From Awareness to Action

It’s time to talk about the big picture. The National Action Alliance for Suicide Prevention has set an aspirational goal of saving 20,000 lives over 5 years.  To meet this challenge, we need to understand how our best prevention and treatment efforts can be combined to have the greatest possible impact.

Over the last 15 years, those of us committed to bringing a public health approach to suicide prevention have accomplished a great deal. We have built infrastructure, expanded capacity, mobilized a workforce, contributed to the body of knowledge, created political will, and identified best practices that can help prevent suicidal behaviors. We have revised the National Strategy for Suicide Prevention and created the Action Alliance to advance this strategy. This month has seen the release of A Prioritized Research Agenda for Suicide Prevention:  An Action Plan to Save Lives. Much has been accomplished.  Yet much remains to be done.

I always try to remember that suicide is both a public health problem and an individual health problem. We need to honor both approaches if we want to save lives. From a clinical perspective, this means introducing effective assessment practices, sound clinical judgment, and proven therapies to help individuals in need recover and reengage with society. We have best practices at the clinical level – dialectical behavioral therapy and cognitive behavioral therapy, to cite two examples. But when we look at clinical practice from a public health perspective, new questions emerge. One of the most important is, “Are mental health providers actually using the best clinical practices for preventing suicide?” If we want to achieve results and save lives, we in the field of suicide prevention should support the dissemination and implementation of clinical best practices, as well as best practices that take a public health approach, such as safe messaging and strategies to protect vulnerable people from access to highly lethal means.

The real opportunities to “move the needle” and lower the rate of suicide are in intervening at the population level. What are those opportunities? I’ve just discussed one – taking a best practice to scale to maximize its impact. Another opportunity is to create comprehensive programs that include a number of complementary best practices. The United States Air Force Suicide Prevention Program is a model of this type of comprehensive program. We should not make the mistake of thinking that a single best practice will transform our world. A study in England by While, et al., demonstrated that providers who implemented at least seven of nine recommendations for improving mental health services reduced suicide rates among their patient populations. Combining best practices into comprehensive programs and institutionalizing those programs is how we transform systems.

And we need to embrace systems transformation if we really want to have an impact. We’ve seen how the Perfect Depression Program at the Henry Ford Health System made suicide prevention an entry-to-exit concern. Systems transformation is the final stage of the journey that begins with understanding how best practices can reduce the suicide risk of individuals, continues with learning how best practices can function together in comprehensive packages, and leads finally to integrating these comprehensive efforts into the very structure of health care systems for maximum impact.

We’ve mobilized the nation’s attention and built awareness that suicide is preventable.  As a member of the suicide prevention field, I am proud of what we’ve achieved. We’ve introduced hope that we can do something to reduce the tenth leading cause of death in the nation. Now, we must challenge ourselves to pursue the results that we know are in our reach, and document those results through evaluation, publication, dissemination, and broad-scale replication. We need to continue to raise the public’s awareness on the prevention of suicide and honor that awareness – and the resources it brings – by taking action and saving lives.

For more information on the study by While, et al., see the Weekly Spark from June 8, 2012.

For more information about the Perfect Depression Program, visit the Henry Ford Health System website.