Other than a few medical adventures, I have no particularly good excuse.

I’ve been busy writing, teaching, thinking, fishing when possible, and working with my colleagues at the QPR Institute to put more suicide prevention skills into the hands of ordinary people.

Meanwhile, the field of suicide prevention has changed. We have better research, better treatments, better training, and more people working to prevent suicide than ever before.

And yet, far too many people continue to die.

This wakes me up early in the morning and causes me to think for an hour. Sometimes two.

After more than half a century in this business, I have become increasingly convinced that our biggest problem is not simply what we don’t know. It is our failure to consistently do what we already know works.

We know a great deal about suicide warning signs. But I would argue that we still don’t know enough, because people continue to confuse us in what they say and what they do, or don’t do, that signals they are in serious psychological distress.

We know how to ask people about suicide. Or at least we think we do. Still, too many professionals ask the question in the wrong way, practically inviting a denial of distress.

We know that evidence-based treatments can help. We have clinical trials of treatments we never had before. We have suicide-specific treatments now, and increasingly, people have a chance of finding a good and rewarding life again if they can get these treatments.

We know that the hours and days following discharge from psychiatric care can be particularly dangerous. Zero Suicide has arrived, with many great ideas and great people pushing those ideas into practice.

But knowing what to do and doing it are two different things. Someone once called this the knowing-doing gap.

A great coach knows the winning play in the last seconds of a game, but can the team execute that play? What happens when the gap between the idea and the action is too great?

I’ve spent much of my professional life trying to close that gap.

So, I’m returning to this blog with a slightly different agenda. Rather than writing long essays, I intend to share shorter pieces about research findings, missed opportunities, practical solutions, and the occasional idea that may irritate somebody. Or even hurt someone in pain over the loss of someone they cared about.

Some will examine failures in our healthcare institutions. Others will explore the gaps between what we know and what we do.

I am especially interested in what happens between recognizing that someone is in danger and actually getting that person safely connected to help that science has shown is effective.

It is not enough to be empathetic and compassionate.

If I am facing surgery, I don’t want a surgeon who talks a great surgery. I want a great surgeon who does a great surgery.

If I take my grandchild to a therapist because he or she is thinking about suicide, I want a therapist who actually knows what to do about suicidal ideation, not one who brushes me off with, “All the child needs is a good listening to.”

I also want to explore the possibility of creating a new kind of suicide prevention professional, someone whose work begins where traditional services sometimes end.

I’ll try to keep the science sound, the language understandable, and the sermons short.

At my age, 86 at this writing, I have neither the time nor the inclination to spend another decade arguing about whether suicide is preventable.

It is.

The question is what we’re willing to do about it.

One other thing has changed since I last wrote here. Thanks to the medical adventures I mentioned, I can no longer type the way I once did, so I have enlisted the help of an artificial intelligence assistant I call Quigley.

Quigley helps me research, organize, draft, and edit these pieces. We’ve worked together enough that Quigley has become reasonably good at writing in my voice, including some of my bad habits.

But I want to be clear about something. The ideas, opinions, clinical experience, and occasional provocations are mine. Quigley helps me get them onto the page, and I review what we produce before it goes out into the world.

At this stage of my life, I’m grateful to have a way to keep writing, even if I can no longer do all the typing myself.

For the most part, my brain seems to work as intended, even if my body no longer pays attention to the man behind the curtain.

Welcome back to On Suicide.

Preventing suicide, it’s what people do.

Dr. Paul