A Introduction: Science, Culture, and Readiness to Act
The current scientifically informed view of suicide is that, while complex, suicide is a health-related outcome. Driven by a convergence of health factors along with other psychosocial and environmental factors, suicide risk is multifactorial. Like most health outcomes, a set of genetic, environmental, and psychological/behavioral factors are relevant. It is critically important that health professionals develop a current understanding of suicide as older views have permeated and clouded societal understanding leading to assumptions and judgment that have silenced generations of people suffering suicidal struggles or loss of a loved one to suicide.
Evolving attitudes toward suicide are not limited to the scientific or medical field. Science is impacting popular culture as well. Recent polls in the USA show that public perceptions of mental health and suicide are changing quite rapidly toward greater awareness, open-mindedness, and diminishing stigma.1 For example, 90% of respondents believe that mental health is as valid and important as physical health, and say they would help if someone they know were to become suicidal. However many add they are not necessarily equipped with skills and language to know how to help.
Suicide, while complex, is a health-related outcome.
Figures 1.1, 1.2, 1.3
Examples of positively evolving attitudes toward mental health and suicide prevention among the American public
New attitudes toward mental health in general and suicide in particular are reflected in the growing suicide prevention movement that has emerged in recent years in the USA, UK, Australia, and other nations. The truth is that for millennia, people who had lost loved ones and people who experienced a loved one’s suicidal crisis or their own largely kept their experiences to themselves, but now are speaking out and are part of leading the movement to advance change. Advocates on all sides of the issue have come together to raise public awareness, to advocate for changes in national policy for increases in research funding, improved healthcare access, for enforcement of mental health parity, and to call for an end to discriminatory practices in school and workplace settings. This public movement has led to hundreds of thousands of people participating in events in the USA such as the Out of the Darkness Walks for suicide prevention in all 50 states, advocacy activities at state and federal levels, and educational programs on how to prevent and respond to suicide in workplaces, schools, and faith-based settings.
The bottom line is that in today’s environment, healthcare providers need not be hesitant to address mental health concerns with their patients. The truth is that many patients may be open to dialog and in need of support but 1) may not be sure if their health provider will respond in a compassionate and knowledgeable way related to suicidal thoughts or mental health concerns, and 2) they may not know how to bring up their symptoms or concerns and may not have sophisticated language for symptoms. But even with these concerns present or with current robust mental health, many patients appreciate having their mental health screened and addressed in a manner similar to physical health.
While culture and attitudes toward mental health are opening up, it is a time of transition in culture and belief systems with natural unevenness to the pace and regionality of changing views. Thus, in general, the public’s level of mental health literacy in terms of when and how to take action remains relatively low.2 Health professionals can help deepen their patients’ understanding of mental health in the same way they do for physical health. As is the case for many physical health targets such as cardiovascular health, for patients who carry any degree of elevated risk, patient education, clinical treatment, family support, and personalized lifestyle habits can improve prognosis and change outcomes.
Patients appreciate having their mental health addressed in a similar manner as their physical health. Routine health maintenance in primary care should include mental health and suicide risk reduction. For all health professionals, basic principles included in this handbook will facilitate caring, competent handling of patients who are at risk for suicide.