Suicide Prevention Awareness
Suicide is a complex and tragic public health issue that affects people across all demographics.
According to the Centers for Disease Control and Prevention (CDC), suicide was the 12th leading cause of death overall in the United States and the 2nd leading cause of death for people ages between 10-14 and 25-34 [1].
However, most suicides are preventable. Raising awareness, providing education, fostering community support systems, ensuring access to mental healthcare, and promoting crisis intervention initiatives can save lives.
This article explores key evidence-based strategies for suicide prevention efforts.
Implementing these recommendations at individual, community, and national levels is crucial for lowering suicide rates and helping more people find the support they need.
Understanding the Scope and Risk Factors
To develop informed solutions, it is essential to understand the scope of suicide nationally and the specific characteristics that increase risk. The most recent CDC data from 2020 indicates that approximately 46,000 Americans died by suicide [1].
Rates rose by 30% between 2000-2018, emphasizing the need for more prevention focus.
Additionally, for each suicide, there are approximately 25-30 suicide attempts [2]. This highlights the extensive need for interventions. Several factors elevate a person's risk:
Mental Health Conditions
Over 90% of people who attempt suicide have a diagnosable mental health issue, commonly depression, bipolar disorder, schizophrenia, PTSD, anxiety disorders, and substance abuse [3].
Symptoms like hopelessness, despair, insomnia, and cognitive distortions directly increase suicidality. Proper diagnosis and treatment of mental illnesses greatly reduce risk.
Life Adversities
Cumulative adversities like financial problems, unemployment, chronic pain, social isolation, trauma, discrimination, relationship conflicts, and legal/disciplinary trouble can lead to suicidal thoughts, especially when combined with limited coping abilities [4].
Access to counseling and support during difficult times provides protection.
Access to Lethal Means
Easy access to highly lethal suicide methods like firearms and analgesics increases the risk of impulsive attempts in vulnerable individuals [5]. Limiting access through safety regulations and medication restrictions saves lives.
Previous Suicide Attempts
A prior suicide attempt elevates future suicide risk, particularly for adolescents. Connecting attempters with help prevents further attempts.
Family History
Individuals with a family member who died by suicide have increased risk, especially if combined with mental illness [6]. Extra support for these individuals is beneficial.
While many factors are outside individual control, social support, coping skills, and treatment can mitigate risk during times of crisis.
Suicide attempt warning signs adapted from the National Institute of Mental Health as a suicide prevention act infographic.
Educating the Public to Promote Awareness
Alongside understanding risks, a core component of suicide prevention is education to promote awareness and overcome stigma. Myths and misconceptions persist about suicide, which generates stigma and barriers to help-seeking.
However, research shows that sensitive, accurate education empowers the public to reach out and assist at-risk individuals. Key educational priorities include:
Defining Suicidal Thinking
It is crucial to help the public recognize warning signs like expressions of hopelessness ("I feel so trapped"), unbearable emotional pain ("This suffering is too much"), perceived burdensomeness ("People would be better off without me"), or suicidal statements ("I'm thinking of killing myself").
These signs require urgent attention. Knowledge reduces delays in connecting high-risk individuals with help.
Challenging Misconceptions
Education should also challenge myths like "asking about suicide causes it" or "improvement after crisis means the risk is over." These misconceptions remain prevalent but inhibit suicide prevention. Open discussion and accurate information are needed.
Reducing Stigma
Stigma restricts help-seeking, portrays suicide as immoral, and isolates at-risk individuals. But sensitively framing suicidal thinking as the manifestation of a health issue requiring compassionate response fights stigma.
Highlighting Treatment Options
Importantly, education must highlight that "suicide is preventable" and multiple evidence-based treatment options exist, including counseling, medication, cognitive-behavioral therapy, conflict resolution, and care for underlying mental illnesses. Conveying hope combats fatalistic attitudes.
With greater public understanding, more community members can provide vital social support, guide others to care, and advocate for prevention policies. Ongoing awareness efforts in schools, workplaces, and communities are essential.
Resources for Immediate Response -- https://mhanational.org/crisisresources
Cultivating Connections and Social Support Systems
Social isolation and loneliness heighten risk [8], whereas interpersonal connections and support protect against suicide [9].
Both reinforcing existing relationships and using community organizations to reach disconnected individuals are key to prevention. Possible strategies include:
Peer Support Groups
Group sessions allow at-risk individuals to connect with others facing similar challenges and gain support. Groups can focus on general emotional struggles or specific issues like addiction, trauma, chronic illness, grief, LGBTQ+ identities, or disabilities. Qualified counselors facilitate healthy processing and coping skills.
Community Outreach
Proactively engaging isolated seniors, disabled adults, homeless populations, incarcerated individuals, and other marginalized groups provide vital social contact and suicide screening.
Partnerships with social workers, advocates, and peer navigators facilitate outreach. Care Transitions
Periods like hospital discharge after attempts or mental health crises leave individuals especially vulnerable. Having protocols to immediately connect them with transitional programs or peer mentors reduces risk during these critical times.
Family and Friend Support
Equipping loved ones with communication strategies and resources helps them assist at-risk individuals and ensures people know how to effectively intervene. Gatekeeper training is a proven approach.
Social connectedness, community involvement, and strong support systems among family and friends are foundational protective factors against suicide risk. Prioritizing human connections saves lives.
Improving and Expanding Mental Healthcare Access
Given the clear link between mental illnesses and suicide, expanding access to high-quality mental healthcare is imperative for prevention. This requires addressing cost barriers, integration challenges, and service gaps limiting care access [10]. Potential solutions include:
Insurance Expansion
Policy and legislative changes must continue expanding mental health insurance coverage so cost no longer prevents care access. Federal and state mental healthcare reforms have made progress but gaps persist.
Service Integration
Linking mental healthcare with primary care, schools, criminal justice settings, and community programs improves coordination and access for at-risk groups. On-site counseling, referrals, and care navigation facilitate access.
Crisis Services
24/7 crisis mental health services offering assessments, stabilization, and inpatient treatment when needed to provide immediate intervention during mental health emergencies and suicide risk. More funding is crucial.
Workforce Training
Programs preparing more psychiatrists, psychologists, counselors, peer specialists, and primary care providers to address suicide risk and associated issues like trauma, addiction, and chronic illness expand care capacity. Loan forgiveness incentives retention.
Access barriers contribute to unmet treatment needs among individuals with mental health challenges, underscoring the need for systemic improvements [11].
Comprehensive access facilitates recovery and suicide prevention.
Implementing Targeted Crisis Intervention Models
Once suicidal risk emerges, prompt crisis intervention is vital to de-escalate distress and connect individuals with appropriate care. Public health models designed specifically to address imminent suicide risk include:
Crisis Hotlines
24/7 crisis hotlines like the National Suicide Prevention Lifeline and Trevor Project provide free confidential emotional support, suicide risk assessment, and linkage to local resources.
Expanded funding improves accessibility and capacity. Call centers also follow up with at-risk individuals to ensure stabilization.
Mobile Crisis Units
Mobile crisis teams of mental health professionals dispatched during suicide emergencies allow rapid in-person assessment and de-escalation of where the person is located.
This immediate response provides a critical alternative to law enforcement intervention. Crisis Stabilization Units
Walk-in stabilization centers offer voluntary short-term psychiatric stabilization services as an alternative to hospitalization for those not requiring inpatient care. They bridge the gap between emergency services and ongoing outpatient treatment.
Post-Crisis Counseling
Connecting suicidal individuals with counseling services immediately after discharge from crisis care ensures continuity and prevents gaps between crisis and recovery treatment. Scheduling follow-up appointments before discharge facilitates transitions.
With prompt access to emergency evaluation and stabilization during crises paired with seamless connections to ongoing care, public health models prevent suicide deaths during high-risk periods.
Restricting Access to Lethal Means
As discussed regarding risk factors, easy access to highly lethal suicide methods increases the likelihood that impulsive suicidal behavior will prove fatal.
Therefore, limiting access to lethal means has tremendous potential to reduce suicide deaths [12]. This involves firearm restrictions, medication safety, and structural interventions.
Firearm Safety
Implementing waiting periods and background checks for firearm purchases reduces impulsive firearm suicides. Temporarily storing guns with retailers, shooting ranges, or law enforcement during crises also helps.
Medication Safety
Prescribing medication for acute suicidality in limited quantities and requiring monthly follow-ups reduces overdose risk. Centralized electronic records help identify risky combinations.
Structural Barriers
Installing bridge barriers, restricting access to tall structures, and improving garage door safety impede impulsive suicide attempts. Surviving a low-lethality attempt allows time for intervention.
While restricting access to lethal means may generate controversy, data shows it could save thousands of lives each year without preventing all legitimate firearm ownership or sacrificing individual rights.
Paired with other prevention strategies, limited access proposals warrant sincere consideration and discussion.
The Tragedy of Veteran Suicide
Veteran suicide is a tragic and pressing issue facing many who have served in the military.
Studies show that veterans are at higher risk for suicide than the general population, with rates increasing for post-9/11 veterans. Some contributing factors include PTSD, depression, chronic pain, and lack of social support after leaving service.
Statistics reveal the stark reality that veterans are more likely to die by suicide than non-veteran adults. Veterans make up just 7.6% of the total US population yet account for almost 14% of all suicide deaths among American adults.[13]
Organizations like the VA and non-profits aim to provide more mental health resources and support networks to prevent veteran suicide. However, more work still needs to be done to understand why veterans are at higher risk and how best to help them.
Overall, veteran suicide is a complex problem related to mental health challenges and transitioning back to civilian life that requires further research and resources to address.
In Conclusion: Moving Forward with Compassion and Resolve
Stemming the tragedy of suicide requires comprehensive, coordinated efforts across healthcare, education, social services, infrastructure, and legislation.
But collaboratively implementing evidence-based public health models highlighted here provides real hope for saving lives.
Progress relies on addressing stigma and generating a more open, compassionate dialogue about suicide risk and prevention.
With greater awareness, strengthened community support systems, improved mental health access, crisis intervention, means reduction, and social will, we can empower more people struggling with suicidal thoughts to seek care and choose life.
Collective action creates change.
References
[1] Hedegaard, Holly et al. “Increase in Suicide Mortality in the United States, 1999-2018.” NCHS data brief ,362 (2020): 1-8.
[2] Drapeau, C. W., & McIntosh, J. L. (2021). U.S.A. suicide: 2020 Official final data. Minneapolis, MN: Suicide Awareness Voices of Education (SAVE), dated December 24, 2021, downloaded from https://save.org/about-suicide/suicide-statistics/
[3] Brådvik, Louise. “Suicide Risk and Mental Disorders.” International journal of environmental research and public health vol. 15,9 2028. 17 Sep. 2018, doi:10.3390/ijerph15092028
[4] Carballo, J J et al. “Psychosocial risk factors for suicidality in children and adolescents.” European child & adolescent psychiatry vol. 29,6 (2020): 759-776.
doi:10.1007/s00787-018-01270-9
[5] Sarchiapone, Marco et al. “Controlling access to suicide means.” International Journal of Environmental Research and Public Health vol. 8,12 (2011): 4550-62.
doi:10.3390/ijerph8124550.
[6] Qin, Ping et al. “Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers.” Lancet (London, England) vol. 360,9340 (2002): 1126-30. doi:10.1016/S0140-6736(02)11197-4
[7] Burnette, Crystal et al. “Gatekeeper Training for Suicide Prevention: A Theoretical Model and Review of the Empirical Literature.” Rand Health Quarterly vol. 5,1 16. 15 Jul. 2015
[8] Calati, Raffaella, and Philippe Courtet. “Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data.” Journal of Psychiatric Research vol. 79 (2016): 8-20. doi:10.1016/j.jpsychires.2016.04.003
[9] Kleiman, Evan M, and Matthew K Nock. “Real-time assessment of suicidal thoughts and behaviors.” Current Opinion in Psychology vol. 22 (2018): 33-37.
doi:10.1016/j.copsyc.2017.07.026
[10] Brådvik, Louise. “Suicide Risk and Mental Disorders.” International journal of environmental research and public health vol. 15,9 2028. 17 Sep. 2018, doi:10.3390/ijerph15092028
[11] Bruffaerts, Ronny et al. “Treatment of suicidal people around the world.” The British journal of Psychiatry: the journal of mental science vol. 199,1 (2011): 64-70.
doi:10.1192/bjp.bp.110.084129
[12] Zalsman, Gil et al. “Suicide prevention strategies revisited: 10-year systematic review.” The Lancet. Psychiatry vol. 3,7 (2016): 646-59. doi:10.1016/S2215-0366(16)30030-X
[13] Ruiz, Frank et al. “A Practical Review of Suicide Among Veterans: Preventive and Proactive Measures for Health Care Institutions and Providers.” Public health reports (Washington, D.C. : 1974) vol. 138,2 (2023): 223-231. doi:10.1177/00333549221085240
