Dogged medical detective work combined with public advocacy to dispel the shame that surrounds suicide — these may be productive ways to attack the public health nightmare of increasing numbers of Americans taking their own lives.
This is a crisis that can’t be hidden or allowed to keep going up, with some experts estimating that roughly 47,000 Americans commit suicide annually. That’s about 129 lives lost each day. Suicide, hitting a record-setting pace, also is a significant problem for the U.S. military.
If you are in crisis or know someone who may be, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text HOME to 741741. Both work 24/7. More resources are available at SpeakingOfSuicide.com/resources.
For those seeking ways to combat suicide, the independent Kaiser Health News Service reported that public health officials are looking hard at work occurring in suburban Portland, Ore. There, Kimberly Repp, a Ph.D. microbiologist who was more accustomed to studying infectious outbreaks, turned her scientific skills to learning more about suicide.
Her sometimes grim research is showing results, with the county she works for showing a rare decline in suicides. She made her findings after a lot of shoe-leather research, following and working with death investigators for the area’s medical examiner or coroner. She went to countless, unhappy death scenes. Her motto, from the Latin, became: Hic locus est ubi mors gaudet succurrere vitae. “This is a place where the dead delight in helping the living.”
Repp slowly developed a swift check list for investigators that helped her build an invaluable database about people who took their own lives. This was information, surprisingly, that others had not collected and studied. As KHN reporter Maureen O’Hagan described the labor and Repp’s list:
“It included not only age and cause of death, but also yes/no questions on things like evidence of alcohol abuse, history of interpersonal violence, health crises, job losses and so on. In addition, the county created a procedure, called a suicide fatality review, to look more closely at these deaths. The review is modeled on child fatality reviews, a now-mandatory concept that dates to the 1970s. After getting the OK from family members, key government and community representatives meet to investigate individual suicides with an eye toward prevention. The review group might include health care organizations to look for recent visits to the doctor; veterans’ organizations to check service records; law enforcement; faith leaders; pain clinic managers; and mental health support groups. The idea, Repp said, isn’t to point fingers. It’s to look for system-level interventions that might prevent similar deaths.”
Repp and county public health officials realized that more area residents could help prevent suicides with even a little training, which previously had been focused for common sense individuals like pastors and teachers. They expanded their outreach:
“[W]ith the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more. It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there. Since 2014 … more than 4,000 county residents have received training in suicide prevention.”
The county-wide prevention push also has spread to law enforcement, with sheriff’s with mental health expertise accompanying officers involved in evictions, and health care organizations scrutinizing their cases in which individuals have taken their lives.
The results, as KHN reported: “From 2012 to 2018, Washington County’s suicide rate decreased by 40%, preliminary data shows. To be sure, though, 68 people died by suicide here last year, so preventing even a handful of cases can lower the rate quite a bit.”
While it sounds like involving many people in the Pacific Northwest in preventing suicide is producing positive outcomes, writers in Los Angeles and Washington, D.C., also have made tough and compassionate descriptions about what individuals can do.
Tough questions to try to save lives of those in dire shape
Stephen Petrow, a Washington Post contributing columnist, wrote recently about his own struggles with depression and how he was helped by a friend with his own severe mental health challenges. His friend took his life, leading Petrow to ask what he could have done. He points to work by the Lighthouse Project, which, a Columbia University professor noted, has developed a six-question survey that can provide individuals with a sense of how urgently they might need to intervene to assist the suicidal.
The questions are tough, and yes answers to any of them should lead loved ones and friends to help someone to medical care. A yes answer to the last three questions demands immediate professional assistance, says the group, whose motto is “Identify risk, prevent suicide”:
- Have you wished you were dead or wished you could go to sleep and not wake up?
- Have you actually had any thoughts about killing yourself?
- Have you thought about how you might do this?
- Have you had any intention of acting on these thoughts of killing yourself?
- Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
- Have you done anything, started to do anything, or prepared to do anything to end your life?
The questions may seem stark and intrusive. They should not be asked lightly. But they need to be posed in certain situations because those who are in deep pain and who are thinking of taking their lives may not know how to ask for help or to speak of their dangerous thoughts, the psychiatrist told Petrow.
A different way to take the stigma out of mental health challenges
Meantime, Jill Halper, an adolescent medicine doctor in LA, has written an Op-Ed in the New York Times that offers a compassionate but difficult view of depression and its role in lives taken. She writes from experience, noting that her husband, who had attempted to do so decades earlier, took his life recently after unceasing struggles with deep depression.
She argues eloquently that depression should be seen not just as a mental illness but as a chronic disease like cancer. That framing can help take away the stigma, as well as describing how her husband succumbed — she says his depression, like cancer, went in and out of remission, but finally contributed to his death. Halper wrote:
“Not all cancers can be cured. Nor can all depressions. With the strong foundation of our love and his excellent care, my husband had almost 20 years of remission before succumbing to his disease. I know that depression is not cancer, but both diseases can be insidious … Researchers believe each is the result of genetic and environmental factors, and with my husband’s family background of mental illness and an abusive childhood, it’s not hard to see why he was sick. Suicide is how my husband died, but depression was what killed him. His suicide was not a rational, intentional act, but a complication and fatal outcome of a very complex and difficult disease. Just as cancer invades the body, depression invades the psyche. And just as the surviving family members of patients with incurable cancers know that they were powerless to stop the progression of the disease, so are the survivors of a person with depression who dies by suicide.”
In my practice, I see not only the harms that patients suffer while seeking medical services, I also see their challenges with accessing and affording mental health care that might help reduce suicide’s terrible toll. The Obama Administration took steps to boost the nation’s mental health care, calling on practitioners and providers to recognize that it should be held to the same high standards we aspire to in this country with treatments for physical disorders. But let’s face it, whether due to lingering stigma or ignorance about the severity of need, the funding and resources for mental health care in this country still lags from where it needs to be in unacceptable fashion.
That may leave to us individually, and in collective efforts at the local level, to do all we can to battle suicide. That also may include speaking up for sensible gun regulation that does not abridge anyone’s constitutional rights, while also keeping weapons locked up or out of the hands of deeply troubled souls, especially in that one moment when their lives could be saved from the taking. We’ve got a lot of work to do all we can to help those in great despair, so they do not take their lives.