IN THE PUBLIC INTEREST

Preventing suicide: a call to action

By Henry Tomes, PhD
APA Executive Director for Public Interest

A few weeks ago I received a copy of the "Surgeon General's Call to Action to Prevent Suicide," in which Surgeon General David Satcher attempts to get the nation's attention and focus on suicide by viewing it as a public health problem. In the cover letter for "Call to Action," he notes that the World Health Organization, in addition to the U.S. Department of Health and Human Services, is asking that greater attention be given to deaths occurring as persons across the world are increasingly taking their own lives.

Scope of the problem

In the United States, much media and political attention has been focused on the dramatic and frightening instances of homicides taking place throughout the nation's communities. Yet in 1996, the last year for which suicide data are available, almost 31,000 people ended their own lives through suicide, compared to about 20,000 people killed in homicides. Except for actions of some fringe religious sects, suicides receive less attention unless, of course, a celebrity is involved.

Reading "Call to Action" caused me to think about an earlier time when I lived in Nashville, Tenn. In the late 1960s, a group of us decided to develop a suicide-prevention center to respond to an increasing rate of suicide in Nashville and surrounding communities. The Crisis Call Center created by that group was staffed by volunteers and became the focal point for responding to a wide range of community crises, including those associated with suicide. (From recent inquiries, I learned that the Crisis Center has become freestanding, incorporated as the Crisis Intervention Center and has a wider range of services. In 1998, it celebrated its 30th anniversary.)

Personal history notwithstanding, "Call to Action" is approaching suicide prevention as a public health matter rather than as a clinical or quasi-clinical intervention focused on individuals and their families. Treatment interventions remain important, but a public health approach utilizes research to identify and focus on high-risk groups. For example, research has indicated that suicides increase with age. White males 65 years of age or older are particularly at risk.

At the other end of the age span, research has determined that suicide is increasing among younger people. In fact, suicide is the third leading cause of death among persons of ages 15 to 24 years, and the fourth leading cause of death among children 10 to 14 years.

Using public health approaches to develop effective interventions for age groups in these examples would mean looking at different risk factors for the different groups. However, such an approach also enables development of interventions based on factors of the differing age groups, which serve to enhance and protect their lives.

While noted but not stressed in "Call to Action," there is growing evidence that firearms are being used more and more in suicides and suicide attempts. While it has been known that males, particularly older men, have frequently used firearms, recently it appears that women are increasingly using firearms to complete suicides, as are African-American males of ages 15 to 19 years. Obviously, the availability, accessibility and lethality of firearms pose new and serious problems in developing suicide prevention interventions.

What can be done?

"Call to Action" places suicide and suicide prevention in a public health context, which provides opportunities for primary, secondary and tertiary modes of intervention and lots of means for psychologists to engage in research and preventive and clinical interventions. More work is needed to define, refine and extend the understanding of risk and protective factors that influence life-taking/threatening behaviors of groups and populations at risk for suicide. While more programmatic and educational interventions are needed, there is also a need for careful evaluation of them.

No call for action would be complete without asking that, in addition to consideration of professional and academic opportunities, psychologists consider volunteering their considerable talents to develop and enhance community programs in suicide prevention.



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