The Power of reaching out: Evolving approaches to suicide prevention

By Kate Barnes

In the past, he noted, many clinicians believed that treating underlying mental health conditions – such as depression, post-traumatic stress disorder or substance use – would naturally reduce suicide risk. Over time, however, researchers learned that addressing those conditions alone was often not enough.

“The field began to realize we needed suicide-specific interventions,” he said. “Treating the underlying issue doesn’t always adequately address the suicidal thoughts or behaviors themselves.”

This brought into focus a goal of identifying individuals at highest risk, particularly veterans.

Using linked medical records through the Department of Veterans Affairs, one of the most comprehensive healthcare data systems in the country, Ilgen and colleagues studied suicide risk among veterans during the early 2010s, when suicide rates among service members returning from Iraq and Afghanistan were rising sharply.

While improving risk identification was important, the team quickly realized prediction alone could only go so far.

“It is important to identify people who may be struggling,” he said, “but our ultimate goal was, and still is, to identify strategies to help support those individuals to stay healthy and safe through a short-term crisis and over the long term.”

Alongside this multidisciplinary team of collaborators, Ilgen worked to build a broader “toolbox” of suicide-specific interventions. The team includes fellow U-M researchers Cheryl King, professor emerita of psychiatry; Frederic Blow, professor of psychiatry; Cynthia Ewell Foster, clinical professor of psychiatry; Courtney Bagge, associate professor of psychiatry and Patrick Carter, professor of emergency medicine. Ilgen, King and Ewell Foster are also members within the U-M Institute for Firearm Injury Prevention. Carter serves as director of the institute.

The collaborative nature of the work proved essential, Ilgen said.

“In mental health research, multiple perspectives are critical to ensure we are considering all viewpoints and backgrounds,” he said. “It really took a full team with different disciplines and expertise to thoughtfully design these approaches.”

The team’s early interventions involved intensive treatment plans spanning roughly twelve sessions over three months. While promising, the researchers began questioning whether shorter, more accessible approaches could reach more people during critical high-risk periods.

At the heart of his suicide prevention work is a simple but powerful idea: suicidal thoughts often come in waves.

“These waves can peak, but, for the vast majority of people, they do pass,” Ilgen said. “A lot of our research is about helping people stay safe long enough to ride out those high stress moments.”

That thinking ultimately led the team to focus on one key behavior: help-seeking.

Working with veterans, National Guard members and patients in acute care settings, the team repeatedly heard the same concerns. Many people who struggled with suicidal thoughts feared being a burden if they reached out for help, while others worried about being hospitalized or misunderstood. Some simply did not know who to call or where to begin.

“Those perceptions and fears were major barriers,” Ilgen said. “So we focused on using this feedback to tailor the program as a more straightforward tool, to help participants be comfortable with reaching out for help before diving into the more intensive intervention.”

The team developed a brief, single-session intervention designed to increase confidence in seeking support and reducing the identified barriers overall. During this intervention, participants practiced making phone calls and engaging in conversations about mental health, often with a therapist present.

“We wanted people to compare what they feared would happen with what actually happened when they reached out,” he said. “And the initial results were encouraging. We found that participants reported positive short-term experiences and, in our first large-scale study, were less likely to make suicide attempts during the following year.”

The initial suicide prevention study, which involved about 300 veterans, has since expanded into larger National Guard and community-based populations. As the participant engagement has grown, the team has seen differing results from their initial findings, which is part of the iterative process of research, Ilgen said.

“As we continue to roll out this program across different populations and in different settings, such as for alcohol use disorder treatments, our outcomes vary in terms of the impact on those outcomes that matter most – like risk of future suicide attempts,” he said. “But participants continue to report appreciating the chance to practice reaching out for help, and we are taking the data and feedback and working to tailor each strategy so it works best for folks where they are at. In addition, within settings like the National Guard, we are working to address the stigma of help-seeking and using similar methods to encourage people to obtain support when they notice that a colleague, friend or loved-one is suffering. We will continue to adjust as we learn more.”

Looking ahead, Ilgen is working to develop more personalized approaches to suicide prevention, recognizing that no single intervention works for everyone.

“A person’s background and setting matter tremendously,” he said. “The goal is to find interventions that are brief, scalable and impactful during periods of high risk. We want to work with our patients to find what works best for them in a sustainable, impactful way.”