SciELO - Scientific Electronic Library Online

vol.114 número5Where are we in the battle of ending tuberculosis in children and adolescents in South Africa?COVID-19 exposes health worker shortages in the USA and UK, but nationalism and self-interest must not exploit medical workforces from low-and middle-income countries índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados



Links relacionados

  • Em processo de indexaçãoCitado por Google
  • Em processo de indexaçãoSimilares em Google


SAMJ: South African Medical Journal

versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.114 no.5 Pretoria Mai. 2024 



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.



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

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



1. World Health Organization. Suicide worldwide 2019. Geneva: WHO, 2019.         [ Links ]

2. Cerel J, Maple M, van de Venne J, Moore M, Flaherty C, Brown M. Exposure to suicide in the community: Prevalence and correlates in one US state. Pub Health Rep 2016;131(1):100-107.        [ Links ]

3. Ailbhe S, Celine L, Paul C, Karen M-S, Ella A. What are the physical and psychological health effects of suicide bereavement on family members? Protocol for an observational and interview mixed-methods study in Ireland. BMJ Open 2017;7(3):e014707.        [ Links ]

4. Kim AM. A relationship between abortion and suicide rates: A cross-sectional analysis of 62 countries. Asian J Psychiatr 2021;65:102821.         [ Links ]

5. World Health Organization. Suicide prevention 2023. Geneva: WHO, 2023. (accessed 27 February 2024).         [ Links ]

6. Cha CB, Franz PJ, E MG, Glenn CR, Kleiman EM, Nock MK. Annual research review: Suicide among youth - epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry 2018;59(4):460-482.        [ Links ]

7. Worldometer. Malawi population (live) 2020. (accessed 13 January 2024).         [ Links ]

8. TradingEconomics. Malawi GDP: TradingEconomics, 2020 (Gross Domestic Product (GDP)). (accessed 14 March 2024).         [ Links ]

9. Masina L. Malawi moves to tackle rising cases of suicide. Voice of Africa (VOA), 2023.         [ Links ]

10. Banda GT, Banda N, Chadza A, Mthunzi C. Suicide epidemic in Malawi: What can we do? Pan Afr Med J 2021;38:69. https://doi.10.11604/pamj.2021.38.69.27843        [ Links ]

11. Pengpid S, Peltzer K. Prevalence and correlates of suicidal behaviour among adults in Malawi: A nationally representative cross-sectional survey in 2017. Int J Ment Health Syst 2021;15(1):57.        [ Links ]

12. TradingEconomics. Suicide mortality rate (per 100 000 population) 2000 - 2016 data, 2020 forecast. TradingEconomics, 2020. (accessed 23 April 2024).         [ Links ]

13. Masina L. Rise in Malawi suicide cases linked to COVID-19. Voice of Africa (VOA), 2022. (accessed 23 April 2024).         [ Links ]

14. Muwotcha A. St John of God proposes establishment of National Suicide Prevention Strategy. Zomba: Youth Network and Counselling (YONECO), 2021. (accessed 23 April 2024).         [ Links ]

15. Malawi Ministry of Health. Suicide prevention implementation framework. Lilongwe: Malawi Ministry of Health, 2023.         [ Links ]

16. Nyasulu JCY, Chirwa MD, Kumwenda J, Chikalipo M. Health systems' resilience during the COVID-19 pandemic public health emergency: The role of existing community health structures in rural Malawi. Am J Disaster Manage 2022;17(3):207-217.        [ Links ]

17. Osborn TL, Venturo-Conerly KE, Arango GS, et al. Effect of Shamiri layperson-provided intervention vs study skills control intervention for depression and anxiety symptoms in adolescents in Kenya: A randomised clinical trial. JAMA Psychiatry 2021;78(8):829-837         [ Links ]

18. Mabrouk A, Mbithi G, Chongwo E, et al. Mental health interventions for adolescents in sub-Saharan Africa: A scoping review. Front Psychiat 2022;13.        [ Links ]

19. Jumbe S, Nyali J, Simbeye M, Zakeyu N, Motshewa G, Pulapa SR. 'We do not talk about it': Engaging youth in Malawi to inform adaptation of a mental health literacy intervention. PLoS ONE 2022;17(3):e0265530.        [ Links ]

20. Matiti L, Velmurugan T. Assessing the effectiveness of children safe spaces (children's corners) on the lives of orphans and vulnerable children: A case of Chanyungu children's corner in Machinga District. Int J Sci Res Manage 2022;10(10):2542-2578        [ Links ]

21. Ndambo M, Munyaneza F, Aron M, Makungwa H, Nhlema B, Connolly E. The role of community health workers in influencing social connectedness using the household model: A qualitative case study from Malawi. Global Health Action 2022;15.        [ Links ]

22. Lawrence RE, Oquendo MA, Stanley B. Religion and suicide risk: A systematic review. Arch Suicide Res 2016;20(1):1-21.        [ Links ]

23. Poorolajal J, Goudarzi M, Gohari-Ensaf F, Darvishi N. Relationship of religion with suicidal ideation, suicide plan, suicide attempt, and suicide death: A meta-analysis. J Res Health Sci 2022;22(1):e00537.        [ Links ]

24. Sjoblom E, Ghidei W, Leslie M, et al. Centering indigenous knowledge in suicide prevention: A critical scoping review. BMC Public Health 2022;22(1):2377        [ Links ]

25. Rock A, Barrington C, Abdoulayi S, Tsoka M, Mvula P, Handa S. Social networks, social participation, and health among youth living in extreme poverty in rural Malawi. Soc Sci Med 2016;170        [ Links ]

26. Inostroza C, Rubio F, Bustos C, et al. Peer-support groups for suicide loss survivors: A systematic review. Social Work with Groups, 2023.        [ Links ]

27. Kauye F, Mafuta C. Malawi. Int Psychiatry 2007;4(1):9-11.         [ Links ]

28. Azizi H, Fakhari A, Farahbakhsh M, Esmaeili ED, Mirzapour M. Outcomes of community-based suicide prevention program in primary health care of Iran. Int J Ment Health Syst 2021;15(1):67.        [ Links ]

29. Cwik MF, Barlow A, Goklish N, et al. Community-based surveillance and case management for suicide prevention: An American Indian tribally initiated system. Am J Public Health 2014;104(Suppl 3):e18-23.        [ Links ]

30. Mann JJ, Michel CA, Auerbach RP. Improving suicide prevention through evidence-based strategies: A systematic review. Am J Psychiatry 2021;178(7):611-24        [ Links ]

31. Haycock D, Jones J, Smith A. Developing young people's mental health awareness through education and sport: Insights from the Tackling the Blues programme. Euro Physical Educ Rev 2020;26(3):664-681.        [ Links ]

32. Kokota D, Lund C, Ahrens J, Breuer E, Gilfillan S. Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: A quasi-experimental and time series study. Int J Ment Health Syst 2020;14(1):3.        [ Links ]

33. Spafford SG, Schuler AE, Baker S, Dedrickson D. Mental wellbeing and resilience in suicide prevention crisis line volunteers. Community Mental Health J 2023;59(8):1562-1567.        [ Links ]

34. Andriessen K. The role of volunteer organisations in suicide prevention. 2021. Oxford Textbook of Suicidology and Suicide Prevention. 2nd ed. New York: Oxford University Press, 2021:787-792.        [ Links ]

35. Vijayakumar L, Armson S. Volunteer perspectives on suicide prevention. In: Prevention and Treatment of Suicidal Behaviour: From Science to Practice. Oxford: Oxford University Press, 2005.        [ Links ]

Creative Commons License Todo o conteúdo deste periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons