Statistics can be chilling: 34,000 people die by their own hands in the U.S. each year (that's a suicide every 15 minutes, nearly twice that of homicides) and more veterans of Iraq and Afghanistan take their lives than die in combat. But it is the emotional agony that precedes the deadly act for the person and the legacy of lifelong pain that follows it for the survivors that haunts the world of those who take their lives.
Few families are spared -- if not death then suicide attempts and the maelstrom they stir. As a doctor, a psychiatrist, who has treated many patients, I had one man who ran away from a hospital on the day I met him, decades ago, and drowned himself in a freezing river. As a clinical administrator of mental health services and medical director of a psychiatric hospital, I know of many people who have taken the ultimate step and ended their lives. But it was a close relative by a former marriage who hung herself many years ago whose memory to this day still sears my mind and stirs doubt about myself and what might have been done.
Ten years ago, a National Strategy for Suicide Prevention (NSSP) was built on the foundation created by Dr. David Satcher, the extraordinary U.S. Surgeon General who had issued a "Call to Action to Prevent Suicide." A common understanding of suicide was established by the NSSP, advocacy efforts begun, public awareness campaigns launched, local and state prevention plans written and commenced; all the best minds and influential people were involved. Shortly thereafter, the then President George W. Bush ordered the President's New Freedom Commission on Mental Health and its report candidly identified what needed to be done to improve a very broken mental health system in this country.
A very auspicious start. But when we take its measure today, a decade later, we cannot show any evidence that the suicide rate across this country has been reduced. We have not "bent the curve" on self inflicted death. Preventable deaths continue. We can and have to do better.
While no specific, single preventative intervention or technique has worked we have seen notable instances where an impact was made in reducing death by suicide. Two remarkable examples stand out. One is the "Perfect Depression Care Initiative" that began in 2001 in the Behavioral Health Services Division of the Henry Ford Health System, a large Health Maintenance Organization with 200,000 members operating in southern Michigan and adjacent states. Since 2008, they have achieved the perfection they sought: 10 calendar quarters have now passed where not one person has died from suicide. The second example was by the U.S. Air Force in the mid-90s to prevent suicide among Air Force personnel; this initiative was driven by top leadership in the wake of growing deaths and produced an 80 percent reduction, initially, and a 50 percent reduction over time.
In September 2010, recognizing that 10 years had passed with disappointing national results, Secretary Kathleen Sebelius, Health and Human Services, and Secretary Robert M. Gates, Department of Defense, accompanied by former U.S. Senator Gordon H. Smith (now CEO of the National Association of Broadcasters), the Secretary of the Army, John McHugh, other officials, and experts announced a public and private partnership called the National Action Alliance for Suicide Prevention. A second meeting of the Action Alliance met on February 9 to build on the efforts of various workgroups and change the static state of suicide prevention. Many ideas are now in play, so focus, feasibility and leadership will be needed.
What works, then, I ask? Some aspects that pertain to Henry Ford Health and the U.S. Air Force are revealing. What about starting with the setting rather than with any specific intervention to reduce suicide? In other words, first identify an established group to work with. This can be a health plan, a university, a government agency or institution, or a business organization. It can be an organization that has information on all its members, the capacity to reach them all, has clear and committed leadership and is well disposed to innovation. One that can specifically measure what will be done to change practices as well as report on the results while using a quality improvement framework to sustain and enhance any gains that are achieved.
Once the setting, or population is chosen, then is the time to identify specific clinical or social interventions (like depression screening, care paths for the suicidal person or for specific mental disorders, reducing access to weapons, engaging spouses and families, treating alcohol and drug abuse, education campaigns, etc) that would fit each unique setting (or population).
This approach inverts a customary approach to suicide which begins with an intervention and looks to where it can be implemented. Since no single intervention has been proven effective it may be time to turn the field on its head: begin by establishing what contexts offer opportunity for getting something done rather than starting with what can be done.
If we can reduce suicidal deaths by 25 percent in the next 10 years near to 90,000 lives will be saved -- that we know of -- not to mention reductions in serious suicide attempts and the catastrophe that suicidal behavior rains upon a person, family and community. If we can send a man to the moon, we can figure out how to save lives on earth.
.............
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Dr. Sederer receives no support from any pharmaceutical or device company.
Visit Dr. Sederer's website at www.askdrlloyd.com - for questions you want answered, reviews and stories.
David Petrie: Talking to a Teenager About Suicide
Jay Tavare: Life or Death: Teen Suicide on American Indian Reservations
Chaplain Mark R. Johnston: Military Suicides: An Epidemic We Must Stop
American Foundation for Suicide Prevention
CDC - Injury - Violence Prevention - Suicide Prevention - Home
the best are ASIST --Applied Suicide Intervention Skills Training -- and safeTALK.
See www.livingworks.net.
We treat the acute phase of a person who is contenplating suicide, even locking him up for 72 hours. Then he goes back to the same life, the same enviornment, the same stresses, the same financial and family situation he had that caused his problem in the first place and is expected to handle it.
More longterm care and followup is needed.
As Dr. Sederer touches upon, the devastation of suicide impacts people of all ages. Suicide is the third leading cause of death among 10-24 year olds. Nearly as many adolescents between the ages of 15 and 19 die by suicide than from cancer, heart disease, flu, diabetes and other diseases combined.
The above statistics are just part of what drive the mission of our center to bring routine screening for mental illness to all adolescents nationwide. Through routine screening, we aim to bring much needed help to those suffering from a mental disorder. And suicide is a major risk factor of untreated mental illness. Please visit our center's website at www.TeenScreen.org to learn more about our programs.
Laurie Flynn
Executive Director
TeenScreen National Center for Mental Health Checkups at Columbia University
They asked her if she was having SU thoughts. She told them every day of her life. They asked her if she wanted a eval. She turned it down. And her T called.
Unblievable as they did nothing, cause they said she said no and she had no plan.
No come on Like she would say.
It floors me. My parents are gone. She is my only living relative. Besides my children.
makes me wonder how many more they have sent home that needed help?
Having watched two friends struggle through clinical depression in recent years, I'm afraid that for some people no level of intervention is sure to work, even if it much improves people's odds. Just watching some of these changes, the sense of someone in the grip of an overwhelming force, is terrifying.
But certainly the risks can be reduced, yes.
If some suicidals are basically healthy elements of our society who just suffer a temporary crisis,then it goes without saying that they need all our empathy & efforts
&...tax dollars to save them.
But if they are adults & they belong to a "psycopathic underworld",as I call it,together with ..."homeless", chronic addicts,incurable psychos who are in & out of mental insitutions,
wasting our tax dollars,then we have to entertain the thought
of leaving them alone to commit suicide. Most of these cases usually repeat
their efforts & eventually die...
A combination of humanitarianism & natural selection is the best way...
Not all suicides are due to a mental illness. Many are what I would consider "justifiable suicide". Basing an article or a plan of action on total numbers alone is IMPO, not productive.
Our culture, for the most part, abhors suicide, in many cultures it's perfectly acceptable under the right conditions.
I personally would not consider loss of face or disgrace to be justifiable reasons (though I will concede........ that would depend on circumstances) However when one is faced with an intolerable position with no solution (terminal diseases such as cancer, that can cause a great deal of physical pain, with no cure available) I would have no moral qualms whatever about a persons decision to take their own life.
Government should not be put in the position of making life or death decisions for individuals without their input.
I would also note that any professional's opinion is not based solely on altruistic reasoning. How many I wonder would still be SO concerned if they had no financial incentive in the process?
Based on personal observation, the medical profession has been losing something in the last few decades.........Empathy. It like America itself, it is not what it once was, and seems to decline with each passing year. Profit has become more valued by many, than people.
My opinions only, You're entitled to your own.
Additionally, Empathy is one thing but where did we as a group decide that we knew better then the individuals on how they should handle their lives? If a person is ill or in pain, then shouldn't they decide how to handle the situation?
One can blame the professionals in the field but remember, you have the power to change providers if someone is not helping you. If you stay with someone not helping, you are not doing yourself any good. Another issue is funding. States are cutting back funding severely to mental health centers, which is lowering the number of visits allowed to those without private insurance. Private insurance has caps on what they will cover and if the "right" diagnosis isn't given, they may not pay at all. Next issue, a lack of education and the stigma of mental illness. My point is this, the answer to how to greatly reduce suicide is not simple. It is a complex answer that varies case to case. One thing for sure, no matter what happened to one in the past, it cannot be changed. A therapist/psychiatrist cannot undo what was done to anyone. Our job is to work with you to help you gain the insight needed to take back your power and create a life worth living. Obviously more complex but than the last sentence makes it sound, but definitely worth the journey.
I, a chronically depressed hyper genius, was imprisoned for two weeks with veritable psychopaths where I was assaulted regularly and treated horribly. There was no therapy, no help, no nothing. There was the attempt to force me to take drugs without having had any contact with a psychiatrist, the degrading clothing you're forced to wear, and the useless things that they force you to participate in or you stay locked up. In two weeks of being locked up, I had less than an hour of contact with any sort of therapist. The rest of the time was sitting around playing cards and board games and going to "therapeutic" classes with certifiably crazy people.
My biggest regret during those two weeks was that I had failed because there is nothing worse than being in a psychhospital.
Doctors, psychiatrist can gather and debate till the end of time, but until they can “give back” to their patients what has been lost or taken (impossible task) there will be just as many, even more as our populations grow, suicides.
The present problem is our society and every society around the globe, in what we do to one another. The long term answer is in teaching children “life”, their’s and all other’s, are more valuable than any and all other treasures on the face of this earth.