For too long, the topic of suicide has been met with silence, shrouded in secrecy, or reduced to statistics. When people cannot talk openly about suicide, they are less likely to reach out, and the people around them are less equipped to recognise and support them.
Research shows that most deaths by suicide occur in the context of depression and other mental health conditions (1). In addition, recent public health crises, including the COVID-19 pandemic, war and conflict, and climate change, have intensified many of the underlying drivers of poor mental health, contributing to a rise in anxiety and depression globally.
Reinforcing upstream approaches to change the narrative: Example of the EAAD Model
World Suicide Prevention Day, which takes place each year on 10th September, strives to change the narrative around suicide by enhancing suicide prevention efforts around the world. While significant strides have been made in suicide prevention, reducing stigma and increasing help-seeking, considerable work still lies ahead. Reducing suicide requires sustained investment in the conditions that support mental wellbeing long before individuals reach a point of crisis. Taking an upstream approach to suicide prevention requires addressing the structural, social, and economic conditions that shape population-level mental health risk. This lies at the heart of the European Alliance Against Depression (EAAD) model (2). Now in its sixth iteration, the EAAD model, through MENTBEST, is currently being implemented across five countries, i.e., Albania, Estonia, Greece, Ireland, and Spain. The project’s overall objective is to support health and mental healthcare professionals, as well as communities across Europe, to prevent and mitigate mental health problems, both clinical and non-clinical. This unique approach aims to improve care for people with depression and to prevent suicidal behaviour in Europe and beyond through a community-based four-level intervention model.
The 4-level community-based intervention
As part of this model, health professionals (GPs and nurses) and mental health professionals (psychiatrists, psychologists, and psychotherapists) receive Level 1 training to reach individuals who often face multiple challenges, such as those with undiagnosed depression, untreated suicidal ideation or limited access to care. The aim is to enhance early identification across multiple settings and address the issue of low help-seeking among people experiencing suicidal behaviours. Community facilitators (e.g., teachers, police officers, youth workers, and others) undertake Level 3 training to increase their awareness of the signs of depression and suicidal behaviour and to learn how to signpost people to appropriate supports. Both Level 1 and Level 3 training programmes can be adapted to suit the context and specific needs of the target population, context and cultural factors. In addition, Train-the-Trainer programmes at both Level 1 and Level 3 support local delivery of training beyond the project duration, which ensures the training remains sustainable and relevant within the implementation region.
Level 2 interventions involve public awareness campaigns and events aimed at reducing stigma and promoting help-seeking behaviours. Finally, Level 4 focuses on providing support for people experiencing depression and suicidal risk, as well as for their relatives. Furthermore, particular emphasis is placed on supporting vulnerable groups, including migrants and refugees, older and younger people, the long-term unemployed, and individuals with mental health conditions, across all levels of the intervention.
A key feature of the 4-Level intervention model is the establishment of an advisory panel comprising relevant stakeholders to guide the local implementation of the project. This ensures that the specific needs of the implementation region are addressed effectively using targeted interventions.
The EAAD four-level model for depression care and suicide prevention
Examples of implementation of EAAD’s 4-Level Intervention
Level 1: Training health and mental health professionals
Level 2: Reducing stigma and myths around depression and suicide through public awareness campaigns
Instances of Level 2 activities in Greece, Ireland, and Albania:
Level 3: Training community facilitators and gatekeepers
Ensuring sustainability of the programme through the Train-the-Trainer programme
Two-day Train-the-Trainer programme in Ireland, May 2026
Level 4: Support resources for people with depression and suicide risk, as well as relatives
Supporting sustainable efforts
EAAD’s legacy in implementing the 4-level community-based model across Europe demonstrates the importance of sustained simultaneous action across key domains of our social and health ecosystem. Recently, a landmark perspective article on the 4-level model for tackling depression and suicidality was published, which compiled key lessons for global mental health programmes (3). Simultaneous action across public, medical, community, and individual levels produce compounding benefits; hence, programmes should work towards a balance in local community leadership with political support, and independence from pharmaceutical influence preserves trust. Adapting resources to local health systems can scale up successful programmes.
Overall, the EAAD four-level community-based model offers a comprehensive and adaptable approach for addressing depression and suicidal behaviour. By engaging primary care, the public, community gatekeepers and individuals at risk, EAAD creates a coordinated response that strengthens mental health systems and reduces stigma. As demonstrated across diverse settings, the EAAD model bridges critical care gaps and supports sustainable, community-driven solutions. This perspective highlights an actionable framework that can be adapted globally, expanding mental health preparedness and response in both routine care and public health emergencies.
If you have thoughts of suicide, or are concerned about someone who might be, get in touch with your local emergency and crisis support services.
For the UK and Republic of Ireland (RoI), support is available:
- In an emergency: 999 or 112
- Samaritans (Ireland and UK): free, 24/7, on 116 123
- Text About It (Ireland): text HELLO to 50808
References
- Yeh HH, Westphal J, Hu Y, Peterson EL, Williams LK, Prabhakar D, Frank C, Autio K, Elsiss F, Simon GE, Beck A, Lynch FL, Rossom RC, Lu CY, Owen-Smith AA, Waitzfelder BE, Ahmedani BK. Diagnosed Mental Health Conditions and Risk of Suicide Mortality. Psychiatr Serv. 2019 Sep 1;70(9):750-757. doi: 10.1176/appi.ps.201800346. Epub 2019 Jun 12. PMID: 31185853; PMCID: PMC6718299.
- Hegerl U, Heinz I, O’Connor A and Reich H (2021) The 4-Level Approach: Prevention of Suicidal Behaviour Through Community-Based Intervention. Front. Psychiatry 12:760491. doi: 10.3389/fpsyt.2021.760491
- Arensman, E., Sadath, A., Callanan, A. et al. The European Alliance Against Depression approach: an evidence-based program to reduce depression and suicidal behavior. Nat. Mental Health 4, 42–51 (2026). https://doi.org/10.1038/s44220-025-00562-9