Suicide and suicide prevention: Have we got it wrong?

Introduction:
Suicide is a complex, multifactorial phenomenon, with intersecting: psychological, medical, moral, religious, social, economic, and political facets. Unfortunately, however, it is almost exclusively viewed through a biomedical prism. Colonized thus by public/mental health professionals, alternative and complimentary approaches have been excluded from the discourse. The review questions many basic premises, which have been taken as given in this context, particularly the ‘90 percent statistic’ derived from methodologically flawed psychological autopsy studies.

Aims and Objectives:
Promoting an alternative perspective that suicide is a societal problem, expropriated by health professionals, despite repeated failures of public health interventions like suicide prevention plans in a data-driven mode.

Materials and Methods:

Review of evidence supporting the proposition that suicide is a societal issue, not a mantal health or public health problem.
Results:

The discourse around suicide illustrates the Rashomon effect. Conceptualized as a social issue by Emile Durkheim, suicide came to be framed almost exclusively as a mental and public health problem, amenable to conventional mental health (based on claims that risk assessment could predict and thereby prevent suicides) and public health (like the successful smallpox and polio eradication programmes) interventions. Another myth, based on methodologically questionable ‘psychological autopsy’ studies, posited that over 90% of those committing suicide suffered from a diagnosable mental health disorder which could be prevented through ‘risk assessment’. Consequently, alternative. evidence-based approached have been side-lined by mainstream psychiatry.

Conclusions:

Rising suicide rates despite numerous prevention strategies illustrate the compelling need to reimagine current public/mental health-oriented approaches through an alternative, societal prism. The psychological autopsies-based 90% doctrine is flawed and suicide risk assessment counterproductive.

Digvijay Goel