National Strategy Seeks To Prevent Suicide

By Marilyn Dickey

Terri Ann Weyrauch, M.D., seemed to have everything. She was a bright, beautiful young woman, board certified in internal medicine and rheumatology, and in private practice in Chicago. But she suffered from depression. Despite the fact that she was doing all the right things—seeing a psychiatrist and taking medication—she took her own life in 1987, at the age of 34.

To reduce the occurrence of such tragedies, the Federal Government launched the National Strategy for Suicide Prevention in May 2001. It is a massive effort, spanning several Federal agencies (including SAMHSA), state governments, nonprofit organizations, communities, and others. Since the strategy's release, numerous activities have been initiated in support of its goals.

"Even one death by suicide is one death too many," says SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., noting that more than 90 percent of suicides are associated with mental illness. "Most suicides are preventable. We need to raise awareness that help is available, treatment is effective, and recovery is possible."

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Convergence of Efforts

Suicide is a far more common problem than many people realize: For every two homicides in this country, there are three suicides. For every person who dies from HIV/AIDS, two people die by suicide. Every year nearly 30,000 people lose their lives to suicide and 650,000 attempt suicide. Suicide is a tragedy that has touched the lives of countless survivors—those who live on after a relative, friend, neighbor, or colleague takes his or her life.

Only recently have efforts to understand and prevent suicide coalesced into a united movement. When Terri Ann Weyrauch ended her life, her parents, Gerald H. Weyrauch, M.B.A., and Elsie Weyrauch, R.N., of Marietta, GA, turned their grief into action. In 1996, they started a nonprofit group called the Suicide Prevention Action Network (SPANUSA) to bring more attention to the issue and act as "a catalyst, a conscience, and a prod to action," in Gerald Weyrauch's words.

Elsie Weyrauch explains, "The people who formed SPANUSA wanted to empower survivors—those close to someone who committed suicide as well as suicide attempt survivors—by helping them make a difference. The World Health Organization's 1996 document, Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies, suggested steps we could take to push for development of a national suicide prevention strategy and helped us come together as a grassroots advocacy organization."

SPANUSA provided the impetus for the formation of an innovative public/private partnership that sponsored a National Suicide Prevention Conference in Reno, NV, in 1998. Participants assembled a list of 81 recommendations that were presented to the U.S. Surgeon General. SPANUSA also collaborated with several other nonprofit groups to form the National Council for Suicide Prevention in 1999, aimed at bringing the issue to the forefront of national attention.

In 1997, galvanized by the memory of his own father's suicide, U.S. Senator Harry Reid (D-NV) took the lead in persuading the Senate to pass a resolution calling for action on the issue. A similar resolution passed in the U.S. House of Representatives in 1998.

In 1999, the U.S. Surgeon General's office issued a brief report, The Surgeon General's Call to Action to Prevent Suicide, based on key recommendations made at the Reno Conference.

Six Federal agencies, including SAMHSA, provided funding in the year 2000 to the Institute of Medicine to assess scientific information on the causes of suicide and to recommend strategies to prevent it. The report was published in 2002.

One of the most significant developments was the 2001 release of the National Strategy for Suicide Prevention. Prepared by a group of public and private sector partners with leadership and support from the Surgeon General, it has guided many of SAMHSA's efforts in this area.

In designing the National Strategy, a Federal Steering Group assisted by the National Council for Suicide Prevention and others, created 11 goals and 68 objectives for preventing suicide. These range from promoting awareness that suicide is preventable to improving access to mental health services to reducing the stigma of mental illness and substance abuse.
(See table.)

The National Strategy aims to provide better resources for people—in all age groups, every region of the country, and all walks of life—dealing with the physical, emotional, and other conditions that can lead to suicide. It also aims to support people whose loved ones died by suicide, reduce the stigma attached to mental illness, and improve the coverage of mental illness, drug addiction, and suicide in the media.

"As we were developing the National Strategy, it became quite clear that public health efforts like this need to have a broad coalition involved in their implementation," says Col. David A. Litts, O.D., special adviser to the Surgeon General for suicide prevention. "No single entity or group can carry these things off alone."

A number of states are moving ahead to develop or implement their own suicide-prevention plans, adds Dr. Litts. "Many are literally lifting the words out of the National Strategy, using the National Strategy as their guide to implementing their state plans," he says.

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SAMHSA's Contributions

The Federal Steering Committee overseeing the National Strategy includes representatives from SAMHSA, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Indian Health Service, the National Institutes of Health, and the Office of the Surgeon General. Each Federal agency is contributing expertise. For example, the National Institutes of Health conducts research into the causes of suicide; the Centers for Disease Control and Prevention tracks the incidence of suicide and collects statistics. SAMHSA likewise has a unique role.

"SAMHSA acts as the link between the Federal effort, states, and local communities," says Gail Hutchings, M.P.A., Acting Director of SAMHSA's Center for Mental Health Services. "By providing resources, funding programs, and evaluating the results, SAMHSA serves as a key connection to the Federal Government for stakeholders seeking to prevent and reduce the incidence of suicide."

A SAMHSA grant of $2.5 million was awarded this fall to create a National Suicide Prevention Technical Resource Center to provide information and other help for clinicians, researchers, survivors, advocates, local and state governments, and tribal organizations. The Education Development Center in Newton, MA, received the funding for 3 years to collaborate with the American Association of Suicidology, the American Foundation for Suicide Prevention, and the Suicide Prevention Action Network on the effort.

SAMHSA awarded another grant, for $9 million, 1 year ago. In the first year of this 3-year grant, the American Association of Suicidology has been working on ways to improve access to crisis centers and hotlines. Lanny Berman, Ph.D., executive director of the association, has three goals: to improve the quality of crisis hotlines across the country, to establish one nationwide number to connect callers with the hotline nearest them, and to build in a system of evaluation to see if hotline services are effective.

The national hotline (1-800-SUICIDE) is already up and running and adding crisis centers to its roster all the time. The goal is to have between 200 and 300 hotlines in the network by the end of the grant period. "If you don't have a center listed in your phone book and you're in a crisis—and you want to call what in effect is a 911 number—you can call this number and it would route your call to the nearest hotline," he says.

One goal of the grant is to urge more hotline and crisis centers to take advantage of a certification program that the organization established more than 20 years ago. Certification, says Dr. Berman, "is a statement to their community that these centers have policies, processes, training, and quality of service that the community can trust."

In addition to the grants, SAMHSA is developing suicide-prevention guidelines for schools based on a model called the Youth Suicide Prevention Strategy developed in New Zealand. The guidelines are being designed to identify students at risk for suicide and to promote a safe, comfortable environment where they can seek and receive help. The goal is to provide a useful tool to school personnel (including teachers), to help them establish evidence-based programs in their facilities.

Another program is the Signs of Suicide Evaluation project, started by a nonprofit group called Screening for Mental Health. This project also targets schools, in particular high school students. During the 2000-2001 school year, 220 high schools participated in a screening for depression and suicidal behavior among students. As part of the program, teens learned about depression and how to recognize it in their peers. Funding from SAMHSA is allowing the organization to take a detailed look at how much teens learned from the program and evaluate its effect on students' suicidal behaviors.

As various efforts are mobilizing, Lloyd B. Potter, Ph.D., M.P.H., associate director of the Center for Violence and Injury Prevention at the Newton, MA, Education Development Center, has taken on the job of developing baseline data as a way eventually of measuring whether the National Strategy's goals and objectives are achieved. That means finding ways of measuring everything from increasing the number of states with suicide prevention plans to promoting research on suicide prevention to providing training to medical personnel, clergy, and teachers—and much more.

Crucial to the success of the National Strategy, says Robert E. DeMartino, M.D., who, as SAMHSA's Associate Director of the Program in Trauma and Terrorism, oversees the Agency's suicide prevention efforts, "is a willingness on the part of all of the players to function as one unit, with one goal: to save lives. We have to keep speaking with one voice."

For more information, contact SAMHSA's National Mental Health Information Center, P.O. Box 42490, Washington, DC 20015. Telephone: 1 (800) 789-CMHS (2647) or 1 (866) 889-2647 (TTY). Or, visit the National Strategy for Suicide Prevention at www.mentalhealth.samhsa.gov/suicideprevention.

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