Evidence-Based Approaches to Decreasing Suicidality in Young People: Preventive Social Practices to Support SDG 3.4.

According to the World Health Organization (2019), 700k. people commit suicide each year, and many more attempt it. Every suicide is a tragedy that profoundly impacts the survivors, including the families, communities, and entire nations. Since it is the fourth leading cause of death among 15-29 year-olds, young people are most at risk. The highest global suicide rate among young people in 2017-2019 was recorded in Guyana, followed by Micronesia and Lesotho in southern Africa (WHO, 2019). Estonia, Lithuania, and Finland have the highest suicide rates in Europe among young people (EuroStat, 2019). In the US, adolescents and young adults have a suicide rate of around 15 cases per 100k. which is still relatively high compared to other countries (American Foundation for Suicide Prevention, 2020). Among the Central Asian countries, Kazakhstan is taking a leading position with around 15 cases per 100k. (WHO, 2019).

Undoubtedly, suicide is a global health issue that transcends borders, impacting individuals across nations, cultures, religions, genders, and socioeconomic classes. The leading factors contributing to most suicide cases in high-suicide-rate countries are acknowledged to stem from a blend of psychosocial factors, including mental disorders, poverty, access to pesticides, alcoholism, violence, interpersonal conflicts, and insufficient access to psychological support (World Population Review, 2019).

The World Health Organization prioritizes reducing suicide mortality as a global goal. In 2013, the Sixty-sixth World Health Assembly adopted the first-ever Mental Health Action Plan, introducing suicide prevention as an integral part (WHO, 2013). Moreover, the indicator of the target has been included in the United Nations Sustainable Development Goals (SDGs) under target 3.4. It states, that

"by 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being"

where indicator 3.4.2. is focused on the suicide mortality rate (WHO, 2020).

The decade of 2020s has finished and we already may witness the effectiveness of action measures that countries under the surveillance of the World Health Organization had provided. The statistics show that the rate has decreased by 9.8% in the six years between 2010 and 2016 (WHO, 2020). Even though the global suicide rate is somewhat in decline, it is important to declare that such a picture is not observed in all countries worldwide. As the majority of suicides are known to occur in low- and middle-income countries, it is not vividly possible to retrieve needed data for representing a 'real' picture. The World Health Organization (WHO, 2020; WHO, 2021) continues appealing to all countries to improve the surveillance of suicide as an important aspect, as it helps to inform planning and evaluation in countries and to accurately assess progress towards global suicide mortality targets.

Since prevention is recognized as an effective way to reduce suicide cases, social services put all their effort to combat it. This article intends to introduce some methods and approaches in the work of suicide prevention, the role of social work in prevention, and the potential for progressing SDG #3 to contribute to reducing the suicide rate worldwide.

METHODS AND APPROACHES IN THE WORK WITH THE SUICIDAL YOUTH

When discussing the topic of suicide, many people focus on the clinical approach to the psychosocial treatment of suicide. Indeed, suicidal ideation, self-harm, and suicide attempts are linked to a range of detrimental effects as they pose immediate threats to an individual's life and well-being. Additionally, these behaviors often contribute to long-term psychological distress, strain interpersonal relationships, and may lead to enduring emotional and physical consequences for the individuals. The use of mental health services, the diagnosis of a mental disorder, and adult suicide are all more likely in those who had attempted suicide as adolescents (SAMHSA, 2020).

While clinical approaches are vital, a holistic view that incorporates community support and addresses social determinants of mental health is equally essential for a well-rounded approach to suicide prevention and treatment. Researchers identify the following evidence-based suicide prevention methods to be the most impactful and effective - restriction of access to lethal means of suicide, pharmacological and psychological treatment, and school-based prevention programs (Zalsman et al., 2016; Wasserman, 2019). This may include programs on medication treatment, psychosocial treatment, different tools of assessment for evaluation of suicide risks, as well as school-based programs, gatekeeper training, and a suicidal awareness campaign.

Safe Alternatives for Teens and Youth (SAFETY) is a 12-week family-oriented treatment designed to build skills, increase safety, and reduce the risk of suicide attempts. Within each young person, their families, and other social systems, this approach increases protective characteristics while lowering risk variables. The main emphasis of the schedule is a young person who sees one therapist while parents also see a separate therapist. Then, children and families gather together to put the skills they have decided are crucial for preventing further suicide attempts into practice. This treatment is distinctive in that it may be carried out either in an outpatient environment or in the client's home, where different social service staff, including social workers, play a vital role in the treatment of suicidal ideation and attempts by providing crucial emotional support, conducting risk assessments, and connecting individuals with appropriate mental health resources.

Since universal suicide prevention typically occurs under the umbrella of curriculum-based education initiatives, they attempt to give interventions to the entire student body through the academic program. The research conducted by Singer et al. (2019) underscores the pivotal role of a social worker as a specialized professional collaborating with adolescents and their families. Their responsibilities include crafting safety plans, facilitating connections with relevant mental health services, and delivering continuous support and counseling.

In school settings, the following prevention program had high achievements - the Signs of Suicide (SOS) Middle School and High School Prevention Programs in the US. SOS is a program for preventing adolescent suicide that has scientific backing and has helped students better comprehend suicide risk and develop positive attitudes toward it. SOS provides materials to help schools, parents, and communities identify at-risk adolescents and take the required action while also teaching students how to spot the warning signs of depression and other mental health deviations as well as suicide in themselves and their peers. Moreover, according to the assessment of SAMHSA (2020), SOS showed a reduction in self-reported suicide attempts by 40%.

In fact, school-based programs bring much-needed evidence on how interventions for suicidal youth can be implemented. One such example would be the national Saving and Empowering Young Lives in Europe (SEYLE) program, where professionals and researchers conducted research on evaluating risk behavior prevention interventions among school students from 11 European countries from 2009 to 2011. The uniqueness of this program was that SEYLE generated an extensive database containing information about socio-demographics, risk factors, lifestyles, and the status of mental health of adolescents in Europe. And even though, the primary setting was at school, it still serves as evidence-based proof of the importance of implementing preventive interventions at any level of the Ecological system including community, interpersonal, and individual environments (Wasserman, 2016).

Kazakhstan ranked highest in adolescent suicide among neighboring countries (21.7) in 2016, with high rates of attempted suicides among school students and a significant percentage at risk (World Bank, 2016). The Adolescent Mental Health and Suicide Prevention program (AMHSP) (UNICEF, 2018) was tested in Kazakhstan's pilot districts from 2015 to 2017 as a solution to this issue, with the assistance of UNICEF Kazakhstan. The final evaluation of the intervention demonstrated the success of the AMSHP pilot program. WHO statistics show a significant reduction in suicide rates in 2019, with students experiencing reduced suicidal ideation, stress, and anxiety. The pilot program improved sociability, academic performance, coping with aggression, bullying, self-development, and improved school psychologist status (UNICEF, 2018).

While certain approaches share common theoretical foundations and often target similar mechanisms, these practical and intervention-oriented strategies underscore the imperative of comprehensive prevention and treatment measures. Their applicability across diverse contexts emphasizes the necessity of addressing suicidal or self-harm behaviors in young individuals, irrespective of their prior histories, through varied forms and agendas.

SOCIAL WORK PRACTICE IN THE PREVENTION OF SUICIDE

Due to social workers' dual focus on the individual and their environment, social work considerably differs from other occupations. While social workers deal with the outside factors that affect a person's position and outlook, they also offer opportunities for evaluation and intervention, help clients and communities successfully adapt to their reality (Mccave&Rishel, 2010).

It is crucial to recognize that in the realm of suicide prevention, social workers are typically not involved in prescribing medications or implementing measures to establish protective infrastructure or restrict access to lethal means. These actions, proven to be highly effective in reducing suicide risk, fall outside the purview of the typical responsibilities of social workers in this context (WHO, 2014). Contrarily, social workers excel in harm minimization through practices such as routine home visits, surveillance, education, problem-solving therapy, and media outreach (WHO, 2014).

The importance of a social worker in suicide interventions has increased over time. The literature review highlights the importance of school social workers in educational settings and the need for them to continually improve their abilities to effectively handle issues, such as juvenile suicidal behavior, in particular. An exploratory study on the experiences of school social workers with youth suicidal behavior in American schools discovered that these school social workers were able to help at least one student who made suicide threats (88%), attempted suicide (50%), was hospitalized for suicide risk (64%), or actually died by suicide (10%) (Singer&Slovak, 2011).

Scott and Guo (2012) identified a number of school-based interventions which were mainly focused on issues such as raising awareness of suicide, encouraging behavioral change, and coping strategies, and were usually delivered by school staff or social workers. Despite good intentions, out of ten suicide prevention programs, only two programs that focused on behavioral change and coping strategies in the general school population demonstrated lowered suicidal tendencies and improved coping ability. The authors explained it that methodological limitations meant that the results from these studies were difficult to compare and the soundness of conclusions based on such studies may be questioned. However, they believe, that the importance of the program cannot be underestimated but require more impact.

This could also have something to do with social workers' ongoing capacity to hone the abilities required to evaluate the resources and risk factors that might present in the child's home, the neighborhood, and the wider social environment. Here, the emphasis on intervening action is placed on the context of the mezzo and macro levels rather than the individual level. These intervention strategies may really entail methods for bringing about change in a variety of contexts, such as the classroom or school, the peer group, the neighborhood, or the general populace.

CONCLUSION

Based on the evidence-based examples presented in this article, youth suicide emerges as a complex societal challenge warranting thorough study, research, and analysis to identify effective solutions. Numerous researchers emphasize the preventable nature of suicides and advocate for policymakers and stakeholders to prioritize comprehensive suicide prevention programs on both national and local scales.

Together with educationalists and mental health service providers, social workers are also uniquely positioned to identify and intervene with at-risk youth in educational and community settings, providing support for those who are at risk or/and affected by suicide. However, their role lacks clarity and prioritization. Strengthening social work practices includes individual and family counseling, connecting clients with resources, and providing crisis intervention. In addition, social workers can offer collaboration with school personnel, mental health professionals, police, and community members by being included in multidisciplinary teams to better address various youth issues which are crucial for preventing adolescent suicide.

All these preventive interventions and practices have the potential to frame the foundation for effective measures in support of the 2030 Agenda and Goals (WHO, 2020) which generally provide a global vision for sustainable development and intersectoral action from multiple stakeholders which aim to strengthen health and social systems. In addition, more scientific research should balance health, social, and environmental determinants for monitoring and evaluation of progress toward Sustainable Development Goal 3.4. and other social-related indicators.

The research on suicide prevention and its relevance for social work remains profoundly significant even beyond 2030. The study not only encapsulates the multifaceted approaches required for effective suicide prevention but also sheds light on the pivotal role of social work in implementing these strategies. Its findings and recommendations emphasize the necessity of integrating mental health and suicide prevention modules within social work education curricula. Moreover, the study underlines the importance of SDGs, particularly Goal 3, and highlights how addressing mental health concerns, including suicide prevention, is integral to achieving broader global development goals.

The ongoing significance of this research lies in its perpetual relevance, as the global community continuously strives to minimize the prevalence of suicide through interdisciplinary approaches, with social work education being a crucial component in fostering sustainable change beyond the set target year of 2030.

References

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