[Clinical psychiatry and suicide prevention]

People do not commit suicide all of a sudden. There is a suicidal process where negative life events are there in the beginning, and social support and help-seeking behavior play an important role in impeding the progress of the process. Mental disturbance would be deeply associated with the suicidal process around the final stage, thinking of the fact that approximately 90% of the suicides suffered from mental disorders at the time of suicide. In considering the strategies for suicide prevention, there are two perspectives: a community model and a medical model. A community model is thought to be related mainly to the first half of the suicidal process and a medical model to the latter half. It is an ideal that both community and medical approaches are put into practice simultaneously. However, if resources available for suicide prevention are limited, a medical-model approach would be more efficient and should be given priority. Starting from a medical model and considering treatment and social resources necessary for suicidal people, the range of suicide prevention activities would be expand more efficiently than starting from a community-model approach. Clinical psychiatry plays a greatly important role in preventing suicide. It is found that approximately 20% of seriously injured suicide attempters were diagnosed as adjustment disorder in Japan, which means that even the mildly depressed can commit suicide. Therefore, no one can take a hands-off approach to suicidality as long as he/she works in the field of clinical psychiatry. It is earnestly desired to detect and treat properly the suicidal patients, but there is no perfect method. It would be helpful to pay attention to patients' personality development, stress-coping style and present suicidal ideation. Besides, as suicide prevention is not completed only in a consulting room, it is important for psychiatrists to look for teamwork.