Is Suicide Preventable?
A cherished young friend and colleague took his life almost two weeks ago, the same week the world lost Kate Spade and Anthony Bourdain. About 120 lives are lost to suicide in the United States every day, sometimes involving brilliant accomplished people like these who had abundant empathy for others but couldn't find a way forward for themselves.
My dear friend's family and friends and I tried our best to console ourselves that there was nothing more we could have done. I suspect most of us, like others who have lost loved ones to suicide, wondered silently if this was accurate. Surely there were countless things we could have done or done differently. We just don't know which one of those things might have made a difference. The question lingers unanswered for me, a practicing psychiatrist, as it does for everyone else.
We know a great deal about risk factors for suicide such as mental health conditions; prior suicide attempts; a history of childhood trauma or combat trauma; being an older white male; relationship problems; legal problems; impending life crises such as eviction; and having access to lethal means such as firearms. However, we still know very little about prediction of suicide at the level of the individual precious life. In the search for clues, researchers continue to scour expansive electronic medical record databases, physiological recordings, blood markers, brain scans and tests of unconscious or implicit bias toward living or dying. It is a still a young science in urgent need of maturing.
[See: Am I Just Sad -- or Actually Depressed?]
To call suicide an epidemic may be an overstatement, but rates of suicide have continued to rise in alarming ways. A report released earlier this month by the Centers for Disease Control and Prevention showed that suicide rates in the U.S. rose by over 25 percent since 1999. Here and abroad, more people lose their lives to suicide than to homicide or war. In this country, suicide is one of the 10 leading causes of death. On that top 10 list, suicide is only one of three conditions whose rates continue to rise while deaths from other scourges, including cancer, heart disease, diabetes and kidney disease, have fortunately declined. While we wait for scientists and clinicians to develop more accurate ways to identify and help individuals at imminent risk of suicide, there's still a lot we can do.
Enhance access to quality mental health services. In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act to ensure that insurance coverage for mental illness and addiction is comparable to coverage for other health conditions such as hypertension or asthma. Despite the crucial legislation, go try to find a mental health clinician who is in your insurance network, who has availability in their schedule, is affiliated with the center where you receive other care and who has expertise relevant to your problem. It's typically an overwhelming task even for those in good health; it's a potential disaster for those in crisis. We need to go beyond parity of coverage for mental health care to parity of access. Individuals, elected officials and advocacy groups need to press insurance companies to build truly adequate networks of available, quality providers as well as to encourage health systems to support outpatient, inpatient and urgent care services commensurate with the high need for such services. We must also do everything possible to inspire high school, college, graduate and professional students with the mission of devoting their careers to treatment and research related to mental illness and addiction in order to ensure a pipeline of talented and compassionate future leaders in the field of mental health.
Promote resilience in schools and workplaces. An increasing range of psychotherapies, from dialectical behavior therapy to mindfulness-based cognitive therapy, offer a rich range of strategies to boost the ability to cope, problem solve and bounce back from adversity. The essential principles and skills at the heart of these approaches are increasingly adaptable to educational and work settings. Although few individuals have access to expert therapists, many individuals -- probably most of us -- can benefit simply from these basic practical skills and insights that contribute to well-being in a stressful world.
[Read: How Parents Can Identify Mental Health Problems in Their College Kids.]
Value connection. While isolation is often a consequence of mental illness or addiction, even in the absence of mental health problems, individuals in the 21st century can lead strikingly solitary lives. When feeling depleted, many of us choose "me time" when "we time" might replenish us more. When concerned about a friend or neighbor, our respect for privacy often overrides our inclination to help. While self-sufficiency has its place, a sturdy sense of community should be considered one of the essential pillars for mental health. We need to check in with one another on a regular basis and reach out to those who are struggling. Social engagement provides the necessary emotional, practical and sometimes spiritual support to get through hard times while introducing diverse perspectives that help broaden the tunnel vision that can accompany despair.
Support research. Death rates from cancer, heart disease and many infectious diseases such as HIV continue to fall, thanks in no small part to advances in biomedical science combined with growing understanding of the social determinants of health. Suicide remains a stubborn public health challenge we still need to get a better handle on. Research on suicide, and on related problems such as mood disorders, problem substance use and trauma, is a crucial part of this battle and needs philanthropic and federal support fully commensurate with the scope and urgency of the problem.
For today. Suicide is not yet fully preventable, but it's far from inevitable. We need to learn more -- but we already know enough to begin to wipe suicide off the list of the top 10 leading causes of death. For starters, we can all reach out today to someone we're concerned about. Chances are he or she is not suicidal but will benefit from our caring.
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
Hotlines and other 24/7 resources are a potentially life-saving support for people considering suicide and those concerned about them. Here are some options:
-- National Suicide Prevention Lifeline: 1-800-273-8255
-- Chat: suicidepreventionlifeline.org
-- Text TALK to 741741 to text with a trained crisis counselor Español
Specialized crisis lines:
-- Español: 1-888-628-9454
-- Veterans: 1-800-273-8255
-- LGBTQ Youth (Trevor Project): 1-866-488-7386
Organizations and online resources exist for individuals and families concerned about suicidality, as well as those who have lost loved ones to suicide:
-- American Foundation for Suicide Prevention
-- Suicide Awareness Voices of Education
-- #BeThe1To
Jonathan Alpert, M.D., Ph.D, professor of psychiatry, neuroscience and pediatrics, and university chair of the Department of Psychiatry and Behavioral Sciences at Montefiore Health System and Albert Einstein College of Medicine, shares what we can do in the face of climbing suicide rates.
