Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Presentation of the Results From the Suicide Prevention Hotline
Evaluation
and Linkage Report
Rockville, MD
March 24, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Good morning. Welcome to our overview of the Suicide Prevention Hotline Evaluation and Linkage Project. You soon will hear the results from two project evaluation studies. The first, presented by Dr. Brian Mishara, is a monitoring study of calls received by the Hopeline Network. This study evaluates the nature of helper assistance provided to callers in crisis, with the long-term goal of improving standards of service delivery. The second study, presented by Drs. Madelyn Gould and John Kalafat, examines short-term outcomes for suicidal callers and others in crisis. These evaluations are among the most important studies of crisis services ever conducted. Why?―Because they respond directly to questions about the effectiveness of crisis hotlines and the role crisis centers play in the support systems we fund.
Before our presentations begin, let me extend my personal greetings to two groups who are here. First, I sincerely thank the crisis center directors whose participation made these evaluation studies possible. With your support, evaluators were able to deal effectively with challenges presented by the studies, such as privacy issues. In addition, you willingly opened up your centers to close scrutiny―and risked possible criticism―in the interest of others. Your deep commitment to providing better services to people contemplating suicide or facing similar personal crises truly is admirable.
Your cooperation demonstrates a point I frequently make when I talk about the future of mental health care. Our overarching goal is to transform the mental health system into one that is consumer driven and focused on recovery, and that will build a person’s resilience to face life’s challenges. Achieving this goal may demand personal as well as system change. It will be our readiness to change and our willingness to risk that will determine the speed and scope of the progress we make.
Second, I offer a heartfelt welcome to the members of the steering committee for the National Suicide Prevention Lifeline. Your role as committee members is twofold: (1) to help the Mental Health Association of New York City administer the Lifeline, and (2) to help the Substance Abuse and Mental Health Services Administration/Center for Mental Health Services move forward with effective, life-affirming crisis and suicide prevention services. Today, you will develop a deeper understanding of the issues involved and possible options for resolving them. Use this knowledge as your foundation to help us shape policies, establish standards, and design project evaluations that will guide the Lifeline’s development. I am looking to you to help ensure that the National Suicide Prevention Lifeline fulfills the promise of its name.
These two evaluation studies can teach us a great deal about necessary as well as potential improvements to crisis center services. View the results of these studies in the broad context of what we hope to achieve through their analysis. Our goal is to improve national standards and methods of service delivery, including linkages between crisis centers and community-based services that can provide followup care to callers.
We have a shared responsibility to use all the results as guidelines for prioritizing improvements. We have invited center directors here today to emphasize how strongly we want to work with you on making necessary changes. We will begin today by giving everyone an opportunity for input at the conclusion of the presentations.
There should be a sense of urgency behind our efforts. In 2002, the last year for which data are available, more than thirty-one thousand individuals committed suicide. Thirty-one thousand lives lost. Also lost: all the wonderful contributions these individuals could have made to their families, their professions, and their communities. In the United States, suicide has become a public health crisis that affects us all.
It’s interesting to note that the Chinese word for “crisis” is written with two characters. The first character is for “danger”; the second is for “opportunity”. These characters symbolize the pivotal point that we have reached in establishing crisis centers and their services within their community mental health systems.
Consider the course of action we can take in light of the evaluation results. The thousands of individuals who call crisis hotlines each year do so because they are at serious risk of harming themselves or others. The sheer number of callers, and particularly the number of repeat callers, reveals a critical gap in our mental health system. That gap is the capacity to identify individuals at risk and to intervene early enough with appropriate supports that will prevent crises. Too many individuals still wait until they have lost nearly all hope in themselves, their lives, and their futures before they are willing to seek help.
The tragedy in Red Lake is a stark reminder to all of us of why we are here today. We must redouble our efforts to ensure that young people like Jeff Weise know that there is a place where they can be heard and―most important―helped to face the many challenges of their young lives.
We must do everything within our power to reduce the danger of suicide to individuals and our communities. How?―By improving immediately the safety networks of services that respond to the short- and long-term mental health needs of people in crisis. The conclusions presented by our own evaluation studies demonstrate that we have numerous opportunities to transform crisis service centers.
The studies, for example, suggest that we can improve services by looking closely at certification standards and at methods to ensure that crisis centers adhere to them. We also can use the crisis hotline evaluation study as an opportunity to understand better how crisis centers and other service systems are working together. This knowledge can help us develop better system linkages.
Crisis centers play a vital role in preventing suicide and in linking callers to appropriate followup care. In fact, these centers represent the community-based coalitions of care that should define the future of national mental health care, with all citizens―from mental health professionals to volunteers―working together for the common good.
Why the emphasis on community? ―Because a suicide never affects just one individual or even just one community. Suicide is a disease that can spread. Among the risk factors listed by the National Institute of Mental Health is this one: exposure to the suicidal behavior of others, including family members, peers, or even through the media.
We must take action to engage our communities in efforts to provide early identification and support to those in crisis. To paraphrase Martin Luther King, Jr., “ At the heart of all that civilization has meant and developed is ‘ community:’ the mutually cooperative and voluntary venture of [people] to assume a semblance of responsibility for [others].” It falls on us to strengthen crisis centers so they can best meet this responsibility.
And, now, I’d like to introduce Dr. Brian Mishara. Dr. Mishara is the director of the Centre for Research and Intervention on Suicide and Euthanasia at the University of Quebec in Montreal. He is a founder of Suicide Action Montreal and vice president of the International Association for Suicide Prevention. Dr. Mishara, as project director, will be presenting the results and recommendations from “A Silent Monitoring Study of Telephone Help Provided Over the Hopeline Network and Its Short-Term Effects.”
Dr. Mishara . . .
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