1. FIVE REASONS WHY WE HAVE NOT BEEN ABLE TO PREVENT SUICIDE Angus H Thompson Department of Public Health Flinders University Suicide Prevention Australia, Adelaide, November 3, 2006

2. “EFFECTIVE” SUICIDE PREVENTION “No single intervention has been shown in a well conducted randomised trial to reduce suicide” (Gunnel & Frankel 1994) “Suicide prevention remains essentially a land of hopes and promises but not of certainties” (de Leo 2002) No evidence found of a demonstrable effect (Alberta Foundation for Medical Research 2003)

3. REASON 1 AN ORGANIZATION WITH “SUICIDE” IN ITS TITLE CANNOT PREVENT SUICIDE!

5. Brain Sculpting Temperament Vocabulary Birth 5 Yrs 10 Yrs 15 Yrs 20 Yrs 25 Yrs Peer Influences Understands Suicide Suicide Ideation Formal Suicide Intervention AGE OF OCCURRENCE OF A NUMBER OF FACTORS RELEVANT TO SUICIDE

6. Figure 3 THE PREVALENCE OF TWO OR MORE TRAUMATIC CHILDHOOD EVENTS BY “COHORT YEAR” AND SEX “Cohort Year” = Date when the youngest person in each group would have been about 15 years of age Source: Thompson AH, Cui X (2000). Increasing Childhood Trauma in Canada: Findings From the National Population Health Survey, 1994/95. Canadian Journal of Public Health, 91(3), 197-200.

7. REASON 2 SUICIDE IS NOT SEEN AS PART OF A CLUSTER OF HUMAN PROBLEMS

8. THE CANADIAN SOCIAL PROBLEM INDEX COMPONENTS Murder Attempted Murder Assault Sexual assault Robbery Suicide Divorce Alcoholism Source: Thompson AH, Howard AW, Yin J (2001). A social problem index for Canada. Canadian Journal of Psychiatry 46, 45-51.

10. THE ASSOCIATION BETWEEN SOCIAL PROBLEMS AND PSYCHIATRIC DIAGNOSES IN THE EDMONTON AREA EPIDEMIOLOGICAL STUDY OF PSYCHIATRIC DISORDERS Source: Thompson A & Bland RC (1995). Social dysfunction and mental illness in a community sample. Canadian Journal of Psychiatry 40, 15 – 20.

11. (r = 0.81) Source: Thompson AH, Borden K, Belton KL. (2004). Intentional & unintentional injuries across health regions in Alberta, Canada: An implication for policy. Crisis 25(4) 156-160.

12. REASON 3 THE MAJORITY OF SUICIDAL INDIVIDUALS EXHIBIT A MENTAL ILLNESS, BUT MOST OF THESE DO NOT RECEIVE TREATMENT

13. Psychological Autopsy Studies Suggest That At Least 90% of People Who Commit Suicide Have a Mental Illness!

14. Psychological autopsies are retrospective in nature Treatment is far from perfect There is an environment by mental vulnerability interaction BUT …

15. REASON 4 SUICIDE PREVENTION PROGRAMS CANNOT “LEARN”

16. “SUICIDE PREVENTION” PROGRAMS RARELY EVALUATE THEIR IMPACTS: Several years required to show an effect

17. “SUICIDE PREVENTION” PROGRAMS RARELY EVALUATE THEIR IMPACTS: Several years required to show an effect Avoidance of personal evaluation

18. “SUICIDE PREVENTION” PROGRAMS RARELY EVALUATE THEIR IMPACTS: Several years required to show an effect Avoidance of personal evaluation Not knowing what one’s job is

19. SELF-REGULATING SYSTEMS AND SUICIDE PREVENTION

20. Gus Thompson Alberta (Co-Chair) Wade Junek Nova Scotia (Co-Chair) Leanne Boyd Manitoba Joseph Kluger Saskatchewan Claire LeBlanc New Brunswick Terry Russell British Columbia Kathryn Sullivan Health Canada (Ex Officio) Susan Moisey Consultant Celebrating Success: A Self-Regulating Service Delivery System for Children & Youth A Discussion Paper Prepared for Health Canada by The Federal/Provincial/Territorial Working Group on the Mental Health and Well-Being of Children and Youth

22. WHAT MAKES A SERVICE DELIVERY SYSTEM SELF REGULATING? FOUR ESSENTIAL COMPONENTS Outcome Measures Feedback Executive Capability Rewards & Incentives

23. SUICIDE PREVENTION REQUIRES THE USE OF LONG, MEDIUM & SHORT-TERM OUTCOME MEASURES 1. HEALTHY DEVELOPMENT 2. PARASUICIDAL BEHAVIOUR 3. COMPLETED SUICIDE

24. REASON 5 WE DON’T KNOW WHY THE SUICIDE RATE IS SO LOW

25. WHY DO WE “GO FORWARD”?

27.  Rose Coloured Glasses  Optimism (Seligman)  Strengthening Behaviour (Skinner)  Traditions (Frankl)  Healthy Brain Development  Control over one's environment  The family  Social Imperative

28. FIVE THINGS TO DO 1. Intervene Very Early (ECD) 2.Address Shared Social Problem Causes 3. Improve Access and Efficacy of Treatment 5. Promote Curiosity, Mastery, Responsibility and Zest for Life 4. Create a System That Can Learn

29. For More Information: Angus H Thompson Dept of Public Health, Flinders University angus.thompson@flinders.edu.au www.socialproblemindex.com http://www.phac-aspc.gc.ca/dca- dea/publications/pdf/celebrating_e.pdf Many Thanks