MEANS RESTRICTION, it’s clear, has been hugely impactful outside of the US. But it won’t get the suicide rate down to zero anywhere. For one, it’s nearly impossible to fully restrict all means. But more importantly, means restriction doesn’t get to the root of the problem—why people feel the urge to take their lives in the first place. This has led to some researchers calling for suicide to be treated as a social justice issue, as opposed to one of a simply psychiatric nature.

In the case of China, better economic stability had a massive impact on bringing the suicide rate down. There’s a strong link between suicide and unemployment, as well as economic crises, including the 2008 global financial crisis. Social safety nets like universal basic income and universal health care could go some way toward bringing suicide rates down, says Gonzalo Martinez-Ales, a psychiatrist-epidemiologist at Harvard University. A 2022 study found that cash transfers targeted at low-income families in Brazil were found to lead to a 56 percent lower suicide rate among those who received them versus those who didn’t. Broad social improvements can have a significant effect on suicide rates.

But beyond means restriction, what are the best bets for specifically targeting suicide rates? One method put forward is risk assessment, the idea that people can be trained to identify individuals most at risk. But Martinez-Ales is skeptical that this would make a real difference, as the time between impulse and action can be so brief. Plus, simply asking people about their suicidal thoughts is not a reliable way of predicting whether they are likely to commit suicide, a 2019 study concluded.

Antidepressant prescriptions, and certain forms of psychotherapy—such as cognitive behavioral therapy and dialectical behavior therapy—have been shown to be effective in treating suicidal ideation and behavior. Other measures that have a good evidence base include school-based education programs and better training for clinicians. But Martinez-Ales wonders just how much impact targeted psychiatric care can have. “That doesn’t mean that I don’t think that providing good care for people who are suicidal is very important,” he says. But the benefits of such interventions are dwarfed by the gains that can be made through means restriction. Ideally, countries should be pursuing all these measures at once.

Aiming solely to reduce the number of people who die by suicide also oversimplifies the larger issue. The number of suicide deaths can obstruct the overall picture of self-directed violence. Men make up the majority of people in the column of deaths, but women and girls dominate every other part of that spectrum, with women more likely to self-harm and to attempt suicide. The reason for this is that men tend to select methods with a higher chance of resulting in death; this is what’s called the gender paradox in suicide. But just because suicidal behavior doesn’t result in death—as is the case for many women—doesn’t mean it can be ignored. “While the deaths might be coming down overall, I think that’s not painting an accurate picture of the fact that a lot of people are in distress,” says Palfreyman. Rates of self-harm are rising rapidly in young women and girls, in particular.

While suicide rates have fallen in many parts of the world over the past decades, for the UN, this isn’t nearly enough. The organization’s Sustainable Development Goals aim to shrink suicide mortality by a third between 2015 and 2030—though hitting that goal may turn out to be wishful thinking. To increase the odds of success, however, lessons from countries that have succeeded in bringing their numbers down will prove invaluable.

If you or someone you know needs help, call 1-800-273-8255 for free, 24-hour support from the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for the Crisis Text Line. Outside the US, visit the International Association for Suicide Prevention for crisis centers around the world.