Target-setting is great for progress, but is it right for suicide prevention?
What is the “right’ suicide prevention target? Does a target of 50% imply acceptance that in Australia 1300 people will die by suicide each year?
Setting targets has become commonplace as a way of measuring achievement and progress. We have seen this recently as the future ecology of our planet and the complexity of international policy on climate change has been reduced to negotiations around a series of targets.
It is as though the targets give meaning to the goal for change.
So surely we should set targets for suicide prevention, right? How better to concentrate efforts than to set targets for a reduction in the tragic loss of life to suicide? And surely setting targets is a way to communicate and engage with the wider community in results-based suicide prevention?
This has already started. In 2013, the World Health Organisation (WHO) promoted a target of 10% reduction in suicides by 2020 for member countries, of which Australia is one. Then, in 2014, the WHO released its first ever report on suicide documenting the key elements of any national strategy for suicide prevention, drawing on research evidence and expert opinion.
Some countries were ahead of this, such as Scotland which in 2002 set a target for a 20% reduction in suicide deaths by 2013. In fact, Scotland achieved an 18% reduction in this time period. Perhaps setting bold targets matched to an effective national suicide prevention strategy actually works.
Here Suicide Prevention Australia has recommended a target of 50% reduction in suicide deaths in 10 years, as an aspirational statement to galvanise support and action.
So far, the governments of Australia have declined to accept this recommendation, and it lies as an unresolved matter after more than 12 months of national review of suicide prevention and mental health programs.
Ethical issues also start to emerge when targets for suicide prevention are raised. Does a focus entirely on reducing deaths diminish our understanding and empathy with the profound despair and pain felt by suicidal persons – whether or not they actually attempt suicide or die?
When it comes to poverty reduction, the trend in international aid and development has been to recognise quality of life and wellbeing factors for vulnerable populations instead of simply calculating the prevention of deaths. Indexes on health, wellbeing and opportunity have been established as measures for success in poverty reduction. Programs seek to achieve outcomes that uphold dignity, self-determination and culture for those exposed to poverty, not just abrupt outcomes indicators of life-span and disease based death rates.
We should not admit to tolerating any loss of life to suicide, nor should we neglect to provide the very best compassion, support and recovery care for those who come to the dark place which suggests death is better than living. All our effort, our programs, our government suicide prevention strategies, our community action should then be measured up against the contribution made towards this target. Our measurement systems then could be associated with celebrating each and every step towards the end result.
Such a stance would reflect the comment from Dr Margaret Chan, director-general of the WHO, when introducing the international report on suicide: “Every single life lost to suicide is one too many.”
Unlike the manipulative White Ribbon campaigners, Dr. Margaret Chan expressed care for men, as much as for women.
I wonder why?
(Clarification: I, Murray Bacon, do support euthenasia, which is a close parallel to suicide. So great care needs to be taken when discussing these topics.)