The UK's first health strategy, launched in 1992, included mental health as one of its four priorities, mostly I suspect because of a rising suicide rate in young people. At the time there didn't seem much a Director of Public Health could do to tackle the problem. Certainly by today's standards of evidence, the evidence was very thin indeed. The best that seemed to be available was an effort on the tiny island of Gotland to train GPs in better diagnosis and use of anti depressants.
In a nice phrase, Bonell and colleagues recently criticised the UK government's Troubled Families programme for being 'under theorised'. But perhaps if you do some sensible things, theory will catch up with practice. That, according to its authors, is what happened with the US Air Force's successful suicide prevention programme. I say 'some sensible things' but one hallmark of the USAF programme was the weight of implementation effort. They recognised that this was a major problem for their community, and explicitly tackled it as a community.
All that came to mind when I read this recent account of another suicide prevention project in another tightly knit community - the Apache nation.
I'm not sure you can do this sort of thing across a whole country of 55m people. It does seem to require whole community effort, and a small enough community to agree that this is what needs tacking. In the case of the Apache nation, I guess the data on comparative suicide rates helped to make that decision / get that commitment.