Our opportunity to reduce suicide
BY NADINE J. KASLOW, PHD • APA PRESIDENT
“Complacency is perhaps the cardinal sin for those charged with protecting public health.”
— Sir Liam Donaldson
We all have personal reasons for doing the work we do, what we
advocate for and what we study. I focus
on suicide prevention because when I
was an adolescent, a close friend’s mother
died by suicide. During my training, I lost
two patients to suicide. I was profoundly affected by these losses
and developed a deep appreciation of the suffering loved ones
experienced related to these deaths. I have dedicated much of
my career therefore to training psychologists and psychologists-
to-be to assess and work competently with suicidal people and
their families and investigate culturally competent interventions
for African Americans who attempt suicide, particularly those
exposed to intimate partner violence.
But if we want societal change, we must go further by
adopting a public health perspective. We can learn from our
successes in tobacco reduction and the HIV/AIDS epidemic to
enhance our suicide prevention endeavors. We must delineate
a public health agenda to address diverse populations to reduce
the morbidity and mortality associated with the continuum of
A public health model must include:
• Standardizing and providing training to trainees and
psychologists on suicide assessment and treatment.
• Training community members as gatekeepers for
identifying and referring those at risk.
• Creating, assessing and disseminating programs that have a
These universal primary prevention strategies can directly
improve people’s lives; doing so is our social responsibility. Such
programs must incorporate an ecological framework and address
the individual, his or her social environment and relationships,
his or her broader communities and society at large. In recent
years, there have been fascinating developments, including:
• Upstream approaches, such as the Good Behavior Game, a
classroom management technique that reduces suicidal ideation
20 years later (Kellam et al., 2011).
• The Signs of Suicide prevention program in high schools.
• Gatekeeping programs in universities, such as Question/
• The U.S. Air Force Suicide Prevention Program, focused on
early identification and treatment.
• The Henry Ford Health System Initiative, which offers
depression care in a large health system (Hampton et al., 2010).
• Finding the Light Within, a community mobilization
public arts effort designed to reduce stigma associated with
We must be familiar with these best practices, modify them
to fit different settings and populations, and be leaders in
creating and promulgating culturally relevant, evidence-based
programs that can be implemented in diverse communities.
Notwithstanding the politics of the Affordable Care Act, the
prospect that millions of Americans will have health insurance
covering mental health benefits at a level comparable with their
physical health care is a watershed moment that could truly
destigmatize mental health care and suicide prevention services.
As psychologists, we must use our research to advocate for
systems of care that effectively identify, target and treat suicidal
people and their families. We can incorporate innovative
interventions in these care systems, such as the Relieflink app
my colleagues and I developed at Emory University.
Moving our public health-oriented suicide prevention
efforts forward requires visionary leadership, honest appraisal
of our past successes and failures, consensus building following
meaningful debate and deliberation, engagement of all relevant
stakeholders including patients and families, and active
engagement in relevant communities. It is tragic that each
year in America, 38,000 die by suicide; there is a recent spike
in the rates of suicide in young veterans; and rates of suicidal
behavior among lesbian, gay, bisexual, transgender, queer
and questioning youth are frighteningly high in part due to
bullying. These are numbers that we must — and we can —
As Dr. Eric D. Caine asserts in the American Journal of Public
Health, “Preventing suicide is a winnable battle!” n
For links to the references and resources in this article, visit our
Web edition at www.apa.org/monitor/2014/04/pc.aspx. To read
more about psychologists’ work on suicide prevention, see the
articles beginning on page 36.