1. 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:

2. 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

3. 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)

4. 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

5. 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

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

7. 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

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

9. 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.

10. 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.