A Public Health Approach to Suicide Prevention Alex Kelter, M. D A Public Health Approach to Suicide Prevention Alex Kelter, M.D. Epidemiology & Prevention for Injury Control (EPIC) Branch California Dep’t of Health Services Phone: 916-323-3480 E-mail: Akelter@dhs.ca.gov

Prevention is possible The Timing of Prevention long before the event (primary) screening, Rx, no suicide attempt within the event (secondary) call to crisis line selection of method, lethality after the event (tertiary) lifesaving response, therapy, rehab

Spectrum of Prevention The Spectrum of Prevention1 Strengthening Individuals’ knowledge & skills Community Education Educating Providers Coalitions & Networks Organizational Practice Change Policy & Legislation 1 Cohen & Swift (1993)

Epidemiological aspects Risk is not uniform in the population Patterns can be found Risk factors can be found Their potency can be estimated Clues to prevention can be found Interventions can be tested

Policy Aspects According to surveys, people want prevention When given risks and benefits, they will choose based on their perceptions and values Government codifies reality, it does not determine it. Everything starts somewhere

How does it work? Define the problem (Who?) Define outcomes (Who?) Identify interventions (Who?) Decide on a plan (Who?) Implement and Evaluate (Who?)

Policy options Passive Alter the physical and social environment, removing choice or altering the context in which choices are made. restrict access to lethal means make self-destructive behavior “un-cool” improve access to mental health services

Policy options Active Education (for behavior change) Enforcement (legislation, regulations to coerce behavior change) Economics (incentives for behavior change)

Conclusions Public Health methods that have reduced poisonings, fire and burn injuries, drowning, cancer deaths, etc. can be applied to preventing suicide. The Surgeon General’s Call to Action to Prevent Suicide can be used as a paradigm.

Conclusions No sector, by itself, can prevent suicide. Cooperation is needed to make research, clinical practice, prevention practice, public policy, and individual behavior come together to focus on this problem.