suicide among would-be crisis line callers, the PAR and PPE are still quite small (Table 8-4). Their value in making a dramatic reduction in suicide is limited because of two factors—they are not used by a high percentage of those at risk, and successful treatment referral is also modest (Gould and Kramer, 2001).

For gatekeeper training, there is some opportunity for significant benefit, provided sufficient numbers of gatekeepers can reach out to those at risk. Two situations are compared to give a range of potential benefit (Table 8-4). In the first situation, the assumption is that gatekeepers are effective in reaching the upper 10 percent who are at risk, and they are only 10 percent effective in reducing their risk. Under these conditions, PAR and PPE are quite modest. On the other hand, if gatekeepers can work more effectively with the top 20 percent at risk, this could lead to sizable reductions in suicide.

In summary, high-risk strategies alone cannot suffice to significantly reduce the incidence of suicide. Our current knowledge forces us to examine universal and selective strategies that can reach individuals early on, when developmental patterns leading to youth problem behavior and psychiatric symptoms can potentially be changed.


  • Imitation of suicides depicted in the media occurs. Education of media professionals can change reporting practices and such changes seem to reduce suicide in certain contexts but the data are limited.

Long-term public education campaigns and media training should be evaluated for their effectiveness both to change the public’s knowledge and attitudes and to reduce suicide and suicidal behaviors.

  • Reduction in access to a means of suicide can result in a decline in the use of that method. This decline sometimes occurs without substitution of means, thereby reducing suicide. Access to firearms is a particular risk factor for youth. Families often do not comply with counseling about the removal of guns from the home or securing the firearms. Evidence suggests that legislation can be effective.

Measures should be taken to reduce the fatality of all methods. Access to guns should be reduced, especially for those at high risk of suicide. Health care providers should involve families in working to reduce access to means. Education of health care providers about these issues would increase their knowledge regarding concerns and options and should be implemented.

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