An interesting article by Moutier in the Journal of the American Medical Association Psychiatry October 16, 2020 discusses this topic.
Moutier suggests that suicide was a leading cause of death with devastating emotional and societal costs prior to the COVID-19 pandemic.
Moutier suggests that as a result of the pandemic, the risk of population suicide increases as a result of the pandemic effect on a number of well-established suicide risk factors.
Prior to the pandemic, many countries were engaged in suicide prevention strategies and although the overall global burden of suicide deaths had increased, some national efforts were beginning to see positive results.
Additionally, the gap between mental health needs and services had been increasing in many nations.
With the added physical and mental health, social, and economic burdens imposed by the pandemic, many populations worldwide may experience increased suicide risk.
Data and recent events during the first six months of the pandemic, revealed specific effects on suicide risk. However, increases in suicide rates are not a foregone conclusion even with the negative effects of the pandemic. In fact, there is some emerging suicide data from several countries which shows no evidence of an increase in suicide during the pandemic so far. Moutier goes on to conclude that suicide prevention in the COVID-19 era requires not only addressing the pandemic specific suicide risk factors, but also pre-pandemic risk factors.
Threats to suicide risk presented by the current pandemic can be categorised into eight areas, each with mitigating strategies.
1. Mental Illness
Healthcare systems and individual clinicians
- Could provide suicide preventative care delivery with improved access.
- Training in suicide prevention and culturally appropriate care.
- Support for healthcare staff and frontline workers.
- Adequate resourcing for a zero suicide framework.
- Isolation, loneliness and bereavement.
- Could support those living alone.
- Mobilise community services.
Friends and family
- Have regular check ins.
Mental Health Services and Clinicians
- Ensure could provide access and ensure availability.
2. Suicidal Crisis
Healthcare systems and individual clinicians
- Could develop risk assessments and clear care pathways.
- Provide evidence based interventions.
- Maintain support and increase their work forces.
- Could increase resourcing for crisis services.
- Could increase alternative crisis resources to replace law enforcement response.
3. Access Means
- They could provide suicide prevention training and vigilance working with distressed individuals.
Governments and non-governmental organisations
- Could provide messaging to ensure that the home and workplaces are safe.
Healthcare systems, emergency departments, primary care physicians
- Could have counselling on providing access to lethal means training.
4. Alcohol Consumption
- Monitor intake.
- Provide messages regarding safe drinking.
- Increase access to Alcoholics Anonymous and other services.
The alcohol industry and non-governmental organisations
- Could provide campaigns regarding safe drinking and crisis resources.
5. Financial Stressors
The government could provide
- Financial safety net.
- Ensure long term measures were in place.
6. Domestic Violence
The government could ensure
- access and support.
- Non-traceable call/testing.
7. Irresponsible Media Reporting
- Media professionals could provide safe reporting in line with existing suicide and mental health messaging.
The author asserts that as suicide is multifactorial with well-established risk factors and there exists evidence of effective suicide prevention strategies, they assert that outcomes related to suicide can be greatly influenced by investments and actions taken now and in the coming months on the part of policymakers, healthcare and community leaders and citizens.
They assert that this is a moment in history when suicide prevention should be prioritised as a serious public health concern.
They continue to argue that specific strategies should be implemented with specific COVID-19 threats to the population with mental health and suicide risk in mind.
The London General Practice continues to monitor the welfare of its population and has close contact with all professionals, including counsellors and psychiatrists involved in mental welfare. It provides a 24-hour service and is able to react immediately in the event of any unforeseen circumstance.
Dr Paul Ettlinger
The London General Practice