A Letter From The Surgeon General
U.S. Department of Health and Human Services
Suicide is a serious public health problem. In 1996, the year for which
the most recent statistics are available, suicide was the ninth leading
cause of mortality in the United States, responsible for nearly 31,000
deaths. This number is more than 50% higher than the number of homicides in
the United States in the same year (around 20,000 homicides in 1996).1
Many fail to realize that far more Americans die from suicide than from
homicide. Each year in the United States, approximately 500,000 people
require emergency room treatment as a result of attempted suicide.2
Suicidal behavior typically occurs in the presence of mental or substance
abuse disorders—illnesses that impose their own direct suffering.3-5
Suicide is an enormous trauma for millions of Americans who experience the
loss of someone close to them.6 The nation must address suicide
as a significant public health problem and put into place national
strategies to prevent the loss of life and the suffering suicide causes.
In 1996, the World Health Organization (WHO), recognizing the growing
problem of suicide worldwide, urged member nations to address suicide. Its
document, Prevention of Suicide: Guidelines for the Formulation and
Implementation of National srategies7, motivated the creation
of an innovative public/private partnership to seek a national strategy for
the United States. This public/private partnership included agencies in the
U.S. Department of Health and Human Services, encompassing the Centers for
Disease Control and Prevention (CDC), the Health Resources and Services
Administration (HRSA), the Indian Health Service (IHS), the National
Institute of Mental Health (NIMH), the Office of the Surgeon General, and
the Substance Abuse and Mental Health Services Administration (SAMHSA) and
the Suicide Prevention Advocacy Network (SPAN), a public grassroots advocacy
organization made up of suicide survivors (persons close to someone who
completed suicide), attempters of suicide, community activists, and health
and mental health clinicians.
An outgrowth of this collaborative effort was a jointly sponsored
national conference on suicide prevention convened in Reno, Nevada, in
October 1998. Conference participants included researchers, health and
mental health clinicians, policy makers, suicide survivors, and community
activists and leaders. They engaged in careful analysis of what is known and
unknown about suicide and its potential responsiveness to a public health
model emphasizing suicide prevention.
This Surgeon General’s Call To Action introduces a
blueprint for addressing suicide—Awareness, Intervention, and Methodology,
or AIM—an approach derived from the collaborative deliberations of
the conference participants. As a framework for suicide prevention, AIM
includes 15 key recommendations that were refined from consensus and
evidence-based findings presented at the Reno conference. Recognizing that
mental and substance abuse disorders confer the greatest risk for suicidal
behavior, these recommendations suggest an important approach to preventing
suicide and injuries from suicidal behavior by addressing the problems of
undetected and undertreated mental and substance abuse disorders in
conjunction with other public health approaches.
These recommendations and their supporting conceptual framework are
essential steps toward a comprehensive National Strategy for Suicide
Prevention. Other necessary elements will include constructive public
health policy, measurable overall objectives, ways to monitor and evaluate
progress toward these objectives, and provision of resources for groups and
agencies identified to carry out the recommendations. The nation needs to
move forward with these crucial recommendations and support continued
efforts to improve the scientific bases of suicide prevention.
Many people, from public health leaders and mental and substance abuse
disorder health experts to community advocates and suicide survivors, worked
together in developing and proposing AIM for the American public.
AIM and its recommendations chart a course for suicide prevention action
now as well as serve as the foundation for a more comprehensive National
Strategy for Suicide Prevention in the future. Together, they represent
a critical component of a broader initiative to improve the mental health of
the nation. I endorse the ongoing work necessary to complete a National
Strategy because I believe that such a coordinated and evidence-based
approach is the best way to use our resources to prevent suicide in America.
But even the most well-considered plan accomplishes nothing if it is not
implemented. To translate AIM into action, each of us, whether we
play a role at the federal, state, or local level, must turn these
recommendations into programs best suited for our own communities. We must
act now. We cannot change the past, but together we can shape a different
David Satcher, M.D., Ph.D.
Assistant Secretary for Health
and Surgeon General
Suicide as a Public Health Problem
On average, 85 Americans die from suicide each day. Although more females
attempt suicide than males, males are at least four times more likely to die
from suicide.1,8 Firearms are the most common means of suicide
among men and women, accounting for 59% of all suicide deaths.1
Over time, suicide rates for the general population have been fairly
stable in the United States.9 Over the last two decades, the
suicide rate has declined from 12.1 per 100,000 in 1976 to 10.8 per 100,000
in 1996.10 However, the rates for various age, gender and ethnic
groups have changed substantially. Between 1952 and 1996, the reported rates
of suicide among adolescents and young adults nearly tripled.1,11
From 1980 to 1996, the rate of suicide among persons aged 15-19 years
increased by 14% and among persons aged 10-14 years by 100%. Among persons
aged 15-19 years, firearms-related suicides accounted for 96% of the
increase in the rate of suicide since 1980. For young people 15-24 years
old, suicide is currently the third leading cause of death, exceeded only by
unintentional injury and homicide.12 More teenagers and young
adults die from suicide than from cancer, heart disease, AIDS, birth
defects, stroke, pneumonia and influenza, and chronic lung disease
combined. During the past decade, there have also been dramatic and
disturbing increases in reports of suicide among children. Suicide is
currently the fourth leading cause of death among children between the ages
of 10 and 14 years.10
Suicide remains a serious public health problem at the other end of the
age spectrum, too. Suicide rates increase with age and are highest among
white American males aged 65 years and older. Older adult suicide victims,
when compared to younger suicide victims, are more likely to have lived
alone, have been widowed, and to have had a physical illness.13,14
They are also more likely to have visited a health care professional shortly
before their suicide and thus represent a missed opportunity for
Other population groups in this country have specific suicide prevention
needs as well. Many communities of Native Americans and Alaskan Natives long
have had elevated suicide rates.16,17 Between 1980 and 1996, the
rate of suicide among African American males aged 15-19 years increased 105%
and almost 100% of the increase in this group is attributable to the use of
It is generally agreed that not all deaths that are suicides are reported
as such. For example, deaths classified as homicide or accidents, where
individuals may have intentionally put themselves in harm’s way are not
included in suicide rates.19-21
Compounding the tragedy of loss of life, suicide evokes complicated and
uncomfortable reactions in most of us. Too often, we blame the victim and
stigmatize the surviving family members and friends. These reactions add to
the survivors’ burden of hurt, intensify their isolation, and shroud suicide
in secrecy. Unfortunately, secrecy and silence diminish the accuracy and
amount of information available about persons who have completed suicide—
information that might help prevent other suicides.
Developing Recommendations for a National Strategy for Suicide
Developing and implementing a National Strategy for Suicide Prevention
should achieve a significant, measurable, and sustained reduction in
suicidal behaviors. The action steps presented in this document were
prioritized from among a variety of recommendations developed through a
public-private collaboration of nongovernmental organizations, federal and
state governmental agencies, corporations and foundations, and public
health, health, mental health experts.
Before the Reno Conference, experts evaluated research studies, programs,
policies, and best interventions to prevent suicide among five U.S.
population groups known to be at high risk of suicide. Those identified as
being at increased risk were youth, the medically ill, specific population
groups, persons with mental and substance abuse disorders, and the elderly.
Following review of the evidence by a second expert, the lead expert
extracted recommendations for suicide prevention. In extracting
recommendations, experts were instructed to consider the robustness of the
available data; an intervention’s likelihood of reducing suicide; its
perceived suitability for implementation in the real world; and estimates of
the lead-time to put the recommendation into practice and produce its
intended effect. They were also asked to consider the ethical implications
and cultural appropriateness of each recommendation.
Those experts’ draft recommendations were brought to the Reno conference.
A broad cross section of conference participants and a highly varied expert
panel were identified to work with the recommendations and evaluate each
one. The panel and the invited conference participants represented diverse
areas of expertise and included researchers, suicide survivors, persons who
had attempted suicide, public health leaders, community volunteers,
clinicians, educators, consumers of mental health services, and
corporate/nonprofit advocates. Financial support was made available so that
socioeconomic status would not exclude panelists and participants who wanted
to contribute from attending the conference. The Regional Health
Administrators of the U.S. Public Health Service served as facilitators in
working with over 400 participants to refine recommendations during the
conference. The expert panel received over 700 written comments from
participants during the course of their deliberations.
The expert panel’s recommendations were derived from a rigorous review of
suicide and suicide prevention research. Existing suicide research is
strongest in the identification of risk factors, particularly mental and
substance abuse disorders, less developed in categorizing protective
factors, and only beginning to analyze the mutual interactions among risk
and protective factors. Some treatments for mental and substance abuse
disorders have been associated with a reduction in suicidal behaviors.22-30
Further research is needed to determine whether these benefits will occur if
treatments are offered to groups outside the small populations that were
The recommendations the panel developed include past and current
initiatives, programs, and interventions. Other recommendations
pragmatically extend findings from existing suicide and suicide prevention
research into proposed applications. Suicide prevention experts from
multiple disciplines endorsed these proposed recommendations as having the
greatest potential for effectiveness.
By the end of the conference, the expert panel had advanced 81
recommendations for consideration for inclusion in a National Strategy
for Suicide Prevention. These recommendations were posted on the SPAN
Web site to allow a period of further reflection and public comment. The CDC
developed a tool for priority ranking the 81 recommendations. Respondents
from all interested sectors prioritized the recommendations using criteria
of feasibility, necessity, clarity, and likelihood of being funded.
Recommendations with the highest priority scores and broadest support were
combined and edited to serve as the essential first steps of an action
agenda for suicide prevention.
AIM to Prevent Suicide
This Surgeon General’s Call to Action introduces an initial
blueprint for reducing suicide and the associated toll that mental and
substance abuse disorders take in the United States. As both evidence-based
and highly prioritized by leading experts, these 15 key recommendations
listed below should serve as a framework for immediate action. These
recommended first steps are categorized as Awareness, Intervention, and
Methodology, or AIM.
Awareness: Appropriately broaden the public’s awareness of
suicide and its risk factors
Intervention: Enhance services and programs, both
population-based and clinical care
Methodology: Advance the science of suicide prevention
Awareness: Appropriately broaden the public’s awareness of suicide and
its risk factors
- Promote public awareness that suicide is a public
health problem and, as such, many suicides are preventable. Use
information technology appropriately to make facts about suicide and its
risk factors and prevention approaches available to the public and to
health care providers.
- Expand awareness of and enhance resources in
communities for suicide prevention programs and mental and substance abuse
disorder assessment and treatment.
- Develop and implement strategies to reduce the stigma
associated with mental illness, substance abuse, and suicidal behavior and
with seeking help for such problems.
Intervention: Enhance services and programs, both population-based and
- Extend collaboration with and among public and private
sectors to complete a National Strategy for Suicide Prevention.
- Improve the ability of primary care providers to
recognize and treat depression, substance abuse, and other major mental
illnesses associated with suicide risk. Increase the referral to specialty
care when appropriate.
- Eliminate barriers in public and private insurance
programs for provision of quality mental and substance abuse disorder
treatments and create incentives to treat patients with coexisting mental
and substance abuse disorders.
- Institute training for all health, mental health,
substance abuse and human service professionals (including clergy,
teachers, correctional workers, and social workers) concerning suicide
risk assessment and recognition, treatment, management, and aftercare
- Develop and implement effective training programs for
family members of those at risk and for natural community helpers on how
to recognize, respond to, and refer people showing signs of suicide risk
and associated mental and substance abuse disorders. Natural community
helpers are people such as educators, coaches, hairdressers, and faith
leaders, among others.
- Develop and implement safe and effective programs in
educational settings for youth that address adolescent distress, provide
crisis intervention and incorporate peer support for seeking help.
- Enhance community care resources by increasing the use
of schools and workplaces as access and referral points for mental and
physical health services and substance abuse treatment programs and
provide support for persons who survive the suicide of someone close to
- Promote a public/private collaboration with the media
to assure that entertainment and news coverage represent balanced and
informed portrayals of suicide and its associated risk factors including
mental illness and substance abuse disorders and approaches to prevention
Methodology: Advance the science of suicide prevention
- Enhance research to understand risk and protective
factors related to suicide, their interaction, and their effects on
suicide and suicidal behaviors. Additionally, increase research on
effective suicide prevention programs, clinical treatments for suicidal
individuals, and culture-specific interventions.
- Develop additional scientific strategies for
evaluating suicide prevention interventions and ensure that evaluation
components are included in all suicide prevention programs.
- Establish mechanisms for federal, regional, and state
interagency public health collaboration toward improving monitoring
systems for suicide and suicidal behaviors and develop and promote
standard terminology in these systems.
- Encourage the development and evaluation of new
prevention technologies, including firearm safety measures, to reduce easy
access to lethal means of suicide.
Risk and Protective Factors
Suicide risk and protective factors and their interactions form the
empirical base for suicide prevention. Risk factors are associated with a
greater potential for suicide and suicidal behavior while protective factors
are associated with reduced potential for suicide.31-33
Substantial age, gender, ethnic, and cultural variations in suicide rates
provide opportunities to understand the different roles of risk and
protective factors among these groups. Risk and protective factors encompass
genetic, neurobiological, psychological, social, and cultural
characteristics of individuals and groups and environmental factors such as
easy access to firearms.34-38 This expanding base of empirical
evidence generates promising ideas about what can be changed or modified to
Clear progress has been made in the scientific understanding of suicide,
mental and substance abuse disorders, and in developing interventions to
treat these disorders. For example, increased understanding of brain systems
regulated by chemicals called neurotransmitters holds promise for
understanding the biological underpinnings of depression, anxiety disorders,
impulsiveness, aggression, and violent behaviors.39 Much remains
to be learned, however, about the common risk factors for mental disorders
and substance abuse, suicide and other forms of intentional violence
including homicide, domestic violence, and child abuse. Expanding the base
of scientific evidence will help in the development of more effective
interventions for these harmful behaviors.
Advances in neurobiology and the behavioral sciences and their
application in developing effective treatments for mental and substance
abuse disorders have generated much hope. Wider public understanding of the
science of the brain and behavior can reduce the stigma associated with
seeking help for mental and substance abuse disorders and consequently may
contribute to reducing the risk for suicidal behavior.
Understanding risk factors can help dispel the myths that suicide is a
random act or results from stress alone. Some persons are particularly
vulnerable to suicide and suicidal self-injury because they have more than
one mental disorder present40, such as depression with alcohol
abuse41. They may also be very impulsive and/or aggressive42,
and use highly lethal methods to attempt suicide. As noted above, the
importance of certain risk factors and their combination vary by age,
gender, and ethnicity.
The impact of some risk factors can be reduced by interventions (such as
providing effective treatments for depressive illness).31,43
Those risk factors that cannot be changed (such as a previous suicide
attempt) can alert others to the heightened risk of suicide during periods
of the recurrence of a mental or substance abuse disorder, or following a
significant stressful life event.31,44
Risk factors include:
- Previous suicide attempt
- Mental disorders—particularly mood disorders such as
depression and bipolar disorder
- Co-occurring mental and alcohol and substance abuse
- Family history of suicide
- Impulsive and/or aggressive tendencies
- Barriers to accessing mental health treatment
- Relational, social, work, or financial loss
- Physical illness
- Easy access to lethal methods, especially guns
- Unwillingness to seek help because of stigma
attached to mental and substance abuse disorders and/or suicidal
- Influence of significant people—family members,
celebrities, peers who have died by suicide—both through direct personal
contact or inappropriate media representations
- Cultural and religious beliefs—for instance, the
belief that suicide is a noble resolution of a personal dilemma
- Local epidemics of suicide that have a contagious
- Isolation, a feeling of being cut off from other
Some lists of warning signs for suicide have been created in an effort to
identify and increase the referral of persons at risk. However, the warning
signs given are not necessarily risk factors for suicide and may include
common behaviors among distressed persons, behaviors that are not specific
for suicide. If such lists are applied broadly, for instance in the general
classroom setting, they may be counterproductive. In effect, indiscriminate
suicide awareness efforts and overly inclusive screening lists may promote
suicide as a possible solution to ordinary distress or suggest that suicidal
thoughts and behaviors are normal responses to stress.45 Efforts
must be made to avoid normalizing, glorifying, or dramatizing suicidal
behavior, reporting how-to methods, or describing suicide as an
understandable solution to a traumatic or stressful life event.
Inappropriate approaches could potentially increase the risk for suicidal
behavior in vulnerable individuals, particularly youth.46,47
Protective factors can include an individual’s genetic or neurobiological
makeup, attitudinal and behavioral characteristics, and environmental
attributes.31 Measures that enhance resilience or protective
factors are as essential as risk reduction in preventing suicide. Positive
resistance to suicide is not permanent, so programs that support and
maintain protection against suicide should be ongoing.
Protective factors include:
- Effective and appropriate clinical care for mental,
physical, and substance abuse disorders
- Easy access to a variety of clinical interventions
and support for help seeking
- Restricted access to highly lethal methods of
- Family and community support
- Support from ongoing medical and mental health care
- Learned skills in problem solving, conflict
resolution, and nonviolent handling of disputes
- Cultural and religious beliefs that discourage
suicide and support self-preservation instincts
The risk factors that lead to suicide (especially mental and substance
abuse disorders) and the protective factors that safeguard against it form
the conceptual framework for the prevention recommendations developed and
presented in this document and in the evolving National Strategy for
Identifying and Addressing Risk
Unfortunately, it is difficult to identify particular individuals at
greatest risk for suicidal behaviors or completed suicide. Measures to
screen the general population for suicide risk lack the precision needed to
identify in advance only those people who eventually would die by suicide.
Because suicide screening in the general population currently is not
feasible, it is especially important for suicide prevention programs to
include broader approaches that benefit the whole population as well as
efforts focused on smaller, high-risk subgroups that can be identified.
Within those subgroups, a different approach to screening—screening programs
for specific disorders, like depression, that are associated with
suicide—can be used to identify and direct people to highly effective
treatments that may lower their risk of suicide.
Often, the suicide prevention efforts in place are directed primarily at
improving clinical care for the individual already struggling with suicidal
ideas or the individual requiring medical attention for a suicide attempt.
Suicide prevention also demands approaches that reduce the likelihood of
suicide before vulnerable individuals reach the point of danger. Applying
the public health approach to the problem of suicide in the United States
will maximize the benefits of efforts and resources for suicide prevention.
The Public Health Approach
Suicide is a public health problem that requires an evidence-based
approach to prevention. In concert with the clinical medical approach, which
explores the history and health conditions that could lead to suicide in a
single individual, the public health approach focuses on identifying and
understanding patterns of suicide and suicidal behavior throughout a group
or population. The public health approach defines the problem, identifies
risk factors and causes of the problem, develops interventions evaluated for
effectiveness, and implements such interventions widely in a variety of
Although this description suggests a linear progression from the first
step to the last, in reality the steps occur simultaneously and depend on
each other. For example, systems for gathering information to define the
exact nature of the suicide problem may also be useful in evaluating
programs. Similarly, information gained from program evaluation and
implementation may lead to new and promising interventions. Public health
has traditionally used this model to respond to epidemics of infectious
disease. During the past few decades, the model has also been used to
address other problems that are likewise complicated and challenging to
prevent, such as chronic disease and injury.
The Public Health Approach Applied to Suicide Prevention
Defining the Problem
The first step includes collecting information about incidents of suicide
and suicidal behavior. It goes beyond simple counting. Information is
gathered on characteristics of the persons involved, the circumstances of
the incidents, events that may have precipitated the act, the adequacy of
support and health services received, and the severity and cost of the
Identifying Causes and Protective Factors
The second step focuses on why. It addresses risk factors such as
depression, alcohol and other drug use, bereavement, or job loss. This step
may be used to define groups of people at higher risk for suicide. Many
questions remain, however, about the interactive matrix of risk and
protective factors in suicide and suicidal behavior and, more importantly,
how this interaction can be modified.
Developing and Testing Interventions
The next step involves developing approaches to address the causes and risk
factors that have been identified. Testing the effectiveness of each
approach is a critical part of this step to ensure that strategies are safe,
ethical, and feasible. Pilot testing, which may reveal differences among
particular age, gender, ethnic and cultural groups, can help determine for
whom a suicide prevention strategy is best fitted.
The final step is to implement interventions that have demonstrated
effectiveness in preventing suicide and suicidal behavior. Implementation
requires data collection as a means to continue evaluating effectiveness of
an intervention. This is essential because an intervention that has been
found effective in a clinical trial or academic study may have different
outcomes in other settings. Ongoing evaluation builds the evidence base for
refining and extending effective suicide prevention programs. Determination
of an intervention’s cost-effectiveness is another important component of
this step. This ensures that limited resources can be used to achieve the
As interventions for preventing suicide are developed and implemented,
communities must consider several key factors. Interventions have a much
greater likelihood of success if they involve a variety of services and
providers. This requires community leaders to build effective coalitions
across traditionally separate sectors, such as the health care delivery
system, the mental health system, faith communities, schools, social
services, civic groups, and the public health system. Interventions must be
adapted to support and reflect the experience of survivors and specific
community values, cultures, and standards. They must also be designed to
benefit from multi-ethnic and culturally diverse participation from all
segments of the community.
As it evolves, America’s National Strategy for Suicide Prevention
must recognize and affirm the value, dignity, and importance of each person.
Everyone concerned with suicide prevention shares the responsibility to help
change and eliminate the societal conditions and attitudes that often
contribute to suicide. Individuals, communities, organizations, and leaders
at all levels should collaborate in promoting suicide prevention. Final
development of a National Strategy for Suicide Prevention and the
success of these essential action steps ultimately rest with individuals and
communities and institutions and policy makers across the United States.
Implementing AIM as an Action Agenda in Communities
As states and local communities apply the public health approach to
AIM recommendations, they must consider both population-based and
clinical care initiatives. Their first step is to define and to describe the
problem of suicide and its associated risk factors locally and measure their
magnitude. Next, causes of the conditions found must be identified. Then,
community interventions must be designed to address the identified needs
through attention to the causes revealed. Evaluating project effectiveness
provides guidance for refining the intervention and expanding benefits to
other settings. The following hypothetical descriptions of community suicide
prevention activities have been created to illustrate applied public health
and clinical management prevention models.
Recognizing the state’s increasing rates of substance abuse and suicide
among youth, the state public health director in consultation with the
Regional Health Administrator brought together concerned representatives to
form a state youth suicide, substance abuse and depression prevention
coalition. The coalition members reflected many sectors in the community
including suicide survivors, educators, social service agencies, the faith
community, businesses, the state cooperative extension programs (4-H),
school psychologists, child psychiatrists, the PTA, substance abuse
treatment counselors, public officials, and the juvenile justice system. The
coalition also established a youth advisory board.
After collecting detailed information on the dimensions of youth
substance abuse, depression and suicide in the state and identifying how few
school systems had screening, referral, and crisis plans, the coalition
formed a multidisciplinary study committee to develop a model suicide
prevention plan. A broad array of public and professional organizations in
the state studied and endorsed the model plan. A corporate partner from the
business community provided a grant to distribute the model plan along with
a curriculum guide for natural helpers to identify high-risk youth. As
school districts adapted the plan and implemented it locally, follow-up
surveys were conducted to determine patterns of use, satisfaction with the
model plan and guide, and impact on substance abuse, depression and suicidal
behaviors in communities statewide. Based on evidence collected from the
evaluations, the model plan was revised to include more guidance on working
with the media to de-sensationalize coverage of suicide, and promote
abstinence from substance use as well as encourage youth to seek treatment
for both substance abuse and depression.
The public health approach has revealed that suicide rates are highest among
the elderly and that most elderly suicide victims are seen by their primary
care provider within a few weeks of their suicide and are experiencing a
first episode of mild to moderate depression. Recognizing that clinical
depression is a highly treatable illness, but treatment has not yet been
adequately provided in primary care settings, a state with a large elderly
population brought together a group of health professionals and community
advocates. Together they devised and supported a pilot program to follow
depression screening in the primary care setting with the addition of an
on-site nurse or social worker specializing in depression services. These
on-site specialists ensured that those elderly patients who screened
positive for depression received depression treatment and follow up from the
physician and assessed patient progress so that ongoing treatments could be
adjusted to increase their effectiveness. Outcomes for patients in the pilot
project were compared to those patients receiving usual treatment in
comparable primary care settings. This evaluation provided information to
fine tune the program and extend its benefits to other primary care settings
in the state.
Advancing a National Suicide Prevention Strategy
The 15 recommendations (AIM) presented in this Surgeon General’s
Call to Action propose a nationwide, collaborative effort to reduce
suicidal behaviors, and to prevent premature death due to suicide across the
life span. The conceptual framework for AIM incorporates analysis of
suicide risk and protective factors and emphasizes the benefits of
effectively treating mental and substance abuse disorders. A comprehensive
National Strategy for Suicide Prevention should include these
elements along with supportive government policy, measurable objectives for
the Strategy, means of monitoring and evaluating progress, and
provision of authority and resources to carry out the Strategy’s
To realize success in preventing suicide and suicidal behaviors,
collaboration must be fostered on this public health priority across a broad
spectrum of agencies, institutions, groups, and representative individuals
throughout the country. As additional elements of a comprehensive
Strategy evolve, the public and prospective implementation partners must
also sustain awareness that improved detection and treatment of mental and
substance abuse disorders represent a primary approach to suicide
prevention. These partners must ensure the availability of evidence-based
guidance for communities to develop and refine effective suicide prevention
approaches. Likewise, as communities implement approaches to recognize and
reduce risk factors to prevent suicide, they must be aware of the dangers of
inadvertently glamorizing suicide, and remain vigilant to avoid doing so.
Ongoing review of research, policy, and program advances in suicide
prevention may expand the number of effective initiatives and interventions
for incorporation into the Strategy. Work should continue that
outlines measurable objectives for an overall Strategy, provides
mechanisms for tracking these objectives, and develops means of
communicating significant progress in preventing suicide and suicidal
Americans in communities nationwide can make a significant difference in
preventing suicide and suicidal behaviors. The recommendations presented in
AIM provide a blueprint and call for action now. Programs and
activities that are carried out and evaluated today will generate additional
recommendations for effective suicide prevention initiatives in the future.
Working together locally, in states, and at the federal level to complete
and implement a National Strategy for Suicide Prevention is an
important step in responding to the major public health problem of suicide
in the United States.
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Suggested Citation: U.S. Public Health Service, The Surgeon General's
Call To Action To Prevent Suicide. Washington, DC: 1999.
Technical assistance and scientific consultation in the preparation of
this document was provided by the CDC, NIMH, Office of the Surgeon General
and SAMHSA. Support for its publication has been provided by the CDC,
National Center for Injury Prevention and Control. Support for the National
Conference on Suicide Prevention in Reno, Nevada, 1998, was provided in part
by the Centers for Disease Control and Prevention (National Center for
Injury Prevention and Control), the Health Resources and Services
Administration, the National Institute of Mental Health, and the Substance
Abuse and Mental Health Services Administration (Center for Mental Health
Written by Lucy Davidson, MD, EdS; Lloyd Potter, PhD, MPH; and Virginia
In collaboration with Virginia Trotter Betts, MSN, JD, RN, FAAN; Alex
Crosby, MD, MPH; CDR Robert DeMartino, MD; Rodney Hammond, PhD; Kay Jamison,
PhD; Jane Pearson, PhD; RADM Darrel Regier, MD, Elsie Weyrauch, RN; and
Gerald Weyrauch, MBA.
Office of the Surgeon General scientific review and editing of this
document was provided by: RADM Susan J. Blumenthal, MD, MPA.
Members of the Conference Expert Panel: Morton M. Silverman, MD
(Chairperson); Alex Crosby, MD, MPH; Laurie Flynn; Dequincy A. Lezine; Jim
Moore; Jane Pearson, PhD; Leslie Scallet, JD; David Shaffer, MD; Scot
Simpson; Susan Soule, MA; Karl F. Weyrauch, MD, MPH.