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Background
Suicide is a serious public health problem. In 2009, suicide was the 10th leading cause of death in the
United States (2nd leading cause of death for adults ages 25-34, and the 3rd leading cause of death for
youth ages 15-24.). A person dies by suicide about every 14.2 minutes in the United States, and it is
estimated that for every person who dies by suicide, more than 30 others attempt suicide.
In 1999, the US Surgeon General released A Call to Action to Prevent Suicide which resulted in the
development of the National Strategy to Prevent Suicide. On September 10, 2012 a
revised National Strategy for Suicide
Prevention (NSSP) was issued. The revised strategy emphasizes everyone's role in protecting friends, family members,
and colleagues from suicide. The National Strategy was revised to reflect major developments in suicide prevention,
research, and practice during the past decade, including: an increased understanding of the link between suicide and
other health issues, new knowledge on groups at increased risk, evidence of the effectiveness of suicide prevention
interventions, and increased recognition of the value of comprehensive and coordinated prevention efforts.
The Suicide Prevention and Risk Reduction Committee (SPARRC)
serves as the main venue for partnership among the Military Services and the Department of Veterans Affairs (VA) on
suicide prevention and ensures system-wide consistency related to suicide, risk reduction policy initiatives, and suicide
surveillance metrics. The SPARRC sponsors the DoD/VA Suicide Outreach Web site which serves as a comprehensive
resource with access to hotlines, treatments, programs, forums and multimedia designed to support all service
members, veterans, families and health professionals.
The National Suicide Prevention Initiative (NSPI) is a multi project effort to
reduce suicide led by the Substance Abuse and Mental Health Services
Administration's Center for Mental Health Services. One of its projects is the
National Suicide Prevention Lifeline which is a 24-hour, toll-free suicide
prevention service available to anyone in suicidal crisis. 1-800-273-TALK (8255).
To ensure veterans with emotional crises have round-the-clock access to trained
professionals, the Department of Veterans Affairs (VA) is partnering with the
National Suicide Prevention Lifeline to operate a national suicide prevention hotline
for veterans. Veterans can call 1-800-273-TALK (8255) and press "1" to reach the
VA hotline, which will be staffed by mental health professionals in Canandaigua,
N.Y. who will work closely with local VA mental health providers to help callers.
Primary care providers play a significant role in identification and treatment of
patients with an elevated suicide risk. Information is provided below to assist primary
care providers in this role.
Table of Contents
Clinical Guidance
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Suicide Assessment Five-step Evaluation and Triage (SAFE-T), 2007
(SAFE-T is a suicide assessment protocol which was developed through a joint collaboration
with Screening for Mental Health and the Suicide Prevention Resource Center and is designed to
help clinicians, specifically mental health professionals, identify risk and protective factors for suicide,
learn the steps in conducting a suicide inquiry and determine the patient's risk level for suicide, providing
a range of possible interventions. The protocol also highlights the importance of documentation.)
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A Resource Guide for Implementing the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 2007 Patient
Safety Goals on Suicide
Developed by Screening for Mental Health, Inc. to facilitate implementation of the Joint Commission patient safety goal on suicide.
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National Suicide Prevention Lifeline: After An Attempt, A Guide for Medical Providers in the Emergency Department Taking
Care of Suicide Attempt Survivors, DHHS Substance Abuse and Mental Health Services Administration, 2006.
Provides quick tips to enhance Emergency Department care for people who have attempted suicide, and also provides
information on patient discharge and resources about suicide for medical professionals, patients, and their families.
- American Psychiatric Association (APA) Assessment and Treatment of Patients With Suicidal Behaviors Practice Guideline
- Best Practices Registry (BPR) For Suicide Prevention
(The BPR for suicide prevention is a collaboration between the Suicide Prevention Resource Center
(SPRC) and the American Foundation for Suicide Prevention (AFSP). It is funded by the
Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of the
BPR is to identify, review, and disseminate information about best practices that address
specific objectives of the
National Strategy for Suicide Prevention.)
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Recommendations for Inpatient and Residential Patients Known to be at Elevated Risk for Suicide, American Association
of Suicidology (AAS), 15 Nov 05
Developed to enhance the provision of care in inpatient and residential facilities and in particular to promote, when possible,
the incorporation of families as meaningful members of the treatment team.
- Approaching the Suicidal Patient, American Family Physician
Vol 68 No 9, ! Nov 03
Written to try to help family physicians prevent suicide by providing a strategy for assessing risk factors and recommending
interventions that fit the existing level of risk.
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Suicide Guidelines, Risk Management Foundation (RMF), 22 Aug 03
RMF has developed guidelines with Harvard medical faculty over the past 10 years to assist primary care and mental health professionals in their
decision-making. These documents address the process of identifying or managing at-risk patients in a hospital or outpatient setting, as well as
collaboration issues among mental health and primary care clinicians.
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Air Force Guide for Managing Suicidal Behavior Strategies, Resources and Tools, 2004.
Developed to help Air Force mental health staff deliver high-quality, evidenced-based care to suicidal individuals.
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Screening for Suicide Risk: A Systematic Evidence Review for the U.S. Preventive Services Task Force, Agency for Healthcare
Research and Quality, May 04. Systematic review of the literature regarding whether screening for suicide risk in primary
care results in decreased morbidity, mortality, or both.
- US Preventive Services Task Force (USPSTF) Screening for Suicide Risk, May 04
- VA/DoD Clinical Practice Guideline for Management
of Major Depressive Disorder in Adults, May 09 (Appendix 3, Suicidality, provides recommendations for assessing the potentially suicidal patient.)
- Preventing Suicide - A Resource Guide for General Physicians,
World Health Organization (WHO), 2000
This booklet is one of a series of resources prepared as part of WHO's Suicide Prevention Campaign (SUPRE).
- Evaluation and Treatment of Patients with Suicidal Ideation.
American Family Physician, 56(6), 15 Mar 99
Provides guidelines for primary care providers in evaluating and treating patients with suicidal ideation.
Policies and Directives
DoD/Joint Forces
Army
- Army Directive 2010-01, Conduct of AR 15-6 Investigations
into Suspected Suicides and Requirements for Suicide Incident Family Briefs, 26 Mar 10
- Army G1, Suicide Prevention Web Page
- USAPHC(Prov) (Formerly USACHPPM)
Suicide Prevention Resources Web Page
- Hooah4Health Suicide Prevention Web Page
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Army G1, Army Suicide Prevention - A Guide for Installations and Units, 15 Mar 08
- AR 600-63, Army Health Promotion, Rapid Action Revision 7 Sep 10
(Paragraph 4-4 Suicide Prevention and Surveillance)
- DA Pam 600-24, Health Promotion, Risk Reduction, and Suicide Prevention, Rapid Action Revision 7 Sep 10
Air Force
Navy/Marines
Coast Guard
Veterans Administration
Federal
Implementation Tools
Brochures and Fact Sheets
Other Related Information
- RAND Report, The War Within: Preventing Suicide in the U.S. Military, 2011
(Written at the request of the Assistant Secretary of Defense for Health Affairs, the report contains information on the epidemiology of suicide; reviews
of scientific evidence and suicide prevention activities; a summary of funding and responsibilities within the services; an assessment of service prevention
programs; and a number of specific recommendations for suicide prevention.)
- Department of Defense Suicide Event Reports (DoDSER) Annual Reports
- Web-based System Helps DoD Track Suicides,
US Medicine, Aug 10
- Final Report of
the DoD Task Force on the Prevention of Suicide Among Members of the Armed Forces, Aug 10
- Report of the Blue
Ribbon Work Group on Suicide Prevention in the Veteran Population, 30 Jun 08
- Congressional Research Service (CRS) Report, Suicide Prevention Among Veterans, 5 May 08
- Army G1, Suicide Prevention Commanders Toolkit
Education and Training
- Army Suicide Prevention Video: Shoulder to Shoulder: "I Will Never Quit on Life", Jun 10 (Features vignettes and testimonials of members of the Army Family who received help for psychological distress or who assisted an individual in need.)
- 2010 DoD/VA Suicide Prevention Conference, Jan 10 (Presentations)
- 2009 DoD/VA Suicide Prevention Conference Jan 09
- EndingSuicide.com (Online Education on Suicide Prevention for Professionals - supported by a contract from National Institute of Mental Health)
- Suicide Prevention Resource Center (SRPC) Training Institute (The SPRC Training Institute provides an array of curricula designed to build capacity for suicide prevention in state, tribal, local, and community-based organizations.)
- Deployment Health Clinical Training Series Module, Suicide, Jan 04
- PowerPoint Presentation Summarizing the APA Suicide Assessment Guidelines, University of Michigan Colloquium Series 19 Dec 03
- VA Satellite Broadcast -"Suicide, Recognizing Risks Across Treatment Settings" (90 minutes) (Can be ordered from US Army MEDCOM Quality Management Office Web site Shopping Cart, Depression Toolkit Item Number DE-000--01-08)
Research
- Military Suicide Research Consortium (MSRC is part of an ongoing strategy to integrate and synchronize U.S. Department of Defense and civilian efforts to implement a multidisciplinary research approach to suicide prevention.)
Related Links
- Federal
- DoD/VA Suicide Outreach Web Site (Comprehensive suicide-related resource with access to hotlines, treatments, programs, forums and multimedia designed to support all service members, veterans, families and health professionals. The Web site is a collaborative effort between each of the Services, the National Guard Bureau, Reserve Affairs, Department of Veterans Affairs, the Office of Armed Forces Medical Examiner, Substance Abuse and Mental Health Services Administration and others.)
- Veterans Crisis Lane (To ensure veterans with emotional crises have round-the-clock access to trained professionals, the Department of Veterans Affairs (VA) is partnering with the National Suicide Prevention Lifeline to operate a national suicide prevention hotline for veterans. Veterans can call 1-800-273-TALK (8255) and press "1" to reach the VA hotline, which will be staffed by mental health professionals in Canandaigua, N.Y. who will work closely with local VA mental health providers to help callers.)
- VA Mental Illness Research, Education and Clinical Center (MIRECC) on Suicide and Suicidality in Veterans (MIRECCS were established by Congress with the goal of bringing best practices in mental health care into the clinical settings of the VA. They conduct research and produce clinical educational programs.)
- Army Behavioral Health, Suicide Prevention Web Page
- CDC, Suicide Prevention Web Page
- National Institute of Mental Health Suicide Prevention Web Page
- National Library of Medicine MedLine Plus Suicide Web Page
- MEDCOM Directory of Suicide Prevention and Related Web Sites, Jun 02 (List of government agencies, voluntary associations, and private organizations that provide suicide prevention or information and resources to the general public and/or healthcare professionals.)
- National Suicide Prevention Lifeline (A 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. 1-800-273-TALK (8255). The National Suicide Prevention Lifeline grant is one component of the National Suicide Prevention Initiative (NSPI), a multiproject effort to reduce suicide led by the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services. )
- Suicide Prevention Resource Center (SPRC) (The SPRC was created in 2002 to fulfill Goal 4.8 of the National Strategy for Suicide Prevention, which called for “the development of a technical assistance and resource center to build capacity for states and communities to implement and evaluate suicide prevention programs.” SPRC is supported by a cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA))
- Private
- American Association of Suicidology (A non-profit organization which promotes research, public awareness programs, public education, and training for professionals and volunteers. In addition, AAS serves as a national clearinghouse for information on suicide.)
- American Foundation for Suicide Prevention
(A non-profit organization exclusively dedicated to understanding and preventing suicide through research and education, and to reaching out to people with mood disorders and those impacted by suicide.)
- American Psychological Association Suicide Web Page
- Mental Health America Suicide Web Page(Mental Health America (formerly known as the National Mental Health Association) is a nonprofit organization dedicated to helping all people live mentally healthier lives.)
- National Action Alliance for Suicide Prevention
- National Alliance on Mental Illness (NAMI) Suicide Web Page (NAMI is “the nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families.”)
- Suicide Awareness Voices of Education (SAVE)(A non-profit organization that was one of the nation's first organizations dedicated to the prevention of suicide and was a co-founding member of the National Council for Suicide Prevention.)
- Stop A Suicide Today(A program of Screening for Mental Health, Inc. which teaches how to recognize the signs of suicide in family members, friends and co-workers. It emphasizes the relationship between suicide and mental illness and the notion that a key step in reducing suicide is to get those in need into mental health treatment.)
- Suicide Prevention Action Network USA (SPAN USA) (A non-profit organization dedicated to preventing suicide through public education and awareness, community action and federal, state and local grassroots advocacy.)
- SPAN USA - State Suicide Information and Contacts (Provides information on suicide prevention plans and contacts for each state.)
- Working Minds (Working Minds provides tools and networks to workplaces to assist with suicide prevention, intervention, and postvention with three strategies: establish a workplace suicide prevention network; provide state-of-the art training; and change the culture of suicide in the workplace)
- Lifeline Gallery: Stories of Hope and Recovery (Lifeline Gallery’s goal is to raise awareness about the effects of suicide, reduce stigma, connect people to emotional support and offer help. It is a project founded by the National Suicide Prevention Lifeline and Link2Health Solutions, Inc. which is a non-profit wholly owned subsidiary of the Mental Health Association of New York City.)
- TAPS (Tragedy Assistance Program for Survivors (TAPS is a non-profit organization that is a front line resource for all who through war, illness, accident or suicide have lost a loved one serving in the Armed Forces. Its comprehensive services include a national network of peer-based emotional support, case work assistance, crisis intervention, and grief and trauma resources.)
- International
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