SAMHSA Supports Efforts To Prevent Suicide
By Jon Bowen
night in mid-July, licensed counselor John Paruch picked
up a ringing phone at the Behavioral Health Response
Crisis Center in St. Louis, MO. The caller was a 50-year-old
man who had lost his will to live.
"A number of things had happened in his life,"
Mr. Paruch says. "He had lost his job, and he had
recently lost his wife. It was all related to a substance
abuse problem. When he called, he was incredibly distraught.
He felt that he was at the end of his rope."
Mr. Paruch needed to act quickly. In the background
behind the caller's voice, he heard the clattering noise
of trains speeding by. The man was standing at an outdoor
pay phone near railroad tracks—deciding, perhaps,
if he would live or die.
Over the next 45 minutes, Mr. Paruch tried to coax the
man toward a better state of mind. "We talked about
his life, his relationship with his wife," Mr. Paruch
recalls. "We talked about what motivated him to
live, about his three children. He had lost time with
them because of his alcoholism; he regretted that."
Realizing that the man's children gave him a sense of
purpose, Mr. Paruch scrambled to get the children on
the phone by conference call. The man's daughter drove
out to where her father was and took him back to his
son's house. By phone, Mr. Paruch followed up with him
there, helping the man find a local counseling resource
by using the Treatment Facility Locator on the SAMHSA
For Mr. Paruch, there's a deep sense of satisfaction
in helping someone in crisis. "You're the last bridge
to life for them," he says.
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Improving the Safety Net
Suicide is a severe public health problem. According
to the National Center for Health Statistics at the Centers
for Disease Control and Prevention, more than 30,000
Americans commit suicide every year. Suicide is the third
leading cause of death among young people between the
ages of 15 and 24 and the eleventh leading cause of death
among persons of all ages.
SAMHSA is supporting a broad national effort to stem
the tide of suicides. The crisis center where John Paruch
works is just 1 of more than 100 centers in communities
across the Nation that are part of the National Suicide
Prevention Lifeline. The Lifeline uses a single, national
toll-free number, 1-800-273-TALK (8255), to connect callers
at risk for suicide to trained counselors close to where
Funded by a 3-year, $6.6 million grant from SAMHSA's
Center for Mental Health Services (CMHS), the Lifeline
came into existence following the 2001 launch of the
National Strategy for Suicide Prevention, a broad initiative
aimed at reducing the number of suicides across the country.
SAMHSA News, Fall 2002.) In addition to
the Lifeline, SAMHSA provides funding for the Suicide
Prevention Resource Center, which offers technical assistance,
training, and informational materials to support suicide
These two programs provide essential help for people
at risk for suicide, but the nationwide "safety
net" created by suicide prevention efforts is becoming
stronger and more encompassing. Soon, SAMHSA will expand
its grants program exponentially, boosting the number
of suicide prevention grantees from 2 to approximately
"SAMHSA will soon be awarding suicide prevention
grants to states and tribes, as well as to colleges and
universities, as authorized by the Garrett Lee Smith
Memorial Act," says Richard McKeon, Ph.D., SAMHSA
Special Advisor–Suicide Prevention.
The Garrett Lee Smith Memorial Act, introduced by Senator
Gordon Smith (R-OR) in memory of his son who died by
suicide, is bipartisan legislation that aims to reduce
suicide among youth. Signed in 2004, the bill authorized
SAMHSA to distribute $82 million in funding over 3 years,
$11.5 million of which is available in 2005.
The new funds will allow SAMHSA to take a more active
approach to suicide prevention, according to Brenda Bruun,
Special Assistant to the Director, Division of Prevention,
Traumatic Stress, and Special Programs at CMHS. The idea
is to create a continuum of care that addresses the needs
of people at risk for suicide long before they become
"When we talk about the tools we need for suicide
prevention," says Ms. Bruun, "we are including
the work we need to do long before an active intervention
takes place for someone in a suicidal crisis."
The key to prevention is identifying—at an early
stage—people who are at risk. "We need to do adequate depression screening, more
public education," says Ms. Bruun. "We need
better training of educators, primary care providers,
and mental health and substance abuse treatment providers."
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Recently, SAMHSA received the evaluation results from two SAMHSA-funded
studies of suicide prevention hotlines—one looking
at the outcomes of calls and the other looking at overall
quality of care.
The first study showed that outcomes were generally
positive. Two weeks after calling the hotline, most callers
were experiencing less depression and fewer suicidal
The other study, however, showed some inconsistencies
in quality of care among the various crisis centers around
the country. Counselors were not always evaluating suicide
risk in a consistent manner, and when evaluations were
made, they were often incomplete.
"It led us to think that there's an issue with
training and accreditation," says Ms. Bruun. SAMHSA,
through the National Suicide Prevention Lifeline, now
has a committee looking at certification standards for
crisis center counselors, and out of that analysis will
come recommendations for training and supervision.
All this analysis is being used to refine the efforts
of the centers involved in the SAMHSA-funded Lifeline.
"People in emotional distress or in suicidal crisis
can call any time from anywhere in the Nation and speak
to a trained worker who will listen to them and assist
them in getting the help they need," says John Draper,
Ph.D., Director of the Lifeline.
To make the public more aware of the Lifeline, SAMHSA
is developing a national marketing campaign to raise
awareness of the Lifeline's toll-free number and to make
people generally more aware of the availability of help
for people in suicidal crisis.
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A Resource for States
One of the goals of the National Strategy for Suicide
Prevention called for the development of a technical
assistance and resource center to help states and communities
establish and evaluate suicide prevention programs. "The
formation of the Suicide Prevention Resource Center in
2002 realized this goal," says Lloyd Potter, Ph.D.,
M.P.H., Director of the Center.
"The National Strategy guides much of the Center's
work and products," Dr. Potter explains. "We
assist states in their efforts to develop and implement
suicide prevention programs. We've also been working
to develop training modules for state and community people
working to prevent suicide and for clinicians and other
professionals who may work with persons at risk for suicide."
The Center is expanding its offerings to provide not
only technical assistance but also a storehouse of information
for those working in the field of suicide prevention
and those whose personal lives have been affected by
suicide. "The Center is the only one of its kind
that provides technical assistance to grantee programs,
and also provides information for researchers, advocates,
and survivors," says Ms. Bruun.
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Overcoming the Stigma
As SAMHSA and other agencies and organizations work
to further the goals of the National Strategy, challenges
arise. One of the barriers commonly encountered by professionals
who work in suicide prevention is the shame and embarrassment
that surround suicide and its contributing factors.
"The stigma surrounding suicide, as well as mental
illness and substance abuse, each of which are significant
risk factors for suicide, is a continuing challenge,"
says Dr. McKeon. The stigma often keeps those who need
help most—the ones who are most at risk for suicide—from
One challenge for the Lifeline staff, according to Dr.
Draper, is the simple lack of public awareness of the
suicide prevention resources that are available. "Promoting
awareness of the toll-free phone number and how hotlines
can help prevent suicide—primarily to populations
not accustomed to seeking mental health assistance—may
well represent the biggest challenge," he says.
Dr. Draper explains that the highest suicide rates are
often seen, unfortunately, among populations where service
use is lowest—in rural populations and among American
Indians and Alaskan Natives, seniors, and white males.
at-risk group is youth. SAMHSA recently released a short report,
Thoughts among Youths Aged 12-17 with Major Depressive Episode.
Data show that approximately 900,000 youth had made a plan to commit
suicide during their worst or most recent episode of major depression,
and 712,000 attempted suicide during such an episode of depression.
The data, from the 2004 National Survey on Drug Use
and Health, show that about 3.5 million youth age 12
to 17 (14 percent) had experienced at least one episode
of major depression in their lifetime.
In response, the Lifeline offers people at risk an easily
accessible, free way to get help.
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What's Needed Now
Much work remains to be done to reduce the number of
suicides in this country.
According to Dr. McKeon, making suicide prevention successful
on a national scale will require commitment from both
the public and private sectors. "No single agency
can do it alone," he says.
In addition, "There are very few evidence-based
programmatic strategies for preventing suicide,"
Dr. Potter explains. He sees a need to identify more
programs that have demonstrated sound evidence of effectiveness
in promoting mental health and preventing suicide. "The
Center has been actively working to identify such programs,
and we are working with other programs to encourage development
of evidence for their effectiveness."
Dr. McKeon says, "There is also a crucial need
to improve training of the mental health and substance
abuse workforce, to improve access to care for individuals
identified as at risk, and to improve continuity of care
for those who have attempted suicide who are discharged
from emergency rooms and inpatient facilities."
Dr. Draper also sees the need to educate the public,
to help people recognize that suicide and related mental
health issues are a public health issue that affects
everyone in one way or another. To get there, he says,
"Prevention programs will need to tell their ‘success
stories,' so that more people can recognize how their
efforts have made a positive difference in their communities
and in the lives of individuals and families."
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.
The SAMHSA short report on youth is available at www.oas.samhsa.gov.
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The SAMHSA-funded Suicide Prevention Resource Center
provides technical assistance, training, and materials
to support suicide prevention efforts in states
and communities across the country. The Web site
carries the latest news related to research and
funding opportunities for suicide prevention.
SAMHSA's National Suicide Prevention Lifeline,
1-800-273-TALK (8255), provides immediate assistance
to individuals in crisis by connecting them to
the nearest available suicide prevention and mental
health service provider through its toll-free telephone
number. The Web site contains information about
the network, training, technical assistance, and
news and events.
The National Strategy for Suicide Prevention is
a broad initiative aimed at reducing the number
of suicides across the country. The Web site includes
suicide facts, information on funding opportunities
and state programs, and legislation news.
In 1999, the U.S. Surgeon General issued a call
to action to prevent suicide. It described suicide
as a serious public health problem and outlined
a strategy for reducing the number of suicides
in this country.
SPAN USA is dedicated to preventing suicide through
public education and awareness, community action,
and Federal, state, and local grassroots advocacy.
The Web site contains information on state suicide
prevention programs and grassroots community organizations.
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