Dr. Tom Insel is a neuroscientist and psychiatrist, and he's been the director of the National Institute of Mental Health (a division of the National Institutes of Health) since 2002. He recently helped lead the development of "A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives" with the National Action Alliance for Suicide Prevention. WBUR's Lynn Jolicoeur spoke with him about the state of research into and understanding of suicide.
Lynn Jolicoeur: How do you feel about where we are at when it comes to understanding suicide, suicide research, when we see the numbers haven't really changed much over the last several decades? How would you characterize how you feel about where we are at as a health care system, as a society, in terms of understanding suicide and working to prevent suicide?
Dr. Tom Insel: What's very clear if you look at the numbers is that at the same time that suicides have trended upwards, now surpassing 40,000 suicides a year — that would be about one every 13 minutes — the rate for homicide has gone down, the rate for traffic fatalities has gone down. The rate for a number of other fatal medical problems, like cancer and heart disease, has gone way down. Part of that is because there are things that will reduce the numbers and prevent suicides that we as a society have just not taken on. There are barriers on bridges. There are locks on guns. There are ways of reducing access to means that do save lives. And yet as a society we haven't taken this problem nearly as seriously as we took traffic fatalities when we started to put in seat belts and change speed limits and make traffic and cars safer. The same thing could be said for about homicide, where we put an entire criminal justice system in place to be able to reduce the numbers. And they have gone way down, over 40 percent. If one asks, 'What have we done for suicide? Who's accountable for the number and making sure that it goes down?" it's pretty difficult to point to anyone.
Your agency, of course, is charged with funding research. How do you feel about where the funding stands since you are the agency — the government agency — charged with funding this research?
I think we do know some things that don't need to be funded. We do know that you can reduce the numbers by preventing suicide by reducing access to means. And so that's not really a research question. And it would be silly for us to continue to invest in proving what's already been proven. On the other hand, there are some things we don't know, which we need to understand better. Many people make attempts. Far fewer of those people die from suicide. And understanding who's at the greatest risk for mortality would be a critical piece of this. That does require the kind of research that takes us into biological risks and other kinds of risks, as well. What is equally important is the kind of science that will tell us what to do for someone who is at risk to ensure that they don't die from suicide. We talk a lot about prevention. But often the problem is something that we've come to call post-vention. After someone makes an attempt, how do you put in place the kind of care that they will need to ensure that they don't make another attempt, which could be more [lethal]?
Do you feel like we're on the cusp of something really exciting in terms of developments where we could be close to actual diagnostic tests and tools that are used in the doctor's office and used as ways to identify risk and level of risk?
I don't think we're there yet. I think we've got a lot of heavy lifting to do. You have to remember that this is an area where in the past, people who have had suicide as a symptom, or suicidal ideation, have often been excluded from research. I think one of the most hopeful signs, though, from the last two to three years, is that for the first time, scientists are beginning to see suicide as the target itself. They're not thinking of this as an adverse event or a side effect, or something that is tacked onto a study of depression or PTSD or drug addiction. They're thinking about the potential of interventions that would be specifically anti-suicidal. And we actually have some rather hopeful signs that some of the medications that are coming along and some of the psychotherapies that are coming along really do seem to have specific effects on reducing suicide. That's incredibly exciting. And while it is not quite there, in terms of being ready to push out broadly, I think it will be within the fairly near future.
I know you were one of the lead forces in this Prioritized Research Agenda that was just recently released. What are the big points on that, since it's such a vast field? There are so many things that contribute to [suicide] and so many different kinds of research that can be done. What are the main points in what you're saying in how we should be prioritizing research into suicide? How do we do that?
I think you want to prioritize by what's going to save lives. What we're talking about is finally bending the curve and measuring our success by how well we bend that curve. It's just unacceptable that these numbers continue to trend up. We wouldn't accept that, certainly, for homicide, and we wouldn't accept it for traffic fatalities. We shouldn't accept it for suicide.
Is the tide changing, at least from the sense that even if the dollars aren't there as you wish they were, that we are starting to talk about [suicide] more and it is getting more out into people's consciousness? Or do you think we're still just so far from where we need to be on that?
Oh, I don't think it gets talked about. There was a discussion about suicide after Robin Williams killed himself, and that kind of shock and awe that someone who people loved at a distance and who they thought was fundamentally so successful, how could he kill himself? There's an enormous misunderstanding about what suicide is. The connection to mental illness and especially depression and schizophrenia and substance abuse is not generally appreciated by the public. But fundamentally, and this is really the most sad part of this story, people don't really know about suicide until it happens to someone they love. And what we frequently say here at NIMH is that for every suicide, there are eleven victims. It's the person who dies and the ten people who love that person who will never be the same. So 40,000 suicides is a lot. You multiply that by 11, and you get some idea of the scope of the problem.