Handwritten Letters May Help Prevent Suicide

In this age of electronic communication, receiving an actual pen-and-paper letter in the mail is a rare and special thing. It could even have medical applications, according to a recent study that found receiving handwritten letters may help prevent suicide. The study which outlined a new method to aid those in danger of self-harm was published in the journal PLOS Medicine in March. The results could have a major impact on how hospitals handle follow-up treatments, radically reducing the number of repeat suicide attempts.

Nearly a quarter of those who have attempted suicide will try it again, and most who die from a completed suicide have made previous attempts. Follow-up treatments such as intensive therapy and one-on-one visits with a mental health professional puts a strain on the limited resources available to overtaxed hospitals. In order maintain the personal touch that the therapy requires while reducing pressure on resources, researchers tested a promising new treatment called Attempted Suicide Short Intervention Program (ASSIP).

In the ASSIP trails, 120 patients admitted to Bern University General Hospital for attempted suicide in Switzerland were randomly assigned to one of two groups. The control group received the standard treatment provided by the hospital after evaluation, and the other group received standard treatment, with the additional ASSIP method. The objective was to see if the inclusion of ASSIP could reduce the chance of a repeat suicide attempt over the following two years.

As part of the ASSIP approach patients went through three therapy sessions. In the first session, they were filmed telling their personal history leading up to their suicide to the therapist. In the second session, they reflected and discussed parts of the video. The third session included a discussion of long-term goals, warning signs, and safety strategies with the therapist. Once released, they received personalized letters from their therapist outlining advice and warning signs over the following 24 months. They received six letters in total — a letter was sent every three months the first year, and every six months over the second year.

While over the two years of the trial there was one death in each group, the incredible results proved that writing letters may actually save lives. In the ASSIP group only five repeat suicide attempts were made compared to the control group's 41 attempts. ASSIP reduced the risk of repeat suicide attempts by a shocking 80 percent. Participants additionally spent 72 percent fewer days in the hospital, which is an incredible relief on resources. While ASSIP was not associated with reduced depression or suicide ideation, the actions of the participants speak for themselves. Konrad Michel, one of the authors of the study commented on the success of the ASSIP strategy to The Washington Post, “We believe the caring letters gave patients a feeling that they were cared about and added a personal touch.”

Around the world, more than 800,000 people die by suicide every year, and in the U.S. it is the second leading cause of death for those ages 25 through 34. This letter writing program may be a breakthrough in how to handle follow-ups, serving as a personal reminder that the patient and their struggle has not been forgotten. In both Finland and the U.S. there is expressed interest in integrating ASSIP into suicide prevention programs.

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