CORRESPONDENCE

 

Improving access to suicide prevention services through the National Suicide Prevention Framework implementation: The community level evidence-based recommendations

 

 

To the Editor: Suicide is catastrophic, and has been reported as a leading cause of death globally, with ~800 000 deaths worldwide each year.^[1-3] Although suicide deaths are preventable, they increase annually in all age groups, with the highest proportion among youths and in low- and middle-income countries.^[1,4-6] Malawi is a landlocked country, with a population of ~19 million^[7] and a gross domestic product (GDP) of USD7.67 billion in 2019,^[8] making it one of the poorest countries in Africa. The country has insufficient mental health structures, with only one public mental hospital, Zomba Mental Hospital, and a few privately owned mental health facilities. These are mostly owned by St John of God (SJoG) Hospitaller Services, making them financially unattainable.^[9,10] In 2017, Malawi reported a 10% suicidal prevalence among adults,^[11] with suicide prevalence rising during the COVID-19 pandemic and reportedly higher than her neighbouring countries such as Zambia and South Africa.^[10,12,13] Anecdotal reports show that in Malawi, suicide cases have more doubled in the past 5 years, which is higher than the global average, with more youths committing suicide than older persons.^[9] In 2021, amid rising cases of suicide in the country, SJOG Hospitaller Services, the mental health and tertiary academic institution in Malawi, proposed the need for the country to develop a National Suicide Prevention Framework in a parliamentary motion.^[14] In response, the Malawi government developed the Suicide Prevention Framework, aimed at reducing suicidal behaviours by reducing factors that increase suicide risk and increasing factors that promote resilience, consequently reducing deaths by suicide.^[15] However, due to the absence of mental health structures from community to national levels, implementation of this framework is problematic.^[9,10,15] On a positive note, Malawi has strong community health structures where lay persons are voluntarily and effectively involved in health service delivery. ^[16] Lay persons have been shown to have greater mental health outcomes than skilled providers, critical evidence for resource-limited countries such as Malawi.^[17,18] One of the critical steps to take in implementing the Malawi suicide prevention framework is to raise awareness around mental health and suicide, since reports indicate lack of awareness leading to stigma and discrimination, as mental health-related challenges are classified as madness.^[9,19] The community health strategy provides a platform for community engagement and involvement in screening, management and referral.^[15]

Therefore, in this communication, we advocate for the maximisation of existing community structures to raise awareness, screen, manage and refer those at risk of suicide and with suicidal ideations. In Table 1, we summarise the Malawi National Suicide Prevention Framework facilitators and barriers to implementation. In addition, we offer evidence-based recommendations for community-based implementation of the framework.

 

Conclusion

This article highlights the increase in suicide cases amid lack of mental health services, including suicide prevention strategies, in Malawi. The development of the Malawi National Suicide Prevention Framework in 2023 is a beacon of hope in promoting access to mental health and suicide prevention services in the country. Malawi has strengths in existence that provide an enabling environment for strategy implementation coupled with challenges. We therefore provide evidence-based recommendations to maximise the strengths and counteract the barriers to promote the national suicide prevention strategy implementation and improve access to mental health services.

J C Y Nyasulu

Division of Health Systems and Public Health, Department of Global Health, Faculty of Clinical Medicine, Stellenbosch University, Cape Town, South Africa, and Health Systems Strengthening, AFRIQUIP, Johannesburg, South Africa

jnyasulu@sun.ac.za

D A Siddiqi

Maternal and Child Health, IRD Global, The Great Room, Singapore

S Seedat

Department of Psychiatry, Faculty of Clinical Medicine, Stellenbosch University, Cape Town, South Africa

J Bantjes

Mental health, Alcohol, Substance use, and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa

M Udedi

Division of NCDs and Mental Health, Department of Curative and Medical Rehabilitation Services, Ministry of Health, Malawi

S Gondwe, S Kambale

Saint John of God Hospitaller Services, Mzuzu, Malawi

M Mkandawire, N Silungwe

Youth Network and Counselling (YONECO), Zomba, Malawi

L A Hendricks

Division of Health Systems and Public Health, Department of Global Health, Faculty of Clinical Medicine, Stellenbosch University, Cape Town, South Africa

I Maposa

Division Epidemiology and Biostatistics, Department of Global Health, Faculty of Clinical Medicine, Stellenbosch University, Cape Town, South Africa

J Vumu

Livingstonia Synode Aids Projecy, Ekwendeni, Malawi

D Skinner

Division of Health Systems and Public Health, Department of Global Health, Faculty of Clinical Medicine, Stellenbosch University, Cape Town, South Africa

 

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