In this issue: brief news items and a commentary on Suicide Risk and Men in their Middle Years
News! On top of the Surgeon General’s National Strategy for Suicide Prevention and the Institute of Medicine’s Reducing Suicide: a National Imperative, now comes the President’s New Freedom Commission on Mental Health report. Released on July 23, 2003, not only does this report endorse the national strategy, but lists as its top recommendation, “1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.”	News! The Partnership of Community Resources for Douglas County, Nevada hosted the QPR Institute’s training of 20 new QPR Instructors. Participants included a cross section of people from all walks of life. This is the first group in Nevada to bring QPR to their community. Nevada has always ranked an unenviable number 1 in completed suicides in America and only in 2000 did Alaska take the lead.
News! Suicide Prevention Outreach Opportunities Through Van’s Warped Tour: The National Hopeline Network is seeking volunteers for an outstanding suicide prevention awareness outreach opportunity through the Van’s Warped Tour (summer concert series). In exchange for free admission to the concert, as well as the opportunity to interact with nearly 10,000 concertgoers at each show, volunteers are asked to help discuss suicide prevention and raise awareness of suicide prevention resources such as 1-800-SUICIDE. For tour dates and cities, visit http://www.warpedtour.com/dates.html; to volunteer, email info@hopeline.com or call 1-800-442-HOPE (4673), option 3.”	News: The SPANUSA conference held in Washington DC in July was a highly charged 3-day meeting that involved people from all over the United States coming together to learn how to advocate for suicide prevention and to help fuel the National Strategy for Suicide Prevention. New Executive Director of SPANUSA, Jerry Reed, announced that SPAN volunteers delivered more than 60,000 advocacy letters to Capital Hill this year, and that since SPAN began its political action and organizing efforts in 1996, more than 500,000 advocacy letters have been delivered to legislators. On a side note, Ken Tullis , M.D., and Paul Quinnett, Ph.D., presented a provocative paper entitled “Suicide as Diagnosis, not Symptom.” Citing a number of studies in which suicidality responds to specific medication effects independent of any Axis I diagnosis, they also addressed a potential new nomenclature, suicide risk detection rates, and the clinical, cultural, political and financial ramifications of elevating suicidality from symptom to diagnosis.
Practitioner tip: Despite clinical lore and according to the research literature and expert clinical suicidologists, there is no scientific evidence that so-called “no suicide” contracts actually save lives or prevent suicide attempts. Despite their widespread use, specific training in their purpose, utility and employment is large unavailable. The use of a no-suicide contract as a defense against a complaint of malpractice is at best dubious, and at worst negligent. However, experts also agree that the refusal of a suicidal person to enter into any good-faith agreement to remain safe (which implies a willingness to participate in recommended treatment), suggests the risk for suicide attempt may well be higher than first assessed. Documentation of clinical status, including the results of a mental status examination, are the best evidence that due clinical diligence was undertaken, not only in the assessment of potential suicide risk, but in the planning of future interventions and treatment. A future clinical tip will address the pros and cons of no-suicide contracts. (This tip is from Counseling Suicidal People, A Therapy of Hope, available in our bookstore. Feel free to reprint and distribute this tip, but please add the source : QPR Institute, 2003. This newsletter will continue to feature free clinical tips for healthcare professionals.)
Commentary Question: Who is most at risk for Suicide? Answer: Men in their Middle Years. In June, the University of Rochester Center for the Study and Prevention of Suicide held a national consensus conference in Washington DC on preventing suicide among men in their middle years (ages 25 to 54). In attendance were several major US corporations and leaders from the National Institutes of Health, the US Air Force, the Employee Assistance Society of North America, the National Institute for Occupational Safety and Health, the Veterans Health Administration, researchers, representatives of the healthcare industry and several international experts. Keynoters highlighted a stark and alarming fact: men in their middle years kill themselves at twice the baseline rate of other Americans, a death rate of more than 22 deaths per 100,000 persons per year. Just as schools are the venue for youth suicide prevention efforts, conference attendees agreed that the workplace is a potential venue for suicide prevention efforts for working adults. Since smart businesses have embraced physical and psychological wellness programs as cost-effective strategies in protecting the human capital necessary to achieve corporate goals, it was further agreed that cost-effective suicide prevention efforts delivered in the workplace might be well received by innovative and bold corporate leaders. To help justify expenditures for such an undertaking definitive studies on the cost of suicide in workplace are needed. However, in the their recent Reducing Suicide, A National Imperative, the Institute of Medicine calculated the economic cost of suicide to society by summing the following: a) emergency and non-emergency medical expenses associated with treating suicidal people (costs ultimately passed on to corporations, workers and taxpayers), b) lost/reduced productivity by suicidal people, c) lost productivity of loved ones grieving the loss of someone to suicide and, d) lost wages of those completing suicide, with the largest number of completed suicides occurring before the age of retirement. According the IOM Committee completing these calculations, “the value of lost productivity was calculated to be $11.8 billion (in 1998 dollars).” We invite our readers to think “out of the box” in a collective effort to a) get suicide prevention awareness and prevention programs into the workplace and b) facilitate ready access to mental health and substance abuse treatment services by working people. We are especially interested in raising awareness in labor unions, professional membership organizations and in industries where the majority of workers are males. We also invite you to think about how to access suicidal men in their middle years. Historically our national focus and funding for suicide prevention has targeted toward youth and, and to a lesser degree, a few special populations. One of the keynoters at this conference noted that she was able to find “only two studies” dealing with suicide by men in their middle years. For our part here at the QPR Institute, we are working to address this unexplored territory. How you can help….. If you are a CEO or HR Director of a medium to large company (or know someone who is), it is likely you have already lost one or more employees to suicide. If so, we would very much like to hear from you about the experience. We are exploring opportunities to take suicide prevention training into the workplace and it would be most helpful for our research team to hear some first person “impact” stories as we determine what variables should be considered in a cost-benefit analysis. You can email or call us directly. Thanks.