For the last couple weeks, we’ve been taking a closer look at Wikipedia in class – a truly fascinating phenomenon, but I’ll spare you the details in this post (check out the Wikipedia article on Wikipedia if you’re interested in how collaborative writing by volunteers across the world has led to an astonishingly reliable compilation of articles covering nearly every topic under the sun).
So, I said I’d spare you the details, but then what is this post about? You’re going to accompany me through my very own Wikipedia journey, which starts with the creation of a user page – mine is here. The next step is picking an article to edit. I decided to go with suicide prevention, given my experience at the Virginia Department of Health this past summer (where I worked primarily on suicide prevention) and the course on suicide prevention I took here at the public health school in the Spring. After deciding on an article, it was time to evaluate it. We were told to assess: comprehensiveness, sourcing, neutrality, readability, formatting, and illustrations.
My Evaluation of the Wikipedia “Suicide prevention” Article
While the introductory list of suicide prevention strategies is fairly comprehensive, the article itself suffers from gaping holes. Overall, the core of the article as it stands now is “Interventions” – but almost all those listed are mental health interventions. Moreover (and particularly distressing to this engineering-turned-public-health-student), there is no discussion of evaluations of these interventions, their effectiveness, etc.
As I anticipated, another major component missing from the article (besides a brief mention in the introductory list) is lethal means reduction (reducing the odds that an attemper will use highly lethal means), which was a major focus of our class, and an integral part of a public health approach to suicide prevention. But the missing content from this article goes far beyond just this subtopic – the suicide prevention gatekeeper trainings and crises centers that formed the centerpiece of the day-to-day suicide prevention activities at the state health department this summer are not even mentioned, nor is there adequate mention of suicide prevention resources such as the national phone line (which is of particular concern given that someone may land on this page when they or someone they know is at risk for suicide).
The article also fails to provide an adequate overview of the topic, with things like the National Strategy for Suicide Prevention not mentioned at all. Suicide prevention can also vary by subpopulations, with youth suicide prevention being a particularly important one (and one that I’m particularly aware of given my work this past summer on looking at peer-to-peer suicide prevention programs on college campuses), but no subpopulations are highlighted. Even the missing content I’ve pointed out so far ignores a huge component of suicide prevention – approaches to suicide prevention outside the U.S.
The sourcing of the article is also lacking, with the article actually flagged for unverified content, specifically a lack of inline citations. In the entire article, there are only two inline citations, neither of which are (to my knowledge) particularly key sources in the field. There is tons of research out there on the topic of suicide prevention and there are also tons of websites for different organizations, programs, and interventions. The citations here are thus definitely not up to par. Even the further reading and external links fail to capture the depth and breadth of the information currently out there (or even link to the most fundamental of resources, like the CDC’s page on suicide prevention).
The article is not currently written from a neutral point of view, because, as I mentioned, it has a heavily mental health focus (with little or no mention of other approaches to suicide prevention, such as gatekeeper training and lethal means restriction). It is also entirely U.S.-centric, with little or no mention of approaches in other countries, differences in suicide prevention globally, etc. (except for a recently added link to an Australian suicide prevention program in the “See Also” section.)
The article is fairly readable and well written, and seems to adhere to the Wikipedia Manual of Style in terms of formatting. There are a few illustrations, and although they are relevant, they do not connect to the text (as currently written).
Additional Sources and Text
The evaluation made it clear that there were numerous ways to improve this article. Given that my experience in this field has been entirely U.S.-centric, I decided to focus (at least initially) on improving the article’s coverage of domestic suicide prevention. First, I considered some sources that would help add to the article.
- CDC webpage on suicide prevention
- Suicide Prevention Resource Center website, including:
- JED Foundation website, including:
- Model for Comprehensive Mental Health Promotion and Suicide Prevention for Colleges and Universities (i.e., the “Bubble Chart”), developed in collaboration with the Suicide Prevention Resource Center.
- Suicide Prevention: Prevention Effectiveness and Evaluation. (pdf) A 32-page guide from SPAN USA, the National Center for Injury Prevention and Control, and Education Development Center, Inc.
- Jose Bertolote. “Suicide prevention: at what level does it work?” World Psychiatry. 2004 Oct; 3(3): 147-151. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414695/
- American Association of Suicidology
My Proposed Additions
I then created an outline for what I’d like to add to the article, and then fleshed it out to create this, a summary article of my additions to the current Wikipedia article (this is just a starting point though – there is still more to add!). My notes are in blue, and there are some sections that I think should be included, but that I have not yet time to research and write.
With Help Comes Hope – In the U.S., call 1-800-273-8255 to reach the National Suicide Prevention Lifeline [This will be listed at the top of the page, as is customary in the suicide prevention field, in order to best serve those looking for immediate help]
Suicide prevention is an umbrella term for the collective efforts of local citizen organizations, mental health practitioners and related professionals to reduce the incidence of suicide.
Such efforts include preventive and proactive measures within the realms of medicine and mental health, as well as public health and other fields – since protective factors such as social support and connectedness, as well as environmental risk factors such as access to lethal means, appear to play significant roles in the prevention of suicide, suicide should not be viewed solely as a medical or mental health issue. [http://www.maine.gov/suicide/about/riskprot.htm, http://www.medterms.com/script/main/art.asp?articlekey=11613]
In the U.S., suicide prevention efforts are guided by the National Strategy for Suicide Prevention, published by the Department of Health and Human Services in 2001. [http://www.sprc.org/library/nssp.pdf] Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414695/]
In recognition of the need for comprehensive approaches to suicide prevention, various strategies have been put forth in the last decade.
In 2001, the U.S. Department of Health and Human Services, under the direction of the Surgeon General, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal behavior throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual). The document also outlines 11 specific objectives, listed below [http://www.sprc.org/library/nssp.pdf]:
- Promote awareness that suicide is a public health problem that is preventable
- Develop broad-based support for suicide prevention
- Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services
- Develop and implement community-based suicide prevention programs
- Promote efforts to reduce access to lethal means and methods of self-harm
- Implement training for recognition of at-risk behavior and delivery of effective treatment
- Develop and promote effective clinical and professional practices
- Increase access to and community linkages with mental health and substance abuse services
- Improve reporting and portrayals of suicidal behavior, mental illness and substance abuse in the entertainment and news media
- Promote and support research on suicide and suicide prevention
- Improve and expand surveillance systems
The JED Foundation, a nonprofit organization working to reduce the rate of suicide and the prevalence of emotional distress among college students, working in collaboration with the Suicide Prevention Resource Center, developed a Model for Comprehensive Mental Health Promotion and Suicide Prevention for Colleges and Universities, a research based model that is useful in conceptualizing suicide prevention broadly (i.e., not just for colleges and universities). [http://www.jedfoundation.org/professionals/programs-and-research, http://www.jedfoundation.org/professionals/_preventionmodel]
INTERVENTIONS (and effectiveness)
Prevention at the Level of the Individual
Identifying Risk and Increasing Help-Seeking Behavior
Developing Life Skills and Promoting Social Networks
Providing Mental Health Services and Crisis Management
Hotlines and Crisis Centers
Prevention at the Level of the Population
Targeting Environmental Risk Factors
Lethal Means Reduction
Means reduction, reducing the odds that a suicide attempter will use highly lethal means, is an important component of suicide prevention. [http://www.hsph.harvard.edu/means-matter/index.html]
For years, researchers and health policy planners have theorized and demonstrated that restricting lethal means helps reduce suicide rates.[ http://www.sprc.org/featured_resources/trainingandevents/conferences/co/pdf/lethalmeans.pdf] One of the most famous historical examples of this is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, composed over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning. [http://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/index.html, http://www.ncbi.nlm.nih.gov/pubmed/953381]
In the United States, numerous studies have concluded that firearm access is associated with increased suicide risk. [http://www.hsph.harvard.edu/means-matter/means-matter/risk/index.html] Because guns are quick and more lethal than other suicide means (about 85% of attempts with a firearm are fatal, a much higher case fatality rate than for other methods), they are often a major driver of suicide rates. [http://www.hsph.harvard.edu/means-matter/means-matter/risk/index.html#What%20is%20it]
[insert information on opposing viewpoint here]
Targeting Societal Risk Factors
Improvement of Media Portrayal of Suicide
Stigma Reducing Efforts