• Professional medical organizations should provide training to health care providers for assessment of suicide risk and provide them with existing tools. Mental health professional associations should encourage (or require, when appropriate) their memberships to increase their skills in suicide risk detection and intervention. National, state, county, and city public health organizations should build on their existing infrastructure to facilitate suicide screening especially in high-risk populations.

  • Medical and nursing schools should incorporate the study of suicidal behavior into their curricula or expand existing education.

  • NIMH and Agency for Health Care Research and Quality (AHRQ) should work with physician associations including American College of Physicians, American College of Family Physicians, American Academy of Pediatricians, American Society of Internal Medicine to implement these recommendations. In addition, through their health services research funds they should support efforts to improve approaches to identifying and treating those at risk.

ENHANCING PREVENTION AND INTERVENTIONS

As the Surgeon General’s Call to Action states, prevention of suicide should be a national priority. The severity of the suicide problem nationally and globally demands that prevention programs be developed. Research is needed to rigorously test approaches at all levels of intervention. Successful experimental programs need to be expanded to larger populations. And effective approaches need to be implemented.

There are examples of promising universal, selective, and indicated interventions. Programs that integrate prevention at multiple levels are likely to be the most effective. Comprehensive, integrated state and national prevention strategies that target suicide risk and barriers to treatment across levels and domains appear to reduce suicide. Evaluation of such programs remains challenging given the multitude of variables on the individual and aggregate levels that interact to affect suicide rates. The value of intervention programs is frequently difficult to assess because of their short duration, inadequate control populations, and limited long-term follow up. Lack of adequate planning and funding for evaluation have seriously hampered prevention efforts.

Universal programs broadly blanketing a school or community have been shown to be effective in reducing suicide rates. For example, the Air Force’s prevention program removed barriers; increased knowledge, attitudes, and competencies within that community; and increased access to



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