Achievements and Challenges of Suicide Prevention Programs in Iran
Explore the success and obstacles faced by suicide prevention programs in Iran, including achievements such as significant reduction in suicide rates and nationwide integration of prevention strategies. Challenges include the need for more incentives and collaborations to combat social stigma on mental health issues. Learn about the empowering of health care staff, improved human resources, and the establishment of a web-based suicide registry system. Discover how local programs, in collaboration with the Ministry of State, have made a remarkable impact on preventing suicide behaviors.
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Suicide prevention programs in Iran the achievement and challenges Malakouti SK Iran University of Medical Sciences malakouti.k@iums.ac.ir malakoutik@gmail.com
Field clinical trial 2008-2009 In three different geographical areas In Khoram Abad project: The rate of suicide in the control city (19.3 reduced to 18.9 deaths per 100000) for one year. In the experimental city, from 12.5 reduced to 5.3 per 100000 people in one year. (P<0.05). 6.3 deaths per 100000 people reduced, according to the population in 2007 (334000 people under cover of the study), 20 lives were saved. School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Web-based registration program, 2009 School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
12 strategies of NSPP were designed and expanded nationwide 2010 - 2016 School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
NSPP, the achievements prevention and surveillance of suicide behaviors are considered a major priority The local programs have been remarkable reState Having involved the Ministry of State as headquarterss There was a growing understanding of the importance of collaboration It depends on the local activation of the mental health officer The PHC network facilitated the implementation of NSPP NSPP has been integrated into PHC since 2010 School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
NSPP, the achievements cont The health care system staff have been empowered Human resources have been improved by enrolling clinical psychologist in the Comprehensive Health Center The National Broadcasting System and other cultural organizations are cooperating with the Ministry of Health for the reduction of social stigma on mental health issues However, in practice, they need more incentives and encouragements Establishing a web-based suicide registry system across the country In 2015, a memorandum of understanding was signed with Forensic Medicine Organization School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Organizations Governmental organization Ministry of Intern/state, as headquarter Ministry of health as a main body for preventing suicide Welfare and Welbeing Organizaition NGOs Suicide prevention committee, Iranian psychiatric Association The Iranian Scientific Society for Suicide Prevention Suicide prevention unit, Mental health research center, IUMS Implementing a suicide prevention hotline for the physicians contributed by the Medical Council of Iran WHOCC develop an e-health technology platform for suicide prevention Translate and support the dissemination of the WHO tool for monitoring responsible media reporting of Suicidal behaviours
Hotline of Welfare organization 1480 telephone 123, social emergency Part time hotline Roozbeh Psychiatric Hospital School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
statistics In the national level: The suicide rate has risen from 5 to 7.5/100000 population in the last 10 years
Joint program to evaluate national suicide prevention and registration, 2017 School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Evaluation of NSPP and registry The rapid appraisal method which included: Conducting in depth interviews with key participants Group meetings and discussion with health staff Field observations Observation of the provided documents School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Evaluation of NSPP By providing and using: Monitoring checklists data registry sheets knowledge of health staff registry pathway and timing referrals paper forms The availability of educational brochures The number of meeting supposed to be held regularly at district s governor office and the minutes The regular reports provided by the mental health officer of district and mental health officer of university The number of identified cases The quality of collaboration of other sectors School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Evaluation results Scaling up the registration program according to 2016 version of WHO Planning the national program according to guideline Monitoring the national program regularly Increase Intersectoral collaboration Optimizing access to real-time data Providing aftercare services for the attempter Providing porstvention services Improving the knowledge and skills of health staff of PHC
Lessons learnt To develop standard program according to WHO plan Developing evaluation and monitoring indicators, regular Developing a protocol for constant supervision on services School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Providing Follow-up care for suicide attempters in 4 provinces with high rate of suicide 2017-2018
Health Transform Program Since 2017, by implementing across the country Comprehensive Health Centers (CHC) were established. Each center covers a population of 20 to 50 thousand people in which at least one psychologist with master degree of psychology. School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Scaling up the Health System at Provincial Level to Scaling up the Health System at Provincial Level to Conduct Telephone Follow Conduct Telephone Follow - -Up Program for Suicide Reattempters Reattempters West Azerbaijan, 2017-2018 Up Program for Suicide School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Suicide attempt rate Experimental and control cities 180 160.6 141.7 160 Exp 140 Control 120 129.43 123.53 100 80 60 40 20 0 2016 2017
SUICIDE Experimental and control cities 12 Control 11 10 9.75 8 Exp 7.18 7 6 4 2 2016 2017 0
In aftercare study: In control cities, the suicide rate increased from 9.75 to 11 per 100000 people. In experimental cities, the suicide rate decreased from 7.19 to 7.03 in one year (no significant differences). Compared to the control group (the cities without aftercare intervention, 1.4 deaths per 100000 people were reduced; according to the population in 2017 under coverage (7,165,657), 100 lives were saved. School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Updated NSPP, the six strategies 2020 School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
The Newly Revised National Program: the GOALS 1. Enhancing the registration system 2. Reducing the social stigma around suicide awareness activities 3. Increasing access to mental health and psychiatric services 4. Proper management of the media coverage of suicide 5. Decreasing access to lethal means of suicide 6. Upscaling of research on all aspects of suicide
STRATEGIES The following main goals and related strategies were planned: 1. Registration To increase the validity of the data Collaboration with forensic medicine department Providing regular reports Optimizing access to real-time data 2. Reduce stigma Public education Re-education the leader of health system
STRATEGIES, continue 3. Service provision To increase the quality and quantity of services Management of at risk cases in PHC Management the at risk cases by specialists Management at risk cases by psychologists Providing porstvention services Providing consistent and continuous services for at risk individuals 4. Media To improve the quality of reflecting the suicide news 5. Access to mean Reduce access to lethal means 6. Research activities To perform at least two HSR research in each province Encouraging the deputy of research in each medical university in at risk provinces to allocate particular budget on this issue
statistics In the national level: Research studies show that it could be estimated 10/100,000 population! Suicide attempts are 20 to 25 times of suicide Hassanian-Moghaddam H, Zamani N. 2017.
Regional plan and research activities are promising Kerman, west azarbayjan, lorestan But serious concern at the national level! School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
The NSPP, challenges Suicide prevention is not considered as a priority to senior non-health authorities. Poor inter-sectoral collaboration mainly dependant on personal factors, and not on a systemic concept. the lack of transparency of shared organizational goals and perspectives Refusing joint leadership, mainly due to organizational mistrust Insufficient human and financial resources School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
The NSPP, challenges cont Frequent replacement of health workers such as GPs psychologist who needs further training Shortage in psychiatric beds supply in some regions Social stigma of suicide Easy access to hypnotic and tranquilizer drugs Easy access to drug of rice shortage of control over media, particularly virtual social media governmental health insurance covers the expences of individuals with suicide, but not the private insurance company School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
New challenges Suicide is considered more political and security issue It may hinder working on it in terms of: Talking freely New wording for suicide such as hope and happiness Access to data School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
The reasons of increasing suicide rate Do not concentrating on hot-geographical areas Social determinant play more important role The NSPP is not supported adequately Socio-economical changes in favor of losing hope generally. School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
CONCLUSION The capacity is established The quality of the execution of the program is under question The budget of the NSPP is not clear Security and political approach to suicide behaviors The program is not focused on th hot area of suicide Social hopelessness is a prevailing issue currently School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
