The Surgeon General's Call To Action
To Prevent Suicide, 1999

HHS Initiatives Addressing Suicide/Risk Factors

COMMITMENT TO A NATIONAL SUICIDE PREVENTION STRATEGY (NSPS)

The Substance Abuse and Mental Health Services Administration (SAMHSA) in conjunction with the Surgeon General and other DHHS agencies will bring together a group of suicide prevention experts, advocates, and practitioners later this year (1999) to outline the scope of work for the continued development of a National Strategy for the Prevention of Suicide and to create a time line for its progress and completion. The group will identify component substeps across many areas—conceptual framework, measurable objectives, necessary resources and ways to monitor progress, and policy gaps and models. Providing a detailed listing of activities and outlining a sequence for completion of each will advance the already remarkable progress seen in national suicide prevention activities in the past several years.

The Centers for Disease Control and Prevention (CDC), working with OHS and other public and private partners mentioned above utilizing the SAMHSA-led blueprint, will complete a draft document for consensus building around the national strategy in early 2000. CDC is currently planning to work with SPAN on a series of large regional meetings to consider and refine this draft. This regional work will culminate in a large national meeting to finalize the National Strategy to Prevent Suicide. The NAPS will include implementation plans for the "best practices" use of the Strategy in communities around the Nation. The CDC currently has requested $2.7 million in FY2000 for these activities.

In addition to continuing to bring high visibility to the issue of suicide as a major public health problem that can be prevented through a variety of national and international presentations, the Surgeon General will utilize his good offices to bring together health professional organizations, educators, health care executives, and managed care clinical directors to discuss gaps in scientific knowledge of effective mental illness interventions and everyday practices in order to improve the health of recipients of care and to decrease the incidence of suicide.

The Health Resources and Services Administration (HRSA) and DHHS’s Regional Health Administrators (RHAs) are developing structured programs for the education and continuing education of primary care providers in depression and anxiety assessment and intervention.

HRSA's internal Mental Health/Substance Abuse Workgroup is currently engaged in identifying training materials and resources relating to depression as an intersecting diagnosis for violence, substance abuse, suicide and other mental health problems. Information on the materials and resources will be made available to entities providing training for HRSA grantees such as State Primary Care Associations, Geriatric Education Centers, Area Health Education Centers, and Education Training Centers for HIV/AIDS.

HRSA will also emphasize working with non-federal safety net providers such as "Meals on Wheels" and workers in Home and Community-Based Medicaid Waiver programs and other nontraditional community workers which often have ties to safety-net programs and providers.

PARTNERSHIPS WITH OTHERS

The Office of Public Health and Science (OPHS) has facilitated a partnership whereby the Ronald McDonald House Charities is providing funding to the American School Counselors Association for the reproduction and distribution to every high school counselor in the country of a special episode of "In the Mix," the national weekly PBS teen series. Funded by the Corporation for Public Broadcasting, the special "Depression: On the Edge" examines ways to destigmatize and detect adolescent depression and prevent suicide.

The Ronald McDonald House Charities continues to prioritize youth suicide prevention and has funded 25 educators/school counselors to be a part of the development of the NSPS believing that their practical and first hand experience as youth change agents on the front-line of working with kids provided valuable insights into honest and realistic prevention possibilities.

Mrs. Gore and the Surgeon General are working with the Ad Council, MTV, the American Psychological Association and other private-sector companies and organizations to develop a national media campaign aimed at eliminating the stigma that often is associated with mental illness which, when it hinders people from seeking the help they need, can lead to suicide. It is anticipated that the campaign will be launched in late 1999/early 2000 in conjunction with the release of the Surgeon General’s Report on Mental Health.

Solvay Pharmaceuticals, the largest financial cosponsor of the SPAN-led Reno conference, provided sponsored scholarships for registration and travel of survivors and attempters of suicide. Additionally, they provided public relations assistance for the conference in Reno as well as the national press conference in Atlanta following Reno. Solvay supports SPAN's ongoing advocacy and political will work in an effort to see that a U.S. National Strategy to Prevent Suicide is completed.

The states of California, Georgia, Minnesota, Nevada, and Tennessee have all committed resources and emphasis to develop a State Strategy to Prevent Suicide using demographics that fit their state suicide profile and following the Reno model for strategy development. California, Georgia, Nevada, North Carolina, and Tennessee have begun state SPAN organizations to advance, through advocacy and political will, the suicide prevention process in their states.

ONGOING FEDERAL INITIATIVES

Center for Injury Prevention and Control, CDC

A case-control study that is examining possible risk factors for suicide, including alcohol use, exposure to previous suicides, and residential mobility that might lessen opportunities for developing social networks.

Convening national conferences to exchange information about research and prevention strategies (including the Suicide Prevention Advocacy Network conference held in Reno in October 1998 and the American Indian/Alaska Native Community Suicide Prevention and Network conference held in San Diego in November 1998).

Supporting four investigator-initiated suicide prevention research projects as well as a number of projects being conducted by CDC scientists in the area of surveillance and risk factor identification.

Development of a national suicide prevention center, the Suicide Prevention Research Center, at the Trauma Institute, University of Nevada School of Medicine.

Continued support for a Native American suicide prevention center.

Evaluation of the effectiveness of current suicide prevention programs, including two interventions—one with youth in New York and one with older persons in South Carolina.

National Institutes of Health/National Institutes of Mental Health

Overall, NIH has requested $26.5 million for suicide-related research in FY00, focusing on improving the treatment, diagnosis, and prevention of mental disorders through its intramural and extramural research programs. Suicide prevention is a priority for the NIMH, as the majority of suicide victims have at least one mental disorder, and suicidal behaviors, including thoughts and attempts, frequently occur among persons with mental disorders such as depression, personality disorder and schizophrenia.

Funding a $7.3 million research project to examine the prevalence of mental health problems in a representative sample of 10,000 Americans age 15 and older. The survey will address issues of vital importance to public health, providing information on the duration of various mental disorders, the kinds of disability they produce, the links between socioeconomic status and mental health, and the relationship between types of mental illness and use of services. The study is funded through a grant to Harvard University, led by epidemiologist Dr. Ronald Kessler. In part, the survey will make it possible to identify trends, a vital tool for planning and assessing public and private mental health services, as well as insurance coverage. The research project will contribute to the World Mental Health 2000 initiative of the World Health Organization (WHO). WHO, in turn, will use this information to increase health policymakers’ recognition of mental disorders as a priority in public health prevention and intervention efforts worldwide.

In fiscal year 1998, NIMH support for suicide research projects was approximately $17 million. Study topics ranged from neurobiological correlates of suicidal behavior, to treatment studies of patients who are suicidal, as well as postmortem studies that investigate possible precursors and risk factors. The age groups studied extend from childhood to later life, and include high risk groups such as American Indians and Alaskan Natives, homeless and runaway youth, and older white males.

Monitors progress in suicide research through the Suicide Research Consortium. The Consortium coordinates program development in suicide research in the Institute, identifies gaps in the scientific knowledge base on suicide across the life span, and stimulates and monitors NIH extramural research on suicide through scientific workshops.

Substance Abuse and Mental Health Services Administration

The Safe Schools/Health Students Initiative, a collaborative effort among the Departments of Health and Human Services, Education and Justice, through which grants totaling more than $180 million a year will be awarded to approximately 50 local educational authorities and their mental health and law enforcement partners to promote healthy childhood development and prevent violent behaviors.

The School Action Grant Program, a school violence prevention effort launched by the Centers for Mental Health Services in collaboration with the Center for Substance Abuse Treatment, that will award $5.7 million a year to encourage communities to promote healthy childhood development and prevent youth violence and substance abuse through the use of programs and practices shown to be effective.

Agency for Health Care Policy and Review

In June 1999, awarded four-year, $2.3 million grant to the Kaiser Permanente Center for Health Research in Portland, Oregon, to find a more effective way of treating depression in teenagers seen in managed care practices—the source of health care for most Americans.

Youth Partners in Care, an AHCPR-funded project is examining the impact of a program designed to improve the outcomes of mental health care for children in managed care practices, and reduce their families' stress, by educating them and their primary care physicians about depression treatment.

Health Resources and Services Administration

Girl Neighborhood Power: Building Bright Futures for Success is a 5-year effort to demonstrate how state and local agencies, organizations, businesses and communities can work together to improve the health, education and well-being of adolescent girls. The Girl Neighborhood Power effort is intended to help girls with physical activity, nutrition, health education, abstinence, mental health, social development, community service and future careers.

HRSA’s Maternal and Child Health Bureau has sponsored Bi-Regional Adolescent Suicide Prevention Conferences to strengthen and expand state and local efforts to develop partnerships and systems of care for preventing youth suicide. The proceedings include conference presentations and state by state data on youth suicide deaths.

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