SAMHSA Supports Efforts To Prevent Suicide

By Jon Bowen

One night in mid-July, licensed counselor John Paruch picked up a ringing phone at the Behavioral Health Response Crisis Center in St. Louis, MO. The caller was a 50-year-old man who had lost his will to live.

"A number of things had happened in his life," Mr. Paruch says. "He had lost his job, and he had recently lost his wife. It was all related to a substance abuse problem. When he called, he was incredibly distraught. He felt that he was at the end of his rope."

Mr. Paruch needed to act quickly. In the background behind the caller's voice, he heard the clattering noise of trains speeding by. The man was standing at an outdoor pay phone near railroad tracks—deciding, perhaps, if he would live or die.

Over the next 45 minutes, Mr. Paruch tried to coax the man toward a better state of mind. "We talked about his life, his relationship with his wife," Mr. Paruch recalls. "We talked about what motivated him to live, about his three children. He had lost time with them because of his alcoholism; he regretted that."

Realizing that the man's children gave him a sense of purpose, Mr. Paruch scrambled to get the children on the phone by conference call. The man's daughter drove out to where her father was and took him back to his son's house. By phone, Mr. Paruch followed up with him there, helping the man find a local counseling resource by using the Treatment Facility Locator on the SAMHSA Web site.

For Mr. Paruch, there's a deep sense of satisfaction in helping someone in crisis. "You're the last bridge to life for them," he says.

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Improving the Safety Net

Suicide is a severe public health problem. According to the National Center for Health Statistics at the Centers for Disease Control and Prevention, more than 30,000 Americans commit suicide every year. Suicide is the third leading cause of death among young people between the ages of 15 and 24 and the eleventh leading cause of death among persons of all ages.

SAMHSA is supporting a broad national effort to stem the tide of suicides. The crisis center where John Paruch works is just 1 of more than 100 centers in communities across the Nation that are part of the National Suicide Prevention Lifeline. The Lifeline uses a single, national toll-free number, 1-800-273-TALK (8255), to connect callers at risk for suicide to trained counselors close to where they live.

Funded by a 3-year, $6.6 million grant from SAMHSA's Center for Mental Health Services (CMHS), the Lifeline came into existence following the 2001 launch of the National Strategy for Suicide Prevention, a broad initiative aimed at reducing the number of suicides across the country. (See SAMHSA News, Fall 2002.) In addition to the Lifeline, SAMHSA provides funding for the Suicide Prevention Resource Center, which offers technical assistance, training, and informational materials to support suicide prevention efforts.

These two programs provide essential help for people at risk for suicide, but the nationwide "safety net" created by suicide prevention efforts is becoming stronger and more encompassing. Soon, SAMHSA will expand its grants program exponentially, boosting the number of suicide prevention grantees from 2 to approximately 46.

"SAMHSA will soon be awarding suicide prevention grants to states and tribes, as well as to colleges and universities, as authorized by the Garrett Lee Smith Memorial Act," says Richard McKeon, Ph.D., SAMHSA Special Advisor–Suicide Prevention.

The Garrett Lee Smith Memorial Act, introduced by Senator Gordon Smith (R-OR) in memory of his son who died by suicide, is bipartisan legislation that aims to reduce suicide among youth. Signed in 2004, the bill authorized SAMHSA to distribute $82 million in funding over 3 years, $11.5 million of which is available in 2005.

The new funds will allow SAMHSA to take a more active approach to suicide prevention, according to Brenda Bruun, Special Assistant to the Director, Division of Prevention, Traumatic Stress, and Special Programs at CMHS. The idea is to create a continuum of care that addresses the needs of people at risk for suicide long before they become suicidal.

"When we talk about the tools we need for suicide prevention," says Ms. Bruun, "we are including the work we need to do long before an active intervention takes place for someone in a suicidal crisis."

The key to prevention is identifying—at an early stage—people who are at risk. "We need to do adequate depression screening, more public education," says Ms. Bruun. "We need better training of educators, primary care providers, and mental health and substance abuse treatment providers."

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A Lifeline

Recently, SAMHSA received the evaluation results from two SAMHSA-funded studies of suicide prevention hotlines—one looking at the outcomes of calls and the other looking at overall quality of care.

The first study showed that outcomes were generally positive. Two weeks after calling the hotline, most callers were experiencing less depression and fewer suicidal thoughts.

The other study, however, showed some inconsistencies in quality of care among the various crisis centers around the country. Counselors were not always evaluating suicide risk in a consistent manner, and when evaluations were made, they were often incomplete.

"It led us to think that there's an issue with training and accreditation," says Ms. Bruun. SAMHSA, through the National Suicide Prevention Lifeline, now has a committee looking at certification standards for crisis center counselors, and out of that analysis will come recommendations for training and supervision.

All this analysis is being used to refine the efforts of the centers involved in the SAMHSA-funded Lifeline. "People in emotional distress or in suicidal crisis can call any time from anywhere in the Nation and speak to a trained worker who will listen to them and assist them in getting the help they need," says John Draper, Ph.D., Director of the Lifeline.

To make the public more aware of the Lifeline, SAMHSA is developing a national marketing campaign to raise awareness of the Lifeline's toll-free number and to make people generally more aware of the availability of help for people in suicidal crisis.

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A Resource for States

One of the goals of the National Strategy for Suicide Prevention called for the development of a technical assistance and resource center to help states and communities establish and evaluate suicide prevention programs. "The formation of the Suicide Prevention Resource Center in 2002 realized this goal," says Lloyd Potter, Ph.D., M.P.H., Director of the Center.

"The National Strategy guides much of the Center's work and products," Dr. Potter explains. "We assist states in their efforts to develop and implement suicide prevention programs. We've also been working to develop training modules for state and community people working to prevent suicide and for clinicians and other professionals who may work with persons at risk for suicide."

The Center is expanding its offerings to provide not only technical assistance but also a storehouse of information for those working in the field of suicide prevention and those whose personal lives have been affected by suicide. "The Center is the only one of its kind that provides technical assistance to grantee programs, and also provides information for researchers, advocates, and survivors," says Ms. Bruun.

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Overcoming the Stigma

As SAMHSA and other agencies and organizations work to further the goals of the National Strategy, challenges arise. One of the barriers commonly encountered by professionals who work in suicide prevention is the shame and embarrassment that surround suicide and its contributing factors.

"The stigma surrounding suicide, as well as mental illness and substance abuse, each of which are significant risk factors for suicide, is a continuing challenge," says Dr. McKeon. The stigma often keeps those who need help most—the ones who are most at risk for suicide—from seeking help.

One challenge for the Lifeline staff, according to Dr. Draper, is the simple lack of public awareness of the suicide prevention resources that are available. "Promoting awareness of the toll-free phone number and how hotlines can help prevent suicide—primarily to populations not accustomed to seeking mental health assistance—may well represent the biggest challenge," he says.

Dr. Draper explains that the highest suicide rates are often seen, unfortunately, among populations where service use is lowest—in rural populations and among American Indians and Alaskan Natives, seniors, and white males.

Another at-risk group is youth. SAMHSA recently released a short report, Suicidal Thoughts among Youths Aged 12-17 with Major Depressive Episode. Data show that approximately 900,000 youth had made a plan to commit suicide during their worst or most recent episode of major depression, and 712,000 attempted suicide during such an episode of depression.

The data, from the 2004 National Survey on Drug Use and Health, show that about 3.5 million youth age 12 to 17 (14 percent) had experienced at least one episode of major depression in their lifetime.

In response, the Lifeline offers people at risk an easily accessible, free way to get help.

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What's Needed Now

Much work remains to be done to reduce the number of suicides in this country.

According to Dr. McKeon, making suicide prevention successful on a national scale will require commitment from both the public and private sectors. "No single agency can do it alone," he says.

In addition, "There are very few evidence-based programmatic strategies for preventing suicide," Dr. Potter explains. He sees a need to identify more programs that have demonstrated sound evidence of effectiveness in promoting mental health and preventing suicide. "The Center has been actively working to identify such programs, and we are working with other programs to encourage development of evidence for their effectiveness."

Dr. McKeon says, "There is also a crucial need to improve training of the mental health and substance abuse workforce, to improve access to care for individuals identified as at risk, and to improve continuity of care for those who have attempted suicide who are discharged from emergency rooms and inpatient facilities."

Dr. Draper also sees the need to educate the public, to help people recognize that suicide and related mental health issues are a public health issue that affects everyone in one way or another. To get there, he says, "Prevention programs will need to tell their ‘success stories,' so that more people can recognize how their efforts have made a positive difference in their communities and in the lives of individuals and families."

For more information, contact SAMHSA's National Mental Health Information Center, P.O. Box 42490, Washington, DC 20015. Telephone: 1 (800) 789-CMHS (2647) or 1 (866) 889-2647 (TTY). Or, visit the National Strategy for Suicide Prevention at www.mentalhealth.samhsa.gov/suicideprevention. The SAMHSA short report on youth is available at www.oas.samhsa.gov. 

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Resources www.sprc.org The SAMHSA-funded Suicide Prevention Resource Center provides technical assistance, training, and materials to support suicide prevention efforts in states and communities across the country. The Web site carries the latest news related to research and funding opportunities for suicide prevention. www.suicidepreventionlifeline.org SAMHSA's National Suicide Prevention Lifeline, 1-800-273-TALK (8255), provides immediate assistance to individuals in crisis by connecting them to the nearest available suicide prevention and mental health service provider through its toll-free telephone number. The Web site contains information about the network, training, technical assistance, and news and events. www.mentalhealth.samhsa.gov/suicideprevention The National Strategy for Suicide Prevention is a broad initiative aimed at reducing the number of suicides across the country. The Web site includes suicide facts, information on funding opportunities and state programs, and legislation news. www.mentalhealth.samhsa.gov/suicideprevention/ calltoaction.asp In 1999, the U.S. Surgeon General issued a call to action to prevent suicide. It described suicide as a serious public health problem and outlined a strategy for reducing the number of suicides in this country. www.spanusa.org SPAN USA is dedicated to preventing suicide through public education and awareness, community action, and Federal, state, and local grassroots advocacy. The Web site contains information on state suicide prevention programs and grassroots community organizations.

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