In recognition of World Suicide Prevention Day 2024, Dr. Piumee Bandara delves into the evidence supporting ‘means restriction’ and its effectiveness as a suicide prevention strategy.
*Warning: contains content about self-harm and suicide that some people may find upsetting. Use this link to find an international helpline – www.findahelpline.com*
When I first entered into the field of suicide prevention research, I questioned the effectiveness of limiting access to means as a strategy for preventing suicide. I assumed that because it doesn’t address the underlying determinants of self-harm and suicide, it would have little impact.
However, I have since realised that it is a powerful and highly effective approach that can prevent many unnecessary deaths.
Limiting access to the means of suicide has repeatedly been proven, across multiple settings, to markedly reduce suicide rates. It is also now endorsed by the World Health Organization (WHO) as an evidence-based, cost-effective intervention for suicide prevention.
Examples of means restriction
Often referred to as “means restriction”, limiting access to the means of suicide, has been employed as a public health measure for several decades.
In the 1960s, the United Kingdom replaced coal- or oil-derived gas with a much less toxic natural gas (0% carbon monoxide). In a study conducted by Kreitman (1976), this replacement was shown to be associated with a significant reduction in suicide by carbon monoxide poisoning and a reduction of all suicides by approximately one third over a decade.
In Australia in the 1990s, while the rate of firearm suicide was already reducing by an average of 3% per year, Chapman and colleagues (2006) demonstrated this rate more than doubled to 7.4% per year after the introduction of gun laws. A reduction in total suicides was also found after the introduction of gun laws.
Other countries, including Switzerland, Austria, Canada and Canada, also reported a fall in firearm suicide rates after gun law reforms.
Bans on highly hazardous pesticides
The most compelling example of the impact of means restriction is seen in national bans on highly hazardous pesticides.
Pesticide self-poisoning is one of the most common methods of suicide worldwide, particularly in rural farming communities in low and middle-income countries where people have easy access to highly toxic pesticides.
In Sri Lanka, Knipe and colleagues (2017) showed removal of just a few highly hazardous pesticides resulted in a staggering 70% reduction in all suicides.
Studies comparing suicide rates before and after national bans on highly hazardous pesticides show similar results in the Republic of Korea, Bangladesh, China, and India.
A recent study of the Americas
The Americas is the only WHO region where the suicide rate has increased in recent years, with firearms and pesticides among the common methods of suicide.
Recently, Lange and colleagues (2024) published a study estimating that over 120,000 deaths could be prevented over 10 years, if access to highly hazardous pesticides and firearms were restricted.
Using data modeled from 2020 to 2030, the study estimated that in countries where pesticide self-poisoning accounted for 40% or more suicides, suicide rates would substantially decrease by 2030 if restrictions were implemented on highly hazardous pesticides.
Most notably, in Guyana, Suriname, and Trinidad and Tobago, countries in the non-Latin Caribbean sub-region, suicide rates would have been reduced by up to 31% among males and 34% among females if restrictions on highly hazardous pesticides were implemented in 2020.
Why means restriction works
People who contemplate suicide are often ambivalent about wanting to die, and many acts of self-harm happen impulsively in response to acute stressors.
However, due to the easy availability of lethal methods (e.g. in local shops or households), many acts of self-harm, carried out in an acute moment of crisis, end in death.
Making lethal means of suicide less easily available provides individuals in distress with time. Time to reflect, time for an acute crisis to pass, and time to access the care they need.
It also provides an opportunity for family members, friends, and health professionals to intervene.
Effective interventions for suicide prevention
Ultimately, effective public health policies and interventions for suicide already exist, alongside guidance on how to implement them.
In line with WHO’s recommended LIVE LIFE interventions for suicide prevention, it is also important to ensure quality psychosocial support is available, that media safely report on suicide and self-harm, and young people are equipped with socio-emotional life skills to manage life’s many challenges.
In addition, ongoing commitment to addressing the social, cultural, and psychological risk factors for suicide is also critical. By implementing a suite of interventions, synergistic effects in reducing suicidal behaviour at a population level are likely.
Among these interventions, limiting access to means, where relevant, is likely to have the most immediate impact, making it a crucial starting point for the prevention of suicide.
Dr. Piumee Bandara
Dr. Piumee Bandara is an honorary research fellow at the University of Bristol, UK and Western Sydney University, Australia. Her research primarily focuses on the epidemiology and aetiology of suicide and self-harm in low- and middle-income countries. In addition, Piumee is a Consultant for the World Health Organization working on global policy and United Nations publications to reduce suicides. The views expressed in this article are her own.
Further reading
Reflecting on three decades of work to prevent deaths from pesticide self-poisoning