Strengthening surveillance of suicide and self-harm

Surveillance is crucial for guiding interventions. Preference should be given to obtaining high-quality data from several representative locations rather than poor-quality data from the entire country. 

Some countries have a civil registration and vital statistics (CRVS) system which formally records the occurrence and characteristics of all deaths (and births). WHO recognizes the importance of strengthening CRVS systems, formulated a CRVS strategic implementation plan, and developed a resource for suicide case registration. 

Given a previous suicide attempt is an important risk factor for suicide, WHO has produced a Practice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm in the health sector (hospital-based surveillance).

Some episodes of self-harm are not captured in hospital data, although they may be known to their communities. 

Where there is not a well-functioning CRVS system, verbal autopsy may be used for community surveillance, whereby a primary caregiver is retrospectively interviewed to ascertain the cause of death. WHO has developed a verbal autopsy instrument to assist standardization of data collection.

Furthermore, the WHO STEPS instrument includes an optional module on suicide that can be used to collect relevant information on suicidal behaviour in the community via population-based survey. WHO has also developed a Training manual for surveillance of suicide and self-harm in communities via key informants. The model involves interviewing third-party key informants (e.g. school principal) and corroborating with data from health/police records to ascertain suicide and self-harm cases. This model is suitable, for example, in isolated or hard-to-reach communities.