As the national debate on mental health continues after the suicides of fashion designer Kate Spade and television host and chef Anthony Bourdain earlier this month, New York Gov. Andrew Cuomo recently announced the adoption of a cutting-edge program for those struggling with a history of suicide attempts.
Rates of death by suicide have been rising in nearly every state, according to the Centers for Disease Control, but the risk factors widely vary, from job loss to relationship stress. A host of risk factors such as depression or social isolation impact New York’s suicide rate. In New York City alone, suicide is the third leading cause of death among 15- to 24-year-olds.
The Attempted Suicide Short Intervention Program, initially developed in Switzerland in 2013 at Bern University, is the first of its kind to be introduced in the United States. Made possible by a grant from the Substance Abuse and Mental Health Services Association, the program has already found success in Finland, Sweden, and Lithuania. The initial study was promising: It reduced suicidal behavior by 80 percent and hospitalizations by 72 percent.
ASSIP involves three sessions. In the first meeting, the patient is recorded on video telling what researchers call the “narrative,” or the details of the patient’s suicide attempt and any relevant mental health history; the second involves the patient and doctor watching and discussing the recording and filling in gaps as needed; the third produces an individualized treatment plan with coping strategies. Following the last meeting, the doctor sends the patient a personalized handwritten letter every three months for a year, and one letter every six months in the second year. The letters strengthen the patient-doctor relationship and may reduce future suicide risk: In the two-year follow-up to the study, the group receiving letters made only five suicide attempts, compared to the control group, which made 41.
As one of three recipients of SAMHSA’s Zero Suicide model, New York state was awarded a $3 million grant to integrate suicide prevention in behavioral health care systems.
Historically, behavioral health systems have been designed to treat conditions from anxiety and depression to schizophrenia but have lacked the comprehensive infrastructure to address suicide prevention. Furthermore, research has been underfunded. For example, in 2017 the federal government spent about $689 million on breast cancer research but only $35 million on suicide prevention, despite the latter exceeding the former by a few thousand more deaths a year.
Dr. Jay Carruthers, the director of the Suicide Prevention Office at the New York State Office of Mental Health, and a team of five other clinicians from the University of Rochester have already begun supervising ASSIP’s use in outpatient referrals, and will expand to hospitalized individuals as soon as possible. “Morally and financially, there’s just a lot of compelling reasons we should be looking at interventions like ASSIP to really provide additional support to individuals who have had more than one suicide attempt,” Carruthers says.
It’s the narrative-driven system that makes ASSIP unique, says Dr. Konrad Michel, who trained Carruthers and his colleagues. “When people tell their stories, there can be any number of reasons for their decision to attempt suicide. But once you listen, there’s always an explanation.” Research shows that sharing personal narratives is an important medical intervention: In a 2011 study measuring the impact of storytelling, patients with hypertension saw “substantial and significant improvements” to their health.
ASSIP has great potential for reducing repeated suicide attempts, but it’s not meant to replace the ongoing psychotherapy often necessary for those with prolonged and severe mental illness (although 54 percent of people who die by suicide do not have a known mental health condition). This makes establishing regular outpatient care—particularly with a trustworthy doctor—crucial.
Because ASSIP can reduce suicide attempts, it would theoretically also impact suicide-related expenses, like medical costs for individuals and families, lost income for families, and lost productivity for employers: Arecent study found that the average cost of one suicide was $1.3 million.
Although researchers are excited about the program’s potential, they acknowledge that the initial findings of the stand-alone study must be replicated elsewhere. And given ASSIP’s current successes in Europe, and interest in Australia and India, Michel feels “very confident” it will serve the people who need it most.