Dr Alexandra Pitman on preventing suicide through individual care and public health approaches
10 September 2024
To mark World Suicide Prevention Day, we spoke to Dr Alexandra Pitman (UCL Division of Psychiatry) about her clinical academic career in suicide prevention and her suggestions regarding promising interventions.
Every year, the 10 September marks a day to focus attention on the issue of suicide, reduce stigma and raise awareness among organisations, governments, and the public, giving a singular message that suicides are preventable. This year, Dr Alexandra Pitman, Associate Professor in Psychiatry in the UCL Division of Psychiatry will be chairing the webinar to mark the launch of The Lancet Public Health Series on suicide prevention, hosted by the International Association for Suicide Prevention. Dr Pitman, along with a panel of international experts, will discuss suicide prevention in the context of a public health approach and discuss key findings and recommendations from this series of papers.
Dr Pitman has always been interested in mental health. As a medical student on placement in an inpatient psychiatric ward, she recalls being struck by how debilitating mental illness can be and how complex it was to unravel the many influences on mental health and suicidal thoughts.
“The detailed psychiatric assessments we conducted explored so many aspects of the patients’ lives and this was fascinating. It was my on-call shifts during psychiatric training that gave me an interest in researching suicide and self-harm. People presenting in the early hours of the morning with suicidal thoughts seemed so isolated in their distress and many of them had friends or family who had attempted suicide or died by suicide.”
It was in these conversations that Dr Pitman saw the impact of suicide on families and friends and the necessity of services – both practical and psychological – to support and intervene to reduce suicidal distress. “Addressing social factors first, such as unemployment, homelessness, ruptured relationships with children and extreme loneliness is key. For many patients these social factors are their most immediate problems and the issues that make them feel most entrapped, a key driver of their suicidal thoughts.”
Peer support workers and support workers are vital for helping patients to tackle these social factors, from helping to arrange accommodation and benefits payments to giving a structure to their week with visits and social activities. “Without the input of the support workers in our team to address these factors it would be difficult for the clinical psychologists to initiate or make progress with therapy or for the psychiatrists to discuss the role of medication. It is often only after the immediate social factors are addressed do patients feel more ready to engage in therapy to address the more longstanding issues underlying their mental distress and suicidal thoughts, or to discuss medication.” However, Dr Pitman notes that whilst psychosocial support is critical within mental health teams for addressing suicide risk early on, many teams lack the staff who can deliver this, and services need more investment.
In parallel to addressing suicide risk and intervening early at an individual level, it is also important to design and implement suicide prevention strategies at the population level. Among these strategies, evidence shows that ‘means restriction’ approaches are the most effective. Means restriction involves preventing access to the means of suicide. These public health approaches include limiting paracetamol pack size, installing barriers on bridges, firearm legislation, pesticide restrictions, and removing ligature points in workplace, healthcare and educational buildings.
“One of the aspects of means restriction that I am working on currently is the cognitive availability of suicide: this is the awareness of suicide as an option and knowledge of possible methods. I am interested in the sometimes misleading information that people have available to them about specific methods. There is a lot of work to do in terms of understanding these influences, and in limiting exposure to detailed technical information about specific methods and inaccurate portrayals of how much pain could be involved.”
Means restriction is one of the topics that will be covered in The Lancet Public Health Series on suicide prevention and will also be featured in the launch webinar on World Suicide Prevention Day 2024. Other approaches that will be covered in the webinar include interventions delivered in schools, and interventions delivered after suicide bereavement.
“We hope that this series of articles will be a really valuable resource for public health professionals in helping to implement changes at a societal level that will reduce suicidal distress and premature deaths”.
About World Suicide Prevention Day
World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention (IASP) in conjunction with the World Health Organization (WHO). The 10 September each year aims to focus attention on the issue, reduces stigma and raises awareness among organizations, governments, and the public, giving a singular message that suicides are preventable.
If you are affected by any of the issues raised, there are services that can help:
- The Samaritans are open every day of the year, you can phone them for free on 116 123 or email jo@samaritans.org (response time: 24 hours)
- Shout 85285 is a free, confidential, 24/7 text messaging support service for anyone who is struggling to cope
- Mind, the mental health charity, offers support by phone at 0300 123 3393 or online
- The NHS mental health information and support website.
- The Support After Suicide Partnership provides a directory of services available nationally to people bereaved by suicide.
Related
- Dr Alexandra Pitma's academic profile
- UCL Division of Psychiatry
- Lancet Public Health Series on Suicide Prevention