A GLOBAL PERSPECTIVE ON MENTAL HEALTH AND SUICIDE

"My father killed himself, and my cousin did too," said the Uber driver taking me to the airport at 5:00 a.m. I often hear such revelations when people learn that I research suicide prevention policy. Almost all of us have a family member or friend who has attempted suicide, but talking about it still feels taboo. According to the World Health Organization (WHO), suicide takes about 800,000 lives annually and is the second leading cause of death for young adults in the world. Reducing this sense of stigma is one of the elements the WHO is recommending in its current campaign for suicide prevention.

On an international scale, many countries are making suicide prevention a high priority. For example, Great Britain recently appointed a Minister for Suicide. And in Japan, where suicide was a taboo topic of conversation fewer than 20 years ago, civil society groups and government officials have joined forces to reframe it as a social problem that can be resolved. In the less wealthy countries of the Global South, numerous health problems compete for scarce resources. Researching if and how countries belonging to the Council of Health Ministers of Central America and the Dominican Republic adopt best practices in suicide prevention allows me to understand what conditions push mental health to the top of the health agenda and which policies are most adaptable. Although the Council prioritized suicide by founding an online platform for national data in 2013, not all of the nations involved have responded equally. Surprisingly, factors such as wealth, political openness, or a comparably high suicide rate do not automatically predispose a country to invest in suicide prevention.

In Costa Rica, suicide became a public cause after the former fiancé of a major political figure jumped to her death in 2016. What is needed to actually design and implement a prevention strategy, however, is state capacity, particularly the ability to collect data about suicide attempts. Experts commonly estimate that there are 10-20 attempts for every completed suicide, so data on attempted and completed suicides provide important information on the age, sex, time, location, and means used by people attempting self-harm. If, for example, the ingestion of pesticides is a common method of inflicting self-harm, countries might pass legislation banning the most toxic of them as several Asian countries have done, including South Korea and Sri Lanka. Mandatory reporting of suicide attempts also tends to oblige health providers to take the problem seriously and provide treatment. Health systems all too often avoid gathering information from patients about problems they cannot or do not want to treat, especially stigmatized conditions. Asking for information about a planned or attempted suicide implies—and warrants—that the patient will be provided mental health services.

As in most of the Global South, psychiatrists are few and far between in Central America so countries must be willing to meet mental health needs through task-shifting, or the training of non-specialists to carry out jobs normally beyond their job duties. For example, the Belizian ministry of health has trained psychiatric nurses to provide almost all mental health care. Ultimately, an often-overlooked requirement for carrying out a suicide prevention policy is that the lead agency, normally the country’s ministry or department of health, have the clout to do so. The agency’s technical competence and political authority to head such a campaign must be recognized by other ministries and by medical associations. The qualifications are especially important in mental health where working with other human service agencies is vital to training teachers and police to treat people with emotional disturbances appropriately and humanely. In Costa Rica, the ministry of health cooperated with the ministry of education to produce a training manual for teachers explaining the nature of suicidal behavior and providing protocols for the situations they may encounter with students.

Like many countries, American universities are increasingly concerned about student mental health. The WHO best practice guidelines and national policies mentioned here provide solid ideas about suicide prevention tactics that could be adapted to college campuses, such as designing responsive preventative interventions and training campus police, professors, and student-facing staff with protocols for students suffering emotional crises. Examining the government policies being put into place in the greater Global South, we can become better informed about how to respond at home.