Q. What can prevent suicide efforts in children, teens and young adults?

A. There are two central components of successful prevention programs. The first is case-finding, which involves efforts to find kids who are at risk, referring them for services and making sure they get appropriate care. The second is risk reduction or primary prevention. This means reducing the risks for suicide and suicidal behavior in the general population, for example, by restricting access to lethal means.

Other preventive strategies that have been shown to hold promise are programs to train community helpers, such as police, clergy, coaches and other natural helpers, to recognize the signs. Training programs with general practitioners and other physicians in recognizing suicide risk and in the use of antidepressants are also effective.

In contrast, evaluations of suicide awareness curricula through schools indicate that they are not effective and are not recommended. Other school prevention programs involving skills training appear to be more promising.

At a more general level, the National Strategy for Suicide Prevention released last year by the federal government is a good example of a comprehensive, coordinated effort that has the potential to be very successful in preventing suicide and suicidal behaviors.

Answering a National Call to Arms

The National Strategy for Suicide Prevention is a comprehensive public health initiative by the U.S. Department of Health and Human Services and partners including the National Council for Suicide Prevention. The NSSP is intended "to be a catalyst for social change with the power to transform attitudes, policies and services." The NSSP aims to:

• prevent premature deaths due to suicide across the life span

• reduce the rates of other suicidal behavior

• reduce the harmful after-effects associated with suicidal behaviors and the traumatic impact of suicide on family and friends

• promote opportunities and settings to enhance resiliency, resourcefulness, respect and interconnectedness for individuals, families and communities.

The NSSP can be ordered at www.mentalhealth.org. Additional information and other resources are also available at that address.

An Age-Old Dilemma:
Elderly Americans Have Highest Rates of Suicide

Yeates Conwell, M.D., is professor and associate chair for academic affairs in the Department of Psychiatry at the University of Rochester School of Medicine. He is a geriatric psychiatrist whose research interests focus on late-life affective disorders and suicidal behaviors. He is co-director of the Center for the Study and Prevention of Suicide at the University of Rochester School of Medicine and consults with organizations worldwide on these topics.

Q. Suicide is increasingly perceived as a public health problem rather than an act by an individual. What has contributed to this change?

A. This change, which is still taking place, has been the result of a process that has evolved over the past 10 to 15 years. In the past, the stigma of suicide kept it in the closet, leaving affected individuals and families in isolation. Stigma also kept suicide from being identified as a public health problem. This was partly because suicide was seen as the province of psychiatry, which operated on a medical model of illness, diagnosis and treatment of individuals. More recently, health care systems have taken a public health perspective, in which problems that afflict communities are identified for prevention. Suicide is certainly one of the preventable public health problems that stands out.

Changes have also resulted from work by individuals and advocacy groups on the political process. In 1997, the U.S. Senate and House adopted resolutions recognizing suicide and suicide prevention as public health issues. In 1, former Surgeon General David Satcher released the Surgeon General's Call to Action to Prevent Suicide which led to the collaborative development of the National Strategy for Suicide Prevention by agencies of the U.S. Department of Health and Human Services, health care providers, consumers and their families. The NSSP was released last year.