with alcohol problems, suicide awareness, prevention strategies, and a counseling program were all placed into service in the community via the counselors of the alcohol treatment program and with support from other mental health professionals and educators. Five years later the suicide rate in this community had fallen 10-fold, from 267 per 100,000 to 26.7. In addition, the overall violent death rate dropped from 253 per 100,000 to 109 (Fox et al., 1984; Ward, 1984). For a critical review of these and other suicide prevention programs among American Indians and Alaska Native communities, see Middlebrook et al., 2001.

International Programs

Lessons from Finland

Finland countered its unusually high rate of suicide (see La Vecchia et al., 1994) by establishing the world’s first nationally implemented, research-based comprehensive suicide prevention program. Organized into a research (1986–1991), implementation (1992–1996), and evaluation (1997–1998) phase, Finland’s National Suicide Prevention Project has offered itself as a learning opportunity for the world’s suicidologists. Both internal and external international teams have evaluated the project, and the United Nations/World Health Organization guidelines (1996) have included the model as a prime example for others to follow. Finland saw a peak in suicide rates in 1990 before project implementation, and then a 20 percent reduction between 1991 and 1996. The suicide rate has since stabilized at 9 percent below pre-project levels (Beskow et al., 1999).

The Suicide Prevention Project seeks to combine reducing suicide and promoting mental health, and therefore includes selective and indicated strategies, such as improving responsibility and cooperation between health services agencies, and universal measures such as enhancing individuals’ inner resources and living conditions. A foundational strategy involved building a national network of contact persons, primarily in health care, but also in the social services, churches, and police and rescue departments. Many prevention components arose from this network as schools and churches developed prevention projects specific to their settings, for example. National policy created better care for suicide attempters, increased knowledge among members of the media about suicide and mental illness, and promulgated media guidelines for reporting on suicide. Furthermore, the national players created an organizational frame for increased mental health research. An acclaimed national depression program targeting the general population that features coordinated basic and specialized services for all ages has also arisen from the Suicide Prevention Project.

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