“There’s no evidence that treating a mental disorder reduces suicide. The evidence is that treating suicidal behavior reduces suicide.”

That’s Marsha Linehan, founder of Dialectical Behavior Therapy and a psychology researcher at the University of Washington. I had to read Linehan’s quote, from this article in Nature Medicine, a couple times before its meaning sunk in. It was a little revolutionary.

Most people who spend a lot of time thinking about how to prevent suicide also spend a lot of time thinking about mental illness. Even for this blog, I’m just as open to writing about mental illness as I am to writing about suicide and suicide prevention. I tend to see it all linked, sometimes inextricably.

But, Linehan makes an important point, one reinforced by what anyone working in the field of suicide prevention can’t deny: It isn’t mental illness that’s linked to suicide. It’s suicidal behavior.

The distinction is subtle, perhaps. To clarify, there are a lot of people who have mental illness who don’t ever think about, plan for, or attempt suicide. So, suicide prevention strategies that focus on treating mental illness might miss the opportunity to focus on something that we know can lead to suicide: suicide attempts.

What makes it hard to figure out how to treat suicide attempts specifically is that it’s so hard to study suicide attempts. Naturally, we don’t want to put vulnerable people in a situation that might lead to them attempting suicide. So, studying a population at risk for attempting suicide isn’t attractive, or even often feasible.

According to the Nature Medicine article, which chronicles the challenges inherent in clinical research on suicide risk, “most psychiatric drug trials today...exclude anyone expressing thoughts of suicide.” For those researchers who are able to enroll participants notably at risk for suicide attempts, it’s been difficult to enroll a high enough number to generate statistically significant results. Or, recruited study participants drop out before the study is complete.

I can't help but think that Linehan’s perspective, perhaps unintentionally, advocates for a comprehensive approach to suicide prevention: one that looks not only at individual factors that influence suicidal risk, but family, community, and systems-level factors. Because it’s not even just treating suicidal behavior that reduces suicide risk.

Copyright 2012 Elana Premack Sandler, All Rights Reserved

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