New Suicide Statistics Show that Things Are Still Getting Worse, but…

The CDC has released new suicide statistics for 2018 (previous numbers were for 2017). The results, by and large, were problematic. In a nutshell:

  • Suicide deaths in America went from roughly 47,173 to 48,344. That’s an increase of about 1.4%.
  • Believe it or not, there’s good news here. The slope of the increase is starting to flatten: Suicides increased 4% from 2016-2017. This would imply…hopefully…that the rate of suicides is starting to slow down.
  • Suicide remains the 10th leading cause of death in the United States.

More data will likely be available in the future, including a breakdown of suicide methods and age breakdowns of those who died. That information, of course, will be particularly insightful. On a personal level, I’m deeply interested in the numbers in Pennsylvania. Since 2013, we’ve had suicide rates that are above the national average. I suspect that those trends remain unchanged and that we will see a small increase over the 2,030 people who took their lives in 2017.

There are two ways to look at these numbers, and I think that both are valid perspectives. On one hand, the problem continues to get worse. Suicide numbers are accelerating, and the numbers continue to get worse, as they have roughly ever year since around 2004.

On the other hand, as the American Foundation for Suicide Prevention accurately noted, there are reasons to be hopeful:

  • The rate of increase has slowed.
  • Awareness about the problems of mental illness and suicide continues to grow.
  • More and more people are going public with their own struggles.
  • More and more units of government are comprehensively addressing suicide and suicide prevention. Such a strategy appears to be working for opioid overdoses, and that should give us all hope when it comes to suicide prevention.

Indeed, articles like the one run by the Huffington Post on the subject do a great job of discussing suicide. They present the statistics in a rational, reasonable manner. They also present stories of hope and specific, concrete suggestions for how to deal with mental illness and suicide. Those suggestions – reach out, be non-judgemental, understand that suicide is a comprehensive illness – they are all evidence-based.

So, yes. There are reasons to be hopeful, but we must continue to acknowledge that we have a major mental health crisis in front of us. One which will require – demand – public policy decisions.

 

New study: 13 Reasons Why did not cause an increase in suicides, and may have done some good

I’ve written repeatedly about Netflix’s 13 Reasons Why, and usually in a pretty damning light. Like others (who are far more informed and educated than I am), I’ve expressed my real concern that the show has unintentionally glamorized suicide, and there has been evidence to suggest that it actually led to an increase in suicides.

However, a new study shows that this may not be the case, and, in fact, that 13 Reasons Why may have done some good.

First, a review. 13 Reasons Why tells the story of Hannah Baker, a teenage girl who dies by suicide and leaves behind tapes for people to listen to, explaining why she died and their role in her demise. The show was criticized by many for glamorizing suicide and presenting it as a possible choice, and Netflix eventually removed the three-minute, highly graphic scene in which Hannah dies.

Of course, that removal came after being viewed millions of times, and at least one report directly tied the show to a rise in suicides.

However, a new study came to the opposite conclusion:

But a recent reanalysis of the data by Dan Romer, research director of the Annenberg Public Policy Center at the University of Pennsylvania, found no evidence of an increase in suicides for boys, and (like the original study) an insignificant increase for girls. Romer adjusted the data to factor in trends like an overall increase in adolescent suicides since 2007.

That’s important. But it’s not as important as this finding:

But when Romer conducted a study on 13 Reasons Why’s effects on self-harm, published last April, he found that teens who watched the entire second season of the show were less likely to purposely injure themselves or seriously consider suicide, even when compared with those who did not watch the show. He said that this could be because of the Papageno effect, which occurs when stories that portray people overcoming their suicidal crisis end up reducing suicide rates. The effect is named for a character in Mozart’s opera The Magic Flute who considered suicide until his friends showed him a different way to solve his problems.

The second season of 13 Reasons Why features a character who is depressed and considers suicide – but survives. This is important, and it feeds in with a larger theme in the mental health universe: We have to share stories of hope, of survival, and of seeking help successfully.

Part of the reason that so many (myself included) thought 13 Reasons Why was so damning, as portrayed, is because it features a character dying by suicide in a graphic manner. This can create copycat scenarios. However, the good news is that the Papageno Effect is real and has been repeatedly backed up by science. This is great news: If you can show someone finding hope, you can inspire others to do the same.

I appreciated this alternative perspective of 13 Reasons Why, and I appreciated the hope that it could potentially inspire in others. It also reinvigorates what I have said for ages: Share your story. It’s why I’m so passionate about sharing mine.

You can save a life.

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.

The Mental Health of our LGBTQ Friends

We celebrated National Coming Out Day last Friday, and it gave me a few things to think about. As we all know, this world is hard enough. The times we live in are more interconnected, more stressful and more difficult than they ever have been, and I do think that the current state of our world is adding to our rising rates of mental illness and suicide.

So, imagine being someone who so many in society say is wrong.

I’m a straight, white man. This comes with many societal advantages. And let me be clear, I cannot imagine how difficult it must be to be a sexual orientation that is different.

But numbers don’t lie: It’s a harder life. A quick look at the statistics:

  • 28% of all LGBTQ youth said they felt depressed most of the time (in the past 30 days), compared to 12% of non-LGBTQ youth.
  • When compared to non-LGBTQ youth, LGBTQ youth are:
    • Twice as likely to feel suicidal.
    • Four times as likely to attempt suicide.
  • Over the course of their lifetime, 30-60% of LGBTQ people deal with depression – 1.5 – 2.5 times as straight individuals.
  • These issues are largely impacted by perceived support and social stigma.

So, what can we do to help individuals who identify as LGBTQ? A few things. First, remember, all language counts. If you show bias towards one group, individuals are far more likely to perceive you as biased towards another. Don’t be that person who uses bias and then jumps in with, “But I have a gay friend!” Don’t show bias in your language. Don’t use derogatory terms to discuss anyone. Language counts. Language reinforces stigma and stereotypes. Use appropriate pronouns. Use language that is kind and respectful. And just…don’t be an ass.

Second: Show your support. You don’t know who is struggling or who is desperate for someone to talk to. One study which was bouncing its way around my Facebook feed showed that an LGBT individual who found a supportive adult could see their risk of suicide drop by 40%. Be that one person. And be so explicitly. Yeah, post something to your Facebook page about how you support LGBT people and you’re a safe person to come out to. Is it gonna get anyone to come out to you? Maybe. But, more importantly, someone who is LGBTQ will see it, and will appreciate it. They will know that you value them as a person. That you believe in their dignity and basic human rights.

Third: Support policies which humanize LGBTQ people. In most places in Pennsylvania, you can be fired or evicted for being gay. That’s madness, and laws matter: When gay marriage was equal in only some states, studies showed that LGBTQ people had better mental health and lower rates of addiction when they lived in states where gay marriage was legal. Again: PUBLIC POLICY MATTERS. It makes a difference! Support your LGBT friends by supporting candidates for office who support human dignity for all.

Others who are better versed in this subject have written about it, and I encourage you to read more about how to help millions of Americans feel loved and safe. I can’t imagine how hard it must be to be a minority in America – particularly today, given that the President is a racist, xenophobic monster who stirs up hatred at anyone he can find. That being said, I remain convinced – now more than ever – that this is the moment to show our friends – all of our friends – the love and respect they deserve. Be that person. Be one of the people who tells our friends that they are loved. You may save a life.

The Hope and Sadness: Out Of The Darkness Walk

With one exception, I’ve had the honor of speaking at every Out Of The Darkness walk which has occurred in the Lehigh Valley in the time I’ve been a State Representative. Since I began publicly discussing my struggles with depression, anxiety and suicidal ideation, my role has expanded, and I’ve MCed the event for the past few years. I came back from this year’s event a few minutes ago, and I wanted to discuss it.

First and foremost: Man. It’s really, really tough. People walk around with shirts and team shirts and mottos and anti-suicide tattoos and teams of people and you just feel their pain. There are sweet dogs everywhere.

I always have a tough time – particularly during the Honor Bead ceremony, where you introduce family members and attempt survivors – and that just breaks you. You read these stories out loud of people with life and love and potential, and they are gone. This year, I had the honor of reading the Honor Bead ceremony with Congresswoman Susan Wild, someone I’m proud to call a friend. As many of you likely read, Congresswoman Wild lost her long-term partner, Kerry, to suicide, and has lead a very public fight for suicide prevention and mental illness. I cannot imagine how hard it was for her.

And I’m not gonna lie, I feel terrible feeling emotional. I’ve struggled with depression, and I have been suicidal, but I’ve never attempted suicide. I’ve lost people I’ve known, but never a dear friend or someone I love. And you walk around this event – people come with shirts and signs of their loved ones – and you can’t even imagine their pain.

Please understand, I am not looking for comfort here. I get why it’s hard. I just don’t think my pain compares to those who walk for someone they love. And I don’t expect it to, either.

The one story I don’t think I’ll ever forget was this:

That…yeah. It was hard.

Here’s the dichotomy of the event though, and I suppose it’s more a reflection on the dichotomy of the human experience. It was still, for all the sadness and grief, a beautiful event.

First of all, they raised over $115,000. YAY!!! Oh, you can go here to donate. And you should.

Second of all. It’s not all sadness. It was stories of hope. People who survived and turned their life around. An army vet who survived addiction and multiple attempts to stand on that stage in honor of the 22 veterans who die by suicide every single day. People who walk to remember, and who find each other. I kept watching people talk to Congresswoman Wild and say thank you. But there was a real feeling of community there.

As I said in my brief remarks, everyone who attended and walked was brave. We all know what a prominent issue suicide is: 47,000 died in 2017, and more than 1.4 million attempts. And yet, still. Silence and stigma. Every step that was taken, every dollar raised – that’s a little crack in the darkness. I’ll take that.

So, despite the sadness and pain of an event like this, you have to find hope. It can be a struggle. It can be emotionally and physically draining. But it was such a beautiful event to participate in. People found hope, found each other. And found an awful lot of puppies. Seriously, that really helped. The puppies.

I won’t lie and say I’m fine – it was a hard event to run. Speaking personally, there’s a sense of burden there. You want to do the best job you can, and you want to let people know that those of us in power are listening. And that we share their pain and want to help alleviate it.

As always, thanks for reading. Please leave any thoughts below!

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.

How To Support A Friend Who Lost Someone To Suicide

It goes without saying that when someone you care about loses a person they love to suicide, you want to do everything you can to support that person. That being said, survivors of suicide loss endure an array of emotions: Guilt and loss, fear and anger, confusion and resentment.

During that experience, you want to do whatever is necessary to help your friend through their trauma. But you want to do so in a way which is most supportive of them and respects their complex emotional needs.

That’s a tough balancing act. On one hand, you want to be there for them – checking in on them, calling/texting, asking if they need anything. On the other the loss can be exceptionally painful, and you want to respect the other person’s space while still making sure they know you’re there.

Walking that line can be difficult. Here are some tips on how to do it.

1) Have realistic expectations: Your friend is undergoing the worst trauma and pain of their life. You cannot make it all better. All you can do is be supportive and caring. Make sure you remember that in all of your interactions with your friend. When my friend lost her husband, I gave myself two goals: Be there for her, and make her laugh with the occasional terrible joke. If you can make a wounded person smile, even for a moment, you’ve done a good deed.

2) Check for professional advice: The American Foundation for Suicide Prevention has a great blog entry on how you can support someone who suffers a suicide loss, and their tips are extremely valuable. Among their advice: Be patient, don’t attempt to empathize (unless you’ve been through a suicide) and read up on suicide loss. Alternatively, if you have access to one, check with a therapist or other professional to get guidance about how to best approach the situation.

3) Follow their lead: The “how” of talking to someone who lost someone to suicide can be difficult. Follow their lead. If they look like they are looking for humor, engage. If they don’t want to talk, but appreciate your calls, tell them about your day. If they are too depressed to move, wrap an arm around them, bake them a cake and watch TV with them. Take your lead from the person in question and understand how emotionally volatile of a time it is for them.

4) Be explicit with your friend: “I will text you every day to say hello, see how you are doing, and ask if you need anything. If you want me to stop, say the word and I will.” Tell your friend anything and everything you are prepared to do. Be specific: Offer to cook meals or do the laundry. Just make sure the person knows you are there. Even if they don’t seem like they appreciate it, I bet they do.

5) Don’t ask questions: “How did they die? Was it suicide? Were they depressed?” It’s a human impulse, but the answer is absolutely, positively none of your damn business, unless your friend decides to tell you what’s happening. Then, and only then, is it appropriate to ask questions, and even then, use restraint and caution. Remember, your goal is to alleviate your friend’s pain, not get your own curiosity satisfied.

6) Don’t spread rumors: Shut. Up. Keep what you learn in confidence. Don’t discuss anything you haven’t been specifically cleared to discuss. In some cases, your friend may want other people to know. In others, they may desire privacy. Whatever your friend wants, respect it. Remember, it’s not your story to tell.

7) Check with people closer: If you’re confused about how to behave – should you call/text, do they want flowers, should you cook a meal, etc – check in with someone closer. There may be closer friends or family in a less emotionally fragile state, and if that’s the case, you can get some additional guidance. When my friend lost her husband, I texted her best friend to ask if it was alright for me to be regularly texting and checking in. The friend confirmed, and I continued.

8) Don’t stop when the immediate crisis is over: In the immediate aftermath of a suicide, the world swarms. Then the funeral happens, and too many people forget. Don’t be that person. The wounds will last a lifetime – don’t let go of your friend. Don’t stop checking in. The pain will remain – make sure your support does as well.

For those of you with additional experience in this realm, I really welcome your feedback for all of us. If you’ve endured such a loss, what did your friends do right? What did they do wrong? What did you want the world to know that they didn’t?

Thanks for reading. I hope if was helpful.

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.