Fear of Feelings! Treating Male Suicide & Depression

The two main traditional solutions for preventing suicide in the last century have been the clinical treatment of suicidal people (i.e., psychotherapy, medication, and hospitalization) and the establishment of suicide prevention centres and community programmes (e.g., schools). However, a third approach to suicide prevention, which is one of the oldest methods of prevention, is known as controlling the environment. Removing the sword from the defeated soldier in battle, for example, is an ancient act of prevention. Yet, this prevention tactic has been infrequently discussed until recently. Presumably because most of the work with regard to the prevention and intervention of suicidal behaviour has remained within the realm of clinical settings, this neglect may be understandable, although given current research, too limiting.

Erwin Stengel (1964) was one of the first in this century to propose controlling the environment as a means for decreasing the incidence of suicide, noting, for example, that the detoxification of domestic gas (from coal gas with high carbon monoxide content to natural gas) might have reduced the suicide rate in nations where the switch had taken place. Subsequent research on the detoxification of domestic gas in England supported Stengel's proposal (Kreitman, 1976). More recently, a review of the research by Clarke and Lester (1989) and an international examination by Leenaars and experts (2000b) from 12 nations validated the approach in treatment.

This perspective on prevention is consistent with a report on suicide prevention of the World Health Organization (WHO). After careful analysis of all measures by an international team of researchers, headed by Bertolote (1993), a series of tactics to prevent suicide that had support in the scientific literature were proposed. The team provided six basic steps for the prevention of suicide. All but one, the treatment of psychiatric patients, are consistent with controlling the environment: gun possession control, detoxification of domestic gas, detoxification of car emission, control of toxic substance availability, and toning down reports in the press. They also offered further measures under the rubric of "other measures". These too are consistent with environmental approaches, such as fencing high buildings and bridges. Although there is no definitive evidence for the effectiveness of the "other measures", the research strongly supports the five measures that call for controlling the environment as effective means of reducing suicide.

Gun control is often cited as the prototypical example of controlling the environment to prevent suicide. Although countries differ in the most frequent method for suicide, firearms are a preferred method in many countries. An opportunity for studying the effects of legislative means restriction, e.g., gun control laws, on their use for suicide is provided by Canada's Criminal Law Amendment Act of 1977 (Bill C-51), enforced since 1978. This Act requires acquisition certification for all firearms, restricts the availability of some types of firearms to certain types of individuals, establishes procedures for handling and storing firearms, requires permits for those selling firearms, and increases the sentences for firearm offences. Early commentators on the impact of this Act found little impact of the Act on firearm suicide in Canada, but presented only simple charts, with no statistical analysis of the trends. Lester and Leenaars (1993) remedied this omission and reported a comprehensive