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.

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.

How Gun Control Can Help Stop Suicides

When people who oppose gun control don’t want to say, “Hey, yeah, I think that we should allow ordinary citizens to own ballistic weapons without so much as a background check,” they don’t do that. Instead, they say, “We shouldn’t focus on gun control – we should focus on mental health.” It’s a lovely political pivot from a group of people who don’t want to actually focus on things which will stop gun deaths.

Related: They then do less than nothing to help people with mental illness.

I’ve attacked that argument before, but now I’d like to add to it: Gun control measures – and specifically Red Flag laws – can help stop suicides.

What is a “Red Flag Law”?

A “Red Flag Law” – also known as an Emergency Risk Protective Order – is a formal court proceeding. They vary from state to state but have the same characteristics: If a person is making threats or found to be a danger to themselves or others, someone (such as a family member or police officer) can petition the Court to have an individual’s guns temporarily removed from their possession. They’ve been promulgated as an effort to stop mass shootings, but the data thus far shows that they are more beneficial in the fight against suicide.

Limiting Access To Deadly Means Stops Suicide

Multiple studies and historical experience have proved it – if you limit someone’s access to the means of suicide, you can reduce suicides. And that is precisely why Red Flag laws are so important for reducing suicides. If crafted appropriately, a red flag law can result in the removal of a gun from someone who may hurt themselves with it.

So, yes. Here’s an area where we can help mental illness – but it’s via sane gun control measures.

Red flag laws are relatively new, so the research on them is somewhat limited. But, from what’s available, they work. For example, take a look at the experience of states like Indiana and Connecticut, which enacted red flag laws relatively recently:

“In Indiana, after the enactment of the law [in 2005], we saw a 7.5 percent decrease in firearms suicides in the 10 years that followed,” Kivisto said. “We didn’t see any notable increase or decrease in non-firearms suicide.”

“And so when we looked at it from 2007 and beyond [in Connecticut], [gun suicides] decreased by 13.7 percent,” Kivisto said.

This furthers the idea that access to deadly means can help control for suicide.

Suicide is a massive societal problem, one which belies simple solutions, involves multiple areas of public policy and will require significant investment to truly tackle. That being said, some small laws can make a big difference, and reducing access to suicidal means can do just that.

Stigma, Shame & First Responders

My mental health and legislative worlds frequently come together, but an article and what happened yesterday really made me blink.

First, the good news. At a hearing yesterday, the Pennsylvania House Veterans Affairs & Emergency Preparedness committee moved a bill of mine. HB1459 would give first responders more mental health resources. It would require trauma and mental health training, create a peer to peer mentorship program and mandate the creation of a toll-free hotline for first responders who are struggling with mental health issues.

I feel like legislation like this is more important then ever. Why? Stories like this, which report on the NYPD’s ongoing mental health and suicide crisis, and the unwillingness of some police officers to seek mental health help, despite the fact that they feel the need to do so:

In a new report, the Department of Investigation’s Office of the Inspector General surveyed officers who retired in 2016 and found that 25 percent of them reported going through a period of emotional stress, trauma or substance abuse that caused them to consider getting professional help.

But more than a third of those officers did not end up seeking assistance, according to the report.

Half of them expressed fear that the department would find out about their decision to seek support.

So, what do we do here?

First, there are internal things that I think the NYPD can do. Chief among them? Work to change the culture and attack stigma by sharing stories of successful police officers who have experienced mental illness, sought help, and thrived.

Furthermore, the NYPD must do whatever it can to stress the confidential nature of their programs. According to the report, 50% of people surveyed were worried about the department finding out about their illnesses, 45% of negative labels, and 39% afraid of being put on a modified assignment. As the NYPD notes, an “extremely small number” of officers do wind up having their weapons taken away, but they are given those back upon successful treatment. Treatment is confidential, except in cases where the officer in question may present a danger to themselves or others.

The second is broader: We need cultural change at a society wide level. When we discuss the importance of stigma when it comes to mental health, this is why. Stigma is more than just how people look at the mental ill, its how we look at mental illness within ourselves. Clearly, as cases like this demonstrate, a culture of machismo and an overabundance of self-reliance can kill. For reasons like this, we clearly must do a better job of reminding people that there is no shame in seeking help, and that in many cases, its the only way to lead a happy, healthy and productive life.

More Than Stigma: Shifting the Nature of the Conversation Around Mental Health and Suicide

Advocates for suicide prevention and mental health often talk broadly about “the stigma” which surrounds mental illness and suicide. Many of us – myself included – believe that if we can just get more people talking and thinking of mental illness, if we can have people discussing their issues with depression, anxiety, addiction and more without shame or fear, we can help to put an end to this epidemic. I firmly believe that this is the case.

I also know its not enough.

And that’s where the conversation around public policy, resources and taxation has to come into pay.

I happened to catch a fascinating column on mental health the other day – I obviously can’t find it now, that would be too easy, but the column made a great broad point: Ending mental health stigma is like cutting holes in a wall, but then there’s nowhere to go because our system of mental healthcare is so broken in this country.

Many of us concentrate our efforts on stigma for a couple of reasons. I think it’s one of the most important things that we can do. But let me expand on the second part of that sentence: That we can do. People do need to know it is okay to seek help and to treat themselves. They need to know that these issues are real, powerful and can kill you. But, as any studies have shown, individual conversations are the best way to break mental health stigma. A face to face talk can make a huge difference in that area. That means that, without question, the most important person to ending mental health stigma is you.

Second, it’s the easiest.

Making society-wide change is really hard, of course. Particularly in areas where colossal interest groups are at play. I’m an elected official – theoretically one of the people who makes state-wide decisions in Pennsylvania – and I fully understand just how difficult this can be.

And the simple truth is that we must make systemic changes to help reduce rates of mental illness and suicide.

From a mental health and suicide perspective, there’s an awful lot that needs to be done. This includes increasing access to mental health care, increasing the number of mental health care practitioners and addressing the mental health care practitioner shortage, reducing costs, enforcing parity in insurance care, reducing access to deadly means of suicide and more. And that’s to say nothing about the major societal problems that we face which contribute to mental illness and suicide, including improving housing options, strengthening the social safety net, increasing the minimum wage, making housing more affordable, etc.

Many of us tackle stigma because we can’t get at these issues. And stigma is something we can control.

So, what does that mean? Should you stop talking about mental health stigma? Hell no. Of course it’s vitally important, but it’s important in more ways than you think, because the more you discuss mental health, the more pressure you can bring on policy makers to address the fundamental inequities and gaps in our system which allow for mental illness to run so rampant. Keep fighting.

But make sure you fight in a public policy realm, in addition to addressing individual changes. Tell policy makers and elected officials that you expect them to do more to address rates of mental illness and reduce suicides. These issues require government intervention, and that requires public pressure. Please help make this happen.

 

Means Matters: Why conversations about reducing access is so important – with a very personal example

I came across this very insightful article on three methods of suicide prevention the other day. If this is an area of interest to you, I highly recommend you check it out. Anyway, one of the many things the article discussed was the importance of reducing access to deadly methods (or means) of suicide. The article made some points which I’d barely or never heard. In Sri Lanka, suicide numbers absolutely tanked after common types of pesticides (which were also common suicide methods) were banned. Suicide rates also dropped in England and Wales in the 1960s when domestic gas was switched to a formula with less carbon monoxide, and when more restrictions were placed on sedatives in Australia during the 60s and 70s.

From the article:

Those early observations are backed by a growing body of research that counters the popular misconception that people who attempt suicide once will keep trying, through whatever means necessary. The reality is that those in the grip of a suicidal crisis often can see only one way out—and if that route is barred, they’re unlikely to turn to another, says Jill Harkavy-Friedman, a clinical psychologist and vice president of research at the American Foundation for Suicide Prevention (AFSP) in New York City.

In my legislative career, I was able to get an amendment passed to a bridge reconstruction bill which required that the Pennsylvania Department of Transportation consider adding protecting fencing to suicide hot spots during reconstruction or bridges or other high points. This was done for the exact reasons listed above – means reductions.

It seems as if every community has that place which is known for suicides – in Allentown, my home, it was the 8th Street Bridge. We lost one person every 1-2 months from that location. Then, during reconstruction a few years ago, protective fencing was added – and we haven’t lost a person at that spot since.

This is why there are so many legislative initiatives to reduce gun access for suicidal people via Red Flag laws. I don’t want to get into a debate about gun control, but the science on this issue is clear: Having a gun in a home is more likely to lead to suicides.

For those of you who are lucky enough to not understand, on an emotional level, what it is like to be depressed or suicide, allow me to try to explain. When you’re depressed, you are more than just sad or tired or miserable. Depending on your exact mood or the exact moment, you lose the ability to think clearly. Furthermore, depression isn’t a constant state – like any other emotional feeling, it ebbs and flows. There are moments it is manageable, and then, ten minutes later, you forget your wife, your kids, your loved ones, your career, your successes…you just want to end the pain. And in a bad moment, with the right triggers, yeah, you may grab whatever is easily accessible. If deadly means are available (and guns are the deadliest – 85% of all suicide attempts with a firearm result in a completed suicide), that may be the moment where you end your life.

My worst moment was in college. It was Freshman year, a few weeks back into my 2nd semester. I was a few weeks into anti-depressants for the first time in my life (which can be a moment where suicide risk increases – something I wish I had known then) and had just been rejected by a girl (appropriately on her part, as I wasn’t in a mental state in which I could handle a relationship at the time). The first semester had been a disaster for me – it resulted in an explosion of depression and anxiety attacks, my first time seeing a counselor, and my first experience with anti-depressants.

The night I got rejected by this girl. It was two in the morning or so, and I called my ex-girlfriend (who I was very close with, and in a complicated relationship with), crying. And in my hands, I had a bottle of my new anti-depressants and a glass of water. And I asked her why I shouldn’t end my life then and there.

I feel terrible about that moment. It was such an unfair burden to put on a 16 year old young woman. But she handled it gracefully and like someone with maturity well beyond her years, and she got me to put the pills down, and as I recall, refused to get off the phone with me until I got into bed. I think she actually had the number of our campus safety but couldn’t find it at that moment. And I think I fell asleep with my phone in my bed that night.

The purpose of this story isn’t just to thank my ex (though, as long as I’m on the subject, thanks very much!), but to prove a point. That moment was the worst in my life. That’s the closest I’ve ever come to suicide: Staring at a bottle of polls, and a glass of water, and wondering.

And I can’t help but wonder what would have happened if I’d had a gun. Because getting through that moment – and it was just a moment, a bad one, but not one to be repeated – gave me my life. My wife, my kids, and decades of joy and hope.

Means matter. Access to deadly means matters. And efforts to reduce suicide must incorporate means reduction. Doing so can help get a person through the most difficult moment in their life. And that may save a life.

 

 

Suicide Prevention Hotline appears set to get a three digit number

Some ridiculously good news out of the federal government (yes, really) when it comes to mental health:

The Federal Communications Commission plans to move forward with establishing a three-digit number for the federally-backed hotline.

Thursday’s announcement from FCC Chairman Ajit Pai signals the culmination of one of the final legislative priorities of former Senate President Pro Tempore Orrin G. Hatch of Utah.

Pai said that he intends to follow a staff recommendation for establishing a three-digit dialing code, likely to be 9-8-8, to reach the network of the National Suicide Prevention Lifeline, currently 1-800-273-8255 (TALK). That program is funded through the Health and Human Services Department.

Why is this so important? Two things.

First is the obvious: It makes it easier for people to get the help that they need. A 1-800 number – even one with “TALK” in it – can be too easy to forget. The Suicide Prevention Hotline is a critical resource for people who are in crisis. Elevating that number, and making it easier for people to call, can help to direct people to the care that they need. This is particularly important for someone who is in a state of mind where suicide seems to be an option. A 1-800 number may be too difficult to dial. A three digit number – one like 911, which has been drilled into our brains since we were kids – is easier.

This is even more important because of the frequent conversations around suicide prevention whenever there is a high-level suicide. In the aftermath of one of these tragedies, there is often an increased effort to make people aware of this number. Think about it. How many times have you heard someone say words to the effect of, “You’re never alone. If you or someone you love is in crisis, call 1-800-273-TALK.”

Let’s keep in mind that this number is a national resource, and the volume of calls it receives is reflective of that. The national hotline will actually route your call to the nearest available center. For information on how many calls your state hotlines received, you can check out this report, which has statistics from July 2018- December 2018. For example, during this period, there were 30,346 calls made from Pennsylvania residents. For added context: In a three month period, .0023% of the state’s 12,810,000 residents called. Folks, that’s not a small number.

Second, and maybe more importantly: This decision elevates the national conversation about suicide prevention. Only important causes get three digit numbers: Emergency services (911), directory assistance (411) and local services (211) are the only ones in Pennsylvania. Making suicide prevention a three digit number will help to push suicide prevention to the top of the public agenda, and this is something we absolutely, desperately need to do. This is a good decision, and I cannot wait to see it finalized.

Any thoughts you want to add? Let us know in the comments below!