Controlling the environment to prevent suicide: international perspectives.

BACKGROUND: Suicide and suicidal behaviour are multifaceted events requiring complex solutions. Controlling the environment is a neglected solution, despite strong support for this approach from the World Health Organization (WHO). METHOD: To discuss this approach from a global view, this review is written by authors from various cultures: American, Australian, Canadian, Chinese, Cuban, Dutch, Indian, Irish, Japanese, Lithuanian, Native North American, Russian, and South African. RESULTS: We examine gun control to illustrate the environmental control approach; however, the worldwide diversity of suicide methods calls for diverse responses. Further, controlling the environment encompasses more than restricting the means of suicide, which we illustrate with examples of toned-down media reports and restricted medicine availability. CONCLUSIONS: Controlling the environment may be a viable strategy for preventing suicide, although research shows that few clinicians implement such approaches.

Suicide: the scourge of Native American people.

Reportedly, Native Americans have a rate of suicide that is greater than any other ethnic group in the United States, especially in the age range of 15-24. Many who are concerned as to why this is the case offer a variety of theories. Most of the theories have yet to be tested. This particular presentation focuses on the traditional tribal structure of most Native Americans and events of history that have impacted the cultures of Native American Tribes. The particular events covered refer to Western education, various religions, and legislation as playing a most significant role in impacting the cultures of Native Americans. With the hope that we can all work together to diminish the scourge of Native American people, I repeat the words of Chief Seattle, "... be just and deal kindly with my people."

Impact of mental disorders upon elderly American Indians as reflected in visits to ambulatory care facilities.

In order to assess the impact of mental health problems among elderly American Indians, a study was conducted on the utilization patterns of ambulatory care facilities by various age groups of Indians. Since most health care of Indians is rendered by the Indian Health Service (IHS), data obtained from IHS computer centers provided a reasonable index of disease patterns. Because the elderly have constituted such a small fraction of the Indian population, they have not heretofore received significant attention. However, their problems are rapidly increasing. By adjusting the frequency of visits according to population, an estimate of visit "rates" was made. These rates showed one visit for every 10 persons in the 0-44 age group, one for every 5 persons in the 45-54 age group, but only one visit for every 25 persons in the 65+ age group. Most of the visits by older Indians concerned "social" problems rather than "mental" disorders as such. These data provided information that should prove especially helpful in the design of social and health programs for elderly Indians.