help and support with a consequent decrease in suicide rates. Reducing the availability or the lethality of a method (such as using blister packs for pills or enacting stricter gun control laws) results in a decline in suicide by that method; method substitution does not invariably occur. Education of the media regarding appropriate reporting of suicides can change reporting practices. Such changes seem to reduce suicide in certain contexts but the data are limited.

Interventions that target groups with a greater likelihood of suicide (selective prevention measures) have also been shown to be effective. Screening programs, gatekeeper training programs, support/skills training groups, and school-based crisis response teams/plans can create a coordinated effort that identifies youth at suicide-risk and provides individual follow-up.

Indicated interventions directed toward individuals at high risk for suicide include medical and psychosocial approaches. Suicide is far more likely to occur in the first month after discharge from a psychiatric hospital than subsequently. Low treatment adherence poses a major risk factor for suicidal individuals. Long-term follow-up care of discharged suicidal individuals holds promise for reducing suicide. Controlling the underlying mental illness through pharmacology and psychotherapy is an important indicated prevention approach. Medication alone is not sufficient treatment for suicidality. Psychotherapy provides a necessary therapeutic relationship that reduces the risk of suicide. Cognitive-behavioral approaches that include problem-solving therapy appear to reduce suicidal ideation and attempts. However, major obstacles to utilizing these resources exist, including doctor–patient communication barriers, limitations on insurance or financing, and stigma of mental illness.

Providing skills and support for youth at risk through school programs appears to show promise. Optimism and coping skills, which enhance both mental and physical health, can be taught. Universal, selective, and indicated prevention programs that provide skills training reduce hopelessness. School-based programs employing a health promotion approach have been shown to effectively prevent and/or reduce suicide risk factors and correlates like adolescent pregnancy, delinquency, substance abuse, and depression. These programs also promote protective factors against suicide including self-efficacy, interpersonal problem solving, self-esteem, and social support. The data are limited, however, on the effectiveness of these programs to reduce completed suicides. Yet the known benefits and the links between these skills and suicide provide a logical rationale for recommending pilot studies in this area. Some international programs (see Chapter 8) have implemented similar efforts and it will be important to learn from their experiences.



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