Break The Cycle: A multi-level approach

by Jim Breen on April 29, 2013

When someone takes their own life, they take with them the power for anyone to help them and every last answer to the countless questions they leave behind. This is what struck home on listening recently to a series of interviews of people bereaved by suicide. These were ordinary people living ordinary lives up until the moment when the extraordinary happened. For them, their lives took an irrevocable turn when their loved ones took an irrevocable route and took their own lives.

So what happens the day after life ceases to be what it once was? Does the word “why” replace the dawn as a new wake-up call to another sleepless night? Are there more holes now in life than threads? Does anger sheath the grief? Or has despair become a backing track to a quiet desolation? We are all born different. We die different. And we grieve different. No two people lost to suicide are the same and no two people living with loss to suicide are the same. It is a multi-level phenomenon with multi-level consequences that requires a multi-level approach – one we must adopt if we are to combat the oozing wound that is suicide. And we can combat it. The battle is already gaining ground. Following the implementation of a multilevel community based suicide prevention programme in Germany (Nuremberg), a 24% reduction in suicidal acts was achieved in a period of two years. In three years this figure increased to 32% with the programme being subsequently rolled out in 73 regions in Germany. This multilevel approach was subsequently rolled out in many other countries and is now endorsed by the European Commission.

The programme’s success is explained in terms of implementing multiple interventions according to a systematic, intensive and sustainable approach. The strategy includes five levels. Out of the five levels, the first two aim to increase professional awareness – training the trainer For instance GPs and mental health professionals (the “gatekeepers”) along with the Gardaí and social workers (community facilitators) need to own an increased awareness and expertise on depression and suicidal behaviour. However, they cannot own this knowledge if it has not been given to them. Similar measures are needed in respect of the third level; namely public awareness. Although, suicide is being talked about more today, we need to talk about suicide in a balanced way and we need to do more. Although the act of suicide itself can never be normalised, the discussion can and this can be achieved with the introduction of helplines of which there can never be enough. We need more internet sites as reference points and we need our media to take a positive involvement against the adversary of mental illness that has the potential to affect every one of us. The fourth strategic level targets our services and interventions which must now  be optimised for the vulnerable and high risk groups; namely those who are self-harming, young and old, those who have survived suicide attempts and those who have been bereaved themselves by suicide. This brings us to the fifth and final level of this multilevel programme – restriction. Restricted access to lethal means of self-harm such as toxic medication along with restricted access to dangerous “suicide spots” need to be imposed. A simple poster on a dangerous bridge with a help number that will be answered on the first ring is what needs to happen. Put plainly, with this strategic tool, reducing and eliminating the number of suicidal individuals who come to that bridge is the ultimate goal.

In Ireland, many of these actions are supported by Reach Out, Irish National Action Strategy for Suicide Prevention and there is scope to integrate the multilevel programme in the Reach Out strategy.

When someone takes their life they leave behind them all the power to help them and take with them every last answer to every last question left behind. This needs to change. We need to change. And we can change. But not without help. Help empowers us collectively to fight the public battle against suicide and help empowers us individually to combat the private struggle within.


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