Healthier Colorado, a nonprofit that advocates for public policies to improve residents' health, has released a new report, “Issue Paper on Acute Suicidality: An Urgent Need for Systemic Change,” that calls for a shift in how suicide risk is understood and treated. The report highlights that suicidal thoughts and actions can escalate rapidly, sometimes within hours, without traditional warning signs.
Co-authored by Christina Walker and Alexis Alltop, with contributions from Jordana Ash and Oliver Lignell, the paper advocates for adding a suicide-specific diagnosis, like Suicide Crisis Syndrome (SCS) and Acute Suicidal Affective Disturbance (ASAD), to medical guidelines. This would improve how suicide risk is documented in healthcare settings, the authors said, and would ensure better communication between providers, ultimately enhancing research, policy, and treatment approaches.
This issue is deeply personal for Ash and Lignell, whose son, Maddy Lignell, died by suicide in May 2021 following a sudden mental health crisis. Walker, a colleague and close friend of Ash, reached out after her family’s loss. “I reconnected with Jordana, and she shared her son’s story of acute, rapid onset,” Walker said. “Within just six days, Maddy had passed, despite having many protective factors in place. We realized if this can happen in her family, it can happen to anyone.”
This realization sparked deeper conversations, driving the group to investigate further. As they delved into research, they recognized a critical gap in understanding acute suicidality, leading to the creation of the report. Their research brought them to Dr. Igor Galynker, a psychiatry professor at Mount Sinai Icahn School of Medicine and an expert on acute suicidality.
Dr. Galynker argues that acute suicidality differs from other suicide presentations and is not always the result of long-term mental illness. “This is not a rational process. It’s an illness, a syndrome,” he explained, emphasizing the importance of early detection and intervention. His work identifies five key SCS warning signs: feeling trapped, intense emotional pain, loss of cognitive control, sleep disturbances, and social withdrawal.
In June 2024, Healthier Colorado hosted the “Convening on Acute Suicidality: An Urgent Need for Systemic Change” in Denver, bringing together experts, including Dr. Galynker, to discuss the issue and propose mental healthcare reforms. “There’s a lot of research out there, but it’s not being applied widely enough,” Walker said. A key proposal was recognizing acute suicidality as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.
Research into suicide-specific diagnoses is already underway, with some U.S. hospitals testing new approaches and showing promising early results. However, even in the absence of an official diagnosis, Healthier Colorado has prioritized raising awareness about rapid-onset suicidality and advocating for a public health campaign to recognize its signs.
Dr. Megan Rogers, an Assistant Professor of Psychology at Texas State University and a contributor to the report, noted the challenge of predicting suicidality. Traditional methods of identifying at-risk individuals often miss those who haven't expressed intent or made a plan. “Up to 70 percent of suicidal individuals haven’t accessed any formal mental health services,” she said. This highlights the need for systems outside of traditional mental health care — like primary care and emergency rooms — to be better equipped to respond to individuals in crisis.
The delay in applying research to clinical practice is a major concern, according to Dr. Galynker and Dr. Rogers, because lives are at stake. “It takes on average about seven years for research to actually translate into clinical practice,” Dr. Rogers said. “We need to be moving now rather than continuing to refine our knowledge through more research.”
The Ash-Lignell family, in partnership with Healthier Colorado, has started a movement advocating for better responses to acute suicidality. Their efforts aim to open conversations about tailored mental health interventions and raise public awareness about suicide prevention. In honor of their son’s memory, they established the Maddy Lignell Legacy Fund to support initiatives to improve mental healthcare.
