Working Together to Prevent Youth Suicide

As psychiatrists, we experience, understand, and grieve a patient's death in various ways.

Especially challenging for us, professionally and personally, is when a young person takes his or her life. Nothing seems more contrary to our purpose as healers.

We are reminded that, even in the best of circumstances, not all suicides are preventable. But as the third-leading cause of death among young adults, suicide is all too common and a major national health concern.

It's some relief to know that we have tools in addition to our profession to help address the problem. Public policy and coalition work can complement and support our clinical work in meaningful ways.

Recently, the level of discourse between mental health advocates and public policymakers has increased. Together we are discussing how to prevent youth suicide and sharing in the anguish when youngsters are not reached in time. Sometimes the outcome of engaging in politics and policymaking buoys us; other times it presents us with an opportunity to redouble our efforts.

An encouraging development was the recent signing of the Garrett Lee Smith Memorial Act (see Original article: page 14), though the impetus for the federal government's new suicide prevention effort was a sad one: the September 2003 suicide of U.S. Sen. Gordon Smith's 21-year-old son.

“I didn't volunteer to be a champion of this issue, but it arose out of the personal experience of being a parent who lost a child to suicide and mental illness,” Smith, a Republican, said this past summer on the Senate floor, urging passage of the bill.

Within hours, Smith's colleagues had approved the bill. Unanimously!

For me, just as heartening as unanimity in the Senate and timely passage of important legislation is the door that Smith opened for fellow senators to share their experiences with suicide and mental illnesses. Smith's heartrending remarks about his son were followed by moving testimonies from Sen. Harry Reid (D) of Nevada, whose father committed suicide after a years-long battle with depression, and Sen. Don Nickles (R) of Oklahoma, who shared a similar story about his father. Stigma faded a little that day.

The discussion ranged from medications and side effects to clinical trials and regulatory authority, and included personal stories about a loved one's suicide and calls to the FDA not to limit access to care.

Deep concerns over youth suicide have been front and center in another context.

In several forums APA has told the FDA that “as part of a comprehensive treatment plan, antidepressants can be extremely helpful and even lifesaving for many young people struggling with depression, an illness with significant long-term consequences, including an increased risk for suicide. We believe the biggest threat to a depressed child's well-being is to receive no care at all.”

Indeed, throughout the process APA expressed its concerns to the FDA, Capitol Hill, the media, and the public about the potential for seeing treatment rates fall. APA leaders, members, and staff, in particular, were exceptional in their efforts to reach the FDA and encourage a patient-focused, science-based approach.

But personal stories seized the attention of everyone at the hearing—and some in Congress—and ultimately moved the FDA to adopt a black-box warning for all antidepressants (Psychiatric News, November 5).

Now recent prescription data, which pharmacy benefit manager Medco Health Solutions released a week after the hearing, suggest the controversy leading up to the warning has already lowered treatment rates (Psychiatric News, October 15). APA is committed to finding ways to stem that trend and mitigate potential adverse impacts of the black-box warning.

For more than six months, we have been working with family practice, pediatrics, and patient advocacy groups to draft guidelines for the treatment of depression in adolescents in primary care settings. This interdisciplinary coalition is known as Guidelines for Adolescent Depression in Primary Care, or GLAD-PC, and it's led by APA member Peter Jensen, M.D., of Columbia University. James MacIntyre, M.D., a child and adolescent psychiatrist in New York, represents APA on the initiative.

We are also in the process of establishing a work group among many of the same coalition partners, which will work quickly to provide information and advice for physicians and parents until the GLAD-PC guidelines are finalized.

And we have called on the FDA to set in place a system to track the impact of the new warning on prescribing patterns, a system that should also track any increase in actions by patients to harm themselves as a result of reduced access to medically necessary treatment with antidepressants.

We, as psychiatrists, are fortunate to be leaders in many efforts to intervene in support of our nation's young people and their well-being. Our clinical work, our advocacy, and our efforts across specialties are interrelated—each part vital to safeguarding the mental health of children and youth. ▪