Can suicide rates be reduced to zero?

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1. Introduction

Around the world a person dies by suicide every 40 seconds, according to the World Health Organization. The social and economic pressure this places on nations – as well as on family, friends and community – is enormous. Yet only 28 countries are reported to have a national suicide prevention strategy.

So how are different countries and communities responding to this issue, and is it possible to develop a public strategy to prevent suicide?

This guide is produced by My Perfect Country for the BBC World Service, presented by broadcaster Fi Glover, entrepreneur Martha Lane Fox, and Henrietta Moore, director of UCL Institute for Global Prosperity.

2. How do these countries deal with suicide?

Click on the country labels to reveal more information

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3. Case-study: Detroit

In Detroit, Michigan, the Henry Ford Health System (HFHS) has been celebrated for its work to reduce suicide rates among mental health patients. In the last two-and-a-half years, they report that they have not lost a single patient to suicide.

"Zero suicides"

The goal of HFHS is to eliminate suicide. As part of their "Perfect Depression Care" they screen every single patient for risk of suicide, not just those who present with mental health problems. Care is then tailored to the needs of patients identified as being at-risk. The centre also promotes communication between patient and healthcare professionals, as well as among the healthcare professionals themselves.

Access to all?

HFHS is a not-for-profit corporation, but is private and used mainly by those with health insurance. The main HFHS mental health clinic is in Detroit, where the poverty rate is 39%, and substance abuse alongside other factors connected to suicide rates are high. So not everyone has access to this service. In 2015, the centre saw 74,000 patients.

Crossing the Atlantic

Elsewhere, the method is catching on. In the UK, Mersey Care, an NHS mental health trust in Liverpool, has also committed to a zero-suicide model, following the HFHS approach. Mersey Care is also working with Stanford University to develop a mobile phone app as a monitoring tool for suicide prevention, which would provide round-the-clock support.

4. How local becomes international

Inspired by the Detroit model, a new approach to suicide prevention has been adopted in the east of England. Caroline Dollery, who is Clinical Director for the East of England strategic clinical network for mental health, explains the benefits and the challenges.

"We wanted to bring the experience, learning and methods from Detroit into the east of England sites that were keen to try this out," says Dollery.

One of the main challenges, says Dollery, was to make sure that they could place the methods used in the Detroit model into a national health service environment - which is based on community work with different partners.

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"We have people within the community who are supporting de-stigmatising and discussing these issues," says Dollery, "helping people connect with services, and helping people understand why they are feeling suicidal."

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Many suicides happen outside the health system altogether, says Dollery, who has also been involved in plans to include police, fire services and social care in the new system.

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Teaching people to "stay well" should be embedded in the primary curriculum, says Dollery. "Perhaps the problem we’ve had in the past is that we’ve just thought about mental illness, we haven’t thought about how you prevent it."

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