In the lead up to World Mental Health Day we sat down with Wendy Orchard, Executive Director of the International Association for Suicide Prevention (IASP) as she prepares to hold a virtual March for mental health, to find out what has been the impact of COVID-19 on mental health and what are the global efforts to curb suicide rates worldwide and what resources exist at a time of heightened concerns for people’s mental health.

1. What has been the impact of COVID-19 on mental health and more specifically on suicide-related risks?

There is currently limited evidence about the impact of the Covid-19 pandemic on suicidal behaviour.  Because of a lag between suicide mortality data and the sensitivities that surround suicide, it is likely that the true figures are hidden through underreporting and misclassification. What’s more, there are few data registries on suicide attempt and self-harm globally.

At International Association for Suicide Prevention IASP we are concerned.  Whilst limited, there is evidence relating to previous public health emergencies.  Historically, deaths by suicide increased in the USA during the 1918–19 influenza pandemic. Fast forwarding to today,studies on Severe Acute Respiratory Syndrome (SARS) found an increase of suicide among the elderly associated with social disengagement, mental stress, anxiety, and fears of being a burden on the family.

Mental ill-health, social isolation, entrapment, grieving, loneliness, hopelessness, unresolved anger, stigma, unemployment, financial strain, domestic violence, and excessive alcohol consumption are all known factors that increase suicidal behaviour. The COVID-19 pandemic may be associated according to recent informed commentaries with increase in suicidal behaviour due to these factors.

We are certainly concerned, and as a result IASP have built a Covid-19 Resource Centre which provides information for those seeking resources related to the pandemic and suicidal behaviour. We also are working in partnership with the International Covid-19 Suicide Prevention Research Collaboration (ICSPRC) with the aim to enhance good quality collaborative research on the prevention and management of suicide and suicidal behaviours in relation to the COVID-19 pandemic; and the Covid-19 Resource Centre hosts a COVID-19 suicide research study register with details of current studies being undertaken globally.

2. Every 40 seconds someone takes their life – what needs to be done so that suicide prevention strategies can reach more people who need help?

The reduction of suicide mortality must be a global imperative and a vital public health consideration.

Suicide remains a universal challenge with millions impacted by suicidal behaviour. Suicide is among the top 20 causes of death globally for people of all ages; limited data means the true extent of suicidal behaviour remains hidden.  Associated with this, suicide is far-reaching leaving many affected and/or suffering intense grief.

National, multi-sectorial suicide prevention strategies are essential to address suicide effectively and are a vital tool to help meet targets for suicide reduction.  Around 40 countries, mostly high-income, have developed national suicide prevention strategies which provide a structural framework to support the delivery of a comprehensive and integrated national response to suicidal behaviour (suicide and non-fatal self-harm).

The World Health Organization (WHO) has made preventing suicide a global imperative and encourages all countries to take effective action to prevent suicidal behaviour. But it recognises that there is no single way forward: “the steps a country should take next will depend on where the country is on the way towards suicide prevention”.

Whether it is in high or in lower and middle Income countries, the World Mental Health Day theme “Mental Health For All: Greater Investment – Greater Access” is a call to action to ramp up vital for suicide prevention activities and strategies to effectively reach and help people. IASP joins this global call for action.

3. How has IASP been working to draw attention to the high rates of suicide worldwide?  

For World Mental Health Day this year, IASP is contributing to the world’s first virtual March for Mental Health. This 24-hour virtual event (due to COVID-19) will focus on suicide prevention and mental health with a specific call to urge governments to decriminalise suicidal behaviour so that it can be recognised and treated as a public health issue, bolstering suicide prevention efforts. Join us and come together to call on the world to move on and invest in mental health for all.

In addition to World Mental Health day, there is also a World Day focused on raising awareness of suicide. World Suicide Prevention Day  is IASP’s primary awareness campaign.  As IASP President, Murad Khan said in his message for World Suicide Prevention Day “The theme of this day, ‘Working together to prevent suicide’ highlights the most essential ingredient for effective global suicide prevention: collaboration”.

Preventing suicide requires the efforts of many. It takes family, friends, co-workers, community members, educators, religious leaders, healthcare professionals, employers, political officials and governments.  Suicide prevention requires integrative strategies that encompass work at the individual, systems and community level.

IASP puts out numerous resources around its World Suicide Prevention Day campaign but one of the most important is the resource “Take a Minute” which encourages individuals to reach out to someone in their community as this may change the course of their life.  We find that people are often reluctant to intervene even when they suspect something is wrong. There are many reasons for this, including a fear of not knowing what to say and the worry of making the situation worse. This hesitancyy is understandable as suicide is a difficult issue to address.  There is also amyth that suggests talking about suicide may prompt vulnerable individuals to contemplate the idea or trigger the act. Evidence points to this is not being the case and that the offer of support, and a listening ear, are more likely to reduce distress, instead of exacerbating it.  Take a Minute directs people to reputable resources to help them gain confidence in reaching out to others who may be at risk of suicide.

Similarly, “Step Closer” a short awareness film released this year builds on this with empathy and compassion around the physical metaphor that ‘every step closer can connect someone to life’.

With World Mental Health Day, is an opportunity to reinforce this message to connect with people in distress and that we all have a role to play in preventing suicide by reaching out to a friend or family member.  As ensuring mental health and suicide prevention are included within Universal Health Coverage efforts, we are also eager to join forces to lobbying governments to commit to suicide prevention efforts and develop National Suicide Prevention Strategies.

4. Why is it important to focus on mental health in the SDG2030 agenda?

One billion people across the world are thought to have a mental or substance use disorder and anyone, anywhere, can be affected. Depression alone is on track to be the leading disease burden in the next ten years. 1 in 10 of us have a mental health condition and those with severe conditions die 10 -20 years earlier than the general population. Suicide is claiming the lives of up to 800,000 people every year – 1 person every 40 seconds – and it’s the second leading cause of death for young people aged 15-29 years.

The Sustainable Development Goals (SDGs) were adopted by the United Nations General Assembly in September 2015 and Goal 3 of the SDGs is to: ‘Ensure healthy lives and promote well-being for all at all ages’.   The importance of mental health is finally being recognised universally and this is represented by its inclusion in SDG Target 3.4 to: ‘By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being’ and of suicide prevention, with the inclusion of suicide rate as an indicator (3.4.2).

There has been historical under-investment in mental health globally and access to quality mental health services remains limited for many worldwide. The extra challenges brought by COVID-19 have highlighted the essential part mental health services play.   This is why the call for “Greater Access and Greater Investment” this World Mental Health Day is so timely, we must act now if we are to meet these goals.

5. What are the main barriers to achieve progress on mental health and suicide prevention and how can the private sector help?  

Whilst awareness for mental health and suicide prevention has grown, funding and resources are still lacking.  This funding is all the more at risk with Covid-19 and the prioritisation of competing health concerns; at a time when many people are potentially at greater risk of suffering from conditions that threaten their mental health.  Mental health and suicide prevention must be included in current priorities and funding streams and should be integral to Covid-19 response and recovery plans as highlighted by the UN Policy Brief: Covid-19 and the Need for Action on Mental Health.

Businesses around the world (employers, employees and clients) all have a role to play by prioritising mental health and suicide prevention in the workplace.  With global economic losses estimated to be US$1 trillion per year in productivity due to depression and anxiety, businesses that invest in building and maintaining good mental well-being report higher productivity and sales, more creativity and customer satisfaction.

Workplaces can be a source of well-being and much has and can be done to prioritise mental health and suicide prevention by businesses.  I would encourage all to read the article “A Global Effort in Workplace Health and Safety: Suicide Prevention” by IASP Special Interest Group Co-Chair Sally Spencer Thomas.

Mental health and suicide prevention are therefore not only a government issue or a public health issue but one that we all have a role to play in investing in and moving forward.

Author

• Wendy Orchard