Challenging the 90% Statistic: Flaws in Current Suicide Prevention Strategies ©

Updated 23 May 2025

Suicide prevention is a critical component of public health strategies worldwide, yet it remains fraught with challenges and inconsistencies. A widely cited statistic used in suicide prevention strategies comes from research by Jonathan Cavanagh, which states that 90% of individuals who died by suicide struggled with mental illness.[1] This figure has significantly influenced current prevention tactics. The validity of this statistic, however, is under scrutiny and evidence suggests the need for a reevaluation of standard approaches. As noted in the VA 2022 National Veteran Suicide Prevention Annual Report, a recent analysis of 365 research studies across 50 years found that mental health indicators were only weakly correlated with suicide or suicide attempts.[2,3] In this article, WHC explores the validity of the 90% statistic, the impact of mental health in suicide prevention, the role of fear-based interventions, and the necessity for sustained, comprehensive strategies aimed at long-term healing and purpose.

While mental illness can be a factor in suicide, it is not a determinant. Suicide is a complex, multifaceted issue influenced by a myriad of factors, including socioeconomic conditions, substance abuse, relationship problems and physical illness, not to mention the more abstract causes that we address in our exploration of the injury to the soul - see other articles. Understanding the broader spectrum of risk factors is essential for effective prevention. Current approaches often medicalize suicide, focusing heavily on diagnosing and treating mental disorders. This narrow focus inadvertently neglects many individuals who do not fit neatly into clinical categories but who are at high risk.

Current suicide prevention strategies often fall short in addressing the long-term needs of individuals at risk. Immediate risk assessment and intervention are crucial, but they need to be complemented by sustained efforts aimed at promoting long-term healing and strengthening of identity and purpose. Programs that foster resilience, self-efficacy, and a sense of belonging can be particularly beneficial at warding off hopelessness that culminates in suicide. These initiatives should be integrated into educational, workplace and community settings, creating environments where individuals feel supported and valued.

While the 90% statistic has been pivotal in shaping modern suicide prevention policies, we should be questioning its validity based on the method of data collection, which was primarily through psychological autopsies. Psychological autopsies involve retrospective examination of the decedent's life, often relying on interviews with family and friends. This approach is prone to introduce confirmation bias, where investigators may inadvertently look for evidence supporting the hypothesis of mental illness. Contrastingly, Centers for Disease Control and Prevention (CDC) research suggests that only 46% of people who died by suicide had a known mental illness, in a study reviewing suicide decedents from the National Violent Death Reporting System across 27 states in 2015.[4]

Given the existing gaps and limitations in current suicide prevention strategies, there is an urgent need to reevaluate our approach to this problem. Policymakers and mental health professionals must be open to innovative and evidence-based practices that address the full spectrum of contributing factors. It is important to understand which groups are most vulnerable to suicide and to understand why. Then it is imperative that we integrate holistic and cause-associated approaches in order to develop interventions that effectively can provide the individual with resources and tools that give them hope and a path forward. Additionally, reducing the stigma associated with mental illness and suicide is crucial for encouraging individuals to seek help and support.

Suicide prevention is not a one-time intervention; it requires acceptance of the liability and a delivery of ongoing maintenance and support. Individuals at risk of suicide often face chronic challenges that necessitate continuous care and monitoring. Effective prevention strategies include regular check-ins, access to therapeutic services and community support systems. A multidisciplinary approach that involves collaboration between healthcare providers, educators, employers and community leaders can help create a comprehensive support network.

Fear-based interventions, such as campaigns that highlight the danger and severity of suicidal behavior, are commonly used in prevention strategies. These methods aim to shock individuals into avoiding suicidal thoughts or actions, but they often backfire - increasing stigma and discouraging requests for help, and may even paralyze individuals, making them less likely to engage in proactive measures that can build hope. What actually works much better are interventions facilitating empowerment and education, providing individuals with the skills and resources needed to navigate their challenges safely.

Suicide prevention is a multifaceted and complex challenge that cannot be effectively addressed through a one-size-fits-all approach. The reliance on the 90% statistic has misdirected current prevention strategies, and the growth of the problem in recent years requires a return to the drawing board to more explicitly understand the reasons why so many are losing hope so that broader, more nuanced interventions can be developed. We submit that suicidal ideation is actually not a symptom of mental illness, but instead a result of injury to the soul. By focusing on long-term healing, understanding and strengthening individuals' sense of identity and purpose, we can develop more effective and compassionate approaches to preventing suicide. It is imperative to embrace the complexity of these issues and work collaboratively across sectors to create a supportive and responsive framework for those in need.

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1. Cavanagh, J. (2003). Psychological Autopsy Studies of Suicide: A Systematic Review. Psychological Medicine, 33(3), 395–405.

2. https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf, p43

3. Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., & Huang, X., et al. (2017). Risk Factors for Suicidal Thoughts and Behaviors: A MetaAnalysis of 50 Years of Research. Psychol. Bull, 143(2), 187-232.

4. https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6722a1-H.pdf, Table 2, p 622 (2018).