A national strategy can be defined as: A comprehensive and nationwide approach to reduce suicidal behaviors across the life span through a coordinated and culturally sensitive response from public or private sectors of society.
The key elements of a suicide prevention strategy are (Mehlum, L. 2004):
- Knowledge transfer, including public awareness promotion
- Interventions for key high-risk groups – particularly individuals with mental and substance use disorders
- Reduced availability and lethality of methods
- Improve reporting of suicide in the entertainment and news media
- Improved support for those bereaved by suicide
- Promote research on suicidal behaviour and suicide prevention
- Establish and improve surveillance systems
Most of the Nordic countries made a national strategy for suicide prevention in the early 1990s as recomended by the World Health Organisation (WHO).
1992: Finland was the first country to launch a suicide prevention program, with the strategy: “Suicide can be prevented. Fundamentals of target and action strategy” (Taipale et al., 1993).
1994: Norway published the first strategy that has been followed by several revised and updated documents (the Norwegian Board of Health Supervision).
1995: Sweden published its first national program for the development of suicide prevention (National Council for Suicide Prevention).
1998: Denmark`s parliament endorsed a proposal for a “Danish Action Plan for Prevention of Suicide and Suicide Attempt” [Sundhedsstyrelsen (Danish National Board of Health), 1998].
The national strategies on suicide prevention
The goal of the Norwegian program for suicide prevention is to reduce the prevalence of suicide in Norway. This goal can be reached by objectives such as:
- Reduce the prevalence of suicide by reducing the risk for suicidal behaviour in the population. An example of efforts under this objective would be to reduce access to means such as firearms.
- Ensure good follow-up of those bereaved by suicide, for example, via voluntary organisations.
- Strengthen training in suicide prevention, for example, among staff of health services.
- Stimulate increased research, generation and dissemination of knowledge, for example, knowledge about risk factors and preventive interventions.
The implementation of the new National Guidelines for Prevention of Suicide in the Mental Health Services and the new Guide for Suicide Preventive Work in the Municipalities, are both a part of such initiatives.
The Swedish program for suicide prevention, which was ratified by the Swedish Parliament in June 2008, includes the following strategies:
- Promoting better life opportunities for groups that are most in need.
- Minimizing alcohol consumption in target and high-risk groups.
- Reducing the availability of means for committing suicide.
- Training gatekeepers in the management of suicide risk.
- Supporting health services in suicide prevention.
- Disseminating knowledge of evidence-based methods for preventing suicide.
- Raising the competence of health professionals.
- Systematically analyzing all suicides that occur in the health care system during the course of care and 28 days after discharge (the ‘Lex Maria’ regulations contained in the Act on Professional Activity in Health and Medical Services).
- Supporting voluntary organizations.
This new comprehensive program for suicide prevention was drawn up jointly by the National Board of Health and Welfare, the National Institute of Public Health, Swedish National Centre for Suicide Research and Prevention of Mental Ill-Health at Karolinska Institute (NASP), along with contributions from six regional networks (National Board of Health and Welfare and Swedish National Public Health Institute, 2006).
The Danish National Programme for Prevention of Suicide and Suicide Attempts was implemented in 1999 and based on following goals:
- Suicidal persons are to be identified and irrespective of possible mental illness, abuse, age, gender and ethnic background offered relevant treatment.
- An increased knowledge of risk factors and groups at risk with the purpose of reinforcing the effort towards groups at risk.
- Improving the resources of the individual and minimising social strains.
- Disadvantaged children and young people ought to be given tools, which enable them to master their own lives and enter into positive, social communities.
- Increased professional competence in the field of working with suicidal persons.
- Increased knowledge about suicidal behaviour by means of research, evaluation and education.
- Discourage that suicidal behaviour is generally perceived to be accepted and normal.
In 2007, The Danish National Board of Health furthermore issued the recommendations that ‘‘suicidal persons should be quickly and correctly assessed by the necessary professional expertise’’ and ‘‘Establishing aid for suicidal persons according to a supportive and attendant principle so that the suicidal person is not left on his or her own before other relevant support is started’’
Danish National Board of Health, 1998. Proposal for a National Programme for Prevention of Suicide and Suicide Attempt in Denmark (in Danish). Copenhagen, Udvalget til udarbejdelse af forslag til handlingsplan til forebyggelse af selvmordsforsøg og selvmord i Danmark, Sundhedsstyrelsen.
Eurostat, 2009. Statistics: Death due to suicide by gender.Luxembourg, Eurostat – European Union.
Evaluation and visitation of suicidal persons. Recommendations for health care professionals. Danish National Board of Health; Copenhagen 2005.
National Council for Suicide Prevention, 1995. Support in Suicidal Crises. The Swedish National Programme to Develop Suicide Prevention. Modin Tryck, Stockholm. Swedish National Board of Health and Welfare and Swedish National Public Health Institute (2006).
Norwegian Board of Health, 1996. The National Plan for Suicide Prevention 1994-1998. Oslo, Statens Helsetilsyn (Norwegian Board of Health), Skriftserie 1996:2 IK-2539.
Taipale,V., Ruokola,M., Eskola,J., Lönnqvist,J., Upanne,M., & Arinperä,H., 1993. Suicide can be prevented. Fundamentals of target and action strategy. Helsinki: National Research and development centre for welfare and health, ISBN 951-47-5755-6.
Swedish National Board of Health and Welfare and Swedish National Public Health Institute, 2006. Proposal for the National Programme for Suicide Prevention: Public Health and Individual-Oriented Strategies and Actions’.
Stockholm: National Board of Health and Welfare. Swedish parliament, 2008. Proposal 2007/08:110 approved by the Swedish parliament 5th of June, 2008. Chapter 8, Suicide prevention. Stockholm, Swedish parliament.