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How (Not) To Prevent Youth Suicide
Less talk, more action
“Pulling Back the Curtain on Suicide Research” is a new paper by Sociologist Kevin McCaffree, and it is damning, to say the least. In little over 2000 words, McCaffree tears apart decades of suicidology research and practice, pointing out how studies and interventions have failed to reduce youth suicide, and how researchers have misrepresented their findings to the public:
[In] almost every case, the conclusion of these studies is that we’ve got actionable solutions, the future is bright, and understanding suicide is a top priority. The words always sound nice and positive… So how bad is the situation, really?..
Buried in technical reviews of intervention efficacy, scholars will admit, “There are no well-established, empirically supported treatments for decreasing suicide attempts or non-suicidal self-injury in adolescents with elevated suicide risk.” Another systematic review published in 2016 admitted that of 32 investigations, “Only one study reported positive effects on multiple outcomes measures (suicidal ideation and deliberate self-harm).”
It is common to come across reports that simply accept programs needn’t be evidence-based to be published, as when researchers state: “We recognize the inherent limitations of presenting a case illustration in the absence of evaluation data,” instead of simply not publishing the intervention until they’re able to evaluate its effectiveness. Ironically, but tellingly, a recent inquiry into the reasons for the low rate of involvement in most suicide prevention programs found that “concerns regarding the efficacy of available treatments” was a significant cause.
The situation is bad, even for social science. Studies will describe an intervention as successful if participants self-report a desire to learn more about how to reduce suicide, or have higher general knowledge about suicide than when they started, even if it doesn’t lead to fewer people actually killing themselves. Some will be described as a success despite large fractions of participants attempting suicide during the study. Many suicide prevention programs don’t even measure whether they actually reduce suicide. Societally significant as it is, there is little financial incentive for those who study the topic to move the needle on it.
Why aren’t suicide interventions working? A big problem is that they’re based around the idea that people commit suicide because they are experiencing a lack of love or emotional support, and that raising awareness and talking things out is the solution. There may be some truth to that theory, but clearly, based on the failure of these interventions, it’s not enough to address the problem.
People often commit suicide impulsively. Yes, it is generally precipitated by bad feelings or events – mental health issues, relationship issues, etc. – but few who experience those, even in their most extreme forms, actually commit suicide. The best way to reduce suicide is to change our environment so that if people have a strong impulse to commit suicide, they can’t, because they lack the means to do so.
There are a few simple ways to do this. Build barriers to stop people from jumping off bridges or onto subway tracks. Make it harder for people, especially those with mental illness, to access guns. If someone is suicidal, make sure they’re not alone, or bring them to the hospital so someone else can look after them. This all might seem obvious, but the “unobvious” way of doing things (elaborate awareness campaigns and therapies) clearly isn’t working. And while surely there are deeper reasons for the rise in suicides we’ve seen over the past decades, one needn’t wait to discover the “root causes” of a problem before beginning to address it effectively.