Question: Is our hyper-focus on “safe messaging” getting in the way of “effective messaging”?
With World Suicide Prevention Day (September 10), National Suicide Prevention Week (September 10-16) and Suicide Prevention Awareness Month (September) around the corner, the issue is going to be getting a lot air time—from the media, from the suicide prevention community, and, hopefully, from the general public.
For years, suicide prevention advocates have focused on “safe messaging,” a series of do’s and don’ts that emphasize help-seeking and discourage mentioning suicide details. The goal of these suggestions is to avoid triggering vulnerable people to over-identify with suicide as a way to escape their emotional pain. Many of these tips – like don’t glamorize or romanticize suicide --are beneficial, and we certainly don’t want our content to cause harm. But I and many others are starting to recognize that a single-minded focus on "safe messaging" may be getting in the way of us being effective in our communication.
“A lot of times, safe messaging turns out to be very boring messaging. People tend to err on the side of caution and safety, which results in very vanilla messages that aren’t particularly compelling or powerful,” says Dr. Bart Andrews, vice president of clinical practice and evaluation at Behavioral Health Response in St. Louis, Missouri. “If the messaging doesn’t do anything to further our cause, it’s not safe—it’s ineffective.”
Dr. Andrews argues that we even abandon the terms “contagion” and “copycat suicide” because of how pejorative they are and that we call it what it is: “a media exposure effect.” The reality is, we don’t really understand this media exposure effect or how following safe messaging guidelines might impact this phenomenon. Andrews notes the absence of randomized control trials showing the effectiveness of implementing safe messaging guidelines. In fact, the one experimental research[1] study investigating the impact of reporting guidelines concluded, “Results indicate some reporting guidelines may be unnecessary.”
The goal of most action-oriented suicide prevention messages is to encourage a person in crisis to seek help or to engender confidence in an individual who knows someone in crisis to reach out. By contrast, awareness messaging—promoting statistics about suicide being a leading cause of death, for example—doesn’t achieve either goal. In fact, when we constantly pound the drum of death data for suicide, we might actually be increasing hopelessness and may even be creating cultural scripts or expectations that suicide is inevitable among certain populations.
What is also concerning is that our hyper-focus on safe messaging may be causing immobilizing fear. For the non-suicide prevention experts the “safe messaging guidelines” can create heightened anxiety around talking about suicide at all for fear of creating a media exposure effect. Confusion persists around discussing suicide as many people still believe the myth that if we talk about suicide we can put an idea in someone’s head. This fear shuts down the whole conversation and suicide remains hidden in the closet.
“If we devoted half the energy we do on safe messaging and exposure effects to mandating suicide prevention training, universal screening and access to care, I believe we would be more effective,” says Dr. Andrews. “I think the guidelines are important as guides but not gospel, and I am more interested in effective messaging than safe messaging.”
One example of the consequence of a hyper-focus on “safe messaging” is that it can shut down conversations about our stories. Stories of hope from people who have come through suicidal despair into healing provide inspiration and a roadmap for to recovery. Personal testimonies from suicide attempt survivors who have lived through their crises have had the most powerful effect on shifting culture and misperceptions I have witnessed.
One excellent example of this is Dese’Rae Stage’s Live through This project. Live Through This is a collection of portraits and stories of suicide attempt survivors. Their portraits, captured by the camera of Dese’Rae have the survivors looking straight into the lens. Their stories are curated by Dese’Rae through interviews and are shared in the words of the survivors. By having the viewer/reader look into the eyes, read the names, and hear the words of the attempt survivors, Dese’Rae hopes people will humanize the experience of being in and healing from a suicide crisis and to ultimately feel empathy.
Stories of suicide bereavement can also move hearts. Here is a very powerful video showing effective ways to talk about suicide grief. When talking about personal experiences with suicide grief I believe it is possible to both honor the life that was lived while not shying away from the tragedy of suicide; however, I have seen how fear of “contagion” can silence communities, halt needed mourning, and prevent people from pulling together.
Additional powerful examples of stories of people with lived experience with suicide – loss and attempts -- can be seen through the new film, The S Word. [Listen to my podcast with the film director Lisa Klein to learn more about the film and how to bring a screening to your community.] The S Word is a documentary that chronicles the lives of several suicide attempt and loss survivors and shares their journeys over time. In her screening of the film, Lisa shares her own losses from suicide and facilitates audience conversation about their experiences to facilitate healing in communities.
Research backs up this approach of sharing stories to reduce prejudice in marginalized groups like suicide loss and attempt survivors. Patrick Corrigan, Distinguished Professor and Associate Dean for Research in the Institute of Psychology at the Illinois Institute of Technology and a leading researcher in stigma reduction, argues that contact between people who live with mental illness and those who do not is the best way to reduce stigma[2]. This personal connection helps to dispel inaccurate and negative beliefs about people living with a mental health condition because it challenges prejudicial attitudes and diffuses tensions and fears. These types of intervention work best when people are seen as having equal status and when the experience is intimate. When we hear firsthand accounts of the lives of suicide attempt and loss survivors we discover we are more common than different. We see the humanity rather than stereotype. This outcome is what storytelling can do when done well.
In addition to sharing powerful stories, many national partners in suicide prevention are shifting their focus to other forms of effective messaging for the 2017 National Suicide Prevention Week efforts. These national partners will leverage existing campaigns like #BeThe1To, #BeThere, Take 5 to Save Lives, and Take a Minute, Save a Life to focus on building a unified front in the message of being there for others and ourselves. Therefore, messaging you will see over the next month, in particular, will increasingly concentrate on emboldening and coaching the people around suicidal individuals.
Why? A recent study found that most Americans experience fear that prevents them from trying to help someone they think might be at risk for suicide. Common fears include:
making things worse rather than better
getting in too deep
not knowing how to locate effective resources
Effective communication strategies working within this theme will focus on the importance of being there for one another as well as the importance of how people who are living with suicidality can be there for themselves.
The National Action Alliance for Suicide Prevention is pushing to change the conversation. Its new Framework for Successful Messaging encourages messages that are focused on prevention and include stories of hope, recovery, and resilience.
“We really need to be focused on action messaging: This is a real problem—we need to let people know what they can do about it,” Andrews agrees.
Easier said than done, of course. To get you started, here are some things to consider beyond the safe messaging framework:
Tailor your message to the group you’re trying to reach. Veterans, for example, may respond better to franker, edgier conversations. Teen girls may need something else.
Engage your intended audience in message development, and then test your messages with your intended audience before promoting them. Just because you think they are good messages doesn’t mean they are right for the community you are hoping to reach.
Include an action item and a resource (e.g., a population-appropriate website link or the National Suicide Prevention Lifeline number).
Use compelling images. That doesn’t mean graphic visuals related to death or depressing images like people with their heads in their hands, but rather find an image that will catch people’s attention and elicit an emotional reaction like hope, empathy or inspiration. Don’t be afraid to use humor like we do in Man Therapy (www.ManTherapy.org).
Make sure your message spurs people to action. A simple communication, such as “Show you care and reach out,” combined with a resource can go a long way.
Don’t be afraid to be bold.
There are plenty of resources available to help in the process, including:
The Action Alliance Framework for Successful Messaging
The Action Alliance webinar: Developing Successful and Positive Suicide Prevention Messaging – Planning Ahead for Suicide Prevention Month.
The Action Alliance’s The Messenger newsletter
World Health Organization’s community engagement toolkit
The most important thing is to create messages that engage people in conversations about suicide as a preventable public health issue. With a little outside the box thinking, we can do so in a smart, safe, effective, and engaging way.
About the Author
Sally Spencer-Thomas is a clinical psychologist, inspirational international speaker and an impact entrepreneur. Dr. Spencer-Thomas was moved to work in suicide prevention after her younger brother, a Denver entrepreneur, died of suicide after a difficult battle with bipolar condition. Known nationally and internationally as an innovator in social change, Spencer-Thomas has helped start up multiple large-scale, gap filling efforts in mental health including the award-winning campaign Man Therapy and the nation’s first workplace suicide prevention initiative. Because of these efforts, she was an invited speaker at the White House in 2015.
Her goal is to elevate the conversation and make suicide prevention a health and safety priority in our schools, workplaces and communities. Spencer-Thomas has also held leadership positions for the National Action Alliance for Suicide Prevention, the International Association for Suicide Prevention, the American Association for Suicidology, and the National Suicide Prevention Lifeline. She has won multiple awards for her advocacy including the 2014 Survivor of the Year from the American Association of Suicidology, the 2014 Invisible Disabilities Association Impact Honors Award, and the 2012 Alumni Master Scholar from the University of Denver, the 2015 Farbarow Award from the International Association for Suicide Prevention and the 2016 Career Achievement Alumni Award from the University of Denver’s Graduate School of Professional Psychology.
She has a Doctorate in Clinical Psychology from the University of Denver, Masters in Non-profit Management from Regis University, a Bachelors in Psychology and Studio Art with a Minor in Economics from Bowdoin College. She has written four books on mental health and violence prevention. She lives with her partner and three sons in Conifer, Colorado.
Connect with Dr. Spencer-Thomas by visiting her website: www.SallySpencerThomas.com and following her on Facebook @DrSallySpeaks, Twitter @sspencerthomas and LinkedIn. To learn more participate in her monthly podcasts, blogs and twitter chats!
[1] World Health Organization (2003). Advocacy and Mental Health, Volume 7. Geneva, Switzerland. WHO.
Spencer-Thomas, S. & Jahn, D. (2012). Tracking a movement: U.S. milestones in suicide prevention. Suicide and Life Threatening Behavior, 42(1), 78-85.
NOTE: Feel free to use the graphic below in your own post. All I ask is that you link back to this article or my website: www.SallySpencerThomas.comThank you!
[1] Anestis, M; Bryan, C., May, A., Law, K., Hagan, C. Bryan, A., Chu, C., Michaels, M., Selby, E., Klonsky, E. & Joiner, T. (2015). Dangerous Words? An Experimental Investigation of the Impact of Detailed Reporting About Suicide on Subsequent Risk. Journal of Clinical Psychology,
[2] Couture, S. & Penn, D. (2003). Interpersonal contact and the stigma of mental illness: A review of the literature. Journal of Mental Health, 12(3), 291-305.