Another Study Ties Higher Minimum Wage with Reduced Suicides

I’ve written about it before: Economics and suicide are tied. To be clear, that’s not to say that poor people are more likely to die by suicide; by and large, suicide crosses economic boundaries. What is more likely to be associated with increases or decreases in suicide rates is a change in economic status: An increase leads to lowered suicide rates, while a decrease leads to higher rates.

And that brings us to this study, published in the Journal of Epidemiology & Community Health. The study examined 25 years of economic and suicide rates in all fifty states and Washington, D.C. From the results of the study:

The effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels.

In other words, an increase in the minimum wage can save lives.

This study was picked up in numerous major media outlets, including CNN and NPR. As the CNN story noted, if you assume that the data from this story is accurate, an increase of $2 could have saved upwards of 40,000 lives between 2009-2015.

This study shows many things, but there are two, in particular, I want to focus on.

First: It challenges the idea that suicide is exclusively related to mental health, or at least adds a qualifier and a modifier to that idea. I think that when most people think of suicide, they think that a person who dies by suicide must be mentally ill. That makes sense, of course, and it’s a perfectly logical conclusion to reach. However, it’s not completely supported by the evidence. If depression was the only thing that mattered when it came to a suicide attempt, the minimum wage wouldn’t make a difference unless you assume that economic status is tied directly to mental health.

What this shows, again, is that suicide is not simply a matter of mental illness.

And that leads me to my second point: Everything is connected. Mental health is deeply connected to economics, and if we can ensure a robust social safety net, fair wages and equal opportunity, we can reduce suicides and save lives. This study proves it – again – and it isn’t even the first to make the argument that work and work hours are tied to minimum wage.

As public policymakers, we have a job to address major problems (like the massive spike in suicides) in a manner that is holistic and comprehensive. That means not only improving access to mental health care but reducing the causes of suicide.

That means increasing the minimum wage.

Why Words Matter – Even If It’s Not You

 

As some of you may have seen in the news or on my Facebook page, we had quite the day this past Friday. Governor Wolf was in town, holding the first of what will be many mental health roundtables. He announced the kick-off of Reach Out PA: Your Mental Health Matters on Thursday. It’s an overall, comprehensive effort to reform and improve Pennsylvania’s mental health system. It’s fantastic and desperately needed.

At the Governor’s Press Conference on Thursday, the Governor said:

“For those struggling with their mental health, we have one message: your mental health matters and it’s okay to reach out for help. We are stepping up our efforts to ensure every Pennsylvanian can access mental health care and more agencies can respond to the challenges facing Pennsylvanians struggling with their mental health. The act of reaching out for help – or to help – can make a huge difference for someone struggling.”

I opened the roundtable with this:

Obviously, I’ve discussed my depression and anxiety before. I haven’t quite gotten that intimate with how close I came to a suicide attempt, so that was a bit new.

I actually wasn’t even planning on doing that until a few hours before the event, when it hit me: I was going back to the place where I had seriously considered ending my life, standing with the Governor, my Congresswoman, friends, colleagues, and advocates, with the goal of saving lives.

(Random side note: I actually tagged my ex-girlfriend on Facebook for saving my life. We’re certainly on good terms, but I can’t imagine how weird that must have been – she looks at her phone and goes, “Wait, who tagged me? Why did that happen?)

I have to say – on a personal level – how much it meant to share that story. At the table with me was the Governor, my Congresswoman (Susan Wild, who has become a dear, dear friend) and Dr. Rachel Levine (PA Secretary of Health). Dr. Levine is brilliant and one of my favorite cabinet members with the Governor. She’s also a pioneer, serving as one of the highest-ranking transgender government officials in the United States. I cannot imagine how many kids and adults look at her and draw hope from her success and competence.

Congresswoman Wild is an advocate for mental health in and of her own right after she lost her life partner, Kerry Acker, to suicide. And Tom Wolf is truly one of the most recent people I’ve ever met in this job.

To be able to share that story – with those fine people, and everyone else in the room – that was meaningful. It gave meaning to what I had endured.

So, away from myself now. What the Governor has said about mental health, what others in his cabinet have said…it matters deeply. It matters because the Governor is lending his personal credibility and institutional strength to a push for better mental health access.

Public policy, public statements, and stigma are all interwoven. By doing events like this, there are people out there who are recognizing what the Governor is doing. At least some people will be touched by his words, by all of our words. And hopefully, they will be more likely to get the help they need and deserve.

Look, this system needs investment. Massive investment. We need more workers, more funding and less stigma. That all ties together. I hope and pray this was the start of a more comprehensive effort.

But I know that hearing someone as important, well known and well-liked as the Governor say that it is okay to ask for help – that matters. And it should matter if you say it, too.

“People who conquered depression and/or anxiety, what’s the #1 factor that helps you?”

As some of my prior entries have indicated, I’m a big fan of Reddit. If you use it the right way it can be hilarious, inspirational and adorable.

One of the more popular subreddits – and certainly one of my favorites – is AskReddit. In AskReddit, users can post a question to the Reddit community. Some of the questions are serious: “Why can’t you sleep tonight?” Some are hilarious: “You’re being interrogated and so far you’ve held strong. What song do they play on repeat that breaks you?”

And then there’s moments like these:

This was truly interesting. The top responses are largely along the lines of answers you might expect: Sleeping well at night, keep busy, stay away from social media (irony, right?), stop overthinking, etc.

I answered this question (surprise!), but I took my answer in a different direction. Here’s what I said:

I’m gonna spin this one on its head a bit. I think it’s important to address this answer to those of us who haven’t conquered depression or anxiety, and who never will.

Depression for some is a temporary condition as a result of a variety of factors, including social or cultural experiences, genetics, your upbringing or traumatic events. For people like this, time, therapy and/or medication – as well as lifestyle changes – can result in permanently defeating depression, and never seeing it again.

For other individuals – and people like me – it’s a permanent, chronic condition. Personally, I’m lucky – my ups are relatively long and my downs are manageable. For now. But, for people who will never truly rid themselves of depression or anxiety – who will experience it all their lives – it’s important to realize that this may be your world. Some people are cursed with physical disabilities which dramatically alter their lives and the way they experience it. For others, like us, it’s a mental disability.

What’s the #1 factor that helped me? I honestly think that one of them is this knowledge. The idea that I will never, truly be rid of depression. Why has this helped? It takes the pressure off. It makes me realize that I can lead a good life, even if this is always who I’ll be. That the “black dog” – as Churchill called it – will be a constant companion and challenge.

Second: To an extent, I have power over it. No, I don’t think I’ll ever be rid of depression. I don’t think I’ll ever be rid of the sinking feeling in my chest, the tension at the base of my neck, the imposture syndrome, the constant fear of losing everything and everyone I love. But I do have control. If I seize it, there are things I can do. That means self-care – therapy, medication, writing, working out being a type-A personality, etc. I accept that it has ruined other parts of my life, but strove to make me better in a variety of others.

Third: Accepting the positives of depression. It has made me constantly force myself to do something to improve myself, my life or those around me. It has made me tougher. It has given me a perspective and sense of empathy which I could never have imagined. And it has dramatically and positively impacted my career (I’m a State Representative in Pennsylvania, where I work largely on mental health issues – I also write and blog on the topic).

Yeah, leave it to a politician to not answer the question and answer it at the same time………..

My answer was long enough and pretty self-explanatory, but it’s worth noting again: Some people don’t “conquer” depression. They just learn to live with it, how to manage its ups and downs. I think that’s me. Once I accepted that – once I stopped kicking myself for feeling the way I did – it let go a lot of stress.

That being said, I don’t want to make it seem like my answer to the question was somehow crapping on the other ones. Less time on the internet, sleeping right, etc. – those are REALLY GOOD WAYS of beating depression. I just think that, for some of us, the idea of “conquering” depression is a bridge too far, sadly.

But that doesn’t mean it gets to run our life!

 

Will new three-digit Suicide Prevention Hotline lead to a surge in calls?

As you may have seen last week, the FCC voted to formally approve the regulatory process which would take the Suicide Prevention Hotline number (currently 1-800-273-8255) and turn it into a three-digit number, 9-8-8. It will take at least a year for the new line to go live.

For many reasons, this is a big deal in the suicide prevention world, and a wonderful development which will save lives. I can think of two reasons why this is so important off the top of my head. First is obvious: It’s an easy number to remember, like 911. Most people haven’t remembered the suicide prevention hotline number (I always have to Google it when I do blog entries like this, and I’m very in tune with the mental health world), and that’s an extra step. When someone is in crisis, you want to make it as easy as possible to get help. For the same reasons, means reductions matters when it comes to preventing suicide.

Second is the cultural statement: Suicide prevention matters. We all know 911 and understand the importance behind needing to call for help as soon as possible. With suicide numbers continuing to rise unabated, having a three digit number is a statement of priorities. It’s our way of saying, “Yes, this is important – really important. So important that we’re going to elevate the ease of getting help.”

But, that’s not to say that issues may not emerge as a result of this very significant and important change. As noted by this article from Pew Trusts, the new number will likely lead to a surge in calls. That’s good if it helps more people get help, but it can only help people get more help if the hotlines are prepared.

As noted by the article, there is not one massive hotline, per se, but a series of local hotlines, and many of them are “woefully underfunded.” Waiting periods and being bounced to a less local line are already occurrences which occur, and this surge in calls may make things worse. Furthermore, some states are in better shape then others. Six states (Georgia, Arizona, Colorado, New Mexico, New York and Utah) have made substantial investments and improvements in their suicide prevention hotlines, centralizing and standardizing systems while also expanding them. These states will be better prepared for the change over, but others may not.

What’s the solution here? The shift to 988 is great – but only if these lines are adequately funded. State and national governments have to expand funding, and they have to do it now. Pennsylvania and the rest of the nation have been utterly devastated by the opioid crisis which has taken more than 70,000 from us in 2017. As a result, we invested tens of millions of dollars in prevention and treatment. Suicide took 47,000 from us in the same time period, and hasn’t seen anywhere near the same levels of investment.

We need to invest the money here, too.

It’s not your fault: The brain circuits behind rumination, depression & anxiety

A fascinating examination of the brains of people who suffer from anxiety and depression has revealed some really interesting insight about how your brain works, and why its so hard to stop thinking once you get in a negative state.

According to a report on the study from Forbes, an examination of 9,000 brain imaging scans has showed that people who suffer from depression or anxiety show low levels of activity in areas of the brain responsible for “cognitive control,” while showing increased activity the parts of the brain which “process emotional thoughts and feelings.”

In other words: People who suffer from depression/anxiety have a harder time controlling their thoughts and keeping their mind from running away from them.

I mean, realistically speaking, this should surprise absolutely no one. If you suffer from depression or anxiety, you know that it is nearly impossible to control your thoughts or your feelings. But, for those of us who suffer, I would hope you can take a degree of comfort in this study, as it physically explains why your brain simply will not shut off on days where you are in pain: It can’t.

It’s okay. It’s not your fault. It never was. But this is just so interesting to me because it shows the biological mechanisms behind depression and anxiety. And it unquestionably lends credence to the notion that we have to treat depression, anxiety and other mental illness as a physical disease, rather than some separate emotional one.

As I’ve written in the past, there is a strong connection between rumination, depression and anxiety, and this study may help explain why: They are all physically connected.

Of course, this begs the question: What can we do about it? When our brains get “locked in” to this state, how can we alter it?

I mean, there’s the usual stuff: Therapy, medication, meditation, exercise, etc. We know that this stuff works to an extent.

I’m not even sure where to go from here, but I do think this study is absolutely fascinating. It provides a biological explanation that we already knew was out there. It explains why its so hard to stop our brains. I am walking, talking rumination, and I would LOOOOOVE to see what my head looks like when I get into a funk.

Let me wrap this entry up by adding to what I said before. If anything, I would hope that this study provides some perspective and can help get rid of some of the guilt and self-loathing that you may experience when you get into a depressed state. Depression and anxiety are not your fault. They never are and they never will be. And this entry helps to prove it. Your brain is, quite literally, working against you and making it hard for you to break out.

A More Preventative Mental Health Model

I caught this article in USA Today and it introduced a fascinating concept – one I hadn’t heard of.

Many of you are likely familiar with the National Suicide Prevention Hotline, which has been used to stave off countless crises and has likely saved thousands of lives. Of course, calling this number is what you do at your worst moment – when you are at the bottom of the barrel and feel as if you might hurt yourself because you have nowhere else to turn.

What if there was a way to reach a person before it hit that crisis point?

Introducing the “warm line” from the Mental Health Association of San Francisco. From the article:

Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis – and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.

In other words – someone can call, get support, talk to someone, and get access to more resources, thus potentially preventing a more expensive and serious crisis.

This is a great idea, and according to article, a wildly popular one. But, does it work? Will it cut down on arrests, suicides or other mental illnesses? According to one analysis, yes.

Here’s the real reason this appeals to me: It’s a paradigm shift. It’s so much more than just a band-aid or a cure for someone in a crisis. Don’t misunderstand – that’s incredibly helpful, and necessary. But what if we can stop someone from getting sick in the first place?

If you stop a physical illness before it gets infected, you save money, time, pain and lives. Hopefully, programs like this can help push in more into that sort of space when it comes to how we discuss, treat and cure mental illness. It’s why we should try to teach mental health in schools. It’s why physicians should conduct mental health screenings on routine exams. It’s why mental health first aid should be taught alongside physical health first aid.

We can stop these problems before they start.

How To Give Thanks When You Aren’t Sure How

My understanding of Thanksgiving has always been to try and take a step backwards and find the things for which I am grateful: Family, friends, food and safety. It’s a moment where you are supposed to be filled with gratitude.

Of course, if depression is clouding up your life, that can be a difficult experience – to put it mildly.

One of the worst things about depression is that it not only makes you feel sad, but it staves your sense of joy. When you are depressed, you cannot enjoy things. You cannot find the things to be grateful for – your mind is just clouded with sadness and pain. That, of course, is awful on every level.

According to an article from Psychology Today, gratitude can make you feel better:

Scientists say that these techniques shift our thinking from negative outcomes to positive ones, elicit a surge of feel good hormones like dopamine, serotonin and oxytocin, and build enduring personal connections.

Another article, this one from Harvard, notes that there is actual science behind this concept, and that multiple experiments have shown that individuals who actually took the time to decide, discuss or write down things that they were grateful for actually felt better and more optimistic about their lives after doing so.

All of this being said – I’ve been there. I get it. When you are in a hole so deep that you cannot see any light, writing down things for which you are grateful can be a challenge…to put it mildly.

If that’s where you are right now, it’s okay. Don’t feel bad, don’t feel guilty and don’t beat yourself up. That’s a pain which millions of others can share with you.

Instead, my advice to you is this: Try to take a step backwards.

If you are reading this, you’re in better shape than large swaths of humanity. You’re able to read and access the internet. Hopefully, you’re at home now, safe and secure, able to access the basic necessities of life. I hope you are warm and comfortable. You’re able to eat and drink whenever you want. I mean, according to the World Health Organization, 785 million people don’t even have access to basic drinking water service. If you are reading this, that almost certainly isn’t you.

Folks, one of the hardest things to remember – particularly if you are one of the 1 in 5 Americans who has a mental illness – is just how lucky you truly are. Start at the basics, and I mean the basics. The food in your stomach. The clothing on your back. And try to remember that there are billions who aren’t as lucky as all of us are.

Whatever our struggles, whatever your pain, I guarantee you are more fortunate than hundreds of millions. Start from there. Use that as the building block and move upwards. Concentrate on the gratitude and joy you’ve gotten from the smallest moments: The quick laugh with a coworker who likes you. The likes on your Facebook status. You can find joy in even the smallest of moments, and sometimes, that’s enough.

To be clear: I’m not an idiot and I’m not pollyanic. A Facebook like or a shared smile with a stranger will not cure your depression. It will not make you whole. But it may take away your pain, if only for a moment. It may help you regain a sense of control over your own mind, something that is absolutely critical when we are battling our own demons. To that end, try to balance your pain-filled moments with the good ones. Write down what you are grateful for. You may be surprised with how it makes you feel.

Happy Thanksgiving, everyone. I hope you are able to celebrate and enjoy it!

 

Do you have a puppy folder?

I had a couple of rougher moments over the past weekend. No real reason, just work and stress – the standard stuff, really. I will admit that I was surprised by how intense it was, but these things happen.

Anyway, I was talking with my wife and trying to snap myself out of it, and with a laugh, I pulled up this video.

The background: I was speaking at an event announcing the moving of the Da Vinci Science Center into downtown Allentown (a big deal, locally!). I was surrounded by elected officials, major developers, local residents, the works. And the microphone just went, “Nahh, f&ck you, I ain’t working.” So we have massive feedback, followed by the microphone just straight up falling as I tried to speak. I know it sound stressful, but honestly, it was hilarious for me, and if you watched the clip, you can see I handled it just by laughing at myself. It wound up being really funny (side note: When faced with an embarrassing situation, just lean into it).

Anyway, whenever I watch this clip, I always get a chuckle. And that’s sort of the point of this entry.

On Monday, I spoke about the need to develop specific tactics which can help you fight back against your anxiety. Things that would temporarily distract you from where your head was swirling off to in order to break the cycle of anxiety and get you out of an attack.

This entry is more or less the companion entry for depression. My suggestion: Have a puppy folder. Have a folder (digital or physical) which you watch that features adorable videos which always cheer you up or make you laugh. It can be movie bloopers, cute pictures of puppies, whatever.

By the way, I do mean, literally, have an actual folder. As you probably know, when you go down the rabbit hole of depression, it can be extremely difficult to pull yourself back out, or to do anything which has even the slightest bit of self-care involved. That’s why I say you should have an actual folder, a one-stop shopping sort of place: When it comes to self-care in your darkest moments, you need to make it as easy as possible for yourself.

To be clear, this isn’t a long-term strategy. It’s a tactic, and there’s a difference. If you find yourself having these dark moments more frequently, if they turn to thoughts of self-harm, or if you start to lose productivity and the ability to function, you need to do more than just watch funny videos: You probably need to see a therapist.

That being said, everyone has down moments. The tactic of a puppy folder can help you break the cycle. It can feel good and give you a moment of joy, and that moment can turn into the foundation for getting yourself out of a rougher moment.

Any videos, pictures or websites which you use on a regular basis to get yourself out of that darkness? Let us know in the comments below!

 

4 Tactics to Stop A Panic Attack In Its Tracks

Ah, panic attacks.

Last week, I wrote about the difference between panic attacks and anxiety attacks. They are both nightmares, of course, but I’d argue that panic attacks are the more intense, nightmarish ones. I consider myself deeply lucky that I haven’t had either in years, but I still remember the pain: The feeling that my bowels were going to turn to liquid, the heart racing, the desperate desire to escape and sensation that you are going to crawl out of your own skin at any moment.

Defeating panic attacks takes quite a bit – often some combination of therapy, medication or tranquilizers. It takes planning, effort, and strategy. However, there are also tactics which I think you can use in order to defeat or slow a panic attack. Yes, I mean tactics: Specific things which you can do in order to feel more powerful and regain control over your own body and mind.

Here are 4 of them:

Pick a Number. Add By 7. Repeat.

My anxiety was out of control in college, particularly senior year. That time period ultimately resulted in a medication adjustment, increased therapy and the development of a series of tactics with my therapist to stop an panic attack. And this one worked, a lot.

When you have a panic attack, your mind just whirls out of control. The key – as exemplified by this effort and others – is to stop it from doing so. To that end, you have to distract yourself.

So, ask yourself? What’s 1,054 + 7? And then another 7? And then another? Get bored? Subtract by 8 now. Just keep going. Take all of that mental energy you are feeling and put it elsewhere. Do whatever you can to break the chain of anxiety which has wrapped its way around your neck.

Notice Stuff

I actually got this one from a LifeHacker article, and it apparently came from BoJack Horesman. Specifically, two characters are talking, and one starts having a panic attack. The other asks him to notice the things which are giving her anxiety, and then start noticing and describing the more mundane things. Chairs. Tables. Lamps.

I think this one works similar to my example above, but with a different basic idea: You try to distract yourself by immersing yourself in another activity. This, of course, can be impossible to do when your mind feels broken, but it is absolutely worth the effort. With this tactic, you try to lose yourself in something else. You find a detailed object and go DEEP. What color is it? What do you think it feels like? When was it made and who do you think made it?

Allow your mind to run away from itself.

Guided Visualization

Guided Visualization is just what it sounds like – you use it to escape your own mind. Either through an audio or visual file, you follow the narrator on a journey. It often involves breathing deeply and relaxing.

Thanks to YouTube, there are no shortage of examples. Even better is that many of them are highly specific to panic attacks.

I’ll say this: These were hard for me when I had bad ones. When they were on their way out or just starting, my wife could often give me a visualization scenario that worked, but as the panic heated up, it became even harder to focus on visualization. Everyone is different, of course, and I hope this works better for you than it did for me.

Understand What’s Happening

Yes, I understand that this one sounds utterly ridiculous, but if you are capable of thinking logically (big if – big big if), this may be helpful. On a biological level, a panic attack is a misfiring of your body’s flight or fight response. Your brain perceives a threat when none exists. As such, you have to try to trick your brain into coming back to reality.

Difficult as it can be, try to take a step back, something akin to mindfulness. Say to yourself: “This is just a misfiring of the neurons of my brain. Nothing is wrong. There is no threat. I am safe.”

If you can understand what is going on – that there is no threat – you may be able to get yourself out of the attack.

As always, I welcome your advise. And also, please understand, much of what I wrote will not work for everyone. Or maybe anyone, I don’t know. But these things did help me – and I hope they can help you, you too.

 

Why We Need More Articles That Get Specific to YOU on Mental Illness

I’ve been relieved to see that more and more people are discussing mental illness lately. When done right, this is a good thing – people become more aware of the breadth and depth of the mental health crisis we have, and hopefully more likely to seek help themselves or encourage their loved ones to do the same.

As long as the topic is approached with sensitivity and empathy, there is no such thing as a “bad” mental health article. Some articles, however, can have more of an impact than others.

Which ones are those? The ones which focus on you or your loved ones.

Consider, for a moment, these articles which focus on specific professionals:

Or these articles, which concentrate on age groups:

Or these racially or location-focused articles:

If you reviewed all of these headlines and identified with any of them, you felt a moment of empathy. You probably felt a touch of happiness at being mentioned in a story like this. If you fell into any of the groups noted above, I bet you were a little more likely to click on the article and read more, and from there, maybe you found a useful piece of information. Maybe you found something that made you think of someone you loved. Maybe you filed a scrap of information away for later.

Either way, stigma and mental health campaigns work best when they are targeted at the person with someone that they recognize. Often times, in the work of mental health planning, you will hear conversations about the need for culturally competent campaigns – meaning campaigns where it’s people of varying ethnic and racial backgrounds.

I’ll take that one step further by point to the above. There’s no question that cultural competence in every area – including mental health conversations – is very important. However, it’s not the only one. We also need to have these conversations where the reader can look at someone and recognize them because of their job, their age group, their location, and that’s why these stories are so important.

Generalities aren’t enough. The more specific we can get – the more targeted we can be in our efforts to discus mental illness and stigma and suicide – the better our campaigns can be.