Iran National Suicide Prevention Program

One of the primary public mental health challenges facing Iran in the recent decade is the mild increasing rate of suicide especially in some provinces of the country¹. We have performed several evaluation projects to analyze whether the National Integrated Suicide Program has been working effectively.

After piloting an action research program in Khoram Abad (Lorestan province) and Nahavand (Hamedan province) back in 2007, the national integrated suicide prevention had been implemented throughout the country. In addition to providing treatment and care, the program also provides aftercare services (brief intervention & telephone follow-up) for people who attempt suicide presented at emergency departments in four western provinces.

The Revised 'National Suicide Prevention Program'

After piloting some action research projects and evaluating the national suicide prevention program and national suicide web-based program, by national and international expert team, the new version and scaled up the National Suicide Prevention Program was developed. The following main goals and related strategies were planned:

1. Improving the registration system to track national suicide trends
   • Involved increasing the validity of the data
   • Collaboration with forensic medicine department
   • Providing regular reports
   • Optimizing access to real-time data
2. Reduce the social stigma around suicide
   • Through engagement in the public education system
   • Re-education within the leadership and governance of the health system
3. Increasing service provision and access to mental health and psychiatric services
   1. Increase the quality and quantity of services
   2. Management of at-risk cases in PHC
   3. Management the at-risk cases by specialists
   4. Management at-risk cases by psychologists
   5. Providing postvention services
   6. Providing consistent and continuous services for at risk individuals
4. Media
   1. To improve the quality of reflecting the news about suicide attempts and behaviours 
5. Access to mean
   1. Reduce access to lethal means of suicide
6. Research activities
   1. To perform at least two Health Services Research projects in each province
   2. Encouraging the Deputy of Research in each medical university in at-risk provinces to allocate a particular budget on this issue

The project for integration of the program into the Primary Health Care

1. Establishing a steering committee for the integration of the programme into the PHC (at provincial level), including:
   1.  Dean of the universities, deputies of health and treatment, psychiatrists working in the community at different levels
   2. The governor of the district to encourage inter-sectoral linkages with other related departments, e.g. regular meeting with the High Council for Health and Food.
2. Designing, developing and implementing a training plan:
   1. Developing training manuals for different tiers of health staff
   2. Executing the training session by Waterfall model to cover the health staff
   3. Evaluating the impact on knowledge and attitude changes through a pre-post test
   4. Re-training (and refresher trainings) plan
3. Enhancing the registration system
   1. Re-training the responsible staff
   2. Monitoring data entry closely 
   3. Controlling the pathway system and flow of the data
4. Increasing access to health services and treatment facilities
   1. Provision of required psychiatric beds
   2. Establishing outpatient services/consultation office
   3. Provision of ECT
   4. Provision of required staff particularly psychiatrists
5. Improvement of screening efforts for early detection of those at risk
   1. Providing screening tools adjusting to the local culture
   2. Training on the utilization of screening tools
   3. Implementing the screening tools to identify at risk cases
6. Effective Monitoring and Evaluation and providing regular feedback to:
   1. Local officials
   2. Steering committees

The project for evaluation of the aftercare program

1. Establishing a steering committee including:
   1. At national level, MoH, police department and welfare organizations
   2. At provincial level (four provinces) including the dean of the university, deputy of curative and health affairs and welfare organizations
   3. Assigning the eligible cities to implement the programs (Criteria including, existence of hospital space and capacity of health staff)
2. Training manuals
   1. Providing educational manual for Emergency Department personnel
   2. Providing educational brochures for attempters and their families presented at EDs
   3. Training manual for brief consultation according to ASSIP method
3. Drawing referral pathway
   1. Designing/clearing the referral pathway from Emergency Departments (hospital/treatment sector) to the District Health Centre (health sector) and finally to Comprehensive Health Centre (psychologist to provide brief intervention and follow-up by telephone)
4. Monitoring and correction of reporting system on the registration web-based network
   1. Re-training on the use of the registration system 
   2. Monitoring closely to evaluate timely reporting
5. Designing telephone follow-up program and data sheet registration
6. Monitoring every three months

The Newly Revised National Program:

This program addresses enhancing preventive actions for suicide across the health system and sectors involved. The main goal of the program is to reduce the rate of suicide attempts, behaviours and death rates in the Iranian population with the following strategic objectives:

• Enhancing the registration system
• Reducing the social stigma around suicide awareness activities
• Increasing access to mental health and psychiatric services
• Proper management of the media coverage of suicide
•  Decreasing access to lethal means of suicide
• Upscaling of research on all aspects of suicide