A New National Strategy...Now What?

By Executive Committee member and co-lead of the National Strategy for Suicide Prevention Task Force Jerry Reed & Suicide Prevention Resource Center's Elly Stout

This year we celebrate Suicide Prevention Week with revitalized purpose as we welcome a new National Strategy for Suicide Prevention. For the first time since 2001, we have an updated Strategy to guide the nation, drawing on eleven years of growth and advances in our field.

The National Strategy is a call to action to guide suicide prevention in the United States over the next ten years. It outlines four strategic directions, with 13 goals and 60 objectives that are meant to work together across all levels of government - and with various local and community programs and activities - to reduce the toll of suicide in the nation. Some of these objectives will best be advanced at the national level, while others will be most appropriately handled at state and local levels. At all levels, partners from different sectors should be involved, be they public or private.

This new National Strategy reminds us all that we all have a role to play in advancing suicide prevention efforts, and recommends specific ways we can get involved. If you are part of a state or local suicide prevention group or coalition, you may be wondering what the new strategy means for you.

As the Strategy is launched, many will consider taking steps to update their own state or local suicide prevention plans. Our hope is that you will use the revised Strategy as a guide and consider it a key resource that should be an important part of your local strategic planning efforts. At the same time, we want to caution that not every recommendation in the Strategy should be applied literally in every state and community.

The National Strategy offers a wonderful menu of options, but it’s up to state and local groups to prioritize what will work best and reach those most at risk in their communities. And the way to figure out what are the best options is simple: Start with your data. Only by looking at data on suicide risk (both quantitative and qualitative) in your community can you focus on the areas of greatest need and effectively pursue programs that reduce suicidal behaviors and save lives.

Based on local data, what groups are at highest risk for suicide in your community? What are the factors that put them at risk or may be protective? What approaches would be best to pursue? Without the data to give you answers to these questions, you really can’t know who is most at risk in your community and what strategies have the best chance of saving lives.

Go ask your state epidemiologist; see if your state has a web-based query system; look at your NVDRS data; use NSDUH, YRBSS, and WISQARS. And once you understand which groups are most at risk, or what approaches would be helpful, look to our new, improved National Strategy to find strategies that can save lives in your community.

This blog post is cross posted from the Suicide Prevention Resource Center.

Facebook & Suicide Prevention

By Joe Sullivan, Chief Security Officer, Facebook, Inc., Action Alliance Executive Committee member, and co-lead of the Public Awareness and Education Task Force

For many people the topic of suicide is hard to open up to others about. For some it brings up feelings unspoken, and for others memories unwelcome. But the more you learn about the topic, the more you appreciate the power of communication in reducing the likelihood of suicide. Communication builds emotional connections, exposes risks, leads to understanding, and gives opportunities for intervention.

Years ago, the employees at a fledgling Facebook discovered the power of communication as a means of intervention, when young people using the service started writing in to our customer support team to report when a friend had posted a status update that could be interpreted as a sign of suicide risk. Confronted with this new type of intentional or unintentional cry for help, we realized that we needed to do two things—to engage with the expert community to learn how to best address these situations, and to use the power of Facebook itself to mobilize friends and counselors to communicate with the at risk person.

Fortunately, the suicide prevention community embraced working with the Facebook team, establishing strong relationships that have helped us mature in our handling of these situations. One key partnership has been our participation in the National Action Alliance for Suicide Prevention. I’m proud to be a co-lead of the Public Awareness and Education Task Force. We fully support the Action Alliance vision of a world free from the tragic experience of suicide, and truly benefit from the rich blend of public and private resources the Action Alliance brings to bear. The Action Alliance has shown that partnership driven solutions can offer the best help in the places where it is needed most and helped us expand our network as widely as possible to make assistance available to everyone who expresses need on our site. Through this network, we have partnered with over 25 different suicide prevention agencies across the world to provide help to all our users, using resources appropriate for wherever they may be.

With the help of these partners, we have built a number of online solutions:

· We started by working with the Action Alliance, Lifeline, and the National Council for Suicide Prevention to create content for our Help Center to help the people who use our service identify those in distress and give them the help they need. Because there is no substitute for the care and concern of a person’s friends and family, we wanted to provide the advice necessary to help this natural support network recognize and respond to risk factors.

· We built on that by creating a robust reporting structure. To help those users who may be in distress we have Report links all over the site. When you click Report you can message your friend directly using our Social Reporting tool or you can report the content to Facebook to be reviewed by our Safety Team.

· And most importantly, using dedicated staffing and relationships with organizations such as Lifeline, we have done our best to pair the user with trained suicide prevention counselors. Initially that was through email connections, but recently we implemented a new solution that has worked even better. Since December last year, those users (in the United States) in distress receive a message from Facebook containing a link to begin a confidential chat session with a crisis worker from Lifeline. We rolled out this feature in partnership with the National Action Alliance for Suicide Prevention and Surgeon General Dr. Regina Benjamin.

· Building on these positive experiences, we have worked with the National Council for Suicide Prevention and SAMSHA to bring together (twice so far) a working group with other leading internet companies to build out a set of joint best practices.

We’re proud and humbled by the role we have been able to play in this team effort, and grateful to the Action Alliance for its important role in our growth. We look forward to the future of this relationship because together we can stop suicide by helping people find the courage to speak up whenever they see the signs a friend or family member is in distress.

Request for Information: Suicide Prevention Research

By Jane L. Pearson, PhD and Chelsea Booth, PhD

Jane L. Pearson, PhD, serves as the chair of NIMH’s Suicide Research Consortium and leads the NIH Support Staff for the Research Prioritization Task Force. Chelsea Booth, PhD, is a Presidential Management Fellow on rotation with NIMH’s Division of Services and Intervention Research. Booth provides staff support for the Research Prioritization Task Force.

As part of the National Action Alliance for Suicide Prevention, the Research Prioritization Task Force is working to develop a research agenda that has the potential to reduce morbidity (suicide attempts) and mortality (suicide deaths) each, by at least 20% in 5 years and 40% or greater in 10 years, if implemented successfully. In order to achieve this goal, we are actively seeking input to identify types of research tools needed to support rapid advancement in suicide prevention research. As such, we have issued a Request for Information (RFI) inviting interested parties to contribute their specific ideas for inclusion in a collection of ways to facilitate suicide prevention research progress.

Specifically, we are asking interested parties to provide input on the following topics: a) the key methodological roadblocks that currently exist in suicide prevention research, and b) new paradigms and theoretical models with the potential to spark innovative research. A methodological roadblock is defined as a critical, unresolved challenge that is clearly limiting progress along an important suicide prevention research pathway. New research paradigms and theoretical models are novel ways of thinking about suicide behavior and avenues for prevention. However, we welcome input on any and all research-related topics on suicide prevention, such as research you would like to see done, information you would like to know more about that you think would be helpful in eradicating suicide, protective factors you think are important in preventing suicide, or lessons you and/or your community have learned about research in the past.

This RFI offers an opportunity for the community to identify and prioritize the critical “bottlenecks” that impede progress, to suggest solutions to one or more significant problems, and to nominate new paradigms for approaching this work.

We invite input from researchers, mental health professionals, suicide prevention and patient and family advocates, individuals who have survived a suicide attempt, suicide loss survivors, private and public mental health care providers and administrators, the pharmaceutical and biotechnology industry, and all other interested groups or individuals.

To submit your ideas and comments, please e-mail us at RBSuicideResearch@nih.gov. You will receive an electronic confirmation acknowledging receipt of your response, but will not receive individualized feedback on any suggestions. We require no minimum or maximum length for your submission.  

This link will take you to the full text of the RFI. Please note, although the official announcement lists a response close date of April 27, 2012, we are still accepting input.

Responses to this RFI are voluntary and will be shared with scientific working groups convened by the National Institutes of Health (NIH) and the National Action Alliance for Suicide Prevention, as appropriate. The Government reserves the right to use any non-proprietary technical information in summaries of the state of the science, and any resultant solicitation(s). The NIH may use the information gathered to develop grant, contract, or other funding priorities and initiatives. This RFI is for information and planning purposes only and should not be construed as a solicitation or as an obligation on the part of the Federal Government, NIH, or individual NIH Institutes or Centers. The NIH does not intend to make any awards based on responses to this RFI or pay for the preparation of any information submitted or for the Government’s use of such information. 

National Action Alliance for Suicide Prevention Tackles LGBT Suicide

By Kellan Baker and Josh Garcia

Kellan Baker is a health policy analyst with the LGBT Research and Communications Project at the Center for American Progress and a member of the Action Alliance for Suicide Prevention LGBT Task Force. Josh Garcia is an intern with the Project. 

Before he completed suicide at the age of 26 in 2010, Joseph Jefferson recorded his final words on Facebook: “I could not bear the burden of living as a gay man of color in a world grown cold and hateful towards those of us who live and love differently than the so-called ‘social mainstream.’”

Though LGBT suicide is frequently portrayed as a wholly youth phenomenon, Joseph was an LGBT activist who had built a life for himself as an adult after getting through what many people assume to be the only tough part of an LGBT person’s life—adolescence.

The National Action Alliance for Suicide Prevention, the public-private partnership aimed at saving the more than 34,000 lives in the United States lost every year to suicide, has taken a lead in changing public misperceptions about LGBT suicide. In particular, the Action Alliance task force that concentrates on the LGBT population has changed its name from the LGBT Youth Task Force to the LGBT Populations Task Force, acknowledging the struggles with suicide ideation, suicide attempts, and death by suicide that many LGBT people confront at different points in their lives.

The reasons that suicide is a lifelong concern for many LGBT people are complex and dynamic. These risk factors include family rejection, lack of social support, lack of access to culturally competent healthcare providers, and the stress of living with discrimination and prejudice.

Because of family or employment obligations, many LGBT adults, like most LGBT youth, do not get to choose where they live and work—often leaving them trapped in hostile environments with family members, co-workers, or neighbors who do not accept them.

Certain protective factors may mitigate these risks. Such factors include family acceptance, affirming and culturally competent mental and behavioral health services, and policies that extend legal protections and promote acceptance.

Indeed, the past several years have seen several advances across the country on behalf of fairness for LGBT people. New York state passed marriage equality for same-sex couples in 2011, and Washington state and Maryland followed suit in 2012. And, recently, the federal government has taken an active role in implementing LGBT-inclusive laws and policies.

But much remains to be done to help eliminate suicidal thoughts and behavior among LGBT individuals. In addition to increased legal protections and working to change stubborn social prejudices, there is a particularly pressing need for further research and data collection regarding mental health and suicide among the gay and transgender population.

Currently, there are no national data regarding suicidal ideation or suicide rates among the LGBT population as a whole. Nor are there sufficient data regarding the experiences of specific segments of the LGBT population, including LGBT youth and elders, transgender adults, and LGBT people of color, who may be at increased risk because of the multiple burdens of discrimination they bear.

Thus, as part of the implementation of the upcoming National Strategy for Suicide Prevention (NSSP), the Action Alliance must take the lead in pushing for nationally representative data on suicide rates among the LGBT population. These data will inform the development and implementation of evidence-based interventions that can help protect the lives of LGBT people.

Such interventions may include initiatives fostering resilience and help-seeking behaviors among LGBT people, connecting them with providers who are both familiar with mental and behavioral health issues and comfortable accepting and respecting their LGBT clients, and promoting supportive school, work, and other environments.

In addition to driving research that can guide efforts to prevent LGBT suicide, the ultimate purpose of the Action Alliance is to save lives by decreasing the rate of suicide in our country. And to do this, each one of us—whether LGBT or ally, pastor or policymaker, researcher or activist—must respond to the moral imperative to help build a world where LGBT people count and are counted, and where they can live their lives free from discrimination, harassment, and the violence of suicide. 

Protecting Life in Indian Country

As the Action Alliance carries out its important work of advancing our National Strategy for Suicide Prevention, I believe that we can make a significant difference in the lives of many. For American Indian and Alaska Native communities, this assistance is especially needed.

Bringing awareness to this issue is of utmost importance and for this reason the Indian Health Service, Bureau of Indian Affairs, Bureau of Indian Education, and Substance Abuse and Mental Health Services Administration recently hosted two Action Summits for Suicide Prevention.  The first Summit was held August 2011, in Scottsdale, Arizona and the second Summit was held October 2011 in Anchorage, Alaska.

Yvette Roubideaux, MD, MPH
Director
Indian Health Service
United States Department of Health & Human Services
National Action Alliance Executive Committee Member

The Summits brought together nationally recognized speakers, behavioral health providers, tribal leaders, health care providers, law enforcement, first responders, school personnel, and many others. In total, more than 1,000 people attended. During this time, we worked to develop and strengthen new and existing collaborations, gather information on best and promising practices, and collect information on the most up-to-date research on suicide and substance abuse prevention, intervention, and aftercare. Most importantly, the Summits provided an opportunity to share personal experiences in addressing suicide and substance abuse in Indian Country.

In order to bring about real change, numerous parties need to be involved and dedicated. The Summits focused on the importance of collaboration among tribal, federal, state, and community- and program-level leadership to promote American Indian and Alaska Native behavioral health.  This work will pave the way for new partnerships and help advance the mission of the Action Alliance.

The Action Alliance American Indian and Alaska Native Task Force has a goal. That goal is to implement suicide prevention strategies to reduce the rate of suicide in American Indian and Alaska Native communities. We are working hard to ensure that we reach our goal.

As a member of the Rosebud Sioux tribe, reducing suicide in Indian country is very important to me and I have dedicated my career to improving American Indian health care. I hope that my leadership of the American Indian and Alaska Native Task Force and membership on the Action Alliance’s Executive Committee will advance suicide prevention in our nation and I work every day to do my part in ensuring that this goal is reached.

Running to Pole 69

Eduardo Vega is the Executive Director of the Mental Health Association of San Francisco and a California Mental Health Services Oversight and Accountability Commissioner. In addition holding a seat on the Executive Committee of the National Action Alliance for Suicide Prevention, where he leads the task force on suicide attempt survivors, he is a member of the Steering Committee of the National Suicide Prevention Lifeline.

Exercise is crucial medicine for me, as it is for many. I feel certain, for instance, that training over many years in yoga, martial arts, and now running, has saved me from the worst effects of recurrent depression that were part of my life since childhood. Whenever possible on Tuesday mornings before work, I run to the center of the Golden Gate Bridge, to the landmark of light-pole 69. More people die by suicide off the Golden Gate Bridge on Tuesday than any other day. And it seems possible that at Pole 69 more people have jumped to their death than any other single place in the world.

You get accustomed to it, of course, but the beauty of the Bridge can still strike you on a given day--the dramatic rise of the red towers through shawls of fog, the infinite vista of ocean, and the powerful detachment from land and city.

As I run on it I think about the people who come here in despair, people who are feeling that death is the best way, or maybe the only way, to wrest power, dignity or simply relief from a life that seems unendurable; people in a place similar to where I once was.

When I get to Pole 69 I spend a quiet moment. Sometimes I think about the four friends I lost to suicide, or the parents, brothers, and sisters I've met whose lives were devastated by loss in the wake of such a death. I look at the water and feel the rails and try to connect with the many people who have come here seeking a resolution, however tragic, to their sense of utter desolation. Sometimes I reflect on my own suicidal moments and attempts. The seemingly endless months where I felt so far from hope, the years in which I yearned daily for an accidental decisive death. I think of the time I took actions to do the same, the fleeting feeling that I was no longer a victim, that in planning to die I finally had taken the power away my pain.

When you look out on most days from the center of the bridge you see Alcatraz island very clearly. It seems lugubrious as a metaphor, but I can’t help but think how that might affect me, if I was planning to jump.

Like it or not, we live in a society that prizes individual freedom above all, one in which punishment is meted out in terms of lives without it. One in which many people see being identified as mentally ill as worse than being a criminal, and some see it as worse than death. For some, the first time one goes through the doors of a locked psychiatric facility, that sense of self is forever altered. For people who struggle and are hospitalized repeatedly, the undermining messages, the insults to personal dignity, and the cuts at hope can be intensely magnified.

People who advocate for such things as mental health services, myself included, sometimes lose perspective on how powerfully such things as hospitalization can affect those on the receiving end. How, ironically, one’s conception of oneself may be shaken, weakened, even damaged by something designed to support it. 

As I stand on the Bridge, I know that somewhere in the world there is someone asking themselves --what is worse, to be a mental patient, or to die? 

Our biases about mental illnesses run deep--cultural prejudice, stigma, and shame are pervasive in our media, our conversations, and our dinner tables. They are alive within the system of mental healthcare, too— even though mental health providers feel professional stigma they also pass it on to clients through slights on individuals’ dignity, mistreatment or low expectations that diminish people’s hope for their lives.

That does not mean that we should not promote good mental health services and supports. Treatments and therapies make a huge difference in saving lives and in helping people grow into their own resources for recovery, self-care, and wellness. But it does mean that, if we want to reduce death by suicide, we have to combat stigma, silence, and shame associated with mental health conditions and treatment.

There is a very good reason the US Surgeon General identified stigma as the biggest barrier to progress for our country’s mental health overall. In order to really eliminate stigma as a barrier to mental health, and thereby as a contributor to death by suicide, we must change no less than society’s view of people themselves. We must embrace the reality that living with mental health problems is a challenge to many, that debilitating mental illness can affect us all, and that its experience is part of being human. To free our society from the tragedies of suicide we must make personal dignity more powerful than symptoms or disability, we must foster communities that believe in and support their people, not regardless of, but especially when they are facing personal struggles. 

I believe we can make this evolution happen-- we can challenge our history of fear and judgment and build on our resources of compassion. We can take the side of people when they are suffering, seeking to understand, rather than label, to help without depriving anyone of the strengths that come with overcoming hurdles.

The course back from the Bridge is tougher. A large part of it is up a steep hill and not too pleasant. Some mornings it can be hard to keep going, even to put one foot in front of the other.

I suffer much less and less frequently now from symptoms of mental illness. But there are still days when getting up, going to work, talking or even walking down the street can feel unendurable. There are moments I feel crushed under a paralyzing weight, when everything real retreats into bleak grey clouds.
Sometimes in those moments, the desire to die returns again, a specter of deliverance emerging like a boat out of the fog.

That boat will take me nowhere, will help no one. There’s just too much work to be done.

It is the work I so often come back to on these little journeys. If we were successful in eliminating stigma, I know people would not be jumping from this bridge twice a month. We would not be dying at Pole 69 because we would be able to prevent mental illness or to manage it successfully; we would have the resources to create enduring wellness in our mental and emotional lives, and an atmosphere of acceptance. We would be healthier because we would have the right kinds of support from our communities and families, from professionals that see people before diagnoses, from helpers who know that dignity is more important than medication, that hope is more powerful than pain.

As an attempt survivor, a loss survivor, and a mental health advocate, I am convinced that preventing death by suicide is the result of many minds, many hearts, and many hands. I’m honored and feel grateful to contribute in my way and to join with the leadership of the Action Alliance in this mission.  As we move forward, I’ll continue to add some legs and feet to the mix, to take your thoughts and good energy with me on the road to Pole 69, where we can all make a difference together.

A Hole in the Soul that Never Heals

It’s as if it were yesterday.

I was a college freshman studying in my room when my very best friend Pam walked in. She was ashen. I asked her what was wrong. In a near-catatonic state she told me her beloved brother John, a high school sophomore, had killed himself. In that instant Pam’s world collapsed. She immediately blamed herself for being away at school when he needed her. I watched the family blame themselves and go through all the stages of grieving – yet they never fully healed.

Even now, decades later, Pam and her entire family are still suffering from that tragic choice

Judy Cushing
President and CEO
Oregon Partnership
National Action Alliance Executive Committee Member

I had never been touched by anything like it. I decided that I wanted to do something that would help prevent other families from going through that level of devastation. It became a very personal mission.

Years later Oregon Partnership, the non-profit organization I direct, was able to add a fully certified Suicide Prevention Lifeline. Last year we received over 19,000 suicide calls to our Lifeline.

I can’t express how satisfying it is to be in our crisis line center and to overhear one of our team members help move a caller from a position of life-threatening crisis to one of safety. It’s literally life-changing. Not only are lives saved on the LifeLine, but compounded waves of tragedy and years of grief have been averted. 

Thousands of families didn’t have to go through what Pam’s did because of our skilled staff and volunteers.  The best news is that there are Lifelines all across the country quietly preventing people from taking their lives.

Suicide is the ultimate “elephant in the room” that our society doesn’t want to acknowledge or talk about.   I am so proud to be part of an initiative like the Action Alliance that is focusing on changing the way society thinks about mental illness and suicide.  I’m confident that some day we will discuss suicide and mental health issues as openly as we would discuss cancer. When suicide is moved out of the shadows of secrecy and shame – the twin enablers - we cast a bright light on it and, in so doing, foster prevention.

Suicide prevention needs to become a national priority. It must receive the level of attention and action of any other pandemic that kills people every day. The formation of the Action Alliance is a huge step in that direction. It’s an honor to serve with so many accomplished decision makers who are ready to influence national suicide policy. I’m also deeply touched by how many of my fellow committee members have been impacted by the devastation of suicide.

My personal area of emphasis on the Action Alliance is the Lifeline network across the country and Military and Veterans and their families.   An average of 18 veterans a day die by suicide in America.    We must come together to provide a safety net for them across all sectors of society.

We must take action to prevent suicide. For Pam, for John, and for all of our families.