The surgeon general has declared suicide a serious public health threat, launching an effort to educate school counselors, parents and even hairdressers on how to spot signs of trouble.
Suicide is the eighth leading cause of death in the United States, claiming about 30,000 lives in 1997, compared with fewer than 19,000 homicides.
"The nation must address suicide as a significant public health problem and put into place national strategies to prevent the loss of life and the suffering suicide causes," Surgeon General David Satcher said in a "call to action" released July 28. "People should not be afraid or ashamed to seek help."
Beyond actual suicides, there are many more failed attempts: About a half-million Americans are treated in emergency rooms each year after trying to kill themselves.
White men aged 65 and older are the most likely to commit suicide, accounting for 20 percent of the cases. And the suicide rate has doubled since 1980 among children aged 10 to 14.
This is the first time a surgeon general has taken up suicide--or even mental health--as an issue. A full report on all facets of mental health is expected by the end of the year, and a comprehensive national suicide strategy is expected in early 2000.
The report on suicide, which was released by Satcher and Tipper Gore, the vice president's wife, grew out of a conference on suicide prevention that Satcher convened in Reno, Nev., last October. Experts compiled 81 recommendations, some of which needed further refinement.
But there were 15 ideas that were broadly accepted, so Satcher opted to begin work on those now.
"Our feeling was, this is too important to wait for the full-blown, comprehensive strategy," said Damon Thompson, Satcher's spokesman. "It's simple, it's understandable, and there's near universal agreement that these 15 steps can prevent suicide."
Many of the recommendations involve educating the public to recognize when someone seems at risk of suicide and how to get that person help. That includes doctors and nurses, but also clergy and others who interact with people and hear about their problems.
"We want coaches, we want school teachers, we want hairdressers, we want people who interact with the community," Thompson said. "It's going to take outreach, it's going to take training. It's going to take communities to realize it's got to be a priority."
Many of these people do not realize that they can help, the report said.
Doris Smith of Atlanta, whose 27-year-old son committed suicide, agreed. "I did not know depression was a disease that could be treated," she said.
Sen. Harry Reid (D-Nev.), whose father shot himself to death in 1972, said that hearings are planned for this fall in the Senate Appropriations health subcommittee. Advocates hope it will be an important step toward getting more money and attention for suicide prevention programs.
Reid encouraged Americans to talk about the issue, saying it took him 24 years to speak in public about his father's death.
Satcher also announced a new outreach campaign to raise awareness of the issue, develop strategies to identify people at risk and improve quality of treatment.
The Clinton administration also announced that the Ronald McDonald House Charities are paying to distribute a PBS video called "Depression: On the Edge" to school counselors to help them detect teen depression.
Gore and Satcher are also working with the Ad Council and MTV to develop a campaign reducing the stigma of mental illness.
And the Department of Health and Human Services plans to work with organizations such as Meals on Wheels to identify people who may be at risk.
Besides seeking more money and national attention to fight suicide, the surgeon general's recommendations include:
* Educating the public that suicide is preventable and working to diminish the stigma of mental illness, substance abuse and suicide.
* Helping primary care doctors and nurses learn how to recognize and treat depression, substance abuse and other problems associated with suicide and increasing referrals to specialists when appropriate.
* Working with news and entertainment media to present balanced portrayals of suicide.
* Increasing research on suicide risk and prevention programs.
* Formally evaluating suicide prevention programs to determine what works.
* Finding better ways for the government to track suicide.