In 1999, the Office of the Surgeon General identified suicide prevention as a national public health priority. Since then, the National Action Alliance has worked to reduce suicides through a series of strategies.
Reducing access to lethal means is key, and several types of psychosocial interventions have been shown to reduce suicide risk. Examples include personalized safety planning, follow-up phone calls and group therapy.
Prevention
Suicide prevention strategies focus on reducing the risk of suicide before it occurs, and on reducing the immediate and long-term harms of suicidal behavior for individuals, families, communities, and society. These include:
Talking therapies (like Cognitive Behavioral Therapy, Interpersonal Therapy and Mindfulness-Based Stress Reduction) and other supportive services. Increasing the availability of mental and physical health care services. Reducing the stigma related to suicide. Providing training and support to help people with suicide thoughts. Reducing access to lethal means of suicide through laws and policies. Providing crisis signs like special telephone numbers on bridges, and 24/7 crisis text lines.
Several brief interventions have been shown to be effective in preventing suicide. These include the Safety Planning Intervention developed by Drs. Barbara Stanley and Gregory Brown; Lethal Means Counseling; and the ED-SAFE study. These programs teach a person to identify their personal warning signs and to come up with alternate ways of dealing with a high-risk situation.
Early Detection
Predisposing risk factors include a history of mental health disorders and substance use, but also chronic and severe physical illnesses. For example, suicide is more common among patients with end-stage kidney disease, ALS, quadriplegia, heart failure and fibromyalgia than those without these conditions.
The earliest detection techniques involve teaching people to recognize warning signs, limiting access to lethal means and providing support. These techniques are scalable and effective, as shown by a national study of gatekeeper training, suicide screening and teaching warning signs that found a 30% reduction in suicide rates across 126 U.S. counties.
Early detection systems could include telemedicine, algorithm-driven electronic health record screening and smartphone passive monitoring to identify those most at risk. Calibrating prevention efforts to the period of greatest risk, such as following a suicide attempt or discharge from psychiatric care or an emergency department visit, and to individual patient clinical profiles is critical for increased effectiveness. This might include means restriction, such as reducing access to firearms, which are used in half of all suicides.
Treatment
Treatment options that reduce the risk of suicide include psychosocial interventions, pharmacologic treatment (especially lithium and clozapine), and specific family therapies such as attachment based therapy for suicidal adolescents. However, small sample sizes and lack of replication studies make it difficult to draw firm conclusions about the efficacy of most prevention strategies.
Universal screening—including the use of a three-question screener to identify suicide risk in all patients entering the emergency department—has been shown to increase identification and thereby reduce suicide attempts. Means restriction—including the removal of firearms, which are used in half of all suicides—and psychoeducation paired with follow-up phone contact have also been shown to decrease suicide attempts.
COMHPS teams are helping to spread the word about 988, the new three-digit number for the national suicide hotline. They’re also promoting the free download of the “988” app, which helps people find help in their area. These efforts complement work being done to promote culturally appropriate resources and education about mental health and suicide prevention.
Support
Suicide prevention involves strategies at all levels of society — from warning signs and education to risk- and protective factors. This includes building life skills, fostering resilience, and reducing social isolation. It also involves enhancing connectedness, including programs that reach out to specific populations at risk of suicide and offer emotional support.
Help them connect with 988 Suicide & Crisis Lifeline (call or text 988) and other resources that can provide a safety net during crisis moments. Encourage them to talk with a trusted friend or family member, spiritual advisor, or mental health professional. Help them develop a safety plan, which can include sources of support, self-soothing activities, reasons to live, and emergency contact numbers. Remove any potential means of suicide, such as pills or other medication, from their home.
Continue your support over the long haul by connecting with them, listening actively, and offering your empathy. Research shows that supportive, ongoing contact can significantly reduce the risk of suicide.