Surgeon General Aims Campaign at Rising Suicide Rate

Declaring suicide a serious public health problem, U.S. Surgeon General David Satcher on Wednesday unveiled a national campaign to prevent suicide, which now claims more American lives than homicide.

“Suicide has stolen lives around the world and across the centuries,” Satcher said. “Meanings attributed to suicide and notions of what to do about it have varied with time and place--but suicide has continued to exact a relentless toll.”

The plan, modeled after an Air Force program that by the late 1990s had cut suicides within its ranks by half, calls for a broad-based communitywide approach to early intervention, counseling and other services.

Praising the Air Force plan, which was developed in consultation with the Centers for Disease Control and Prevention, Satcher said that a national attack on the suicide epidemic comes none too soon.

More than 30,000 Americans take their lives annually, making it the nation’s eighth-leading cause of death. Among young people, the rate has tripled since 1952, making it the third-leading killer of those ages 10 to 24.

There are three suicides for every two murders, and suicide kills twice as many people as does AIDS.

“Only recently have the knowledge and tools become available to approach suicide as a preventable problem with realistic opportunities to save many lives,” Satcher said, stressing that suicide can be prevented by the combined efforts of families, schools, doctors, states and the federal government.

The Air Force confronted a frightening escalation in suicides that accounted for nearly a quarter of all deaths among active-duty personnel from 1990 to 1994 and was the second-leading cause of death, after unintentional injuries.

Enlisting the help of federal health officials, the Air Force designed a program that emphasized early intervention and support services. They also trained unit leaders, chaplains and medical and mental health providers to recognize people at risk. The program was implemented in 1996.

By 1998, the suicide rate in the Air Force had dropped from 16.4 suicides per 100,000 members to 9.4.

To be sure, the military is a closed society with “the ability to impose the kind of discipline that’s not available for the public at large,” said a spokesman for Satcher. “Nevertheless, it proves such a program can work.”

The surgeon general’s suicide prevention report lays out a similar blueprint of public and private actions on a national scope, identifying goals for each segment of the community.

Among other things, the report urged that teachers, clergy and doctors be trained to recognize at-risk behaviors and that suicide risk screening should become part of every primary health care practice.

It also called for insurance coverage of services to treat mental health conditions and substance abuse, since the majority of suicides occur among individuals suffering from these disorders.

“Our society is in denial,” said Michael M. Faenza, president of the National Mental Health Assn., which issued its own survey Wednesday showing that as many as 8.4 million Americans have contemplated suicide. “Just as millions of Americans a decade ago were in denial of cancer risks, Americans today are in denial of the risks of untreated mental illness.”

Thirty-two states now require health plans to offer some mental health coverage, including California, according to the National Alliance for the Mentally Ill.

“Because of the lingering stigma of mental illness and discriminatory insurance practices, too many Americans are not seeking and receiving the treatment they deserve,” Faenza said. “After every suicide, the question is always, ‘Why? Why did he give up? Why didn’t she reach out?’ The real question society needs to ask . . . is, ‘Why are we still living in the Dark Ages when it comes to mental illness?’ ”

Taking aim at the portrayal of mental illness on television and in the movies, Satcher said that media portrayals can affect the suicide rate--all too often in a harmful way. “Negative views of these problems may lead individuals to deny they have a problem or be reluctant to seek treatment--and untreated mental illness and substance abuse are strongly correlated with suicide,” the report said.

Satcher’s report also challenged the notion that suicide is inevitable among those determined to kill themselves.

“If the general public understands that suicide and suicidal behaviors can be prevented, and people are made aware of the roles individuals and groups can play in prevention, the suicide rate can be reduced,” the report said.