Part I of II

For three weeks, I've been writing about suicide prevention without defining suicide prevention. I've been assuming that what I mean by that term is interpreted by others in the way I intend. But, given that other terms I use are often interpreted in ways different than what I have in mind (i.e., "social work," most often interpreted as child protection, or "public health," usually thought of as related to epidemic control), it is probably useful to define suicide prevention.

From a public health perspective, which is the perspective that I present in this blog, there are three stages of prevention: primary, secondary, and tertiary.

Primary prevention takes place before suicidal behavior occurs. The target of primary prevention is the cause of suicidal behavior. Strategies including building protective factors, increasing access to mental health services, decreasing access to lethal means, and addressing media coverage of suicide could all fall into this stage.

Secondary prevention takes place as suicidal behavior happens, with the goal of reducing the injury that may occur. Early recognition of suicidal ideation and appropriate referral to a mental health professional are secondary prevention interventions.

Tertiary prevention takes place after suicidal behavior occurs. The purpose is to reduce the severity of the impact. Crisis intervention and therapy are both examples of tertiary prevention.

So, what's the line between prevention and treatment? The camps are often very divided. When can treatment be prevention? When can prevention be treatment?

Thinking about suicide prevention forces us to think beyond the clinical dimensions of mental health, more broadly to the social and environmental arenas, the context of life. The question of why any individual might lose hope is related to the mental health of that individual, but that mental health can be influenced, in part, by social and environmental elements and conditions. Suicide prevention is not limited to manipulating the biology of an individual (through medication) and not necessarily so broad as to include any intervention related to improving well-being.

In the second post on this topic, I'll address three levels of suicide prevention: universal, selective, and indicated.

Copyright 2009 Elana Premack Sandler, All Rights Reserved

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