The Research Prioritization Task Force Report

1. The Research Prioritization Task Force Report Thomas R. Insel, MD Director, NIMH February 26, 2014

2. National Strategy for Suicide Prevention Goal 12. Promote and support research on suicide prevention. Objective 12.1: Develop a national suicide prevention research agenda with comprehensive input from multiple stakeholders. Objective 12.2: Disseminate the national suicide prevention research agenda. Objective 12.3: Promote the timely dissemination of suicide prevention research findings. Objective 12.4: Develop and support a repository of research resources to help increase the amount and quality of research on suicide prevention and care in the aftermath of suicidal behaviors.

3. Suicide Rates have not decreased since 1990 Fact: Homicides have dropped from 9.8/100,000 in 1992 to 4.8/100,000 in 2010 (<15,000/yr). Fact: Suicides have not decreased over past 2 decades. Rate Per 100,000 SOURCES: Bureau of Justice Statistics (homicide); CDC (suicide)

4. 6 Key Questions for Research Question 1: Why Do People Become Suicidal? Question 2: How Can We More Optimally Detect/Predict Risk? Question 3: What Interventions Prevent Individuals From Engaging in Suicidal Behavior? Question 4: What Services Are Most Effective for Treating the Suicidal Person and Preventing Suicidal Behavior? Question 5: What Other Types of Preventive Interventions (Outside Health Care Settings) Reduce Suicide Risk? Question 6: What Existing Infrastructure Can Be Better Utilized, and What New Infrastructure Needs Must Be Met In Order to Further Reduce Suicidal Behavior in the United States?

5. Research Agenda Cross-cutting Themes/ Recommendations • Improve surveillance to identify individuals in and across low- and high-risk periods • Leverage investments using common data elements; data banking; data sharing • Use efficient designs to test reduced access to lethal means and fast acting medications; test new technologies for predicting risk and intervention response • Field practical, randomized trials to test various approaches to quality improvement in care systems • Use multi-disciplinary approaches to understand and harness media influence • Test approaches to initiate and maintain health, protective behaviors • Add measures of suicidal behavior to studies already targeting risk factors • Determine how to improve adoption, fidelity of implementation, and sustainability of effective suicide prevention programs

6. A Prioritized Research Agenda for Suicide Prevention

7. Past Year Suicide Attempts in Boundaried Settings Opportunities to Reduce 648,000 Adult Suicide Attempts by 20% (135,600 fewer attempts) Source: National Action Alliance for Suicide Prevention

8. Burden Map of 38,000 Suicide Decedent Subgroups in the United States Firearm Deaths 19,392 MVCO Deaths ~ 735 College Students 200-1,000 Any Healthcare Accessed 30 days before death ~ 9,500 U.S. Army (CONUS) ~200 (est.) Criminal Justice System American Indians/AN Male Veterans ~500 Emergency Department Attempt visits ~430 ~7,000 (~2% of 390,359) 7,800 • Data Sources: • CDC WISQARS 2010 • CDC NVDRS 2005 • Bureau of Justice Statistics 2008-2009 • U.S. Army (2009-2010) • Schwartz 2011 • Trofimovich et al 2012 • Miller & Barber MVCO estimates 2013

9. Implementing the Plan • Better detect those at risk - Key Q 2 – multiple initiatives (NIMH, AFSP, DARPA) • Continuity of treatment after an attempt Key Q 4 • Effective treatment of mental disorders (CBT, collaborative care, medication, social contact) Key Q 3 • Reduce means (firearms, bridges, CO, education and peer support) Key Q 5

10. Paving the Way for Prevention, Recovery, and Cure www.nimh.nih.gov Research = Hope