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The Surgeon General's Call to Action
to Prevent Suicide, 1999
Department of Health and Human Services
U.S. Public Health Service
Copyright Information: Material contained in this report is in the public
domain and may be used and reprinted without special permission; citation as to
source is however appreciated.
A Letter From The Surgeon General
U.S. Department of Health and Human Services
Suicide is a serious public health problem. In 1996, the year for which the
most recent statistics are available, suicide was the ninth leading cause of
mortality in the United States, responsible for nearly 31,000 deaths. This
number is more than 50% higher than the number of homicides in the United States
in the same year (around 20,000 homicides in 1996).1 Many fail to
realize that far more Americans die from suicide than from homicide. Each year
in the United States, approximately 500,000 people require emergency room
treatment as a result of attempted suicide.2 Suicidal behavior
typically occurs in the presence of mental or substance abuse
disorders—illnesses that impose their own direct suffering.3-5
Suicide is an enormous trauma for millions of Americans who experience the loss
of someone close to them.6 The nation must address suicide as a
significant public health problem and put into place national strategies to
prevent the loss of life and the suffering suicide causes.
In 1996, the World Health Organization (WHO), recognizing the growing
problem of suicide worldwide, urged member nations to address suicide. Its
document, Prevention of Suicide: Guidelines for the Formulation and
Implementation of National srategies7, motivated the creation of
an innovative public/private partnership to seek a national strategy for the
United States. This public/private partnership included agencies in the U.S.
Department of Health and Human Services, encompassing the Centers for Disease
Control and Prevention (CDC), the Health Resources and Services Administration (HRSA),
the Indian Health Service (IHS), the National Institute of Mental Health (NIMH),
the Office of the Surgeon General, and the Substance Abuse and Mental Health
Services Administration (SAMHSA) and the Suicide Prevention Advocacy Network
(SPAN), a public grassroots advocacy organization made up of suicide survivors
(persons close to someone who completed suicide), attempters of suicide,
community activists, and health and mental health clinicians.
An outgrowth of this collaborative effort was a jointly sponsored national
conference on suicide prevention convened in Reno, Nevada, in October 1998.
Conference participants included researchers, health and mental health
clinicians, policy makers, suicide survivors, and community activists and
leaders. They engaged in careful analysis of what is known and unknown about
suicide and its potential responsiveness to a public health model emphasizing
suicide prevention.
This Surgeon General’s Call To Action introduces a blueprint
for addressing suicide—Awareness, Intervention, and Methodology, or AIM—an
approach derived from the collaborative deliberations of the conference
participants. As a framework for suicide prevention, AIM includes 15 key
recommendations that were refined from consensus and evidence-based findings
presented at the Reno conference. Recognizing that mental and substance abuse
disorders confer the greatest risk for suicidal behavior, these recommendations
suggest an important approach to preventing suicide and injuries from suicidal
behavior by addressing the problems of undetected and undertreated mental and
substance abuse disorders in conjunction with other public health approaches.
These recommendations and their supporting conceptual framework are
essential steps toward a comprehensive National Strategy for Suicide
Prevention. Other necessary elements will include constructive public health
policy, measurable overall objectives, ways to monitor and evaluate progress
toward these objectives, and provision of resources for groups and agencies
identified to carry out the recommendations. The nation needs to move forward
with these crucial recommendations and support continued efforts to improve the
scientific bases of suicide prevention.
Many people, from public health leaders and mental and substance abuse
disorder health experts to community advocates and suicide survivors, worked
together in developing and proposing AIM for the American public. AIM
and its recommendations chart a course for suicide prevention action now as well
as serve as the foundation for a more comprehensive National Strategy for
Suicide Prevention in the future. Together, they represent a critical
component of a broader initiative to improve the mental health of the nation. I
endorse the ongoing work necessary to complete a National Strategy
because I believe that such a coordinated and evidence-based approach is the
best way to use our resources to prevent suicide in America.
But even the most well-considered plan accomplishes nothing if it is not
implemented. To translate AIM into action, each of us, whether we play a
role at the federal, state, or local level, must turn these recommendations into
programs best suited for our own communities. We must act now. We cannot change
the past, but together we can shape a different future.
David Satcher, M.D., Ph.D.
Assistant Secretary for Health
and Surgeon General
Suicide as a Public Health Problem
On average, 85 Americans die from suicide each day. Although more females
attempt suicide than males, males are at least four times more likely to die
from suicide.1,8 Firearms are the most common means of suicide among
men and women, accounting for 59% of all suicide deaths.1
Over time, suicide rates for the general population have been fairly stable
in the United States.9 Over the last two decades, the suicide rate
has declined from 12.1 per 100,000 in 1976 to 10.8 per 100,000 in 1996.10
However, the rates for various age, gender and ethnic groups have changed
substantially. Between 1952 and 1996, the reported rates of suicide among
adolescents and young adults nearly tripled.1,11 From 1980 to 1996,
the rate of suicide among persons aged 15-19 years increased by 14% and among
persons aged 10-14 years by 100%. Among persons aged 15-19 years,
firearms-related suicides accounted for 96% of the increase in the rate of
suicide since 1980. For young people 15-24 years old, suicide is currently the
third leading cause of death, exceeded only by unintentional injury and
homicide.12 More teenagers and young adults die from suicide than
from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and
influenza, and chronic lung disease combined. During the past
decade, there have also been dramatic and disturbing increases in reports of
suicide among children. Suicide is currently the fourth leading cause of death
among children between the ages of 10 and 14 years.10
Suicide remains a serious public health problem at the other end of the age
spectrum, too. Suicide rates increase with age and are highest among white
American males aged 65 years and older. Older adult suicide victims, when
compared to younger suicide victims, are more likely to have lived alone, have
been widowed, and to have had a physical illness.13,14 They are also
more likely to have visited a health care professional shortly before their
suicide and thus represent a missed opportunity for intervention.15
Other population groups in this country have specific suicide prevention
needs as well. Many communities of Native Americans and Alaskan Natives long
have had elevated suicide rates.16,17 Between 1980 and 1996, the rate
of suicide among African American males aged 15-19 years increased 105% and
almost 100% of the increase in this group is attributable to the use of
firearms.18
It is generally agreed that not all deaths that are suicides are reported as
such. For example, deaths classified as homicide or accidents, where individuals
may have intentionally put themselves in harm’s way are not included in suicide
rates.19-21
Compounding the tragedy of loss of life, suicide evokes complicated and
uncomfortable reactions in most of us. Too often, we blame the victim and
stigmatize the surviving family members and friends. These reactions add to the
survivors’ burden of hurt, intensify their isolation, and shroud suicide in
secrecy. Unfortunately, secrecy and silence diminish the accuracy and amount of
information available about persons who have completed suicide— information that
might help prevent other suicides.
Methodology
Developing Recommendations for a National Strategy for Suicide Prevention
Developing and implementing a National Strategy for Suicide Prevention
should achieve a significant, measurable, and sustained reduction in suicidal
behaviors. The action steps presented in this document were prioritized from
among a variety of recommendations developed through a public-private
collaboration of nongovernmental organizations, federal and state governmental
agencies, corporations and foundations, and public health, health, mental health
experts.
Before the Reno Conference, experts evaluated research studies, programs,
policies, and best interventions to prevent suicide among five U.S. population
groups known to be at high risk of suicide. Those identified as being at
increased risk were youth, the medically ill, specific population groups,
persons with mental and substance abuse disorders, and the elderly. Following
review of the evidence by a second expert, the lead expert extracted
recommendations for suicide prevention. In extracting recommendations, experts
were instructed to consider the robustness of the available data; an
intervention’s likelihood of reducing suicide; its perceived suitability for
implementation in the real world; and estimates of the lead-time to put the
recommendation into practice and produce its intended effect. They were also
asked to consider the ethical implications and cultural appropriateness of each
recommendation.
Those experts’ draft recommendations were brought to the Reno conference. A
broad cross section of conference participants and a highly varied expert panel
were identified to work with the recommendations and evaluate each one. The
panel and the invited conference participants represented diverse areas of
expertise and included researchers, suicide survivors, persons who had attempted
suicide, public health leaders, community volunteers, clinicians, educators,
consumers of mental health services, and corporate/nonprofit advocates.
Financial support was made available so that socioeconomic status would not
exclude panelists and participants who wanted to contribute from attending the
conference. The Regional Health Administrators of the U.S. Public Health Service
served as facilitators in working with over 400 participants to refine
recommendations during the conference. The expert panel received over 700
written comments from participants during the course of their deliberations.
The expert panel’s recommendations were derived from a rigorous review of
suicide and suicide prevention research. Existing suicide research is strongest
in the identification of risk factors, particularly mental and substance abuse
disorders, less developed in categorizing protective factors, and only beginning
to analyze the mutual interactions among risk and protective factors. Some
treatments for mental and substance abuse disorders have been associated with a
reduction in suicidal behaviors.22-30 Further research is needed to
determine whether these benefits will occur if treatments are offered to groups
outside the small populations that were studied.
The recommendations the panel developed include past and current
initiatives, programs, and interventions. Other recommendations pragmatically
extend findings from existing suicide and suicide prevention research into
proposed applications. Suicide prevention experts from multiple disciplines
endorsed these proposed recommendations as having the greatest potential for
effectiveness.
By the end of the conference, the expert panel had advanced 81
recommendations for consideration for inclusion in a National Strategy for
Suicide Prevention. These recommendations were posted on the SPAN Web site
to allow a period of further reflection and public comment. The CDC developed a
tool for priority ranking the 81 recommendations. Respondents from all
interested sectors prioritized the recommendations using criteria of
feasibility, necessity, clarity, and likelihood of being funded. Recommendations
with the highest priority scores and broadest support were combined and edited
to serve as the essential first steps of an action agenda for suicide
prevention.
Results
AIM to Prevent Suicide
This Surgeon General’s Call to Action introduces an initial
blueprint for reducing suicide and the associated toll that mental and substance
abuse disorders take in the United States. As both evidence-based and highly
prioritized by leading experts, these 15 key recommendations listed below should
serve as a framework for immediate action. These recommended first steps are
categorized as Awareness, Intervention, and Methodology, or AIM.
Awareness: Appropriately broaden the public’s awareness of suicide
and its risk factors
Intervention: Enhance services and programs, both population-based
and clinical care
Methodology: Advance the science of suicide prevention
Awareness: Appropriately broaden the public’s awareness of suicide and its
risk factors
-
Promote public awareness that suicide is a public health problem and, as
such, many suicides are preventable. Use information technology appropriately
to make facts about suicide and its risk factors and prevention approaches
available to the public and to health care providers.
-
Expand awareness of and enhance resources in communities for suicide
prevention programs and mental and substance abuse disorder assessment and
treatment.
-
Develop and implement strategies to reduce the stigma associated with
mental illness, substance abuse, and suicidal behavior and with seeking help
for such problems.
Intervention: Enhance services and programs, both population-based and
clinical care
-
Extend collaboration with and among public and private sectors to complete
a National Strategy for Suicide Prevention.
-
Improve the ability of primary care providers to recognize and treat
depression, substance abuse, and other major mental illnesses associated with
suicide risk. Increase the referral to specialty care when appropriate.
-
Eliminate barriers in public and private insurance programs for provision
of quality mental and substance abuse disorder treatments and create
incentives to treat patients with coexisting mental and substance abuse
disorders.
-
Institute training for all health, mental health, substance abuse and
human service professionals (including clergy, teachers, correctional workers,
and social workers) concerning suicide risk assessment and recognition,
treatment, management, and aftercare interventions.
-
Develop and implement effective training programs for family members of
those at risk and for natural community helpers on how to recognize, respond
to, and refer people showing signs of suicide risk and associated mental and
substance abuse disorders. Natural community helpers are people such as
educators, coaches, hairdressers, and faith leaders, among others.
-
Develop and implement safe and effective programs in educational settings
for youth that address adolescent distress, provide crisis intervention and
incorporate peer support for seeking help.
-
Enhance community care resources by increasing the use of schools and
workplaces as access and referral points for mental and physical health
services and substance abuse treatment programs and provide support for
persons who survive the suicide of someone close to them.
-
Promote a public/private collaboration with the media to assure that
entertainment and news coverage represent balanced and informed portrayals of
suicide and its associated risk factors including mental illness and substance
abuse disorders and approaches to prevention and treatment.
Methodology: Advance the science of suicide prevention
-
Enhance research to understand risk and protective factors related to
suicide, their interaction, and their effects on suicide and suicidal
behaviors. Additionally, increase research on effective suicide prevention
programs, clinical treatments for suicidal individuals, and culture-specific
interventions.
-
Develop additional scientific strategies for evaluating suicide prevention
interventions and ensure that evaluation components are included in all
suicide prevention programs.
-
Establish mechanisms for federal, regional, and state interagency public
health collaboration toward improving monitoring systems for suicide and
suicidal behaviors and develop and promote standard terminology in these
systems.
-
Encourage the development and evaluation of new prevention technologies,
including firearm safety measures, to reduce easy access to lethal means of
suicide.
Discussion
Risk and Protective Factors
Suicide risk and protective factors and their interactions form the
empirical base for suicide prevention. Risk factors are associated with a
greater potential for suicide and suicidal behavior while protective factors are
associated with reduced potential for suicide.31-33
Substantial age, gender, ethnic, and cultural variations in suicide rates
provide opportunities to understand the different roles of risk and protective
factors among these groups. Risk and protective factors encompass genetic,
neurobiological, psychological, social, and cultural characteristics of
individuals and groups and environmental factors such as easy access to
firearms.34-38 This expanding base of empirical evidence generates
promising ideas about what can be changed or modified to prevent suicide.
Clear progress has been made in the scientific understanding of suicide,
mental and substance abuse disorders, and in developing interventions to treat
these disorders. For example, increased understanding of brain systems regulated
by chemicals called neurotransmitters holds promise for understanding the
biological underpinnings of depression, anxiety disorders, impulsiveness,
aggression, and violent behaviors.39 Much remains to be learned,
however, about the common risk factors for mental disorders and substance abuse,
suicide and other forms of intentional violence including homicide, domestic
violence, and child abuse. Expanding the base of scientific evidence will help
in the development of more effective interventions for these harmful behaviors.
Advances in neurobiology and the behavioral sciences and their application
in developing effective treatments for mental and substance abuse disorders have
generated much hope. Wider public understanding of the science of the brain and
behavior can reduce the stigma associated with seeking help for mental and
substance abuse disorders and consequently may contribute to reducing the risk
for suicidal behavior.
Risk Factors
Understanding risk factors can help dispel the myths that suicide is a
random act or results from stress alone. Some persons are particularly
vulnerable to suicide and suicidal self-injury because they have more than one
mental disorder present40, such as depression with alcohol abuse41.
They may also be very impulsive and/or aggressive42, and use highly
lethal methods to attempt suicide. As noted above, the importance of certain
risk factors and their combination vary by age, gender, and ethnicity.
The impact of some risk factors can be reduced by interventions (such as
providing effective treatments for depressive illness).31,43 Those
risk factors that cannot be changed (such as a previous suicide attempt) can
alert others to the heightened risk of suicide during periods of the recurrence
of a mental or substance abuse disorder, or following a significant stressful
life event.31,44
Risk factors include:
-
Previous suicide attempt
-
Mental disorders—particularly mood disorders such as
depression and bipolar disorder
-
Co-occurring mental and alcohol and substance abuse disorders
-
Family history of suicide
-
Hopelessness
-
Impulsive and/or aggressive tendencies
-
Barriers to accessing mental health treatment
-
Relational, social, work, or financial loss
-
Physical illness
-
Easy access to lethal methods, especially guns
-
Unwillingness to seek help because of stigma attached to mental and
substance abuse disorders and/or suicidal thoughts
-
Influence of significant people—family members, celebrities, peers who
have died by suicide—both through direct personal contact or inappropriate
media representations
-
Cultural and religious beliefs—for instance, the belief that suicide is
a noble resolution of a personal dilemma
-
Local epidemics of suicide that have a contagious influence
-
Isolation, a feeling of being cut off from other people
Some lists of warning signs for suicide have been created in an effort to
identify and increase the referral of persons at risk. However, the warning
signs given are not necessarily risk factors for suicide and may include common
behaviors among distressed persons, behaviors that are not specific for suicide.
If such lists are applied broadly, for instance in the general classroom
setting, they may be counterproductive. In effect, indiscriminate suicide
awareness efforts and overly inclusive screening lists may promote suicide as a
possible solution to ordinary distress or suggest that suicidal thoughts and
behaviors are normal responses to stress.45 Efforts must be made to
avoid normalizing, glorifying, or dramatizing suicidal behavior, reporting
how-to methods, or describing suicide as an understandable solution to a
traumatic or stressful life event. Inappropriate approaches could potentially
increase the risk for suicidal behavior in vulnerable individuals, particularly
youth.46,47
Protective Factors
Protective factors can include an individual’s genetic or neurobiological
makeup, attitudinal and behavioral characteristics, and environmental
attributes.31 Measures that enhance resilience or protective factors
are as essential as risk reduction in preventing suicide. Positive resistance to
suicide is not permanent, so programs that support and maintain protection
against suicide should be ongoing.
Protective factors include:
-
Effective and appropriate clinical care for mental, physical, and
substance abuse disorders
-
Easy access to a variety of clinical interventions and support for help
seeking
-
Restricted access to highly lethal methods of suicide
-
Family and community support
-
Support from ongoing medical and mental health care relationships
-
Learned skills in problem solving, conflict resolution, and nonviolent
handling of disputes
-
Cultural and religious beliefs that discourage suicide and support
self-preservation instincts
The risk factors that lead to suicide (especially mental and substance abuse
disorders) and the protective factors that safeguard against it form the
conceptual framework for the prevention recommendations developed and presented
in this document and in the evolving National Strategy for Suicide Prevention.
Identifying and Addressing Risk
Unfortunately, it is difficult to identify particular individuals at
greatest risk for suicidal behaviors or completed suicide. Measures to screen
the general population for suicide risk lack the precision needed to identify in
advance only those people who eventually would die by suicide. Because suicide
screening in the general population currently is not feasible, it is especially
important for suicide prevention programs to include broader approaches that
benefit the whole population as well as efforts focused on smaller, high-risk
subgroups that can be identified. Within those subgroups, a different approach
to screening—screening programs for specific disorders, like depression, that
are associated with suicide—can be used to identify and direct people to highly
effective treatments that may lower their risk of suicide.
Often, the suicide prevention efforts in place are directed primarily at
improving clinical care for the individual already struggling with suicidal
ideas or the individual requiring medical attention for a suicide attempt.
Suicide prevention also demands approaches that reduce the likelihood of suicide
before vulnerable individuals reach the point of danger. Applying the public
health approach to the problem of suicide in the United States will maximize the
benefits of efforts and resources for suicide prevention.
The Public Health Approach
Suicide is a public health problem that requires an evidence-based approach
to prevention. In concert with the clinical medical approach, which explores the
history and health conditions that could lead to suicide in a single individual,
the public health approach focuses on identifying and understanding patterns of
suicide and suicidal behavior throughout a group or population. The public
health approach defines the problem, identifies risk factors and causes of the
problem, develops interventions evaluated for effectiveness, and implements such
interventions widely in a variety of communities.48,49
Although this description suggests a linear progression from the first step
to the last, in reality the steps occur simultaneously and depend on each other.
For example, systems for gathering information to define the exact nature of the
suicide problem may also be useful in evaluating programs. Similarly,
information gained from program evaluation and implementation may lead to new
and promising interventions. Public health has traditionally used this model to
respond to epidemics of infectious disease. During the past few decades, the
model has also been used to address other problems that are likewise complicated
and challenging to prevent, such as chronic disease and injury.
The Public Health Approach Applied to Suicide Prevention
Defining the Problem
The first step includes collecting information about incidents of suicide and
suicidal behavior. It goes beyond simple counting. Information is gathered on
characteristics of the persons involved, the circumstances of the incidents,
events that may have precipitated the act, the adequacy of support and health
services received, and the severity and cost of the injuries. This step covers
the who, what, when, where, how, and how many of the identified problem.
Identifying Causes and Protective Factors
The second step focuses on why. It addresses risk factors such as depression,
alcohol and other drug use, bereavement, or job loss. This step may be used to
define groups of people at higher risk for suicide. Many questions remain,
however, about the interactive matrix of risk and protective factors in suicide
and suicidal behavior and, more importantly, how this interaction can be
modified.
Developing and Testing Interventions
The next step involves developing approaches to address the causes and risk
factors that have been identified. Testing the effectiveness of each approach is
a critical part of this step to ensure that strategies are safe, ethical, and
feasible. Pilot testing, which may reveal differences among particular age,
gender, ethnic and cultural groups, can help determine for whom a suicide
prevention strategy is best fitted.
Implementing Interventions
The final step is to implement interventions that have demonstrated
effectiveness in preventing suicide and suicidal behavior. Implementation
requires data collection as a means to continue evaluating effectiveness of an
intervention. This is essential because an intervention that has been found
effective in a clinical trial or academic study may have different outcomes in
other settings. Ongoing evaluation builds the evidence base for refining and
extending effective suicide prevention programs. Determination of an
intervention’s cost-effectiveness is another important component of this step.
This ensures that limited resources can be used to achieve the greatest benefit.
As interventions for preventing suicide are developed and implemented,
communities must consider several key factors. Interventions have a much greater
likelihood of success if they involve a variety of services and providers. This
requires community leaders to build effective coalitions across traditionally
separate sectors, such as the health care delivery system, the mental health
system, faith communities, schools, social services, civic groups, and the
public health system. Interventions must be adapted to support and reflect the
experience of survivors and specific community values, cultures, and standards.
They must also be designed to benefit from multi-ethnic and culturally diverse
participation from all segments of the community.
As it evolves, America’s National Strategy for Suicide Prevention
must recognize and affirm the value, dignity, and importance of each person.
Everyone concerned with suicide prevention shares the responsibility to help
change and eliminate the societal conditions and attitudes that often contribute
to suicide. Individuals, communities, organizations, and leaders at all levels
should collaborate in promoting suicide prevention. Final development of a
National Strategy for Suicide Prevention and the success of these essential
action steps ultimately rest with individuals and communities and institutions
and policy makers across the United States.
Implementing AIM as an Action Agenda in Communities
As states and local communities apply the public health approach to AIM
recommendations, they must consider both population-based and clinical care
initiatives. Their first step is to define and to describe the problem of
suicide and its associated risk factors locally and measure their magnitude.
Next, causes of the conditions found must be identified. Then, community
interventions must be designed to address the identified needs through attention
to the causes revealed. Evaluating project effectiveness provides guidance for
refining the intervention and expanding benefits to other settings. The
following hypothetical descriptions of community suicide prevention activities
have been created to illustrate applied public health and clinical management
prevention models.
Youth
Recognizing the state’s increasing rates of substance abuse and suicide among
youth, the state public health director in consultation with the Regional Health
Administrator brought together concerned representatives to form a state youth
suicide, substance abuse and depression prevention coalition. The coalition
members reflected many sectors in the community including suicide survivors,
educators, social service agencies, the faith community, businesses, the state
cooperative extension programs (4-H), school psychologists, child psychiatrists,
the PTA, substance abuse treatment counselors, public officials, and the
juvenile justice system. The coalition also established a youth advisory board.
After collecting detailed information on the dimensions of youth substance
abuse, depression and suicide in the state and identifying how few school
systems had screening, referral, and crisis plans, the coalition formed a
multidisciplinary study committee to develop a model suicide prevention plan. A
broad array of public and professional organizations in the state studied and
endorsed the model plan. A corporate partner from the business community
provided a grant to distribute the model plan along with a curriculum guide for
natural helpers to identify high-risk youth. As school districts adapted the
plan and implemented it locally, followup surveys were conducted to determine
patterns of use, satisfaction with the model plan and guide, and impact on
substance abuse, depression and suicidal behaviors in communities statewide.
Based on evidence collected from the evaluations, the model plan was revised to
include more guidance on working with the media to de-sensationalize coverage of
suicide, and promote abstinence from substance use as well as encourage youth to
seek treatment for both substance abuse and depression.
The Elderly
The public health approach has revealed that suicide rates are highest among the
elderly and that most elderly suicide victims are seen by their primary care
provider within a few weeks of their suicide and are experiencing a first
episode of mild to moderate depression. Recognizing that clinical depression is
a highly treatable illness, but treatment has not yet been adequately provided
in primary care settings, a state with a large elderly population brought
together a group of health professionals and community advocates. Together they
devised and supported a pilot program to follow depression screening in the
primary care setting with the addition of an on-site nurse or social worker
specializing in depression services. These on-site specialists ensured that
those elderly patients who screened positive for depression received depression
treatment and follow up from the physician and assessed patient progress so that
ongoing treatments could be adjusted to increase their effectiveness. Outcomes
for patients in the pilot project were compared to those patients receiving
usual treatment in comparable primary care settings. This evaluation provided
information to fine tune the program and extend its benefits to other primary
care settings in the state.
Advancing a National Suicide Prevention Strategy
The 15 recommendations (AIM) presented in this Surgeon General’s Call
to Action propose a nationwide, collaborative effort to reduce suicidal
behaviors, and to prevent premature death due to suicide across the life span.
The conceptual framework for AIM incorporates analysis of suicide risk
and protective factors and emphasizes the benefits of effectively treating
mental and substance abuse disorders. A comprehensive National Strategy for
Suicide Prevention should include these elements along with supportive
government policy, measurable objectives for the Strategy, means of
monitoring and evaluating progress, and provision of authority and resources to
carry out the Strategy’s recommendations.
To realize success in preventing suicide and suicidal behaviors,
collaboration must be fostered on this public health priority across a broad
spectrum of agencies, institutions, groups, and representative individuals
throughout the country. As additional elements of a comprehensive Strategy
evolve, the public and prospective implementation partners must also sustain
awareness that improved detection and treatment of mental and substance abuse
disorders represent a primary approach to suicide prevention. These partners
must ensure the availability of evidence-based guidance for communities to
develop and refine effective suicide prevention approaches. Likewise, as
communities implement approaches to recognize and reduce risk factors to prevent
suicide, they must be aware of the dangers of inadvertently glamorizing suicide,
and remain vigilant to avoid doing so. Ongoing review of research, policy, and
program advances in suicide prevention may expand the number of effective
initiatives and interventions for incorporation into the Strategy. Work
should continue that outlines measurable objectives for an overall Strategy,
provides mechanisms for tracking these objectives, and develops means of
communicating significant progress in preventing suicide and suicidal
self-injury.
Conclusion
Americans in communities nationwide can make a significant difference in
preventing suicide and suicidal behaviors. The recommendations presented in
AIM provide a blueprint and call for action now. Programs and activities
that are carried out and evaluated today will generate additional
recommendations for effective suicide prevention initiatives in the future.
Working together locally, in states, and at the federal level to complete and
implement a National Strategy for Suicide Prevention is an important step
in responding to the major public health problem of suicide in the United
States.
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