Building Bridges

Suicide Prevention Dialogue

with Consumers and Survivors

“From Pain to Promise”

A meeting held with prevention professionals, 

health care providers, researchers, policymakers, 

and consumers with personal experience in suicide.

Annapolis, MD, November 28–29, 2007

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Acknowledgements

This publication was prepared under contract 280-02-0400, 

AFYA, Inc. for the Substance Abuse and Mental Health 

Services Administration (SAMHSA), U.S. Department of 

Health and Human Services (HHS). Christopher C. Marshall 

and Stacey Lesko served as the Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are 

those of the dialogue participants and do not necessarily 

reflect the views, opinions, or policies of the Center for 

Mental Health Services (CMHS), SAMHSA, or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced without permission 

from SAMHSA. Citation of the source is appreciated. This 

publication may not be reproduced or distributed for a 

fee without specific written authorization of the Office of 

Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at 

http://www.samhsa.gov/shin. Or, please call SAMHSA’s 

Health Information Network at 1-877-SAMHSA-7 (1-877-

726-4727) (English or Espanol).

Recommended Citation

Suicide Prevention Dialogue with Consumers and Survivors, 

From Pain to Promise. HHS Pub. No. (SMA)10-4589. Rockville, 

MD: Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 2010.

Originating Office

Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 1 Choke Cherry 

Road, Rockville, MD 20857.

HHS Publication No. (SMA)10-4589.

Printed 2010

iii

v

Contents

Definitions ....................................................................... vii

Preface ............................................................................. xi

Introduction ....................................................................... 1

Suicide Dialogue Meeting .................................................. 5

In Their Own Words .......................................................... 7

Advancing the Suicide Prevention Agenda ...................... 13

In-depth Conversations ................................................... 19

Consumer Study................................................................ 27

Recommendations............................................................. 29

Next Steps ......................................................................... 45

Resources .......................................................................... 47

Participant List ................................................................. 53

vii

Definitions

The focus of this report is on sharing the concerns and 

recommendations of people who have direct personal 

experience with suicide, particularly those who have 

attempted suicide and those who have lost a loved one 

to suicide. These people collectively are called consumers 

and survivors.

Consumer – a past or present recipient of mental 

health services.

Suicide attempt survivors – people who have 

experience with suicidal thinking and behaviors 

including individuals who have survived a suicide 

attempt.

Survivors – family members, significant others, 

acquaintances, or providers of health services who 

have lost a loved one or client due to suicide.

The term suicide is often used broadly to include thinking 

about suicide, self-harming behaviors, suicide attempts, 

and deaths by suicide. It is important to be clear about 

what aspect of suicide is being discussed. 

Death by suicide – death from a self-inflicted act 

(e.g., injury, poisoning, or suffocation) where there is 

evidence that the act was intentional.

Deliberate self-harm (DSH) – intentional selfinjurious behavior where there is no evidence of 

intent to die.

• DSH includes various methods by which individuals 

injure themselves, such as self-laceration, selfbattering, taking overdoses, or exhibiting deliberate 

recklessness.

Suicidal communications – direct or indirect 

expressions of suicide ideation, expressed orally or 

through writing, artwork, or other means.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

Suicide attempt – a non-fatal, self-inflicted act 

(e.g., injury, poisoning, or suffocation) with explicit 

or inferred intent to die. 

• Death does not occur in an attempt for one of the 

following reasons: the act was not lethal; the person 

was rescued or thwarted; or the individual changed 

his or her mind. A suicide attempt may or may not 

result in injuries.

Suicide ideation – thoughts of harming or 

killing oneself. 

• People who have suicide ideation may or may not 

form the intent to do themselves harm. They may or 

may not have a plan. Ideation may be transient or 

ruminative, active or passive, acute or ongoing.

Efforts to prevent suicide may be categorized in the 

following ways.

Prevention – interventions designed to stop 

suicide attempts or completions from occurring by 

focusing efforts on at-risk individuals, environmental 

safeguards, reducing the availability of lethal methods, 

and systemic reform.

Intervention, support, or treatment – the care of 

suicidal people by peers, loved ones, certified peer 

specialists, consumer-operated services, licensed 

mental health caregivers, health care providers, 

and other caregivers with individually tailored 

strategies designed to support, empower, respect, and 

change the behavior, mood, and/or environment of 

individuals, and help them identify and satisfy their 

needs without engaging in self-destructive behaviors.

viii
ix

Postvention/post intervention – actions taken after a 

suicide has occurred largely to help survivors such as 

family, friends, and co-workers cope with the loss of a 

loved one. 

Warm lines – confidential non-crisis telephone 

support lines answered by trained consumers who 

offer support, hope, strength, understanding, and a 

willingness to listen.

• The operators of warm lines span all the stages of 

recovery from mental illnesses.

xi

Preface

Building Resilience ... Facilitiating Recovery... 

A Life in the Community for Everyone

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) has established a clear vision 

for its work: a life in the community for everyone. To 

realize this vision, the Agency has sharply focused its 

mission on building resilience and facilitating recovery 

for people with, or at risk for, mental health and/or 

substance use problems.

Suicide prevention is a priority as depicted in SAMHSA’s 

matrix (http://www.samhsa.gov/matrix/brochure.aspx), 

which identifies 11 priority program areas. These areas 

have been seen as the most important for ensuring that 

the Agency’s work is congruent with what people with 

substance use and mental disorders need to live a full, 

rewarding life in the community. A matrix workgroup 

that meets regularly across SAMHSA’s three centers (the 

Center for Substance Abuse Prevention [CSAP], the Center 

for Substance Abuse Treatment [CSAT], and the Center 

for Mental Health Services [CMHS]) promotes attention 

to suicide as a critical issue.

Center for Mental Health Services 

The Center for Mental Health Services is the Federal 

entity within SAMHSA that leads national efforts to 

improve prevention and mental health treatment services 

for all Americans. CMHS uses a number of vehicles for 

disseminating information about consumers’ needs and 

interests so that these can be considered when policies 

and plans are being formulated. Some of the most 

important are described briefly here. 

National Consensus Statement 

on Mental Health Recovery

Mental health recovery is a journey of healing and 

transformation that enables a person with a mental health 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

xii

problem to live a meaningful life in a community of his 

or her choice, while striving to achieve his or her full 

potential. The National Consensus Conference produced 

this statement at a December 2004 meeting of more 

than 110 expert panelists: consumers, family members, 

providers, researchers, public officials, and others. The 

full statement can be found on SAMHSA’s Web site 

(http://mentalhealth.samhsa.gov/publications/allpubs/

sma05-4129).

The 10 fundamental components of recovery are as follows. 

1. Self-direction and defining one’s own life goals and 

unique path toward those goals

2. Individualized and person-centered care based 

on one’s unique strengths and resiliencies, needs, 

preferences, experiences, and culture

3. Empowerment to choose from a range of options 

and to participate in all decisions

4. Holistic approaches that encompass one’s whole life, 

including mind, body, spirit, and community

5. Non-linear process of continual growth, occasional 

setbacks, and learning from experience

6. Strengths-based valuing and building on one’s 

capacities, resiliencies, talents, coping abilities, and 

the inherent worth of the individual

7. Peer support, including the sharing of experiential 

knowledge and skills and social learning

8. Respect, including the protection of rights and 

eliminating discrimination and stigma

9. Self-responsibility for one’s own self-care and 

journeys of recovery

10. Hope, the essential and motivating message of a 

better future—that people can and do overcome the 

barriers and obstacles that they must confront
xiii

National Strategy for Suicide Prevention

Representing the combined work of advocates, clinicians, 

researchers, and survivors, the National Strategy for 

Suicide Prevention was published in 2001 by the U.S. 

Department of Health and Human Services. It outlines a 

coherent national plan to enhance the suicide prevention 

infrastructure, including the creation of a technical 

assistance and resource center. In 2002, the Suicide 

Prevention Resource Center (SPRC) was established with 

funding from SAMHSA/CMHS. The National Strategy for 

Suicide Prevention can be found on the SPRC Web site 

(http://www.sprc.org).*

President’s New Freedom Commission 

on Mental Health

The President’s New Freedom Commission on Mental 

Health report, Achieving the Promise: Transforming 

Mental Health Care in America, 2003, sets out several 

goals. The first states that in a transformed mental health 

system, Americans will seek mental health care when 

they need it—with the same confidence that they seek 

treatment for other health problems. The Commission’s 

first recommendation for achieving the first goal is 

directed toward suicide prevention. The recommendation 

is to advance and implement a national campaign to 

reduce the stigma of seeking care and a national strategy 

for suicide prevention. The second recommendation for 

achieving the first goal is to address mental health with 

the same urgency as physical health.

* On September 10, 2010, SAMHSA Administrator Pamela S. Hyde 

joined U.S. Health and Human Services Secretary Kathleen Sebelius 

and Defense Secretary Robert Gates to launch the National Action 

Alliance for Suicide Prevention. This group will update and advance 

the National Strategy for Suicide Prevention, develop approaches 

to constructively engage and educate the public, and examine ways 

to target high-risk populations.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

xiv

Consumer Affairs

The Consumer Affairs program within the Office of 

the CMHS Director plays a lead role in developing and 

implementing consumer information activities, supporting 

consumer-directed initiatives, and coordinating CMHS 

social inclusion efforts. The program works in partnership 

with other Federal entities, as well as with public and 

private health and human service agencies, to develop 

policy and guidance for mental health services. It also 

ensures that consumer mental health needs receive 

adequate attention and promotes consumer participation 

in service design and delivery (e.g., peer support). 

The Consumer Affairs Program amplifies the voices of 

recipients of mental health services by promoting and 

facilitating meaningful consumer participation in all 

aspects of CMHS programs. This report is one of the 

Building Bridges series of reports of dialogues held in 

previous years with consumers of mental health services. 

This report presents the statements, discussions, and 

recommendations of a consumer/survivor dialogue 

meeting held in Annapolis, MD, on November 28 and 29, 

2007, with consumer leaders and representatives of the 

suicide prevention community.

Public Policy

The history of suicide prevention legislation began 

in 1997, with the passage of resolutions by Congress 

recognizing suicide as a national problem and declaring 

suicide prevention a national priority. This was followed 

by the Surgeon General’s Call to Action to Prevent 

Suicide (1999), which led to the creation of the National 

Strategy for Suicide Prevention. Since then, two major 

laws have been enacted: The Garrett Lee Smith Memorial 

Act (PL 108-355) and the Joshua Omvig Veterans Suicide 

Prevention Act (PL 110-110). In addition, many State 

governments have passed suicide prevention legislation, 

including resolutions recognizing suicide as a problem 

and authorizing the development of State suicide 

prevention plans.
xv

The Garrett Lee Smith Memorial Act, October 2004, 

to Implement Suicide Prevention Programs, Enhance 

Mental Health Services on College Campuses, and 

Support Research and Training Centers

More than 350 members of the House of Representatives 

and the entire Senate voted to pass the Garrett Lee Smith 

Memorial Act, bipartisan legislation to reduce youth 

suicide. The language that became the act was introduced 

by Senator Gordon Smith (R-OR) in memory of his son, 

who had recently died by suicide.

The Joshua Omvig Veterans Suicide Prevention Act 

On November 5, 2007, President George W. Bush signed 

this law, which directs the Department of Veterans Affairs 

to develop and carry out a comprehensive program 

aimed at reducing suicide among veterans. Mandatory 

training for staff would be put in place, and veterans 

would be offered mental health screening and referrals, 

at their request, for counseling and treatment. Randy 

and Ellen Omvig, the parents of a young Iowa reservist 

who killed himself after returning from Iraq, exemplify 

the consumer/survivor activism that transforms grief 

into action to prevent future tragedies and the courage 

to speak out on the important public health issue of 

veterans’ suicide.

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Introduction

Suicide is a Major Public Health Problem

in the United States

This is not an easy field to be in, nor an 

easy topic to talk about... It’s a bigger 

problem than most people can ever know. 

What motivates me is that it “takes a 

village.” Just imagine what it is like for a 

person who is suffering right now. If not us 

(to take action) who...if not now, when?

— Conference participant

Suicide—talked about, attempted, or completed—ripples 

like a stone dropped in a pond, spreading beyond the 

individual to the family, loved ones, friends, and the 

larger community; to caregivers and associates; and 

to policymakers and those who seek to help through 

research. The emotional tolls are impossible to calculate, 

and their effects endure well beyond the event, often for 

a lifetime.

What we can quantify are the alarming epidemiological 

studies and costs of suicide.

In 2005, 32,637 people died by suicide, making it the 

11th leading cause of death in the United States; at this 

rate, someone dies by suicide every 16 minutes.* In the 

United States, more people die by suicide each year 

than die because of high blood pressure or homicide. In 

2002, more than 130,000 Americans were hospitalized 

following suicide attempts; another 116,000 were treated 

in emergency departments and released.

* Source: National Vital Statistics Reports, 56(10)(available online at 

http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf).
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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Suicide is the third leading cause of death among 

Americans between the ages of 15-24 and the second 

leading cause of death among those between the ages of 

25-34. Among college students, suicide is the third leading 

cause of death.

According to the National Violent Death Reporting 

System, approximately 20 percent of all suicide deaths 

occur among veterans.

Suicide rates increase with age. Elderly people who die 

by suicide are often divorced or widowed and suffering 

from a physical illness. The percentage of elderly people 

who die by suicide is greater than the percentage of 

elderly people in the population.

Ninety percent of suicides that take place in the United 

States are associated with mental illness, including 

disorders involving the abuse of alcohol and other drugs. 

Half of those who die by suicide were afflicted with 

major depression. The suicide rate of people with major 

depression is eight times that of the general population; 

there also is a strong association between trauma and 

suicide (attempts and completions).

In addition to the tragedy of lost lives, mental illnesses 

come with a devastatingly high financial cost. In the 

United States, the annual economic, indirect cost of 

mental illnesses is estimated to be $79 billion ($63 billion 

in lost productivity, $12 billion in mortality costs, and $4 

billion in productivity losses for incarcerated individuals 

and for the time of those who provide family care). The 

Suicide Prevention Resource Center (SPRC) has calculated 

the financial cost of each completed and attempted 

suicide at $4,000 and $9,000 per case, respectively.*

*

Source: National Strategy for Suicide Prevention, Harris & Barraclough, 

1997. http://download.ncadi.samhsa.gov/ken/pdf/SMA01-3517.pdf 
3

Consumer/Survivor Involvement in Suicide Prevention

Suicide attempt survivors have become increasingly 

involved in efforts to promote suicide prevention, 

support, and treatment. They have joined a growing 

movement of survivors (family members and significant 

others who have lost a loved one to suicide) in 

providing guidance on policy, planning, and prevention 

services. This new way of engaging in issues parallels 

the growing activism in the design and delivery of 

mental health services.

In fact, the first-ever conference for survivors of suicide 

attempts, health care professionals, clergy, and laity took 

place on October 19-21, 2005, in Memphis, TN, and was 

attended by more than 100 people. It focused national 

attention on the continuing needs of individuals who 

have attempted suicide and—for the first time—how 

health care professionals, faith communities, and others 

can learn from attempt survivors to improve services and 

save lives. The conference, created by the Organization 

for Attempters and Survivors of Suicide in Interfaith 

Services (OASSIS) and the Suicide Prevention Action 

Network (SPAN USA), was titled “The First National 

Conference for Survivors of Suicide Attempts, Health Care 

Professionals, and Clergy and Laity.” A summary can be 

found at the SPRC Web site (http://www.sprc.org/library/

SOSAconf.pdf).

The publication of Lifeline Service and Outreach 

Strategies: Final Report of the Attempt Survivor Advisory 

Summit Meeting and Individual Interviews in 2007 

was another important milestone. (To view the report, 

go to http://www.suicidepreventionlifeline.org/media/

pdf/NSPL-SOSA_Report-7-31-07_FINAL.pdf). In June

2006, the Steering Committee of the National Suicide 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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Prevention Lifeline Network (Lifeline) identified better 

outreach and service to suicide attempt survivors 

as a strategy for reducing suicide nationally, since a 

previous suicide attempt is one of the strongest known 

predictors of suicide. Eight attempt survivors attended 

a summit meeting in New York City on January 16, 

2007, and four other attempt survivors contributed 

their suggestions during individual in-depth phone 

interviews conducted between January 25, and February 

1, 2007. The aforementioned report summarizes the 

findings from the meeting and interviews. SAMHSA/

CMHS has supported the consumer/survivor effort 

by creating the National Mental Health Consumers’ 

Self-Help Clearinghouse and by funding Alternatives 

Conferences—national conferences organized by and 

for mental health consumers and survivors. Information 

about these conferences can be found on the CMHS 

Web site (http://mentalhealth.samhsa.gov/csp/consumers/ 

alternatives.asp) by typing the phrase “alternatives 

conference” in the search window.
5

Suicide Dialogue Meeting

The purpose of the Suicide Prevention Community 

Dialogue with Consumers and Survivors meeting, 

held November 28–29, 2007, was to accomplish the 

following goals.

• Improve mutual understanding, respect, and 

partnerships between people who have experience 

with suicidal thoughts and behaviors and providers 

of health care, researchers, policymakers, and 

others involved in suicide prevention and 

behavioral health.

• Develop a set of recommendations that can lead to 

improved responses to suicidal thoughts, behaviors, 

and prevention efforts with a particular focus on 

overcoming attitudinal and other barriers that 

hinder recovery.

• Develop a report that will share consumers’ voices 

with health care providers, researchers, and 

policymakers who have responsibilities for suicide 

prevention in this country.

Participants at this meeting reviewed this report prior 

to publication and provided many useful comments and 

suggestions to ensure that the report accurately reflects 

their thoughts and intentions.

Participants recommended the names of places and people 

for national distribution: SAMHSA’s suicide prevention 

grantees and list of stakeholder groups; researchers 

funded by the National Institute of Mental Health (NIMH); 

policymakers and those responsible for creating and 

implementing State suicide prevention plans; national 

suicide prevention organizations and trade associations for 

every relevant discipline; providers and their professional 

organizations across the healthcare spectrum as well as 

those working in corrections; and graduate education 

programs in appropriate discipline areas.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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Meeting Expectations and Norms

Recognizing the emotionally potent and delicate content 

of the meeting, participants and facilitators established 

expectations and norms at the outset. Included in these 

expectations and norms are the following.

• Take the morning to get to know each other and 

establish trust.

• All information is confidential.

• Keep in mind people’s experiences; everyone in 

the room has a level of expertise; remember to be 

respectful and sensitive.

• It’s important for everyone to say everything she or 

he needs to say; really listen to each other; no side 

conversations.

• If you need to leave, do that, but try to stay focused 

and be there for each other. If you need peer or 

clinical support, please ask.
7

In Their Own Words

Participants at the dialogue meeting introduced 

themselves and shared experiences that highlighted their 

pain and expressed their hope, what they are doing to 

make a difference in suicide prevention, and what they 

would like providers of health care services to know. 

Space prohibits sharing every comment, but the ones 

below represent a spectrum of experiences and concerns.

The Pain

The pain that led to an attempt or that followed an 

attempt (completed or not) of a loved one was expressed 

in many ways. Here are some quotes.

My sister—7 years older than me—had depression, 

as did my father. A few weeks before I was set to 

graduate from college, my sister took her life. I was 

totally unprepared, shocked. I was her support 

system, but I was not prepared for a suicide. In 

taking care of her papers afterward, I found out 

that she had called me 7 times that day. I know 

what it is like to deal with the impact of suicide on 

the individual and the family.

I lost my youngest son 11⁄2 years ago...in all, five 

close family members, including my husband 

[have died by suicide]. The pain lasts the rest 

of your life. My 14-year-old granddaughter 

attempted suicide last July. Native Americans 

have to deal with a number of issues that the 

general population doesn’t know about. We get 

commodity care if we get care at all, and then 

only when you are in danger with life or limb. 

Health care is very inadequate; mental health 

care is even worse. I spent many years keeping my 

husband and son alive.
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It isn’t safe to be gay with a mental health problem 

and it isn’t safe to be healthy and gay. I live with 

bipolar disease and have been 7 years in recovery 

from addictions. I have problems from head 

to toe—I’ve been HIV positive for 19 years; I’m 

dyslexic, have a hearing loss, to name a few...and 

I am a suicide attempt survivor. My sister, who 

was an addict, was admitted to a 3-day program, 

rather than 30 days with a medication; that is not 

good for addictions. She died by suicide 2 weeks 

later; I honor her and know that she is here at the 

table with me.

I struggle with depression and have a family 

history of suicide. I grew up in rural America; my 

aunt threatened to kill herself by jumping into a 

cistern.

I remember very clearly as a young psychology 

intern working with a man who was at very high 

risk of suicide. During his hospitalization I had 

to leave for a few days to defend my dissertation. 

While I was gone, this man had been discharged 

to day treatment, a change in his level of care. He 

took an overdose and died. I remember vividly how 

disorienting it was when I returned. I was looking 

for him in his usual spots; but he wasn’t there.

I was working in the emergency department and 

talking with the family of a mother who had taken 

an overdose. A staff member came in to tell us 

that the mother had died. I can still hear the cry of 

anguish from the family.

The Promise—Never Give Up Hope

Believing in hope, believing in a future, no matter how 

intense the pain or bleak the prospect, kept many from 

acting on their thoughts. Indeed, the need for hope 

was expressed in many different ways throughout 

the meeting. And for some, the realization of the pain 
9

they might cause others was a powerful force. Some 

participants’ comments are below.

In my darkest moments I sat in my car in the 

garage, turning the engine on and off ...wanting 

to end the pain, not really my life.

My daughter was actively suicidal and came close 

on a number of occasions; but I’m a firm believer 

of recovery and hope and how that inspires others. 

I was a depressed teenager myself. It’s not just about 

willpower...it’s about willpower and certainly 

hope. My daughter decided that she would live; she 

wrote in her college essay, “I have manic/depressive 

illness, but it doesn’t define my life.”

My younger son has had depression and expressed 

suicidal thoughts. Last spring, when he was home 

from school, we received a call from my older son 

who told us that a mutual friend of theirs since 

childhood had died by suicide at college. We went 

to the wake...and my younger son saw the grieving 

parents of the young man who died and saw how 

destroyed they were by their son’s death. He said, 

“I didn’t realize how awful it would be for you.”

I’m moved by hearing other people’s courage and 

strength; it helps me to be more open about my 

life. I have had suicide attempts; my parents had 

mental illnesses. I’m passionate about care in the 

emergency department. The care I received had 

a coldness and harshness. I was 14 years old. I 

believe I lost my adolescence due to fragmented 

systems of care. I’m passionate about wellness and 

developing internal resilience to deal with life’s ups 

and downs.

I have a diagnosis of schizophrenia and anxiety 

disorder. It’s humbling to hear what I have heard 

here today. I attempted suicide in my younger 

years as a result of mourning my father’s death. 

The schizophrenia started after my wife’s death 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

10

from cancer. My last attempt resulted in a lockup in an institution. I am very attuned to the 

brutalization that occurs in a system controlled by 

providers. When locked up, I survived by centering 

prayer, and mindfulness meditation... I still have 

daily practices. Spirituality is key.

I have had mental illness, [been] dysfunctional, 

housebound, completely isolated due to severe 

anxiety, panic attacks, phobias, and ADHD, 

and made a near-death suicide attempt. [But] 

I suddenly realized I hadn’t tried everything 

and I had no right to kill myself unless I had 

tried everything possible to save my life. I’m 

now married with children and have just about 

completely recovered... I recognized the trauma 

that I had experienced and that my illness [had] 

developed to help me recover.

Making a Difference

It is not unusual for those whose lives have been 

touched by suicide to want to help others. Many have 

been inspired to become active in suicide prevention in 

the hope that they can ease the pain of others, as they 

describe below.

My journey began after my son’s suicide while he 

was in college. I teach “Suicide and the Human 

Experience” on college campuses, direct a federally 

funded grant program for college students, and 

teach suicide assessment in medical schools. I 

started a national organization with a mission to 

create an open dialogue in communities of color 

about mental illness and suicide prevention and to 

support those who have lost loved ones to suicide.
11

Seventeen years ago my sister shot herself. We 

didn’t know at the time, but I know now, she was 

a victim of rape and kept it a secret. I started 

a nonprofit organization to address suicide in 

young people. I’m an advocate for reducing access 

to lethal means of suicide to people at risk. Suicide 

and secrets are a deadly combination.

I realized it was the depression that was talking 

when I heard the voices saying that “things 

would be better if you were dead.” I’m passionate 

about relapses, those who have been treated, but 

relapse and go on to die by suicide. I founded a 

nonprofit organization dedicated to supporting 

people affected by depression or the loss of a 

loved one to suicide.

My first suicide attempt was when I was 12. I’m 22 

now, a student, and on the board of directors of 

several organizations dealing with health.

In 1998 I was diagnosed with bipolar after a 

mental breakdown. I had paranoia, delusions, 

and so many medications to take. I was up and 

down due to my lack of compliance, and dived 

into depression on weekends. I also dived off the 

Golden Gate Bridge in San Francisco. After fully 

recovering from my physical injuries, I was still 

in denial and just wanted it all to go away. In my 

last episode, I saw that parents and friends were 

getting very tired...and had an epiphany that I 

wanted to get better. I happened to read an article 

about the need to have strict structure. Now I am 

on the speaking circuit, talking about this with 

Tipper Gore’s campaign; and I wrote a memoir. 

It’s important for those of us who have survived a 

suicide attempt to speak about our experience and 

what we learned.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

12

I have been suicidal and been involved in 

the consumer/survivor effort for 20 years. 

What contributes to the problem is the feeling 

of worthlessness that occurs in people with these 

diagnoses [e.g., bipolar, personality disorder, 

obsessive-compulsive]; how do we integrate the 

messages we receive that go along with these 

diagnoses?

For 7 years I worked with a mobile crisis unit in 

New York City and came to believe that the best 

way to care for people is in their homes, with their 

family. Getting into their world and in their lives 

has taught me more than sitting with patients 

in offices.

From these personal histories, participants moved to 

a discussion of how to advance the agenda of suicide 

prevention.
13

Advancing the Suicide 

Prevention Agenda

Participants discussed what helps and what does not 

help from a consumer/survivor perspective in suicide 

prevention, intervention, and postvention. The initial 

discussion focused on individual and clinical issues, 

followed by a discussion of systems-related issues.

Individual and Clinical Issues

What Helps?

Throughout, many meeting participants spoke about the 

need for sensitivity in the way that language, especially 

diagnostic language, is used; they emphasized the need 

to see a person as more than his or her diagnosis and not 

to pathologize a person or that person’s behavior. Many 

also spoke with urgency about the need for education 

that would lead to a greater awareness of and sensitivity 

to mental health issues; they saw this need as urgent in 

educational environments where teachers could learn to 

recognize warning signs. Others emphasized “everyday” 

factors that can be addressed that might minimize crises, 

including encouraging proper diet, rest, exercise, and 

companionship for those who seem to be depressed 

or showing other signs that might be of concern. 

Participants also mentioned that community counseling 

centers, which offer free and/or sliding scale services, 

are a helpful resource when attempting to reach the 

underserved community.

Perhaps above all, participants repeated the idea that it is 

important for both those in treatment and for the public 

at large to understand that there are far more success 

stories than stories with unhappy endings.

Each person finds something unique or individual that 

helps. Here are statements from the participants.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

14

Get out of learned helplessness. Learn how to live 

with your voices...do not let yourself be treated as 

victims or helpless. Normalization is important, 

rather than being in a fishbowl of only family 

and therapists.

When my suicidal thoughts were demystified, I 

realized that they are just thoughts and that I can 

work with them; work proactively with suicidal/

negative voices.

I find support groups to be very helpful.

Hopelessness and aloneness can be dealt with; 

sharing stories of recovery builds hope; it helps to 

know others feel like I do and are getting better.

Look for suicide ideation in substance abuse and 

substance abuse relapse; talk about what might 

happen when you relapse.

Encourage people to have a purpose in life; to 

reclaim their dreams...go beyond treatment goals 

and recovery.

Have an individualized recovery plan and safety 

plan when in a crisis situation.

What Does Not Help?

A frequently heard theme was that silence about suicide 

is ill advised; conversely, openness— as mentioned 

above—is often a great relief not only for the person, but 

for family and friends as well. Support may be withdrawn 

after an attempt, or even just a discussion; many found 

this extremely discouraging and emphasized that 

thoughts of suicide may never disappear completely, so it 

is vitally important that continuing care and concern be 

available. Below are statements from participants.

Hearing only about bad outcomes in the press 

doesn’t let people know you can do something to 

prevent suicide; this bad press results in shame 

and not talking openly about suicide.
15

Being treated poorly at the scene of a suicide 

attempt or death is detrimental.

Force doesn’t work.

People want you to get better quickly because it 

is so painful to them; people don’t understand 

the need for acute [and chronic] care...they think 

people are better when they leave the hospital.

Issues related to Native Americans are unique. For 

example, Native Americans face discrimination. 

Men often don’t talk about their problems and 

if you do, it’s a sign of weakness. In reality, they 

can’t talk about it because it is too painful.

Lack of communication between the psychiatrist 

who prescribes the medication and the 

psychotherapist is a common problem.

Alcohol abuse makes suicidal thinking and 

behavior worse.

Being given a treatment plan and not being a 

partner in the treatment planning doesn’t work; 

plus...we need a recovery plan, not a treatment plan.

Systems Issues

Attempt survivors and family members engaged in 

suicide prevention and treatment have a unique lens 

through which to see how we might change our systems 

of care to better help those receiving services. The need 

for peer support came up many times, as did parity in 

insurance coverage for mental health treatment and 

having good access to prevention services and treatment. 

Participants urged policymakers and funders to pay 

more attention and provide funding to rural and tribal 

areas; these groups are behind and just starting to think 

about suicide prevention.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

16

Many also noted the need for well-funded, long-term 

research studies that might point the way to improved 

services and supports. Here is a list of suggestions for what 

helps and what doesn’t help related to systems issues.

What Helps?

• Linkages between emergency department and 

outpatient services.

• Same-day scheduling needed for crisis that does not 

require emergency department services.

• Emphasis on prevention and public health...too 

divided on the different kinds of prevention. Think 

about prevention broadly.

• Expertise and competency—primary care providers 

should think about their skills and limitations...

how much mental health care can be provided by 

primary care providers?

• Connection between provider groups and 

consumer/survivor groups.

• Education in judicial and legal systems. One 

participant noted, “Our Tribe didn’t know what to 

do with my son; they turned him over to the State 

system. He needed mental health care, not prison 

or punishment. My son was put in a holding cell 

(not the other person involved); [my son] hung 

himself. I was told you ‘can’t prevent everything’ 

but it [the cell] wasn’t a safe place to put my son.”

• Booklets that help you choose a provider or 

questions to ask your provider. Anything that is 

readable reinforces hope; makes it concrete when 

you see it on paper.
17

What Does Not Help?

• Lack of attention to men, especially given [their 

suicide death] rates; we don’t target that population. 

What systems would men access? Our systems are 

more accessible to women. What is structurally 

different that would appeal to or support men?

• Rushing to blame in the aftermath of a suicide 

in a facility. It is important how people respond; 

providers are traumatized as well. They have to 

explain and deal with the media.

• Criminalization of mental health problems. There 

was a case in Florida where the initial crime was 

sleeping on a park bench, then mental health 

problems in prison were seen as problematic 

behaviors or offenses that could result in 

punishment or an extended sentence.

• Lack of research in alternative approaches. 

Leadership at leading research institutions should 

support recovery-oriented or alternative approaches 

to prevention and healing.

• Force or coercion into hospital care. When people 

hear the word suicide, it connotes that something 

needs to be fixed by getting people help. Then it is 

the job of people with little training to make that 

happen, first responders, for example, to get them 

into care. They have the most contact with people 

in crisis, which often leads them to be coercive 

as the only solution to avert a crisis. Provide 

more training regarding alternatives to force and 

coercion, and expand the options of where people 

can go, not just hospitals.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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19

In-depth Conversations

At several times throughout the day, participants had indepth conversations about a topic that held particular 

interest. Here are the comments made about these topics.

“Committing” suicide

The term “committing suicide” is a problem. Is it 

empowering to use that term? Committing suicide 

sounds like it is a commitment, a decision that 

someone makes...what you are committed to. Is it 

a choice, something you are committed to do?

It is better to say, “He died by suicide” or “He killed 

himself.” Much more direct, without language that 

has underlying negative connotations.

There was a voice telling me to jump, it was a 

voice, not my conscious self. I didn’t decide...the 

voices compelled me to jump.

It’s not a choice that people make.

“It is difficult and tiring to be around someone who is suicidal.”

Families need concrete assistance with what 

to do. I understand that it must be exhausting 

to be vigilant.

Fatigue is not an education issue...it is more about 

family support. Peer helpers become fatigued as 

well. Family fatigue is a systems issue...need for 

caregiver support.

As providers, we generally are good the first time 

we see someone, after the second attempt, we 

may not be as compassionate. The more we see 

someone, the more judgmental we become. Why 

is that so...why become more judgmental? The 

provider experiences self-doubt, doesn’t know what 

to do, so it is easy to blame the patient. Who is 

defining the expectations of what the recovery is? 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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Are you supposed to be better after 10 sessions...or 

does it take years? Or do patients decide?

Fatigue, of emergency department personnel, 

is common; they are often in situations with 

individuals with suicidal thoughts or behaviors 

and don’t know what to do.

Trauma-informed care

Participants returned to the topic of trauma several times 

throughout the meeting, underscoring the importance 

of understanding and dealing with the connection 

between trauma and how it impacts depression, suicide, 

and other mental illnesses. Interventions should not retraumatize individuals who have experienced trauma 

earlier in their lives.

Ask, “What happened with you?” rather than 

saying or implying, “What’s wrong with you?”

I had abandonment issues starting at a very early 

age. I was born to addicted people. I had many 

physical symptoms of illness...all emotional.

I was adopted at an early age.

I was sexually abused and assaulted three times.

I was traumatized by the mental health system.

I want people to really look at what works...

and what leads to suicide. I will not ever go to 

the ER [emergency room] and will only seek care 

from people I trust. When I was in the hospital 

for a physical health issue, I was guarded by two 

people, even though I wasn’t in for mental health 

reasons. I was guarded because I revealed the 

medication I take.
21

Force and coercion

Participants spoke about some negative experiences 

with the health care system related to the use of force 

and coercion. Many concluded that the liberal use of 

force and coercion has no inherent healing properties 

and often prevents the person at risk for suicide from 

seeking services.

We must have alternatives to emergency rooms...

more options; also, same day scheduling for 

mental health services and in-home crisis care.

Hospitals and other mental health care settings 

must be non-judgmental and psychologically safe 

places in which to receive services.

Peer support services1

Many participants spoke passionately about the need 

for peer support in prevention, intervention, and post 

intervention services. An example pointed to a study that 

showed that individuals reported a range of negative 

experiences in emergency departments following visits 

for suicide attempts.

Why is there a much higher bar when it comes 

to research on whether or when mutual or peer 

support helps? When is the resistance to alternative, 

peer support approaches going to stop?

During this conversation, participants pointed to research 

and services that address peer support from various 

perspectives.

• State Medicaid programs can reimburse for peer 

support services.

1Consumer and family experiences in the emergency department 

following a suicide attempt. Cerel J, Currier GW, Conwell Y. Psychiatr 

Pract. 2006 Nov; 12(6):341-7.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

22

In August 2007, the Director of the Federal 

Centers for Medicare & Medicaid Services 

(CMS) informed Directors of every State 

Medicaid program that CMS “recognized that 

the experiences of peer support providers, as 

consumers of mental health and substance abuse 

services, can be an important component to a 

State’s delivery of effective treatment.” Director 

Dennis G. Smith spelled out the conditions 

that would apply to Medicaid payment for 

peer support services, while noting “...the 

mental health field has seen a big shift in the 

paradigm of care over the last few years. Now, 

more than ever, there is a great emphasis on 

recovery....” The full text of the letter, which also 

contains information about a contact person at 

CMS, can be found online (http://www.ncmhcso.

org/downloads/smd07011%20(2).pdf).

The Georgia Certified Peer Specialist 

Project has developed a model training and 

certification process that allows services 

provided by certified peer specialists (CPS) to 

be reimbursed by Medicare under Georgia’s 

new Rehab Option. (See the Web site at 

http://www.gacps.org/Home.html.)

For information on States currently using peer 

support counselors, please contact the National 

Association of Peer Specialists (NAPS) at 755 

Alta Dale SE., Ada, MI 49301, or by e-mail at 

steveh@napos.org.

• In Memphis, the crisis intervention teams (CIT) 

program is a community effort joining the police 

and the mental health community together for 

common goals of safety, understanding, and 

service to the mentally ill and their families. 

Police officers receive training to increase their 

awareness of how to handle people who are 
23

in crisis. This approach can reduce incidents 

of “suicide by cop,” when a person in a suicidal 

crisis is shot by a police officer. For more 

information, see the Web site (http://www.

cityofmemphis.org/framework.aspx?page=302).

• Hotlines and warm lines, such as SAMHSA’s 

National Suicide Prevention Lifeline, are 24-hour, 

toll-free suicide prevention services available to 

anyone in suicidal crisis. If you need help, please 

dial 1-800-273-TALK (8255).

• Safe haven houses are places where individuals 

and families may go to share and ease their pain. 

A crisis hostel is a place where people who are 

experiencing an emotional or mental crisis have 

an alternative to psychiatric hospitalization.

“What we would like providers of care to know.”

This conversation took place throughout the 2-day 

meeting. The discussion was focused especially on 

what participants thought would help providers offer 

more effective and sensitive support, services, and 

treatment, and how health care systems could better 

address their needs.

Help us to set goals that go beyond relieving 

suicidal thoughts.

Work with us to create individual safety plans...

what should I do when I have these thoughts?

Be understanding and take our individual 

concerns seriously and go the extra mile. For 

example, one of my providers actually tasted a 

medicine to see how awful it tastes. Be genuinely 

interested and supportive of changed behavior. 

For example, one of my therapists made a deal 

with me: “Sleep at least 6 hours and I’ll stand on 

my head; you can take a picture of me.”
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

24

Take a holistic approach, including recognizing 

the physical issues that affect emotional health 

(e.g., nutrition and sleep) and spirituality.

Erase and eradicate your judgment that “he or she 

will never get better.” Empathize 100 percent with 

that person, every day.

Build resilience with your clients; teach them early 

how to manage emotions.

Be willing to refer clients to someone else if you 

lack the expertise in certain areas...and provide 

qualified references.

Eliminate the fixer/fixee- and helper/helpee duality 

thinking. We are all in this together. Each person 

takes responsibility; the provider is not solely 

responsible.

Be aware of your perspectives and beliefs while 

interacting with consumers, and be aware of your 

cultural beliefs about mental illness; different 

cultures view suicide differently.

Deal with your impatience and your thoughts 

about the helplessness and hopelessness when you 

don’t know what to do...providers need to patiently 

accept what they do not know and be comfortable 

with ending up in a place of not knowing. Then 

they can bear witness to that and share it with 

the patient. Then, spontaneously, solutions may 

appear.

Avoid automatic alarm or jumping to hospitalize 

when listening would work.

Don’t be afraid to talk with us about suicide...

don’t be afraid that talking will make it happen.
25

In response, a health care provider shared an observation.

Professionals learn through both education and 

experience, and many experiences stay with them 

over years, shaping their perceptions and molding 

their approaches in new ways while deepening 

their respect for the resilience of those they seek to 

help. In a forum such as this, professionals have a 

unique opportunity to tell their own stories, listen 

to consumers, and share thoughts with each other.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

26
27

Consumer Study

Ed Knight, a participant, presented a brief overview of 

a study conducted with 205 consumers in 14 consumerrun dialogue meetings in New York State.2

 The purpose 

of the study was to identify how individuals with severe 

mental illnesses and a history of suicidal behavior cope 

with suicidal thoughts. Study participants were asked 

to identify up to five strategies they use to deal with 

suicidal thoughts. They named the following groups 

of first-line coping strategies, starting with those 

mentioned most often:

• Spirituality/religious practices: 18 percent of study 

participants;

• Talking to someone/companionship: 14 percent;

• Positive thinking: 13 percent;

• Using the mental health system: 12 percent;

• Considering consequences to people close to me: 

9 percent;

• Using peer supports: 8 percent;

• Doing something pleasurable: 8 percent;

• Protecting myself from means: 5 percent;

• Doing grounding activities: 4 percent;

• Considering consequences to myself/fear: 2 percent;

• Doing tasks to keep busy: 2 percent;

• Maintaining sobriety: 1 percent;

• Helping others: 0.5 percent; and

• Seeking emotional outlets: 0.5 percent.

2Ed Knight et al. Coping with Thoughts of Suicide: Consumers’ 

Strategies. Paper presented at the annual meeting of the American 

Public Health Association, November 7, 2007.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

28
29

Recommendations

After identifying and addressing what promotes and 

what hinders recovery and effective suicide prevention, 

the participants made recommendations about what 

should be done in several areas of suicide prevention, 

intervention, and post intervention.

In addition, participants thought about what they could 

do individually and as a group to keep the dialogue 

going and be more proactive in their areas of work and 

influence.

Participants were asked to suggest recommendations that 

would further suicide prevention from personal, clinical, 

and systems perspectives, keeping in mind that the 

recommendations should be specific to suicide prevention 

rather than to mental health recovery in general.

Participants made the following recommendations:

1. Include the consumers’ voice and active 

consumer participation, specifically that of 

the suicide attempt survivor, in policymaking, 

educating the public, training health care 

providers, and planning and improving 

prevention and support services.

Everyone agreed that “there should be more than 

one seat at the table” because no one person can 

adequately represent the diversity of perspectives 

that must be brought to bear. This thought expanded 

to suggestions of how and where consumer/survivor 

voices need to be heard: the Suicide Action Alliance 

was mentioned as a critical venue, as well as the 

myriad opportunities that might be taken to have 

consumers/survivors visible not only to the public 

but also to health care providers. SAMHSA was seen 

as a vital resource, not only for creating opportunities 

but also for providing scholarships and financial 

support to ensure that consumers/survivors could 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

30

be present at the many venues where their voices 

could make a difference. It is important to support 

consumers and survivors when they are sharing their 

experiences. Participants noted that there is a great 

deal of fear on the part of consumers/survivors about 

talking openly of their experiences.

2. Many, many groups must be educated from a 

consumer perspective.

One goal of such education, said a participant, 

would be to “change prejudices and stereotypes” 

both by addressing specific groups (e.g., first 

responders) and by seeking publication opportunities 

(e.g., the publications of the American Association 

of Suicidology). Faith-based communities were 

also mentioned as a group to work with, and one 

participant made the following observation:

A prominent reverend of a national church 

spoke about someone who died by suicide 

and said that suicide is not a sin; this was an 

important message to come from him that was 

so healing.

Work with those who organize conferences to ensure 

that there are opportunities to hear from suicide 

attempt survivors and family member survivors.

3. Educate the physical and mental health workforce 

from a consumer/survivor perspective.

One participant noted that it is important for 

providers to be free of fear that something they 

might do would increase the risk of suicide; in 

this and many other areas, education is critical. All 

physicians should be exposed to a suicidology course 

that incorporates the thoughts and experiences of 

consumers/survivors. Across the board, educational 

materials should teach providers “how to call 

upon consumers/survivors and other resources 

that are available in their community.” Participants 

also agreed that physicians and other health care 
31

providers should receive training and support 

that includes strategies to cope with their own 

feelings of fatigue and distress when working with 

mental health consumers. Mental health consumers 

sometimes feel that they are treated with detachment 

and disrespect by health care providers. Training 

may help alleviate those issues.

4. Support workforce development and training of 

health care providers.

All health care providers should be trained to be 

alert to the risk of suicide; participants suggested 

the advisability of training providers to “conduct 

suicide assessment early in the treatment of atrisk populations and those who have experienced 

trauma.”

In addition, participants thought that mental health 

professionals needed encouragement to work in rural 

areas, and that it would be desirable to incorporate 

peers in all hospital workforces. The need for 

trained Native American providers and educators 

was also mentioned, with the suggestion that more 

scholarships be available.

The discussion included the need to train providers 

on alternatives to seclusion, restraint, coercion, and 

involuntary treatment. One participant noted that this 

type of training is already a requirement, and made 

the following observations.

What would we recommend to raise the bar? 

Reporting requirements should be tied to 

funding; or loss of accreditation. The system 

should promote consumer monitoring and 

encourage consumers to report violations, using 

external advocates to help with monitoring.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

32

5. Promote cultural respect.

Specific suggestions included incorporating linguistic 

competency whenever there is talk of “cultural” 

competency; generating more data, research, 

education, and inclusion regarding the gay, lesbian, 

bisexual, and transgendered (GLBT) and Native 

American communities; and ensuring diversity by 

including a wide variety of consumers/survivors.

6. Improve mental health service delivery and 

service options.

Suggestions for such improvements covered a wide 

range of issues, but major themes involved alternative 

types of services/providers, better understanding of 

communication among providers, and the importance 

of trauma-informed care.

• Provide alternatives to emergency departments.

Participants stressed how helpful it would be to 

have “...same day scheduling for mental health 

services and in-home crisis care, crisis intervention 

teams.” They also pointed to the growing trend (but 

unmet need) to integrate physical and mental health 

services, pointing out that “...medical doctors are 

providing early intervention and assessment and 

being reimbursed for these services.”

• Increase peer support services.

Echoed in a variety of contexts throughout the 

meeting, there was a strong, favorable sentiment to 

making increasing use of peer specialists: “It is a 

high priority to have peer specialists in the hospital/

ER like the rape crisis model SANE3

 to help people 

through the process.”

3 Sexual Assault Nurse Examiner (SANE) Programs: Improving the 

Community Response to Sexual Assault Victims (available online at 

http://www.ojp.usdoj.gov/ovc/publications/bulletins/sane_4_2001/

welcome.html).
33

• Create postvention services similar to those 

being created for other issues.

At the other end of the intervention spectrum, the 

utility of a post-attempt follow-up “...visit from a 

social worker to a person who attempted suicide” 

was mentioned. In a similar vein, it was suggested 

that community-based guidelines be developed “that 

have to be implemented after a suicide, similar to 

the protocol for a trauma, disaster, violent behavior 

event; it would be a postvention protocol.”

• Ensure that providers communicate with each 

other when caring for the same individual.

With regard to communication among providers, 

one participant noted “The most common factor 

in all sentient events is [lack of] communication,” 

while another pointed to the urgency of ensuring 

that “people treating the same person are in 

communication with each other. Ensure that 

providers understand that the Health Insurance 

Portability and Accountability Act (HIPAA) allows 

shared information.” Also, ensure that providers 

request and respect informed consent in the use 

of personal health care information.

• Ensure trauma-informed care.

A strong theme emerged around the needs related to 

preventing trauma (e.g., by “increasing awareness of 

bullying and increasing school policies to deal with 

it”) and addressing the consequences (e.g., ensuring 

that care after a “violent or traumatic experience” is 

adequate and sensitive, and understanding the longterm, enduring aspects of trauma on mental health).

Moreover, participants urged that “Suicide prevention 

organizations collaborate with the SAMHSA/CMHS 

National Center for Trauma-informed Care (NCTIC) 

to create trauma-informed care settings. Traumainformed organizations, programs, and services are 

based on an understanding of the vulnerabilities or 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

34

triggers of trauma survivors that traditional service 

delivery approaches may exacerbate, so that these 

services and programs can be more supportive and 

avoid re-traumatization.”

7. Dedicate resources to explore the issue of 

involuntary hospitalizations from a consumer 

perspective in the context of providing real 

alternatives. Create a SAMHSA-supported task 

force to explore this issue from a consumer 

perspective.

“Eliminate the use of force and coercion.” This 

theme was heard throughout the meeting as an 

issue that requires thoughtful attention across 

a range of ethical and legal considerations: 

“Involuntary hospitalization is to prevent self-harm 

or harm to others; how do you accomplish this 

without traumatizing the individual or criminalizing 

the behaviors?” Participants voiced concerns about 

both a general lack of information about how an 

involuntary commitment affects the consumer, and 

about what alternatives might be available to avoid 

commitment.

Participants were very enthusiastic about the 

recommendation that SAMHSA sponsor a task 

force on alternatives to involuntary commitments. 

Subjects to be explored include “promoting crisis 

intervention teams,” “having advance directives” for 

consumers to ensure their autonomy, and “valuing 

peer support services as a means of avoiding 

involuntary commitments.”

8. Promote the SAMHSA wellness initiative within 

the suicide prevention movement.

Participants were familiar with the SAMHSA/CMHS 

Wellness Initiative and the 10 by 10 campaign to 

reduce premature mortality by 10 years over the 

next 10 years. The life expectancy for individuals 

with serious mental illnesses is decades less than 
35

the general population. As reported on the SAMHSA 

Web site, data show that male consumers are likely 

to die at a younger age than female consumers. The 

National Association of State Mental Health Program 

Directors (NASMHPD) Medical Director’s Council 

recently reported that more people with serious 

mental illnesses die of treatable medical conditions 

that are caused by modifiable risk factors such as 

smoking, obesity, substance abuse, and inadequate 

access to medical care (go to http://mentalhealth.

samhsa.gov/newsroom/speeches/091707.asp).

In addition, participants recommended the following: 

“Understand and promote protective factors (such 

as having peer support); do not focus exclusively 

on reducing risk factors; conduct focus groups 

and understand college students’ perspectives on 

wellness.” Participants urged SAMHSA to collaborate 

and share information with other Federal entities 

as it develops an action plan related to a recent 

conference on wellness.

As mentioned in the introduction to this report, 

SAMHSA/CMHS convened the National Consensus 

Conference on Mental Health Recovery in 2004. The 

full statement and the 10 fundamental components of 

recovery can be found on SAMSHA’s Web site (http://

mentalhealth.samhsa.gov/publications/allpubs/

sma05-4129/).

The concept of wellness embraces the growing 

recognition of the fundamental integration of mental 

health and physical health. Working toward wellness 

underscores the major goal of recovery for mental 

health consumers, and acknowledges that recovery 

must encompass the whole person.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

36

9. Establish funding for the following priorities.

Participants listed many areas where they felt more 

funding was needed. Their priorities are as follows.

• Create a nonfatal surveillance data system and 

funding to collect the data. We only have rough 

estimates of the prevalence of suicide attempts. Be 

sure to “de-identify” by using numbers, not names.

• SAMHSA/CMHS, the National Institute of Mental 

Health (NIMH), the Health Research and Services 

Administration (HRSA), and other relevant Federal 

entities should fund consumer/survivor-run 

services and treatment and conduct research on 

cost-effectiveness.

• Disseminate effective programs, including effective 

consumer-operated programs.

• Provide technical assistance related to the 

evaluation of programs and development of longterm solutions.

10. Promote research priorities and involve 

consumers in research initiatives.

Participants identified the following research 

priorities.

• Environmental issues that are outside a biomedical 

research focus

• Cost-effectiveness of consumer-run services

• Determine the explanation(s) for the 25-year 

disparity in life expectancy

• Research that includes the experiences of suicide 

attempt survivors, rather than excludes attempt 

survivors from participating in research studies
37

Participants recommended supporting the 

research interests of coroners; for example, some 

State coroners are very interested in conducting 

psychological autopsies. A psychological autopsy 

helps promote the epidemiological study of suicide. 

It is important that it not be used to assign blame. 

This is a research method that offers the most direct 

technique currently available for examining the 

relationship between particular antecedents and 

suicide. The autopsy helps answer the question, 

“Why did the individual kill himself?” The results 

of a systematic review that examined studies of 

suicide that used a psychological autopsy method 

indicated that mental disorder was the most strongly 

associated variable of those that have been studied.4

Further studies should focus on specific disorders 

and psychological factors; suicide prevention 

strategies may be most effective if focused on the 

treatment of mental disorders. Also, coroners could 

play an important role in looking into accidents 

and poisonings, and the relationship of these topics 

to suicide.

In addition to these funding priorities, participants 

recommended “increased training of survivors/

suicide attempt survivors so that they may design, 

implement, and participate in research” and 

“involving consumers in review and setting the 

research agenda (not token representation).”

11. Engage media on a regular basis.

Throughout the meeting, participants pointed to 

the power of the media as both a positive and 

negative force. As a positive force, media can help 

to dispel stereotypes and educate the public; as a 

negative force, media can perpetuate misconceptions 

and stigma. Engaging the media is critical, and 

participants had several recommendations for how to 

approach this.

4

Psychol Med. 2003 Apr; 33(3):395-405. 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

38

• SAMHSA and the participants should promote 

the suicide dialogue report and the meeting in 

the media.

Others mentioned the need for editorials and opinion 

pieces, and suggested the Suicide Prevention Action 

Network’s (SPAN) Web site as a source of useful 

templates for preparing materials for newspapers.

• Create a suicide prevention award.

Some noted that various types of awards are often 

a useful way to garner positive media attention, and 

mentioned the example of the Didi Hirsch Annual 

Erasing the Stigma Leadership Award, made in 

California, for people who have made a significant 

contribution to alleviating the stigma attached 

to mental illness, and especially to suicide. The 

recipients often have national prominence in sports, 

the arts, or other fields.

• Use electronic media—Internet and television—

to reach young people and college-age audiences.

More specifically, “Include suicide issues on TV 

shows that are popular with high school and college 

students; have a Web site after the shows, to have 

an online discussion.” Another participant noted that 

Lifeline is using the Internet successfully to reach 

young people through YouTube, MySpace, and so 

forth, and mentioned Lifeline’s new online project, 

Lifeline Gallery: Stories of Hope and Recovery,

which allows survivors, suicide attempt survivors, 

helpers, and advocates to share their experiences 

with suicide online (see the Web site at http://www.

lifelinegallery.org).

• Promote a consistent and hopeful message...

recovery is possible.

All media were thought to be good avenues for what 

many consider the most difficult and critical message 
39

of all: that recovery is possible. SAMHSA might 

consider working with advertising agencies and other 

mainstream organizations as well as well-known public 

figures to send positive messages about recovery. At 

the same time, such messages demand sensitivity and 

careful thinking. As one participant mentioned, “A 

person with mental illness doesn’t look any different...

so how would you show someone who may be at risk 

for suicide...maybe you are adding to the problem, by 

saying ‘you never [can] know.’”

12. Support families.

Family support can be manifested in a variety 

of ways. For example, it would be helpful to 

have “guidelines for college campuses to use for 

determining when they can notify parents of a 

student’s issues [while still] respecting the need for 

confidentiality.” In addition, participants urged that 

consumers should have the ability to make clear 

directives about who should be informed of their 

situations, “similar to advanced directives. In this way, 

consumers would be empowered to take personal 

responsibility for their care.”

13. Adapt and adopt programs and services to 

address rural/frontier issues.

Participants pointed out that face-to-face service in 

rural/frontier areas is often not practical. Regulations 

must be relaxed for these areas with regard to the 

types of services offered and their reimbursement. 

These include “evidence-based practices that don’t 

apply to rural/frontier settings such as some Assertive 

Community Treatment (ACT) recommendations,” 

which need to be adapted for use outside urban 

areas. At the same time, it is important to identify 

and reimburse practices that do work, such as telepsychiatry or tele-mental health, and to offer such 

alternatives as warm lines.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

40

Participants also suggested looking into the 

possibility of student loan forgiveness as an incentive 

for (mental) health professionals to work in rural or 

economically distressed areas.

14. Native Americans must get direct and appropriate 

national funding, not funds funneled through the 

State.

Throughout the dialogue, the message was clear 

that Native Americans face a host of cultural and 

structural issues that may be more profound than for 

other groups. Many supported the recommendation, 

for example, that requests for proposals specifically 

allow flexibility to adapt national policy to native 

culture (noting, too, that Native Americans have their 

own Institutional Review Board requirements). At 

the same time, Tribes and native organizations need 

technical assistance to help write grants, and there 

should be “genuine outreach to help communities 

apply for grants.”

15. Promote gun safety and restriction of access to 

lethal means to at-risk individuals.

Participants recognize that even the most insistent 

suicidal voices or impulses can be quelled if the 

means to act on them are not available. With this in 

mind, the issues of gun safety and the safety of other 

lethal means sparked several recommendations, most 

having to do with educating the public and special 

interest groups on mental health issues. For example, 

the LOK-IT-UP campaign is a public awareness 

program encouraging the safe storage of firearms 

and is underway in several counties in Washington 

State (for further information, go to http://depts.

washington.edu/lokitup/overview.html).
41

Recommendations for proactive gun safety efforts 

included the following.

• Post hotline numbers near places where people can 

legally obtain guns.

• Host a plenary session at firearm association 

conventions to educate and create awareness about 

implications of access to guns.

• Work with the firearm associations on gun safety 

programs.

• Promote collaboration with the Brady Campaign 

and share information about mental illnesses and 

suicide prevention.

• Promote safe storage and separation of ammunition 

from firearms.

• Share successful program stories. For example, 

the State police in Pennsylvania are passing out 

gun locks free of charge. In Maryland, gun locks 

are mandatory.

• Create protocols for the restriction of lethal 

means and methods of self-harm for people at 

risk for suicide.

16. Promote and widely disseminate information 

about suicide prevention organizations and 

effective programs.

• The American Foundation for Suicide Prevention 

(AFSP) is composed of a number of programs, 

including support and community educationfocused programs. In 2001, AFSP began developing 

an innovative, Web-based screening method to 

identify college students at risk for suicide and 

encourage them to get treatment. In collaboration 

with Emory University, in Atlanta, GA, and the 

University of North Carolina, in Chapel Hill, NC, 
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

42

the method was pilot-tested over a 3-year period 

(2002-2005). (go to the Web site at http://www.

afsp.org).

• The National Suicide Prevention Lifeline is a 

network of more than 130 crisis centers across 

the nation that are available 24/7 via one toll-free 

phone number: 1-800-273-TALK(8255).

• Active Minds on Campus is a campus-based, college 

peer advocacy program focused on decreasing 

stigma about mental health issues and treatment 

(go to http://www.activemindsoncampus.org/).

• The Lok-It-Up Campaign (go to http://depts.

washington.edu/lokitup/overview.html).

• Applied Suicide Intervention Skills Training (ASIST) 

was developed by Living Works. The 2-day, highly 

interactive, practical, practice-oriented ASIST 

workshop is for caregivers, and others who are in 

positions that help others, who want to feel more 

comfortable, confident, and competent in helping 

to prevent the immediate risk of suicide (go to 

http://www.livingworks.net/).

• On Our Own of Maryland, Inc., is a statewide 

mental health consumer education and advocacy 

group that promotes equality in all aspects of 

society for people who receive mental health 

services; it also develops alternative, recoverybased mental health initiatives. Programs include 

an anti-stigma campaign, The Recovery Training 

Project Main Street Housing, Inc., and the Olmstead 

Peer Support Program. (go to their Web site at 

http://www.onourownmd.org).

• Yellow Ribbon is a community-based program 

using a public health approach with an emphasis 

on preventing teen suicide. See their Web site 

(http://www.yellowribbon.org) and/or e-mail for 

further information (ask4help@yellowribbon.org).
43

• Jason Foundation: Provides educational and 

training curricula for students, educators/youth 

workers, and parents, on the subject of youth 

suicide (http://www.jasonfoundation.com).

• NAMI, New Hampshire, has many resources, 

including a post intervention program for survivors 

(http://www.nami.org/frameworks_community_

protocols_postvention_main_page.php); there is 

also a national support line, Friends of Survivors, at 

1-800-646-7322.

• San Francisco Suicide Prevention (SFSP) is the 

oldest volunteer crisis line in the United States. 

Founded in 1963, with the initial focus of providing 

telephone intervention to people experiencing 

suicidal crisis, the focus of the agency has gradually 

shifted from strictly suicide prevention to more 

general counseling services. Services are provided 

24 hours a day by more than 150 trained volunteers 

with the supervision of a small multidisciplinary 

staff (go to http://www.sfsuicide.org/index2html 

for further information).

• Memphis, Tennessee’s, Crisis Intervention Team is 

operated through the city’s police department to 

work with mental health consumers and family 

members (go to http://www.cityofmemphis.org/

framework.aspx?page=302 for more information).

• Erasing the Stigma Leadership Awards (information 

is available at http://www.didihirsch.org/news/

ets_awards).

• Sexual Assault Nurse Examiner (SANE) Programs: 

Improving the Community Response to Sexual 

Assault Victims (more information is available 

at http://www.ojp.usdoj.gov/ovc/publications/

bulletins/sane_4_2001/welcome.html).
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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• Managing Sudden Traumatic Loss in the Schools, 

by Maureen M. Underwood and Karen DunneMaxim, is a program for school staff to help them 

understand grief in school populations (an excerpt 

is available at http://www.psybc.com/pdfs/Loss_

article).

• People, Inc., in New York State, provides a unique 

model for partnerships between members of the 

public and professionals to meet special needs. 

Although it does not target services to people 

with mental health issues, the ideas and their 

implementation may be of interest to groups 

with similar goals of “...providing support so that 

individuals can participate and succeed in an 

accepting society.” (go to the Web site at http://

www.people-inc.org/what_we_do.asp).

• SPRC/AFSP Best Practices Registry (BPR) for 

Suicide Prevention (go to http://www.sprc.org/

featured_resources/bpr/index.asp).

• Means Matter (http://www.hsph.harvard.edu/

means-matter/).
45

Next Steps

Participants reflected on what they could do when they 

return home from this meeting. Here are some of their 

thoughts.

We have providers, family members, attempt 

survivors in one room, here today; we could 

promote collaborative organizations.

Foster collaboration between consumer 

organizations and suicide prevention 

organizations. We can work to have the consumer 

organizations that we belong to include suicide 

prevention in their activities.

SAMHSA, perhaps through its Suicide Prevention 

Resource Center (SPRC) could do a schematic of 

all the groups and how they inter-relate...and 

then network with each other... a clearinghouse 

of sorts.5

Promote our own accountability on these issues 

and recommendations and reconvene to discuss 

progress.

The National Council of Suicide Prevention is a group 

of 10 nonprofit organizations with a mission of suicide 

prevention. Participants agreed to support the inclusion 

of consumer-run organizations.

5

 The Suicide Prevention Resource Center (SPRC), funded by SAMHSA/

CMHS, provides prevention support, training, and resources to assist 

organizations and individuals to develop suicide prevention programs, 

interventions and policies, and to advance the National Strategy for 

Suicide Prevention.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

46

Final Thoughts

Participants shared their thoughts as the meeting came to 

a close.

We wear many hats, as researcher, policy[maker], 

family member...it’s great to wear all these hats in 

one place.

This has been a phenomenal process...moving, 

inspirational, and informative...so many different 

voices sitting around the table.

This was a useful experience, pragmatic purpose...

it wasn’t a waste of time. It is useful to hear from 

people whom I don’t normally talk [with]. It is good 

to know that the consumer voice is being taken 

seriously.

We welcome the voice of the attempt survivor.

We’ve learned that people can have their emotions 

and feel their pain and they can move on.
47

Resources

Data generated by the Center for Disease Control and 

Prevention’s WISQARS system.

Association of State and Territorial Health Officials, Nov. 

2004. http://www.astho.org/pubs/SmithActpdf.pdf

Centers for Disease Control and Prevention (2004). 

Suicide Fact Sheet. Available at http://www.cdc.gov/

ncipc/factsheets/suifacts.htm

Centers for Disease Control and Prevention, National 

Center for Injury Prevention and Control. Webbased Injury Statistics Query and Reporting System 

(WISQARS), available at: http://www.cdc.gov/ncipc/

wisqars

Conwell, Y. and Brent, D. (1995). Suicide and Aging.

I: Patterns of Psychiatric Diagnosis. International 

Psychogeriatrics 7(2): 149-64.

Department of Health and Human Services: Substance 

Abuse and Mental Health Services Administration 

(2002). National Household Survey on Drug Abuse: 

Volume I. Summary of National Findings; Prevalence 

and Treatment of Mental Health Problems.

Goldsmith, S., Pellmar, A., Kleinman, A. and Bunney, 

W. (editors) (2002). Reducing Suicide: A National 

Imperative. Washington, DC: National Academy Press.

Jacobs, D, Brewer, M, and Klein-Benheim, M. (1999). 

Suicide Assessment: An Overview and Recommended 

Protocol. In: The Harvard Medical School Guide to 

Suicide Assessment and Intervention (D. Jacobs. Ed.). 

San Francisco: Jossey-Bass).

Kochanek, K.D., Murphy, S.L., Anderson, R.N. and Scott, 

C. (2004). Deaths: Final data for 2002. National Vital 

Statistics Reports 53(5). Hyattsville, MD: National 

Center for Health Statistics.
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

48

Moscicki, E.K.. (2001). Epidemiology of Completed 

and Attempted Suicide: Toward a Framework for 

Prevention. Clinical Neuroscience Research 1: 310-23.

National Suicide Prevention Lifeline (2006). After an 

Attempt—A guide for taking care of yourself after 

your treatment in the emergency department. Also 

available in Spanish as Cuidándose depués de un 

intento de suicidio—Siguiendo adelante después de 

su tratamiento en la sala de emergencies. CMHSSVP-0157, Rockville, MD: Center for Mental Health 

Services, Substance Abuse and Mental Health Services 

Administration. Available from SAMHSA’s Health 

Information Network at http://www.mentalhealth.

samhsa.gov/publications/allpubs/SVP-0157

National Suicide Prevention Lifeline. After an Attempt— 

A guide for medical providers in the emergency 

department taking care of suicide attempt survivors.

CMHS-SVP-0161, Rockville, MD: Center for Mental 

Health Services, Substance Abuse and Mental 

Health Services Administration, 2006. Available from 

SAMHSA’s Health Information Network at http://www.

mentalhealth.samhsa.gov/publications/allpubs/SVP0161

National Suicide Prevention Lifeline.(2006). After an 

Attempt—A guide for taking care of your family 

member after treatment in the emergency department.

Also available in Spanish as Cuidandose a si mismo 

y a su familia—Una guía familiar para su pariente 

en la sala de emergencies. CMHS-SVP-0159, Rockville, 

MD: Center for Mental Health Services, Substance 

Abuse and Mental Health Services Administration. 

Available from SAMHSA’s Health Information Network 

at http://www.mentalhealth.samhsa.gov/publications/

allpubs/SVP-0159
49

Web sites for consumers and survivors

1. What A Difference A Friend Makes:

 http://www.whatadifference.samhsa.gov

2. National Mental Health Information Center: 

http://www.mentalhealth.samhsa.gov

3. National Center for Trauma Informed Care: 

http://mentalhealth.samhsa.gov/nctic

4. Suicide Prevention Action Network: 

http://www.spanusa.org

5. American Society of Suicidology: 

http://www.suicidology.org

6. Suicide Prevention Resource Center: 

http://www.sprc.org

7. Suicide Prevention Resource Center: 

http://www.afsp.org

8. National Association of Peer Specialists: 

http://www.naops.org

9. National Mental Health Awareness Campaign: 

http://www.nostigma.org

10. The Jason Foundation:

http://www.jasonfoundation.com

11. Suicide Anonymous: 

http://www.suicideanonymous.org
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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Resource materials

SAMHSA services and programs

− 1-800-273-TALK(8255), the National Suicide 

Prevention Lifeline: 

http://www.suicidepreventionlifeline.org

− Suicide Prevention Resource Center: 

Center for Technical Assistance and Resources

Telephone: 877-GET-SPRC (877-438-7772)

TTY: 617-964-5448

Web: http://www.sprc.org

Email: info@sprc.org

− Grant programs

• Garrett Lee Smith Memorial Act Grant Program: 

Youth Suicide Prevention

Contact SAMHSA’s Division of Grants Management 

at 240-276-1400.

• Garrett Lee Smith Memorial Act Grant Program: 

Campus Suicide Prevention Grants

• SAMHSA: State/Tribal Youth Suicide Prevention 

Grants

• SAMHSA: SM06-010: Hurricane Katrina-related 

Suicide Prevention Grants
51

Coordinating groups

• The Action Alliance for Suicide Prevention. Objective 

2.2 of the National Strategy for Suicide Prevention 

called for the establishment of public/private 

partnership(s) (e.g., a national coordinating body) 

with the purpose of advancing and coordinating the 

implementation of the National Strategy. For more 

information contact SPAN USA.

Suicide Prevention Action Network USA (SPAN USA)

1010 Vermont Avenue, NW, Suite 408

Washington, DC 20005

Phone: (202) 449-3600

Fax: (202) 449-3601

E-mail: info@spanusa.org

• As a follow-up to the President’s New Freedom 

Commission Report, a Federal working group for 

suicide prevention was created to gather information 

and collaborate with representatives of Federal 

Agencies involved in suicide prevention. For more 

information contact the co-chair of the group, 

Richard McKeon, at SAMHSA/CMHS.

53

Participant List

Planning Committee

Mark Davis, M.A.

Special Needs Analyst

Behavioral Health System

Philadelphia Office of Behavioral Health

PMHCC, Inc.

Philadelphia, PA 19109

Anara S. Guard, M.L.S.

Associate Center Director

Suicide Prevention Resource Center

Education Development Center, Inc.

Newton, MA 02458

Edward L. Knight, Ph.D., C.P.R.P.

Vice President

Recovery, Rehabilitation and Mutual Support

Adjunct Professor

Boston University

Colorado Springs, CO 80920

Jerry Reed, M.S.W.

Executive Director

Suicide Prevention Action Network USA

Washington, DC 20005

Eduardo Vega, M.A.

Program Director

Office of Consumer Rights and Advocacy

Department of Mental Health

County of Los Angeles

Los Angeles, CA 90005
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

54

Dialogue Participants

Donna Holland Barnes

President

NOPCAS

Washington, DC 20013

Lidia Bernik

Director of Network Development

National Suicide Prevention Lifeline

Link2Health Solutions

New York, NY 10004

Lori Bradshaw

Information Specialist

Suicide Prevention Resource Center

Newton, MA 02458

Heidi Bryan

Director

Feeling Blue Suicide Prevention Council

Radnor, PA 19087

Mary Cesare-Murphy, Ph.D.

Executive Director

Behavioral Health Program

The Joint Commission

Oak Brook Terrace, IL 60515

Mark A. Davis

LGBT Liaison

Philadelphia Department of Behavioral Health

Philadelphia, PA 19147

John Draper, Ph.D.

Project Director

National Suicide Prevention Lifeline

New York, NY 10004
55

Montatn P. Fleury

Student

Student Service Department

Blackfeet Community College

Browning, MT 59417

Leah Harris

Washington, DC 20012

Alethia (Lynn) Hendrickson

Special Projects Coordinator

Community Health and Development Department

Salish Kootenai College

St. Ignatius, MT 59865

John Kevin Hines

National Mental Health Awareness Speaker

The National Mental Health Awareness Campaign

San Francisco, CA 94132

Lisa Hurka-Covington

Founder/President

Speak for Them

Baltimore, MD 21286

Edward L. Knight

Vice President of Recovery

ValueOptions

Colorado Springs, CO 80911

Heidi Levine

Dean of Students

Cornell College

Mt. Vernon, IA 52314

DeQuincy Lezine

Postdoctoral Research Fellow

Department of Psychiatry

University of Rochester

Rochester, NY 14642
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

56

Richard McKeon

Public Health Advisor

CMHS/DPTSSP

Prevention Initiatives & Priority Program Development

 Branch

Rockville, MD 20857

Desiree Peone

St. Ignatius, MT 59865

Debbie Plotnick

Director of Advocacy

National Consumers’ Self-Help Clearinghouse

Mental Health Association of Southeastern Pennsylvania

Philadelphia, PA 19107

Jerry Reed, Ph.D., M.S.W.

Director

Suicide Prevention Center

Education Development Center, Inc.

Washington, DC 20007

Shannon Wiltsey Stirman

Program Director

Center for the Treatment and Prevention of Suicide

Philadelphia, PA 19104

Federal Representatives: SAMHSA/Center for Mental Health Services

Paolo del Vecchio, M.S.W.

Associate Director

Consumer Affairs

Center for Mental Health Services

Substance Abuse and Mental Health Services

 Administration

Rockville, MD 20857
57

Anisha Imhoff-Kerr

Public Health Analyst

Consumer Affairs

Center for Mental Health Services

Substance Abuse and Mental Health Services

 Administration

Rockville, MD 20857

Stacey Lesko, M.S.W., L.G.S.W.

Consumer Affairs Specialist

Center for Mental Health Services

Substance Abuse and Mental Health Services

 Administration

Rockville, MD 20857

Christopher C. Marshall

Consumer Affairs Specialist

Center for Mental Health Services

Substance Abuse and Mental Health Services

 Administration

Rockville, MD 20857

Carole Schauer, M.S., R.N.

Senior Consumer Affairs Specialist

Center for Mental Health Services

Substance Abuse and Mental Health Services

 Administration

Rockville, MD 20857

Carlton Speight

Consumer Affairs Specialist

Office of Consumer Affairs

Center for Mental Health Services

Substance Abuse and Mental Health Services

 Administration

Rockville, MD 20857
Building Bridges: Suicide Prevention Dialogue with Consumers and Survivors

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Facilitator

Dianne Dorlester

Senior Director, Consumer Advocacy Director

National Consumer Supporter Technical Assistance Center

Mental Health America

Alexandria, VA 22311

Writer

Sandy Lundahl

Note Taker/Writer

AFYA, Inc.

Laurel, MD 20707

Participants were informed that a paper was being 

created based upon the conference.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

HHS Publication No. (SMA)-10-4589

Printed in 2010

30597.1210.8746010501