September 7, 2001

Testimony of the
AMERICAN PSYCHOLOGICAL ASSOCIATION
Submitted to the

Children and Families Subcommittee
Health, Education, Labor and Pensions CommitteeOMMITTEE
UNITED STATES SENATE

For the Hearing Record on
TEEN AND YOUNG ADULT SUICIDE: A NATIONAL HEALTH CRISIS

The American Psychological Association (APA) is pleased to have the opportunity to submit this testimony to the Subcommittee to become part of the written record on the September 7, 2001, hearing on Teen and Young Adult Suicide: A National Health Crisis. APA represents 155,000 members and affiliates, many of whom conduct behavioral research on teen suicide, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute of Mental Health (NIMH), the Indian Health Service (IHS), and the Centers for Disease Control and Prevention (CDC).

Background

In 1998, a public/private coalition organized the first conference on suicide prevention in Reno, Nevada. The conference was organized by numerous federal agencies in the U.S. Department of Health and Human Services and advocacy groups such as the Suicide Prevention Advocacy Network. The conference produced a set of recommendations that eventually became the foundation for the Surgeon General's National Strategy for Suicide Prevention: Goals and Objectives for Action. The APA strongly supports the Surgeon General’s efforts to draw attention to the 11th leading cause of death in our society, and we strongly endorse the aims and objectives of the report. A public health approach that clearly defines the problem, identifies risk and protective factors, develops and tests interventions, implements interventions and evaluates effectiveness is the most promising approach.

Statistics

The suicide rate for teens and young adults has been increasing dramatically in the past 20 years, and certain ethnic groups are at a particularly high risk. According to the Surgeon General's report, from 1980 to 1996, the suicide rate among youth aged 10-14 increased by 100 percent, and among African Americans aged 15-19, the rate has increased by 105 percent (Peters, Kochanek & Murphy, 1998). Between 1952 and 1995, the incidence of suicide among adolescents and young adults has nearly tripled, and suicide is now the third leading cause of death for people aged 15-24, with most instances being firearm-related (Koop & Lundberg, 1992). The suicide rate for American Indian/Alaska Natives aged 10-19 is 25 to 28 per 100,000 and is the highest suicide rate among all ethnic groups. In addition to the increased risk factors for ethnic groups, there is also evidence that gay, lesbian, and bisexual teens are also at a high risk for suicide. In fact, suicide is the number one cause of death for gay teens.

Psychological Theories

A number of theories about what causes suicide have been developed since Emile Durkheim first postulated his sociological model on the different types of suicides. Most of the research on the causes of teen suicide has focused on the relationship between depression and teen suicide. One of the more recent theories on teen suicide has examined modeling or imitation as a contributing factor. Imitation refers to a behavior that a teenager has heard about or seen and decides to copy. Newspaper accounts of "epidemics" of teen suicide are examples of imitation. The best predictor of suicide among adolescents is a history of attempted suicide by a friend. Although we have learned more about the various forces at work in teen suicide, a strong commitment to federal funding for research, treatment and prevention is necessary if we are to keep pace with a society that is constantly changing and placing new demands on our teenagers.

APA Initiatives

The APA has recognized the importance of reducing violence in youth and has been actively involved on a variety of teen suicide initiatives. The APA, along with about two dozen other professional associations, is engaged in a collaborative effort with the U.S. Departments of Education and Justice, in developing educational materials for principals, teachers, mental health professionals, and families to keep our nation's children safe and to help them gain access to the mental health services they need. So far, two documents have been developed and widely circulated: Early Warning, Timely Response: A Guide to Safe Schools and Safeguarding Our Children: An Action Guide. Strategies are presented to help detect early warning signs of mental health problems, to develop referral networks and to provide intensive interventions for troubled students in order to reduce the risk of serious mental disorders and youth suicide.

A second initiative involves a collaborative effort between APA and MTV, which is aimed at helping teens and young adults proactively address the problem of violence. This joint effort provides teens and young adults with information about how to identify the warning signs of violent behavior and how to get help if they recognize these signs in themselves or their peers. The project aired a 30-minute MTV special, titled Warning Signs. This was one program in MTV's 1999 pro-social campaign series entitled, "Fight for Your Rights: Take a Stand Against Violence."

APA also published the book, Reason to Hope: A Psychosocial Perspective on Violence and Youth (1994), in which experts present the case for a developmental and sociocultural perspective on the etiology of youth violence.

Federal Initiatives

A number of federal agencies have taken a leadership role in suicide prevention efforts. SAMHSA’s activities have centered on implementing and evaluating suicide prevention programs. Various SAMHSA-initiated programs have also aimed at reducing the stigma associated with psychological disorders to increase the probability that teens and young adults will seek mental health services and refrain from committing suicide. NIMH has established a Suicide Research Consortium that provides suicide-related information to researchers to further the development of research programs for suicide prevention. The IHS has a program aimed at providing consultation and technical assistance to tribes struggling with suicide. The CDC maintains national data on suicide and has recently conducted a study that examines the risk factors associated with suicide. Although these programs have produced some significant results, the federal government's efforts in this area must be dramatically increased.

APA Recommendations

The APA supports the implementation of a national suicide prevention strategy and recommends increased funding for CDC (+$10 million), SAMHSA (+8.5 million), and IHS (+$5 million).

CDC

The additional funding would specifically include the following:

• +$3.325 million to support eight state/local agencies to develop, implement, and evaluate community-based intervention programs; +$3.325 million for 4 to 6 research projects to develop preventive interventions;
  
• +$2 million to fund a National Resource Center;
  
• +$1.35 million to enhance state/local data collection on suicide attempts.

SAMHSA

• The Children's Health Act of 2000 authorized a $75 million suicide prevention program within SAMHSA. However, the President's FY 2002 budget requested no funding for this initiative. APA advocates for $8.5 million to be provided to SAMHSA to begin implementation of a full-scale national initiative as authorized by the Children's Health Act of 2000. This increased funding should be provided to evaluate, in collaboration with CDC, current suicide prevention initiatives, to ensure that all school-age children and youth have adequate access to referral services, and to support prevention programs and the funding of appropriate health professionals in schools.

IHS

• APA recommends +$1.5 million for an American Indian/Alaska Native Suicide Prevention Center and +$3.5 million to support the development, implementation, and evaluation of eight reservation-based intervention programs.

Thank you again for the opportunity to submit testimony for the record. For further information, please contact the APA's Public Policy Office at (202) 336-6062.

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