Opinion: The number of U.S. suicides is unacceptable, so we need a new approach to address the problem

Suicide rates are at an 80-year high.
(MedPage Today photo)

In April, the Centers for Disease Control and Prevention shared this grim data: "In the past two decades, suicide rates have been consistently higher in rural America than in urban America." National suicide statistics are even more dire: Last week, the CDC reported that U.S. suicide deaths reached an 80-year high. While there was a "modest" improvement in youth data, the report pointed to a national suicide crisis. With that backdrop, Russell Copelan, a retired emergency department psychiatrist, suggests a new approach in his opinion for MedPage Today.

"Consider the American Foundation for Suicide Prevention's aspirational goal launched in 2016, to reduce the annual U.S. suicide toll by 20% by 2025. Since the initiative began, there has instead been a 10% increase in suicide deaths. We should be nothing short of appalled and dismayed by these numbers.

"Perhaps it is now best to consider the advice of Davy Crockett to young hunters: 'Whenever a fellow gets bad lost, the way home is just the way he don't think it is.' The field of suicidology is indeed 'bad lost.' We are in urgent need of a new 'way home.' So let's get out our compasses and make directions based on where we are standing, our present state.

"Here is a starting point. Saving life is difficult. If it were easy, everyone would be doing it. Well, in suicide prevention and research, everyone is trying to do it. And yet, the escalating press of self-directed death marches on. For foundations, alliances, and associations, the definitional issues, fragmentary data, ubiquitous risk training. . . and entrenched leadership make it difficult to determine a true North Star. . . . It is currently equivalent to the blind leading the blind -- and falling in a ditch.

"Ideation-centric assessments have continued to be promoted as 'best practices.' Under mounting evidence of insensitivity to risk, statistical inefficiencies, unreliable patient recruitment. . . confirmatory bias, should these assessments continue to serve as surrogates or the 'gold standard' in suicide risk evaluation? None of these instruments have been sufficiently accurate.

"Where is the proactive management to identify the root causes of our current and miserable predicament? Where is the preparatory understanding of the basic elements of the 'map' that could have empowered the field of suicidology to stay found?

"Let me ask again: Is conventional suicide prevention practice good enough? No. Unequivocally, no! What medical specialty would tolerate such a recurring -- indeed '80-year high' -- disaster?

"The topic of suicide is complex, complicated, and dark, and attempting to systemize and communicate improved risk probability stratification is considered by many either too difficult or a lost proposition.

"But you must fight with implacable doggedness, challenge old laws, and test new hypotheses. Demonstrate the miracles of good sense, connected observations, and strong convictions. Maximize your cause and seize your direction."

To read the theory and practice of Copelan's "new way home," click here.