Access to guns means higher rates of suicide. What we can do about it is a harder question.

I recently shared this article on my Facebook page. The crux of the article is this: States with higher gun ownership have higher rates of youth suicide, and the gun ownership leads directly to more suicide. According to the article, “For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9 percent.”

This study comes in addition to the overwhelming evidence which shows that access to guns leads directly to higher rates of suicide. This isn’t just in terms of youth suicide, but for individuals across the country, regardless of age.

Why is this? While suicidal thoughts and ideation can be a long standing problem, the impulse to actually kill oneself is often a fleeting impulse. That’s why so many advocates – including me – have concentrated on means reduction when it comes to suicide: If we can get someone through that terribly difficult moment, we may be able to get them the help that they need.

Unfortunately, guns are one of the deadliest methods of suicide. If someone attempts suicide with a gun, that method will tragically “work” more than four out of five times. Gun use also explains some of the gender differences of suicide attempts vs. suicide completions: “…women are roughly three times more likely to attempt suicide, though men are around three times more likely to die from suicide.” This is, at least in part, because men are more likely to use a firearm.

While the evidence is overwhelmingly clear that there is a problem, how we address that issue is something else entirely. Like it or not, guns are overwhelmingly pervasive in America, and basic gun ownership is legally protected. Furthermore, it can be difficult for someone who favors gun control methods to advocate for reducing gun-related suicides without seeming like you are actually advocating for more gun control and to take away guns from law abiding citizens (trust me on this – I’ve run into the issue many times!). Any effort to reduce the access of suicidal people to guns has to be balanced with already existing legal protections.

So, what can we do? Many states have enacted so-called “red flag laws” which create a process by which guns can be temporarily removed from someone’s home if there is evidence which shows they can be a danger to themselves or others. Such laws can be effective in reducing suicide: According to a 2016 study of such laws in Connecticut and Indiana, “Indiana’s firearm seizure law was associated with a 7.5% reduction in firearm suicides in the ten years following its enactment, an effect specific to suicides with firearms and larger than that seen in any comparison state by chance alone. Enactment of Connecticut’s law was associated with a 1.6% reduction in firearm suicides immediately after its passage and a 13.7% reduction in firearm suicides in the post–Virginia Tech period, when enforcement of the law substantially increased.”

That’s an amazing number. And that’s a real difference.

But it doesn’t just take a law or official government action to make an impact in this regards. Take New Hampshire, where the Gun Shop Project has encouraged New Hampshire firearms instructors to “show a video about suicide prevention in their classes.” That information, coming from peers, can be powerful. I hope that research is conducted on these efforts in the future.

We have to find a way of respecting the rights of gun owners while protecting those with mental health challenges, but I do have to think there is common ground here. It is my hope we can find that space.

Climate change – and a potential climate apocalypse – are contributing to depression

The evidence, unfortunately, is clear: Climate change is here, it is accelerating, and it is going to get worse, with potential cataclysmic changes occurring as soon as 2040.

That, obviously, can and will have massive implications on all of our lives. However, as this NBC article notes, one of those negative impacts from a mental health perspective: The depression which comes as a result of “climate grief.”

I didn’t realize this until this article, but the American Psychological Association released a long report on how climate change is affecting mental health. That’s available here. That report, it seems, concentrates largely on the effects of climate change on the mental health of those who are more directly impacted by the negative impacts of climate change, including some of the enhanced hurricanes and extreme weather events. However, it also notes that personal relationships and psychological can be impacted:

Psychological well-being includes positive emotions, a sense of meaning and
purpose, and strong social connections. Although the psychological impacts of
climate change may not be obvious, they are no less serious because they can lead to
disorders, such as depression, antisocial behavior, and suicide. Therefore, these
disorders must be considered impacts of climate change as are disease, hunger,
and other physical health consequences.

I gotta say, personally, I totally get this, and I bet you do too. Worry about the planet’s health has starting permeating some of my worst fears, and particularly in terms of what we are leaving behind for our children. My children.

The NBC article notes that a woman featured in it, who has three very worried children, enrolled in a ten step program (the Good Grief network), which helps people deal with collective societal problems. I like this strategy a lot because it actually involves doing something – not just sitting and waiting.

I will refer again to an earlier entry I wrote in the aftermath of the Tree of Life shooting – how to have hope in a world filled with darkness. One of the specific items I wrote was this: Find what you can control, and do something about it. Is climate change an issue which is important to you? It should be. The question needs to me this then: What can you do about it? As an individual, there are quite a few things. This involves changing what you buy, what you use and how you take care of yourself. This also means connecting with elected officials and becoming a citizen activist.

On this issue, the best advice I can give is this: You aren’t helpless, and you aren’t powerless. If you are worried about climate change, do something.

Depression rates by state, and what one state is doing about it

USA Today has run a fascinating and eye opening article on the state by state depression rates throughout the country.

First, here’s the basics (sorry, tried to get this as an infographic but having trouble getting the link to load):

Depression By State.png

 

The bluer the state, the higher the rate of depression. Leading the pack, sadly, is Utah, which has 3,977.6 cases of depression for every 100,000 people. At the bottom is New Jersey, with 2,353.3 cases. My state, Pennsylvania, is in the lower half of the country, with depression rates of 2,881.8.

The USA Today article largely focuses on the very high rates of depression in the Mountain West region of the country, which, as you can see, are very high. The article discusses the damning role of stigma, lack of access to health care, the rural natural of many of these states and high levels of gun ownership, which, unfortunately, often lead to suicide.

The article blames much of the rise of depression in this region on its self-reliant culture, particularly in terms of how it affects men. That’s one of the reasons why articles like this are so important: They can hep shatter the stigma which surrounds depression, and particularly by using personal stories of men who have suffered and sought help.

To Utah’s credit, they have done a variety of things to address their rising rates of depression and heavy rates of suicide. This includes:

  • Development of a smartphone app which can provide counseling.
  • Requiring students to take classes on life skills, mental health and substance abuse.
  • Creation of a suicide prevention research coordinator.

The App is widely known within mental health circles and has saved lives. The requirement that student take courses in life skills is interesting, particularly if it teaches things like resilience and coping skills. I know – it seems difficult to imagine that classes are now needed in this area – but the world has changed. It has evolved. And these classes are now, apparently, painfully, necessary.

This article makes a broader point: Depression, suicide and mental illness are rising. We, in the public policy arena, must address these changes for our society to have any hope of evolving and surviving. The world seems to have become a darker place. We have to be the ones who give it light.

Suicide rates are on the rise

Bad news, per a press release from the American Foundation for Suicide Prevention. The CDC has released it’s 2017 mortality report on suicide and found that 47,173 Americans killed themselves – an increase of 3.7% over the 44,965 Americans who killed themselves in 2016.

The suicide rate is at a 50 year peak, an astonishingly high number, and one which is actually contributing to a decrease in the life expectancy of the average American. Suicide is the currently 10th leading cause of death in America.

The American Foundation for Suicide Prevention says that five things need to change in order to comprehensively address suicide reduction:

  1. Cultural attitudes about help seeking and overall awareness about mental health conditions.
  2. Access to affordable mental health care.
  3. Training for primary care physicians to screen for mental health and suicide risks.
  4. Reducing access to lethal means of suicide.
  5. Better data collection.

I’d add this, based on other research that I’d seen: We need a stronger social safety net. This means that we need a more activist government that can provide a social and financial backstop for people who are in need of it. Studies have shown that suicide rates are lower in areas where there is a stronger social safety net, but that connection seems to be particularly strong when there is good access to health care and housing assistance.

This is a harder one to advocate for, to be honest, and I think there are two reasons behind that.

First, the concept of a “stronger social safety net” is broader and more abstract. The five points noted above are relatively clear-cut, and the connection between them and suicide reduction is clear. I think that connection is weaker when it comes to improving the social safety net, but it doesn’t mean that the two aren’t connected.

Second – and maybe this is just in my head – is a political concern: A stronger social safety net requires more government intervention and funding. That, of course, is a much broader and more political statement, one which slants more towards the progressive end of the ideological spectrum. And that gets difficult for non-partisan organizations which typically fight for stronger mental health services.

I think that’s a long term challenge for the mental health community. Again, I’m a Democrat and pretty progressive, so I’m biased, but I do think that the research bears this out: A more progressive political orientation is better for individuals with mental health challenges and to reduce the scourge of suicide.

That is NOT to say that Republicans or conservatives don’t care about mental health or suicide reduction – nothing could be further from the truth, and I have very proudly worked with Republicans and conservatives on mental health and suicide reduction legislation. But, it is a challenge. The simple truth is that making improvements in these areas requires more government intervention.

Anyway, as always, I’m curious to hear your thoughts – do you agree or disagree with me? Let us know in the comments below!

Empirical data confirms it: “Trump Anxiety Disorder” is real

Let me add a disclaimer here: This one is going to be difficult, because I’d like to approach the subject below as a legitimate mental health issue, not a political one.

I’ve written about this before, but a new Politico article, along with some of the data in it, has pushed this topic back to the surface.

From the article:

 The American Psychiatric Association in a May survey found that 39 percent of people said their anxiety level had risen over the previous year—and 56 percent were either “extremely anxious” or “somewhat anxious about “the impact of politics on daily life.” A 2017 study found two-thirds of Americans’ see the nation’s future as a “very or somewhat significant source of stress.”

All of this has led to the creation of – and I can’t believe I’m typing these words – “Trump Anxiety Disorder.” According to Dr. Jennifer Panning, that disorder is defined by, “increased worry, obsessive thought patterns, muscle tension and obsessive preoccupation with the news.”

Additional research has shown that the election resulted in people having a more difficult time having “open and honest” conversations and damaged relationships.

On a personal level, this jives with not only my experience, but conversations I’ve had with others. Years ago, I remember speaking with my therapist about how I was very stressed by the state of world affairs, and I commented that I knew how ridiculous that sounded. He looked at me as if I had three heads. “That’s not ridiculous at all. Almost all of my patients have said that.”

I was so, so relieved. And as I have relayed this story to others, they are relieved as well – it’s not just them! At all!

So, what is there to do about this? Yeah, on that one, I have very little. Unplugging and setting boundaries is important, but the best way I have been able to keep my focus in the age of Trump is this: Concentrate on where you can make a difference. Focusing on the non-stop news cycle (CNN/MSNBC/FoxNews are the worst things on the planet) will drive you nuts, no matter who you are. Concentrate on the areas where you can make a positive difference, and go from there.

That’s the best advice I can give. If you have anything better, please leave it in the comments below!

Ties that bind: Liberals, conservatives and mental health

It’s not much of an exaggeration to say that there are some…umm, slight…differences between liberals and conservatives in America today. I continue to believe – perhaps naively – that the things which unite us are bigger than the things that divide us.

One of those things, without a doubt, is mental health.

First, speaking in generalities: Liberals tend to want government to do more, conservatives tend to want governments to do less. This is a very broad statement and there is a lot of room for nuance within it, but I think that’s pretty accurate. Looking at that from a mental health perspective, that tends to translate into liberals wanting government to do more (even if it means raising tax rates), conservatives want them to do less.

I have a theory: That’s not completely accurate, because conservative areas need as much help as liberal areas when it comes to this.

Let me approach this from a different perspective: Urban vs. rural. Again, broadly speaking, but urban areas tend to be more liberal, rural ones more conservative. But – and this is important – rural areas really, really struggle when it comes to mental health. Suicide rates are higher in rural areas than urban areas. This is for any reasons, including an increased prevalence of firearms and a lack of access to health care practitioners.

At the same time, urban areas – which have high levels of poverty and minorities – also really struggle in these areas. Urban areas with high levels of poverty have significantly higher rates of mental illness. Unfortunately, poverty makes mental illness worse, and the mentally ill are more likely to be pushed into poverty and lose access to health insurance and care – thus creating a viscous cycle.

Here’s my theory: These can be united. While I represent an urban area, I don’t want anyone to suffer or struggle, no matter what they look like or where they live, and I am sure that the vast majority of conservatives feel the same. We all care about the people we represent, and I’m hoping that, over the next couple of years, I can find more people to work with in order to bridge the gap between liberals and conservatives/urban and rural areas. I’m hoping that we can use mental health to do that, and in so doing, help all of the people we represent.

 

 

 

How the Center for the Disease Control says we can stop suicide

Yesterday, I wrote a little bit about a really insightful technical package offered by the Centers for Disease Control. It’s a long document, but for those of you who care about how we can stop suicide and are looking for ideas (if you are involved in the government or not!), I think it’s a great read.

I don’t want to get insanely in-depth into what sort of recommendations were contained in the document. But I do think it’s worth reviewing the broad outlines of it, just in case you don’t have time to read a 60 page governmental white paper. Broadly speaking, it broke down it’s recommended solutions into a few categories:

  • Strengthening Economic Supports: This one was the topic of my entry yesterday, and I’d argue the most important for both suicide and protecting vulnerable people in our society. This specifically deals with making sure that people who may be at risk for suicide as a result of economic conditions have access to the services that they need to recover, and includes items like robust unemployment benefits, medical benefits, foreclosure assistance and more.
  • Strengthen Access & Delivery of Suicide Care: Here’s where things start to align with what I think most people would expect. This includes the obvious systemic changes needed to be made to our mental health system, including improvements to the insurance system (parity between physical and mental health), reducing provider shortages (a huge issue of mine which, unfortunately, largely needs to be dealt with at the federal level), and broader changes to the mental health care system in order to better address mental illness and suicide prevention.
  • Create Protective Environments: Here’s where what I’ll call “stop-gap” methods really come into play. This includes means reduction (guns are  huge issue here, but this also includes restricting access to suicide hotspots) and improving organizational/social systems to promote protective environments (particularly in at risk locations) and addressing excess alcohol use (which is connected to suicide).
  • Promoting Connectedness: Thanks to phones and technology, we are more connected than ever before. Except we’re not. And as social connectedness breakdown, suicide rates will continue to increase. This specific approach recommends addressing suicide by establishing peer norm programs and engaging in increased community engagement activities.
  • Teaching Coping & Problem Solving Skills: One of the keys to surviving any bout of mental illness – and I’ve written about it before – is building resilience, or an ability to cope. This includes creating social/emotional learning programs and addressing parenting and family relation skills.
  • Identify and Support People at Risk: This includes training gatekeepers, improving crisis intervention and broad-based treatment for people at risk of suicide.
  • Postvention: The aftermath of a suicide attempt can have a dramatic impact on both the victim and those around them. This section of the report deals with postvention for those who were close with a suicide victim and addresses safe reporting/messaging in the aftermath of a suicide.

This is really comprehensive, and again, worth a read. If you have any thoughts or questions, I’d love to hear them! Leave your questions or comments in the section below.

The next time there’s a high profile suicide, don’t just tweet a phone number. Do this instead.

As part of my legislative work, I just finished reading a technical package from the Centers for Disease Control. The topic was suicide. It was some pretty heavy reading. At the same time, it was informative for many reasons, as it included a wide array of programs that people in government and the non-profit world can enact in order to reduce suicides.

Something, in particular, was highly instructive about the packet. It contained a wide array of information dealing with numerous public policy areas. But let me talk about the first chapter in terms of specific recommendations about suicide reduction. What do you think it was? Was it access to mental health care? The need for more research into better drugs? Controlling access to means of suicide?

Nope. It was economic supports.

Suicide rises in times of economic strife. The connection is clear. So, the first two specific recommendations within the packet:

  • Strengthening household financial security via programs like unemployment benefits, temporary assistance and livable wages.
  • Enacting programs that reduce foreclosure risk.

The report went on to note that ample evidence exists showing that stronger social safety net programs can reduce the risk of suicide.

Other areas of this report also showed the strong demonstration between public policy, public health and reducing suicides rates. Various sectors of our society are critically important as well, of course, but government can be – and should be – a primary actor when it comes to suicide reduction.

Let me go back to the title of this blog entry. Like many others, when there is a high-profile suicide, I’ll tweet out the “thoughts and prayers” line, as well as information on the National Suicide Prevention Hotline. That’s good, and it’s helpful. But it’s not enough. I want to start treating suicide in public the way we treat gun violence. It’s not enough to tweet support. We have to demand action from our policy makers:

Look, I’m a flaming progressive, so this may just be my political orientation, but I think we need more common sense gun reform measures in the worst way – things like red flag laws (which would allow for a temporary removal of weapons from people who are a danger to others or themselves), universal background checks and more. And I’m glad now that, whenever we have yet another tragic shooting, it’s not just “thoughts and prayers” but “thoughts, prayers and CAN WE PLEASE ACTUALLY DO SOMETHING ABOUT THIS.”

I want to take this mantra and apply it to mental health and suicides. Let’s stop pretending that suicides are a problem of an individual or their family. They aren’t. They are a societal, communial and governmental problem. We need to do more at the societal level to address mental health and suicide, and that means doing more than just working to improve mental health. If we can acknowledge that, we can make a change.

So, I say to you, dear reader: Don’t just tweet the suicide hotline numbers. Demand that policy makers make the changes necessary to save lives.

OP-ED: Massacres, gun safety & mental health

The Morning Call, which is my local newspaper, recently published this op-ed that I wrote, following up on the Parkland massacre.  I’m publishing it here because it does touch on mental health, but specifically from the perspective of violence and publish policy.  First, remember, someone who is mentally ill is far more likely to be the victim of violence, rather than the perpetrator.  Second, I’m tired of hearing about, in the aftermath of these shootings, how we must repair our mental health system and then the only things that are done is funding cuts.

Anyway, read on for more.  I hope you find this useful

Seventeen dead students and teachers.

Fifty-eight dead concert goers.

Forty-nine dead club attendees.

Twenty-seven dead students and teachers.

These are some of the worst gun massacres in the history of the United States. And they have all occurred within the past five years.

We have reached the point in our society where kindergarteners are being trained how to cower in the event that an armed gunman barges in on their class. Teachers are now being lauded for laying down their lives for their students. There is serious conversation about whether or not school staff, including administrators, teachers and janitors, should walk around school with guns locked and loaded.

We have hit this low point in our society. But we aren’t powerless. We aren’t lambs being led to the slaughter. We are the United States of America. The country that beat the Nazis can surely be the country that stops senseless bloodshed in sacred public places.

We need real gun safety, and we need it now.

•First: Reinstate the assault weapons ban that was in effect from 1994-2004. It is harder for a 19-year-old to purchase Sudafed than an assault weapon. More to the point, the 1994 ban worked. According to one analysis, gun massacres and deaths from assault weapons tripled since the expiration of the assault weapons ban. Military-style weapons are responsible for almost every one of these crimes, and we can do something about it.

•Second, close the loophole that allows for individuals to purchase firearms without being subjected to a background check. If you want to buy a gun, you should always be subjected to a background check, and right now, you can legally purchase certain types of guns at certain types of sales without doing so. This massive loophole allows for terrorists or convicted felons to have access to firearms.

•Third, enact state Senate Bill 501, which would bar individuals who have a protection from abuse order from owning firearms and make it easier to take weapons away from those convicted of domestic assault. Many of the perpetrators of our worst massacres have been convicted of this heinous crime, and no one who beats an intimate partner should have access to a firearm.

It’s also vitally important that we discuss mental health. We frequently hear in this country that there is a need to improve our mental health system to prevent these types of massacres, despite the fact that someone with mentally illness is significantly more likely to be a victim of a crime than a perpetrator of one.

Indeed, opponents of gun safety often shake their heads, offer their “thoughts and prayers” and pledge to deal with our mental health system. That is followed immediately by … absolutely nothing, except attempts to repeal Obamacare and Medicaid expansion, both of which would fundamentally devastate our mental health system by cutting off funding, preventive care and hospital beds.

If you are opposed to gun safety measures, and want to improve our mental health care system, it’s not enough to say words that sound good. You have to stand for something.

Here are some suggestions. First, address the rising shortage of psychiatrists and psychologists by increasing reimbursement rates and Medicaid/Medicare slots for mental health care. Second, increase funding to critical and crisis care treatments, allowing for the creation of additional hospital beds to treat those experiencing a mental health crisis. Third, increase the reach of programs like the nurse family partnership and pre-K education, which have been proven to dramatically decrease mental illness.

Each and every one of us — from the most ill homeless person to the president of the United States — is never more than one moment away from a mental health crisis and running headlong into a system that doesn’t care about us. One in 5 American adults suffer from mental illness; 1 in 20 suffer from an illness so debilitating that they can no longer work. If you don’t care about the mentally ill, fine, but remember, this could be you or someone you love in a heartbeat.

There is no single solution to stopping gun violence, and individual and familial responsibility has an enormous role to play in ending this bloodshed. Background checks and banning the sale of military-style weapons won’t stop every massacre; after all, all of our laws and police activity don’t stop every crime. But our law enforcement — and the laws they enforce — do save countless lives and stop innumerable crimes every day.

We aren’t powerless. There are solutions. American ingenuity and know-how can save thousands of lives, and the only way to guarantee that the problem only gets worse is to do nothing.

All of us have an obligation to each other to make the world a better place, and we should be tired of living in a society which allows for over 13,000 gun deaths every year, including 17 dead children and adults on the floor of the freshman building of Marjory Stoneman Douglas High School in Parkland, Fla..

Mike Schlossberg of Allentown is state representative from the 132nd District.

Physician shortages: The biggest challenge facing mental health in America

I often write about stigma and the devastating role it can play in terms of keeping people out of treatment.  I think a big part of the reason I discuss it so frequently is that it’s the one area that people can actually get involved in and feel like they are making a difference.

That being said, I need to be clear about this one: Stigma reduction, though important, is not the most critical issue facing mental health.  That, I would argue, is a lack of capacity, largely in terms of mental health practitioners.

The facts on our ongoing physician shortage crisis are staggering:

  • According to a report by the Association of American Medical Colleges, over the next eight years, the United States will experience a doctor shortage of between 61,700 – 94,700.
  • That problem is much more acute in the area of mental health.  According to one report, in order to meet demand, the United States needs to add 70,000 providers over the next eight years if we are going to meet a growing demand.  The problem is even worse for people who live in rural areas; 60% of all people in rural areas live in a mental health professional shortage area.  In general, according to NAMI, only 41% of all people with mental illness are treated, while that number increases to 63% of all people with a serious mental illness.
  • The shortage doesn’t just affect personnel, but facilities.  It can be extremely difficult for the mentally ill who need inpatient care to have access to it, with some surveys estimating that the United States needs a whopping 123,000 psychiatric beds.

How did we get here?
As you can imagine, there are a variety of culprits, including:

  • Incredibly high standards to get into medical school and a long length of time for training.
  • Crushing medical student loan debt (averaging $207,000).
  • A shortage of residency slots for hospitals.  These slots are almost entirely funded by Medicaid, and that funding has not increased since 1997.
  • High cost of malpractice insurance.
  • Varying reimbursement rates for different specialties (more on this later).

Why is this problem so much worse in mental health?
This problem is even more acute in the mental health universe, where amount of psychiatrists declined 10% from 2003-2013.  The shortage gets even more severe as you go into mental health specialties, such as pediatric and geriatric care.

Again, there are many reasons that this issue is so problematic for mental health.  For one thing, hospitals and insurance companies pay doctors more if they are involved in specialties that turn a profit, like orthopedic surgery and urology…not psychology or psychiatry.  Additional public cuts to human services and mental health further exacerbate the problem. As a result, there is less staff in this area, regardless of it’s importance.

Physician burnout is also a problem, with one study noting that “86 percent reporting high exhaustion and 90 percent reporting high cynicism.”

Another problematic area is physician training, where there are concerns that training models have not evolved enough to introduce more medical students to mental health areas.

There’s more – much more than a simple blog entry can handle.  For a more in-depth look, I highly recommend that you review this report by the National Council for Behavioral Health.

What can we do about it?

  • Increasingly utilize technology and telehealth, which some studies have shown to be promising in the area of mental health.  With additional capacity, telehealth can help overcome geographic shortfalls that occur.  Other systems, such as bed and doctor registries, can help patients in need of treatment find appropriate resources.
  • Expanded number of residency slots.
  • Adjustment to reimbursement rates to ensure that mental health services achieve parity with other areas.
  • Adjustment to licensure laws in order to allow for other certified professionals – with appropriate training – to treat patients.

It is important to not lose sight of this simple truth: The mental health practitioner shortage can devastate the quality of life of the mentally ill.  It can kill people, frankly.  In my government job, my office regularly fields calls from constituents who need help but can’t find it.  Mental health is an issue that society is only truly starting to understand and deal with.  We must ensure that the mentally ill have the access to the resources that they need.