In reply to DancingOnRock:
But you can't separate the two in that way.
Both are entirely relevant if you are drawing up a public health strategy to reduce suicide rates. You try to improve recognition of abnormal mental states that suggest an increased risk of suicidal acts, and improve interventions to manage these mental states when recognised.
But you also try to deal with the availability of the means to complete suicide in the environment. A high number of suicidal acts are impulsive in nature, and restricting access to more lethal means is an effective way of reducing the suicide rate. This is why the maximum number of paracetamol that could be bought at one time was reduced in the UK- yes, people can go to another shop and get more, but the more steps you put between the person and accessing the means to end their life, the less likely it is they will go on to do so.
There is also a well recognised relationship between occupation and suicide, with occupations where there is ready access to lethal means having a higher rate- farmers with access to shotguns, vets and doctors with access to medications.
And clear epidemiological evidence that this works as an intervention to reduce suicide- the single biggest drop in the suicide rate in the UK happened when we switched from coal gas to North Sea gas, as it had lower carbon monoxide levels and 'sticking your head in a gas oven' became an uncomfortable way to spend time rather than lethal.
The other biggest determinant of the suicide rate is the performance of the economy. Evaluations of mental health interventions show these make much less of a contribution.
So if public health America wanted to reduce the suicide rate in the US, the single most effective step would be to control access to firearms.
I'm not going to hold my breath though, as the 'it's not the guns' argument will continue to be deployed every time the issue come up, even though its obvious it really, really is...