Suicide prevention must include preventing all suicides.

There seems to me to be a cognitive dissonance in the suicide prevention arena that seems to set aside concern about suicides that are related to advocacy networks such as Exit International. This happens at a number of levels and in a number of ways; some perhaps understandable but none excusable.

Australia has one of the highest incidences of youth suicide in the western world. It makes good sense to focus resources in this critical area of prevention. But there's something missing in the public discussion that should have become crystal clear from recent media coverage in the Fairfax press.

Journalist Craig Butt reports on suicide deaths using Nembutal and highlights its use by young people:

New data from the national coronial information system shows 120 people died by taking Nembutal – dubbed the "peaceful pill" – between July 2000 and December 2012.

The number of deaths from the drug reached a high of 24 in 2011, compared with nine in 2001. In 2012, there were 17 deaths. However, there may be more as the data obtained by Fairfax Media does not include cases before the coroner.'

The deaths included one person under the age of 20, 11 people in their 20s and 14 people in their 30s.

That's 22% of all Nembutal deaths over a little over 11 years being suicides of persons under 40 years of age and 10% under 30 years. The data does not include deaths still under investigation.

Where are the suicide prevention agencies? Nary a comment. True, these deaths comprise only a small percentage of the suicide deaths each year, but that will be of little comfort to family members left to ponder the unanswerable questions, left to grieve. Suicide may be a solitary act, but its effects are far reaching.

True, suicide prevention is not so much about removing or reducing access to particular methods of suicide but, properly, about reaching people with mental health difficulties, keeping them safe and seeking to address their issues. But when their efforts are being critically undermined by clandestine operations and where few are ringing alarm bells about such activities, suicide prevention agencies raising public concern should be a 'no-brainer'. Is this virtual silence tacit endorsement or is something else at play?

To their credit, a number of prevention agencies did respond well to an ABC 7:30 report on the suicide death of West Australian man, Nigel Brayley in 2014 who was shown to have had dealings with Exit International. A connection between Brayley and Exit was well established and at least one of these agencies did respond by making a formal notification to the Australian Medical Board. (Note: the extent of that relationship and whether or not that connection constitutes a breach of the criminal code on assisting in suicide is not proven and I make no inference in that regard.)

It was perhaps this proven connection that prompted action; but that still leaves unanswered the whole question of public suicide advocacy and how that undermines prevention.

There's a further complication that is somewhat understandable but nevertheless inexcusable.

From time to time our media will run stories of older Australians looking to end their lives using methods or substances that are the stock-in-trade of these advocacy networks. In recent times some of these people have been ill, but others simply tired of life with no particular ailment other than the effects of aging.

In general, the media is either neutral or sympathetic in its portrayals including an almost mandatory potted history of the person's life which tends to create an air of sympathy; 'they've had a good life'. There's a different treatment of the suicide of a young person and that of someone at the other end of life's spectrum. Why should this be the case?