grams to reduce the discrimination faced by those with mental illness, many will forego potentially life-saving treatment.

Evaluating the problem of suicide globally is especially difficult because of the variability in the reporting of suicide and inadequate databases in developing countries. As described in Chapter 6, rates may be under-reported in countries where the predominant religion prohibits suicide, such as Catholicism in Ireland, because of the greater stigma (Kelleher et al., 1998; Myers and Farquhar, 1998). Furthermore, the reporting process can differ significantly and introduce additional artifacts. In developing countries, no registries may exist. The lack of accurate accounting for deaths by suicide makes assessment of risk factors and of effectiveness of interventions difficult if not impossible. Under-reporting and consequently underestimating the magnitude of the problem can reduce the effort and resources applied to finding solutions.

FINDINGS

  • Stigma represents a major barrier to reducing suicide. The stigma against mental illness results in diminished opportunities and lower self-esteem. Stigma prevents people from seeking treatment for symptoms of mental illness. Untreated mental illness increases suicide risk.

Approaches to reduce the stigma associated with mental illnesses and their treatment must be sought.

  • Most people who complete suicide had contact with a health professional within a year of their death, 40 percent within a month of their death. Screening for depression or substance abuse is not routine in primary care. Even when depression is accurately diagnosed, only a minority of patients receives adequate treatment. Primary care physicians lack training and evidence-based screening, assessment, and referral practices for suicidality.

Professional evidence-based guidelines for suicide risk screening, assessment, and referral need to be developed and implemented into primary health care settings. Screening, treatment, and referral for the major suicide risk factors depression and alcohol abuse disorders should be conducted in primary health care settings.

  • Many individuals cannot access proper care for mental illness because of the fragmentation of services. This particularly affects those with co-occurring substance use.

Mental health services, including treatment for substance use disorders, should be delivered in an integrated fashion.



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