Shifting Suicide Prevention Paradigms: Looking Beyond Clinical Settings

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Project Summary: Shifting Suicide Prevention Paradigms: Looking Beyond Clinical Settings Every 10 minutes one person dies by suicide in the US, a result of a public health epidemic that has increased over the last 15 years and incurred over $70 billion in medical costs and lost productivity. A common lamentation in the wake of suicide is, “If we had only known how bad things were.” A crucial scientific gap in suicide prevention stems from the majority of suicide research relying on individual psychopathology, largely overlooking meaningful constellations of risk in a broader context of social environmental life disruptions that commonly precede suicide. Job loss, financial strain, divorce, legal problems, housing instability – these life disruptions can be semaphores of despair that are misinterpreted as coincidental rather than causal; thus overlooked as points for timely detection and intervention. I propose a paradigm shift in suicide research by prioritizing social determinants to develop public health research and prevention through broad, but strategic, partnerships with industries outside of mental health and health care, including the specific industries of family law, mortgage foreclosure, and unemployment services. This proposal uses a two- pronged approach that ventures beyond traditional funding mechanisms by challenging what we typically consider to be “health” vs. “non-health”-related suicide prevention research and intervention. First, by taking the tested methodology of psychological autopsy and reinventing it as a social autopsy, we will dive deeply both into the nature of life disruptions that often precede suicide and the contacts with non-medical services that a suicide decedent may have made prior to their death. Second, by surveying and interviewing employees of industries that commonly deal with life disruptions (i.e., divorce, mortgage foreclosure, and job loss), we will explore their experiences with suicidal clients, such as occupational wisdom and intuition around warning signs among clients, training around suicide prevention, knowledge about suicide, and approaches they may have used when working with clients in distress. Seeking unconventional upstream strategies to identify and reach people at risk for suicide is all the more urgent against the backdrop of the COVID-19 pandemic, which created historic job loss, relationship strain, and increased potential of mortgage foreclosures. As a researcher trained in public health sciences, I investigate the social production of health problems, exemplified in my focus of how social determinants contribute to poor mental health, suicidal ideation, and suicide attempt. My perspective, coupled with extensive experience in survey data research and efforts in training medicolegal death investigators, uniquely qualify me to successfully implement these novel approaches to change suicide risk detection and prevention. True integration of social determinants into suicide prevention research requires rethinking the problem of suicide as solely a clinical mental health problem requiring clinical solutions, to suicide as a problem at a social and clinical nexus, thus necessitating both social and clinical solutions.