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The undersigned organizations are committed to preventing suicide through education, public
awareness, research, crisis and support services and advocacy. The Advisory Committee process
presents an opportunity for the NCSP to bring to people’s attention the significant public health
problem of suicide and attempted suicide by people who suffer from serious mental illnesses such as
mood disorders, schizophrenia and substance abuse disorders. With over 32,000 deaths by suicide each
year, suicide is a leading cause of premature death, years of potential life lost and tremendous economic
and social impact on the citizens of this country.

Research shows that schizophrenia is a serious psychiatric disorder that affects up to 1% of the world’s
population. It is characterized by severe, but variable symptoms including delusions, hallucinations,
disorganized and impeded speech or behavior, blunted or restricted mood expression, profound apathy
and social withdrawal. This substantial social impairment often leads to a variety of social, educational,
occupational and environmental stresses including among other things unemployment, alcohol and drug
abuse, and contact with law enforcement. Many may not know that schizophrenia is also associated
with increased morbidity and mortality. People with schizophrenia have an estimated 2-3 fold increase
in mortality compared to the general population. About 50% of patients with schizophrenia will attempt
suicide and approximately 10% will die by suicide.

Patients suffering from schizophrenia who seek medication as part of a combined therapy and medical
treatment regimen often move through various therapies, looking for improved efficacy as
approximately 30% of patients are not satisfactorily responsive to currently available medications.
While we are not supporting any particular medication or form of treatment for schizophrenia, we do
support there being a wide range of treatment alternatives for those suffering with this debilitating and
at times fatal disease.

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Introduction
People have traditionally accessed crisis services by telephone crisis lines or face-to-face crisis centers in or near their local community.  Technological advances have increasingly brought people to communicating through written channels including Instant Messaging, Texting, Online Chats and social networking sites including Facebook, Twitter, MySpace and YouTube. These mechanisms for communication, including crisis communications, allow for an even greater level of anonymity than traditional telephone services, and may be increasingly used in the future by people in need.

With increasing use of these forms of technology, the NCSP recognizes that Internet-based interventions may and will be developed for on-line crisis services. Further, it is reasonable to expect that a number of these on line users will be in suicidal crisis, thus on line crisis response services will be involved in suicide interventions. There are, however, a variety of issues and challenges raised by this development. The Veterans Administration recently completed a 6- month pilot test of Veterans Chat service and has noted several of these challenges, ranging from issues regarding security, privacy, the lack of precedent, the non-linearity of interactions, to the greater anonymity of the visitor thus difficulties in getting persons at risk the immediate help that may be needed, etc. To date, these issues have not been sufficiently explored and solved; nor have quality assurance and improvement mechanisms been sufficiently developed for these types of services. Most importantly, the VA has recognized significant concern and need for extensive training and ongoing monitoring of interactions provided via chat services.

Position
The NCSP supports and has partnered with local and national crisis intervention and telephone services. The NCSP strongly supports accreditation systems for telephone crisis intervention services which, in general, requiring extensive (a minimum of 32-40 hours) training followed by ongoing supervision and quality improvement systems. Crisis lines have been singular in their focus on training and supervision to insure that those who provide services first do no harm and, second, develop skills sets that go well beyond simple gatekeeper functions. Therefore, the NCSP strongly urges further research, development and standardization of training protocols that recognize the complexity and challenges inherent in this model of service delivery and, in light of the issues raised above, training programs for chat volunteers equal to or more extensive than those required of and provided to crisis telephone workers so that the health and welfare of those using the services is best provided and maintained.

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Make sure to know the facts on suicide prevention and inhalant abuse prevention to raise awareness in your home, community or business during and after NIPAW.

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