A continuous commitment is needed in order to prevent male suicide through incorporating policy and regulatory approaches and strategies to mitigate this public health issue in Sri Lanka.

This recommendation was made in a review article on "How Australia prevents male suicides: Lessons learnt and implications for Sri Lanka" which was authored by B.H. Denuwara and N.J. Reavley (both attached to the Melbourne University's School of Population and Global Health's Centre for Mental Health) and published in the Journal of the College of Community Physicians of Sri Lanka's 29th Volume's First Issue in May, 2023.

According to the World Health Organisation (WHO), approximately 700,000 persons commit suicide each year and it has become a major public health issue. Per the WHO's "Global health observatory data repository, 2019", nearly 77% of suicides usually happen in low- and middle-income countries like Sri Lanka. In Australia, according to the Australian Bureau of Statistics' "Intentional self harm, key characteristics. Causes of death, Australia, 2021", 3,139 deaths occurred in 2020 due to suicide. Males, per the Australian Institute of Health and Welfare's "Suicide – Self harm monitoring, 2020", have a higher risk of suicide, approximately three to four times more than for females. The Sri Lankan male suicide rate was 22.3 per a population of 100,000 in 2019, which was three to four times higher than that among females.

Australia has approximately a 30-year history of Commonwealth public policy in the prevention of suicide. The history of public policy in the prevention of suicide in Australia is thus: 1995 (the initial suicide prevention strategy entitled the National Youth Suicide Prevention Strategy was commenced), 2000 (the National Suicide Prevention Strategy [NSPS] was established by the Government and the Government released the Living is for Everyone [LiFE] Framework), 2006 (most States and Territories had adopted their own suicide prevention strategies largely based on the LiFE Framework, and the National Specific Purpose Payments also contribute funds to other large programmes including the Access to Allied Psychological Services Additional Support for Patients at Risk of Suicide and Self Harm Project [ATAPS Suicide Prevention Service Initiative] and the Mind Matters Initiative, and the evaluation of the NSPS was done), 2008 (the Australian Suicide Prevention Advisory Council [ASPAC] was established and the first NSPS Action Framework [2009-2010 and 2010-2011] was developed), 2010 (the announcement of the Taking Action to Tackle Suicide [TATS] was done), 2011 (the announcement of the Delivering Mental Health Reform budget package was done), 2012 (the formation of the National Mental Health Commission and the delivery of A Contributing Life: the 2012 Report Card on Mental Health and Suicide Prevention was done), 2013 (the first National Aboriginal and Torres Strait Islander Suicide Prevention Strategy was launched and Local Government involvement has been largely focused on measures to curb suicides and suicide attempts at particular public places, which specially means restriction), 2017 (the fifth National Mental Health and Suicide Prevention Plan was released and it is the first to give specific focus to suicide, and under the auspices of the said Plan, a National Suicide Prevention Implementation Strategy was launched), and 2020 (the National Mental Health and Well-being Pandemic Response Plan navigates through the Covid-19 pandemic). 

More men?

Men’s suicide pathways are very complex and multifactorial, and it is strongly associated with, as noted in the Centres for Disease Control and Prevention's "Injury prevention and control: Suicide prevention, 2014", a previous suicide attempt, substance misuse, long term physical and mental disease, legal and financial problems, adverse childhood experiences, violence, victimisation, social isolation, bullying, family and a loved one’s history of suicide, stigma associated with mental illness and help seeking, easy access to lethal means, and unsafe media portrayals of suicide.

S. Struszczyk, P.M. Galdas and P.A. Tiffin's "Men and suicide prevention: A scoping review" revealed that interventions conducted for men’s suicide prevention are awareness programmes, psychological support, education programmes which targeted general practitioners and depressed or suicidal men, and training programmes for community gatekeepers and men preferring to get help in an informal setting from a trustworthy and respectful person. Factors which interrupted the suicide related process were reframing help seeking as masculine, using emotional regulation techniques, and connecting with other people.

The concern about the rising suicide rate in Australia led to the funding of several programmes and initiatives. The Million Minds Mental Health Research Mission funded the Buoy Project last year (2022). It is about promoting men’s help seeking and then making mental health services more male friendly when they do seek help. It tests the effectiveness of seven male suicide prevention programmes.

Cultural sensitivity

Thus, we can consider promoting culturally sensitive suicide prevention trials in Sri Lanka and use the evidence to develop male suicide prevention programmes, Denuwara et al. observed. Improving mental health literacy and gatekeeper training is, as mentioned in S.T. Kathriarachchi, V.L. Seneviratne and L. Amarakoon's "Development of mental health care in Sri Lanka: Lessons learned", important to reduce suicides in Sri Lanka. Thus, per the Melbourne University's Centre for Mental Health's Global and Cultural Mental Health Unit's "Suicide first aid guidelines for Sri Lanka", implementing already developed mental health first aid programmes in Sri Lanka is an initiative to reduce the suicide rates.

Australia Men’s Health Forum (AMHF) is promoting the lives of men and boys in Australia. Male Suicide Prevention Australia is dedicated to reducing male suicides for 25 years with principles such as ensuring support, providing respect and valuing men’s strengths, taking a situational approach, supporting men in all their diversity, and creating lived experience and support provision expertise, which are informed by research and data. The Australian Institute of Male Health Studies' (AIMHS) Men’s Watch Suicide Prevention Initiative, Beyond Blue, Men’s Sheds and Life in Mind are other initiatives to reduce male suicides.

Prevention

Sri Lanka can also promote an online male suicide prevention initiative with all the helplines to improve the awareness of this public health issue. Anti-stigma campaigns can also be used to break the barrier to access mental health services. Defining the vulnerable groups and providing culturally appropriate interventions in Sri Lanka is very important. As in Australia, the primary health care system can be used to deliver suicide prevention services effectively. Media professionals and health experts can work together when reporting male suicides and continuous surveillance is important as conducted by SANE’s stigma watch programme. According to the suggestions in the Sri Lanka Medical Association's (SLMA) Expert Committee on Suicide Prevention's "Suicide prevention in Sri Lanka: Recommendations for action", the involvement of all stakeholder groups in the development of policies is important.