As it is indicated in the first report on suicide prevention (WHO 2014 [ 1]) many universal, selected and indicated strategies have been implemented worldwide to improve the knowledge about suicide, increase the access to health care professionals, train the gatekeepers and therefore lead to an improvement in identification and management of people at risk.
Appropriately, gatekeeper training employed educational strategies to improve gatekeepers' intent to respond to individuals at risk of suicide [ 25].
Two studies evaluated the effectiveness of gatekeeper training only [ 35, 36, 38], and one evaluated gatekeeper training combined with other strategies, including individual counselling, education and support, and group-based social and cultural activities [ 37].
Three studies evaluated the effectiveness of gatekeeper training [ 35- 38], all of which reported that gatekeeper training programs were developed in consultation with targeted Indigenous groups and communities [ 35- 38].
Nevertheless, as with evaluations of gatekeeper training interventions in non-Indigenous communities [ 14, 25], future evaluations of gatekeeper training in Indigenous communities would be strengthened by the measurement of intermediate outcomes, such as referral and treatment rates of individuals identified at risk of suicide [ 14].
Concerning the reduction of the number of suicides, the results of the both gatekeeper training courses were comparable to those reported in the literature [32, 33].
The gatekeeper training teaches them to identify people at risk by recognising suicidal risk factors, to assess the levels of risk, and to manage the situation appropriately by employing adequate approaching tactics.
Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization.
Special attention was given to the development of new approaches to non-technical measures (i.e. "soft" measures) to prevent suicides (e.g. gatekeeper training) and trespassing accidents (e.g. collaboration, education).
The main intervention strategies employed included: Community Prevention, Gatekeeper Training, and Education.
