The National Strategy aimed to cut the suicide rate by one fifth by 2025, and recommended that states introduce action plans to curb the spread. Federal grants were announced, and every state appointed a suicide prevention coordinator.
But according to Jerry Reed, co-author of the National Strategy, progress has been sluggish: “At this point in time, there is no state in the US that has successfully implemented a comprehensive and integrated suicide prevention program.” If current trends continue, the US won’t simply fail to significantly reduce suicide, its suicide rate will be significantly higher than in 2012.
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But, at the foot of the Rocky Mountains, the tide could be about to turn. Colorado is set to launch a groundbreaking suicide prevention plan in the first six months of 2019. With high-profile national backing and a raft of financial support, the state’s plan could set the benchmark for the country to take to scale.
Data, design, demographics
Using data from hospitals, police records and mortality databases, Colorado took a granular view of its suicide problem. Data revealed exactly where suicides were most common, in which demographics and in which professions. And it made that data public with an interactive suicide data dashboard.
“Everything we do is data-driven,” said Jarrod Hindman, Deputy Chief of Violence and Injury Prevention at the State of Colorado who has directed the state’s suicide prevention efforts for over a decade.
“In Colorado, the vast majority of suicide prevention dollars were dedicated to youth suicide prevention, but working-age males carry the heaviest suicide burden,” Hindman said. To meet the 20% reduction target, the state used its data to design different programs to target young people, adults, and older adults.
For young people, the state is focusing on schools. “We know that feeling more connected to school, positive peer support and having positive caring adults are protective factors not just for suicide, but other types of problem behaviour from bullying to teen dating violence,” said Hindman.
In 2019, the state intends to implement the Sources of Strength program statewide, a peer leadership project which fosters trusting relationships between students and adults to ensure suicidal youth can access support when they need it.
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For adults, “it gets really tricky”, Hindman said, “because there are so few evidence-based programs.” One promising approach focuses on the means by which some 51% of Americans take their lives: firearms.
“In the state of Colorado, the message cannot be that we want to remove guns from people’s homes permanently,” Hindman said.
Instead, the state is rolling out the Gun Shop Project, a partnership with firearms retailers to distribute leaflets on the importance of preventing suicidal friends or relatives from accessing firearms. Extensive research suggests that the likelihood of death by suicide is dependent not only on intent but the methods used.
But an alternative approach focuses more squarely on prevention. In 2016, Colorado unveiled ManTherapy.org, a mental health awareness and support website specifically designed to appeal to men.
“We know that traditional messages of help-seeking and taking care of yourself and suicide prevention don’t resonate with masculine men, so we’re trying to reach men where they’re at.”
For older people, the approach is different again. One arm of the strategy focuses on boosting suicide awareness in primary care.
“A high percentage of older people who die by suicide have accessed or seen their primary care physician in the weeks and months prior to death,” Hindman said, but many aren’t screening for suicide risk.
“It should be unacceptable for this country to have so many people dying by suicide”
The other arm instead embeds suicide awareness in-home care workers, helping them to refer at-risk old people to appropriate services and offering support where required. The strategy of taking services to users will be vital in the state, where half the population remains in rural areas, often with fewer hospitals and mental health care professionals.
Those demographic-specific interventions are supplemented with population-level programs. Healthcare facilities are set to implement Zero Suicide, a seven-point strategy that aims to reduce suicide risk for people in the medical system by embedding suicide prevention strategies across multiple sectors and departments.
Taken as a whole, the set of programs are robust. But suicide is a notoriously complex phenomenon and there is no guarantee that the states aims will be met.
“The fundamental challenge we face in suicide prevention is we are dealing with very few evidence-based programmes that actually can show they can reduce the suicide rate. We are implementing a lot of best bets,” Hindman said.
Hindman credits the work in Colorado to a degree of both financial and technical support that is not yet available to all other states.
It has also received more funding than many other states could muster. Yet despite a five-fold increase in funding in just two years, not every program has the money to roll out statewide. “We don’t yet have the amount of funding we need to implement on the scale that we think will be meaningful,” said Hindman, though he was optimistic that more money will be found when implementation begins.
And the state also has an infrastructure for suicide prevention that others do not. While all states now have a suicide prevention coordinator, many still do not have a dedicated staff and funding pool for prevention efforts.
Some rely solely on grants and federal dollars, a less consistent funding stream than Colorado, where state dollars are ringfenced for suicide prevention.
Much rides on Colorado. If the project succeeds, it could provide a model to scale up nationwide. Without it, the US’s national suicide reduction goals could be yet another undelivered promise.
“The most recent data showed that 49 of 50 states saw an increase in their suicide rate,” said Hindman. “If that report doesn’t create a swell of support and funding for suicide prevention then something is going seriously wrong. It should be unacceptable for this country to have so many people dying by suicide.” — Edward Siddons
(Picture credit: Flickr/Keith)