Our Nation's failure to prioritize mental health is a national tragedy. So many lives are at stake, so many families and communities struggle to stay afloat. This interim report has focused, for the most part, on the shattered lives of adults and children who suffer from mental illness. However, no loss is more devastating than suicide. Over 30,000 lives are lost annually to this largely preventable public health problem. About ninety percent of those who take their life have a mental disorder (IOM, 2002). Many have not had the care in the months before their death that would help them to affirm life. The families left behind live with shame and guilt—a "half-stitched scar," in the words of poet Elizabeth Jennings (cited in Jamison, 1999).

Model Program

Put simply, there is no airtight method of preventing suicide. As intractable as suicide may seem to be, some organizations have chosen to confront it. They have tried to change steadfast attitudes that suicide is somehow inevitable. They have taken a stand to stop suicide the best way they can.

One of those organizations comes literally from out of the blue: the U.S. Air Force. In 1996, the Air Force's Chief of Staff created a suicide program that doesn't even have a name, a logo, or a brochure. He and his organizers rolled up their sleeves and asked why, why on earth, one-quarter of their Air Force deaths in the early 1990s were from suicide. Their answer: Air Force personnel were reluctant to get help. The Chief of Staff sent not one, but many, hard-hitting messages to personnel worldwide, encouraging them to seek help in times of emotional pain and trauma. Messages were sent from the top of the command structure, from those who embodied the most uplifting ideals of American fortitude, resolve, heroism, and commitment to life.

"Suicide poses a threat to the health and well-being of our community. This is not the time to put this program on autopilot. The loss of a single airman is a loss to us all."
   —General Michael Ryan, Air Force Chief of Staff, in a service-wide electronic message, 2000

The Air Force program has many features (Box 9), but none as inspiring as messages from its leader to change a military culture, to reverse centuries of stoicism in the face of hardship—to encourage going for help. What is known so far is that the suicide rate in the Air Force dropped, from 1994 to 2002, by about 50% (Figure 5). This is a dramatic decline, saving the lives of many in uniform. Because suicide rates are affected by many factors, it is not yet known whether the decline is solely from the program itself, and whether the recent rebound in the rates is from the loss of the program's early momentum. While the program's impact is under study, the Air Force has set an awe-inspiring example. Strong leadership from the top with a comprehensive approach has the potential to save lives in many other settings where leaders can step up to the plate: in colleges and universities, faith communities, businesses, and schools.

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