Suicide Survivors Loss Day Honored at New York State Psychiatric Institute

On Nov. 19, Columbia University and New York State Psychiatric Institute  hosted the New York chapter of the American Foundation for Suicide Prevention (AFSP) for its annual International Survivors of Suicide Loss Day event.

Survivor Day events, which take place in communities all over the world the Saturday before Thanksgiving, offer family and friends of those who have died by suicide to come together for a day of healing and hope and to find connection with others.

The event, held in the auditorium of the Pardes building, was attended by nearly 100 individuals, most from the New York City area. Blair Simpson, MD, PhD, interim chair of the Department of Psychiatry at Columbia and interim director of the NYS Psychiatric Institute, kicked off the event with opening remarks, followed by a panel led by two survivors, a video featuring suicide loss survivors, lunch, breakout sessions, and a closing healing ceremony.

Read the text of Dr. Simpson’s remarks below:

Good morning. On behalf of Columbia University and the New York State Psychiatric Institute, I welcome you and thank you for being here. I am humbled to be asked to speak with you today, and I'm here not just representing our institution but also as a person who’s also been affected by suicide.

We are honored to host this very special event, where those bereaved by suicide have the opportunity to come together and find connection and hope and talk about loss. This event isn't just here in this one room today. International Survivors of Suicide Loss Day brings people together in countries across the globe because suicide affects all of us all around the world.

I probably don't need to tell you this, but over the past two decades, the annual suicide rate in the U.S. increased by 30 percent. In 2021, more than 46,000 lives were lost to suicide, and the numbers are even higher for people in vulnerable groups including teens and young adults, the LGBT community, and people of color. Globally, more than 700,000 people die by suicide each year. That’s one person every 40 seconds. So, you're not alone. But that's not a good thing to say, right? We're not alone. And so, as a nation and as a world in a society, we can, and we must do better.

I'm a researcher. Research is one of the things that gives me hope, not only for suicide but for all of mental illness. Research is how we can learn how best to prevent suicide. Suicide prevention and suicide research is one of the top priorities not only of mine but of others in the department, and I would like to highlight a little bit about the work here and give a shout out to the investigators who've dedicated their lives to trying to advance the field in many different ways.

I'm going to start with Columbia research scientist Maddy Gould who started evaluating suicide prevention hotlines two decades ago, at a time when they were not held in high regard. This was not seen as flashy research to be doing, but based in large part on that research, suicide hotlines today are considered a crucial gateway to life-saving resources and treatment. Her preventative intervention work laid the foundation for the development of state and national level suicide prevention programs, including the new 988 suicide crisis line.   

Columbia Psychiatry’s Kelly Posner, another researcher in our department, spearheaded the team that in 2007 developed a scale called the Columbia suicide severity risk scale. It's a set of simple questions that anyone can ask, and it’s now considered the gold standard for assessment of suicide ideation and behavior. Referred to as the Columbia Protocol, it has been implemented in thousands of public health settings, schools, hospitals, college campuses, fire departments, the justice system, and primary care. It was recognized by the White House this fall, when during Suicide Prevention Awareness Month, the Biden-Harris Administration outlined its key actions to improve suicide prevention, among them, requiring private health plans to cover the Columbia Protocol at no cost. What we know is that if you don't ask, you can't intervene, and this very simple intervention, which is asking people to ask in a standard way about ideation and plans, has already had a big effect.

We also have many researchers who are studying the brain and trying to understand the biology of what happens when someone is headed toward suicide, or the changes that occur after an attempted suicide, which we know can put people at increased risk for another attempt.

In particular, Columbia has what is known as the Conte Center for Suicide Prevention. The center is under the leadership of John Mann, who is an internationally recognized expert on the biology and treatment of mood disorders and suicide behavior. And in this lab, researchers are using brain imaging, neurochemistry, and molecular genetics to probe the biological causes of depression and suicide. Their goal is to identify markers that might help us figure out who's at higher risk—and to identify individuals who may be thinking about suicide, but haven't acted, and need more intensive intervention. The center is also trying to understand changes in the brain that might lead to new targets for treatments.

Working alongside John is Barbara Stanley, who developed with her colleague Gregory Brown at the University of Pennsylvania, the Safety Planning Intervention, a written list of warning signs, coping strategies, and resources generated collaboratively by provider and patient that individuals can use in an emerging suicide crisis. The Safety Planning Intervention is based on evidence that these strategies can help. The plan is now employed in emergency departments; inpatient and outpatient facilities; throughout the VA system, where we know unfortunately that veterans have a very high rate of suicide; as well on crisis hotlines. There is recently published data in one of our high-profile journals called JAMA Psychiatry that this intervention cut short-term suicidal behaviors nearly in half. This is promising and another example of how research can lead to changes in policy.

Last but not least, I want to highlight the work of Randy Auerbach who runs the Columbia Translational Research on Affective Disorders and Suicide Laboratory. Randy and his team are committed to improving our understanding of depression and suicide in adolescents. They are gaining insights about how self-injurious and suicide behaviors develop in real time, for example, following people using smartphones to better understand what facilitates the transition from suicidal thinking to behaviors. Randy is interested in developing what he calls a “just-in-time intervention,” such that smartphone data might be able to predict this transition and enable an intervention in real time. He’s now partnering with NewYork-Presbyterian Hospital on developing such potentially lifesaving strategies for adolescents presenting with psychiatric crises to the emergency department.

Research is important for what we can do tomorrow. However, sometimes research takes a long time. Our clinical programs are committed to helping people right now who are having suicidal thoughts and behaviors, which typically occur in the context of psychiatric illness. In the interest of time, I will highlight two of them:

One is a program launched last year in interventional psychiatry to help people with treatment-resistant depression, which happens in about a third of patients with depression. People with major depressive disorder who are not responding to standard care are at particularly high risk of suicide. The program’s clinical team, led by Jacques Ambrose and Josh Berman, are working to develop individualized plans that might include conventional treatments but also use state-of-the-art treatments, including transcranial magnetic stimulation and ECT, which remains one of our most powerful treatments in very severe depression, as well as intravenous and intranasal ketamine, which is showing great promise as a treatment that can rapidly reduce suicidal thinking and behaviors.

The second program I want to highlight was made possible because of philanthropy. As you probably all know, our mental health system is problematic in terms of reimbursing for good mental health care. So, philanthropy is one of the ways our department is able to launch novel programs. Thus, we are incredibly grateful to a family foundation who gave a very generous gift to help us expand access to dialectical behavioral therapy, one of our most effective interventions for people with suicidal ideation and behaviors. The program, being launched right now, focuses on adolescents and families. It’s about improving the management of emotions, decreasing impulsive behaviors, and providing adolescents with group-based support after school and evenings, which allows them to continue with their activities. The ultimate goal of the foundation is to ensure that all people to have access to dialectical behavioral therapy. Their championship of this evidence-based treatment has been amazing!

I'm here talking to you about in my institutional role and what we as a department are doing in terms of research and clinical programs, but I want to end on a personal note. Two of my best friends lost a parent to suicide. I knew one parent well. I have personally witnessed the impact of those losses over a lifetime. Just this fall, the daughter-in-law of a close family friend, a mother, committed suicide, and we all are still grieving that event. Thus, my commitment to work on suicide and suicide prevention in not just an institutional commitment but a personal one as well. I also stand here as a person who has some sense of what this means.

Thank you so much for coming today. I'm a real believer in what you're doing: You are working to transform this dark loss into light and human connection. In fact, we know from research that one of the biggest factors that that protects people and leads to resilience is community and connection. It is one of the things that we lost through COVID, and it is really important for all of us to regain.

So, thank you to AFSP for hosting this. Thank you all for being here.

The American Foundation for Suicide Prevention (AFSP) gives those affected by suicide a nationwide community empowered by research, education, and advocacy to take action against this leading cause of death. The organization has local chapters in all 50 states and Puerto Rico, with programs and events nationwide.  Learn more