Goal 6: Implement Training For Recognition of At-Risk Behavior and Delivery of Effective Treatment

Studies indicate that many health professionals are not adequately trained to provide proper assessment, treatment, and management of suicidal patients, nor do they know how to refer clients properly for specialized assessment and treatment. Despite the increased awareness of suicide as a major public health problem, gaps remain in training programs for health professionals and others who often come into contact with patients in need of these specialized assessment techniques and treatment approaches. In addition, many health professionals lack training in the recognition of risk factors often found in grieving family members of loved ones who have died by suicide (suicide survivors).

Key gatekeepers–people who regularly come into contact with individuals or families in distress– need training in order to be able to recognize factors that place individuals at risk for suicide, and to learn appropriate interventions. Key gatekeepers include teachers and school personnel, clergy, police officers, primary health care providers, mental health care providers, correctional personnel, and emergency health care personnel.

The objectives established for this goal are designed to ensure that health professionals and key community gatekeepers obtain the training that will help them prevent suicide. They include:

• Improving education for nurses, physician assistants, physicians, social workers, psychologists, and other counselors
• Providing training for clergy, teachers and other educational staff, correctional workers, and attorneys on how to identify and respond to persons at risk for suicide, and
• Providing educational programs for family members of persons at elevated risk.

Goal 7: Develop and Promote Effective Clinical and Professional Practices

One way to prevent suicide is to identify individuals at risk and to engage them in treatments that are effective in reducing the personal and situational factors associated with suicidal behaviors (e.g., depressed mood, hopelessness, helplessness, alcohol and other drug abuse, among others). Another way to prevent suicide is to promote and support the presence of protective factors, such as learning skills in problem solving, conflict resolution, and nonviolent handling of disputes. By improving clinical practices in the assessment, management, and treatment for individuals at risk for suicide, the chances for preventing those individuals from acting on their despair and distress in self-destructive ways are greatly improved. Moreover, promoting the presence of protective factors for these individuals can contribute importantly to reducing their risk.

The objectives established for this goal are designed to heighten awareness of the presence or absence of risk and protective conditions associated with suicide, leading to better triage systems and better allocation of resources for those in need of specialized treatment. They include:

• Changing procedures and/or policies in certain settings, including hospital emergency departments, substance abuse treatment centers, specialty mental health treatment centers, and various institutional treatment settings, designed to assess suicide risk
• Incorporating suicide-risk screening in primary care
• Ensuring that individuals who typically provide services to suicide survivors have been trained to understand and respond appropriately to their unique needs (e.g., emergency medical technicians, firefighters, police, funeral directors)
• Increasing the numbers of persons with mood disorders who receive and maintain treatment
• Ensuring that persons treated for trauma, sexual assault, or physical abuse in emergency departments receive mental health services
• Fostering the education of family members and significant others of persons receiving care for the treatment of mental health and substance abuse disorders with risk of suicide.

Goal 8: Improve Access to and Community Linkages with Mental Health and Substance Abuse Services

The elimination of health disparities and the improvement of the quality of life for all Americans are central goals of Healthy People 2010. Some of these health disparities are attributable to differences of gender, race or ethnicity, education, income, disability, stigma, geographic location, or sexual orientation. Many of these factors place individuals at increased risk for suicidal behaviors.

Barriers to equal access and affordability of health care may be influenced by financial, structural, and personal factors. Financial barriers include not having enough health insurance or not having the financial capacity to pay for services outside a health plan or insurance program. Structural barriers include the lack of primary care providers, medical specialists or other health care professionals to meet special needs or the lack of health care facilities. Personal barriers include cultural or spiritual differences, language, not knowing when or how to seek care, or concerns about confidentiality or discrimination. Reducing disparities is a necessary step in ensuring that all Americans receive appropriate physical health, mental health, and substance abuse services. One aspect of improving access is to better coordinate the services of a variety of community institutions. This will help ensure that at-risk populations receive the services they need, and that all community members receive regular preventive health services.

The objectives established for this goal are designed to enhance inter-organizational communication to facilitate the provision of health services to those in need of them. They include:

• Increasing the number of States that require health insurance plans to cover mental health and substance abuse care on par with coverage for physical health care
• Implementing utilization management guidelines for suicidal risk in managed care and insurance plans
• Integrating mental health and suicide prevention into health and social services outreach programs for at-risk populations
• Defining and implementing screening guidelines for schools, colleges, and correctional institutions, along with guidelines on linkages with service providers, and
• Implementing support programs for persons who have survived the suicide of someone close.

Goal 9: Improve Reporting and Portrayals of Suicidal Behavior, Mental Illness, and Substance Abuse in the Entertainment and News Media

The media–movies, television, radio, newspapers, and magazines–have a powerful impact on perceptions of reality and on behavior. Research over many years has found that media representations of suicide may increase suicide rates, especially among youth. "Cluster suicides" and "suicide contagion" have been documented, and studies have shown that both news reports and fictional accounts of suicide in movies and on television can lead to increases in suicide. It appears that imitation plays a role in certain individuals engaging in suicidal behavior.

On the other hand, it is widely acknowledged that the media can play a positive role in suicide prevention, even as they report on suicide or depict it and related issues in movies and on television. The way suicide is presented is particularly important. Changing media representation of suicidal behaviors is one of several strategies needed to reduce the suicide rate.

Media portrayals of mental illness and substance abuse may also affect the suicide rate. Negative views of these problems may lead individuals to deny they have a problem or be reluctant to seek treatment--and untreated mental illness and substance abuse are strongly correlated with suicide.

The objectives established for this goal are designed to foster consideration among media leaders of the impact of different styles of describing or otherwise depicting suicide and suicidal behavior, mental illness, and substance abuse, and to encourage media representations of suicide that can help prevent rather than increase suicide. They include:

• Establishing a public/private group designed to promote the responsible representation of suicidal behaviors and mental illness on television and in movies
• Increasing the number of television programs, movies, and news reports that observe recommended guidelines in the depiction of suicide and mental illness, and
• Increasing the number of journalism schools that adequately address reporting of mental illness and suicide in their curricula.

Goal 10: Promote and Support Research on Suicide and Suicide Prevention

All suicides are highly complex. The volume of research on suicide and its risk factors has increased considerably in the past decade and has generated new questions about why individuals become suicidal or remain suicidal. The important contributions of underlying mental illness, substance use, and biological factors, as well as potential risk that comes from certain environmental influences are becoming clearer. Increasing the understanding of how individual and environmental risk and protective factors interact with each other to affect an individual's risk for suicidal behavior is the next challenge. This understanding can contribute to the limited but growing information about how modifying risk and protective factors change outcomes pertaining to suicidal behavior.

The objectives established for this goal are designed to support a wide range of research endeavors focused on the etiology, expression, and maintenance of suicidal behaviors across the lifespan. The enhanced understanding to be derived from this research will lead to better assessment tools, treatments, and preventive interventions. The objectives include:

• Developing a national suicide research agenda
• Increasing funds for suicide prevention research
• Evaluating preventive interventions, and
• Establishing a registry of interventions with demonstrated effectiveness for prevention of suicide or suicidal behavior.

Goal 11: Improve and Expand Surveillance Systems

Surveillance has been defined as the systematic and ongoing collection of data. Surveillance systems are key to health planning. They are used to track trends in rates, to identify new problems, to provide evidence to support activities and initiatives, to identify risk and protective factors, to target high risk populations for interventions, and to assess the impact of prevention efforts.

Data on suicide and suicidal behavior are needed at national, State and local levels. National data can be used to draw attention to the magnitude of the suicide problem and to examine differences in rates among groups (e.g., ethnic groups), locales (e.g., rural vs. urban) and whether suicidal individuals were cared for in certain settings (e.g., primary care, emergency departments). State and local data help establish local program priorities and are necessary for evaluating the impact of suicide prevention strategies.

The objectives established for this goal are designed to enhance the quality and quantity of data available on suicide and suicidal behaviors and ensure that the data are useful for prevention purposes. They include:

• Developing and implementing standardized protocols for death scene investigations
• Increasing the number of follow-back studies of suicides
• Increasing the number of hospitals that code for external cause of injuries
• Increasing the number of nationally representative surveys with questions on suicidal behavior
• Implementing a national violent death reporting system that includes suicide
• Increasing the number of States that produce annual reports on suicide, and
• Supporting pilot projects to link and analyze information on self-destructive behavior from various, distinct data systems.

Looking Ahead

The National Strategy for Suicide Prevention creates a framework for suicide prevention for the Nation. It is designed to encourage and empower groups and individuals to work together. The stronger and broader the support and collaboration on suicide prevention, the greater the chance for the success of this public health initiative. Suicide and suicidal behaviors can be reduced as the general public gains more understanding about the extent to which suicide is a problem, about the ways in which it can be prevented, and about the roles individuals and groups can play in prevention efforts.

The National Strategy is comprehensive and sufficiently broad so that individuals and groups can select those objectives and activities that best correspond to their responsibilities and resources. The plan's objectives suggest a number of roles for different groups. Individuals from a variety of occupations need to be involved in implementing the plan, such as health care professionals, police, attorneys, educators, and clergy. Institutions such as community groups, faith-based organizations, and schools all have a necessary part to play. Sites for suicide prevention work include jails, emergency departments and the workplace. Survivors, consumers and the media need to be partners as well, and governments at the Federal, State, and local levels are key in providing funding for public health and safety issues.

Ideally, the National Strategy will motivate and illuminate. It can serve as a model and be adopted or modified by States, communities, and tribes as they develop their own, local suicide prevention plans. The NSSP articulates the framework for national efforts and provides legitimacy for local groups to make suicide prevention a high priority for action.

The National Strategy encompasses the development, promotion and support of programs that will be implemented in communities across the country designed to achieve significant, measurable, and sustainable reductions in suicide and suicidal behaviors. This requires a major investment in public health action.

Now is the time for making great strides in suicide prevention. Implementing the National Strategy for Suicide Prevention provides the means to realize success in reducing the toll from this important public health problem. Sustaining action on behalf of all Americans will depend on effective public and private collaboration–because suicide prevention is truly everyone's business