Changing the Conversation from Suicide to Suicide Prevention:Messages that can Save Lives

John Draper, Ph.D.

Lifeline Executive Director

GLS Plenary

March 2018

Hotlines & Public Health: Promote Awareness & Help-seeking

“If only the signs were this easy to read”1-800-LIFENETNYC DMH Anti-stigma campaign, 2000

Post-9/11: Disaster Mental Health and Resilience

Even Superheroes Need Help Sometimes.1-800-LIFENET,Project Liberty, NY State, 2002

Lifeline: Online MessengerMillions of suicide prevention stakeholders across the United States are promoting the Lifeline, with 75% of Lifeline callers first learning of the service from online resources…

Any search that is suicide related results in a prominently displayed “one box” through our partnership with Google.

Our partnerships with social media companies reach up to seven million people annually. Lifeline has more “FB fans” than any other suicide prev. organization

When people in the United States mention suicide to Apple iPhone’s Siri, she refers them to the Lifeline.

2015-2017: Lifeline Web Site Visits

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User Overview February 2015 - December 2017

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2016 unique visitors (2.6m) were 22% more than 2015 (2.1m)2017 unique visitors (4.5m) were nearly 75% more than 2016

Lifeline and the Mass Media

What is Our Message for This?

• Does publicizing warning signs work? • If action step is only Hotlines or Professionals:

Suicide Prevention is other people’s business!

• If our efforts are mostly “Safe Messaging”:• Does not intentionally work with media to

reduce suicide rate (just avoid making it worse)

• Behavior change = telling people what more they can do is most effective

• Reactive and endless pursuit of bad actors; how will we know it’s working?

• Can potentially alienate media as partners in reducing suicide (Give them stories to help their reporting!)

Limitations of Traditional Suicide Prevention PH Messaging

USA National Action Alliance for Suicide Prevention Priority #3One of Top 3 Priorities:

Change the public conversation around suicide and suicide prevention. The Action Alliance will leverage the media and national leaders to change the national narratives around suicide and suicide prevention to ones that promote hope, connectedness, social support, resilience, treatment and recovery.

750,000Hospitalizations**

1,000,000 AttemptsRequiring Medical Attention**

2,600,000Suicide Attempts**

12,600,000 Seriously Considered Suicide**

44, 965Suicides*

SLIDE FROM DR. DeQuincy LeZine, Prevention Communities Inc. Primary author, The Way Forward, publication of the NAASPSource: * National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2009). Web-based Injury Statistics Query and Reporting System (WISQARS). Available from: www.cdc.gov/injury/wisqars/index.html. And CDC YRBS, 2016**Substance Abuse and Mental Health Services Administration, Results from the 2015 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016. And CDC YRBS, 2016.

The Tale of Tragedy and Misery

750,000Hospitalizations**

1,000,000 AttemptsRequiring Medical Attention**

2,600,000Suicide Attempts**

12,600,000 Seriously Considered Suicide**

38,364Suicides*

Changing the Conversation

44,965Suicides

NAASP Response to CDC Report on Suicide Rates

“The CDC data remind us that there is more we must all do to prevent suicide in our communities. However, it is important to be aware of data that indicates suicide prevention is effectively occurring daily, in ways that are rarely finding headlines. For every one person who tragically dies by suicide in the U.S., there are approximately 278 people who have moved past serious thoughts about killing themselves, and nearly 60 who have survived a suicide attempt, the overwhelming majority of whom will go on to live out their lives. These untold stories of hope and recovery are the stories of suicide prevention, stories which are informing the Action Alliance’s efforts to prevent more suicides every day.”Excerpt from NAASP Press Release, 4/22/2016

NAASP: Framework for Successful Messaging

Public Health Messaging Reduces Deaths

• 43% reduction in heart disease deaths since 1969 (over half due to prevention efforts)

• 23% decline in cancer death rates since 1991 (over half deaths can be prevented via behavior change)

Key Message #1 Primary Audience: Potential Helpers

“YOU can take actions that can help prevent suicide.”

Samaritans

Teaching Community Members Can Save Lives

GLS Evaluations, 2007-2010:Counties with GLS programs had sig. lower suicide rates for ages 10-24 the year after GLS activities were implemented. Impact on suicides did not persist after a year. Authors: staff turnover, need for refresher gatekeeper training, focus on comprehensive programming fades over time.Walwrath, C, Garraza, LG, Reid, H, Godston DB & McKeon, 2015

What does the public think about suicide prevention?

2015 Harris Poll, by NAASP, AFSP, ADAA:• Most (94%) believe suicide is preventable• Most (93%) would do something if

someone close to them had suicidal ideas• Most believe mental health conditions like

depression increase suicide risk• Most believe mental health care is helpful• Most (55%) have been affected by suicide

(someone close died by suicide, had thoughts of suicide, etc.)

The Public. Almost 50% of Americans identified barriers that stopped them from trying to help someone at risk for suicide, such as (Harris poll 2015): fear that they would say or do something to

make things worse rather than better, and not knowing how to find help for a person in

crisis.

Public and MH Professionals: What Can I Do to Help?

The Professionals. NY State survey (2014) of 1585 providers,

64% little or no suicide prev training NAASP Survey (2013) of 30,000 MH

professionals. Approximately half reported not enough skills, training or supports to work with suicidal persons

What Help Do Suicidal Persons Need?

Australia survey of 127 persons with LE of suicide, 33 mental health professionals. Suicidal persons wanted:• To have their suicidal thoughts taken

seriously• To be asked about suicide directly• To be listened to nonjudgementally and be

supportive

Professionals rated more highly taking action.

Pirkis on Report to beyondblue, IASP, 2017

What do Suicidal Persons Want?

WHO Study, Bruffaerts, et al, 2011(over 55,000 persons in 21 countries with recent suicidal thoughts/behaviors)Of 45%-51% attempt survivors that did not receive care:

• 58% said “low perceived need” for care• 40% wish to handle the problem alone• 15% structural barriers (financial, distance)• 7% stigma

Gould, Munfakh, Kleinman & Lake, 2012 (376 suicidal Lifeline callers from 16 centers interviewed)Of the 48% not linking to care after the call, over half said that the problem was not severe enough and could be managed on their own without treatment

Self-Help and Suicide Prevention

Gould et al, SLTB, 2012:“Our findings emphasize the necessity of respecting and targeting individuals’ strong need for self-efficacy to optimize their receipt of help….The strategy of enhancing and promoting self-care and informal care has long been employed by crisis counselors, and our findings suggest that this should continue….”

First Line Coping Strategies

• Spirituality/religious practices 18 % • Talking to someone/companionship 14 % • Positive thinking 13 % • Using mental health system 12 % • Considering consequences to

people close to me 9 % • Using peer supports 8 % • Doing something pleasurable 8 % • Protecting myself from means 5 % • Doing grounding activities 4 % • Considering consequences to

myself/fear 2 % • Doing tasks to keep busy 2 % • Maintaining sobriety 1 %

198 adults with history of mental illness/treatment and at least one suicide attempt were asked:

“If your darkness and despair escalated to actual thoughts of suicide, what has helped you in the past to not take that action?”(write up to 5 coping strategies)Alexander et al, 2009

BeThe1To.com (2016)

#BeThe1To Action Steps

Facebook: Promoting self/other help to prevent suicide

How to help suicidal persons on Facebookhttps://www.youtube.com/watch?v=2iBpfEEJWxk

“We know that one of the best ways to prevent suicides is to promote caring connections between people.”

What Can I Do to Prevent Suicide?

• Video: Nearly 30m views• Stories across media• Over 16m subscribers • Both messages conveyed

Key Message #2 Primary Audience: Persons at Risk

“Healing, hope and help are happening”. Stories of positive coping with

suicidality, hope and recoveryResearch demonstrating

treatments or actions that prevent suicide

“Papageno Effect”

“The possibility of a suicide-protective effect of media items on positive coping in adverse circumstances, which has been discussed in the literature on a purely theoretical basis, was empirically supported by the present findings. Reporting of individual suicidal ideation (not accompanied by attempted or completed suicide) was associated with a decrease in suicide rates.” Niederkrothenthaler et al, Brit. Jrnl Of Psychiatry, 2010

“The study suggests that prevention of suicidal behavior by media reports is possible.” Niederkrothenthaler et al, 2010

Stories of Hope & Recovery

Papageno Effect from SP Websites

RCT exposed 161 adults to 3 German suicide prevention websites (educational information, coping tips, stories of persons with lived experience):• Significant, sustained increase in suicide

prevention knowledge• Signficant reductions in suicide ideation among

participants with SI“…results lend further support for PapagenoEffect…the websites clearly highlighted the fact that individuals with suicidal ideation…were not alone and further provided examples of persons with lived experience of suicidality.”Til, Tran, Voracek & Neiderkrotenthaler, Brit Jrnl of Psychiatry, 2017

Papageno: Logic’s 1-800-273-8255

Logic’s song named after the Lifeline was released in April 2017, and the song’s video came out in August 2017. The song became a #1 hit globally, and the video has been seen by over 200m people. Both were nominated for Grammy Awards; the song was performed at Grammys & MTV’s VMAs.

• Calls increased 26% after VMA and 30% after Grammys

• Avg. daily calls six months later (after song’s release): 31% increase over prior six months

• Calls are 60% higher than this time one year ago

Logic’s Video: Papageno Effects

• Over 210m views• Many thousands of

positive comments• Grammy nominated

Changing the Conversation

Changing the Conversation

Changing the Conversation

“…what might [survivors of suicidal experiences] say if they did not fear judgment, scrutiny and

stigma? They might tell you something that I have heard from hundreds of survivors, that I lived myself;

the truth that, for many, going through struggles with suicide completely transforms their lives for

the better.”Eduardo Vega, MH Advocate, Huff Post, 7/19/2017

Next steps

• National/International Consensus on Positive Message Framework (coming)

• Sharing (or creating) content related to action stepsBethe1to.com#BeThere (veteranscrisisline.net)Take 5 to save lives (do your part)

https://www.take5tosavelives.org/doyourpart)• Share (or create) stories of help and

recovery• Lifeline Stories of Hope and Recovery• Livethroughthis.org

Thank you!

Dr. John DraperExecutive Director, Lifelinejdraper@mhaofnyc.org212-614-6309http://suicidepreventionlifeline.org

Frances GonzalezLifeline Communications Directorfgonzalez@mhaofnyc.org(212) 614-5765

Our Panelists: Stories of the Storytellers

Craig A. MillerAuthor/Speaker

www.ThisisHowitFeels.comVideo of story: https://youtu.be/YFDdu7YyGco

Shelby Rowe, MBAOK GLS Youth Suicide Prevention

Project DirectorVideo: https://youtu.be/_iVIcyBvNtw

Blog: https://afsp.org/three-keys-managing-ptsd/