FIVE REASONS WHY WE HAVE NOT BEEN ABLE TO PREVENT SUICIDE

Angus H ThompsonDepartment of Public Health

Flinders University

Suicide Prevention Australia, Adelaide, November 3, 2006

“EFFECTIVE” SUICIDE PREVENTION

• “No single intervention has been shown in a well conducted randomised trial to reduce suicide” (Gunnel & Frankel 1994)

• “Suicide prevention remains essentially a land of hopes and promises but not of certainties” (de Leo 2002)

• No evidence found of a demonstrable effect (Alberta Foundation for Medical Research 2003)

REASON 1

AN ORGANIZATION WITH “SUICIDE” IN ITS TITLE CANNOT PREVENT SUICIDE!

BrainSculpting

Temperament

Vocabulary

Birth 5 Yrs 10 Yrs 15 Yrs 20 Yrs 25 Yrs

Peer Influences

Understands Suicide

Suicide Ideation

Formal Suicide Intervention

AGE OF OCCURRENCE OF A NUMBER OF FACTORS RELEVANT TO SUICIDE

0%

10%

20%

30%

40%

1935 1950 1965 1980 1990

Prev

alen

ce

Females

Males

Figure 3THE PREVALENCE OF TWO OR MORE TRAUMATIC

CHILDHOOD EVENTS BY “COHORT YEAR” AND SEX

“Cohort Year” = Date when the youngest person in each group would have been about 15 years of age

Source: Thompson AH, Cui X (2000). Increasing Childhood Trauma in Canada: Findings From the National Population Health Survey, 1994/95. Canadian Journal of Public Health, 91(3), 197-200.

REASON 2

SUICIDE IS NOT SEEN AS PART OF A CLUSTER OF HUMAN PROBLEMS

THE CANADIAN SOCIAL PROBLEM INDEX

COMPONENTSMurder

Attempted MurderAssault

Sexual assaultRobberySuicideDivorce

Alcoholism

Source: Thompson AH, Howard AW, Yin J (2001). A social problem index for Canada. Canadian Journal of Psychiatry 46, 45-51.

SOCIAL PROBLEM INTERCORRELATIONS ACROSS PROVINCES: 1971/1981

Att.Murder Assault Rape Robbery Divorce Suicide

Alco-Holism

Homicide .91/.90 .47/.50 .58/.69 .71/.61 .65/.66 .47/.81 .43/.82

AttemptedMurder .36/.24 .58/.44 .80/.61 .56/.48 .38/.79 .43/.59

Assault .23/.73 .26/.00 .76/.54 .41/.30 .17/.63

Rape .84/.35 .71/.68 .68/.34 .76/.83

Robbery .72/.67 .63/.66 .75/.65

Divorce .77/.70 .68/.77

Suicide .79/.66

THE ASSOCIATION BETWEEN SOCIAL PROBLEMS AND PSYCHIATRIC DIAGNOSES IN THE EDMONTON AREA EPIDEMIOLOGICAL STUDY OF PSYCHIATRIC DISORDERS

Source: Thompson A & Bland RC (1995). Social dysfunction and mental illness in a community sample. Canadian Journal of Psychiatry 40, 15 – 20.

Alcohol Abuse

Drug Abuse Divorce

Unem- ployment

Suicide attempt Felony

Spouse Abuse

Child Abuse

Schizophrenia

Mania

Depression

Dysthymia

Phobia

Panic Disorder

Obsessive Compulsive

Antisocial Personality

OR < 5 OR 5 - 9.9 OR 10+

(r = 0.81)

Source: Thompson AH, Borden K, Belton KL. (2004). Intentional & unintentional injuries across health regions in Alberta, Canada: An implication for policy. Crisis 25(4) 156-160.

REASON 3

THE MAJORITY OF SUICIDAL INDIVIDUALS EXHIBIT A MENTAL ILLNESS, BUT MOST

OF THESE DO NOT RECEIVE TREATMENT

Psychological Autopsy Studies Suggest That At Least 90% of People Who

Commit Suicide Have a Mental Illness!

• Psychological autopsies are retrospective in nature

• Treatment is far from perfect

• There is an environment by mental vulnerability interaction

BUT …

REASON 4

SUICIDE PREVENTION PROGRAMS CANNOT “LEARN”

“SUICIDE PREVENTION” PROGRAMS RARELY EVALUATE THEIR IMPACTS:

• Several years required to show an effect

“SUICIDE PREVENTION” PROGRAMS RARELY EVALUATE THEIR IMPACTS:

• Several years required to show an effect

• Avoidance of personal evaluation

“SUICIDE PREVENTION” PROGRAMS RARELY EVALUATE THEIR IMPACTS:

• Several years required to show an effect

• Avoidance of personal evaluation

• Not knowing what one’s job is

SELF-REGULATING SYSTEMS AND

SUICIDE PREVENTION

Gus Thompson Alberta (Co-Chair)

Wade Junek Nova Scotia (Co-Chair)

Leanne Boyd Manitoba

Joseph Kluger Saskatchewan

Claire LeBlanc New Brunswick

Terry Russell British Columbia

Kathryn Sullivan Health Canada (Ex Officio)

Susan Moisey Consultant

Celebrating Success:A Self-Regulating Service Delivery System for

Children & YouthA Discussion Paper

Prepared for Health Canada byThe Federal/Provincial/Territorial Working Group on the

Mental Health and Well-Being of Children and Youth

A SIMPLE SELF-REGULATING HEALTH SYSTEM

GOVERNINGPOLICIES

INTERPRETATION& DECISION

SERVICEDELIVERY

HEALTHOUTCOMES

FEEDBACK

WHAT MAKES A SERVICE DELIVERY SYSTEM SELF REGULATING?

FOUR ESSENTIAL COMPONENTS

• Outcome Measures

• Feedback

• Executive Capability

• Rewards & Incentives

SUICIDE PREVENTION REQUIRES THE USE OF LONG, MEDIUM & SHORT-TERM

OUTCOME MEASURES

1. HEALTHY DEVELOPMENT

2. PARASUICIDAL BEHAVIOUR

3. COMPLETED SUICIDE

REASON 5

WE DON’T KNOW WHY THE SUICIDE RATE IS SO LOW

WHY DO WE “GO FORWARD”?

WHY DO WE “GO FORWARD”?

Rose Coloured Glasses

Optimism (Seligman)

Strengthening Behaviour (Skinner)

Traditions (Frankl)

Healthy Brain Development

Control over one's environment

The family

Social Imperative

FIVE THINGS TO DO

1. Intervene Very Early (ECD)

2.Address Shared Social Problem Causes

3. Improve Access and Efficacy of Treatment

5. Promote Curiosity, Mastery, Responsibilityand Zest for Life

4. Create a System That Can Learn

For More Information:

Angus H ThompsonDept of Public Health, Flinders University

angus.thompson@flinders.edu.au

www.socialproblemindex.com

http://www.phac-aspc.gc.ca/dca-dea/publications/pdf/celebrating_e.pdf

Many Thanks