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The UN meeting of Social Welfare Ministers in 1987 approved Guiding Principles for Developmental Social Welfare Policies and Programmes in the Near Future (United Nations, 1987). In 1991, assistance was requested from government, non-government organizations and university institutions (for the first time) to prepare a global report of progress toward the 1987 objectives. The University of Calgary response, prepared by a social work academic and co-founder of LivingWorks Education, largely addressed the 1982 “Alberta Model” of suicide prevention and the suicide intervention training developments of an Alberta team working in collaboration with the Canadian Mental Health Association and federal, provincial and state level government departments in Canada and the United States (United Nations, 1991a, 11-13).
The UN response to the university report acknowledged suicide as “a problem we have neglected hitherto…” (personal communication, Michael Stubbs, August 9, 1991). Immediate steps were taken to explore the role of social welfare approaches, including the possibility of UN collaboration with Canada to hold the first interregional ‘experts’ meeting on national strategies for the prevention of suicide (United Nations, 1991b, 11). The invitation was accepted and with Canadian-raised funds, the meeting was held in Calgary and Banff in 1993. Fifteen (15) members attended from 12 countries (Australia, Canada, China, Estonia, Finland, Hungary, India, Japan, Netherlands, Nigeria, United Arab Emirates and the United States), along with WHO and UN representatives from Geneva and New York, and observers from Sweden and Australia. The Prevention of Suicide: Guidelines for the formulation and implementation of national strategies was published in 1996 (United Nations, 1996).
Lloyd Potter (with Centers for Disease Control at the time), one of the U.S. members at the meeting, provided Jerry Weyrauch, the eventual founder of SPAN, with a draft copy of the UN document. After reviewing the document and consulting with Mort Silverman (keynote speaker at the UN meeting), David Clark (past president of AAS) and Potter at the AAS meeting in 1994, he concluded that the “grass roots” process in the community-initiated section of the Guideline was needed in the United States and the silent segment of society, i.e. survivors of suicide were an obvious force to energize and lead the way to create a national policy on suicide. Weyrauch’s belief in this process was motivated in part by a remembered Abraham Lincoln quote:
“Public opinion is everything. With public sentiment, nothing can fail. Without it, nothing can succeed. Therefore, he who molds public opinion goes deeper than he who enacts statutes or pronounces decisions.”
If Lincoln was correct, “then the survivors of suicide in the U.S. have the potential to mold public opinion about the need for a national policy on suicide.” (Weyrauch, 1995,1).
Weyrauch and one of the organizers of the UN meeting and co-founder of LivingWorks met at the 1995 AAS conference. His dream to have a National Survivors Day on Capitol Hill on Mother’s Day was outlined a few months later. “Survivors from across the U.S. would be invited to come… The seeds for this are being sown. I will let you know if any of them germinate” (personal communication, J. Weyrauch, September 9, 1995).
In the same year the social welfare ministers met in Vienna, the Weyrauch family experienced the tragic death of their daughter, Terri Ann, to suicide. Bereavement support came from many sources, including Iris Bolton, co-author of My Son, My Son: A Guide to Healing after Death, Loss or Suicide (Bolton and Mitchell, 1984). Iris offered what turned out to be a prophetic vision: “there’s a hidden gift in this. You may find it somewhere down the road” (Ernst, 2001, 23). The gift began to emerge when the first “National Awareness Day for Suicide: A National Problem” happened as dreamed on Mother’s Day 1996. Advocacy letters from 43 states were hand-delivered to a congressional delegation by SPAN advocates and close to 150 supporters, from California to Florida, marched on Capitol Hill.
Prior to the UN Guidelines, national suicide prevention strategies were primarily left to individual countries (Taylor, Kingdon and Jenkins, 1997). Taylor et al. used the key elements of the UN Guidelines to survey the involvement of several countries in suicide prevention, finding three groups: nations with comprehensive strategies (or setting them up); nations with national preventative programs; and nations without national action. Finland, Norway, Australia, New Zealand and Sweden were in the first group. The U.S., Netherlands, England, France and Estonia were in the second group. Canada, Japan, Denmark, Austria and Germany were in the third group. Their analysis acknowledged that the Bush administration in the 1980s had identified suicide as an important public health problem within an overall national strategy for disease prevention and health promotion. The Report of the Secretary’s Task Force on Youth Suicide recommended a national level strategy but minimal action was taken. By 1994 there was little evidence of any further progress by the Clinton administration.
Progress in getting the U.S. initiative from the second to the first group got a big boost in 1997 through the tireless efforts of Senator Harry Reid. History was made on May 6, 1997 when he obtained unanimous support for Senate Resolution #84 on suicide and suicide prevention. Major support for this success was credited to SPAN members who delivered 20,000 advocacy letters (more than three times the inaugural number in 1996) to Capitol Hill legislators. In the same year, Representative John Lewis introduced House Resolution #212 and with almost single-handed persistence stayed focused on the importance of this resolution until it was unanimously passed in October 1998. Lewis, an African-American colleague of Dr. Martin Luther King, never let up on inspirational messages to SPAN: “Don’t give up, Don’t give out and Don’t give in—Keep On, Keep On.” Both resolutions urged the development of “an effective national strategy for the prevention of suicide” (AAS, 1997b, 1; SPAN USA, 1999,3).
By November 1997, a SPAN Steering Committee, co-sponsored by the National Center for Injury Prevention and Control (NCIPC) of CDC, met to begin development of the National Suicide Prevention Strategy. The objective of the committee and its six sub-committee structure was to set the stage for a National Summit in Reno, Nevada in October 1998.
The National Summit was organized as a Consensus Development Conference (NIH, 1993): Advancing the National Strategy for Suicide Prevention: Linking Research and Practice. The challenge was daunting. Asking 450 people with diverse interests to work in a conference atmosphere for three days to formulate national strategy recommendations seemed impossible. It happened through the strong leadership of many, including key roles played by U.S. representatives at the UN meeting in Canada—Morton Silverman, Chair of the Expert Panel, responsible for the final report and Lloyd Potter, a key member of the Summit Planning Committee. A recommendations report was presented to Surgeon General David Satcher, at the close of the Summit. More than 450 participants furnished 290 ideas for recommendations to the Expert Panel, who then prepared a draft preamble and 81 recommendations for the National Suicide Prevention Strategy (SPAN, 1999, 4).
The Preamble highlighted the following:
Dr. Potter acknowledged the impact of the UN Guidelines on the success of the Summit in a personal note to one of LivingWorks’ co-founders on the final day: “Without you, this would never have happened. We all owe you so much, most don’t even know.” (personal communication, October 18, 1998). The impact was formally recognized in the 1999 Surgeon General’s Call to Action acknowledging that the Canadian drafted UN document “motivated the creation of an innovative public/private partnership to seek a national strategy for the United States” (Satcher, 1999,1).
Progress toward a comprehensive National Suicide Prevention Strategy (NSPS) was significant in 2000. Senate Hearings on suicide were held for the first time. Experts were consulted, concluding that the NSPS scope should:
Four strategically located national public hearings provided valuable public input to the Goals and Objectives for the NSPS and their planned release in 2001.
Within a six-year period (1994-2000), development of the U.S. national strategy had moved through several stages of the community-initiated process to the stage where the national government is poised to designate a national coordinating body for suicide prevention. The UN Guidelines outline the steps needed to support this stage:
The U.S. effort provides an excellent case study of a community-initiated process. However, the process will not be complete until necessary government-initiated steps of the process are firmly in place. If these steps are not completed it will soon be apparent that “all the progress in the U.S. will be largely for naught if we are not able to create and implement this National Coordinating Body” (personal communication, J. Weyrauch, February 24, 2001). There is optimism through the involvement of state planning groups and work at the state level. The U.S. adopted community-initiated process is almost completed. It will be completed when the coordinating body is in place and statewide implementation plans are commonplace and actively evolving throughout the country.
Beyond the impact of the UN Guidelines, the U.S. community-initiated process is available for others to follow. A recent report claims “The endorsement by both the World Health Organization and the United Nations of the framing of national strategies has put particular onus on governments to respond in an area of health in which they traditionally have had little interest” (Jenkins and Singh, 2001,613). These endorsements and the tremendous impact of grass roots organizations like SPANUSA, has considerably increased activities by national governments in suicide prevention. Jenkins and Singh suggest the impact of these developments “augurs well for continuing progress in trying to prevent one of the most tragic events in the life of a family and a community (614).
Looking back to the UN meeting and Terri Ann Weyrauch’s untimely death in 1987, no one could have imagined that Iris Bolton’s ‘hidden gift’ prediction would materialize through LivingWorks, the UN, SPAN and many others toward the realization of a comprehensive U.S. National Suicide Prevention Strategy.
Please note this page is a summary only. Download the full paper (including references) in PDF format (372 Kb)