For more than a half century suicide hotlines have been cornerstones in our efforts to prevent the tragedy of suicide, and they have saved countless lives. These services are staffed by trained responders who attempt to convince distraught callers from harming themselves, and ideally connecting them with help. But such worthy and necessary hedges against suicide must not be our only response. Closing the gap between the first onset of emerging mental health problems and professional treatment needs to be part of a more comprehensive public health approach to suicide. This will require all of us to be more literate about mental health and wellness.
Consider what we know today about cancer detection and treatment. We would never dream of predicating a public health response solely on a capacity to treat stage III or IV metastatic cancer once detected. We know so much more today about early detection and screening and we can begin treatment before a health crisis has developed. The need to speak in hushed voices about the "c" word has been replaced with awareness campaigns that result in open and bold talk about Cancer. In the same way, we need to begin closing the gap between emerging mental health problems before they metastasize into burdens so heavy that suicide seems like the only option for relief. Suicide prevention can begin well before a crisis is at hand by being alert to early signs and symptoms of possible mental health problems.
From a landmark literature review based on the WHO World Mental Health (WMH) surveys we know that the first onset of most mental disorders usually occurs in childhood or adolescence; earlier for anxiety and depression disorders and a bit later for psychosis. We also know there is a median delay of 10 years after the first symptoms of an emerging mental illness until the first contact with a general medical doctor, and 11 years until the first contact with a psychiatrist. This is the gap that needs to be closed as part of a comprehensive approach to suicide prevention.
The public health approach for closing this gap can be advanced through a purposeful mental health literacy campaign that includes educating young and old alike, families and whole communities. Health curriculums in schools should be teaching about mental health. Evidence based Mental Health First Aid should be as ubiquitous in our society as Red Cross First Aid and CPR. The Mental Health Association in New York State (MHANYS), for example, has been promoting legislation to include mental health as part of the health curriculum taught in middle schools and high schools. There is also a growing movement to fund Mental Health First Aid training in a number of states as well as being a proposed component of comprehensive mental health bills awaiting action in Congress.
There was a time in our not-too-distant past that the average person knew of no linkage between basic hygiene such as hand washing and infection control. Cleaning cuts prevents infected wounds. These facts have become so common sense that we take them for granted. Recognizing and responding to mental health problems can become common sense, too, but we need to start the dialogue. Yes fear and stigma stand in the way of our being more proactive in addressing the mental illnesses that will strike one in four of us at some time in our lives. But fear and stigma wither in the light of open teaching and discussion.
Suicide rarely springs suddenly from a mentally healthy life. More often than not there is a veiled history and experience of undetected or dismissed mental illness or mental health problem. This is not the fault of anyone in particular but rather the absence of public health policies aimed at encouraging and advancing the conversation in schools, workplaces and the community at large. Not until we are collectively more literate about mental health and wellness will we begin to close the gap between illness and proper treatment. This can be our greatest hedge against the tragedy of suicide.
For more information about mental health and suicide prevention policy in New York State visit MHANYS.org.
John Richter, MPA is the Director of Public Policy at the Mental Health Association in New York State (MHANYS). He is a certified trainer of Mental Health First Aid and SafeTALK suicide prevention training and has been instrumental in advancing legislation allowing mental health instruction to be included in school health curriculums. You can contact him at 518-434-0439 and email@example.com.
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Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.