Possibilities for prevention Communitybased suicide prevention

The principal public health approaches to suicide prevention have been as follows:

• crisis hotlines

• method control

• media counselling to minimize imitative suicide

• indirect case-finding by educating potential gatekeepers, teachers, parents, and peers to identify the 'warning signs' of an impending suicide

• direct case-finding among high-school or college students or among the patients of primary practitioners by screening for conditions that place teenagers at risk for suicide

• training professionals to improve the recognition and treatment of mood disorders. Crisis hotlines

Although crisis hotlines are available almost everywhere in the United States, research so far has been fairly limited and has failed to show that they impact on the incidence of suicide/49 Possible reasons for this include the fact that actively suicidal individuals (males and individuals with an acute mental disturbance) do not call hotlines because they are acutely disturbed, preoccupied, or intent on not being deflected from their intended course of action. It also seems that the large majority of callers are females, whereas males are at the greatest risk for suicide, that crisis lines are often busy and there may be a long wait before a call is answered so that callers disconnect, and that the advice that individuals receive on calling a hotline may be stereotyped, inappropriate for an individual's needs, and perceived as unhelpful by the caller.

While each of these deficiencies is potentially modifiable, to date there have been no systematic attempts to do so. Research studies in this area have been sparse and are sorely needed.

Method restriction

Method preference varies by gender and by nationality. In the United States, the most common method for committing suicide is by firearm, and it has been suggested that reducing firearm availability will reduce the incidence of suicide. However, in a natural experiment in the United Kingdom, when self-asphyxiation with coal gas became impossible after the introduction of natural gas, the decline in the suicide rate was marked but short-lived. There is, as yet, no good evidence that reducing access to firearms by gun-security laws has a significant impact on suicides attributable to such, although they do impact on accidental and homicidal deaths from firearms.(50)

Media counselling

The United States Centers for Disease Control have issued sensible guidelines for reporters and editors, pointing to the risks of exaggerated or prominent coverage of youth suicide in general, and of the risks in focusing attention on an individual suicide. (!!) These sensible guidelines should be known to child clinicians who are engaged in public-health practice, even though there is, as yet, no good evidence that their application is effective in reducing the suicide rate.

Indirect case-finding through education

Controlled studies have failed to show that classes for high-school students about suicide increase students' help-seeking behaviour when they are troubled or depressed.(51> On the other hand, there is evidence that previously suicidal adolescents are perturbed by exposure to such classes. (5!> Such educational programmes seem, therefore, to be both an ineffective mode of case-finding and to carry with them an unjustified risk of activating suicidal thoughts.

Direct case-finding

If asked in a non-threatening way, adolescents will provide accurate information about their own suicidal thoughts and/or behaviours. (21.) Therefore a sensible approach to suicide prevention is to systematically screen 15- to 19-year-olds (the age group at greatest risk) for previous suicide attempts, recent serious suicidal preoccupations, depression, or complications of substance or alcohol use. Youths identified in this way should be referred for evaluation and, if necessary, treatment.

Training primary care physicians and gatekeepers in the recognition and treatment of mood disorders

Preliminary and, as yet, unreplicated studies in Sweden(52) suggest that education of primary practitioners to identify the characteristics of mood disorders better and to treat these effectively produced a significant reduction in suicide and suicide-attempt rates in women. Because the optimal treatment of adolescent depression is not as well understood as that of adult depression, this is an option that may prove to be useful, but further work is needed.

Funny Wiring Autism

Funny Wiring Autism

Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.

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