Week 13: The implications of healthcare financing and strategies for sustaining innovation related to suicide prevention among first responders

Almost 800,000 people die each year by suicide. For each completed suicide, there are more than 20 suicide attempts. Aside from the pain and emotional toll of the attempt survivors, suicide has a ripple effect on families, friends, colleagues, communities, and societies (1). The Ruderman Foundation determined that first responders have a suicide rate 20% higher than the general population, with more first responders dying by suicide than in the line of duty (2). The actual number of suicides may be even higher as many first responder suicides go unreported due to the stigma surrounding mental health.    

Suicide also has economic costs for individuals, families, communities, states, and the nation as a whole. These include medical costs for individuals and families, lost income for families, and lost productivity for employers. Economic costs of suicide are staggering.  A recent study (3) estimated the average cost of one suicide at $1,329, 553. More than 97 percent of this cost was due to lost productivity. The remaining 3 percent were costs associated with medical treatment. In 2013, the total cost of suicide and suicide attempts was estimated at $93.5 billion. The same study indicated that every $1.00 spent on psychotherapeutic interventions and interventions that strengthened linkages among different care providers saved $2.50 in the cost of suicides.

By bringing awareness to the economic costs of suicide, and to the savings resulting from suicide preventing measures, private organizations such as the American Foundation for Suicide Prevention (AFSP) can help convince policymakers and other stakeholders that suicide prevention is an investment that will save dollars as well as lives. By doing so, they advocate for suicide prevention policies.

As Patton discusses in her book (4), an advocacy plan can take many forms depending on the desired goals. Implementing a plan involves goal refinement, application of influence, strategic issue framing, and targeting of the message to an audience. In order to sustain any kind of plan, including suicide prevention efforts, Patton suggests first identifying resources and support that are readily available, as well as those that need to be acquired, including people and manpower, data, finances, and communication capabilities (4).

The AFSP is an example of organizations that provide manpower, “research, education and advocacy to take action against this leading cause of death” (5). As stated in AFSP mission statement, they are “dedicated to saving lives and helping those affected by suicide. They create a culture of mental health awareness by funding scientific research, educating the public about mental health and suicide prevention, advocating for public policies in mental health and suicide prevention, and supporting survivors of suicide loss and those affected by suicide in our mission” (5).

During a State Capitol Day organized by the AFSP earlier this year, the AFSP provided all the participants with brochures on the latest suicide data. They scheduled meetings with the legislators, and also provided information on the two bills advocated by the AFSP, HB 2072 and HB 2321. HB 2072 would provide loan forgiveness for licensed mental health professionals, which would encourage new graduates to pursue careers in mental health and to provide services to underserved communities. HB 2321 would create a legal process for Severe Threat Orders of Protection and prohibit a person at risk for suicide from having a firearm in his or her possession for a period of up to one year.

Policymaking does not happen overnight. It is a process that takes time and continuous effort on the part of legislators, and public and private sector. Longest (6) explains that in the healthcare arena there is a preference for incrementalism, or continual modification of policies at small, modest increments, rather than large scale modifications. He explains that incrementalism in policymaking increases the likelihood of reaching compromises among the diverse interests in the political marketplace. It also allows for the results and consequences of incremental decisions that are more predictable and stable than those of decisions not made incrementally. To implement and sustain any kind of innovation related to suicide prevention in Arizona, it would be beneficial to adopt the way of incrementalism, as the slower pace would allow the “economic and social systems to adjust without being unduly threatened by change” (6).

1. WHO (2020). Suicide prevention. Retrieved from https://www.who.int/health-topics/suicide#tab=tab_1
2. Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders. Retrieved from http://rudermanfoundation.org/ white papers/ police- officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/
3. Shepard, D., Gurewich, D., Lwin, A., Reed, G., Jr., & Silverman, M. (2015). Suicide and suicidal attempts in the United States: Costs and policy implications. Suicide and Life-Threatening Behavior. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/sltb.12225
4. Patton, R., Zalon, M, & Ludwick, R. (2014). Nurses making policy from bedside to boardroom. New York, NY: Springer publishing company.
5. American Foundation for Suicide Prevention (2020). About AFSP: Mission. Retrieved from https://afsp.org/about-afsp/
6. Longest, B. (2014). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.