Are in-school suicide-prevention programmes and strategies converging in four countries with high youth suicide rates?

Edurne Scott Loinaz

Considering the myriad cultures of the world and all their differences – customs, ideas, social behaviours and languages – the very notion that they could all assimilate into one ‘world culture’ is hard to imagine, yet this is essentially the crux of globalisation theory.  The notion that culture is just as susceptible to international influence as goods and services is a relatively new concept, but one that fundamentally affects the way in which we understand how education systems are influenced by international forces. This paper wishes to discuss whether globalisation is indeed causing a global convergence by comparing and contrasting four countries with a common issue – nearly double the average youth-suicide rate – and a proposed solution to the problem: in-school suicide-prevention programmes.  The theory of policy borrowing will also be touched upon to analyse how suicide-prevention strategies were adapted from country to country. By analysing both globalisation and policy borrowing theories this paper has come to four conclusions: (1) National suicide-prevention strategies are indeed converging in the four case studies and all cover similar topics: the need to implement programmes, the need to reduce means of suicide and the need for further research on the subject; (2) Suicide-prevention in-school programmes are converging in that they exist in all the case studies, but the programmes vary significantly from culture to culture, which points to a case of divergence; (3)  Policy borrowing occurred in the four cases due to one (or more) of three factors: geographical proximity, a shared problem (high youth suicide rates) and influence of supranational organisations; (4) Glocalist rather than hyper-globalist theories are better equipped at analysing both the converging and diverging elements in cross-cultural comparison.


For more than twenty years now, globalisation theory has dominated the academic arena splitting itself into two camps- the ‘hyper-globalists’ and ‘transformationalists/glocalists’: the former predicting worldwide convergence (universalising), the latter ‘zooming’ into particular contexts to report both converging and diverging elements (particularising) (Green & Mostafa, 2013). But before discussing these two camps in detail, it is imperative to define globalisation theory itself which is no easy task considering that it encapsulates international interactions in myriad ways – culturally, politically, economically, socially and technologically.  The present paper uses Giddens’ (1990) definition which describes globalisation as the “intensification of worldwide social relations which link distant localities in such a way that local happenings are shaped by events occurring many miles away and vice versa” (21).  What globalisation theory thus postulates is that education systems (and education programmes within the system) are now themselves subject to international influence as much as (or even more so than) national agents.  The aim of this paper is to analyse the implications of this theory and apply it to four countries – New Zealand, Finland, Ireland and Lithuania – that were specifically chosen due to the fact that they all share youth suicide rates at nearly double the global average (or more), as can be shown in the graph below:  

Thus, if the suicide-prevention programmes and strategies are identical in all four countries it will provide evidence for the hyper-globalist argument of convergence (nomothetic homogenisation); if there are similar policies – such as State suicide prevention strategies – but the programmes in the education system are different, it will provide evidence for the glocalist argument of particularising (ideographic hybridisation); if all or some of the four countries are dealing with the same issue differently – which includes doing nothing about it at all – it will highlight the limits of globalisation theory to explain divergence.  

Hyper-globalists versus Glocalists

The hyper-globalist argument states that there is a ‘world culture’ gradually eroding systemic differences between countries, which of course includes national education systems themselves.  This ‘stateless’ process is propelled as much by top-down processes at a global and national level, as well as by bottom-up grassroots movements, in turn leading “to a degree of structural isomorphism in national societies despite the latter’s enormous differences in resources and traditions” (Green & Mostafa, 2013, 17).  This type of whole-scale convergence, claim the hyper-globalists, can be found within the national curricula of different countries which share the same purpose of “socio-economic development, welfare and individual justice, rights and equality” (ibid, 17). Hyper-globalists claim that this cultural diffusion has been responsible for the modernisation of education (Wiseman et al., 2010).  It is interesting to note that such a philanthropic purpose for education has allowed for suicide prevention programmes to become part of the curriculum in the first place, and if this phenomenon was part of a ‘world culture’ these programmes would indeed be seen around the globe in different countries.

Hyper-globalists too point at the evidence of convergence due to supranational agencies exerting pressure on individual countries to adopt common policies; education in a hyper-globalist world would thus be more centralized, with fewer national decision-making authorities.  In terms of suicide prevention policy, for instance, supranational agencies exist like the International Association for Suicide Prevention (IASP) which is an official partner of the World Health Organization, the European Network of Health Promoting Schools (ENHPS) and the United Nations who in 1996 released their publication ‘Prevention of Suicide Guidelines’.  By 2002, the World Health Organization commissioned a European monitoring survey on national suicide prevention programmes and strategies where “Programmes are here understood as concise action plans, combining various specific national strategies in order to achieve predefined goals and objectives, whereas national strategies are defined as different preventive approaches established nationally in different settings” (World Health Organization, 2002).  Though the WHO found that Ireland and Finland both had national suicide prevention strategies and programmes (as did New Zealand at this time), Lithuania only had a strategy and the promise to draft national programmes in the near future. By comparing its differences to other countries – and thus its lack of available programmes – the World Health Organization thus exerted pressure on Lithuania to create practical solutions for suicide prevention, inevitably pushing for a convergence with suicide-prevention programmes in other countries.  This is the case with any other educational policy since, “Educational decision-makers in these ‘target’ countries, in turn, look at other countries’ systems to evaluate, benchmark, and develop their own educational systems using the experiences and evidence from them” (Wiseman et al., 2010, 6). This policy convergence is what hyper-globalists would describe as the forming of a ‘world culture’.

Glocalists, on the other hand, believe hyper-globalists are over-simplifying a complicated process: the converging and diverging elements in every country that result in adaptation and hybridisation.  One must compare the results of identical policies, argue the glocalists, to be able to judge properly whether whole-scale global convergence is actually happening. For instance, it is not enough to say that there is a worldwide convergence due to a shared curriculum based around socio-economic development since this is a “very high level of generality … [but rather] focus more on the details of what is in the constitutions or curricula, or how they are put into practice, and at this level may find much more divergence”  (Green and Mostafa, 2013, 18). As Green et al. (1999) concluded, there is a difference between ‘policy rhetorics’ converging, and practices on the ground converging. The case of Lithuania’s suicide prevention policy is a case in point, in that even though the country has suicide prevention policies in the form of a ‘strategy’, this did not translate into long-term suicide-prevention programmes being implemented. Glocalists therefore paint a very different picture of the future of education than that of the hyper-globalists, the main difference being the impact of the cultural context and its role in decentralisation.  In the four countries studied for this paper also, suicide-prevention programmes have been run by charities alongside State initiatives (and were around long before any national strategy), which shows how grassroots movements can help solve problems without policy rhetoric.

Convergence versus Divergence

Wiseman et al. (2010) define convergence as, “The effects of a process of policy change over time toward a common point, which goes further conceptually than the alignment or harmonisation of isomorphism.  Consequently, policy convergence is an increase in similarity over time of a certain policy across a predetermined set of jurisdictions” (13). Though it is beyond the scope of this paper to answer why some cultures have higher suicide rates than others, it is interesting to note that all the countries in this study have steadily declining suicide rates every year for the past ten years (World Health Organization, 2009), which in itself is a converging trend.  It also must be mentioned that scholars Milner et al. (2011) and Kelleher and Chambers (2003) have pointed to globalisation as a possible explanation for suicide. Milner et al. (2011) came to this conclusion using globalisation indices – like the KOF – that have been developed to show the level of influence globalisation has had on a particular country, and they concluded that the globalisation index was related to increased suicide rates – an argument supported by the fact that suicide rates in Lithuania jumped from 26.1 per 100,000 people in 1990, to 44.1 per 100,000 people in 2000 (World Health Organization, 2009).  

(Countries from bottom to top: Finland, Ireland, Lithuania and New Zealand)

Regardless, the KOF graph above undoubtedly highlights the similarities between the four countries of this study – the major change being Lithuania after the fall of the Soviet Empire – but as Wiseman et al. (2010) warn, “Convergence is more than an approximation of similarity.  It is a growing together (sigma), catching up (beta), process of dynamic mobility (gamma), and the minimisation of the distance to an exemplary model (delta)” (15). Thus, Lithuania’s ‘beta convergence’ in its attempt to ‘catch up’ to the other countries in this study, and Finland, Ireland and New Zealand’s ‘sigma convergence’ in their attempt to ‘grow together’, prove that the convergence concept espoused by globalisation theory is indeed taking effect.

Another point of convergence between the four countries, and a direct development of globalisation, is the use of technology – specifically in the way that it is reshaping the classroom.  As scholars Rizvi and Lingard (2000) state, “[Technological] developments and many others associated with globalization now define the space within which education takes place, and which must be taken into account when analyzing education policy … Technology is able to uncouple culture from its territorial  base so that, unattached, it can reach through the airwaves to anyone with the means to receive its sentiments; the result is new hybridized cultural practices that can be packaged for consumption by those connected to the network society” (Rizvi & Lingard, 2000, 424). Technology is thus changing not only how we teach but who we teach and where.  This is an important consideration when discussing how suicide prevention programmes are disseminated to students – especially those that do not have in-school prevention programmes like Lithuania. Though this will be discussed in much greater detail in the case studies, it is interesting to note that all four countries do indeed have suicide-prevention websites specifically targeted to young people (both State-run and charity-run), highlighting the Internet’s capacity to act as an extended classroom.  For two of the countries in the study that share a language – Ireland and New Zealand – it means that young people from either country on opposite hemispheres of the world can access and utilise the exact same resources- this technological development associated with globalisation has thus redefined the space in which suicide-prevention can take place.

Policy Borrowing and Lending

Why four countries with different histories, languages and cultures would converge to have similar (or sometimes identical) policies regarding suicide-prevention can be analysed through globalisation theory.  How convergence takes place rather than why it takes place, however, is the study known as policy borrowing and lending, defined here as, “The transfer of ideas, policies and organisational models from one place to another … with lending, one is typically more interested in the context from which a given idea, policy or organisational model originates; with borrowing, one is usually more concerned with the context in which it is received” (Waldow, 2012, 411).  It is also important to emphasise, as scholar Phillips (2005) states, that policy borrowing is itself a conscious, deliberate and purposive act, “There is much in a country’s approach to education that might influence practice elsewhere, and that ‘influence’ might take many forms, but influence does not imply a process of ‘borrowing’ unless there has been a quite deliberate attempt to ‘copy’, ‘appropriate’, ‘import’ (etc.) a policy or practice elsewhere identified as being of potential value in the home country” (24).  There is thus a marked difference between susceptibility to influence and ‘conscious’ borrowing – the term ‘policy borrowing’ only refers to the latter category. Some common reasons why one country would like to borrow an educational policy from another include:

  • Serious scientific/academic investigation of the situation in a foreign environment;
  • Popular conceptions of the superiority of other approaches to educational questions;
  • Politically motivated endeavours to seek reform of provision by identifying clear contrasts with the situation elsewhere; and
  • Distortion (exaggeration), whether or not deliberate, of evidence from abroad to highlight perceived deficiencies at home.

(Phillips, 2000, 299)

How borrowing policy shapes globalisation theory is another interesting point since borrowing/lending policy focuses on the details – the hybridisation of policy from culture to culture – and thus borrowing policy cannot help but gather evidence for the glocalist camp, a fact that becomes clear when reading Waldow (2012), “Whether borrowing takes place, and in what form it does so, depends on the borrowing context, not the place of origin of what is borrowed.  The model is in the eye of the beholder” (417). Waldow’s statement argues that all policy is up for subjective interpretation, a conclusion that he shares with Niklas Luhmann, the German sociologist, who coined the term ‘externalisation’ to describe how other countries’ policies are used as checks and balances for the education system: “Externalisation does not come to the system from the outside: it is both instigated from within and processed within the system … These include externalisation to values, to organisation or to the principles and results of science” (Waldow 2012, 418).  It is then a given that if policy can be interpreted subjectively by each country – let alone by each policy maker therein – that there would be a considerable difference in the implementation of the same policy in each country.

So what of suicide-prevention strategies and policy borrowing?  Though the history of suicide-prevention will be discussed at length below, a summary of policy borrowing within this very specific subject is useful to mention here.  Suicide-prevention programmes have been active from the mid-20th century onwards thanks to charities such as The Samaritans in England that was established in 1952 with the aim to listen and talk to people experiencing suicidal thoughts.  The first ever national-scale suicide-prevention strategy, however, was published in Finland in 1986 and after six years of research on 1,397 suicides, Finland implemented a nation-wide suicide prevention programme in 1992 when its youth suicide rates were the highest in the world  (Upanne, 1999). This strategy was closely followed by Sweden (1993), Norway (1994), Australia (1995) and finally the United Nations (1996) who published their ‘Prevention of Suicide Guidelines’ and recommended that national suicide strategies should have “support from government policy; a conceptual framework; well established aims and goals; measurable objectives; identification of organisations capable of implementing objectives; and ongoing monitoring and evaluation” (United Nations, 1996). 

The geographical proximity between Finland, Sweden and Norway will no doubt provide evidence as to why policy borrowing took place between the three countries in such a short amount of time, but as Play (2011) warns, “Geographical proximity does not mean necessarily that individual nations will share all the same cultural, political or historical imperatives … hence, automatic and systematic ‘policy borrowing’ should be avoided”  (167). This proves to be the case when you look at suicide statistics for young men (15 to 24 years old) in the three countries directly before the suicide prevention programmes were set in place: Finland’s rate was the highest at 43.7 per 100, 000 (higher than Lithuania’s today for the same age range and gender), Norway’s rate was 26.0 and Sweden’s rate was 15.5.

(Kelleher and Chambers, 2003, 178)

It was Finland’s decreasing youth suicide rate that no doubt caught the attention of the country’s neighbours, and in fact from 1990 to 2005 Finland’s suicide rate has decreased by 40% (European Union, 2008, 2).  Yet after Finland’s neighbours adopted similar suicide-prevention strategies, the next country to adopt a suicide-prevention strategy, Australia, was in a different hemisphere altogether. Though geographical proximity had nothing to do with Australia’s adoption of its own suicide-prevention strategy in 1995, it could be argued that it did in the case of New Zealand’s first Youth Suicide Prevention Strategy in 1998.  In this case, policy borrowing of suicide prevention strategies – started by Finland’s research in the 1980s – would be explained by Phillips (2000) as serious scientific/academic investigation of the situation in a foreign environment. By 1996 the involvement of the United Nations allowed for a supranational agency to exert pressure on individual countries to adopt common policies, thus creating the situation in the present day where it is rare to find a country with a high youth suicide rate without a suicide prevention strategy.  And what of the last two countries in this study? Lithuania published their suicide-prevention strategy in 2002, meaning that policy borrowing between the country with the highest youth suicide rates in 1992 and the country with the highest youth suicide rates in 2002 took 10 years to converge. In Ireland the National Health Strategy was published in 2001, and only two years later Ireland had made it compulsory to integrate suicide-prevention programmes in the form of its ‘Social, Personal and Health Education programme (SPHE)’ in its curriculum.  It was not till 2005 that Ireland officially published its suicide-prevention strategy, ‘Reach Out – A National Strategy for Action on Suicide Prevention’.

Suicide Prevention History

The study of suicide and the discussion around what would constitute effective suicide-prevention programmes can be traced back to the late 19th century to Durkheim (1897) who just like Milner et al. (2011) concluded that increased suicide rates were partly due to modernisation and thus that suicide is influenced by social factors.  In terms of youth suicide, Hosanky (2012) states that researchers did not start paying attention to this subject before the 1970s, mostly due to the fact that most psychologists believed young people could not suffer from depression. It was not till 1980 that childhood depression was finally listed as a, “diagnosable psychiatric condition in the authoritative Diagnostic and Statistical Manual on Mental Disorders (DSM-III) … The increased suicide rate forced psychologists and policymakers in the 1990s to begin viewing mental health disorders in the young as a significant public health problem” (Hosansky, 2012, 307).  The impetus to provide suicide prevention programmes in public education as a solution to high youth suicide can also be attributed to academic suggestion and research also:

  • “Taking a population-health perspective, we advocate a continuum of response with a series of levels, from the community through to specialist services … Schools and colleges in particular offer a unique setting for mental health promotion in young people, via the emphasis on reducing risk factors and strengthening protective factors” (Patel et al., 2007, 1308);
  • “Recent research suggests that school-based skills training and direct screening programs can increase coping skills and identify individuals at risk of committing suicide” (Hosansky, 2012, 309);
  • “ It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g., education, labour, police, justice, religion, law, politics, the media)” (World Health Organization, 2014). 

The World Health Organization’s ‘Preventing Suicide: A resource for teachers and other school staff ‘(2000) fundamentally changed suicide-prevention strategies from the top down since it described teachers as vital agents in curbing high youth-suicide rates.  From then on it was natural that suicide-prevention programmes would become available in schools – both in offline and online classrooms.

Case Studies

New Zealand

Ever since New Zealand’s first suicide-prevention policy, ‘Youth Suicide Prevention Strategy’ was published in 1998, the island country in the Southern Pacific Ocean has been a point of ‘externalisation’ for other countries in regards to suicide-prevention programmes.  The New Zealand Ministry of Health is prolific in its studies of suicide-prevention and as of 2014 has eleven separate suicide-prevention initiatives including Kia Piki te Ora (addressing suicidal behaviour in New Zealand’s indigenous Maori community), Towards Wellbeing (where clinical psychologists make site visits to support young adults with suicidal thoughts) and finally Travellers (a first-year secondary school suicide-prevention programme specifically targeted at students who are experiencing major upheaval in their lives)  (Ministry of Health, 2008). The latter in-school programme, Travellers, was developed by the Ministry of Health in partnership with the University of Auckland’s Injury Prevention Research Centre, and is currently in its tenth year with over a third of secondary schools in the country using the programme and with 300 trained facilitators. The programme uses the ‘life is a journey’ metaphor to explore four subjects: (1) change, loss and transition experiences; (2) navigating their movement through change, loss and transition in safe and adaptive ways; (3) linking how they think and feel about change, loss and transition situations and how their thoughts and feelings influence how they cope and respond; and (4) enhancing supportive environments and improving their learning outcomes (Travellers, 2014).  The programme ‘Kia Piki te Ora’ highlights the fact that young Maori men still have the highest suicide rates out of any age, gender or ethnicity in New Zealand.  As a whole the, “Maori youth suicide rate for 2011 was 36.4 per 100,000 Maori youth population – 2.4 times higher than that of non-Maori youth (15.1 per 100,000 non-Maori population)” (Ministry of Health, 2008).  In terms of online support, New Zealand has countless hotlines and websites specifically dedicated to youth, run by both the Ministry of Health and charities.


Since Lithuania’s 2002 suicide-prevention strategy was published, along with the Suicide prevention programme for 2003-2005 (approved in 2003), the only programme put into place in schools has been the aptly titled ‘Suicide Prevention Programme’ (2005) which was implemented to improve the skills of school teachers to identify students at risk of suicide – this programme finished in 2007 (ASPEN Project, 2007).  In terms of support offered to suicidal young people, there is a State-funded programme called Child-line which can be reached by phone, internet or post yet, “In 2005 there were 1.2 million attempts to reach the service by phone but only 50,000 could be answered” (European Union, 2007, 3). The only other youth-line available in Lithuania is that run by the Youth Psychological Aid Centre (YPAC) which has been running since 1993 with 12 staff and approximately 120 trained volunteers.  This charity runs the hotline, a mobile crisis intervention group, an internet counselling program with “Letters to a Friend” and a day-care centre for at-risk children and families.  It also organises annual suicide prevention concerts called “Choose Life” (JPPC, 2011).  In the 2007 Mental Health Briefing Sheet about Lithuania conducted by the European Union, the resistance towards suicide-prevention programmes and the field of mental health in general is briefly discussed, “Modern approaches in the field of public mental health are often met with resistance by dominant biomedical attitudes amongst a large part of the population, as well as major stakeholders and decision makers. Such attitudes based on historical tradition, which lacked tolerance of vulnerable groups, were associated with stigma and discrimination of people with mental health problems. Therefore reforms in the educational curriculum for the future public health professionals are being undertaken” (European Union, 2007, 4).  In this way Lithuania plans to use education as a means to combat the stigma of suicide and mental health.


Ireland has been successfully integrating its suicide-prevention programmes within the national curriculum since 2003.  Ireland has pushed the envelope as to how much schools should be involved in students’ mental health through the ‘Social, Personal and Health Education” programme (SPHE)’ as can be witnessed in the Department of Health and Children’s 2005 publication ‘Reach Out’ (Ireland’s first suicide-prevention strategy), “Education about mental well-being and mental health problems should become an integral part of the school curriculum, starting in primary school. It is especially important to address the myths and stigma surrounding mental health which, for many young people, are barriers to seeking help for emotional and mental health problems. Finally, the support needs of staff in developing mental and emotional health promotion must be acknowledged and met” (21).  There is also information for schools as to how to best respond to suicide (tertiary post-vention), and the need for collaboration between departments, specifically the Department of Education and Science (DES) and the Department of Health and Children (DoHC). Ireland is also concentrating on anti-bullying programmes (‘Mental Health Matters’) as a form of suicide-prevention in collaboration with the Irish Society for the Prevention of Cruelty to Children, the National Youth Council and the National Youth Federation  (European Union, 2008, 3). Groups like ‘BeLonG’ are helping lesbians, gays, bisexual and transgender youth who “are more likely to be medicated for depression and are more likely to engage in … deliberate self-harm” (Reach Out, 2005, 37). The Internet is also being utilised by many groups to provide information on suicide prevention, the most prominent being SpunOut which is run by youths for youths and aims to “guide young people through life with quality information and support as well as providing a platform for young people to express their opinions, realise that they are not alone and get heard” (European Union, 2008, 3).


And what of the first country to introduce suicide-prevention strategies and programmes in the world?  Finland’s school programme is named YHTEISPELI (meaning ‘playing and working together’) which aims at promoting “children’s socio-emotional development in kindergarten and in elementary school.  Tools and practices for teachers and other school personnel are being developed to enable schools to promote children’s psychological development more systematically and efficiently” (European Union, 2008, 2).  Finland’s other initiatives include the Effective Family project which works with parents suffering from severe mental illness to prevent their children from suffering the same fate. Finland is also the only country to target the gender imbalance in suicide rates which is common to all four countries.  The programme ‘Time Out! Getting Life Back on Track’ aims to develop a “psycho-social support programme for preventing the process of exclusion among young men. The purpose of the project is to develop the content of support interventions, draw up models for service organisation and to examine the impact of support interventions” (European Union, 2008, 2).


If a hyper-globalist were to review the suicide-prevention strategies of Lithuania, New Zealand, Ireland and Finland she would find evidence of convergence: all four countries after all have almost identical strategies that wish to reduce suicide rates, implement programmes for specific groups, reduce means of suicide, support the bereaved, help the media in how to deliver news sensitively and support new research.  She would also find evidence of convergence in declining suicide rates, the disproportionate number of young men killing themselves compared to young women and the use of technology as a means to disseminate online suicide-prevention programmes. A glocalist, however, would find examples of hybridisation (and thus divergence) in all four countries from the nearly identical national strategies: New Zealand’s programmes targeted at secondary-school students rather than Finland’s and Ireland’s socio-emotional development programmes in primary schools; Lithuania’s lack of any available programmes compared to the ongoing commitment in the other three countries; and finally, how each country has tailor-made programmes for specific high-risk groups – Maori, LGBT and young men – for instance.  At the end of the day, as with any theory, one sees what they want to see, yet the hyper-globalist argument that national differences are eroding to create a ‘world culture’ fails to stand up in this case considering the vastly different programmes that are being implemented in each country (if any at all). Why Lithuania has been so reluctant to put any long-term programmes in place proves to be a very clear case of divergence, one that can be explained by Green’s (1997) theory that globalisation theory may describe convergence in Western countries but falls apart thereafter. In terms of suicide rates this proves to be the case too as the World Health Organization (2005) concluded that, “The gap between the newly independent states of the former Soviet Union (NIS) and European Union (EU) countries is 15.8 per 100 000 population.”  In terms of policy borrowing there is a clear-cut case that Finland’s geographical proximity to other Nordic countries led to similar strategies being implemented in such a small space of time, though it was the similar problem of high suicide-rates that led to Australia and New Zealand adopting similar practices from the other side of the world. After the new millennium, however, most countries’ national suicide strategies have no doubt been greatly influenced by supranational agencies and publications, like the World Health Organization’s “Monitoring survey on national suicide prevention programmes”.   


The comparison of four countries’ suicide prevention strategies and programmes  – the common thread running through the four being the high youth suicide rates they share – proves the glocalist theory that globalisation can only be seen to be eroding national differences if one ignores the finer details.  As the four case studies in Lithuania, New Zealand, Ireland and Finland have hopefully shown, there is a vast difference between policies and implementation, and though policies and national strategies might be converging, their implementation is still very much subject to cultural hybridisation.  There has been a convergence in national strategies for suicide-prevention, mostly thanks to policy borrowing in three situations: influence of supranational organisations, geographical proximity and a shared common problem. One can only hope that the continuing global reduction of suicide rates means these shared policies and their consequent programmes are working, no matter how they change to adapt to different environments.  


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