By Alexandr Kasal.
After graduating from a Public and Social Policy Master study-program, and working as an intern within the National Institute for Mental Health (NIMH) in the Czech Republic, I was offered a job in in their Public Mental Health research group. One of the long-term goals of our efforts is to raise awareness on suicide, suicidal behaviour and its prevention.
We advocate for these topics annually on World Suicide Prevention Day (WSPD) and media uptake of our releases is usually high, as the topic is attractive for the audience.
We have managed to progress our press releases from only stating, that the national suicide rate is above EU and global average to now including educational materials on warning signs and on how-to help when we suspect someone is in crisis. Recently, we have been able to direct the general public towards an announcement of the preparation of the NAPSP taking place in collaboration with World Health Organisation (WHO).
As our calls were heard by the Ministry of Health (MoH), we established the collaboration with the local office of WHO and set up a plan, which should result in NAPSP in the primary goal of reducing suicidality in the Czech Republic.
The stages of the given plan were:
- To establish the national working group (NWG) including a broad spectrum of relevant actors, including people with lived experience of suicide, which will serve as a consulting body. Members of NWG than provided feedback in all further stages.
- To establish the International Working Group (IWG) of experts who would provide consultation in all further stages.
- To conduct interviews and utilise available quantitative data and publish these in Situational Analysis of Suicide Prevention in the Czech Republic  in Czech and English.
- To create a list of candidate evidence-based interventions  and discuss these in order to prioritise and tailor them to the Czech context if needed.
- To draft the NAPSP 2030. The draft should identify measures to be taken with specified responsibilities, indicators and needed funds.
The IWG, namely outstanding prof. Ella Arensman supervised the realisation of the above-mentioned steps. Then, a lengthy review procedure taking several months began. It consisted of two rounds of comments from the MoH and one round of comments, where all ministries were asked to provide feedback.
After going through the feedback and several high-profile inter-ministerial meetings, the final version of NAPSP 2030 was recommended by Government Council for Mental Health for adoption by the government in the second half of July and is now online on the NIMH web page. The National Action Plan should be adopted in late in August.
What will follow
Adoption by the Government will be a great achievement. However, it will be only the first part of a much greater effort which must follow, if we want to save lives—the effort called implementation. NAPSP contains more than 30 measures spanning from universal interventions over selective to interventions indicated for the people going through a crisis or after a suicide attempt.
An evaluation of such broad policy with the primary outcome of suicidal behaviour will be challenging. However, there are several examples, which may be followed as good practice. Fortunately, the Czech Republic has quite well-established health registers for the cause of death and cause of hospitalisation providing reliable data. We will do our best to evaluate the NAPSP in order to provide the international research community with relevant results from our evaluation efforts based on these registers.
What I learned
It was a great experience, and I have learned a lot. If I should highlight something, it would be the importance of thinking of a broad context of suicide prevention and in line with this involving lot of different stakeholders. It resulted in good collaboration with the NWG, which was crucial for the whole project of development. The NWG will be of even greater importance in the future, when it should serve as one of the vehicles of an implementation providing contacts on care providers and implementation partners.
Also, the supervision of IWG helped a lot with providing expertise and experience from abroad.
Lastly, I want to acknowledge the many suicide prevention publications of WHO, which were a great information resource, namely the publication Preventing Suicide: A Global Imperative.
I hope that I will be writing a similar blog in the future with the title “National Experience of Implementing and Evaluating the Suicide Prevention Action Plan”.
Here I would like to thank everyone involved in the formulation of the NAPSP. All stakeholders, people with lived experience, ministerial officials and colleagues who made this thing possible.
- Niederkrotenthaler, T., et al., Increasing help-seeking and referrals for individuals at risk for suicide by decreasing stigma: the role of mass media. American journal of preventive medicine, 2014. 47(3): p. S235-S243.
- Sonneck, G., E. Etzersdorfer, and S. Nagel-Kuess, Imitative suicide on the Viennese subway. Social science & medicine, 1994. 38(3): p. 453-457.
- Kasal, A., et al., Situation Analysis of Suicide Prevention in the Czech Republic; A background document for the National Action Plan for Suicide Prevention 2020–2030. 2019, National Institute for Mental Health, Czechia; World Health Organization: National Institute for Mental Health, Czech Republic.
- Kasal, A., K. Mladá, and P. Winkler, Metodika prevence sebevražednosti – zpráva z projektu a jeho praktické implikace [in Czech] Suicide Prevention Methodics – Report from the Project and Implications for Practice. Psychiatrie, 2018. 22(1).