Tag: suicide

Great Minds with Lost&Found podcast: Suicide Prevention and Gun Safety with Veterans Affairs and Moms Demand Action

Content Warning: Great Minds with Lost&Found episodes contain mature themes, including mental health, suicide, addiction, and others that may not be appropriate for all audiences. Listener discretion is advised.
 

Using the CDC’s seven strategies for preventing suicide to guide our work, we spoke with Patty Mayrose (a veteran, a VA nurse, and Moms Demand Action volunteer) and Emily Thomas (the State Chapter Lead for the South Dakota Chapter of Moms Demand Action) about how they create protective environments for those at risk of suicide and improve the mental health landscape in Sioux Falls and South Dakota. Learn more about the Be SMART program, designed to help adults and parents normalize conversations about gun safety and take responsible actions that can prevent child gun deaths and injuries. If you are a veteran or know a veteran (or anyone else) struggling with mental health challenges or facing suicidal thoughts, call 988, then press 1 to be connected to the Veterans Crisis Line.

 

To learn more about the work that Lost&Found is doing to prevent suicide among youth and young adults, go to resilienttoday.org.  Follow us on Facebook, Instagram, Twitter, LinkedIn and YouTube (@resilienttoday).

 

Listen on Spotify or find other listening options on Anchor.

You can also watch this episode on YouTube.

Seven Ways You Can #DoMore to Prevent Suicide Today

Suicide doesn’t start in a moment of crisis. By addressing the risk factors that contribute to suicide and building up the protective factors that keep people from considering suicide, we can save lives. These seven actions are adapted from the CDC’s seven strategies for suicide prevention. While the CDC’s strategies are largely directed toward mental health professionals and policymakers, there are ways that every one of us can do more to prevent suicide. Read through the list and see how you can take action today to save lives.

 

1. Help people facing dire financial situations or the loss of housing.

Financial stress, homelessness, or even worries about finances or eviction can increase the risk of suicide. If you know of someone going through a hard time, make sure they don’t feel alone. Work to connect them to resources that can help with both their situation and their mental health. Also, be sure to support policies that ensure people aren’t falling through the cracks.

 

2. Learn what mental health and suicide prevention resources are available in your area.

The awareness of the importance of mental health is increasing, and the stigma around talking about and seeking mental health is decreasing. This means you are more likely to hear about someone’s struggles than you might have been even a few years ago. Then the question becomes, how can you help? Lost&Found offers a variety of tools for helpers, starting with the EARS framework (described in Lost&Found’s Let’s Talk about Mental Health Guide) to guide your conversation—engage, attend, reinforce, seek. Prepare yourself for the “seek” part of the conversation—seeking help together—by becoming familiar with the mental health and suicide prevention resources available in your area. Lost&Found’s Resources page provides a good overview. The first and easiest resource to become familiar with is this number: 988. This goes to the National Suicide & Crisis Lifeline, and it can be reached by calling or texting.

Here is an overview of the EARS framework. Find more information about the EARS framework in the Let’s Talk About Mental Health Guide.

 

3. Reduce access to lethal means in your home, workplace, and community.

Two key pieces of data support this action: First, research shows that attempting suicide is often an impulse based on an intense emotion—the time between deciding to act and attempting suicide can be as little as 5 or 10 minutes. Second, if a person chooses a highly lethal method of suicide, but that method is not available, they tend not to substitute a different method. This means that if we can stretch the time between the decision and the attempt, and if we can make lethal means harder to access, we can save lives. Make sure medications and firearms are safely stored—in other words, behind a lock—in your home. Also look around your workplace and community—if there are places such as bridges where a suicide could take place easily, consider installing signs to encourage people to seek help.

 

4. Get involved in your community, and work to include those who might be isolated.

Studies suggest there is a correlation between social capital—meaning the sense of trust in a community and the connections between its members—and mental health. This means that all sorts of things that might not seem directly connected to mental health, such as knowing and interacting with your neighbors, block parties, and community improvement projects, are actually long-game suicide prevention strategies. In school settings, this can include participating in clubs or sports, as well as peer support programs. Consider how you could help build social capital in your community. If you are already involved in your community, invite someone else to participate with you to draw the circle of community support a little bigger.

 

5. Commit to learning—and teaching—how to deal with conflict.

Having the skills to deal with the stresses and adversities of life can help protect people from turning to suicide as an option. Programs that teach these skills, such as social-emotional learning programs for children and teens, or parenting skills and family relationship programs, can give people tools for dealing with problems—and, just as important, they can plant the idea that life’s problems can be solved, or at least managed and improved. One life skill that can help decrease stress and build relationships is learning how to deal productively with conflict. As polarization in society increases and gives people the idea that animosity in the face of conflict is a virtue, knowing how to address conflicts productively is a vital skill. This article on the basics of dealing with conflict in relationships is a good place to start.

 

6. Work to be accepting of people in marginalized demographic groups that are at higher risk of suicide.

Some groups have higher rates of suicidal behaviors than average. They include people with lower socio-economic status, people with a mental health problem, people who have previously attempted suicide, veterans and active military, people who are the victims of violence, LGBTQIA2S+ people, and members of some racial and ethnic groups. One group that is at higher risk is LGBTQIA2S+ youth. A Trevor Project survey found that 45 percent of LGBTQ youth had seriously considered suicide in the past year, including more than half of transgender and nonbinary youth; 14 percent of LGBTQ youth had attempted suicide in the past year. The survey also pointed to an obvious way to help: suicide attempts were significantly lower among LGBTQ youth that were in accepting communities or who had accepting family and friends. Accepting LGBTQIA2S+ youth for who they are can save lives.

 

7. Learn how to talk about suicide in ways that don’t add to the trauma of those who have suffered a suicide loss.

The risk of suicide is higher for people who have lost a friend, family member, or other close contact to suicide. While talking about suicide is important—not talking about suicide can feed into a sense of shame for survivors of suicide loss—knowing how to talk about suicide is just as important so we don’t inadvertently add to a survivor’s pain. For example, one phrase to remove from your vocabulary is “committed suicide.” “Committed” is left over from the outdated belief that suicide is a criminal act. It’s better to say “died by suicide.” There are more suggestions for how to talk about mental health and suicide on page 26 in Lost&Found’s Let’s Talk About Mental Health Guide—download it free here.

 

You can review the CCD’s seven suicide prevention strategies here. Click on the image to see the full report.

 

This article is part of the 30 Days, 30 Stories: Let’s #DoMore to Prevent Suicide project. See a new story of resilience for every day of National Suicide Prevention Month here.

 

Project shares stories of resilience during National Suicide Prevention Month

SIOUX FALLS, SD — A South Dakotan’s story of resilience in the face of mental health challenges or suicide will be shared each day of September, which is National Suicide Prevention Month, as part of a project called “30 Days, 30 Stories: Let’s #DoMore to Prevent Suicide.”

The project is sponsored by the suicide prevention organization Lost&Found, in partnership with the South Dakota Humanities Council and 4Front Studios.

The stories are told by 30 South Dakotans (or people whose stories are connected to South Dakota). They include written stories, photos, and a short video that are released on the project website, 30stories.org, as well as shared on social media. Four episodes of the Great Minds with Lost&Found podcast will also be released in September featuring five of the storytellers. One episode with special guest and TikTok influencer Gabe Dannenbring will be recorded live on Sept. 8 at Severance Brewing in Sioux Falls.

Dannenbring is one of several storytellers this year with names that might be familiar to South Dakotans. Their stories about mental health, however, may be known to just a few.

“The 30 Stories campaign brings much needed awareness and resources for mental health and suicide prevention to the public eye at a time when suicide death is impacting youth and young adults in larger numbers than ever before,” said Erik Muckey, Executive Director/CEO of Lost&Found. “These courageous South Dakotans choosing to share their struggles and the resources that helped them will make a difference not just in one life, but thousands here in South Dakota and beyond.”

The project has three main goals:

  • Increase awareness of mental health challenges all around us, as this can reduce the stigma of mental illness and seeking help.
  • Empower people to share their stories. This includes the people who are featured here, but also those who read and identify with these stories and may find courage to tell their own. Storytelling involves deciding what details matter (and which don’t), and finding meaning in a series of events. This process can be healing in itself.
  • Promote the resources that can help people through even the darkest of times. The project aims to make people more aware of the statewide suicide prevention resources that young adults and families have found relevant to their experiences, identities, and communities.

Lost&Found conducted the first #30Days30Stories project last year. Those stories reached an impressive number of people through social media channels and also yielded insights on the empowering possibilities of storytelling.

Great Minds with Lost&Found podcast: The Economic Impact of Suicide with Brad Hearst

Brad Hearst, Founder and President of Survivors Joining for Hope, a newly acquired program of Lost&Found’s, is on the show to talk about the economics of prevention, intervention, and postvention of suicide.

Using the The CDC’s seven strategies for preventing suicide found in their technical package for suicide prevention, to guide his work, Brad shares how increasing economic supports can be a protective factor against suicide. We get into the ways finances and economics can be both risk factors and protective factors for prevention, depending on the situation.

To learn more about the work that Lost&Found is doing to prevent suicide among youth and young adults, go to resilienttoday.org. Follow us on Facebook, Instagram, Twitter, LinkedIn and YouTube (@resilienttoday).

Two S.D. nonprofits addressing suicide to merge

Survivors Joining for Hope’s work supporting suicide loss survivors will become a department of Lost&Found

Survivors Joining for Hope, a nonprofit that provides financial support to families that have suffered a suicide loss, will cease to be an independent organization on August 1, but its work and its name will continue as a department of the suicide prevention organization Lost&Found.

The board of Survivors Joining for Hope (SJ4H) voted on June 20 to dissolve the organization and pass its assets, as well as its mission and programming, to Lost&Found.

Board members of SJ4H, which has been run entirely by volunteers, see the integration with Lost&Found as a way for SJ4H to have a bigger impact and get closer to reaching its potential.

“Survivors Joining for Hope is tremendously excited at the opportunity to unite with Lost&Found,” said SJ4H Founder and Executive Director Brad Hearst. “Alliance of the two organizations brings the opportunity to support a larger audience and grow SJ4H’s programming to levels that our present capacity didn’t allow. The mental health community and survivors of suicide loss will now have greater support structure throughout South Dakota.”

Lost&Found sees the addition of SJ4H’s programming as a way to expand its work addressing the scourge of suicide in South Dakota and the surrounding region.

“We have been honored to partner with Brad Hearst and Survivors Joining for Hope (SJ4H) over the past six years to prioritize and support suicide prevention efforts in our community,” said Erik Muckey, Executive Director and CEO of Lost&Found. “The Lost&Found team is energized by the opportunity to join forces and continue the impact of SJ4H and its programs and financial assistance for suicide loss survivors for decades to come.”

Stakeholders from both organizations are working together to shape how SJ4H’s work will continue as part of Lost&Found. These are some of the changes that will be part of the integration:

  • The name “Survivors Joining for Hope” will continue as the name of Lost&Found’s new postvention services department.
  • Lost&Found’s mission has been updated to include youth as young as 10 years old (youth as young as 15 had previously been part of its target demographic) and to include suicide postvention as well as prevention services.
  • SJ4H’s Financial Assistance Program for survivors of suicide loss will continue, prioritizing youth and young adults (ages 10-34) and/or their support networks in South Dakota, starting with the campus partners currently served by Lost&Found.
  • The Survivors Support & Resource Network will continue.
  • The new department will work to craft and recommend postvention policies for schools, colleges, and employers.
  • SJ4H’s Youth Prevention programming will be integrated into Lost&Found’s programming.
  • The work of highlighting stories of those impacted by suicide loss will continue through blog posts, videos, and podcast content.

The work of the Survivor Support & Resource Network, the development of postvention policies, and the Youth Prevention Program will be done with new staff and community partners. These programs will be rolled out in coming months.

“Our hope is that, through unification with Lost&Found, we will be able to provide direct support to the youth throughout our service area,” Hearst said. “We felt that L&F had the infrastructure and programming to bring both our survivors loss support program and youth program to a new level. The goal will be to bring loss support programming to college-aged students and younger as well as to grow our peer-to-peer support network.”

 

About Survivors Joining for Hope

Survivors Joining for Hope was founded in 2016 by Brad Hearst of Sioux Falls, S.D., after his brother died by suicide. The name of the organization honors his brother, Sergei Joseph Hearst, through its initials. SJ4H was founded to provide funding to families that had suffered a loss by suicide so they could focus on grief recovery instead of financial pressure.

The board initially had four members; over six years, it grew to 11 members. By 2022, the organization’s initial focus on the Sioux Empire had expanded to cover the entire state of South Dakota and beyond—SJ4H has served people from nearly every state on the East and West Coasts. Its programming also expanded to include a support network, support groups, and suicide prevention programming for youth.

 

About Lost&Found

Lost&Found was founded in 2010 by five high school graduates from South Dakota who were motivated to “do more” to prevent suicide. For the first eight or so years, Lost&Found’s work was centered on its campus chapters, which raised awareness of mental health needs and advocated for suicide prevention policies.

The organization has grown significantly in the past four years—from no employees to 15, from a focus on campus chapters to work in three departments (Student Programs, Education & Advocacy, and Evaluation & Research Services), and from three campus chapters to working with 13 post-secondary institutions in South Dakota and Minnesota. More geographical and audience expansion is coming this year.

The organization is headquartered in Sioux Falls and currently serves communities as far west as the Black Hills and as far east as the Twin Cities.

Record number of South Dakotans died by suicide in 2021

Suicides in South Dakota increased to a record level last year, according to provisional data released by the South Dakota Department of Health in April.

In 2021, 198 South Dakotans died by suicide. This is higher than in 2019 and 2020, which each had 185 suicides, and is the highest ever recorded in the state.

Provisional Suicide Data, South Dakota (2020-2021)

Provisional Suicide Data, South Dakota (2020-2021)

 

The finalized death data from 2020 show several significant problems for South Dakota:

  • South Dakota had the 8th highest suicide rate in the United States in 2020.
  • Four South Dakota counties rank in the top 1% highest suicide rates in the U.S. (2010-2019).
  • American Indian suicide rates are 2.5 times higher than White race rates in South Dakota (2011-2020).
  • In 2020, suicide was the leading cause of death among those ages 10-19 and the second-leading cause of death among those ages 20-29.

“The particularly strong impact on youth and young adults is concerning for the future of our state,” said Erik Muckey, CEO and Executive Director of Lost&Found.

 

Pandemic-related increase

The timing of the increase—with more suicides in the second, third, and fourth quarters of 2020 and the first quarter of 2021—suggest that the increase is at least in part related to the COVID-19 pandemic.

“While we continue to analyze underlying factors for this record, we know that the pandemic impeded many of the protective factors against suicide while increasing certain risk factors for suicide,” Muckey said.

These are some of the protective factors that prevent suicide that were affected by the pandemic: 

  • Access to mental health care – Many people who had been seeing a mental health professional were not able to continue that care in person when social distancing was practiced. (Meeting through video conferencing allowed care to continue in many cases.)
  • Connectedness to others – Social distancing made connecting with others more difficult. Connecting through technology helped but wasn’t quite the same and left out people without access to or knowledge of that technology.
  • Sense of purpose in life – Layoffs and school closings may have diminished the sense of purpose for some people.
  • Talking about mental health – Mental health concerns may have been more difficult to discuss when not face to face with another person.

The pandemic also increased some of the risk factors that increase the risk of suicide: 

  • Substance use disorders – For those struggling with a substance use disorder, staying home more often when work and other places were closed may have increased substance use.
  • Family dysfunction – People who otherwise might have left home for work or school were less likely to do so during the pandemic, which may have exacerbated fraught family dynamics.
  • Endured prolonged stress or a traumatic event – Because of the pandemic, more people were dealing with illness and death of a loved one. Prolonged social isolation can also be damaging to mental health.

Just because suicides increased during the pandemic does not mean, unfortunately, that the end of the pandemic (whenever that is) will result in lower suicide rates. Research suggests that the mental health effects of the pandemic will last beyond the reduction of physical illness in society, especially for those more closely and seriously affected by Covid-19. Pandemic-related poorer mental health and increased risk of suicide is likely to exist for some time to come.

 

Comprehensive strategy

We can, however, learn from this moment. The pandemic has shown what happens when much of society sees a reduction in the protective factors that can prevent suicide, and an increase in the factors that can increase risk of suicide. Enacting policies and programs that protect people from suicide and reduce the risk of suicide—especially for those most at risk—can save lives.

Since the factors that lead to suicide come from all levels of society—within individuals, but also in relationships, in communities, and in society as a whole—suicide prevention requires a systemic approach. Lost&Found is one organization out of many working on suicide prevention, but more people, organizations, schools, and workplaces need to get involved in the work of building up protective factors and reducing risk factors.

“The more comprehensive our suicide prevention efforts become, the more effective they will be,” Muckey said. “That is absolutely essential to saving lives.”

 

Learn more about protective and risk factors in Lost&Found’s Let’s Talk About Mental Health guide, which can be downloaded here. Learn more about getting involved with Lost&Found’s suicide prevention efforts here.

Suicide as a Public Health Concern: History and Strategies for Prevention

Editor’s Note: Lost&Found is beginning a regular series of articles and podcasts about research and best practices in mental health, resilience, and suicide prevention. This first article is an overview of the idea of suicide prevention as something that requires a public health approach, as well as of the seven prevention strategies that our work is based on. 

 

 

cover page of Suicide as a Public Health Concern article

Read and download this article as a printable PDF by clicking on the image above.

“Suicide is a public health problem,” U.S. Surgeon General Satcher wrote in 1999, adding that suicide prevention requires a public health approach.

While suicide is—by definition—an individual act, suicide affects and is influenced by all levels of society—individuals, their relationships, communities, and society as a whole. This understanding of suicide as part of a larger system is the basis for the suicide prevention strategies developed by the Centers for Disease Control and Prevention, and those strategies in turn are the basis for the programs developed and implemented by Lost&Found.

This article gives a brief history of this approach to suicide prevention and an overview of the CDC’s seven suicide prevention strategies. Future articles will look more closely at the seven strategies and the Lost&Found programs that are working to carry them out.

 

Suicide prevention as a societal concern: A brief history

Who can prevent a suicide?

If you had asked this question in 1958, when the first suicide prevention center in the United States opened in Los Angeles (Morris, 2011), the answers probably would have been limited to a small circle of people: The people with suicidal ideation themselves; perhaps the people closest to them, who may have noticed signs or who were confided in; and those who were trained in crisis intervention.

The rest of society could sympathize and support, perhaps, but for most people, there was no active role to play unless (and one hoped it never happened) thoughts of suicide struck them or a loved one.

By the late 1990s, that view was changing. A key pivot point was in 1998, when stakeholders gathered in Reno, Nevada, for the first National Suicide Prevention Conference (U.S. Public Health Service, 2001), which resulted in 81 recommendations for action. The key points from the conference indicated a shift in suicide prevention from solely focusing on individuals to recognizing the role that society more broadly could play in preventing suicide:

  1. Suicide prevention must recognize and affirm the value, dignity, and importance of each person.
  2. Suicide is not solely the result of illness or inner conditions. The feelings of hopelessness that contribute to suicide can stem from societal conditions and attitudes. Therefore, everyone concerned with suicide prevention shares a responsibility to help change attitudes and eliminate the conditions of oppression, racism, homophobia, discrimination, and prejudice.
  3. Some groups are disproportionately affected by these societal conditions, and some are at greater risk for suicide.
  4. Individuals, communities, organizations, and leaders at all levels should collaborate to promote suicide prevention.
  5. The success of this strategy ultimately rests with individuals and communities across the United States. (Office of the Surgeon General, 2012)

In 1999, then-U.S. Surgeon General Dr. David Satcher issued a national call to action developed from the findings from the Reno conference. It included this explanation of a view of suicide prevention that looks beyond the individual:

“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.” (U.S. Public Health Service, 1999)

In 2000, a Federal Steering Group was formed to respond to this call to action, which resulted in the publication of the National Strategy for Suicide Prevention in 2001. It included 11 goals and 68 objectives based on the framework Satcher had put forward in the call to action. The strategy document was a planted flag of sorts for those working in suicide prevention, giving them a common understanding and language to work from, as well as a way to direct attention and resources to suicide prevention efforts. One result of this strategy, for example, was the development of the National Suicide Prevention Lifeline (800-273-TALK/8255), which connects callers to a responder at the closest crisis center.

 

Gathering evidence and best practices

Over the past 21 years, the public health understanding of suicide prevention has increasingly shaped the progress and development of the field, and researchers have gathered evidence of what public health approaches are effective. In 2017, the CDC published Preventing Suicide: A Technical Package of Policy, Programs, and Practices (Stone et al, 2017). Like other technical packages produced by the CDC, the document compiles a set of strategies that communities can use to achieve a desired outcome—in this case, the prevention of suicide—along with specific approaches to advance the strategy, as well as evidence for why those strategies work. This technical package guides much of the suicide prevention work happening now across the United States, including the programs offered by Lost&Found.

Dr. Deb Stone of the Division of Violence Prevention at the Centers for Disease Control and Prevention is one of the authors of the technical package and spoke with Lost&Found in a phone interview (Stone D., 2022).

The process of creating the technical package involved a review of the literature and many conversations with subject matter experts, Stone explained. “We really looked for programs, practices, and policies that showed evidence for reducing actual suicide or suicide attempts, or that impacted on suicide risk and protective factors. The evidence we found … had to come from rigorous scientific studies such as meta-analyses or systematic reviews, or from randomized, controlled trials, just to name a few of the types of studies that we were looking at.”

The public health approach underlying this work meant that the researchers had a broad view of whom to target with their efforts. This includes people all along the timeline of a suicide.

“We knew that we needed to find strategies that would help to prevent suicide risk in the first place—sometimes called primary prevention or upstream prevention,” Stone said. “We wanted to help support people who were already at increased risk, and then also work to prevent re-attempts among people who may have attempted, and help support people who have suffered a suicide loss.”

Another viewpoint that is critical to the understanding of suicide prevention, Stone said, is recognizing that, while suicide is an individual act and is influenced by factors in that individual, it is also influenced by factors in a person’s relationships, the community, and society at large.

“The contributors or the causes of suicide occur at the individual, relationship, community, and societal levels, and those four levels comprise the social ecological model,” Stone said.

For example, at the individual level, people with mental health challenges, substance use, or who have attempted suicide in the past are at increased risk of suicide. At the relationship level, a recent breakup, the death of a loved one, or having been the victim of violence increase risk. At the community level, increased risk can result from difficulty accessing mental health care. And at the societal level, suicide risk is affected by whether policies allow easy access to lethal means such as firearms and medications, as well as societal stigmas around mental illness or seeking help.

“To have the biggest impact, we may need to consider strategies that will address factors across all these levels,” Stone said. “Sometimes, that’s where we get stuck, because we might only focus on one thing, but we really need to be taking a broader perspective and a broader approach.”

This wider view can help to combat a common misconception about suicide—that it is based on a single factor.

“In our desire to understand why someone would take their own life, we sometimes rush to conclusions and point to one thing,” Stone said. “But this really minimizes what the person was going through, and data tell us … that there are many factors involved. And so, if we’re going to prevent suicide, we really need to consider all of these factors.”

Another common misconception about suicide is that a person who dies by suicide was weak or selfish, and an evidence-based public health approach suggests ways to combat this misconception as well.

“People who are struggling with thoughts of suicide are in immense emotional and sometimes physical pain. And this pain is typically related to the culmination or a confluence of many factors. So when you’re in this level of pain, the options and the solutions can become so narrowed that suicide may seem to be the only way out,” Stone said. “We want to prevent people from ever getting to the point of having a crisis like that. We want to prevent situations that spurred these crises from occurring in the first place.

“But if we are past that point, there’s still a lot we can do to help people. We can help destigmatize getting help … and we can make sure that professionals are equipped with ways of helping people in suicidal crisis by training on effective approaches for suicide prevention. And then we can all, working together in a society, learn the warning signs and ask the hard questions. ‘Are you thinking about suicide?’ We know that this will not put the thought in someone’s head, and it can actually break the silence that is so detrimental.”

 

The CDC’s seven strategies for suicide prevention

The CDC’s technical package on suicide prevention distills its recommendations into seven strategies that “are intended to work in combination and reinforce each other to prevent suicide,” according to the document (Stone et al, 2017, p. 12). The strategies, as a whole, approach suicide prevention at all four levels of the social ecological model (individual, relationships, communities, and society).

What follows is a summary of each of these strategies from the CDC document and one or two key approaches to implementing that strategy.

 

Strategy 1: Strengthen economic supports.

Economic and financial strain, such as job loss, long periods of unemployment, reduced income, difficulty covering medical, food, and housing expenses, and even the anticipation of such financial stress may increase an individual’s risk for suicide or may indirectly increase risk by exacerbating related physical and mental health problems. Buffering these risks can, therefore, potentially protect against suicide. (Stone et al, 2017, p. 15)

“We sometimes forget the real devastation that can impact people and that people can feel due to financial and economic concerns,” Stone said.

Some of the ways to improve those situations and help prevent suicide include increases to the minimum wage and policies that allow people to stay in their homes or find secure housing.

 

Strategy 2: Strengthen access and delivery of suicide care.

[M]ental illness is an important risk factor for suicide. State-level suicide rates have also been found to be correlated with general mental health measures such as depression. Findings from the National Comorbidity Survey indicate that relatively few people in the U.S. with mental health disorders receive treatment for those conditions. (Stone et al, 2017, p. 19)

“This strategy is focused on making sure that all people have access to quality care, especially in underserved areas such a rural communities, and that once people are engaged in care, that they don’t fall through the proverbial cracks as they transition in and out of the healthcare system,” Stone said.

One approach for implementing this strategy is remote mental health care, also called telemental health, which became more common during the Covid-19 pandemic. Another is ensuring that mental health conditions are covered in health insurance policies.

 

Strategy 3: Create protective environments.

Prevention efforts that focus not only on individual behavior change (e.g., help-seeking, treatment interventions) but on changes to the environment can increase the likelihood of positive behavioral and health outcomes. Creating environments that address risk and protective factors where individuals live, work, and play can help prevent suicide. (Stone et al, 2017, p. 23)

One way in which the environment can be addressed in terms of suicide prevention is access to lethal means.

“We know that reducing access to lethal means such as a firearms, especially among people at risk of suicide, can really make all of the difference in saving someone’s life,” Stone said, because “putting time and space between someone who is thinking about suicide and the means to carry it out is absolutely critical.”

Another approach is improving policies and social norms around help seeking—both allowing and encouraging people to take time off from work to seek mental health care, for example.

 

Strategy 4: Promote connectedness.

[S]tudies suggest a positive association between social capital (as measured by social trust and community/neighborhood engagement), and improved mental health. Connectedness and social capital together may protect against suicidal behaviors by decreasing isolation, encouraging adaptive coping behaviors, and by increasing belongingness, personal value, and worth, to help build resilience in the face of adversity. Connectedness can also provide individuals with better access to formal supports and resources. (Stone et al, 2017, p. 27)

“As far back as the late 1880s, we had this great sociologist, Emile Durkheim, who told us that social connectedness … is a protective factor. And what that means is that it can protect people from ever becoming suicidal in the first place, and it can reduce the chances that someone would ever attempt suicide,” Stone said.

Stone would like to see more research in this area, since the limited research on connectedness and mental health is promising. For example, people working together on a community greening initiative showed reductions in anxiety and depression. “In addition, pride in the community would increase, and people would support each other through those kinds of engagement activities,” she said.

The Covid-19 pandemic limited our usual ways of connecting, which shows what can happen when the connectedness we typically rely on isn’t available: Anxiety and depression increased 25 percent worldwide in the first year of the pandemic, according to a brief by the World Health Organization (Brunier, 2022). The stress of social isolation was cited as one of the causes.

 

Strategy 5: Teach coping and problem-solving skills.

The inability to employ adequate strategies to cope with immediate stressors or identify and find solutions for problems has been characterized among suicide attempters. Teaching and providing youth with the skills to tackle everyday challenges and stressors is, therefore, an important developmental component to suicide prevention. (Stone et al, 2017, p. 31)

“We know that teaching people—not just kids, but kids and adults—how to cope and solve conflicts can really go a long way to preventing crises that sometimes escalate to the point that someone is thinking about suicide,” Stone said. “It’s not often discussed, but problems in relationships such as bullying or breakups or other kinds of conflicts are some of the most common contributors to suicide. And many of us were, frankly, never really taught how to cope with conflict or how to problem-solve. But the good news is that there are skills that we can all learn and excel at with practice.”

Programs that teach these life skills to children are having payoffs down the road in preventing the risk of suicide and other adverse outcomes. These programs could be scaled up and expanded to reach more people, including adults, Stone said.

 

Strategy 6: Identify and support people at risk.

In order to decrease suicide, care of, and attention to, vulnerable populations is necessary, as these groups tend to experience suicidal behavior at higher than average rates. Such vulnerable populations include, but are not limited to, individuals with lower socio-economic status or who are living with a mental health problem; people who have previously attempted suicide; veterans and active duty military personnel; individuals who are institutionalized, have been victims of violence, or are homeless; individuals of sexual minority status; and members of certain racial and ethnic minority groups. (Stone et al, 2017, p. 35)

This strategy works to support people who are at high risk of suicide or who are known to have thoughts of suicide. The good news is that treatments are showing great promise in helping with mental health conditions and reducing the suicide risk.

“The evidence for different forms of therapy, such as cognitive behavior therapy, especially with collaborative care components, is really mounting, and that’s really exciting,” Stone said.

An approach to implement this strategy is to continue the research for these programs and to provide more training for practitioners.

 

Strategy 7: Lessen harms and prevent future risk.

Millions of people are bereaved by suicide every year in the United States and throughout the world. Risk of suicide and suicide risk factors has been shown to increase among people who have lost a friend/peer, family member, co-worker, or other close contact to suicide. Care and attention to the bereaved is therefore of high importance. Despite often good intentions, media and others responding to suicide may add to this risk. (Stone et al, 2017, p. 41)

This strategy aims to help people after a suicide has taken place. This includes people who were directly connected to the person who died by suicide, ensuring that they receive support and can access professional mental health care if they need it. This strategy also includes those in the community or society more broadly who hear that a suicide has happened. One important way to implement this strategy is to learn better ways to talk about suicide, especially for those in the media.

“We still have a long way to go in safe reporting,” Stone said. “This really means avoiding sensationalizing a suicide, describing the details or means of suicide, or glamorizing somebody who died by suicide, because we know that those things can inadvertently increase risk for people who may be vulnerable or thinking about suicide themselves. … This is an area where we can continue to promote positive messaging and resources and make sure to get people the help that they need.”

 

Looking ahead

A lot has happened in the world and in the field of suicide prevention in the nearly five years since the CDC’s technical package of suicide prevention strategies was released. While not all the developments have been positive, many significant findings and events of the past five years have strengthened the evidence for and emphasized the importance of a public health approach to suicide prevention.

Perhaps the biggest change has come from the Covid-19 pandemic, which changed the way that people live, work, and gather with friends and family. Many have died from the virus, so many others are dealing with grief; many are dealing with poorer health because of long Covid; and many immunocompromised people remain socially isolated because the risk of Covid remains high for them. These changes have affected mental health across the globe (World Health Organization, 2022). “There are increases in anxiety and substance use and distress, and even in suicidal thinking, particularly among young people but also among people who have been disproportionately impacted by Covid-19,” Stone said.

The CDC is working on a new release of the technical package, to be made public sometime this year. The seven strategies will remain, Stone said, backed up by new evidence. Some of this is based on improvements in data collection—researchers now have the ability to track and monitor data related to suicide ideation and suicide attempts in closer to real time, Stone said, and machine learning can help to forecast suicide trends in the future. New studies have also provided additional evidence to support some of the programs and policies recommended in the 2017 report, as well as evidence to support new programs and policies.

Stone is also looking forward to the way that the development and promotion of a three-digit number (988) for the National Suicide Prevention Lifeline will increase support for people with suicidal thoughts. That number will go live in July.

“We have a long way to go, but we’re certainly making great strides to help individuals and communities reduce this incredible burden of suicide,” Stone said.

 

References

Brunier, A. D. (2022, March 2). Covid-19 pandemic triggers 25% increase in prevalance of anxiety and depression worldwide. Retrieved from World Health Organization website: https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide

Morris, L. (2011). History of the Suicide Prevention Center. Los Angeles Suicide Prevention Summit, (pp. 5-6). Los Angeles, CA. Retrieved from http://file.lacounty.gov/SDSInter/dmh/166651_HistoryoftheSuicidePreventionCenter.pdf

Office of the Surgeon General. (2012). Appendix C: Brief History of Suicide Prevention in the United States. 2020 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: Office of the Surgeon General (US); National Action Alliance for Suicide Prevention (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK109918/

Stone, D. (2022, January 27). Interview with Dr. Deb Stone. (H. Marttila-Losure, Interviewer)

Stone, D.M., Holland, K.M., Bartholow, B., Crosby, A.E., Davis, S., and Wilkins, N. (2017). Preventing Suicide: A Technical Package of Policies, Programs, and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf

U.S. Public Health Service. (1999). The Surgeon General’s Call to Action to Prevent Suicide. Washington, DC. Retrieved from https://sprc.org/sites/default/files/migrate/library/surgeoncall.pdf

U.S. Public Health Service. (2001). National Strategy for Suicide Prevention: Goals and Objectives for Action. Rockville, MD: U.S. Department of Health and Human Services. Retrieved from https://redmondschools.org/wp-content/uploads/2021/08/National_Strategy_for_Suicide_P.pdf

World Health Organization. (2022). Mental Health and COVID-19: Early evidence of the pandemic’s impact. Scientific brief. Retrieved from World Health Organization website: https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1