Addressing the Global Impact of Suicide

It has long been established that suicide is a major challenge affecting communities around the globe. The World Health Organization (WHO) reported approximately 727,000 deaths by suicide in 2021, with 73% of those occurring in low- and middle-income countries (LMICs)—a designation given by the World Bank based on a country’s gross national income.  

The actual statistics are likely higher due to stigma, a lack of human and financial resources, and other barriers. Though the majority of the world’s population lives in an LMIC, one analysis found that less than 15% of suicide-related research is conducted in these countries.

By comparison, in the United States, 49,000 people died by suicide in 2023—the equivalent of 1 death every 11 minutes—according to the Centers for Disease Control and Prevention (CDC). The American Foundation for Suicide Prevention estimates 1.5 million attempts were made that same year.

In addition to lack of access to mental health providers, there are a number of barriers that hinder prevention efforts, says Tammy McCreery, NCC, LPC, CAMS-C, a combat veteran and clinician at Stop Soldier Suicide, a national nonprofit that provides suicide-specific care to U.S. veterans at no cost. McCreery works closely with fellow veterans to help prevent suicide and foster long-term recovery.

Differences among cultures often present challenges due to belief systems, family dynamics, language, and other unique aspects.

“Cultural consideration is a factor that must not be overlooked,” McCreery says. “While frameworks across cultures may be consistently applied to sessions or treatment, having cultural awareness is an invaluable asset for providers. There is not a one-size-fits-all when it comes to cultural approach, and without awareness, there is a barrier to efficacy. Openly speaking about what works well and where we are seeing forward progress with our clients will help others feel confident in pursuing prevention efforts and additional training for themselves.” 

To raise awareness and help bridge the gap in care, NBCC Foundation’s Global Capacity Building Department created the framework for its Mental Health Facilitator (MHF) training program in 2003 in collaboration with WHO to train laypeople to help hundreds of millions of people with little or no access to mental health services in their communities.

MHF training provides basic mental health skills and education to individuals working outside the mental health field. Rather than creating a separate profession, the program fights stigma and increases service capacity by training individuals who encounter others in the course of their work to identify, refer, and support those with mental health needs in their communities. In addition to the core MHF curriculum, NBCC has developed an abridged MHF-ASAP! Curriculum; an Educator’s Edition; and an abridged version of the school-based curriculum, the Express Education’s Edition. You can learn more about these curricula here.

To foster international suicide prevention efforts, WHO created its LIVE LIFE initiative with several partners in 2021 in an effort “to reduce by one-third premature mortality from noncommunicable diseases through prevention, treatment and promotion of mental health and well-being by 2030, of which suicide mortality rate is a key indicator.” The initiative is focused on four key evidence-based interventions:

Limiting access to the means of suicide.
Interacting with media for responsible reporting of suicide.
Fostering socio-emotional life skills in young people.
Early identification and support to everyone affected by suicide and self-harm.

“LIVE LIFE: An Implementation Guide for Suicide Prevention in Countries” can be downloaded from the WHO website and is designed as a guideline for use in community, health, and other settings.

By the nature of their work, counselors and other helping professionals across the globe are poised to reduce stigma and increase awareness of suicide and prevention, McCreery says.

“Mental health professionals are uniquely positioned to help reduce stigma because we are trusted experts within this space. Our credentials create an ability to promote open dialogue and integrate mental health literacy into community programs. We can, and should, collaborate with community leaders, schools, and faith-based organizations to normalize discussions about suicide while providing accessible resources. We should say the word ‘suicide’ when appropriate and talk about it in ways that model responsible communication for others.” 

Conversations about suicide, though difficult, are essential.

“Having the professional and personal courage to have the tough conversations proactively will foster safe, stigma-free environments that support help-seeking behavior. As professionals, we cannot know what we do not ask. Regardless of where an individual chooses to align their work professionally, obtaining the skill to know how to ask the hard questions—‘Have you had thoughts of wanting to die?’—is not only critical from a clinical perspective but also from a destigmatization perspective.” 

Some communities seem siloed in their approach to suicide prevention, and a collaborative effort can help counselors expand their reach, McCreery says, adding that “Targeted outreach, such as campaigns for suicide prevention and peer-led support groups, help to address misconceptions and encourage early intervention.”  

Counselors can also gain new insights through trainings on suicide risk assessment and prevention as part of their continuing education, she says.

“In addition to supporting ethical practice, specific training can equip professionals to more easily navigate the challenges of these discussions when they come up in sessions or with patients. An additional step would be for providers to seek out training in suicide-specific care that can be safely and effectively implemented in an outpatient setting, such as Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT-SP) or Collaborative Assessment and Management of Suicidality (CAMS) in all types of practice. Suicidal ideation knows no age or demographic limitations. Every practice in the field is exposed to the challenge of supporting individuals in getting the help they need. Having the adequate training, tools, and supportive staff to face this challenge head on, in real-time, is an essential aspect for reducing suicide risk in communities near and far.”

Acknowledging that suicide risk assessment and prevention can feel daunting, McCreery says there is an abundance of additional resources that can help prepare counselors of all experience levels to work with and advocate for these clients in different settings.

“Deciding to pursue a specialty within suicide-specific treatment required facing my own fears and beliefs about what this work would mean to me as a person,” McCreery says. “I wondered, could I do it and make a difference? What I know now is that there are amazing programs that will develop your skills in managing suicide risk such as BCBT-SP and CAMS. What I also know now is that regardless of where my career takes me next, I am equipped to meet my clients where they are and know how to identify if suicidal ideations are a challenge that they struggle with. I am now a big advocate for all licensed professionals actively developing skills in suicide risk and prevention, and together we can help people experiencing their most difficult moments, one conversation at a time.”

Tammy McCreery commissioned in the U.S. Army after earning her BS in psychology from the University of Utah. McCreery proudly served as a combat veteran and was awarded The Bronze Star. After her military service, she earned an MS in human services from Walden University and an additional MS in counseling psychology from Alabama A&M University. McCreery has been an educator in psychology for a community college and serves as guest lecturer at her alma mater, Alabama A&M. 

 **Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.