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
thingsseeing a psychiatrist and taking medicationshe
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."
Back to Top
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 survivorsthose 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 survivorsthose close to someone who committed suicide
as well as suicide attempt survivorsby 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.
The National Strategy aims to provide better resources for peoplein
all age groups, every region of the country, and all walks of lifedealing
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
"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
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,"
Back to Top
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 crisisand you want to call what
in effect is a 911 numberyou 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
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
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 teachersand 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.
Back to Top