Linking mental illness and suicide: suicide is a leading cause of death worldwide. World Mental Health Day next month focuses on the links between mental illness and suicide.

More people die by suicide each year than are killed by homicide, wars and terrorist attacks combined. In 2001, murder claimed 500,000 lives and war 230,000 lives, compared with approximately one million suicide deaths, according to the World Health Organisation (WHO). (1) Estimates suggest the number of suicides could reach 1.5 million by 2020. Worldwide, suicide ranks among the three Leading causes of death for people aged 15 to 44. Experts estimate that for every completed suicide, at least 20 times as many suicide attempts occur. (1)

In New Zealand in 2003, the latest year for which statistics are available, 515 people died by suicide, compared with 465 in 2002. (2) In 2003, the road tote was 461. (3) The age-standardised suicide rate was 11.5 deaths per 100,000 population but Maori suicide rates were higher. For Maori males and females, the age-standardised rates were 21.1 and 6.4 deaths per 100,000 population respectively; and for non-Maori males and females they were 15.6 and 5.9 deaths per 100,000 population respectively. (2)

October 10 is Word Mental Health Day and this year's theme is Building Awareness/Reducing Risk: Mental Illness and Suicide. The World Federation for Mental Health (WFMH), which coordinates the day, has initiated an awareness and educational campaign that highlights the rote mental illness, including substance abuse and dependence, can play in risk for suicide. Studies in Europe and the United States reveal that up to 90 percent of individuals who died by suicide evidenced some form of mental disorder, including alcohol and drug abuse. In the United Kingdom, 50 percent of all suicide cases occured in current or former diagnosed psychiatric patients. The lifetime risk for suicide among people experiencing mood disorders is six to 15 percent, white for schizophrenia the risk is four to ten percent. A national audit in the United Kingdom found that 25 percent of those who died by suicide had been in contact with mental health services in the East 12 months. Of these, 16 percent were psychiatric inpatients and 24 percent had been discharged from inpatient care in the last three months.

Non-compliance with treatment and loss of contact with services are common factors in death by suicide, according to the WFMH. "It is clear that those suffering from mental illness are much more likely to die by suicide if they are not being treated or are receiving inadequate treatment. This fact should give all involved in the mental health care community a renewed sense of urgency in the work they are carrying out all around the world," the WFMH states in its campaign introduction.

It calls for both health care and public health initiatives to tackle suicide among those with mental illness. Prompt diagnosis of those with mental illness, adequate treatment and comprehensive rehabilitation programmes, along with public health approaches emphasizing that mental illness is treatable and suicide preventable, were important ways of reducing suicide deaths.

Key messages

The federation's key campaign messages include the fact mental health is a major risk for suicide; treatment of mental illnesses can reduce suicide risk; myths that surround suicide need to be exposed; rapid, easy access to helping resources must be available for people in imminent danger; responsible and informed media coverage is critical to community awareness; and the cultural context of suicide and mental illness is important. The myths the federation wants exposed are: that people who talk about suicide won't really do it; that if a person is determined to kill him/herself, nothing can stop him/her; and that talking about suicide may give someone the idea.

In its campaign material on the relationship between suicide and mental health, the federation looks at some of the major types of mental disorders and describes how they may increase the risk of suicidal behaviour in people with these disorders. A Finnish study of people diagnosed with depression found that key indicators for suicide included previous self harm; severity of the illness; alcohol or drug abuse; serious or chronic physical illnesses; lack of a partner, anxiety, and personality disorders.

Other links between mental illness and suicide include an elevated suicide risk among women suffering severe postpartum depression; the suicide risk for those who suffer bipolar depression is 15 times higher than that of the general population; an estimated four to ten percent lifetime risk for suicide among those with schizophrenia and a 40 percent lifetime risk of suicide attempts; and eating disorders have the highest mortality rate of any mental illness, including both suicide and death from direct complications of the eating disorder.

The WFMH's campaign material also includes articles on mental illness and suicide across the lifespan, on how suicide risk can be reduced for people with mental illness, on mental illness and suicide in the media, and on cultural and religious issues influencing suicide and mental illness. It also contains a fact sheet on the warning signs of suicide. According to the federation, the strong and most disturbing signs are verbal eg "I can't go on", "Nothing matters any more" or "I'm thinking of ending it all". Other common warning signs include becoming depressed or withdrawn; behaving recklessly; getting affairs in order and giving away valued possessions; showed a marked change in behaviour, attitudes or appearance; abusing drugs or alcohol; and suffering a major loss or life change.

More information on the federation and World Mental Health Day can be obtained from: www.wfmh.org.

References

(1) World Federation for Mental Health. (2006) World Mental Health Day. Building Awareness Reducing Risk: Mental Illness and Suicide. Virginia, USA: World Federation for Mental Health.

(2) Suicide Prevention Information New Zealand. (2006) Suicide Facts: Provisional 2003 All-Ages Statistics. www.spinz.org.nz/pages.php?p=53. Retrieved 29/08/06.

(3) Land Transport New Zealand. Road Death Statistics. www.ltsa.govt.nz/research/fata15yr.html. Retrieved 29/08/06.