of life, it is estimated that for every suicide, more than 20 people make attempts to take their own life.

To give further context, suicide accounts for more deaths than other leading causes, including malaria, HIV/Aids, breast cancer, war and homicide. Each tragic death by suicide impacts on an estimated 135 people in families, amongst friends and acquaintances, and in communities (Cerel, 2018); that’s approximately 94.5 million people every year.

While it may be challenging to think about the economic consequences of suicide, each individual loss of life was calculated in 2011 to cost the economy £1.67m. This includes loss of life to the individual, pain and suffering of family and friends, lost income and output for families, and lost productivity for employers (Department of Health, London School of Economics, King’s College London, Centre for Mental Health, 2011).

Data published just this week by the ONS indicates that 5,224 people died by suicide in England and Wales in 2020, a fall of 734 deaths compared with 2019. We must, however, treat these figures with caution. Given the delays to coroner inquests and subsequent suicide registrations caused by the pandemic, suicide numbers and rates could in fact be higher.

Suicide is complex. Various links have been established, including between mental disorders, particularly depression and substance abuse. Individuals might have characteristics that mean they are more vulnerable and, coupled with environmental factors and life events, increase the risk of suicide. Life stressors such as adverse childhood experiences (ACEs), relationship issues, financial problems, chronic pain and illness, family and community violence, abuse and neglect, discrimination (particularly amongst vulnerable groups), grief, loss and change experiences - individually or in combination - can lead to an individual feeling a sense of hopelessness, unable to change their contexts. According to the WHO (2021), a prior suicide attempt is the single most important risk factor for suicide.

While, for some, there may appear to be no apparent warning prior to their suicide, suggesting impulsivity, this is not supported by evidence, which suggests that most people do communicate their intent prior to their suicide, even if it is subtly.

Whatever the background to each suicide, there is no clear and obvious pathway. Each person’s life is unique and the details around each suicide is unique to them. We do, however, continue to gather increasing insight through research, practice, the development of theory, from those with lived experience and from support services. Notably, the WHO has recommended four effective evidence-based strategies for suicide prevention:

  1. Limit access to the means of suicide
  2. Interact with the media for responsible reporting of suicide
  3. Foster socio-emotional life skills in adolescents
  4. Early identify, assess, manage and follow up anyone who is affected by suicidal behaviours

We also know that, where possible, helping someone to construct a safety plan as to how they will keep themselves safe can also be effective.

Given the scale of the challenge, the complexity of suicide, and the prevention strategies identified above, we may ask ourselves: ‘What can I do? How can I make a difference?’

We know that one of the major challenges that can lead to people struggling with their mental health and thinking about taking their own life is a lack of connectedness. Loneliness and feeling as if no one cares about you can leave a person feeling very vulnerable, especially if trying to cope with life’s stressors. Having no one to talk to and no one to support you can lead to feelings of helplessness and hopelessness.

This is where we can take some action. Our awareness, our knowledge and our reaching out to connect with compassion, can all provide hope to those who are struggling.

If you notice that someone - that could be family, friend, colleague, acquaintance, even a stranger - is struggling and you have concerns about their mental health, reach out to them. Their struggle might not be very obvious but it could be that they have withdrawn, become quieter, not engaging socially as they used to, their mood has changed, their alcohol or drug intake has increased, or they’re raging, acting recklessly, taking risks - something is different.

Remember that most people who are thinking about suicide, or who make an attempt on their life, do not want to die. They want their pain to end and cannot see a way out of the situation they are in. They are often feeling isolated and disconnected from everyone. By reaching out and connecting, you are extending a hand of support and giving them hope. By listening to them, you are giving them an opportunity to tell their story and have someone else witness it.

While suicide prevention is a challenging issue which requires multi-faceted solutions, we can most certainly be a piece in the puzzle. We can provide connection and hope.

If you are having suicidal thoughts or are worried about someone you know and would like support, you can read our resources or text ‘SHOUT’ to 85258 to speak to a trained volunteer any time of the day or night.