General psychiatry and suicide prevention

I am grateful to Eagles et al (2001) for their recent editorial on the role of psychiatrists in the prediction and prevention of suicide. I am a member of the Royal Australian and New Zealand College of Psychiatrists' working group on suicide, and we are currently deliberating how to vote on a proposal to disband our group and hand responsibilities back to the College — after all, suicide is part of mental health.

Eagles et al start with how traumatic it is for psychiatrists when their patients commit suicide. Is this not a bit self-indulgent? Our surgical colleagues dealing in trauma frequently contend with the death of ordinary people in the operating theatre. More importantly, the authors do not even mention the suffering of family members affected by suicide.

In their conclusions Eagles et al focus on four points: first, they advocate less epidemiology and more multi-centre treatment trials with suicidal people; second, they advocate more support for traumatised psychiatrists; third, they make a plea to politicians and health service planners to realise what a difficult task suicide prevention is for us; fourth, they note that prediction is a very limited art (I entirely agree), but claim that “all of our patients are at increased risk of suicide”. Taking their first and last points together, perhaps if they were more aware of epidemiological data they would realise Blair-West et al's (1999) calculations have refuted the suggestion that 15% of people with depression eventually kill themselves: for this to be true, the annual number of suicides would have to be several times greater than it currently is. They recalculated the lifetime risk of suicide in people with depression as 3.4% with a lifetime risk of 7% for males and 1% for females.

As regards traumatised psychiatrists, I would simply say that all traumatised workers deserve support and that support should be in proportion to their trauma. I suspect that psychiatrists would rank well down the list, below fire, ambulance and police officers and many other medical workers — not to mention contemporary farmers in the UK!

The point relating to re-educating politicians and health planners about our limitations in influencing suicide rates has some validity. However, prevention is much more than that which might result from prediction. Nowhere in the editorial did I find any mention of basic public health concepts such as primary, secondary and tertiary prevention (Silverman & Maris, 1995). If general psychiatrists have not woken up to the fact that this is the basis of national suicide prevention strategies, I think I will have to vote in favour of retaining our local specialist-interest suicide prevention group.