Topic 1: Restriction to access to the means of suicide
“Restriction of Access to Methods of Suicide as a Means of Suicide Prevention”
Professor Keith Hawton
Centre for Suicide Research
University of Oxford, United Kingdom
Professor of Psychiatry and Director of the Centre for Suicide Research at Oxford University. For 35 years he and his research group have been conducting investigations concerning the epidemiology, causes, treatment, prevention and outcome of suicidal behaviour. Current major interests include restriction of access to means for suicide, effectiveness of treatments and services for self-harm patients, self-harm in adolescents, suicide and the media, risk factors for suicide in specific psychiatric disorders, and suicide and self-harm in prisoners. He has published more than 400 papers and chapters and 15 books, including The International Handbook of Suicide and Attempted Suicide (2000), Prevention and Treatment of Suicidal Behaviour: From Science to Practice (2005), and By Their Own Young Hand: Deliberate Self Harm and Suicidal Ideas in Adolescents (2006). Professor Hawton has received the following awards: Stengel Research Award from the International Association for Suicide Prevention (1995); Dublin Career Research Award from the American Association of Suicidology (2000); Research Award of the American Foundation for Suicide Prevention (2002).
Restriction of access to means for suicide is a key element in national suicide prevention strategies. This is because access to means can increase the likelihood of a suicidal act and influence whether or not it is likely to be lethal. The principles of restricting access to means will be described, including the concept of case fatality. The following key approaches of this kind will then be illustrated, together with examples:
1. Withdrawal of method;
2. Making methods safer less toxic
3. Reducing amount of method available;
4. Reducing ease of access to method.
Finally, the issue of how substitution by new methods of suicide and how media reporting of such methods can undermine restriction of access to a particular method will be examined.
“Restricting the Means of Suicide by Charcoal Burning”
Professor Paul Yip
Director and Professor
The Hong Kong Jockey Club Centre for Suicide Research and Prevention
Department of Social Work and Social Administration
The University of Hong Kong, Hong Kong
Professor Yip is the director of the HKJC Centre for Suicide Research and Prevention and a Professor of Social Work and Social Administration at the University of Hong Kong. He is a national representative of the Hong Kong SAR for the International Association of Suicide Prevention (IASP) and a fellow of the International Association of Suicide Research, a consultant for Beijing Suicide Prevention Services, a board member for Suicide Prevention Service (Hong Kong). He has done innovative suicide prevention work in restricting means of charcoal in a community-based exploratory study. He is a pioneer in developing sophisticated surveillance system in monitoring and estimating suicide rate. He has received the Outstanding Research Award, The University of Hong Kong in 2009, a Distinguished Alumni Award, and La Trobe University in 2008 for his excellent research and service on population health. He is also a recipient of an Excellent Research Award "Charcoal Burning Suicide" by the Health and Welfare Bureau of Hong Kong SAR Government, 2007 and a Silver Asian Innovation Award, by Asian Wall Street Journal and Singapore Economic Development Board, 2005.
Charcoal burning suicide by carbon monoxide poisoning has become one of the most frequently used methods in Hong Kong and Taiwan. The profiles of this type of suicide deaths, however, are significantly different from other methods – mainly, employed, middle aged, with financial debt and less mental illness. These suicides are not a replacement of the existing but reflect an attraction of a new cohort into the suicide population. We conducted an exploratory controlled trial to examine the efficacy of restricting access to charcoal in preventing suicides from carbon monoxide poisoning by charcoal burning in Hong Kong. All charcoal packs were removed from the open shelves of major retail outlets in the intervention region for 12 months; in the control region, charcoal packs were displayed as usual. The suicide rate from charcoal burning was reduced by a statistically significant margin in the intervention region (P<0.05) but not in the control region. We observed no significant change in the suicide rate using other methods in either location. Difficulties in how to expand the prevention method to be implemented in the whole community will be discussed.
Topic 2: Suicide across the ages
“Suicide in the Elderly: Psychiatric Disorders and Help-Seeking Behaviour”
Professor Diego de Leo
Australian Institute for Suicide Research and Prevention
Griffith University, Australia
Professor Diego De Leo, Doctor of Science, is the Director of the Australian Institute for Suicide Research and Prevention and Professor of Psychiatry at Griffith University. The Institute is also a World Health Organization Collaborating Centre in Suicide Research and Training, as well as the Commonwealth-appointed National Centre of Excellence in Suicide Prevention. He has been a President of both the International Association for Suicide Prevention (“IASP”) and the International Academy for Suicide Research (“IASR”). He is a member of the Australian Suicide Prevention Advisory Council and is Chair of the Advisory Committee on Data Quality and Evaluation. He is the Editor-in-Chief of the international journal Crisis, and sits on the editorial board of 12 other journals. Professor De Leo has won several national and international awards, including the Stengel Award (IASP), the Life Research Award (SPA), and the Dublin Award (AAS). He has published extensively (in excess of 700 publications, including 250 peer‐reviewed articles, 145 book chapters and 33 volumes). He is the ideator of World Day for Suicide Prevention, taking place every September 10th since its establishment in 2003. Current research interests are represented by improving quality of data, definitional issues, and pathways of care for suicidal people.
Worldwide, suicide in old age has still the highest rates. This presentation will highlight the main characteristics of suicidal behaviour in late life and its differences from other age groups. Trans-cultural diversity will also be reported. Especially, the presentation will examine the principal results of a new collaborative study on the last contact with health care providers before suicide, with particular reference to the presence of mental disorders and attitudes of elderly people to cope with them. These findings have the potential for informing new preventative directions.
“Youth Suicide 2011”
Dr Alan (Lanny) Berman
International Association of Suicide Prevention (IASP)
United States of America
President of the International Association for Suicide Prevention (2009-2013); Executive Director of the American Association of Suicidology (1995-present). Dr Berman served as Director of the National Centre for the Study and Prevention of Suicide at the Washington School of Psychiatry (1991-1995) after a 22 year career (1969-1991), retiring as a professor of psychology at the American University in Washington, DC. He has published (authored/edited) 7 books (including Adolescent Suicide: Assessment and Intervention (2006, 1991); and more than 100 peer-reviewed journal articles and book chapters. He is the recipient of the Dublin and Shneidman Awards from the American Association of Suicidology (respectively for career contributions to suicide prevention and early career research contributions in suicidology) and a Lifetime Career Achievement Award from the Section on Crises and Behavioral Emergencies of the American Psychological Association. He is a fellow of the International Academy of Suicide Research and the American Psychological Association and on the editorial boards of three journals. He maintains a part-time practice of psychological and forensic consultation in Washington, DC.
Youth suicide is a particularly compelling concern for suicide prevention professionals and researchers across the globe. The prevention of suicide among the young demands better understanding of, hence the early detection of, youth at risk, as well as evidence-based programs for reducing that risk. This presentation will briefly overview what is known about youth at risk for suicide and will focus significant gaps in our current knowledge base demanding significant research attention to better accomplish the prevention of suicidal behaviours in this age group.
Topic 3: Assessing and formulating suicide risk
“The Suicidal Patient – Principles of Assessment”
Professor Murad Moosa Khan
Chairman of the Department of Psychiatry
Aga Khan University, Pakistan
Dr Murad Moosa Khan, MBBS, MRCPsych, CST, PhD is Professor & Chairman Department of Psychiatry, Aga Khan University. He has been member of IASP since 1995 and is currently the Chair of National Representatives and Board member of IASP since 2007. His research interests include epidemiology of suicide, mental health of women and elderly, psychosomatic medicine and bioethics. He is the Principal Investigator of Karachi Suicide Study (KaSS), a collaborative study with the Institute of Psychiatry, London, studying suicide in Karachi using the psychological autopsy methodology He is on the editorial board of several national and international journals including Crisis, The International Review of Psychiatry and Shanghai Archives of Psychiatry.
Suicide is a common cause of death, especially in young people and elderly men. Many people who commit suicide have seen a physician shortly before their death, though this may not be so in many developing countries with poorly developed health systems. Suicidal patients may frequently be very depressed and may be abusing alcohol. Unless questioned, they are not likely to reveal these problems to the physician. The assessment of suicidal thoughts or behaviour and its management are topics relevant to all clinicians, not just mental health professionals. Careful assessment of the risk factors for suicide and treatment of depression and alcohol abuse, with the involvement of the patient’s family and friends, could potentially save many lives.
“The Suicidal Patient – Principles of Management”
Dr William Lo
Chief of Service in Psychiatry
Kwai Chung Hospital, Hong Kong
Dr William Lo, MBBS, FRCPsych, FHKAM (Psychiatry), FHKCPsych, is Chief of Service and a Consultant Psychiatrist at Kwai Chung Hospital, Hong Kong. Dr Lo obtained his medical degree from The University of Hong Kong and had received training in Warneford Hospital, Oxford, United Kingdom. He was appointed Consultant Psychiatrist at Kwai Chung Hospital in 1994. He is an Honorary Associate Professor of the Department of Psychiatry, Chinese University of Hong Kong. He is also Honorary Associate Professor of the Family Medicine Unit, LKS Faculty of Medicine as well as an Associate Director of the HKJC Centre for Suicide Research and Prevention, University of Hong Kong. His recent research interests include studies on tolerability, safety and efficacy of newer anti-psychotic medications, mental health recovery and community –based response to suicide clusters. Dr Lo is a general adult psychiatrist and has been a regular clinical teacher to General Practitioners taking Postgraduate Diploma Course in Community Psychological Medicine. It serves to harness GP’s clinical interest hence better professional services to patients with Common Mental Disorders in primary care setting in Hong Kong.
Managing the suicidal patient starts with careful clinical assessment on the risk of suicide and 0treatment needs of individuals concerned. The primary motive, in most cases, is not death but for some other reasons that is embedded in a wide range of psychosocial issues. Treatments of suicidal patient usually include the use of a combination of pharmacological and psychosocial interventions. Involvement of non-medical staff in treatment of suicidal patient who does not require psychiatric admission is of proven value. There is a need to build up a District-based Multi-layered Intervention Service Structure to support a timely and professional community-based response in cases of suicide/attempted suicide including the locations of suicide clusters.