Suicide Prevention by Research Is Fundamentally Important

Two years ago on Memorial Day, I wrote: “There is no better way to honor the men and women who have died by suicide – and their remaining families and friends – than to ensure that the State does all it can to prevent future untimely deaths.” This message is especially important this year as the U.S. Department of Defense (DoD) continues to struggle with the growing number of suicides in the military.

I believe that research can make a difference, and at RAND we are focusing significant efforts on conducting high-quality, unbiased research to prevent suicides. This work began in the military. In 2011, RAND published a report, The War Within, which identified strengths and gaps in the military's current approaches to suicide prevention.

The report's findings and recommendations formed the basis for Senator Patty Murray's 2013 amendment to the National Defense Authorization Act, which called for a comprehensive military suicide prevention program.

In 2012, as part of its work for the California Mental Health Services Authority (CalMHSA), the RAND Task Force, led by Joie Acosta, presented a model illustrating how each of nine different types of suicide prevention programs could lead to a reduction in suicides.

This was an important “next step” in relation to the recommendations of The War Within study, as it identified the types of programs that could constitute a comprehensive approach to suicide, whether used in a school, workplace, community, military unit or state.

Acosta led another RAND working group that developed a step-by-step tool for the Department of Defense to help stakeholders assess suicide prevention efforts. The importance of this product, which will be released in the coming weeks, is best expressed in the authors' foreword:

“Evaluations are critical for measuring the impact of suicide prevention investments and can help inform decisions about continuing or expanding existing efforts.” RAND is also working with the Army to develop recommendations on how the Army could develop a strategic roadmap for future suicide prevention research.

The Army will provide its NCOs with comprehensive training on how to identify and interact with people at risk for suicide. In fact, such “gatekeeper” programs are commonplace in suicide prevention programs across the United States.

As part of the upcoming study, RAND interviewed more than 1,000 Army NCOs and nearly 1,000 Navy NCOs to determine whether they believe they are gatekeepers and what might prevent them from intervening with people at risk.

We also interviewed military chaplains and military chaplain assistants, to whom service members in crisis often turn for confidential help. This study may suggest that a combination of individual and cultural characteristics influences whether an NCO or chaplain refers a person in crisis to a behavioral health care provider.

In California, CalMHSA has funded 12 hotlines to improve their services in a variety of ways, such as expanding their reach, improving language skills, and offering new ways, such as online chat or text messaging, for people to communicate with counselors. CalMHSA also funded a statewide social marketing campaign focused on promoting transitional behavior.

Hotlines and social marketing campaigns are widespread, but it is unclear whether they help prevent suicide. RAND will help fill this gap by conducting a comprehensive evaluation of CalMHSA efforts, which include funding gatekeeper training statewide, support for community-based service providers across the state, and a variety of activities to reduce mental health stigma.

RAND is also dedicated to helping people who have lost someone to suicide. In another study for the Department of Defense that is nearing completion, RAND researchers reviewed the literature available to help organizations and agencies respond to employee or member suicide.

The purpose of our work is to identify the goals of the literature (e.g., to help people grieve, prevent suicide, or both) and the evidence to date of the effectiveness of the recommendations in achieving these goals.

Although our research has taught us much about suicide prevention-and we continue to do research in other areas-we believe there are two areas where further research is urgently needed. The first is gun control. Fifty percent of suicides are caused by firearms, and more than 60 percent of all firearm deaths are suicides.

However, as my colleagues have pointed out, there has been little research on gun violence, including self-inflicted injuries, since 1996, when the House of Representatives withdrew funding for firearm injury research from the Centers for Disease Control and Prevention.

As for suicide prevention, the evidence in favor of restricting the means of committing suicide is compelling, but we need more information on how background checks, safe storage of firearms, and even firearm design affect suicide rates.

Another issue is the quality of behavioral care available to those who need it. We know that certain medications and psychotherapies are effective in improving mental health and even reducing suicide rates. Research is needed to develop new treatments, but we also need to see to what extent patients who receive them benefit from treatments that have been shown to be effective.

We also need translational research to encourage community providers to adopt evidence-based practices and consumers to demand evidence-based treatments. Improving the quality of behavioral health care is critical to preventing suicide in the United States.

RAND is well positioned to conduct this research because it believes that suicide among U.S. soldiers is preventable. Like many Americans, I'm spending this Memorial Day at a family picnic to welcome the summer season and take a break from work.

But at the same time, I remind my supporters that it is also a time to honor the service and sacrifice of the men and women in uniform. This includes honoring those whose suffering was so great that they tragically chose to end their lives. These men and women deserve our respect and our commitment to do everything in our power to ensure that these tragedies never happen again.