News Type: Director's Corner

Growing up, I always looked forward to February. Throughout much of my education, Black people were not seen as the holders of knowledge, were not represented in curriculum, and were only recognized a specific time of year—Black History Month. Every February, I could count on my school, church, and community to organize programs and events to commemorate our rich culture and contributions to American history. It was a beautiful time when I felt seen and proud. As I continued to grow and learn, I discovered information about my own culture and identity that had never been shared at school. My eyes were open to just how much more learning I had to do, which helped inform my career in promoting justice, equity, diversity, and inclusion and current role at SPRC.

As a part of the SPRC’s six-part webinar series to help crisis centers build relationships with tribal communities, next week I will be co-hosting a webinar on cultural humility. While this training will be focused on collaborating with tribal communities, the principles of cultural humility are broadly applicable and critical to our work in suicide prevention, regardless of the population or setting.

There are three important elements of cultural humility. The first is a lifelong commitment to learning. Cultural humility involves a continual process of examining your own values and beliefs and learning about others’. This does not mean achieving a certain level of skill or knowledge about a particular person or group but allowing your insights and perspectives to evolve over time. Remember, this is lifelong learning, and we are all in different places on that journey. Be patient with yourself and others.

The second aspect of cultural humility is addressing power imbalances. An easy place to start that is to see everyone as a holder of knowledge and create space for those with different experiences, history, and information. In the past, the knowledge and voices of intentionally marginalized communities have often been minimized and silenced. To help address those imbalances, incorporate diverse sources of knowledge in your work. For example, collaborate with the groups you’re trying to reach to ensure your suicide prevention efforts are based on their needs, values, and beliefs. Look for culturally resonant community-based programs with great outcomes and consider how they could be adapted for your setting. Recognize the unique knowledge we all hold and learn from each other. There is a place in suicide prevention for everyone, regardless of their position, identity, or experience.

Finally, cultural humility is about connecting and building. The work to create positive change is work we must do together. Starting with the systems and organizations we are a part of, we must strive to establish justice, equity, diversity, and inclusion. In our prevention efforts, we should incorporate strategies to address the conditions that put some groups more at risk of suicide than others. These are large tasks, and they might seem overwhelming, but that is where collaboration comes in. Working toward change requires deep community relationships, strong coalitions, and strategic partnerships with those who are also working to dismantle systemic barriers.

When I think about my own journey, it pairs with cultural humility. I now view February, not as the one time of year that Black knowledge is recognized, but a reminder and recommitment to continual learning, both about myself and others. Black History Month is an invitation to not only celebrate but also to learn, build, organize, and address the challenges disproportionately faced by Black communities. I invite you to join me in fostering cultural humility, within ourselves and across our field.

Brittany Carradine, MEd

SPRC Director of Justice, Equity, Diversity, and Inclusion 

University of Oklahoma Health Sciences Center

Friends,

I recently had the honor of attending a community suicide prevention training, where I sat with a group of women who were receiving formal instruction in suicide prevention for the first time. As they were learning a key prevention step—to ask someone who is struggling whether they’re thinking about suicide—I watched as they wrestled with it.

The woman next to me, a loss survivor, was determined to get comfortable asking the question but was concerned she didn’t know all the resources available for someone in crisis. I smiled and told her she didn’t need all the resources. She looked at me, confused. “You know the number for 988, you’re good at being kind, and you have such a compassionate and supportive presence,” I said. “All of those have the potential to be lifesaving.”

We seem to intuitively understand this when someone is suffering from a physical health issue. We don’t feel responsible for treating their illness, but we may feel compelled to check on them, bring them dinner, or mow their lawn. That instinct to nurture, to share our presence, is also needed by those affected by suicide, whether through the death of a loved one or their own struggles. If you’re unsure what to do or say in those cases, ask yourself what you would do if they had cancer, and then do that. Their condition may require intensive treatment, far beyond what we as friends, family, or coworkers can provide. But our kindness and support can help them feel like they are not traveling that road to recovery alone.

While this can be a season of gift-giving and celebration, it’s also a time of year when some may be feeling lonely, coping with loss, or going through a tough transition. If you’re worried about someone, reach out and let them know you’re thinking about them. Send them a funny meme, card, coffee—or one of my personal favorites, chocolate! Talk with them about their pet, favorite movie, heartbreak, or disappointment. The topic is not nearly as important as the time spent together.

The women I met at that suicide prevention training may have been new to prevention practices, but they already had some of the skills that are so central to our work—the ability to show up, be there, and connect. This season and all year round, reach out and share your presence. It’s the greatest present you can give those around you.

Warm wishes for 2023,

Shelby Rowe

SPRC Executive Director

I was a lifeguard in my early twenties. During that time, I rescued two swimmers from drowning, which helped solidify my career goal to help others. For me, there was no greater feeling than saving someone in a moment of crisis until . . . I began teaching people to swim.

Swim instruction is an equally fulfilling and life-saving effort, in that it reduces the risk of a swimmer needing rescue later. When I was older, I had the pleasure of teaching my nephew to swim, which brought me the joy of knowing he is better able to stay safe when he’s around water. I share these personal stories to illustrate that drowning prevention can and should take a comprehensive approach, by many different folks, with many different skill sets—just like suicide prevention.

Let’s look at where our work falls on the prevention continuum. Like safety in and around water, preventing suicide requires multiple strategies at multiple time points. That may take the form of intervening in a suicidal crisis, like a rescue from drowning, or an earlier “upstream” involvement that prevents the crisis from happening, like swim instruction.

Reducing suicide risk is known as “upstream suicide prevention.” The U.S. Surgeon General recently called for six critical actions to implement the National Strategy for Suicide Prevention, including the necessity to “address upstream factors that impact suicide.” Such factors may include exposure to trauma, racism, economic stressors, or disparate access to health care. To address them, evidence suggests the following may be most effective:

1. Promote and enhance social connectedness and opportunities to contribute.
2. Strengthen economic supports.
3. Engage and support high-risk and underserved groups.
4. Dedicate resources to the development, implementation, and evaluation of interventions aimed at preventing suicidal behaviors.

Addressing the big-picture factors that contribute to suicide risk may sound daunting, but it’s happening every day—in schools, juvenile justice systems, faith communities, and many other settings across the country. Upstream work requires thinking broadly about what suicide prevention means and considering how we can partner with diverse groups, sectors, and communities to ensure multiple strategies are working together across the prevention continuum. It requires listening, collaborating, and cooperating in both new and traditional ways.

I’m delighted to announce that SPRC’s new Best Practices Registry (BPR) is coming soon and will include a special focus on upstream strategies for preventing suicide. This BPR is the same one-stop source you know and trust for suicide prevention programs and interventions, guided by a new vision—to increase health equity through expanded access and representation, of which upstream work is a critical part.

To make this vision a reality, we need you:

• If you or someone you know is doing amazing upstream work, please apply to the BPR. We’re seeking applications for programs and interventions that incorporate best practices and culturally relevant approaches. We’re accepting more forms of evidence than ever before, and we welcome programs based on community and culturally defined knowledge.
• Start thinking about how to incorporate upstream strategies in your work through new or existing partnerships. What groups in your community are doing work downstream from yours? How might you collaborate to increase your collective impact? I challenge you to reach out to a partner today.
• Stay tuned on the release of the new BPR by signing up for the Weekly Spark.

Just as lifeguards and swim instructors have different yet equally important roles in keeping swimmers safe, so too do the crisis counselors at the 988 Suicide & Crisis Lifeline, physicians, faith and spiritual leaders, school staff, and many others who help prevent suicide every day. Let’s expand and renew our efforts by working together toward the shared goal of saving lives. See you in the water!

Victoria Waugh-Reed, EdD

SPRC Director of Best Practices Registry

University of Oklahoma Outreach

Southwest Prevention Center   

In a box at home, I have a well-worn, dog-eared paperback that has survived several moves in the past decade—my print copy of the 2012 National Strategy for Suicide Prevention (National Strategy). At the time of its publication, I had just started a new job as suicide prevention project coordinator at Arkansas Children’s Injury Prevention Center and was serving as president of the American Foundation for Suicide Prevention Arkansas chapter. I immediately downloaded the document and created a PowerPoint presentation highlighting the 13 goals and 60 objectives laid out in its pages.

From that point forward, every project I planned and every training budget I submitted for approval referenced the National Strategy. It became my compass in the field of suicidology, my marching orders, and my beacon of hope. Any initiative that didn’t align with the National Strategy didn’t happen on my watch. In its pages, I found instructions—and inspiration—for developing truly effective, comprehensive, inclusive suicide prevention efforts at the organizational, community, state, tribal, and national level. 

Developed to guide the nation’s suicide prevention efforts, the first National Strategy was released in 2001, launching a coordinated movement to prevent suicide across the country. Ten years later, the National Action Alliance for Suicide Prevention (Action Alliance)—the nation’s public-private partnership for suicide prevention—formed an expert task force to revise and update that landmark document, resulting in the 2012 National Strategy that has guided our efforts ever since. 

When the Action Alliance convened that 2012 task force, they helped pave the way for our field’s innovation over the past decade. By bringing together public and private sector leaders, they helped ensure suicide prevention efforts are multi-pronged, multi-sectoral, and include all members of society. They helped ensure the revised document was based on an understanding that there is no single cause for suicide, there is no single strategy for prevention, and we all have a role to play in saving lives.

In the decade since the release of the 2012 National Strategy, the Action Alliance and its partners have led the field in advancing its goals and objectives. In collaboration with SPRC and other national groups, the Action Alliance has developed foundational guidance on preventing suicide in a variety of settings, including communities, health care systems, and workplaces. They have also led key initiatives in Zero Suicide, public messaging, tribal and faith communities, and lived experience. In addition, the Action Alliance’s crisis services recommendations are reflected in the recent nationwide rollout of the 988 Suicide & Crisis Lifeline.

Ten years on, our field has made huge strides—including the 2021 release of The Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention—yet there is more work to do. In a period when suicide rates have risen disproportionately in some communities and mental health has been pushed to the forefront by the pandemic, we can see both the progress we have made and the opportunities to do more. This is made clear in a newly released national public perception poll.

That poll comes from a multi-year collaboration between SPRC, the Action Alliance, and the American Foundation for Suicide Prevention to understand the public’s beliefs and attitudes about suicide and mental health. Carried out by The Harris Poll and building on surveys from previous years, the 2022 poll found large gains in the public valuing suicide prevention and mental health but persistent barriers to helping others and getting help. Some key findings were:

• While 76% of U.S. adults believe mental and physical health are equally important, over half (51%) do not feel they are treated equally in health care systems.
• Most U.S. adults (94%) believe suicide is preventable, but 83% would be interested in learning how they can play a role in helping someone who may be suicidal.
• Most of those surveyed believe there is a need for greater access to mental health care, and education and training of providers and lay responders to help prevent suicide.

Overall, the poll indicates that progress has been made, but there is more to do. And to do more, we need to look to what has spurred our progress thus far—the National Strategy. It is the compass that has guided us this far, and the compass that will lead to future progress. We must continue to learn more about suicide and mental health, particularly through increased research; teach everyone how to help prevent suicide and promote mental health; and expand access to care and crisis services.

I invite you to learn more about the public perception poll data and join us in taking action to build on the progress we have made in bringing the goals and objectives of the National Strategy to life over the past decade.

Shelby Rowe, MBA

SPRC Executive Director

Center on Child Abuse and Neglect

University of Oklahoma Health Sciences Center

At SPRC, we believe in the power of words to help effect positive change, in people and the world around us. But after recent incidents of mass violence, we’ve struggled with the limitations of language to convey what many of us have at times felt—grief, anger, even despair—and to communicate a helpful vision for a way forward.

Faced with the widespread inequities that put some racial and ethnic groups at higher risk of experiencing gun violence and other forms of trauma, it would be understandable if we as helping professionals felt some discouragement. Faced with the systemic injustices that leave many children unsafe in their neighborhoods and schools, it would be understandable if we questioned whether we could make a meaningful difference in the lives of young people.

At such moments of doubt or depletion, let us find sustenance in each other, let us lean on the supports of our communities, let us see hope in the progress we have made, let us seek renewal in our collective mission to alleviate suffering and save lives, let us remember that our work matters, and we are not alone in our efforts.

As a field, we have so much to offer those who are struggling in the aftermath of violence—tools and resources for preventing suicide, addressing trauma, and promoting mental health among youth, families, school staff, first responders, and those experiencing disproportionate adversity. We also know many evidence-based approaches that can help make communities places of greater safety and belonging for all their members.

But as clinical and public health professionals, we’re also keenly aware of the circumstantial factors affecting the health and well-being of the individuals, families, and populations we work with, many of which are outside of our control. We acknowledge that living in a safe environment is better than having tools to cope with danger. We recognize that our skills and resources may help to heal, but that our country must strive to eliminate the disparities causing harm in the first place.

Addressing the pervasive issues that put some people more at risk for adversity, illness, and death is a collective marathon, not a solo sprint. And to run that distance, we need to take care of ourselves and each other. At SPRC, we retain our belief in and commitment to the effective potential of words and actions to help prevent suicide but appreciate the importance of taking time for quiet and rest to sustain us and our efforts.

As we head into the summer months, we encourage you to incorporate recovery in your personal and professional lives. Below are some resources that may be helpful for you and those you work with:

• Check out a self-care toolkit for social workers, resources for provider well-being, and coping tips for health care professionals and emergency responders.
• Find resources to help children cope with mass violence, and for school communities dealing with crisis or loss, as well as crisis services for anyone who has experienced a natural or human-caused disaster.
• Use a toolkit to help organizations prevent vicarious trauma, and consult the SAMHSA Disaster Technical Assistance Center to help territories, states, tribes, and communities prepare to address behavioral health needs after a disaster.

Beverly W. Funderburk, PhD

Professor of Research

SPRC Senior Advisor

Center on Child Abuse and Neglect

University of Oklahoma Health Sciences Center

As pandemic disruptions stretch into a third year, creating supportive environments for children and families can help reduce the risk of child maltreatment—and prevent suicide. Throughout COVID-19, risk factors for child abuse and neglect are up, which may increase the short- and long-term risk of suicide. Providing families with the supports they need now can help protect children from maltreatment and lessen the impact of the pandemic on their mental health and suicide risk. This National Child Abuse Prevention Month, we encourage you to integrate strategies to support children and families into your suicide prevention efforts.

Child maltreatment is physical, sexual, or emotional abuse or neglect by a parent or caregiver resulting in actual or potential harm to the child. Research has shown that experiencing early abuse or neglect is linked to poor physical and behavioral health outcomes throughout life, including increased suicide risk in childhood and adolescence as well as adulthood. Maltreatment is just one type of adverse childhood experience that can place young people at risk, which is why addressing early adversity is a critical part of a comprehensive approach to suicide prevention.

Unfortunately, child maltreatment is prevalent in the U.S.—but more importantly, it is preventable. When families have the support, resources, and tools to create safe relationships and environments, child abuse and neglect is reduced. The Center for Disease Control and Prevention’s (CDC) Essentials for Childhood Framework guides states, communities, and organizations in how to prevent maltreatment and promote the healthy development of children and families. Like suicide prevention, child abuse prevention is more likely to be effective when multiple strategies are implemented across all levels of society. CDC outlines such strategies, ways to advance them, and their evidence base in a corresponding technical package.

Among the factors that can protect against child abuse, supportive family environments and social networks are critical. However, these are the very systems that have been challenged during the pandemic. In the past year, many families are experiencing financial strain, social isolation, and a loss of resources, most notably the loss of the safety net provided by in-person schooling. To counter the impact of these stressors, communities should strengthen economic and social supports for families, use every means to ensure educational continuity, and seek to enhance parenting skills.

Fortunately, there are evidence-based treatments available that provide parents and caregivers with the skills to reduce risk of child maltreatment and family disruption, as well as foster their child’s healthy development. These treatments cover the age range from infancy (e.g., Nurse-Family Partnership) though early childhood (e.g., Parent-Child Interaction Therapy, SafeCare, The Incredible Years, ) into adolescence (e.g., Multisystemic Therapy, Alternatives for Families: A Cognitive Behavioral Therapy). In addition, Trauma-Focused Cognitive Behavioral Therapy can strengthen coping and resilience in children who have experienced trauma. Most of these effective treatments can be offered in person or virtually.  

During the pandemic, it can also be helpful to provide parents with tips on family coping and how to manage their own emotions, such as anxiety and frustration, to avoid passing them on to children. Prevention practitioners and clinicians should tailor their supports to the particular individual, family, and community they are working with, as their context and needs will vary.

Given the strong evidence linking child maltreatment and suicide risk, more efforts are needed to prevent and address early abuse and neglect as part of a comprehensive approach to suicide prevention. With the pandemic disrupting many of our social and economic systems, and placing increased stress on families, now is the time to take action to protect the immediate and long-term mental health of our children. Through cross-sector collaboration, prevention practitioners and clinicians from each of these disciplines can work with families and communities to ensure all young people have access to safe, nurturing homes.

Learn more about the innovative prevention work being done in communities around the country to support children and families, and consider how you might integrate it into your suicide prevention efforts.

Dolores Subia BigFoot, PhD

Presidential Professor

SPRC Co-Director

Center on Child Abuse and Neglect

Indian Country Child Trauma Center

University of Oklahoma Health Sciences Center

Beverly W. Funderburk, PhD

Professor of Research

SPRC Co-Director

Center on Child Abuse and Neglect

University of Oklahoma Health Sciences Center

At the beginning of March, Health and Human Services (HHS) Secretary Xavier Becerra released a statement reaffirming HHS support and protection for LGBTQI+ children and youth. The statement was made in response to state legislatures enacting an unprecedented number of anti-LGBTQ+ policies in 2021. According to the Human Rights Campaign, 2021 saw the highest number of anti-LGBTQ+ state laws passed in recent history, with a similar wave already underway in 2022. Sadly, this is not without consequence. A recent poll by The Trevor Project found two-thirds of LGBTQ+ youth said their mental health has deteriorated because of these recent efforts to restrict access to services like gender-affirming care for transgender youth.

How is this related to suicide prevention work? Our mission is to reduce suffering and lives lost to suicide. Transgender people have similar risk factors for suicide as cisgender people but also face factors such as discrimination or lack of access to gender-affirming health care. These added risk factors are associated with higher rates of suicidal thoughts and suicide attempts among transgender people than their cisgender peers. Studies have found roughly 40% of transgender adults have attempted suicide in their lifetimes and 30% of transgender youth have attempted suicide in the past year. Yet, research suggests that experiencing respect, affirmation, and support can help lower that risk.

Socioeconomic stressors are common among transgender people and are associated with a higher risk of suicidal thoughts and suicide attempts. Such stressors include experiencing discrimination, mistreatment, or violence in a variety of settings that should be safe, such as at home, school, or work, and in places of public accommodation, housing, health care, or law enforcement. Transgender people who need access to gender-affirming health care, such as hormone therapy or surgical care, may experience barriers to receiving that care, including high cost, lack of providers, and prohibitive policies, which are compounded by recent laws.

As of 2021, over 45,000 transgender youth lived in states where legislation had passed or been proposed to prohibit them from accessing gender-affirming health care. A study published that year found more than 3 in 4 transgender and nonbinary youth reported symptoms of generalized anxiety disorder and more than 2 in 3 reported symptoms of major depressive disorder. Providing transgender and nonbinary youth with gender-affirming care can help reduce their risk of mental health issues. As we continue to pursue suicide prevention and well-being for all, we must educate ourselves on these issues and stand with the transgender community.

Reducing suicide among transgender individuals requires implementing laws, policies, and programs that aim to reduce discrimination, increase family and social support, and improve access to gender-affirming care. In addition, filling gaps in official data collection systems, like the National Violent Death Reporting System, to improve the accuracy of data on transgender populations can also help inform prevention planning.

March 31 is the International Transgender Day of Visibility, an annual awareness day celebrating transgender and gender-nonconforming people while advocating for increased efforts to achieve equity and justice. In addition to celebrating Transgender Day of Visibility, we encourage you to consider the following ways of getting involved:

• Support your local GSA Network and PFLAG chapters.
• Educate yourself on how to be an ally to transgender and nonbinary youth, including in schools.
• Make your support visible with graphics and posters.
• Follow organizations that share current information and resources for transgender youth and for those who love and work with them, such as The National SOGIE Center, The Trevor Project, GLSEN, Transgender Law Center, and the National Center for Transgender Equality.
• Reach out to the Center of Excellence on LGBTQ+ Behavioral Health Equity, which provides practitioners with information on supporting people identifying as LGBTQI+, two-spirit, and other diverse sexual orientations, gender identities, and expressions, including free webinar sessions. 
• Check out A Practitioner’s Resource Guide: Helping Families to Support Their LGBT Children from the Substance Abuse and Mental Health Services Administration that offers guidance for practitioners throughout health and social service systems.

Now more than ever, supportive action is critical. As always, we appreciate your continued work to make suicide prevention efforts effective, equitable, and accessible to all community members.

Alex Karydi, PhD, LMFT, CAC, CASAC II 

SPRC Director of State and Community Initiatives

Education Development Center

This piece was produced with support from SPRC Co-directors Dolores Subia BigFoot, PhD, and Beverly W. Funderburk, PhD, as well as SPRC communications staff Jesse Danielle Gass, MPH, Helle Lord-Elliott, BA, and Linda Sobottka, BS, MLIS.