Brief History of Suicide Prevention in the United States (original) (raw)

NATIONAL MILESTONES IN SUICIDE PREVENTION (PDF, 212K)

First Steps

In 1958, the first suicide prevention center in the United States opened in Los Angeles, California, with funding from the U.S. Public Health Service. Other crisis intervention centers followed. In 1966, the Center for Studies of Suicide Prevention (later the Suicide Research Unit) was established at the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH). This was followed by the creation of national nonprofit organizations dedicated to the cause of suicide prevention.

In 1970, NIMH convened a task force in Phoenix, Arizona, to discuss the status of suicide prevention in the United States. NIMH presented the findings in the 1973 report Suicide Prevention in the 70s, which also identified future directions and priorities.111 In 1983, the Centers for Disease Control and Prevention (CDC) established a violence prevention unit that brought public attention to a disturbing increase in youth suicide rates. In response, the Secretary of the U.S. Department of Health and Human Services (HHS) established a Task Force on Youth Suicide, which reviewed the existing evidence and issued recommendations in 1989.112

The Push for a National Strategy

Suicide became a central issue in the United States in the mid-1990s, when survivors of suicide loss saw the need to mobilize attention and the political will to prevent suicide in the nation. Using the United Nations (U.N.) guidelines for the creation and implementation of national strategies published in 1996,53 these grassroots groups launched a citizen-initiated campaign to encourage the development of a national strategy in the United States. These efforts resulted in two Congressional Resolutions—S. Res. 84 and H. Res. 212 of the 105th Congress—recognizing suicide as a national problem and suicide prevention as a national priority.

As recommended in the U.N. guidelines, these groups set out to establish a public and private partnership that would be responsible for promoting suicide prevention in the United States. This innovative public-private partnership jointly sponsored a national consensus conference on suicide prevention in Reno, Nevada, which developed a list of 81 recommendations.

The Reno conference is viewed as the founding event of the modern suicide prevention movement. Informed by its findings, in 1999, Surgeon General David Satcher issued his Call to Action to Prevent Suicide, which emphasized suicide as a serious public health problem requiring attention and action.5 This document introduced a blueprint for addressing suicide prevention through a number of efforts organized under the framework of “Awareness, Intervention, and Methodology” (AIM). It included 15 broad recommendations consistent with a public health approach to suicide prevention, along with goal statements and broad objectives.

Key Points From Reno, Nevada, Conference

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.

A year later, the HHS Secretary formed a Federal Steering Group to coordinate efforts and ensure resources for the development of the national strategy. The group brought together individuals and organizations from the public and private sectors to collaborate in this effort and sought input through four strategically located national public hearings. These efforts culminated with the release of the National Strategy for Suicide Prevention in 2001.6

The National Strategy for Suicide Prevention (National Strategy) set forth an ambitious agenda, consisting of 11 goals and 68 objectives, organized under the AIM framework described in the Surgeon General’s Call to Action. The document was meant to serve as a wide-ranging “catalyst for social change, with the power to transform attitudes, policies, and services (p. 27).”6 For the broader suicide prevention community, the National Strategy provided a common point of reference and a resource for advocacy at the state and local levels, while directing more attention to the needs of those affected by suicide.

Key Developments and Accomplishments

In the years that followed, several other key developments helped advance suicide prevention in the nation. Among these was the 2002 report Reducing Suicide: A National Imperative, which summarized the state of the science base, gaps in knowledge, strategies for prevention, and research designs for the study of suicide.9 This landmark report presented findings from a 13-member committee formed by the Institute of Medicine in 2000, at the request of several federal agencies.

Another important document was the 2003 report Achieving the Promise: Transforming Mental Health Care in America, prepared by the New Freedom Commission on Mental Health.113 Assembled by President George W. Bush in 2002, the commission was asked to study the mental health service delivery system, and to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbances to live, work, learn, and participate fully in their communities. After 1 year of study, and after reviewing research and testimony, the group issued its final report, which identified six goals and corresponding recommendations.

Activity in the field of suicide prevention has grown dramatically since the National Strategy was issued in 2001. Government agencies at all levels, schools, nonprofit organizations, and businesses have started programs to address suicide prevention. Charting the Future of Suicide Prevention, a progress report commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA) and released in October 2010, discusses many of these accomplishments.7

Federal Policy Initiatives

Enacted in 2004, the Garrett Lee Smith Memorial Act (GLSMA) is the most important legislative accomplishment in the field of youth suicide prevention in the past decade. The act was named for Sen. Gordon Smith’s (R-OR) son, a college student who died by suicide in late 2003. The GLSMA created the first significant federal grant program directed specifically at suicide prevention. Administered by SAMHSA, the program provides grants to states, tribes, territories, and institutions of higher education for the implementation of youth and college suicide prevention efforts. More than 300 GLSMA suicide prevention grants have been funded since the program’s inception, including 27 grants funded through the Prevention and Public Health Fund created by the Affordable Care Act.

Another federal law, the Joshua Omvig Veterans Suicide Prevention Act (JOVSPA) of 2007, has supported the development of a comprehensive program to reduce the incidence of suicide among veterans. Named for a veteran of Operation Iraqi Freedom who died by suicide in 2005, the act directed the Secretary of the U.S. Department of Veterans Affairs (VA) to implement a comprehensive suicide prevention program for veterans. Components include staff education, mental health assessments as part of overall health assessments, a suicide prevention coordinator at each VA medical facility, research efforts, 24-hour mental health care, a toll-free crisis line, and outreach to and education for veterans and their families. In the summer of 2009, VA added a one-to-one “chat service” for veterans who prefer to reach out for assistance using the Internet.

Program Initiatives

In 2001, SAMHSA established the country’s first program with the mission of effectively reaching and serving all persons at risk of suicide in the United States through a national network of local, certified crisis call centers. This program, now called the National Suicide Prevention Lifeline (800–273–TALK/8255) serves as a central switchboard, seamlessly connecting callers to a crisis center geographically nearest the caller from among a national network of more than 150 crisis centers in 49 states. It provides services in English and Spanish, 24 hours a day, 7 days a week. It also includes a feature allowing callers to press “1” and be connected to a VA crisis center. The Lifeline also operates a website (www.suicidepreventionlifeline.org) and works closely with social networking websites. In October 2011, the Lifeline answered its 3 millionth call.

The Lifeline used evaluation results to introduce best practice standards used across the network. To improve service quality, SAMHSA funded two evaluations of network crisis center practices in 2003–04. These evaluations culminated in groundbreaking findings for the field, released in 2005 and published in 2007.114, 115 These findings demonstrated both effective crisis center practices (e.g., significant reductions in caller distress and suicidal risk) and needs for improvement (e.g., better risk assessment, more uniform approaches for callers at imminent risk of suicide, a need to monitor calls and more follow up with callers).

The creation of the first national resource center on suicide prevention was another important accomplishment. Established by SAMHSA in 2002, the Suicide Prevention Resource Center (SPRC) conducts a broad range of activities intended to improve the development, implementation, and evaluation of suicide prevention programs and practices. The center disseminates information, products, and services to various audiences through its website (www.sprc.org), online and face-to-face training programs, webinars, and direct consultation and support from its expert staff. SPRC also maintains an online library and clearinghouse of suicide prevention information and a registry of evidence-based programs and best practice recommendations.

The 2001 National Strategy specifically called for the creation of a national violent death reporting system to gather information from several data sources that were not otherwise linked. In Fiscal Year 2002, Congress appropriated funds for the development and implementation of the National Violent Death Reporting System (NVDRS). Originally implemented in six states, the system was extended to a total of 18 states in Fiscal Year 2009, via a congressional appropriation of $3.5 million. The system collects data on violent deaths from four primary sources: death certificates, police reports, medical examiner and coroner reports, and crime laboratories. Data are available for public use through the Web-Based Injury Statistics Query and Reporting System (WISQARS, at www.cdc.gov/injury/wisqars/index.html).

The 2001 National Strategy also called for the development of comprehensive state suicide prevention plans that would coordinate across government agencies; involve the private sector; and support plan development, implementation, and evaluation in communities. Today, nearly all states have a suicide prevention plan in place and some have formed public-private partnerships to advance their plans. Although these suicide prevention plans vary in terms of the groups they serve, involvement of the private sector, and resources available for services, their development represents an important first step and achievement in the field of suicide prevention.

Recent Developments

Recent milestones in the history of suicide prevention in the United States include the formation of the National Action Alliance for Suicide Prevention, in 2010, and the revision of the National Strategy in 2012. These milestones represent continuing progress toward the prevention of suicide in this country. For more on these recent developments, see the Introduction section.