By Jacqueline Feldman, M.D., NAMI Associate Medical Director
Of all the topics in mental health, one of the most difficult to consider is suicide. People contemplating it often do not speak directly of it. Families are surprised, stunned, mortified, angry, and devastated in the face of it. Non-mental health professionals may feel uncomfortable asking about anything related to it. And mental health professionals feel helpless, as we are terrible at discretely predicting and preventing it. There are tragedies, and there is fear; suicide is at the crossroads when these two meet.
As I review scientific articles, and program after program, the despair continues. In spite of more folks talking about it, more people training to identify it, and more programs put in place to prevent it, suicide continues.
So what do we know? The Centers for Disease Control (CDC) says suicide is the 10th leading cause of death in the U.S., and the third leading cause of death for those aged 15-24. More than 800,000 around the globe die each year; many more attempt it. The figures boggle the mind, and challenge us all: how can we possibly intervene?
Many of us know to watch for warning signs—a history of loss (social support, job, resources, health), prior attempts, family history, recent violence; changing appearance or behavior like plummeting grades or productivity, tearfulness, negativism, social isolation, drugs and alcohol); we’re not so good at communicating our concern or finding help.
Programs like Typical or Troubled from the American Psychiatric Foundation and QPR (Question, Persuade, Refer) to name just two of the many that have been developed, frequently focus on training sentinels—folks in a position to observe people at risk—to heighten awareness of those with potential for suicide, and help find relief and support for the person in need. And yet, still we struggle.
On January 9, an article was published in Lancet looking at the results of 3 different kinds of suicide prevention training on over 11,000 students in Europe: QPR, where teachers act as sentinels; ProfScreen, where mental health professionals provide screening, and the Youth Aware of Mental Health Program, which trains the students themselves. This program used “lectures, role playing, and education about mental health and suicide risk” with students. At 12 months, there was a significant reduction of suicide attempts, and of severe suicidal ideation, compared to the other control groups. It has been suggested that perhaps this program was more effective because it offers interventions “before there are outward signs of risk, and doesn’t stigmatize individual students.” It's an interesting idea: going to the at-risk population itself, giving them the education, and empowering them to make different choices.
The CDC suggests the key to reducing suicides is to reduce risk and increase resilience. We cannot begin to reduce risk or abolish stigma or enhance resilience if we cannot even talk about the topic. We need a structured national conversation, an engaged public, an engaged media, engaged policy makers, and engaged legislators.
How about a president who starts by mentioning the “dignity and worth of every citizen… (including) Americans with mental illness” in his State of the Union speech? (He did, last week!) How about asking every pediatrician and every primary care doc and every pastor and preacher (heck, place signs in every bus stop, subway, and grocery store for that matter) to educate each family to store firearms locked and unloaded, with ammunition locked separately, if a household member is at high risk for suicide? How about widespread movements to have the public certified in suicide prevention like so many of us are certified in CPR? How about offering NAMI Ending the Silence to every 9th grader to let them know about the warning signs of a mental health condition and what they can do? The list is endless.
I know we all care. I’m ready to start talking, and doing; how about you?