CASE STUDY

Suicide Rate in Jackson, Mississippi: Primary Care and Public Health Perspective

Suicide Rate in Jackson, Mississippi: Primary Care and Public Health Perspective

Introduction

Approximately 1 million people die from suicide currently per year: a 'global' mortality rates of 16 per 100 000, or one death every 40s. In the last 45 years, suicide rates have increased by 60% worldwide, although there was a trend towards a reduction of suicide rates in the last few years. Suicide rates are particularly high in the Russian Federation and other former Soviet states (e.g. 30.8 per 100 000 inhabitants in Lithuania, 2007 estimate) and relatively low in Mediterranean countries (e.g. 3.5 per 100 000 inhabitants in Greece, 2006 estimate). Latest available figures indicate that the US suicide rate is 6.4 per 100 000 per year.

Background of the Study

There are two main methods for suicide prevention: population-based strategies and intervention-based strategies in high-risk groups. To date, the population-based strategies that have shown promise in reducing suicide can be summarized as follows:

Restriction of access to means to suicide. For example, alcohol, firearms, toxic over-the-counter medicines, carbon monoxide and access to suicide hot spots.

Issuing media guidelines on reporting suicides.

Psychological education.

Training primary care workers in the screening and detection of patients with a high risk of suicide (Langwith, 2008).

Secondary prevention, namely intervening after someone has self-harmed to prevent repetition and subsequent death by suicide, is also possible. Psychological interventions such as problem-solving cognitive behavior therapy (CBT) and other community-based psychotherapy can have a small impact. The roll-out of wider access to CBT through the government's flagship Improving Access to Psychological Therapies only began in autumn 2009 (Pedahzur, 2006).

The growing concerns over the upward trend in suicide rates in the American community in the mid-1990s led the Department of Health to set a working party to report on this phenomenon (Lester, 1997). In its White Paper 'Saving lives: Our Healthier Nation', the government set out a target for the reduction of suicides in the US by at least a fifth by 2010—saving up to 4000 lives in total. A National Suicide Prevention Strategy put in place for achieving this target (Ougrin and Low, 2008).

The Healthcare Commission set out 32 performance indicators for primary care trusts (PCTs) to monitor the quality of their services in 2007/08. The performance indicators include establishing a suicide audit and prevention group to coordinate local suicide surveys and audits and develop local action plans or suicide prevention strategies. This group expected to include representatives of the PCTs, Mental Health Trusts (MHTs) and public health specialists. Some PCTs also introduced a system to support family doctors to conduct suicide reviews following suicides in their practice population (Ougrin and Low, 2008). However, these developments were not universal and many PCTs fall short of these standards. It may be that the lack of a whole-system approach to suicide underpins these deficits.

Whereas suicide by people with mental illness comprehensively monitored by national level of institutions into suicide and homicide, the primary care and public health aspects of suicide have been relatively under-researched (Halbwachs, ...