By Dr David Laing Dawson
Over the years I have been several times involved in planning mental health services, sometimes in a general and wide sense, sometimes specific programs. In each case I usually ask, “How much money do we have to spend? What is the budget?” And usually there is no answer to this question. The game is not played that way. First the proposal to compete with other proposals and then, within a highly politicized process, the allocation of funds.
This means of course, that the words are being sold, promoted. Not the actual evidence based possibility of major effectiveness with consideration of budget. But rather the most pleasing, hopeful, expansive words of promise (with fewest political complications) are being sold and often funded. This may be a good way to fund an arts program, but for health, we really should turn to science.
If we say, instead, “We have 10 million dollars to spend to prevent suicide in a particular state or province; how should we spend it for best results?” then our thinking might be clarified for us. What do we actually know about suicide and suicide prevention? What do studies from various parts of the world show? Where are the high risk populations? Which ones can we actually target?
Then we might look at the large range of social and economic factors that comprise risk factors that indirectly, or at a distance, contribute to a high suicide rate, and pass on these. They are usually broad conditions that can be gradually improved, and should be gradually improved through political action and do require political will and good economic times. (housing, minimum wage, employment, social programs, education)
Then we could look at specific high-risk populations and figure how we could spend that 10 million effectively to measurably reduce the suicide rate.
Then we might notice that a very high risk group for completed suicide comprises people too-late identified as suffering from severe mental illness, recently discharged psychiatric patients, and especially those suffering from a severe and chronic mental illness who drop out of treatment and/or stop their medications.
And then we can ask if there is a way of spending that 10 million dollars to improve and repair the services offered this group of people. They are identifiable. They are at high risk. And it is possible with limited money to enhance the programs that serve them. Especially during visits to emergency, drop-in clinics, and family doctors, and then in the years following diagnosis and/or discharge from hospital.
Of course we need to improve the resilience and mental health of our children, if we can. But not as a means to reduce the suicide rate, but rather for overall success of our children as adults. And this means, not a suicide prevention program, but rather more money and support for the educational system and improvements in this system utilizing all we know about learning, nutrition, physical health, exercise, social growth, stress management, disability accommodation, ensuring each child has some success and a chance to belong.
When it comes to suicide then, we don’t need a “national strategy”. We need to continue to improve all our services and our lives, with improvements in our educational systems, income support and equality, a healthy economy and good jobs, improved general health care systems and easy access to same, addictions programs, income and social support for the elderly, affordable housing…… And we need to turn our attention to those people we know to be at especially high risk for suicide (sufferers of severe mental illness, recently discharged patients) and improve our services and access to services for these people.