2C
Increase the public’s knowledge of risk factors for suicide, recognition of warning signs in individuals, and preparedness to support and respond to those individuals.
Definitions:
- Suicide prevention training: This is often referred to as “gatekeeper training” when it is provided to the general public. The aim of this type of training is to prepare people to recognize someone at risk of suicide and respond by referring them to appropriate resources.
- Postvention: This is an organized response in the aftermath of a suicide to accomplish one or more of the following:
- Facilitate the healing of individuals from the grief and distress of suicide loss.
- Mitigate other negative effects of exposure to suicide.
- Prevent suicide among people who are at high risk after exposure to suicide.
- Suicide contagion: This describes an increase in suicide and suicidal behaviors due to exposure to such behaviors within one’s family, peer group, or through media reports of suicide or suicide attempts.
- Public messaging: In this context, public messaging is the dissemination of information and messages about suicide in websites, social media, news articles, educational materials, billboards, and other print and digital communications. It is important that this information be conveyed in ways that support suicide prevention rather than increase risk.
There are a number of ways to increase the public’s knowledge of risk factors and prepare people to respond to individuals who may be in crisis. The Wisconsin Violent Death Reporting System provides narrative information from coroners and medical examiners, as well as law enforcement, that can be used to learn about the circumstances present in the life of individuals who died by suicide. This information can then be used to guide prevention. Figure 48 displays suicide-related themes that were qualitatively extracted from narratives, broken down by age group. The age groups used represent pre-high school age (10 to 13), high school age (14 to 17), young adult (18 to 24), working age adult (25 to 44), middle years (45 to 64), and retirement age (65 and older). The similarities and differences displayed in this table indicate that, while there are some shared contextual factors present across age groups, different age groups experience different life stressors prior to a death by suicide.
Figure 48. Top 5 suicide-related themes by age group
| Themes |
10–13 |
14–17 |
18–24 |
25–44 |
45–64 |
65+ |
| 1. |
Recent argument with parent |
Recent argument with parent |
Alcohol use |
Alcohol use |
Alcohol use |
Physical health problems |
| 2. |
Bullying victim |
Bullying victim |
Legal issues |
Financial strain |
Physical health problems |
Chronic pain |
| 3. |
Loss of privileges/items |
Self-harm |
Substance abuse |
Argument with partner |
Financial strain |
Anxiety |
| 4. |
History of self-harm |
Alcohol use |
Argument with partner |
Anxiety |
Chronic pain |
Cancer diagnosis |
| 5. |
Recent suspension from school |
Anxiety |
Relationship problems |
Physical health problems |
History of alcohol misuse |
History of alcohol misuse |
Suicide prevention training
There are many tools available for training people to recognize the warning signs of someone who might be in crisis and prepare them to intervene. The Centers for Disease Control and Prevention (CDC) provides a technical package that includes best practices on identifying and supporting people at risk.19 For example, QPR (Question, Persuade, and Refer) is a short educational program that provides simple instructions for intervening with individuals considering suicide in the same way that CPR provides instructions for assisting people who have a physical need. Though QPR was developed for a general community audience, it can be adapted for use by specific groups of professionals or volunteers who interact with people at risk of suicide.
It is critical that the public be aware of appropriate referrals when a person is at risk. Crisis intervention approaches provide support and referral services, typically by connecting a person in crisis to trained volunteers or professional staff via telephone hotline, online chat, text messaging, or in-person. Wisconsin crisis intervention services programs (also called emergency mental health services programs) provide 24/7 phone services to most counties. These programs also provide walk-in and mobile services during significant portions of the week.
Culturally relevant interventions
While suicidal thoughts and behaviors can occur in all populations, there are certain populations at disproportionate risk of suicide, such as: individuals with lower socio-economic status; individuals living with a mental health issue; suicide attempt survivors; veterans and active duty military personnel; individuals who are institutionalized, have been victims of violence, or are experiencing homelessness; lesbian, gay, bisexual, or transgender individuals; and members of certain racial and ethnic groups. Prevention approaches are not “one-size-fits-all.” It is important to further explore and develop culturally relevant resources for groups at disproportionate risk of suicide and offer opportunities for these interventions to take place where groups at risk spend most of their time.
Engaging individuals in non-traditional sectors
Non-traditional sectors, meaning sectors where suicide prevention efforts do not typically occur, that could be engaged in creative efforts include: government (local, state, and federal); social services; business; labor; justice; housing; media; and organizations that comprise the civil society sector, such as faith-based organizations, youth-serving organizations, foundations, and other non-governmental organizations. Countless opportunities exist to educate the public about risk factors for suicide and increase the ability to respond in a supportive, nonjudgmental way.
Voices From the Field
"Increasing public awareness of suicide warning signs, how to identify individuals who are struggling, those in crisis, and knowing how to reach out to them, is imperative to reducing the likelihood of the occurrence of suicide. The American Foundation for Suicide Prevention is dedicated to educating communities by offering lifesaving education programs like Talk Saves Lives, More than Sad, and It’s Real: College Students and Mental Health, at no cost to participants."
– Gena Orlando, Wisconsin Area Director, American Foundation for Suicide Prevention
Postvention approaches
Research has established that family members of people who have died by suicide are at increased risk of suicide themselves.20 Postvention strategies are positive approaches that can be implemented after a suicide death in order to support individuals bereaved by suicide loss. They are activities designed to promote healing and reduce suicide risk among loss survivors. Strategies can include debriefing sessions; counseling; bereavement support groups; and outreach to the affected community through schools, workplaces, and places of worship. In order to be prepared for postvention needs after a suicide death, training on postvention must be provided in advance to first responders, school personnel, coroners and medical examiners, funeral directors, and others who have contact with recently bereaved individuals. Postvention is future prevention.
Safe messaging about suicide
The way that suicide is portrayed in the media, on social media, and in other public forums matters. The media plays a large role in preventing suicide contagion. It is important that media outlets and community organizations use safety-focused guidelines when reporting on suicide events and presenting data. Communications about suicide should be designed to encourage help-seeking, focus on positive prevention efforts, promote hope and resiliency, and include vetted helping resources such as county crisis lines, the National Suicide Prevention Lifeline, and the HOPELINE Crisis Text Line. (See Additional Resources in Appendix 1.)
"People with mental health challenges sharing their recovery experiences in a targeted, local, credible, and continuous way is the current, primary, evidence-based practice to reduce stigma."
– WISE (the Wisconsin Initiative for Stigma Elimination)
Reducing stigma
According to WISE (the Wisconsin Initiative for Stigma Elimination):
The stigma associated with mental illnesses prevents treatment and impedes recovery. It is fundamental to discrimination in housing, employment, healthcare and insurance reimbursement. Stigma impacts productivity in the workforce and community health. Research on addressing discrimination and stigma has shown that individuals’ attitudes improve when they have direct contact with people with mental illnesses, when they can get to know people beyond labels and myths (contact strategies). Research also demonstrates that some efforts to reduce stigma such as protesting and education about illnesses, while well intentioned, in some cases have actually increased the negative attitudes and behaviors of stigma. If one of the goals of a presentation is to reduce stigma, contact with a person living in recovery has been shown to be the most effective both immediately after the presentation and in follow-up evaluations.
Targeted media strategies and initiatives within specific sectors, such as workplaces, health systems, and schools, can work to eliminate stigma around mental health and suicide by engaging people with lived experience (those who have survived an attempt or lived with suicidal ideation) to reduce stigma through intentional contact strategies, such as those supported by WISE.
Meeting people where they are
- Several coalitions and local health departments in Wisconsin work with bartenders to disseminate suicide prevention messaging in local bars and restaurants.
- A faith-based mental health group in Milwaukee hosts suicide prevention events at churches and community centers.
- A Wisconsin construction company offers QPR trainings at their headquarters.
- Gun shop owners share their own stories of suicide loss to start the conversation about prevention with their customers.
- A farmer in rural Wisconsin speaks at mental health awareness events and leads a group to bring other farmers together to talk about daily stress and other issues.
This list is not comprehensive. There are abundant opportunities to reach at-risk individuals in the community, including at: hair salons and barber shops; public transportation; banks and credit unions; domestic violence and homeless shelters; perinatal programs; family courts; re-entry programs for individuals following incarceration; and substance use treatment programs.
2C: Increase the public’s knowledge of risk factors and preparedness to respond