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.
Showing posts with label suicide prevention research. Show all posts
Showing posts with label suicide prevention research. Show all posts
Thursday, July 9, 2015
Thursday, May 14, 2015
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:
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.
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.
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.
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