Public health surveillance is essential to the practice of public health, to guide prevention, monitor activities and evaluate outcomes of such activities (1). The WHO report, ‘Preventing Suicide: A Global Imperative’, emphasizes surveillance of suicide and suicide attempts as a core component of national suicide prevention strategies (2). This E-learning program follows on from the ‘WHO Global Mental Health Action Plan 2013-2020’ in which all WHO Member States have committed themselves to work towards the global target of reducing the suicide rate in countries by 10% by 2020 (3). Target 3.4 of the the ‘United Nations Sustainable Development Goals’, is by 2030 to reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being (4), and suicide mortality is an indicator for this target.
Improvement in the availability and quality of both suicide mortality and suicide attempt data is needed for all countries. Major differences exist between countries in suicide recording procedures (2, 5). The WHO report, ‘Preventing Suicide: A Global Imperative’, identified a need for guidance on the surveillance of suicide attempts presenting to general hospitals. Currently the number of countries that have established a surveillance system of suicide attempts is limited, and comparison between established systems is often hindered due to between-system differences (2).
Improved surveillance and monitoring of suicide attempts and self-harm is a core element of the public health model of suicide prevention (2, 6, 7).
When a person presents at a hospital, it should be possible for a clinician to state in the medical records whether or not the injury or poisoning was self-inflicted and whether it was intentional or accidental. However, the intention to die can be more difficult to ascertain (and therefore to record) since in certain cases even the individual involved may not be certain about his or her intentions.
A hospital-focused surveillance system will inevitably represent cases of self-harm with varying levels of suicidal intent and varying underlying motives, and not only suicide attempts characterized by high levels of suicidal intent.