Prevention

The prevention of interpersonal violence A rigorous review of the literature on the effectiveness of strategies to prevent interpersonal violence identified the seven strategies below as being supported by either strong or emerging evidence for effectiveness.[19] These strategies target risk factors at all four levels of the ecological model. Developing safe, stable and nurturing relationships between children and their parents and caregivers Among the most effective such programmes to prevent child maltreatment and reduce childhood aggression are the Nurse Family Partnership home-visiting programme[20] and the Triple P (Parenting Program).[21] There is also emerging evidence that these programmes reduce convictions and violent acts in adolescence and early adulthood, and probably help decrease intimate partner violence and self-directed violence in later life.[22][23] Developing life skills in children and adolescents Evidence shows that the life skills acquired in social development programmes can reduce involvement in violence, improve social skills, boost educational achievement and improve job prospects. Life skills refer to social, emotional, and behavioural competencies which help children and adolescents effectively deal with the challenges of everyday life. Reducing the availability and harmful use of alcohol Evidence is emerging that violence may be prevented by: Reducing the availability of alcohol (e.g. by restricting hour or days of sale and raising alcohol prices); Brief interventions and longer-term treatment for problem drinkers; Improving the management of environments where alcohol is served (e.g. reducing crowding, increasing comfort levels, improving physical design and staff training). Reducing access to guns Evidence emerging suggests that limiting access to firearms can prevent homicides and injuries and reduce the costs of these forms of violence to society. There is some evidence, for example, to suggest that jurisdictions with restrictive firearms legislation and lower firearms ownership tend to have lower levels of gun violence.[24][25][26][27] Promoting gender equality and challenging gender norms and roles to prevent violence against women Evaluation studies are beginning to support community interventions that aim to prevent violence against women by promoting gender equality. For instance, evidence suggests that programmes that combine microfinance with gender equity training can reduce intimate partner violence.[28][29] School-based programmes such as Safe Dates programme in the United States of America[30][31] and the Youth Relationship Project in Canada[32] have been found to be effective for reducing dating violence. Changing cultural and social norms that support violence Rules or expectations of behaviour norms within a cultural or social group can encourage violence. Interventions that challenge cultural and social norms supportive of violence can prevent acts of violence and have been widely used, but the evidence base for their effectiveness is currently weak. The effectiveness of interventions addressing dating violence and sexual abuse among teenagers and young adults by challenging social and cultural norms related to gender is supported by some evidence[33][34] Victim identification, care and support programmes Interventions to identify victims of interpersonal violence and provide effective care and support are critical for protecting health and breaking cycles of violence from one generation to the next. Examples for which evidence of effectiveness is emerging includes: screening tools to identify victims of intimate partner violence and refer them to appropriate services;[35] psychosocial interventions such as trauma-focused cognitive behavioural therapy to reduce mental health problems associated with violence, including post-traumatic stress disorder;[36] and protection orders, which prohibit a perpetrator from contacting the victim,[37][38] to reduce repeat victimization among victims of intimate partner violence. Interventions to prevent collective violence Not surprisingly, scientific evidence about the effectiveness of interventions to prevent collective violence is lacking.[39] However, policies that facilitate reductions in poverty, that make decision-making more accountable, that reduce inequalities between groups, as well as policies that reduce access to biological, chemical, nuclear and other weapons have been recommended. When planning responses to violent conflicts, recommended approaches include assessing at an early stage who is most vulnerable and what their needs are, co-ordination of activities between various players and working towards global, national and local capabilities so as to deliver effective health services during the various stages of an emergency.[40] Suicide prevention Not all suicides can be prevented, but a majority can. There are a number of measures that can be taken at community and national levels to reduce the risk, including: reducing access to the means of suicide (e.g. pesticides, medication, guns); treating people with mental disorders (particularly those with depression, alcoholism, and schizophrenia); following-up people who made suicide attempts; responsible media reporting; training primary health care workers. At a more personal level, it is important to know that only a small number of suicides happen without warning. Most people who kill themselves give definite warnings of their intentions. Therefore, all threats of self-harm should be taken seriously. In addition, a majority of people who attempt suicide are ambivalent and not entirely intent on dying. Many suicides occur in a period of improvement when the person has the energy and the will to turn despairing thoughts into destructive action. However, a once-suicidal person is not necessarily always at risk: suicidal thoughts may return but they are not permanent and in some people they may never return