Feature Article
A Landmark Program Beyond Compare
It's a unique and groundbreaking community-wide suicide prevention program, the first ever to suggest that suicide is a preventable public health problem.
It's aimed at:
• decreasing stigma
• building social networks and help-seeking behaviors
• enhancing understanding of mental health in the community
And it's associated over time with an 33 percent risk reduction for completed suicide.
Most important, it provides substantial evidence for the first time that suicide is indeed a preventable health problem.
It's the landmark U.S. Air Force (USAF) suicide prevention program. And its very noteworthy outcomes have just been published in the “British Medical Journal's” Dec. 13, 2003, issue.
“There is nothing that compares with this program,” says David Jobes, Ph.D., professor of psychology at The Catholic University of America and past president of the American Association of Suicidology. “There have never been results quite as striking as these.”
What distinguishes the USAF program and the research documenting its successes from a host of other programs and research studies aimed at preventing suicide?
“This is the first program of its kind with demonstrated results over a six-year period” says Kerry L. Knox, Ph.D, a researcher at the University of Rochester and lead author on the USAF study published in the “British Medical Journal.” “We found a 33 percent relative risk reduction for completed suicide after implementation of the program.”
Not only is the USAF program associated with the reduction in suicide, but also reduced incidence of violent acts against self and others.
“The ongoing program also reduced rates of other adverse outcomes that share similar underlying risk factors for suicide. We measured significant declines in violent crime, family violence and deaths due to unintentional injuries that occurred concurrently with the suicide intervention program,” adds Knox. “This shows the interconnectedness of many stressors that affect us - and the importance of enhancing protective factors while decreasing risk factors.”
Key to the USAF program and its remarkable success are these fundamental cornerstones:
• LEADERSHIP IS KEY: Unless top leadership of an organization fully endorses, advocates, authorizes and mandates that suicide prevention will be a priority, prevention efforts will have limited success. Depending on the organization and its nature, engaging full leadership support may be difficult to achieve. Nonetheless the Air Force program shows that successful suicide prevention needs to come from the top down and filter through all levels of an organization or community.
• COMMUNITY IS KEY: Suicide is viewed not only as a medical problem but as a community problem. This community-based program is designed to aid all airmen - not just those deemed at risk. All members of the community participate in ongoing efforts to prevent suicide. They tap an enhanced social network to gain better understanding and tools needed to play a role in preventing suicide - in themselves, their families, friends and fellow airmen. The program demonstrates the importance of using multiple agencies and all-inclusive outreach efforts to address suicide prevention. It's about marshalling the entire community to work toward a common goal.
• REDUCING STIGMA IS KEY: Only by implementing radical change in social norms to decrease stigma around help-seeking behaviors for all members of the community can suicide be reduced. Thus the USAF program addresses overall social, behavioral and health issues not only of those at risk but of all its airmen. And this radical change is strongly endorsed by Air Force ranks that work to sustain these newly stated values.
• EARLY INTERVENTION IS KEY: Emphasis is placed on early prevention by inter-vening at the first signs of dysfunction or stress - before risk of suicide is imminent. The program emphasizes the entire range of afflictions experienced by individuals, families and their com-munities. It also enhances detection and treatment of those in increased danger of taking their lives. How? By institutionalizing community-wide training to heighten awareness of a range of risk factors that make one vulnerable to behavioral and physically adverse outcomes, foremost of which is suicide.
About this series
With the December 2003 publishing of the University of Rochester study of suicide in the U. S. Air Force (USAF), “Preventing Suicide” is proud to present an in-depth look at this groundbreaking program - the first of its kind to suggest that suicide is indeed a preventable health problem.
In this special issue we consider this landmark community-based program and its publication in the Dec. 13 “British Medical Journal” from various angles:
• PROGRAM INCEPTION: What was the impetus for the USAF taking a closer look at suicide within its ranks - and for implementing a program to curb it?
• PROGRAM DEVELOPMENT: What specific actions did the USAF take to create a program that could indeed curb suicide? What people did they call on - within the Air Force and outside - to develop the program?
• PROGRAM IMPLEMENTATION: Once a suicide prevention program was developed, how was it implemented within the ranks of the USAF? What tools were created and how were they disseminated?
• PROGRAM EVALUATION: What effects did the program have on reducing suicide rates? Did it affect other violence-related behaviors such as family abuse, homicide and deaths from unintentional injuries? How did researchers at the University of Rochester who studied the program evaluate its effectiveness - and what did they find?
• PROGRAM RAMIFICATIONS: Given the findings of the U of R study of the USAF program, what are implications for future research? For applying findings to other semi-closed communities beyond the military, communities such as workplaces, jails, colleges and even small countries? What are the next steps in carrying this groundbreaking community-based program and its successes forward to further suicide prevention efforts at-large?
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Putting the program into practice - Tools to use
Analyzing program results through research
