is vice president of mission engagement for the AFSP and a licensed psychologist.

Doreen Marshall, PhD

The American Foundation for Suicide Prevention (AFSP), the National Action Alliance for Suicide Prevention (Action Alliance), and the Suicide Prevention Resource Center (SPRC) recently partnered with The Harris Poll to conduct a new national public perception survey of more than 2000 US adults to better understand the public’s attitudes and beliefs about mental health and suicide prevention. We sat down with Doreen Marshall, PhD, Vice President of Mission Engagement for the AFSP, to discuss the poll’s findings.

PT: According to the poll, the majority of adults in the US (94%) see suicide as a preventable public health issue and 83% say they would be interested in learning how they might be able to help someone who may be suicidal. Do these numbers surprise you?

 I am not surprised in that it seems the public is becoming increasingly aware that suicide is, at its core, a health issue and can be prevented. Over the past few years, we have heard more of those in the public eye speak about their mental health struggles, and this has helped to increase dialogue about both suicide prevention and mental health. While I am glad to see that so many are interested in helping others, it does mean that we need to provide individuals the necessary education to be able to help someone who is struggling.

PT: It is really exciting to see an increase in the value placed on mental health and suicide prevention. What do you think has led to this increase? Has the recent release of the 988 Suicide Hotline impacted public perception?

The survey findings show that hopeful gains have been made in valuing mental health and suicide prevention. While there are a multitude of factors that could be contributing to the increased value placed on mental health and suicide prevention, it’s been clear that the COVID-19 pandemic has had a significant impact on the population’s mental health. Experiences such as depression, anxiety, and suicidal thoughts remain prevalent. However, protective mental health measures continue to have a positive impact. There is also a readiness to engage and implement effective suicide prevention strategies widely. The silver linings of the pandemic have been increased dialogue around mental health and help seeking and more individuals reaching out for support, all of which could continue to help prevent suicide.

Our survey also supports this. More people understand the importance of mental health and believe that suicide can be prevented, and more than ever, people are recognizing the importance of and need for taking care of their mental health and seeking help. For example, since the start of the pandemic, a large majority (81%) have become more aware of the importance of taking care of their own mental health, which is on the rise since 2020 (73%).

Since the country has just transitioned to 988, it is unclear what impact it has had on public perception. However, our survey explored the public’s awareness of 988 and its understanding about usage, expectations, and barriers to using crisis services. Currently, there is lukewarm familiarity with 988—17% of US adults are somewhat familiar with it, but only 11% are very familiar. But once described, 8 in 10 say they would be somewhat likely and 39% would be very likely to take advantage of it.

Ideally, the shift to 988 will help make the hotline easier to remember and ultimately increase people’s access to help and support. To help build awareness and education around 988, outreach should be done on the national and state levels. Whether you are a nonprofit organization, business owner, state agency or crisis center, everyone has the responsibility to communicate about 988 effectively in order to help save lives.

PT: Lack of knowledge and training, and lack of affordable and accessible care and support are cited as main barriers to suicide prevention. What do you think are the top 3 ways we can overcome these barriers?

We have an opportunity to implement actionable steps that mitigate suicide risk. A few actions I believe policymakers, health care leaders, and organizational leaders can take to overcome these barriers include the following:

Increasing federal and state investments in and implementing policies that expand access to resources and suicide prevention strategies.

Giving health care professionals the training, evidence-based treatments, resources, and institutional support necessary to identify signs of suicide risk and provide resources to those struggling. In fact, our survey reaffirms this approach, with 78% of respondents saying they believe training and education for professionals, including first responders, health care providers, community leaders, and faith leaders, would be the most helpful for reducing the number of individuals who die by suicide.

Improving mental health and suicide prevention among marginalized communities by focusing on efforts and interventions that are based on and reflect the needs and beliefs of the demographic groups they are trying to reach.

PT: Only 31% of adults believe physical health and mental health are treated equally in our current health system. Do you believe they are treated equally? If not, what steps do you think we as a country need to take? How can the average mental health clinician help?

I think we have made progress in prioritizing mental health as we do physical health, and it is hopeful to see 76% of respondents say their own mental health is equally important to physical health. However, we must continue to set a societal standard of helping mental health and physical health be valued, discussed, and treated equally in health care. We all have mental health just as we do physical health, and there will be times in our lives when our mental health and/or our physical health is not optimal. Just as you would go to the doctor for a physical health concern like a sprain or high blood pressure, consider doing the same for your mental health.

As a country, we must continue to enforce mental health parity at the national and state levels. The Mental Health Parity and Addiction Equity Act of 2008 ensures equal coverage of mental health and addiction. If you have unlimited visits with your heart doctor, the same is supposed to occur for mental health coverage. In the past, mental health conditions were typically covered at far lower levels than policies for physical health conditions.

On an individual level, there a few steps clinicians can take to reduce suicide risk, including:

Incorporate routine suicide and mental health screening/rating scales into their practice.

Use the safety planning intervention and lethal means counseling as an ongoing practice with all patients who have any level of suicidal ideation or suicide risk factors.

Become familiar with counseling on lethal means and practice this with patients during periods of increased suicide risk.

Increase the frequency of outpatient visits or communication during periods of increased risk.

Involve the patient’s family in supportive actions to every extent possible with patient permission. For example, including family in helping to make the home environment safe from lethal means.

Have a referral list ready to go for CBT, DBT or CAMS-specific suicide risk reducing forms of therapy.

Learn the data related to treatments including medications and suicide prevention, you can read more 

Use AFSP resources to help patients and families learn more (eg,

Advocate with the leadership of your health care organization to make suicide prevention a priority of the health system.

PT: According to the poll, 57% believe having open dialogue about mental health is “brave.” How can we get the other 43% on board?

Individuals are becoming more comfortable talking about their mental health with clinicians and loved ones and being there for others who are struggling. This progress is encouraging and together, we are reducing barriers to talking about mental health and suicide. For example, our survey found:

61% of respondents were comfortable talking about mental health, compared to 2020 when it was only 55%.

53% of US adults see getting help from a mental health professional as a sign of strength and having open dialogue about mental health is widely seen as “brave” among most adults in the US. (57%).

More than half of respondents (57%, up from 50% in 2020) reported that they would go to a mental health provider followed by turning to family or friends (52%), or a crisis line (46%).

While a greater number of people want to take action to help, they need more education around how to talk about mental health and suicide. Most US adults today (69%, higher than in 2018) say something would prevent them from talking about suicide with others, in particular not knowing the right words to say (29%) and not feeling like they have enough knowledge (27%).

However, you do not need special training to have an open, authentic conversation about mental health. Often, just talking about it can be the first important step in staying connected for yourself or someone else and helping get support or treatment if needed. Some quick tips for having a conversation include:

When someone is struggling, focus on listening to what they are experiencing

Let the other person share at their own pace

Refrain from judgment or offering advice—just be there for them

Check back in, and offer to connect them to help if they need it

about how to start these types of conversations, how to reach out for help, if someone tells you they are thinking about suicide, and how to talk to a suicide loss survivor.

PT: About 8 in 10 individuals would be interested in learning how they might be able to play a role in helping someone who may be suicidal. What information or resources can mental health clinicians share to assist these interested individuals in recognizing warning signs?

I think it is important to share information that is accurate but also provides hope. We have several resources on our website (afsp.org). We also have chapters in all 50 states that provide both in person and virtual education and awareness events, all of which can help increase one’s knowledge about suicide prevention and how to prevent it.

PT: Finally, is there anything else you think psychiatrists and mental health clinicians should know about this survey?

Anyone who would like to learn more about the survey and how to get involved in advocacy efforts can go to suicidepreventionnow.org. We all have a role to play in preventing suicide and protecting our mental health and becoming informed is an important first step.

Articles

A new poll sought to understand the public’s beliefs about mental health and suicide prevention. Here are the results. 

New Poll Data Shows US Adults Believe Suicide Can be Prevented

The American Foundation for Suicide Prevention (AFSP) has contributed expertise and content on suicide to Most Days, a daily routine app that helps people track their mental health and well-being through different routines and provide support through the app’s community network. To discuss the upcoming collaboration, 

 sat down with Doreen Marshall, PhD, vice president of mission engagement for the AFSP and a licensed psychologist.

Psychiatric Times (PT): Most Days is the AFSP’s first collaboration in the mental health digital app space. What makes this app special?

 While there are many apps in the mental health space, it is important that app developers work with mental health experts and clinical providers to ensure that the content being provided actually does support mental health. Most Days approached AFSP with a desire to improve their app’s content in terms of suicide prevention and suicide grief. They also clearly communicated that the app is not a replacement for professional treatment and are eager to share resources that would help those in crisis get the help they need. After many discussions, we felt that a collaboration would help bring needed resources as well as support to individuals who may not be aware that these resources exist.

PT: You drafted the 4 routines related to suicide prevention for Most Days: (1) Thoughts of Self-harm or Suicide, (2) Healing After Surviving a Suicide Attempt, (3) Supporting Others Who May Have Thoughts of Self-harm or Suicide, and (4) Grieving Loss of a Friend or Family Member from Suicide. Could you tell us more about the routines and their accompanying resources? How did you pick these 4 routines?

 We know that when people are struggling with their mental health, it can be difficult to adhere to a daily routine that helps them. We also know that small actions matter. Most Days has a number of expert-developed routines that support mental health for those struggling with depression, anxiety, sleep problems, and grief. We thought that if we could build additional habits into the routines to help people based on what we have learned, it would help support suicide prevention and suicide grief work.

The habits we added will guide individuals toward actions that can support their other efforts to help themselves or others. For example, reminders to take medication as prescribed, review one’s safety plan, take steps to stay connected, can all have a positive impact on one’s mental health and may even save a life. Again, while using the app is not a substitute for working with a mental health professional, using an app to track habits and to connect to a supportive peer community can encourage people to proactively take daily steps to help their mental health.

We also thought there might be similar routines that could help support those who are caring for others or grieving a suicide loss. AFSP engages in several program efforts to educate the public about supporting those who may be struggling or grieving a suicide loss. Incorporating similar information into an app seemed to be an important way to extend these efforts to reach more people.

Finally, part of this collaboration was to include resources that can help someone who approaches the app and needs immediate support, so we incorporated the National Suicide Prevention Lifeline, a phone line that provides access to crisis counseling, to appear when someone engaged one of the suicide prevention related routines.

PT: How do routines help maintain an individual’s mental health?

 There is good research to support that maintaining a daily routine can support one’s mental health. When we are not experiencing optimal mental health, it can be more difficult to do the very things we know help us. Yet, we know that our daily actions matter, and things like remembering to take prescribed medication, getting some daily exercise, and reaching out to others can all have a positive impact on our mental health. Routines and prescribed daily habits can also help anchor us and provide some sense of control when we feel overwhelmed or unable to think about the next thing we can do to help.

PT: Part of the Most Days app’s appeal is the community aspect. Could you elaborate on the importance of communal support in building self-care routines?

 I think we all do better knowing there is support whenever we are trying to make a positive change. Most Days has a community of people who are actively trying to make positive changes to support their mental health, and for someone trying to do the same, it can help to know that others are working through similar challenges and that you are not alone.

PT: How can apps like Most Days build upon the clinical treatment patients receive?

 This is an important caveat for the use of apps related to mental health—they are not to be used instead of clinical treatment, but rather as an adjunct to treatment when treatment is needed. We know, though, that clinical treatment is usually limited—you may see an outpatient mental health professional for an hour a week, but you have lots of other hours outside of treatment to navigate your daily life and put into practice what you are learning in treatment. Apps that help track daily habits can help clients with reminders to engage in those helpful actions, as well as help them track their own behavior outside of treatment to be able to report accurately what they are experiencing to their clinical provider. And it always helps treatment when patients can accurately describe what is happening in between treatment sessions, which can be especially hard for patients to do when feeling depressed or struggling with their mental health.

PT: Finally, what is the most important thing about Most Days that you think mental health clinicians should know about?

 Apps cannot and should not replace clinical treatment when that is what is needed. But I think clinicians can consider how these existing mental health apps may support treatment efforts. They can work with patients to identify apps that are evidence-informed and contain expert content and resources. We should also remember that our patients are not the only ones that can benefit from apps to support our mental health—they can be helpful to us as clinicians in managing our mental health, too.

The American Foundation for Suicide Prevention collaborates with Most Days, a mental health app, to provide suicide prevention expertise and content. Learn more about the partnership here. 

Doreen Marshall, PhD

Articles

New Poll Data Shows US Adults Believe Suicide Can be Prevented

Mental Health App Collaborates With the American Foundation for Suicide Prevention