Experts demand urgent government action to prevent coronavirus suicide risk

Experts have warned that governments need to give “urgent consideration” to their public health response to prevent any possible impact of the coronavirus pandemic on the number of suicides.

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There growing concern about the far reaching impact Covid-19 may have on people’s mental health, with the consequences likely to be present for longer and peak later than the actual pandemic.

Forty two researchers from around the world, including Professor Ann John, Deputy Head of Swansea University Medical School, have formed the International COVID-19 Suicide Prevention Research Collaboration.

Ann John, who is also Chair of the National Advisory Group to Welsh Government on suicide and self-harm prevention, said “We don’t know yet whether the Covid-19 pandemic and the measures taken to curb it will affect suicide rates but we do know that suicide is potentially preventable if we take action to mitigate those effects now rather than later.

“Those actions range from supporting those who are lonely and vulnerable including those on the frontline, young people and the bereaved to responsible media reporting and economic policy.”

Writing in The Lancet Psychiatry, the researchers said “Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups. Preventing suicide therefore needs urgent consideration. The response must capitalise on, but extend beyond, general mental health policies and practices.”

There is some evidence that deaths by suicide increased in the US during the 1918–19 Spanish flu pandemic and among older people in Hong Kong during the 2003 SARS epidemic. The current context is different and evolving.

The researchers said “A wide-ranging interdisciplinary response that recognises how the pandemic might heighten risk and applies knowledge about effective suicide prevention approaches is key. Selective, indicated, and universal interventions are required.”

They said the likely adverse effects of the pandemic on people with mental illness, and on population mental health in general, might be exacerbated by fear, self-isolation, and physical distancing.

They wrote “Suicide risk might be increased because of stigma towards individuals with COVID-19 and their families. Those with psychiatric disorders might experience worsening symptoms and others might develop new mental health problems, especially depression, anxiety, and post-traumatic stress (all associated with increased suicide risk). These mental health problems will be experienced by the general population and those with high levels of exposure to illness caused by COVID-19, such as frontline health-care workers and those who develop the illness.”

The consequences for mental health services are already being felt, for example through increased workloads and the need to find new ways of working.

The researchers said “Some services are developing expertise in conducting psychiatric assessments and delivering interventions remotely (eg, by telephone or digitally); these new working practices should be implemented more widely, but with consideration that not all patients will feel comfortable with such interactions and they may present implications for privacy. Making evidence-based online resources and interventions freely available at scale could benefit population mental health.”

People in suicidal crises require special attention. Some might not seek help, fearing that services are overwhelmed and that attending face to face appointments might put them at risk. Others may seek help from voluntary sector crisis helplines which might be stretched beyond capacity due to a surge in calls and reductions in volunteers.

The researchers said “Mental health services should develop clear remote assessment and care pathways for people who are suicidal, and staff training to support new ways of working. Helplines will require support to maintain or increase their volunteer workforce, and offer more flexible methods of working. Digital training resources would enable those who have not previously worked with people who are suicidal to take active roles in mental health services and helplines. Evidence-based online interventions and applications should be made available to support people who are suicidal.”

Loss of employment and financial worries are well recognised risk factors for suicide. The researchers believe governments should provide financial safety nets, such as food, housing, and unemployment support.

The researchers wrote “Consideration must be given not only to individuals’ current situations but also their futures. For example, many young people have had their education interrupted and are anxious about their prospects. Educational institutions must seek alternative ways to deliver curricula and governments need to be prepared to offer them financial support if necessary. Active labour market programmes will also be crucial.”

The pandemic could adversely affect other known precipitants of suicide. For example, domestic violence and alcohol consumption might increase during lockdown.

The researchers said “Public health responses must ensure that those facing interpersonal violence are supported and that safe drinking messages are communicated. Social isolation, entrapment, and loneliness contribute to suicide risk and are likely to increase during the pandemic, particularly for bereaved individuals. Providing community support for those living alone and encouraging families and friends to check in is helpful. Easily accessible help for bereaved individuals is crucial.”

Access to means is a major risk factor for suicide. Certain lethal means, such as firearms, pesticides, and analgesics, may currently be more readily available, because they’ve been stockpiled in homes.

The researchers said “Retailers selling such products should be especially vigilant when dealing with distressed individuals. Governments and non-governmental organisations should consider temporary sales restrictions and deliver carefully framed messages about reducing access to commonly used and highly lethal suicide means.

“Irresponsible media reporting of suicide can lead to spikes in suicides. Repeated exposure to stories about the crisis can increase fear and heighten suicide risk. Media professionals should ensure that reporting follows existing and COVID-19-specific guidelines.”

The researchers believe comprehensive responses should be informed by enhanced surveillance of coronavirus related risk factors contributing to suicidal behaviours. Some suicide and self-harm registers are now collecting data on Covid-19 related stressors contributing to the episode.

The researchers said “Summaries of these data will facilitate timely public health responses. Repeat representative cross-sectional and longitudinal surveys will help identify increases in population-level risk, as might anonymised real-time data on caller concerns from helplines. Monitoring demands and capacity of mental health-care providers over the coming months is also essential to ensure resources are directed to those parts of the system under greatest pressure. These efforts need to be appropriately resourced and coordinated.”

The suicide related consequences of the pandemic might vary depending on different countries’ public health control measures, sociocultural and demographic structures, the availability of digital alternatives to face to face consultation, and existing support.

The researchers said “The effects might be worse in resource-poor settings where economic adversity is compounded by inadequate welfare supports. Other concerns in these settings include social effects of banning religious gatherings and funerals, interpersonal violence, and vulnerable migrant workers. COVID-19-related stigma and misinformation may be particularly acute in these settings; many of the solutions proposed above will be applicable globally, but additional efforts will be required in resource-poor settings.”

The researchers added “These are unprecedented times. The pandemic will cause distress and leave many people vulnerable to mental health problems and suicidal behaviour. Mental health consequences are likely to be present for longer and peak later than the actual pandemic. However, research evidence and the experience of national strategies provide a strong basis for suicide prevention. We should be prepared to take the actions [we’ve] highlighted…backed by vigilance and international collaboration.”

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