Safe Messaging
Safe and
Effective Messaging for Suicide Prevention These recommendations address message content, but not the equally important aspects of planning, developing, testing, and disseminating messages. While engaged in these processes, one should seek to tailor messages to address the specific needs and help-seeking patterns of the target audience. For example, since youth are likely to seek help for emotional problems from the Internet, a public awareness campaign for youth might include Internet-based resources.4 The Do’s—Practices that may be helpful in public awareness campaigns: • Do emphasize help-seeking and provide information on finding help. When recommending mental health treatment, provide concrete steps for finding help. Inform people that help is available through the National Suicide Prevention Lifeline (1-800-273-TALK [8255]) and through established local service providers and crisis centers. • Do emphasize prevention. Reinforce the fact that there are preventative actions individuals can take if they are having thoughts of suicide or know others who are or might be. Emphasize that suicides are preventable and should be prevented to the extent possible. 5 • Do list the warning signs, as well as risk and protective factors of suicide. Teach people how to tell if they or someone they know may be thinking of harming themselves. Include lists of warning signs, such as those developed through a consensus process led by the American Association of Suicidology (AAS). 6 Messages should also identify protective factors that reduce the likelihood of suicide and risk factors that heighten risk of suicide. Risk and protective factors are listed on pages 35-36 of the National Strategy for Suicide Prevention. • Do highlight effective treatments for underlying mental health problems. Over 90 percent of those who die by suicide suffer from a significant psychiatric illness, substance abuse disorder or both at the time of their death.7-8 The impact of mental illness and substance abuse as risk factors for suicide can be reduced by access to effective treatments and strengthened social support in an understanding community.9 The Don’ts—Practices that may be problematic in public awareness campaigns: • Don’t glorify or romanticize suicide or people who have died by suicide. Vulnerable people, especially young people, may identify with the attention and sympathy garnered by someone who has died by suicide.10 They should not be held up as role models. consider suicide do not overtly act on those thoughts, but find more constructive ways to resolve • Don’t normalize suicide by presenting it as a common event. Although significant numbers of people attempt suicide, it is important not to present the data in a way that makes suicide seem common, normal or acceptable. Most people do not seriously consider suicide an option; therefore, suicidal ideation is not normal. Most individuals, and most youth, who seriously consider suicide do not overtly act on those thoughts, but find more constructive ways to resolve them. Presenting suicide as common may unintentionally remove a protective bias against suicide in a community.11 • Don’t present suicide as an inexplicable act or explain it as a result of stress only. Presenting suicide as the inexplicable act of an otherwise healthy or high-achieving person may encourage identification with the victim.12 Additionally, it misses the opportunity to inform audiences of both the complexity and preventability of suicide. The same applies to any explanation of suicide as the understandable response to an individual’s stressful situation or to an individual’s membership in a group encountering discrimination. Oversimplification of suicide in any of these ways can mislead people to believe that it is a normal response to fairly common life circumstances.13 • Don’t focus on personal details of people who have died by suicide. Vulnerable individuals may identify with the personal details of someone who died by suicide, leading them to consider ending their lives in the same way.14 • Don’t present overly detailed descriptions of suicide victims or methods of suicide. Research shows that pictures or detailed descriptions of how or where a person died by suicide can be a factor in vulnerable individuals imitating the act. Clinicians believe the danger is even greater if there is a detailed description of the method.15 SPRC thanks Madelyn Gould, PhD, MPH [Professor at Columbia University in the Division of Child and Adolescent Psychiatry (College of Physicians & Surgeons) and Department of Epidemiology (School of Public Health), and a Research Scientist at the New York State Psychiatric Institute] for her extensive contributions and guidance in drafting and editing this document. ________________________________ 1 Gould, M. S., Jamieson, P. & Romer, D. (2003). Media contagion and suicide among the young. American Behavioral Scientist, 46(9), 1269-1284. 2 Gould, M.S. (1990). Suicide clusters and media exposure. In S. J. Blumenthal & D. J. Kupfer (Eds.), Suicide over the life cycle (pp.517-532). Washington, DC: American Psychiatric Press. 3 Chambers, D. A., Pearson, J. L., Lubell, K., Brandon, S., O’Brien, K., & Zinn, J. (2005). The science of public messages for suicide prevention: A workshop summary. Suicide and Life-Threatening Behavior, 35(2), 134-145. 4 Gould, M. S., Velting, D., Kleinman, M., Lucas, C., Thomas, J. G., & Chung, M. (2004). Teenagers' attitudes about coping strategies and help seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43(9), 1124-1133. 5 U.S. Department of Health and Human Services. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville, MD: Author. 6 Rudd, M. D., Berman, A. L., Joiner, T. E., Nock, M. K., Silverman, M. M., Mandrusiak, M., Van Orden, K., and Witte, T. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262. 7 Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53 (4), 339-348. 8 Conwell Y., Duberstein P. R., Cox C., Herrmann J.H., Forbes N. T., & Caine E. D. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. American Journal of Psychiatry, 153, 1001-1008. 9 Baldessarini, R., Tondo, L, & Hennen, J. (1999). Effects of lithium treatment and its discontinuation on suicidal behavior in bipolar manic-depressive disorders. Journal of Clinical Psychiatry, 60 (Suppl. 2), 77-84. 10 Fekete, S., & A. Schmidtke. (1995) The impact of mass media reports on suicide and attitudes toward self-destruction: Previous studies and some new data from Hungary and Germany. In B. L. Mishara (Ed.), The impact of suicide. (pp. 142-155). New York: Springer. 11 Cialdini, R. B. (2003). Crafting normative messages to protect the environment. Current Directions in Psychological Science, 12(4), 105-109. 12 Fekete, S., & A. Schmidtke. op. cit. 13 Moscicki, E.K. (1999). Epidemiology of suicide. In D. G. Jacobs (Ed.), The Harvard Medical School Guide to suicide assessment and intervention (pp. 40-51). San Francisco: Jossey-Bass. 14 Fekete, S., & E. Macsai, (1990). Hungarian suicide models, past and present. In G. Ferrari (Ed.), Suicidal behavior and risk factors (pp.149-156). Bologna: Monduzzi Editore. 15 Sonneck, G., Etzersdorfer, E., & Nagel-Kuess, S. (1994). Imitative suicide on the Viennese subway. Social Science and Medicine, 38(3), 453-457. Source: www.sprc.org/sites/default/files/migrate/library/SafeMessagingrevised.pdf
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