# Suicide Prevention: Can We Talk?



## David Baxter PhD (Jan 28, 2015)

*Suicide Prevention: Can We Talk?*
By Jacqueline Feldman,  M.D., NAMI Associate Medical Director
Wednesday, January 28, 2015

 Of all the topics in mental health, one of the most  difficult to  consider is suicide. People contemplating it often do not speak   directly of it. Families are surprised, stunned, mortified, angry, and   devastated in the face of it. Non-mental health professionals may feel   uncomfortable asking about anything related to it.  And mental health  professionals feel helpless,  as we are terrible at discretely  predicting and preventing it. There are  tragedies, and there is fear;  suicide is at the crossroads when these two meet. 

 As I review scientific articles, and program after program,  the  despair continues. In spite of more folks talking about it, more people   training to identify it, and more programs put in place to prevent it,  suicide  continues. 
 So what do we know? The Centers for Disease Control (CDC) says suicide is the _10th_ leading cause  of death in the U.S., and the _third_ leading cause of death for those aged 15-24.  More than 800,000 around the globe die each year; many more attempt it.  The figures boggle the mind, and  challenge us all: how can we possibly  intervene?

 Many of us know to watch for warning signs?a history of loss  (social  support, job, resources, health), prior attempts, family history,   recent violence; changing appearance or behavior like plummeting grades  or  productivity, tearfulness, negativism, social isolation, drugs and  alcohol);  we?re not so good at communicating our concern or finding  help. 

 Programs like Typical  or Troubled from the American Psychiatric Foundation and QPR (Question, Persuade, Refer)  to name just two of the many that have been developed, frequently focus  on  training sentinels?folks in a position to observe people at risk?to  heighten  awareness of those with potential for suicide, and help find  relief and support  for the person in need. And yet, still we struggle.

 On January 9, an article was published in _Lancet_ looking at  the results of 3  different kinds of suicide prevention training on over  11,000 students in  Europe: QPR, where teachers act as sentinels;  ProfScreen, where mental health  professionals provide screening, and  the Youth Aware of Mental Health Program,  which trains the students  themselves. This program used ?lectures, role playing,  and education  about mental health and suicide risk? with students. At 12  months,  there was a _significant_ reduction of suicide attempts, and of  severe suicidal ideation, compared to the  other control groups. It has  been suggested that perhaps this program was more  effective because it  offers interventions ?before there are outward signs of  risk, and  doesn?t stigmatize individual students.? It's an interesting idea: going  to  the at-risk population itself, giving them the education, and  empowering them  to make different choices.

 The CDC suggests the key to reducing suicides is to reduce  risk and  increase resilience. We cannot begin to reduce risk or abolish stigma or   enhance resilience if we cannot even talk about the topic. We need a  structured  national conversation, an engaged public, an engaged media,  engaged policy  makers, and engaged legislators. 

 How about a president who starts by mentioning the ?dignity  and  worth of every citizen? (including) Americans with mental illness? in  his  State of the Union speech? (He did, last week!) How about asking  every  pediatrician and every primary care doc and every pastor and  preacher (heck,  place signs in every bus stop, subway, and grocery  store for that matter) to educate each family to store firearms  locked  and unloaded, with ammunition locked separately, if a household member   is at high risk for suicide? How about widespread movements to have the   public certified in suicide prevention like so many of us are certified  in CPR? How about offering NAMI Ending the Silence  to every 9th grader to let them know about the warning signs of a  mental health condition and what they can do? The list is endless.

 I know we all care. I?m ready to start talking, and doing;  how about you?


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