Champions, Catalyzers, and Cultivators

By Doryn Chervin, DrPH, Executive Secretary of the National Action Alliance for Suicide Prevention and Vice President and Senior Scientist at Education Development Center, Inc.

The National Action Alliance for Suicide Prevention (Action Alliance) continues to work toward fulfilling a vision of a nation free from the tragedy of suicide. As executive secretary of the Action Alliance, I am incredibly grateful to the members of this public-private partnership for their ongoing dedication and efforts to champion, catalyze, and cultivate suicide prevention as a national priority.

The last 18 months have been exceptionally noteworthy. The vision, perseverance, and accomplishments of our Executive Committee, Task Forces, and Tiger Teams have resulted in steady progress in advancing the objectives of the 2012 National Strategy for Suicide Prevention. I would like to acknowledge some of the many Action Alliance members whose contributions have made a significant and lasting impact in the field of suicide prevention.

In March 2015, under the leadership of Research Prioritization Task Force co-leads Thomas Insel (National Institute of Mental Health [NIMH]) and Phillip Satow (Jed Foundation), the Action Alliance released U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses. This report showed that investments in suicide research are severely lagging relative to research on other leading causes of death. The Portfolio Analyses calls for a large-scale research investment focused on a comprehensive prevention strategy and timely and effective evidence-based interventions. This report was made possible only through the herculean efforts of Jane Pearson from NIMH. She deserves all of our gratitude for her tireless work on this important initiative.

Also deserving of our thanks is each and every person who contributed his or her time and expertise to the development of two important sets of guidelines released by the Action Alliance. Special thanks go to the co-leads of our Clinical Workforce Task Force, Brian Boon (CARF International) and Alexander Ross (Health Resources and Services Administration). In November 2014, this task force released Suicide Prevention and the Clinical Workforce: Guidelines for Training. This resource will help assure that the nation’s clinical workforce is prepared to treat persons at risk for suicide. Under the leadership of Drs. Boon and Ross, the task force spent more than three years creating guidelines which can serve as the foundation for creating suicide prevention training programs in health and human services professions. Gratitude is also due to Lori Rogers (CARF) for her time and contributions to this important work.

I also would like to acknowledge Franklin Cook (Unified Community Solutions), Karen Moyer (Moyer Foundation), and John Jordan (Family Loss Project), the co-leads of the Action Alliance’s Survivors of Suicide Loss Task Force. Their hard work and dedication brought forth the landmark report Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines. This publication, released in April 2015, is a set of comprehensive and strategic guidelines detailing how communities can effectively respond to the devastating impact of suicide loss. These guidelines pave the way for decisive advances in postvention. Responding to Grief also puts forth a call to strengthen and expand care to meet the needs of the bereaved and others who suffer from the effects of suicide loss.

A very special thanks is due the Action Alliance’s Faith Communities Task Force which, in September 2014, launched the Your Life Matters! campaign. Your Life Matters! is an opportunity for any faith community to focus one Sabbath each year on the core characteristics common to most faiths that help prevent suicides.The task force co-leads, Talitha Arnold (Unified Church of Santa Fe), Anne Matthews-Younes (Substance Abuse and Mental Health Services Administration), and David Litts (formerly with SPRC) worked diligently on the campaign’s successful launch and are true stewards, serving those in suicidal despair through their work with faith leaders and faith communities.

Several members of the Action Alliance’s Public Awareness and Education Task Force have contributed significantly to suicide prevention educational programs and resources. Jack Benson (Reingold, Inc.) and Dan Reidenberg (Suicide Awareness Voices of Education), along with partners from the Department of Veterans Affairs, the American Foundation for Suicide Prevention, and SPRC were instrumental in establishing the Poynter/Action Alliance Covering Suicide and Mental Health Reporting Institutes. In one year these educational sessions equipped 90 journalists from 30 states with the tools to produce balanced and safe suicide prevention coverage.

Finally, I wish to recognize and celebrate the accomplishments of Public Awareness and Education Task Force co-lead Brian Dyak (Entertainment Industries Council, Inc.) for the Council’s ongoing development of educational resources: Social Media Guidelines for Mental Health Promotion and Suicide Prevention and Entertainment and Media Depiction Suggestions for Portraying Behavioral Health Conditions: Mental Illness and Substance Abuse Disorders.

Again, to all our hard-working and committed volunteers, thank you!


This post has been cross-posted on the Suicide Prevention Resource Center website.

Treating and Preventing Suicidal Behavior

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Brian Ahmedani, Henry Ford Health System; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

There is no one-size-fits-all approach to treating and preventing suicidal behavior. That is why it’s important to understand a variety of research-based strategies that can help you most effectively serve your patients’ unique needs.

1) Train Providers
Research shows that clinicians are likely to come in contact with individuals at risk for suicide over the course of their training and careers, but too few clinicians (even those trained in behavioral health) are adequately prepared to work with individuals at risk for suicide.

It is critical to assess the training needs of clinicians in your organization. For example, a staged training approach might be best-suited to your organization’s needs where all staff has basic knowledge and skills to identify individuals at risk for suicide, and clinicians most likely to see high-risk patients receive advanced training in suicide assessment and treatment. Research can inform the most effective models for sustaining clinician knowledge include ongoing training sessions like annual training or regular online training.

The National Action Alliance for Suicide Prevention recently released Suicide Prevention and the Clinical Workforce: Guidelines for Training. This tool can help you develop suicide training guidelines specific to the needs of your organization’s clinical staff to improve the delivery of suicide care.

2) Increase access to affordable care
Suicide rates are higher where there is less access to trauma centers and where there are high rates of uninsured individuals. There are a number of ways to improve access to affordable care. Mental health parity benefits legislation is one way to encourage utilization of mental health services for people who need them. Implementation of comprehensive parity legislation has proven to increase access to care, increase diagnosis of mental health conditions and reduce the prevalence of poor mental health and suicide rates. Specifically, strong state mental health parity laws have been associated with decreases in suicide rates in the year after the law is enacted.

3) Improve Continuity of care
A 2010 research review on continuity of care concluded that the lack of continuity of care within and across systems increases suicide risk. Repeated follow-up contacts after hospitalization or emergency care have been found to reduce suicidal behavior.

Consider how your organization can establish systems, policies and practices that improve the likelihood of continuity of care for your patients at risk for suicide as part of your standard care, and how you can track these improvements.

One promising example is from Henry Ford Health System’s Perfect Depression Care initiative. In 2001, Henry Ford implemented follow-up appointments based on risk level, established access to a 24-hour crisis line, offered online and drop-in appointments provided email contact and tracked patient follow-up in an electronic medical record system. The results were impressive with suicide mortality rates dropping from over 100 per 100,000 to less than 20 per 100,000 after full implementation.

4) Increase help-seeking and referrals for at-risk individuals
Reluctance to seek help is often multi-faceted. Embarrassment or shame, the belief that treatment is not needed, treatment would not be effective, treatment is inconvenient and/or difficult to obtain, treatment will be unpleasant, or treatment would be detrimental to a specific career path are all factors that can discourage people in need from pursuing care.

To improve help-seeking, it is important for clinicians and organizations to address this reluctance, whether it is related to self-stigma or other beliefs that get in the way. It is not enough to talk broadly about improving awareness by “reducing stigma.” In fact, experts suggest avoiding the term “stigma” in public messaging as it can reinforce negative attitudes and be counter-productive. Instead, it may be more useful to provide stories of successful treatment—by expert providers, peer support specialists and/or family members—where describing a range of effective treatment options and outcomes could improve the community’s knowledge about behavioral health services.

This post has been cross-posted on the National Council for Behavioral Health site.

What Is in Your Treatment Toolbox? Clinical Interventions to Prevent Suicidal Behavior

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Joel Sherrill, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

Community behavioral health providers are expected to know how to treat suicidal patients. As so often is the case, though, the practice demands are ahead of the research. New studies are testing the best ways to treat and prevent suicidal behavior, but how do you treat these behaviors without a full toolbox?

Medication Interventions

Many individuals with suicidal ideation will receive medications to address symptoms and “underlying” psychiatric conditions. However, most medication takes weeks to provide relief from psychiatric symptoms.

Currently, the only medication with a specific FDA indication relevant to suicide is clozapine. Clozapine is indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder. However, agranulocytosis, a rare side effect of clozapine, results in the need for frequent monitoring of white blood cells, which limits its use in practice.

Although not FDA-indicated, lithium medication has been associated with lowering suicide risk in individuals with bipolar disorder. Research has found that individuals who remained adherent to lithium treatment were at lower risk for suicide, but placebo-controlled studies of lithium are still needed to isolate the medication versus compliance benefits in reducing suicide risk.

Ketamine, originally used as an anesthetic, is a repurposed medication that is showing promise as a fast-acting treatment for severe depression and suicidal ideation. Additional research is needed to determine the safety, feasibility, dose and duration for the use of Ketamine, but it does open up the potential for future fast-acting medication treatments for suicidal ideation that could be used in acute care settings.

In addition to tracking possible untoward side effects, there is also a need to test suicidal events as outcomes in medication research studies focused on treating mental disorders. In the past, many industry-sponsored trials excluded suicidal individuals from efficacy trials.

Psychotherapy Interventions

Several research reviews have found that outpatient psychotherapies (e.g., cognitive behavior therapy; dialectical behavior therapy; problem solving therapy) reduce suicidal thinking and re-attempts among high-risk adult patients. One review notes that psychotherapy recipients had, on average, a 32 percent reduction in the likelihood of a suicide attempt compared with usual care within a year.

Another study from the Danish health care registry followed recipients of psychotherapy and those not receiving psychotherapy for up to 20 years. Those who received psychotherapy were 16 percent less likely to attempt suicide and 25 percent less likely to die by suicide.

Modeling the future

In 2014, the Action Alliance’s Research Prioritization Task Force modeled optimal implementation of evidence-based psychotherapy delivered to the U.S. population of adults seen in emergency care for suicide attempts. The model estimated that more than 109,000 suicide attempts and more than 13,000 suicide deaths could be averted over 5 years by delivering effective psychotherapy to adults seen in emergency care settings for self-harm. This demonstrates enormous potential for successful intervention. In the meantime, we must continue to invest in suicide research.

Unanswered Questions

Research challenges include the need to better understand developmental and contextual factors:

• Youth, adult, older adult;
• Transitional, work and health contexts such as discharge from military and COPD onset;
• Co-occurring psychopathology (e.g., substance use);
• Social context (LGTBQ; domestic violence; recent loss);
• Prior suicidal behavior;
• Treatment history and
• Current setting–including immediate (referred from inpatient or emergency care)–in intervention research.

We need to know how to better match potential interventions to the patient’s needs. New treatment targets (e.g., isolation; anhedonia; insomnia; agitation; psychosis) might also be more efficiently addressed.

While suicide research around effective interventions is rapidly increasing, there remain many questions left to answer. For lives to be saved, effective research must be translated into practice.

As community behavioral health providers on the front line, you are the lifeline for patients at risk for suicide and those recovering from an attempt.

(See Section IX in the Research Agenda for citations for all research mentioned above. )

This post has been cross-posted on the National Council for Behavioral Health site.

What We Know (and What We Don’t) About Predicting Suicide Risk

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Lisa Colpe, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

Screening for suicide risk is common to most suicide prevention efforts and clinical practices that aim to identify at-risk individuals. To reduce suicide’s burden, there are a number of research-supported screening and risk detection tools to employ, but there is no doubt that further research is necessary to better understand the various factors that put people at risk of suicide.

The Continuum of Suicide Risk
Ideas about screening reflect our assumptions about a continuum of suicide risk—it is assumed there is a progression of suicide ideation, plans and eventual behavior (i.e., suicide attempts, suicide death). For example, multinational surveys have found that about a third of individuals who think about suicide make a plan and about a third go on to attempt suicide. Meanwhile, another subgroup reports having made an attempt with little or no ideation or planning.

Active versus Passive Ideation
Current approaches to assessing risk are heavily weighted toward identifying active ideation with a plan versus passive ideation (e.g., desire for death). However, some studies have found that passive ideation is just as strongly associated with morbidity as active ideation.

Screening Approaches
Many stakeholders consider screening for suicide risk an essential step in reducing suicides—and there are many opportunities to screen. Holding an annual depression screening day in the workplace or a school screening event following a suicide are two community examples. Screenings can be standalone, web-based for use in public settings or clinical tools (e.g., PHQ-9) integrated into primary care or other intake procedures to detect and monitor depression with suicide ideation. In fact, research looking at a large set of electronic health record data found a six-fold increased risk for suicide attempt (includes 709 attempts and 46 deaths) if someone responded ‘every day’ to the question, “Over the past two weeks, how often have you been bothered by thoughts that you would be better off dead, or hurting yourself in some way?” on PHQ-9.

Screening within Health Systems
Screening practices are ahead of research. The Joint Commission recommends screening in all medical care settings to prevent suicide attempts and deaths. However, health care settings vary with regard to the proportion of patients at risk and the steps necessary to get identified patients to adequate care. In any setting, risk detection alone will not reduce suicide. Assessment, adequate intervention and ongoing monitoring must support screening and detection efforts to have the desired impact of reduced suicidal behavior.

Promising Research
Research links neurocognitive science with risk detection and screening. For example, the Suicide Implicit Association Task (IAT) has shown to improve prediction of who will attempt suicide in the future. It examines reaction times to ‘life’ and ‘death’ words and can be administered on the computer in 5-10 minutes. It is currently being studied in emergency department environments with both youth and adults.

Recent research has also identified specific genetic markers for suicidal behavior, but the studies require replication before having a role in clinical practice.

How Can Risk Detection Contribute to Achieving a 20% Reduction in Suicide?
There are a number of ways to model how our nation could achieve a 20% reduction in suicides. One strategy is to stratify risk and identify those in the high-risk group due to risk factors and those in the low-risk group due to risk and protective factors. If we can identify those in the high-risk group and intervene so we move more individuals into the lower part of the triangle (see graphic), we can begin to reduce suicide’s burden on our nation.

On January 29, the National Council launched a six-part webinar series highlighting the National Action Alliance for Suicide Prevention’s Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. This series is a collaborative effort between the National Council for Behavioral Health,National Action Alliance for Suicide Prevention and the National Institute of Mental Health. Subsequent webinars will describe how this current understanding influences detecting those at risk, clinical care and services, as well as highlighting a number of the pressing research needs to reduce the burden of suicide. For more information about this webinar series, see Linda Rosenberg’s recent blog post announcing this collaboration.

This post has been cross-posted on the National Council for Behavioral Health site.

The Four Factors that Lead to (and Protect Against) Suicide

By Dr. Jane Pearson, National Institute of Mental Health & Action Alliance; Dr. Elizabeth Ballard, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention Secretariat

The ultimate answer to “Why do people become suicidal?” is complex, and as depicted in the figure below, research has focused on several long- and short-term risk factors that interact to place an individual at increased suicide risk.

1. Social Determinants

Healthy connectedness with family members, neighborhoods, cultural groups and society can serve as a protective factor against suicide. Conversely, social isolation is associated with increased risk. Social networks can be leveraged to promote protective influences across all ages. Young people’s attachment to their family and schools can serve as a protective factor with “school-connected” teens exhibiting a decreased risk for suicidal behavior over time. Interventions that increase healthy connections have been related to reduced suicide risk in older Japanese adults.

At the same time, certain types of social networks can relate to increased suicide risk, both in person and via media influences. Social networks can contribute to a “contagion” of suicidal behavior, potentially through imitation, idealizing and/or by ‘normalizing’ suicidal behavior. Media reporting of high-profile suicides also carries a concern for increased suicidal behavior.

2. Clinical Factors

Research has identified a host of clinical suicide risk factors. Psychiatric risk factors for suicide include depression, anxiety, post-traumatic stress and addiction; physical symptoms include pain and insomnia. Suicide has been associated with specific cognitive symptoms such as suicidal thoughts, making a plan, hopelessness, feeling like a burden and impulsiveness. However, it is important to note that the vast majority of people with behavioral health and physical illness diagnoses do not kill themselves.

3. Neurocognitive Factors

There is a connection between suicide attempts and deficits in basic cognitive functions (e.g., attention, memory), executive performance (e.g., conceptual processes, reversal learning), impulse control, decision-making and implicit thought processes (e.g., implicit associations, like preference and self-esteem). The neurocognitive findings associated with suicide risk include motor impulsivity, decision-making, response inhibition, flexibility of response generation, self-monitoring/error-processing, sensitivity to others’ anger, impaired response to positive emotional stimuli, harm avoidance and an inability to delay rewards. Recent research demonstrates that teens who attempt suicide may have impaired decision making on tasks such as the Iowa Gambling Test.

None of these factors has been determined to be entirely specific to suicide—whether or not these factors can be used reliably as clinical predictors remains to be seen.

4. Biomarkers that Reflect Biological Processes

Early research provided some evidence that suicidal behavior is heritable. Twin studies report 36-43 percent heritability; non-fatal suicide attempts have heritability estimates of 17-45 percent, even after controlling for any psychiatric disorders. In addition, children are five times more likely to attempt suicide if a parent has a history of suicide attempts, and it may relate to impulsive aggression. Another example of tragic and toxic parent-child outcomes, between 10-40 percent of individuals who experience suicidal thoughts and behavior have a child abuse history.

Immune factors, patterns of brain activity observed with imaging and genetic variants, have all been studied to identify biomarkers that can help predict risk or resilience. Current research trends include serotonergic functioning, glutamatergic functioning and responsiveness to stress in the HPA (hypothalamic–pituitary–adrenal) axis, which may be linked to childhood traumatic experiences.

At this point in time, there is no biomarker with diagnostic clinical utility.

There is a great deal to be hopeful about with regard to improving our understanding of why people consider and try to kill themselves. For more information and detailed citations on the information presented above, see the full Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives.

On January 29, the National Council launched a six-part webinar series highlighting the National Action Alliance for Suicide Prevention’s Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. This series is a collaborative effort between the National Council for Behavioral Health, National Action Alliance for Suicide Prevention and the National Institute of Mental Health. Subsequent webinars will describe how this current understanding influences detecting those at risk, clinical care and services, as well as highlighting a number of the pressing research needs to reduce the burden of suicide. For more information about this webinar series, see Linda Rosenberg’s recent blog post announcing this collaboration.

This post has been cross-posted on the National Council for Behavioral Health site.

Breaking the Silence – Learning from the experience of Suicide Attempt Survivors

By Doryn Chervin, Action Alliance Executive Secretary

We live during a time, for better or worse, in which suicide is prominently covered in the media. Whether the story is a high-profile suicide, the ongoing fight to prevent military and veteran suicide, or other tragic stories of grief and loss, there is one voice that has been missing – the voice of the suicide attempt survivor. There is a movement underway to change this.  Suicide attempt survivors are emerging with a collective voice and a plan for re-shaping the delivery of suicide care in health care, strengthening community services, and improving suicide prevention efforts.

This Suicide Prevention Week, September 8 – 14, we embrace and support the suicide attempt survivor movement. For far too long, the perspectives of those with lived experience of suicide have not been integrated into treatment services and suicide prevention efforts. Whether this was due to fear, stigma, shame, or other reasons – the important fact is that this is changing.

For the many thousands of Americans who are now living as attempt survivors, their experience of resiliency and lived experience is an untapped resource that could potentially advance suicide prevention and save the lives of others in suicidal despair.  They understand better than providers or researchers how to find meaning in the midst of great darkness.

The National Action Alliance for Suicide Prevention (Action Alliance) is the nation’s public-private partnership advancing the National Strategy for Suicide Prevention and championing suicide prevention as a national priority. The Action Alliance’s Suicide Attempt Survivors Task Force, recently released a groundbreaking report, The Way Forward, which makes recommendations to improve our nation’s health systems, emergency services, and suicide prevention efforts based on the experience of attempt survivors. This report, which incorporates the lived experience of recovery and resilience, provides the missing bridge between suicide attempt survivors and treatment services, suicide prevention leaders, and policy makers.

The Way Forward marks the beginning of a new era, in which families, communities, clinicians, and health systems do not fear persons with a known history of suicidal thoughts and behaviors. Similar fears and concerns were once directed at persons with histories of mental illness, and alcohol or drug abuse; yet we have increasingly benefited and learned from the inclusion of persons with these lived experiences.

Let’s mark this week, 2014 Suicide Prevention Week, as the moment when families, communities, and organizations commit to fully supporting suicide attempt survivors in their recovery and in our efforts.

As the Executive Secretary of the Action Alliance, I welcome this movement. I welcome the stories of survival, hope, and recovery that suicide attempt survivors contribute to the cause of suicide prevention. The era of silence is over. Just as people once whispered about cancer, we will one day look back in wonder that we ever whispered about this.

If you, or someone you know is in crisis (no matter how small or big), help is available. By calling the 24/7 National Lifeline, 1-800-273-TALK (8255), you’ll be connected to a skilled, trained counselor who will help you find a reason to keep living.

Doryn Chervin, Dr.P.H., M.Ed.

Executive Secretary, National Action Alliance for Suicide Prevention
Vice President and Senior Scientist, Health and Human Development Division, Education Development Center, Inc.

The Framework for Successful Messaging

By Dr. Jerry Reed, member of our National Strategy for Suicide Prevention Revision/Update Task Force and Director of the Suicide Prevention Resource Center

Each September, World Suicide Prevention Day and National Suicide Prevention Week provide special opportunities to bring our message of prevention to millions of people around the world. This year, we have an exciting new resource to help us engage the public in suicide prevention and enlist them in supporting the cause that means so much to so many of us. The new resource is the National Action Alliance for Suicide Prevention’s Framework for Successful Messaging.

The Framework is a web-based resource developed to support the Action Alliance’s priority to “change the national narratives around suicide and suicide prevention to ones that promote hope, connectedness, social support, treatment, and recovery.” It will help everyone who communicates with the public about suicide – educators, researchers, policy makers, practitioners, and advocates – to create messages based on the best available evidence about safe, effective, and helpful communications. The Framework should be used when developing any message for the public, including educational materials, newsletters, event publicity, and fund-raising appeals.

The Framework outlines four critical issues to consider when messaging to the public about suicide. These issues are:

Strategy. Successful messages are focused and intentional. Understanding the audience and tailoring messages to their context is key to successful messaging. It is important to ask ourselves questions such as:
Why we are messaging?
How does the message fit into our overall mission and connect to other suicide prevention efforts?
Who is the audience for this message?
What channels will best reach this audience?
What do we want the audience to do in response to the message?
How can we frame the message to achieve this result?

Safety. Safety focuses on avoiding potentially harmful message content. We have made great strides in ensuring that we do not unintentionally raise the risk of suicide by, for example, discussing the data on suicide risk in ways that normalize suicide or imply that there is nothing that can be done to prevent suicidal behavior. We have worked hard to spread this message to our colleagues in mental health services and journalism, and must continue to consciously ensure that our own messaging is both safe and helpful.

Positive Narrative. We need to ensure that our messages “accentuate the positive” about suicide prevention and offer solutions rather than focus on the problem of suicide. There are many ways to promote a positive narrative; the best approach will be guided by your strategy. Our messages can help the public envision prevention by including concrete actions that the audience can take to help prevent suicide; sharing stories of coping, resilience, and recovery; describing the successes of prevention programs; helping people access valuable resources; and sharing what we know about effective prevention.

Guidelines. It is important to consult recommendations and best practices that apply to your particular messages. The Guidelines section of the Framework website links to a variety of resources, for example, guidelines for telling personal stories, discussing LGBT suicide, reaching young people, and creating culturally specific messages. Additional guidelines will be added over time.

As we prepare for World Suicide Prevention Day on September 10 and National Suicide Prevention Week September 8-14, let us be intentional about our messaging. By considering Strategy, Safety, Positive Narrative, and Guidelines as we craft our important messages, we can engage the public to take action and join us in our quest to prevent suicide and save lives. I urge everyone who creates suicide prevention messages to visit the Action Alliance Framework for Successful Messaging and take advantage of this unique resource.

This post was cross-posted on the Suicide Prevention Resource Center's Director's Corner.

New Directions for Suicide Prevention among Juvenile Justice-Involved Youth

By Joseph J. Cocozza, Ph.D., Director of the National Center for Mental Health and Juvenile Justice at Policy Research Associates, Inc. and co-lead of the National Action Alliance for Suicide Prevention’s Youth in Contact with the Juvenile Justice System Task Force

The suicide rate among American youth is alarmingly high, and the rate for justice-involved youth is even more concerning. Specifically, data show that:

• youth in juvenile justice residential facilities have nearly three times the rate of suicide compared to their peers in the general population; 
• suicide continues to be the leading cause of death for youth in custody; and
• up to one-third of justice-involved youth report having experienced suicidal ideation in the past year. 

Despite the gravity of these findings, there exists a significant gap between the seriousness of the problem and the adequacy of response to it. Given this disparity, the National Action Alliance for Suicide Prevention formed the Youth in Contact with the Juvenile Justice System Task Force (Task Force), which I was pleased to have co-led along with Melodee Hanes, the former Acting Administrator for the Office of Juvenile Justice and Delinquency Prevention.

As members of our Task Force came together, it became abundantly clear that much needed to be done to address this issue. Many juvenile justice practitioners and providers require a greater awareness of how significant and frequent the problem of suicide is for youth in their care. In an effort to bridge the gap from awareness to action, specific training and prevention protocols need to be implemented. Additionally, we need to learn more through research and evaluation about what works best to prevent suicide among justice-involved youth.

The goal of the Task Force was to focus attention on the unique needs of youth in contact with the juvenile justice system by developing new suicide prevention resources for the field. Objectives were organized around four areas:

• raising public awareness and education regarding suicide and prevention
• reviewing and integrating the best available research into the resources
• providing guidance around suicide prevention programming and training
• encouraging greater collaboration among the mental health and juvenile justice systems

Task Force members’ review of the available information, identification of the gaps in knowledge and practice, and recommendations for action, represent the best researched and documented body of work on their topics. The Task Force produced the following:

• Need to Know: A Fact Sheet Series on Juvenile Suicides provides concise, practical information about youth suicide prevention to three critical groups: 1) judges and juvenile courts, 2) juvenile detention and secure care staff, and 3) juvenile probation staff. Each fact sheet includes data on the prevalence of juvenile suicide, risk and protective factors associated with suicide, and steps that both staff and systems can take to prevent suicide.
•  Suicidal Ideation and Behavior among Youth in the Juvenile Justice System: A Review of the Literature summarizes the relevant, peer-reviewed literature on suicide in the juvenile justice system. It explores the prevalence of recent and past suicidal ideation and suicide attempts among justice-involved youth, gender and ethnic differences, and variables associated with suicidal ideation and attempt.
•  Screening and Assessment for Suicide Prevention: Tools and Procedures for Risk Identification among Juvenile Justice Youth examines the juvenile justice system’s responsibilities in preventing suicide, the contexts in which screening and assessment instruments are used, and specific instruments that are available. It also provides recommendations for implementing tools for both detecting and intervening with youth at risk for suicide.
• Guide to Developing and Revising Suicide Prevention Protocols for Youth in Contact with the Juvenile Justice System offers a standardized approach for youth suicide prevention among juvenile justice programs and providers. It describes critical components of a sound justice system, as well as strategies for implementing these components across the points of contact with the juvenile justice system.
•  Preventing Juvenile Suicide through Improved Collaboration: Strategies for Mental Health and Juvenile Justice Agencies recommends priorities and strategies that mental health and juvenile justice agencies at the state and local levels can pursue to inform joint policy and budgeting decisions associated with suicide prevention for youth involved in juvenile justice in an effort to enhance the provision of appropriate services to this vulnerable population.

A complete list of the membership, products, and findings of the Task Force can be found in the Executive Summary.

To help disseminate this important information, a variety of activities are occurring. The Action Alliance released the work of the Task Force on its website, and many Task Force members have disseminated the information via their own organizations’ Listserv, website, and/or newsletter. On April 17, I was joined by Dr. Linda Teplin, a Task Force member and an expert on youth suicide from Northwestern University, in presenting Preventing Suicide among Justice-Involved Youth: Newly Developed Tools, Recommendations, and Research, which was the first of a series of free webinars hosted by the Action Alliance and the Substance Abuse and Mental Health Services Administration (SAMHSA). Additionally, the National Center for Mental Health and Juvenile Justice developed a new web resource, Preventing Suicide Among Justice-Involved Youth, for the Mental Health and Juvenile Justice Collaborative for Change website, which also includes other information and resources about mental health and juvenile justice.

It is my hope that through this work, in addition to our ongoing collective efforts, youth suicide can be prevented. Our duty to protect children, in particular those who are most vulnerable, is an obligation that must be taken seriously. This mission requires an urgency that cannot be overstated and I am privileged to have a role in seeing it succeed.

New Social Media Guidelines Offer Tips for Talking Effectively About Mental Health and Suicide Online

By Brian Dyak, President & CEO of Entertainment Industries Council, Inc. and co-lead of the Action Alliance Public Awareness and Education Task Force

Social media has become ubiquitous. People communicate online about their lives and get their information about the world from sites like Facebook, Twitter and blogs. When one in four people experience mental health challenges each year, social media is a place where some will turn to talk about their experiences, to seek support from their friends and to find helpful information. Social media offers a venue in which people are more comfortable discussing their own mental health issues, which in turn increases the likelihood that others will seek help when they need it.

With that in mind, the Entertainment Industries Council’s TEAM Up project has just released the first-of-its-kind Social Media Guidelines for Mental Health Promotion and Suicide Prevention. These new guidelines are designed to assist individuals and organizations in safely and effectively talking about mental health and suicide-related issues via social media. With tips for posting and responding on Facebook pages, groups, Twitter feeds, Tumblr pages, websites and blogs and more, the guidelines take into account the unique safety, privacy and stigma-related aspects of these issues.

The recommendations in this document were reviewed by experts in social media and the related health fields. Organizational supporters of the Guidelines include the National Action Alliance for Suicide Prevention, California Mental Health Services Authority, Facebook Inc. and leading journalism organizations the National Association of Broadcasters and Radio Television Digital News Association.

“Whether you want to share your own story, discuss events in the news or help others understand mental illness and encourage them to seek help when they need it, these recommendations will be a helpful resource for everyone, especially in teaching children and teens how to communicate about these issues. Safe, constructive communication via social media, that avoids stigmatizing or derogatory language and does no harm, changes the conversation and decreases discrimination,” said Brian Dyak, Entertainment Industries Council, President and CEO and Co-Chair National Action Alliance for Suicide Prevention Public Awareness & Education Task Force, when the Guidelines were released.

“Social media makes it easier than ever to connect and share with the people you care about,” said Joe Sullivan, Chief Security Officer, Facebook and Co-Chair of the National Action Alliance for Suicide Prevention Public Awareness & Education Task Force. “Knowing effective ways to seek input and offer support to your friends and families about difficult topics is an important part of building a safe online community."

“The guidelines have been reviewed by experts in social media and the related health fields. When communicating online avoiding descriptions and images of suicide acts or methods can help reduce the risk of suicide contagion. Anyone can use this new tool to help someone who may be in crisis and potentially help save a life,” Executive Director, Suicide Awareness Voices of Education Dr. Dan Reidenberg commented.

Social media can be instrumental in bringing about social change – by spreading ideas from person to person, by bringing people together for a common purpose, by sharing and reinforcing social norms and by making it easy for people to take action. Social media is not about the technology, but rather it’s about people talking to people, often on a massive scale. By using these powerful tools in a strategic way, and encouraging others to do so as well, we can harness their power to change how people think about mental health and suicide prevention.

Visit TEAM Up for more information.

A Vision for Research

By Phillip Satow, Private Sector Co-lead, Research Prioritization Task Force, National Action Alliance for Suicide Prevention; Representative, National Council for Suicide Prevention; Chair of the Board, The Jed Foundation

At the end of 1998 I lost my son Jed to suicide. Since then, like so many survivors, caregivers, and advocates, I have worked hard to understand this unendurable tragedy. Sixteen years later, I am happy to be part of the creation of A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. This blueprint, if implemented, has a high probability of making a significant impact on our knowledge of suicidal behavior and, most importantly, on the suicide rate itself. The Agenda is a product of the Research Prioritization Task Force of the National Action Alliance for Suicide Prevention, a public-private partnership whose mission is to advance the National Strategy for Suicide Prevention. I have the honor of being the private sector co-chair of this task force. The public sector co-chair is Dr. Tom Insel, Director of the National Institute of Mental Health.

Our task force had a vision — a vision of creating a paradigm based on the careful prioritization of suicide research efforts. How else could we allocate our limited resources as effectively as possible to prevent the maximum number of people from taking their own lives?

Our activities in the mental health 501(c)3 world tend to fall into silos. That is, our organizations generally focus their programming and funding within particular DSM categories or illnesses. We know, however, that there are often associated symptoms, co-morbidities, and other complications that caregivers cannot ignore during treatment. For example, substance abuse is associated with many mental illnesses, while symptoms of depression and anxiety disorders may be associated with each of a full spectrum of disorders.

In addition, there is a connection between suicide and emotional illnesses that is stronger than most people realize. Suicide mortality in populations with a mental disorder is about three times that of the general population. Depressed patients have a 20-fold greater lifetime risk for suicide than the general population. Bipolar illness, panic disorder, and schizophrenia are also associated with suicide risk. These associations speak to the interdisciplinary nature of our mission. We all need to understand the brain better than we do if we hope to progress, not only in suicide prevention but in finding better treatments for all illnesses of the brain. Clearly, improving our prospects for suicide research and discovering better approaches to prevent self-harm will benefit all of our respective missions and our common goal of preventing suicide.

Unfortunately the suicide rate has not decreased appreciably in the last 50 years. It’s hard to believe that nearly 700,000 individuals annually report having received medical attention for a suicide attempt each year. Nearly 40,000 people die by their own hand annually. The number of suicide deaths over the years 2000-2009 increased by nearly 26 percent. During the same period, mortality from HIV, asthma, heart disease, and many cancers has declined.

Each year, we spend 40-50 million dollars on suicide research in the United States. The vast majority of these funds come from the National Institute of Mental Health. However, other organizations, like the American Foundation for Suicide Prevention, also fund research. If we added Veterans Administration and Department of Defense expenditures, the total would be somewhat higher.

Doesn’t it make sense that these funds should be directed to the projects most likely to advance our knowledge base and reduce the suicide rate? I am confident that we all agree that there is no lack of ideas emanating from our research community. But how can we feel confident that funds are directed toward establishing research pathways that would truly reduce the burden of suicide in an optimal manner? The question always remains: if funding was increased, if new funding was developed, how should it be allocated?

There has never been a reluctance to recognize the need for a research agenda. However, because of a combination of the lack of sufficient funding, the lack of an appropriate implementation vehicle, and the inability to galvanize the many disciplines required for the effort, we have not been able to systematically address that need until now. The 2002 Institute of Medicine report Reducing Suicide: A National Imperative recognized the importance of interdisciplinary research on suicide. Both the original National Strategy for Suicide Prevention promulgated by Surgeon General Satcher and its 2012 update explicitly call for a research agenda. The long elusive goal of completing a targeting agenda has now been accomplished.

At the urging of Tom Insel, the Task Force established a specific numerical goal for reducing suicide burden. We set a goal of developing an agenda for research that, if fully implemented, has the potential to reduce morbidity and mortality by at least 20 percent in five years and 40 percent in ten years. This goal is aggressive and far-reaching — but doable! The achievement of our task force’s goal in five years could lower the suicide rate to less than 10/100,000 and less than 8/100,000 in ten years.

We also agreed that we needed a broad sampling of stakeholders in our field — survivors, caregivers and researchers — to inform us of their personal aspirational goals for future suicide prevention research. More than 700 people who have been touched by suicide answered our questionnaire. The many hundreds of aspirational goals offered by stakeholders were reduced to 12 that were deemed to be of highest priority.

A literature search was conducted, followed by a portfolio analysis which documented the state of ongoing research studies. Opinion-leading scientific minds weighed in to help design or identify research pathways to achieve the prioritized aspirational goals which represented the "wishes," if you will, of the suicide community.

With research pathways identified, the task force and our advisors and experts established short- and long-term research objectives. The recommended pathways and objectives are central to the final task force product and to the achievement of our underlying goal.

So, why do we think it can be achieved? We conducted a systematic review of available suicide death and attempt surveillance, data which helped to uncover promising areas of future research. We developed several models of interventions to estimate the potential benefit for individuals at risk within boundaried communities (enclosed entities like our criminal justice system, college campuses, integrated health care complexes, and HMOs). There are more than two million suicide attempts in boundaried communities. Developing effective interventions for these environments has the potential to bring about major reductions in attempt rates.

Critical to achieving our goals is funder cooperation and transparency. And we must not forget the amount of hard work that mental and health supporters put into advocating for an increase in federal funding for suicide research.

The implementation plan for the task force's final report is critical. We expect all the key funders of suicide research to familiarize themselves with its content. We hope that future funding will be directed at the objectives that are clearly outlined in the agenda. The task force expects that the details of its work will be broadly disseminated and will appear in widely read scientific journals. We hope that researchers will focus their efforts on priorities consistent with those suggested in the plan. We also hope that future funding will be allocated to studies that incorporate thematic elements highlighted across multiple pathways, for example, the increased use of common data elements, banking and sharing to leverage research investments, fielding practical research designs, and finding service quality improvements to reduce suicide.

Lastly, I expect that stakeholders, whose aspirational goals are targets for achievement, will now have a potential rallying point and that they will find the task force’s research priorities understandable and see them connected to their own aspirations and to potential reductions in suicide burden. They may also appreciate the broad definition of research that the document considers, including services research, outcomes research, and prevention research — research that for many may have a more direct and practical association to suicide prevention programing.

Most importantly, we can’t let the agenda sit on a shelf. The potential to save thousands of lives, including those of so many military personnel and veterans, deserves support. I hope each of you can help foster a groundswell of awareness and support for this unique opportunity to help move the suicide prevention field forward.

This post was cross-posted on the Suicide Prevention Resource Center's Director's Corner. 

“Lighting the Way Forward”: The National Summit on Lived Experience in Suicide Prevention

By Eduardo Vega and John Draper, Suicide Attempt Survivors Task Force co-leads, and David Covington, Zero Suicide Advisory Group co-lead, National Action Alliance for Suicide Prevention

On March 5-6, a landmark meeting occurred between two groups of the National Action Alliance for Suicide Prevention (Action Alliance). Members of the Suicide Attempt Survivors Task Force (SAS TF) met with leaders of the Zero Suicide Advisory Group (ZSAG) to discuss, in detail, how the values, insight, and expertise of people with lived experience of suicide can create better supports and services to reduce suicide for those in clinical care. Held in San Francisco through the support of the Mental Health Association of San Francisco, the National Suicide Prevention Lifeline (Lifeline), the Suicide Prevention Resource Center (SPRC), and the Substance Abuse and Mental Health Services Administration (SAMHSA), the Summit on Lived Experience in Suicide Prevention may be the first time in history that a major national care initiative such as Zero Suicide has engaged with people ‘who have been there’ to strategize directions for fostering healthier communities and preventing suicide death.

The Summit involved leadership from the Action Alliance’s Executive Committee and Suicide Attempt Survivors Task Force, including John Draper and Eduardo Vega, and the Zero Suicide Advisory Group, including David Covington, CEO & President of Crisis Access, LLC, and Becky Stoll, Vice President for Crisis and Disaster Management, Centerstone of America. Members of the SAS TF from around the nation participated actively throughout the Summit. Reflecting the Summit’s significance and importance, Richard McKeon, SAMHSA’s Suicide Prevention Branch Chief, Jerry Reed, Director of SPRC, and Sally Spencer-Thomas, AAS board member and director of the innovative Carson J. Spencer Foundation, were also active participants.

The meeting of these two groups was one of intense dialogue and progress, and a true spirit of mutual interest was fostered through discussion of each other’s work.  As Vega, co-lead for the SAS TF pointed out, “Today we are a team. We are finding ways to support each other’s efforts and bringing our energies and values into alignment. In doing so, we are radically changing thinking about suicide prevention, setting the stage for innovation that brings the expertise of attempt survivors into focus with that of our healthcare providers.”

A major focus of the meeting was a pivotal technical document “The Way Forward”, soon to be released by the SAS TF, which lays out recommendations for policies, practices, and programs to support people experiencing suicidal thoughts and feelings and for the engagement of people with this ‘lived expertise’ in services and systems change. This document, in development for over two years by SAS TF members, builds on the 2012 National Strategy on Suicide Prevention and provides a core values framework that advances the conversation.  Bringing its recommendations into focus with the priorities of Zero Suicide is a bold concrete step for change in the way services and providers think about prevention of suicide. As Covington, co-lead of the ZSAG, remarked, “Wherever Zero Suicide is developed, we need lived expertise to be ‘baked in, not bolted on’ to the project.”

Draper, director of the Lifeline, who brings his leadership to both the SAS TF and ZSAG, outlined the value of the collaboration directly: "'Zero Suicide' is a goal that we can aspire to only if clinicians and persons who have a history of suicidal thoughts or actions collaborate in ways that enable choice, trust, and shared responsibility. This meeting was a perfect model for the kind of collaboration that will build connectedness, hope, and meaning for persons seeking help for suicidal thoughts in clinical systems of care."

In addition to strategic directions for collaboration and support, summit attendees discussed crucial issues related to the field of suicide prevention, including: risk, community intervention practices, stigma and prejudice, and other historical challenges to progress. For example, although mental health service providers have developed extensive dialogue with their service ‘consumers’ over many years, and lived expertise in the area has resulted in many new and transformed programs, the suicide prevention community has historically had very limited dialogue with people with lived experience of suicidality. This history of disengagement was broached openly.

In the words of Leah Harris, communications director for the National Empowerment Center, who is also on both the SAS TF and ZSAG: “After my suicide attempts, I experienced re-traumatizing treatments from systems that were supposed to help me. For years, I also felt the attempt survivor’s voice was not valued in suicide prevention. But that is changing. Today, we built trust, and a lot of healing took place."

A New Research Agenda for Suicide Prevention

By Thomas Insel

More than 38,000 Americans died by suicide in 2010, the most recent year for which we have national data. This makes suicide, once again, the tenth leading cause of death for all ages; the second leading cause of death for young adults ages 25 to 34.¹ Despite changes in recent decades that might reasonably have been expected to reduce suicide rates—increased awareness about mental disorders, the availability of treatment, and community-based public health efforts aimed directly at preventing suicide—U.S. rates of suicide deaths have not decreased. In fact, suicide has proven stubbornly difficult to understand, to predict, and to prevent.

This grim reality contrasts with the successes achieved in other areas of medicine and prevention. Death rates from heart disease, cancer, traffic accidents, and homicides are all declining. For heart disease and cancer, research has identified risk factors as well as new pathways to prevention and treatment. Changes in automobile design along with road safety measures have contributed to an ongoing reduction in traffic deaths. Homicides now number less than half the annual total of deaths by suicide in this country.

Why is suicide different? There are a number of public health approaches, from redesigned bridges and buildings to firearm safety, that need the kind of aggressive engineering and policy approaches we have seen with automobile safety. And, learning from heart disease and cancer, we can do better detecting and helping individuals at risk. Despite our best efforts, it remains very difficult to predict who will attempt suicide and, thus, difficult to intervene. The presence of mental illness is a risk factor, but it is not universally present or identified in those who attempt suicide. Treatment can be effective, but too many high-risk individuals are not getting the effective care they need. Suicide remains one of the top five sentinel events (unanticipated events resulting in serious injury or death) for health care systems.² To reduce suicide, we need to know how to target our efforts: to be able to reliably identify who is at risk, how to reach them, and how to deter them from acting on suicidal thoughts.

In a blog post last September, I talked about a newly updated National Strategy for Suicide Prevention and the research agenda being developed by a task force of the National Action Alliance for Suicide Prevention . This week, the Research Prioritization Task Force (RPTF) released A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives.

The stated goal of the Research Agenda is to reduce suicides by 20 percent in five years and 40 percent in the next ten (assuming all recommendations are fully implemented). The Research Agenda bases its recommendations on the impact of currently known interventions and the potential number of suicide attempts and deaths prevented. For instance, it was estimated that in 2010 there were 735 suicides from motor vehicle carbon monoxide inhalation.³ One model illustrated the hypothetical effect of shut-off devices in cars linked to carbon monoxide sensors, a technology that could be inexpensive per vehicle and is currently feasible. The results suggest that installing devices the way we install seat belts could prevent most suicides from carbon monoxide poisoning in automobiles.

What are we doing to jumpstart this agenda? Two new initiatives will focus on priorities of the Research Agenda. First, NIH recently announced  funding opportunities calling for research on violence with particular focus on firearm violence. This call for proposals was developed in response to the Presidential memorandum  in January 2013 directing science agencies within the U.S. Department of Health and Human Services to fund research into the causes of firearm violence and ways to prevent it. The resulting research will help us understand the risk factors for firearm violence and prevention opportunities, directed at self as well as others.

In 2010, suicide was the third leading cause of death for adolescents. It remains a challenge to predict individual risk, and once a young person screens positive for suicide risk, there are few, if any, strategies to guide matching of individuals to the appropriate intervention. As a second initiative, NIMH released a request for applications  to support research that addresses both issues: developing and testing screening approaches for use in emergency departments (EDs) to identify children and adolescents at risk for suicide; and developing methods to help assign youth who screen positive to appropriate interventions. Given the numbers of young people who may be at risk, and the high number of them who visit the ED, developing effective screening and assessment approaches to gauge the level of risk can give providers the tools they need to better use limited resources.

A friend who lost his son to suicide told me that every suicide has at least 11 victims: the person who dies and at least ten others who will never be the same. This is a problem that sooner or later, unfortunately, touches us all. Developing the Research Agenda was a 3-year effort by the RPTF, chaired by Phillip Satow, chair of the board at the Jed Foundation , and myself. The RPTF called on more than 60 national and international research experts and more than 700 individuals representing stakeholders in this research to identify priorities. We believe the Research Agenda gives us a roadmap to save lives.

References

¹ Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System, http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html .

² The Joint Commission. Sentinel Event Alert. Issue 46, November 17, 2010. http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html .

³ National Action Alliance for Suicide Prevention: Research Prioritization Task Force. (2014). A prioritized research agenda for suicide prevention: An action plan to save lives. Rockville, MD: National Institute of Mental Health and the Research Prioritization Task Force. 

___________________

This post was originally posted on the NIMH Director's Blog.

New Action Alliance Executive Secretary Introduction

It is my great honor to become the next Executive Secretary of the National Action Alliance for Suicide Prevention. David Litts is a shining example of leadership and commitment who set the stage for our next chapter. I thank him for his wisdom and hard work to bring the Action Alliance to its current place of great possibility.

Here is a little information about my background. My three decades of public health experience are comprised of results-driven program improvements and work with all levels of Government, as well as with nongovernmental and community organizations to help translate research and science into policies and programs. Most recently, in my role of Executive Vice President and Principal Scientist at SciMetrika, I directed the Social and Behavioral Sciences Division and led key corporate initiatives. Before that I served as a senior leader at ICF International (formerly Macro International) which included serving as Vice President of work in the Public Health Research and Evaluation practice and addressing a broad spectrum of public health issues. I’ve directed more than 180 state and national program evaluations, policy assessments and evaluations, training projects, and research studies over my career, including work in heart disease and stroke prevention, school policies in asthma-management, and policies to improve testing and treatment for HIV among adolescents. My experience has helped to shape my commitment and dedication to good health, including the promotion of mental health and suicide prevention.

We begin the next chapter of the Action Alliance with a laser-sharp focus on meeting our goal of saving 20,000 lives in five years. Our opportunities include championing the most effective policies to prevent suicides and catalyzing research and practice communities to develop strong measures, so that we know where we are making a difference. Finally, with strong policies and reliable measures, we can monitor ways in which the Action Alliance and its productive partners change the trajectory of suicide in the United States. I look forward to beginning my work with the Action Alliance and contributing my efforts to help build a nation free from the tragic experience of suicide.

In health,

Doryn Chervin, Dr.P.H.
Executive Secretary
National Action Alliance for Suicide Prevention

Substance Abuse Prevention is Suicide Prevention

By Action Alliance Executive Secretary David Litts & Colleen Carr

When we prevent or successfully treat substance abuse, we prevent suicides. There is a powerful connection between the missions of the substance abuse prevention and treatment communities and the suicide prevention community – and much to be gained when these groups come together around their common goals.

Drug poisoning deaths have increased 120 percent in recent years – from 17,415 in 2000 to 38,329 in 2010. The majority (58 percent) of the drug deaths involved pharmaceuticals, and 75 percent of those deaths involved prescription pain relievers.[i] In 2010, U.S. emergency departments treated 202,000 suicide attempts in which prescription drugs were used as the means, 33,000 of which were narcotic pain relievers.[ii]

The suicide and substance abuse prevention fields need to align their efforts to promote healthy individuals and healthy communities.

Many of the factors that increase the risk for substance abuse, such as traumatic experiences, also increase the risk for suicidal thoughts and behaviors,[iii],[iv] and substance abuse, like mental health problems, is linked with a several-fold increase in suicide risk.[v],[vi]

There is hope, however: Prevention works, treatment is effective, and recovery is possible. Life skills that support effective problem-solving and emotional regulation, connections with positive friends and family members, and social support can protect individuals from both substance abuse and suicide. Treatment and support are important precursors for recovery from substance abuse as well as recovery from suicidal thoughts.[vii],[viii]

In September 2012, a newly revised National Strategy for Suicide Prevention (NSSP) was released by the National Action Alliance for Suicide Prevention (Action Alliance) in conjunction with the Office of the Surgeon General. The Action Alliance is a public-private partnership, jointly launched in 2010 by the Secretaries of Health and Human Services and Defense, envisioning a Nation free from the tragic experience of suicide. The connection between suicide prevention and the prevention and treatment of substance abuse is either implicit or explicit in each of the 13 goals of the NSSP, as it should be. Recognizing this, the NSSP calls for several actions, including:

• Train staff in substance abuse treatment settings to ask their clients and patients directly and in a non-judgmental way whether they are having thoughts of suicide or think things would be better if they were dead. Ask on intake and periodically throughout the course of treatment, and ask in a way that opens the door for a truthful response. 
• Work with individuals, families and other social groups, and communities to reduce access to drugs, especially access to lethal quantities of drugs among individuals at increased risk for suicide. This includes reducing stocks of medications kept in the home, locking up commonly abused medications, and encouraging the proper disposal of unused and unneeded prescription drugs, a key component of the 2013 National Drug Control Strategy.

Let us commit to stronger collaboration between substance abuse and suicide prevention efforts at all levels: community, state, tribal, and national. And let’s take action. The stakes are too high to do otherwise.

---

[i] Centers for Disease Control and Prevention. National Vital Statistics System. 2010 Multiple Cause of Death File. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.

[ii] www.samhsa.gov/data/2k13/DAWN2k10ED/DAWN2k10ED.htm#6.2

[iii] Dube, S, Felitti V et all. (2003). Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study. Pediatrics, Vol. 111 No. 3.

[iv] Afifi T, Murray W, et al. (2008) Population Attributable Fractions of Psychiatric Disorders and Suicide Ideation and Attempts Associated With Adverse Childhood Experiences. American Journal of Public Health 2008, Voi 98, No. 5.

[v] Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbest NT, Caine ED (1996). Relationships of age and axis I diagnoses in victims of completed suicide: A psychological autopsy study. American Journal of Psychiatry, 153(8): 1001-1008.

[vi] Moscicki EK (2001). Epidemiology of completed and attempted suicide: Toward a framework for prevention.Clinical Neuroscience Research, 1, 310-323.

[vii] Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial. JAMA: Journal of the American Medical Association, 294(5), 563-570.

[viii] Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63(7), 757-766.

This blog entry is cross-posted on the white house website.

The Enduring Legacy of My Son, Garrett

Today, September 9, brings to mind some of the most wonderful times in my life and also the saddest. You see, on this day 32 years ago, my precious son Garrett came into my wife Sharon’s and my life. He was a beautiful baby who soon grew into a kind and generous boy. However, this same day 10 years ago was the first time Sharon and I awoke with the knowledge that Garrett no longer was on this Earth. 

Gordon H. SmithPresident and CEO,
National Association of Broadcasters
Former U.S. Senator from the State of Oregon
Private Sector Co-Chair,
Action Alliance for Suicide Prevention

Sadly, the day before, we received the news that Garrett had taken his life in his college apartment in Utah. Even in his death, Garrett was a kind and considerate boy. He gave away some of his most precious possessions, ensured the safety of his beloved dog Oliver, and wrote a note absolving Sharon and me of any fault. 

Yet, in looking back over Garrett’s life, we realized we were ignorant of the signs of mental illness and because of that Garrett struggled for much of his life with an undiagnosed ailment.  While he began receiving care close to the time of his death, we knew it came too late and we wondered how different his life would have been had we known of his struggle and connected him to care much earlier in his young life.

However, in Garrett’s death came a call to action. I became and continue to be focused on helping other young people and adults who struggle with mental illness and who are at risk for suicide. In Garrett’s memory, an outstanding piece of legislation was enacted into law – the Garrett Lee Smith Memorial Act. It was passed by the U.S. Senate with support from all 100 Senators and passed the U.S. House of Representatives with significant bipartisan support.  President George W. Bush signed it into law on October 21, 2004. And to this day, the programs that bear Garrett’s name continue to receive full funding and wide bipartisan support.

It is through these programs that millions of Americans have been helped. The Garrett Lee Smith Memorial Act provides states, tribal nations and organizations, and colleges and universities with much needed funding to create and implement youth suicide prevention plans with a significant focus on early identification. To date, 49 states, DC and Guam, and 46 tribal organizations have received funding, as well as 135 institutions of higher learning. Further, through the Garrett Lee Smith Memorial Act, more than 600,000 people have been trained in suicide prevention, including teachers, coaches and other youth-serving individuals. The law also authorizes and funds the Suicide Prevention Resource Center (SPRC). The center’s key functions are to provide technical assistance, training and resources to federal grantees. The SPRC also works closely with the federally funded National Suicide Prevention Lifeline (Lifeline) (1-800-273-TALK) and its network of more than 160 crisis centers. Lifeline provides free and confidential support to people in suicidal or emotional distress, including veterans, active military, and their families and friends. This year, the Lifeline expects to answer more than 1.1 million calls.

While early identification efforts and training to recognize the signs of mental illness and suicidality are important to saving lives, access to evidence-based treatment is the most critical component – and often the most difficult to achieve. That is why I was so pleased to support the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act. Enacted at the end of 2008, this law, once fully implemented, will help ensure persons in need of treatment receive it. The law eliminates the differentiation in cost between physical and mental illnesses and will further reduce the stigma of mental illness. 

I was honored to accept the appointment by Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS), to serve as the private sector co-chair of the National Action Alliance for Suicide Prevention. Created in 2010, the Action Alliance has a mission of advancing the National Strategy for Suicide Prevention by championing suicide prevention as a national priority, catalyzing efforts to implement high priority objectives, and cultivating the resources needed to sustain progress in suicide prevention. I am privileged to be joined by the public sector co-chair, John M. McHugh, Secretary of the U.S. Army. Our aspirational goal is to save 20,000 lives over the next five years.

In Garrett’s memory, Sharon and I continue to try and find meaning in helping others. This past July, with support and funding from the members of the National Association of Broadcasters, I was able to launch the OK2TALK media campaign. As these public service announcements have hit the airwaves, public awareness about mental illness and assistance in connecting with care is growing exponentially. In just the first month, the PSAs have been aired on TV over 48,000 times and on radio 3,300 times. The total financial accounting of this free airtime totals $6.9 million. America’s broadcasters should be commended for their generosity and support. To ensure people receive needed care, HHS launched in conjunction with our effort a new website www.mentalhealth.gov, and we launched a Tumblr page. To date, the Tumblr page has had 198,000 page views; 100,000 total visits; 13,900 followers; 774 submissions; 22,000 engagements; and 17,000 have clicked “Get Help” to access mentalhealth.gov/suicide hotline resources.

While Sharon and I will never stop longing to see and hold our precious son just one more time, we do rejoice in the knowledge that in his death has come so much good. On this day, the day that Garrett would have turned 32, I invite all of you to join us in celebrating all of the outstanding accomplishments our nation has made in the past 10 years to expand access to mental health identification and treatment, and to reduce the tragic event of suicide. We also call on you to continue the fight, continue working to save lives one person at a time.

On Being Bold in Suicide Prevention: Innovative Approaches in Innovative Places

By Sally Spencer-Thomas, Co-Lead of the Action Alliance Workplace Task Force and CEO & Founder of the Carson J Spencer Foundation

I had been in the field of mental health 16 years before my brother Carson took his life in 2004, and I would

Sally Spencer-Thomas,
CEO & Founder,
Carson J Spencer Foundation

say that since then I have learned much about the “gaps” that need to be filled in the field of suicide prevention. In the aftermath of his death, our family and his friends came together in our grief, as many people do, with a strong sense to “do something” and formed the Carson J Spencer Foundation (CJSF). From CJSF’s inception, what quickly became obvious was the huge “gap” between the target population of most suicide prevention efforts and population that most represented by those who were dying. We were shocked to learn that most people who took their lives were just like Carson: white, working-aged men. We made the commitment to be bold and try to fill this “gap” with innovative approaches in innovative places.

Innovation is critical in the field of suicidology because it helps us engage untapped resources, explore new partnerships, and ultimately expand our capacity. Without innovation, we will just keep repackaging the same methods and will be limited in our ability to create the significant change we all envision. Innovation begins with an idea to take a radically different approach – especially if it’s difficult.

In hindsight, we can usually see the benefits of innovation, but at first they are sometimes considered radical ideas. Where would we be if that first crisis call center had never emerged or if the Air Force had decided, like so many others had before, that there was nothing that could be done to prevent suicides? Often, because innovation challenges convention of how things get done, initial backlash and doubt ensue. Inevitably, trial and error cycle as the innovative idea evolves. Sustained change comes as the context of discovery moves into the context of justification, and rigorous evaluation helps us better understand the cause and effect cycle of change.

Since my brother Carson was a gifted entrepreneur and not afraid of risk-taking, the founders of CJSF not only dedicated our mission to preventing what happened to him from happening to others, but also to celebrating his gifts as a dynamic and bold visionary.  

When taking an inventory of existing suicide prevention efforts, we noted that very few people were addressing suicide prevention in the workplace, and this gap became ours to fill. In 2007 CJSF launched the Working Minds program (www.WorkingMinds.org) and in 2009 we published the Working Minds Toolkit, which was accepted to the National Best Practice Registry in 2010. The goal of these efforts is to build capacity in workplaces, so that they are better able to implement comprehensive and sustained suicide prevention programs.

Today, with the help of the National Action Alliance for Suicide Prevention’s Workplace Task Force, workplace suicide prevention efforts are better able to leverage the influence of leaders from across the country and create a “tipping point” of change. We are bringing together executives and industry leaders to be spokespeople for the cause; we are pulling together resources to outline a blueprint for change; and we are partnering with the Public Education and Awareness Task Force to “Change the Conversation.”

The Workplace Task Force, in partnership with CJSF and others, has launched three new innovative resources for workplaces:

•  A Manager’s Guide to Suicide Postvention in the Workplace: 10 Action Steps for Dealing with the Aftermath of Suicide
• A Comprehensive Blueprint for Workplace Suicide Prevention
• VIDEO: Firefighters Coping with the Aftermath of Suicide

In addition, we need innovation to reach those at highest risk for suicide – men of working age with multiple risk factors, who are also least likely to seek care. For years, the same message – “if you are depressed, seek help” – was repackaged with little success in reaching this demographic.  What the effort needed was a brand that was compelling to high-risk men. In 2007, the Carson J Spencer Foundation, Cactus Marketing and Colorado’s Office of Suicide Prevention – a public-private-nonprofit partnership – came together to find a new way to reach high-risk men by using “manspeak” and humor.

On July 9, 2012, after four years of research, development, and planning, the partnership launched the one-of-a-kind Man Therapy™ campaign (www.ManTherapy.org) with an article in the New York Times. While the unconventional approach raised a few eyebrows, our initial results look promising so far – the campaign seems to be reaching the target audience and having the intended effect. In just nine short months, the website has experienced over 200,000 unique visitors averaging over 6 minutes per visit. More than 60,000 people have completed the 18-point head inspection (a self-screening tool) and 15,000-plus have accessed information on crisis services. The qualitative feedback we have received from men and therapists alike is that men’s thinking about mental health shifts during their interaction with www.ManTherapy.org  and they are more likely to do something different about their problems as a result.

While innovation is particularly unnerving in a profession where lives are at stake, we must “be visible, be vocal, be visionary. There is no shame in stepping forward, but there is great risk in holding back and just hoping for the best.” (Higher Education Center)