Suicidality and How to Respond Effectively
Those who know me personally know that my life has been tragically shaken by suicide. In fact, I probably wouldn't be a mental health clinician if that weren't the case. You see, what better work to dedicate your life to than an issue that has rocked every ounce of who you thought you were over, and over, and over again?
The United Health Foundation reports that suicide has jumped in prevalence 25.4% from 1999 to 2016. The North Carolina Department of Health and Human Services reports that suicide is the second leading cause of death for ages 15 to 34 and is the third leading cause of death for ages 10 to 14.
In 2017 there were an estimated 1.4 million suicide attempts and over 47,000 completions of suicide, with half of these involving firearms. The CDC states that this is the equivalent of one death by suicide every 11 minutes. This means that for 2017 there were twice as many deaths by suicide than by homicide.
Those numbers are staggering, folks. Ten to fourteen-year olds? This isn't just an adult problem or an adolescent problem; this is a child problem too. Let me also reiterate, nearly one and a half MILLION suicide attempts in one year in our country. And that's why suicide is an issue we should ALL care about. Truth is, we all know someone that suicide has directly impacted. We are all responsible for being the solution.
According to the United Health Foundation, the highest risk factors for suicide are mental health disorders and/or substance use disorders. Other risk factors are stressful life events, access to lethal weapons, previous suicide attempts, and a family history of suicidality. Also of interest, men are significantly more at risk of completion than women, though women are more likely to attempt.
American Indian males and females have the highest suicide rates in the U.S., followed by non-Hispanic males and females. For older populations: males 65 and older and males 45-54 are at the highest risk and for females highest risk is in the 45-54 range, followed by ages 55-64.
Suicide rates are consistently higher for veterans and anyone in the LGBTQA community. Geographically, the risk for suicide is higher in rural areas.
Other risk factors to note include: physical health conditions, prolonged life stress (bullying, harassment, unemployment, domestic violence, etc.), history of abuse or neglect, and other trauma experiences across the lifespan.
What To Look Out For:
It's important to note that most people will not meet all of these criteria and what suicidality looks like for each person can be vastly different. This list does, however, provide some good indicators that suicidality is a possibility.
Long lasting depression or hopelessness
Frequent anger or hostility, mood shifts
A shift from depression and hopelessness to sudden peace (indicating that the person might have chosen to end their life)
Significant life changes (loss of a job/finances, ending of a relationship, loss of a home, trauma experiences, legal trouble, etc.)
Increase in drug or alcohol use
Giving away possessions or pets
Making updates to their will
Lack of focus on future, might make comments about not worrying about them "much longer", not needing or scheduling future medical appointments
Comments about being a "burden" to others, wanting to die, having no reason to live, or being trapped
Becoming more inward and distant from others, or also having special conversations with loved ones (saying goodbye, making apologies, etc.)
Dwelling on death and dying, research on ways to die
Reckless actions such as driving drunk, having risky sex, driving fast
General behavior changes such as sleeping a lot more or a lot less, changes in eating patterns, changes in personal grooming or cleanliness of self or personal space
Unwillingness to seek help for mental health issues due to stigma
Barriers to effective mental health treatment
Suicide Prevention: What Works and What Doesn't
Since my life was personally impacted by suicide in 2008, I've had almost 12 years to take notice of how suicide is handled and talked about in my small community in rural North Carolina. What I've noticed is this: when a suicide happens in our area, everyone is shocked, upset, and enraged for a period of time. After all, everybody knows pretty much everybody else and anything like this happening is big news. Everyone is wondering, How could this happen? What was going on for him/her? Naturally with small towns the rumor train is rampant. Suddenly, lots of people are posting about suicide prevention all over Facebook for a few days. But then, just as quickly as the fascination comes, it passes with little other impact until the next suicide happens. I believe this dynamic occurs for several reasons. 1) Suicide is uncomfortable to talk about or think about for any period of time. 2) Out of sight out of mind. 3) People don't know what to say about suicide, even if they want to.
Our small town, for brief time periods, operated a suicide prevention and awareness task force. There were monthly meetings held with many of the same people each time in attendance and efforts were made to start and continue events such as an annual Walk Out of Darkness. Like many volunteer run groups, the task force fizzled out due to lack of man power and interest. Again, uncomfortable to deal with regularly and out of sight, out of mind. Unfortunately, this also means that we aren't looking for people who may be at risk and therefore we likely experience people everyday who are struggling with suicidality that are being silenced.
This is not what effective suicide prevention looks like. While the periodic and timely Facebook posts and care and concern for one another is valuable, we have to keep the momentum going. We have to keep talking about suicide, and yes that means actually saying the word out loud. We have to take notice of what is happening around us, with people we know closely and also with people we don't. We have to educate ourselves on the risk factors, on what suicidality might look like, and we have to ask the hard questions of those we are concerned about. We have to tackle the stigma of mental health head on.
According to the United Health Foundation, what works to minimize suicide in a community is this:
Universal screenings at Emergency Rooms to identify patients at high risk and safety planning with those high risk people including identifying and aligning with family/friend based supports
Cognitive behavioral therapy to identify suicidal thoughts, images, and beliefs before they lead to a suicide attempt
Collaborative care with primary care doctor, therapist, and other health professionals
Reduction of access to lethal methods of suicide including firearms, lethal doses of medications, and alcohol.
The CDC adds the following:
Strengthening of economic supports including increasing housing stability and financial stability
Strengthening access to mental health care including coverage of mental health conditions on medical insurance and reducing provider shortages in under-served populations
Community connectiveness programs
Teaching coping and problem solving skills at the community level
Effective communication about suicide after it's occurrence
How to Talk to Someone at Risk
The American Foundation for Suicide Prevention outlines several steps you can take if you are concerned that someone might be considering suicide. First, have an honest conversation. It's best to assume that you are the only person who is reaching out. Too often we think it's "someone else's" responsibility to reach out when there's a problem. This has to be everyone's responsibility. Here are some helpful tips:
Talk to them in private
Listen to their story
Tell them you care and validate that what they are going through matters
Ask directly if they are considering suicide - if they are, do they have a plan?
Encourage them to seek professional help regularly from a therapist
AVOID minimizing problems, giving advice, or debating the meaning of life
If they are in immediate danger of harming themselves, STAY WITH THEM. Help them remove lethal means for their own protection. Take them to the Emergency Room or contact a mobile crisis unit near you. In the local Northwestern NC area: Daymark Mobile Crisis can be reached at 866-275-9552 for immediate assistance.
Help create a safety network of family, friends, coworkers, neighbors, etc. who are aware of the situation, capable, and willing to help
National Suicide Prevention Hotline: 1-800-273-8255
Crisis Text Line: Text "talk" to 741741 (free, open 24/7)
American Foundation for Suicide Prevention: https://afsp.org/
It is my sincere wish that suicide become a problem of the past so that no other family has to endure what mine has gone through. Suicide is an extremely difficult topic to talk about, I get it, but something has got to change in the way we view mental health and mental illness in our country, our state, and even this little rural community we live in.
Instead of viewing mental illness like the plague, we need to embrace that these challenges are as prominent as many physical health conditions that we go to the doctor for everyday. Seeing a therapist needs to be as normal and socially acceptable as going to your doctor to monitor blood pressure, migraines, or diabetes. When we allow the stigma of mental health to perpetuate, we minimize and silence every single person who suffers with depression, anxiety, PTSD, suicidality, etc.
One thing I've learned from my training and research on the topic of suicide is that people who complete suicide don't want to die, they just want the pain to end. What would happen if we shifted to a community of checking on one another, validating the struggles and pains others experience, and normalize seeing a therapist? I challenge each of you to take a proactive approach in bashing the stigma of mental health by talking about it, saying the words out loud, checking on people around you, and sharing how effective mental health treatment has made a difference in your life.