I have thus far presented a case that peer support could be considered a promising practice based on research, theory, and a solid historical background. The final step in this series is to present an argument for suicide prevention to invest in peer programs (sooner the better).
Folks keep asking, “Why haven’t we made a dent in the suicide rate?” Some say that it’s because our interventions are not effective. Yet, we have studies that show that some of the programs and practices used in suicide prevention can have a measurable impact on individuals (see, for example, the Best Practices Registry). Some places even see changes in rates for specific sub-populations that received a lot of attention (e.g., youth in well-funded states). So what’s going on?
One of the most well-described models I’ve seen that can explain this is the RE-AIM framework. Basically, it says that large scale impact (like changing suicide rates) does depend on how well something works in ideal settings, but also depends on the number of people who can be reached (and the things that lead up to that). Almost all of the research and practice in suicide prevention (and many other fields) focuses on the first part – how well something works in a small and/or specific condition.
When you look at the second part, how many people are reached, it is easier to understand why we don’t see an impact on national numbers or rates. [For my math and statistics friends I “show my work” in a separate post to spare most people from the mind-numbing number crunching involved].
If the purpose of something with national reach (National Suicide Prevention Lifeline) is to get people into competent care, and you also add in the number of people referred through the emergency departments (EDs), again with them all reaching perfect mental health care, then with several generous assumptions you could help 14% of the attempt survivors.
What happens to the other 86% of attempt survivors?!
Increasing the number of people who make calls or visit EDs runs into resource limitations. One of the areas with the largest potential impact (in terms of reach) is by increasing the number of individuals who receive a referral who actually receive support and services. Every year, each person who will attempt suicide has 2,499,999 peers. This number doesn’t even include the potential help from friends and family of the attempt survivors. I believe that within that group we have enormous potential for increasing the availability, acceptability, accessibility, and community use of suicide prevention supports.
Why haven’t we made a dent in the rate? Because we’re focusing too much on interventions that reach a small number of individuals. We need to jump in earlier for bigger impact. We need to focus on community-based methods and engage a much bigger group of helpers if we are going to see major changes in the rates of suicidal behavior.
[For all of my research, stats, and math friends, the raw numbers and calculations behind those used in this post are in an “Appendix” post]