Incorporating suicide prevention in the WPA Action Plan 2023‐2026

The WPA Action Plan 2023-2026 has structured its commitments around two main components: advancing good clinical practices and enhancing preventive public mental health initiatives1-4. The Plan is aligned with the United Nations 2030 Agenda for 17 Sustainable Development Goals (SDGs), emphasizing the critical intersection of SDG 3.4 on mental health and well-being with the remaining SDGs5. Reducing suicide rates is one of the indicators for the progressive fulfilment of SDG 3.4, highlighting the urgent need for effective public mental health strategies and clinical interventions. A total of 970 million people live with a mental disorder worldwide, accounting for 13% of the global population. Of these, females make up 52.4%6. Approximately 418 million disability-adjusted life years (DALYs) are attributable to mental disorders (16% of global DALYs)7. The economic value associated with this burden is estimated at about USD 5 trillion7. Nevertheless, on average, countries allocate just 2% of their health budget to the treatment and prevention of mental health conditions6, a level of investment that is largely inadequate to tackle the unmet mental health needs. Despite a 36% decrease in rates over the last 20 years, suicide still claims over 700,000 lives annually and remains one of the leading causes of death worldwide among young people8. The decline in rates is not uniformly distributed across countries and regions. For instance, in the World Health Organization (WHO) Region of the Americas, suicide rates have increased by 17% during the same period6. The risk factors for suicide are complex, requiring multifaceted prevention strategies that include treatment of underlying psychiatric disorders, restrictions on access to means of suicide, and comprehensive public and clinical health interventions9. The strongest risk factor for suicide is a previous suicide attempt8. Globally, for every suicide death, there may be up to 20 suicide attempts6. Timely treatments and ongoing follow-up care for individuals with a history of suicide attempt are among the best practices. One such intervention is the WHO Brief Intervention and Contact (BIC) Program, which is at a crossroad of health care-directed psychiatric treatment strategies and public mental health approaches, utilizing community resources and volunteers10. The program is an essential post-suicide attempt strategy within a comprehensive chain-of-care model, underscoring the importance of ongoing structured follow-up in reducing suicide risk9. It also emphasizes that public mental health and clinical components must work together, mutually strengthening each other to achieve the best possible outcomes on a broad scale. The objective of the WHO BIC Program is to reduce a person's risk for suicide post-discharge by enhancing engagement in treatment, building self-efficacy, and increasing social support and connectedness11-13. The program consists of two major elements: a brief motivational session prior to discharge from a hospital after a suicide attempt, and a structured support for 18 months after discharge, with more intensive follow-up at the beginning and gradual attenuation after three months, according to a set schedule. The program was evaluated in a multicentre randomized controlled trial (RCT) conducted in five countries (Brazil, India, Iran, Sri Lanka and China)10 within the WHO SUPRE-MISS initiative14. The RCT assessed the effectiveness of the program for individuals who presented at an emergency department following a suicide attempt. There was a statistically significant reduction of suicide rate in those who received the program in comparison with a control group that only received treatment as usual10. The WPA Action Plan 2023-2026 aims to promote the integration of the BIC model and its evaluation methods into WPA Member Societies’ clinical practice, to reduce mortality due to suicide. The description of the BIC Program and the evaluation methods are available on the WPA website, along with supporting video materials on how to perform BIC training and follow-up contacts. Both a pre-post design and a more rigorous RCT protocol are presented on the website for those who want to implement and evaluate their local BIC intervention. The aim of the straightforward and easy-to-implement pre-post design is to ensure that each local hospital, clinic or ward can readily integrate evaluation activities into ordinary clinical practice, and estimate results in local suicide preventive work. This approach can help uncover the local potential and any hindrances that may be faced in conducting suicide preventive initiatives, offering critical insights into local structures and resources. Incorporating the BIC model and evaluation in clinical practice not only targets immediate suicide prevention, but also strengthens capacity building of young clinicians in research methodology in different continents. This, in turn, can foster trans-cultural collaboration among mental health professionals by promoting a comprehensive and culturally sensitive approach to care, as the WPA includes 147 psychiatric associations from around the globe. In line with SDG 17, which emphasizes the importance of partnerships for sustainable development, collaboration among governments, professional bodies (such as WPA Member Societies), private entities, patients and clients, and civil society is vital for advancing mental health worldwide. This BIC Program, as a collaborative effort, is crucial for addressing the pervasive and escalating challenges of mental health and suicide globally. By promoting evidence-based interventions such as the BIC Program, the WPA Action Plan 2023-2026 underscores the WPA's leadership role in providing strategic guidance, fostering innovation, and creating opportunities for knowledge exchange and capacity building across diverse cultural and health care settings. This comprehensive approach ensures that mental health care is not only evidence-based, but also adaptable and sustainable across different regions and communities. The WPA also promotes the EDIT principle15, which stands for Equality across genders, ages and ethnicities, Developmental life course perspective, Inclusion of under-represented groups, and Transcultural awareness. By embedding these values into its initiatives, such as the BIC Program, the WPA ensures that public mental health and psychiatric clinical activities, research, education and meeting organization are inclusive and responsive to the diverse cultural and developmental needs of global populations.