Consumers' reliance on formal therapeutic supports and support from peers and family suggests that education and support for dealing with individuals in despair and crisis should be targeted to the social networks of this high-risk population. The disparity between availability of formal mental health services and reliance on them when consumers are suicidal suggests that suicide prevention efforts should evaluate whether they are effectively engaging high-risk populations as they struggle to cope with despair.
Suicide is a serious public health challenge, ranking as the 11th most frequent cause of death in the United States. In 2004 suicide took the lives of over 32,000 Americans of all ages, and estimates of the number of attempts for every death suggest that an additional 380,000-780,000 individuals survived a suicide attempt in that year (1,2). Persons with mental and substance use disorders, the elderly population, youths, and people with general medical illnesses are at particularly high risk of attempting suicide (3).Among the causes of premature mortality among people with severe mental illness, deaths from external causes (suicide, accidental death, and homicide) rank second only to coronary heart disease (4). Compared with other people at poverty levels, individuals with severe mental illness alone are twice as likely, and those with mental illness and a co-occurring substance use disorder are four times as likely, to die from these external causes (5). These statistics are not surprising, given the vulnerability of people with severe mental illness to social and individual risk factors for suicide, including alcohol and drug use problems, childhood and adult victimization, sparse social networks, and, the best predictor of eventual completed suicide, prior attempts (2,(6)(7)(8)(9)(10)(11)(12)(13)(14). Multiple and prolonged stressors such as these degrade a person's quality of life and contribute to social isolation
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