Adopt this suicide prevention approach

My first time in a psychiatric hospital was traumatic. In a room with white walls and chairs bolted to the floor, fluorescent lights buzzed. Staff gripped my arms tightly. "Stop resisting!" they shouted, but I was sobbing and shaking so hard I barely heard. As they pinned my body to the ground, the nurse jabbed me with a needle.

When the doctor asked if I was having suicidal thoughts, all I wanted was to go home. "No, I'm not thinking of killing myself," I lied. In a matter of hours, I was discharged from Stony Brook University Hospital and returned to my parents in Smithtown.

Two decades later, I've lied my way out of several hospitals. Many of us can.

People who live with suicidal thoughts quickly learn how to navigate the system. It isn't difficult when the risk assessment, the Columbia Protocol, is a checklist of yes-or-no questions — a script easy to memorize.

More than 48,000 Americans die by suicide annually, yet our prevention strategy hasn't changed since the 1970s. Risk assessment relies on an honest response to the question, "Do you plan to kill yourself?" The odds of a correct prediction are about the same as tossing a coin. This isn't surprising given that about three out of four people who die by suicide never tell anyone their thoughts. No other medical condition relies so heavily on self-diagnosis. Still, that question remains the backbone of our evaluation.

Despite the abundance of funding and research, our approach to suicide prevention is failing, utilizing a method that's not only inaccurate but often worsens the problem. The person in distress will likely lose trust in the assessor and be less willing to reach out for help, fearing the "solution" to suicidal thoughts: forced hospitalization. Their risk may even increase: Studies show the weeks after leaving a psychiatric hospital are the most dangerous.

The missing piece of the puzzle? The voices of people who've been there, voices typically ignored.

Aiming to prevent unnecessary hospitalizations, researchers have developed an approach to risk assessment that incorporates feedback from individuals with lived experience. I've been honored to work as one of these consultants for the Mount Sinai Suicide Prevention Research Lab directed by Dr. Igor Galynker.

Along with scientists internationally, the lab has identified a short-lived mental state before an attempt: suicide crisis syndrome. SCS, which is under consideration for addition to psychiatry's diagnostic manual, has five clear criteria, and whether or not a patient admits to suicidal thoughts, SCS-based risk assessments have been proven to improve clinical outcomes.

Rather than a script of standardized questions, which may miss important clues, SCS is evaluated through conversation. Every situation is unique. Slowing down to explore a patient's feelings, clinicians are encouraged to build rapport, use plain language, and let conversation flow naturally. By the end, it's clear if a person is actively suicidal — no interrogation required.

We must adopt SCS-based risk assessment, or else suicide will continue unabated. You learn far more about someone through genuine dialogue and open-ended questions. Treat people as humans instead of liabilities, and they're also more likely to be honest.

It's more urgent than ever to replace outdated, inaccurate checklists with a tool that actually works. Every time I've left somewhere after lying my way out, I thought: It shouldn't be this easy to hide my pain.

Suicide prevention requires listening, connecting and sitting alongside each other in the darkness. A better way exists, so let's use it. Anything less is deadly.

This guest essay reflects the views of Marisa Russello, a New York-based peer specialist who's writing a memoir.