Suicide prevention and the broad-spectrum approach to health promotion

Suicide remains a significant cause of death in the UK. In highlighting this tragedy, the British government, inHealth of the Nation (Department of Health, 1992) and Our Healthier Nation (Department of Health, 1998), set targets for Health Authorities to introduce positive interventions and reduce the rates of suicide in the populations for which they were responsible. This is reiterated in Standard 7 of the National Service Framework for Mental Health (Department of Health, 1999). Unfortunately, for both users and providers of services, the relevant literature reveals an immense and complex diversity in thinking as to how this might be achieved. Theories of causation, procedures for assessment and strategies for prevention are numerous, and result in a variety of theoretical frameworks and interventions being presented to those involved in suicide prevention (McElroy, unpublished). One option, however, is to target high-risk groups; in particular, individuals who have attempted suicide or deliberately harmed themselves (Department of Health, 2002). Morgan (Morgan, 1994) and others (Department of Health, 2002) have maintained that almost all completed suicides have a history of mental illness. It might, therefore, be inferred that suicide can be prevented by improving our knowledge and treatment of mental illness. In Sweden, for example, claims of this sort have been made following programmes that educated general practitioners in the treatment of depression (Rutz et al., 1992). The literature, however, indicates serious problems with the role psychiatry (i.e. the medical treatment of mental disorder) plays in relation to deliberate self-harm (DSH), particularly as many individuals find the care they are offered undesirable or unhelpful (Morgan et al., 1993; Sainsbury Centre for Mental Health, 1998).