Although we have made great strides in many areas of mental health over the past three decades, we have still not made sufficient progress in predicting and preventing suicide. Dr. Thomas Insel, Director of the National Institute of Mental Health (NIMH), pointed out in a recent interview that while we have actually seen significant decreases in homicide and accidental traffic deaths during the past 30 years, suicide rates have sadly not reflected the same decline.
While suicide remains a relatively infrequent event, it has proven to be difficult to track. In the college setting, there has only been one major long-term study tracking rates of suicides on a number of campuses. Whenever the Centers for Disease Control collects data, they do not even specify if a 22-year-old suicide victim had been a college student. In addition, we cannot always be sure whether a death classified as accidental might have actually been a suicide. When you combine the rarity of the event with multiple contributing factors, it becomes even more apparent why we remain unable to predict suicide with any degree of certainty or reliability.
Clinicians who work directly with suicidal patients compensate by attempting to make very short term predictions based on a combination of urgent risk factors such as intensity of depression, hopelessness, availability of means, impulsivity and a professional "gut feeling" among many others. This can be relatively successful at helping prevention but is obviously not an exact science -- even in the near term.
What do we do in the face of this challenge? I would like to highlight two important ideas that are of particular relevance to college mental health:
1) Devise a better way to collect data. (We will never be able to know whether interventions are working at this level if we do not have better information)
2) Recognize that the best approach to prevention is early intervention.
We know that certain psychiatric conditions, emotional traits, and social circumstances have an impact on suicide rates. As a result, we need to do the best we can to identify and robustly address these problems before a suicidal crisis emerges. It is essential we do this both on an individual and community level. This means making sure individuals have access to excellent mental health care, while simultaneously working to develop programs that actively encourage mental health, resilience and support on a community basis.
This suggestion is not so different from what our society does to prevent heart attacks. Cardiologists do not go around looking for people who are about to have a heart attack. Instead, they treat the pre-conditions, such as hypertension and elevated cholesterol as effectively as possible. We also work to prevent heart disease by encouraging weight control and exercise and listing fat content on ingredient lists.
Overall, the effort and money we put into a broad, community-based program for suicide prevention will also pay dividends in the promotion of general mental health throughout a campus and will help promote student success, retention, and optimal functioning. When viewed from this much wider perspective, this is an obvious and unarguable idea. While this approach may take years to show clear statistical dividends, there is no greater reward than a saved life.