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NIMH Director Talks with NIMH Researcher about the High Priority Research Strategies of Suicide Prevention

NIMH Director Thomas Insel discusses strategy with NIMH research Dr. Jane Pearson.


Announcer: At the National Institute of Mental Health in Bethesda, Maryland, suicide prevention is one of the highest priorities. The goal, through scientific research, is to bring down the mortality rate from suicide. In September 2012, a new national strategy was released to address this global crisis.

Dr. Thomas Insel: To talk about the new strategy Dr. Jane Pearson from our Division of Services and Interventions Research is going to join us and give us some idea of what’s involved with this new approach. And where the science is currently in the prevention of suicide. Jane welcome- tell us about the national strategy and what people need to know about it.

Dr. Jane Pearson: Sure. The original strategy came out in 2001 and that was a very broad roadmap and it had lots of opportunities for a lot of people to do a lot of things about suicide prevention- which we know is a complex problem. The update focuses our approach to this in some ways and we’ve been thinking about how to change the conversation about suicide prevention. We’re also thinking about what data we need in terms of surveillance to make it useful and timely. And probably most important for NIMH is to figure out what a prioritized research approach to suicide prevention would be.

Dr. Thomas Insel: What’s so striking is if you look at the numbers- suicide hasn’t really changed that much in terms of the rate- we’ve seen the rates of homicide go down… the rates of traffic fatalities go down… both actually lower now than the national rate of suicide. What have we learned in the last decade that now could be applied to change those statistics?

Dr. Jane Pearson: Well, we’ve made some headway I think in terms of how to treat people who have attempted suicide. We’ve figured out how to develop treatments that could address it directly but that’s not enough. I think we’re learning that we’re going to have to think of new strategies to reach people who are not in care systems and we’re trying to understand how many people we can help within the care system. How many people outside the care system and that’s why we need that surveillance data to figure out where to put our resources. We certainly want providers to know how to treat suicidal people and I think we can certainly help develop some evidence based practices there.

Dr. Thomas Insel: So, when you say there… and you’re talking about providers… of the 35… 36 thousand suicides a year in this country… which is about four per hour… what would be the right area to focus? Is it going to be in primary care or is it going to be in a hospital settings… should it be in mental health settings? Where do you think is the most important place for us to put our energy?

Dr. Jane Pearson: I think we’re still trying to figure that out. We’re trying to make our best estimates given what we know about who attempts suicide, who dies by suicide and what those circumstances are. But it’s still a challenge to figure out, for example, the people who die outside the care system- we’re still trying to understand what settings they might have been in, how could we have reached them, what their histories are. So, that’s part of our prioritized plan what we’re working on to understand where we can make the biggest difference.

Dr. Thomas Insel: Emergency departments... is that a place we should be looking?

Dr. Jane Pearson: Well, it’s one place that people assume they could get care for a crisis and we’re concerned because there are no evidence based practices for providers in emergency care settings, so we would like to help them find approaches to screening, approaches to managing that risk right in the setting and also help people link to care. Because we know people don’t often seek care after they’ve been to the emergency department or don’t follow up on the referrals they are given. So part of our research approach is to think about how we can bolster evidence based practices for the places that people do go when they have self-identified.

Dr. Thomas Insel: And just roughly, out of the 36-thousand, how many in a given year have actually sought treatment or had a contact with the health care system but go on to kill themselves anyway? What kind of numbers are we talking about… roughly?

Dr. Jane Pearson: Well, we know from different surveys that at least 600 to 700 thousand people say in the past year they have attempted suicide and they’ve sought some medical treatment. We don’t know if they’ve gone to the emergency room or a health care provider outside that system because of our lack of surveillance data. We just don’t know exactly where they’re being seen. So part of the challenge is to understand that flow of where patients go for help. In terms of the number of people who died who have been in the emergency department we also don’t know that. We would like to learn more. We can make some estimates but we do know that if we work harder at preventing reattempts we should have some success at preventing some deaths there as well. So we’re actually in the middle of trying to estimate what that might be and help providers- help health care systems understand what impact they could make by doing a better job to prevent those reattempts.

Dr. Thomas Insel: What’s the goal? Where do you want to be in five years?

Dr. Jane Pearson: We would really like to show that we could make a difference in changing the suicide numbers in some ways. It might be that we find out through this effort that we need that surveillance data outside the heath care systems to understand the bigger picture. And I think we’ve got a lot of help from the CDC in helping us think through how we could we get that- what’s the best way. So, it’s going to be a team effort. I think they’ll be also private entities like health care and insurance systems that might have data that we could use as well. So, we’re asking everyone to help us figure out this big puzzle.

Dr. Thomas Insel: What’s the role of the National Football League in the NFL initiative that was recently announced. How does that fit in?

Dr. Jane Pearson: We need employers, like, we have the Army for example, focused on suicide prevention and we need their help in terms of how to talk about this in a way that… if people are concerned about suicide… that they’re not embarrassed to seek treatment… that they don’t feel like they’ll be penalized for getting help. They need to know that there’s a safe way to get help. And that it could help. So, in terms of how the NFL has handled this, with their approach in integrating it into regular health care as a way of de-stigmatizing it… could be a way forward for other employers. So, it’s a great example especially for men who are often reluctant to seek help for mental health, for substance abuse issues as a way forward.

Dr. Thomas Insel: So, what about the Army? You mentioned the Army… what’s the project that we need to know about?

Dr. Jane Pearson: So, Army STARRS is one of the largest projects on military suicide prevention and I should say risk and resilience. We’d like to understand through the study what trajectories there are in terms of individuals who have risk factors but still don’t take their own lives or attempt suicide and what protects them. We’re trying to figure out through many approaches within the study launched to a known cross sectional what those risk factors and protective factors might be. We brought to the Army what we know best about civilian suicide prevention but we know from this study, which affords us this opportunity to follow cohorts over time. A lot of information that will come back to help civilians in terms of understanding suicide prevention.

Dr. Thomas Insel: One last thing. I know you’ve been deeply involved with the Action Alliance for Suicide Prevention- it’s again a national public-private partnership. You’ve specifically been deeply involved with the research task force. Where is that going and what is that supposed to accomplish?

Dr. Jane Pearson: So, the action alliance came about two years ago… September 10… and the initial strategy for suicide prevention called for an alliance that would bring together both the public and private partners in suicide prevention to move a strategy forward. That group has worked very hard to identify areas where we could make some progress in suicide prevention. And I think the opportunities that have come through with the many task forces of that action alliance give us those opportunities. Some are focused on infrastructure needs. Some are focused on population needs. The research task force, they are the research prioritization task force, has worked, as you know, on defining a goal of trying to find research that would reduce the burden of suicide and we’re getting to the step now where we’re getting experts to help us think through research pathways going forward and we hope to release that next spring.