The pathways to suicidal behaviour are often long and complex. Therefore, treatment and prevention of suicidal behaviour require attention to a range of broad and specific strategies. A variety of treatments have been developed, evaluations of which provide some guidelines for clinical practice, but there is a major need for large-scale treatment studies which will provide definitive results.

While there are general strategies for suicide prevention which are probably relevant to most communities (e.g. reducing the availability of means for suicide), specific local cultural factors will necessitate emphasis on particular strategies in certain countries. There is a general trend towards establishment of suicide prevention programmes in many countries. This is to be welcomed, not only because of the potential benefits in terms of suicide prevention, but also because of the likely benefits for the broader population of individuals with mental health problems.

It is too soon to know the extent to which national suicide prevention programmes are effective. The most impressive programme is probably that which has been developed in Finland. It is based on information from a detailed national study of all suicides in one year and includes a wide range of elements. The recent decline in the Finnish suicide rate has been attributed to the programme.(68) National suicide targets were set in the early 1990s in the United Kingdom, (69) since when suicide rates have also declined.(64) Thus, while prevention strategies are difficult to evaluate (7°) and have been assessed rather pessimistically by some authors, (7!> there is now reason to be more optimistic that programmes for prevention of suicide on a national scale can be effective.

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