Five horrifying statistics about suicide today

As I wrote earlier this week, we’re in a bad way when it comes to suicide as a nation. Suicide rates are rising – badly – and we need to do more to address this ongoing crisis.

We need to have a better understanding about where we are at when it comes to suicide as a country. To that end, here are five things you should know about suicide in America, 2019.

Suicide rates are at near fifty year highs. After hitting lows in the late 1990s, suicide rates began to climb again. They are now at rates which haven’t been seen in fifty years, and have increased 33% since they hit their lowest point in 1999. More than 47,000 Americans died by suicide in 2017, making suicide the 11th leading cause of death in the United States. The number is so high that it has actually begun to drag down the average life expectancy of Americans.

Gun ownership and suicide rates are directly related. This isn’t to say that gun owners are more likely to kill themselves, but it does show a direct relation between the means of suicide and actual suicides. One study revealed that suicide rates are higher in states with high rates of gun ownership, and lower in states with lower rates. Another showed that firearms account for roughly half of all suicide deaths.

For every completed suicide, there are twenty-five attempts.

Women are more likely to attempt suicide, but men are more likely to complete it. This is, in part, due to the method by which each gender typically attempts suicide. Women are more likely to attempt suicide by drug overdoses and other less violent means, giving rescuers a greater opportunity to reverse suicide attempts. Men are more likely to use firearms and asphyxiation related methods, which are typically harder to reverse.

Suicide rates are highest in the Mountain West states, and lowest in the Mid Atlantic. According to the CDC, the states with the highest suicide rates are Montana, Alaska, Wyoming, New Mexico and Idaho. States with the lowest rates are New York, New Jersey, Massachusetts, Maryland and California.

If you are looking for more information about suicide, I highly recommend you visit the American Foundation for Suicide Prevention’s website. After all, the only way to stop a problem is to fully understand it.

Suicide rates are rising in girls – with the highest rise among ages 10-14

I guess I should warn you ahead of time, but this entry has some absolutely brutal statistics. For those who may be disturbed by such content, please note that the following blog entry will review information on suicide, including methods.

A new study which appeared in JAMA examined whether or not the gap between suicide in boys and girls was narrowing. Broadly speaking, while women are more likely to attempt suicide, men are more likely to complete it. This is for a variety of reasons, but the most obvious one is that men typically use more violent means to commit suicide, and are thus less likely to be saved by medical professionals.

The results of the JAMA study were disturbing. It examined 85,051 suicides of children and teenagers, ages 10-19, between 1975 and 2016. The most painful result:

Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years

From the conclusion of the study:

A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.

Further examination of the data reveals that the rate at which women were using hanging and suffocation for suicide were approaching the same rates as men. In other words, girls are starting to use more lethal means to kill themselves, a highly disturbing trend, and one that will lead to additional deaths.

A key and tragic consideration to keep in mind when it comes to suicides is that, for every death by suicide, there are an estimated 25 attempts. A rise in use of more lethal means of suicides means that more suicide attempts will result in death.

To put the above statistic another way: If every suicide attempt led to a death, we’d lose approximately 1,175,000 people every year.

Unfortunately, none of this information is all that surprising, though it is deeply disturbing to know that more 10 year olds are killing themselves at accelerating rates. A study which came out last months showed that the number of children going to the emergency room doubled between 2007-2015. Suicide is the 2nd leading cause of death of 15-34 year olds in America, and rates of mental illness are rising among young adults faster than any other age group.

Clearly, our young people are under more pressure than ever before, and clearly, we are failing them if we don’t do a better of job of addressing this crisis.

Back to the study above. One of the things I’d like to focus on – at least when it comes to trying to reduce this gap – is means reduction. If young girls are starting to use more violent means for suicide, we must do a better job of determining why, and what, if anything, we can do about it. There are public policy options when it comes to guns, but I’m not sure what you can do, if anything, when it comes to suffocation or hanging.

We have to do something. The only way to guarantee failure is not try anything.

Report: Netflix’s 13 Reasons Why tied to rise in suicides

13 Reasons Why started as a book and then made it’s way to a Netflix series. From the summary:

Clay Jensen returns home from school to find a strange package with his name on it lying on his porch. Inside he discovers several cassette tapes recorded by Hannah Baker—his classmate and crush—who committed suicide two weeks earlier. Hannah’s voice tells him that there are thirteen reasons why she decided to end her life. Clay is one of them. If he listens, he’ll find out why.

Clay spends the night crisscrossing his town with Hannah as his guide. He becomes a firsthand witness to Hannah’s pain, and as he follows Hannah’s recorded words throughout his town, what he discovers changes his life forever.

The series on Netflix generated no shortage of controversy when it graphically depicted the suicide of Hannah. At the time, there was concern that the depiction of suicide may encourage other vulnerable young adults to do the same.

A new report suggests those fears were well founded.

The brutal findings, courtesy of a study conducted by the Journal of the American Academy of Child and Adolescent Psychiatry:

The Netflix show “13 Reasons Why” was associated with a 28.9% increase in suicide rates among U.S. youth ages 10-17 in the month (April 2017) following the shows release, after accounting for ongoing trends in suicide rates, according to a study published today in Journal of the American Academy of Child and Adolescent Psychiatry…The number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period examined by the researchers.

The study notes that suicide rates spiked during the promotion for 13 Reasons Why and in the aftermath of its immediate release, and spiked particularly among young males. Homicide rates – which are influenced by similar cultural and sociological factors – did not show a spike during the same time.

As this Vox article notes, this increase is likely tied to the concept of suicide contagion – the idea that one suicide will encourage more. At least one suicide expert advised Netflix not to release the show:

His fears sprang from the problem of suicide contagion, which is what it’s called when media attention focused on one prominent suicide leads other people who are struggling with suicidal ideation to try to kill themselves. It’s a danger that young people are especially vulnerable to.

To be fair, there are certain concerns with the conclusion of this study. This includes the it’s design (which makes it impossible to rule out other sources) and the fact that boys drove the rise in suicide (girls would have been more expected, given the fact that the lead character is a girl).

This tragic result reiterates an important point: The media and entertainment industries have a moral obligation to be careful with how they discuss and depict suicide.  ReportingOnSuicde.org gives some helpful advice. These include:

  • Avoid glamorizing the death, sensational headlines and showing pictures of grieving and weeping families.
  • Describing the suicide as sudden or “without warning.”
  • Treating suicide as any other crime.
  • Showing or describing the method of death in graphic detail.
  • Using appropriate language, including “died by suicide,” “completed” or “killed himself” INSTEAD of “successful/unsuccessful.”

I never watched 13 Reasons Why, but from what I have read, the show’s depiction of Hannah’s suicide violates all of these rules.

Between the research already done and the study which came out last week, it’s clear that 13 Reasons Why is contributing to an ongoing massive spike in suicide rates – and one that is particularly acute among young adults.

The show should be pulled off the air.

Religion and suicide

About two weeks ago, I was able to participate in a Jewish Federation event on mental health and stigma. The participants included myself, a psychologist, the head of our local NAMI Chapter and a Rabbi. Much of the information I heard during this presentation was things that I had heard before, but the newest perspective actually came from the Rabbi, who discussed what happens with Jews who do die by suicide.

Apparently, in Judaism (like many other religions), a strict interpretation of suicide views the action as a major sin, and those Jews should not be buried in a Jewish cemetery. Thankfully, this Rabbi believes (like many others) that those who do die by suicide are clearly ill at the time of their death; thus, they should not be “punished” for that action and should be allowed to be buried in a Jewish cemetery.

This entire conversation had me thinking about suicide and religion. Are there differences in suicide rates by religion? What about those with no religion – do they have higher or lower suicide rates? How can religion help or hurt someone’s mental health?

The relationship, as best I can tell, is complicated. According to a 2016 study on the subject:

We found that past suicide attempts were more common among depressed patients with a religious affiliation (OR 2.25, p=.007). Suicide ideation was greater among depressed patients who considered religion more important (Coeff. 1.18, p=.026), and those who attended services more frequently (Coeff. 1.99, p=.001). We conclude that the relationship between religion and suicide risk factors is complex, and can vary among different patient populations.

This study would obviously suggest that religion and suicide are positively correlated. But, as a 2017 article from the American Sociological Association notes, the real relationship is more complicated – and that largely depends on where in the world you are discussing:

A Michigan State University sociologist reports in The Journal of Health and Social Behavior that religious participation affects suicide rates differently around the world, and in Latin America particularly, high religious involvement is associated with low suicide rates.

In contrast, in East Asia, where residents are reportedly more secular, higher levels of religious involvement are connected to higher suicide rates. A one percent increase in religious participation is associated with a one percent increase in suicide rates in East Asia.

Statistics for the United States generally follow with the statistics for Latin America, although the link between religious participation and low suicide rates is not as pronounced in the United States.

An interesting 2017 article from the Huffington Post makes a similar argument but from a reverse perspective: That it is atheists, not religiously affiliated people, who have a “suicide problem.”

When I started this entry, I was curious to see what religions have higher or lower rates of suicide. I now see that it’s not that simple. Religion and suicide are related, and that makes sense, of course. On one hand, religion can give people additional joy, purpose and value. Fear of divine punishment can also serve as a powerful motivator to keep people from killing themselves. However, religion can also alter perspectives and force negative value judgments.

My conclusion: The relationship between religion and suicide is complicated and depends on a variety of factors.

As always, let us know what you have to say in the comments below!

No, you cannot “implant” the idea of suicide

One of the great myths of suicide is that you shouldn’t talk about it with someone (particularly younger people) because doing so may somehow “implant” the idea of killing oneself into someone’s head. That’s categorically, unquestionably not true, and I wanted to take a moment to discuss the idea.

The idea that we can unintentionally encourage suicide by discussing it is a frightening prospect because it leaves us powerless. One of the things that many mental health advocates say (and this certainly includes me!) is that we must discuss suicide and mental health. However, there is a persistent fear that discussing suicide may cause someone to consider attempting the act.

There’s good news though: It’s just not true.

There is ample evidence to back up the notion that discussion of suicide doesn’t increase suicidal ideation or attempts; indeed, thankfully, the opposite is true. According to a 2014 review on just this subject:

None [of the studies reviewed] found a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts. Our findings suggest acknowledging and talking about suicide may in fact reduce, rather than increase suicidal ideation, and may lead to improvements in mental health in treatment-seeking populations. Recurring ethical concerns about asking about suicidality could be relaxed to encourage and improve research into suicidal ideation and related behaviours without negatively affecting the well-being of participants.

This is great news, particularly for anti-suicide and mental health programs, as it means that you can talk about suicide without supposedly putting the idea of suicide into someone’s head.

That doesn’t mean, of course, that suicide and mental health can just be discussed in a willy-nilly sort of way; there must be specific guidelines to these conversations.

According to this article from Psychology Today, these conversations can range from casual to serious. Addressing the issue is important, but it doesn’t have to be done in an ultra-serious way. Asking your child about high-profile suicides in the news, asking their thoughts, inquiring about their feelings and state of mind – these are all positive ways of addressing the subject.

The article also does a good job of explaining what to do if someone you know or love says that they have had thoughts of suicide. It notes that many of us have had those thoughts at some point, and that isn’t inherently dangerous. What is dangerous is if these thoughts are persistent, overwhelming or come with specific plans. That’s when more action may be needed.

So, the summary is this: Talk about suicide with your children or others you care about. Do so in a way that is factual and avoids glamourizing the issue, but in a caring and supportive way. This will not encourage the idea of suicide – indeed, it will help prevent it.

It’s important that we have these conversations with people we love, and do so without fear of “implanting” the idea of suicide. This goes for schools, parents – really, all of us.

The Parkland tragedy continues, as two survivors kill themselves

Originally, this entry focused on Sydney Aiello’s tragic suicide. I finished it early Sunday morning. And by Sunday afternoon, came to the tragic realization that it needed to be updated.

First: Parkland survivor Sydney Aiello died by suicide last week. The young teenager had survived the massacre at Stoneman Douglass High School, which claimed 17 lives.

According to Sydney’s mother, Sydney “struggled with survivor’s guilt and was diagnosed with post-traumatic stress disorder in the year following the tragedy. And while she reportedly never asked for help, she struggled to attend college classes because she was scared of being in a classroom.”

Like all Stoneman students, Sydney was affected by the tragedy. Like far too many, she lost a friend:

Sydney Aiello & Meadow Pollack

Sydney lost her “longtime friend,” Meadow Pollack, in the shooting.

Next: The second victim. On Sunday afternoon, news broke that a second Parkland survivor had killed themselves. It was a sophomore male, and he, like Sydney, shot himself. As I type this entry, much is unknown about this student, including his name. Unfortunately, the notion of a suicide contagion effect is very, very real – and it is highly possible that this is what we are witnessing here.

The ugly truth is that a trauma never ends when the bullets stop firing. There are always long-term after effects. According to a 2018 survey:

  • Nearly 22% of people who had been raped had also attempted suicide at some point in their life.

  • Approximately 23% of people who had experienced a physical assault had also attempted suicide at some point in their life.

  • These rates of suicide attempts increased considerably among people who had experienced multiple incidents of sexual (42.9%) or physical assault (73.5%). They also found that a history of sexual molestation, physical abuse as a child, and neglect as a child were associated with high rates of suicide attempts (17.4% to 23.9%)

  • People with a diagnosis of PTSD are also at greater risk to attempt suicide. Among people who have had a diagnosis of PTSD at some point in their lifetime, approximately 27% have also attempted suicide.

There is no easy, glib solutions here, but there are ways to mitigate suicide risk after a traumatic event. The American Psychiatric Association lists a few helpful ways to deal with a traumatic event, including:

  1. Keeping informed but avoiding over-saturation with an event.
  2. Learning about local resources and sharing that information.
  3. Remembering that you are not alone and talking with family and friends about your experiences.
  4. Remembering that anxiety and depression after an event are normal, and seeking help if this continue or if you become overwhelmed.

There is, as always, a relatively standard thread here: If you endure a traumatic event, seek help. You are not alone, you are not weak or foolish, and you didn’t deserve whatever happened to you. Therapy – or even just talking to someone – can make a powerful difference.

I have a tendency with these blog entries to take smaller events and turn them into larger points. That’s a conscious decision informed by my experience with mental illness. But I want to conclude this entry by making sure we don’t lose sight of Sydney Aiello or the second student, name currently unknown.

It goes without saying: Sydney and others affected by Parkland didn’t deserve what happened to them. It’s a human tragedy. But Sydney and her classmates spent much of their time after the shooting advocating for a better world. I hope that some good comes of this tragedy, and I hope it is done, at least in part, in memory of Sydney, this second student, and all those affected by this tragedy.

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.

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!

An in-depth look at worldwide suicide

The Economist has an absolutely fascinating and thought provoking look at suicide trends across the world. The most interesting item in the article is the graph above, which shows two things. First, suicide worldwide is declining. Second, the United States is the exception – we’re the only place in the western world where suicide is increasing, which is terribly upsetting.

The article is well worth reading, but it is a long one. I’ll try to summarize some of the trends it notes.

First, and most importantly: Suicide rates are down 38% from 1994. That’s fantastic news. But, of course, those decreases haven’t occurred evenly across all subgroups.

In China and India, significantly less women are killing themselves. This is attributed to public policy changes – and changes in culture – which have given women more freedom and independence. As gender norms have changed, women have gained more control over their lives, thus leading to lowered suicide rates. In other words, gender equality can save lives.

Increased urbanization is helping with this as well, as rural suicide rates are higher than urban ones – a trend which seems to be relatively constant across the word.

In Russia, cultural and political changes contributed to massive spike in suicides among middle aged men. That number, though still high when compared to the rest of the world, is now at half of its peak in the 1990s. This is attributable to a few things. First, the article notes that men have learned how to live in Russia’s new society and economy, having more success at getting a job and earning a living. Unemployment and economic upheaval leads to suicide, so as more men get jobs, they are less likely to kill themselves, and this is a constant across the world, in all cultures.

Additionally, studies have noted that suicide rates are tied with health care access. In countries where the unemployed still had access to health care, suicide rates did not increase during recessions – something that was not true in countries where health care was harder to come by.

Alcohol is also linked to suicide – alcohol consumption and suicide rates move together, though the article was unclear about whether or not one caused the other or a third factor moved both.

Suicide rates are higher among the elderly than they are the young or middle-aged population. As health care and poverty improves among this group, suicide rates fall.

The article also notes that means reduction – be it with guns, poison or gas – can have a major effect on suicides. The impulse to kill oneself is often fleeting, and reducing access to deadly weapons can absolutely reduce suicides.

What are the broad, global conclusions of this article? The one thing that I get out of it – more than anything else – is that public policy can have a major, major impact on suicide. Efforts to enhance economic security, increase access to health care, spread economic freedom and enhance gender equality plays a big role in reducing suicides. These are important factors which must be taken into account for any mental health conversation.

A mental health hero: Jason Kander

Last week, a brave politician made national news by dropping out of a high profile Mayoral race. That man is Jason Kander, and he’s someone worthy of our attention and praise.

Kander is the former Missouri Secretary of State. In 2016, he ran for the U.S. Senate as a Democrat, and in a tough year for Democrats, he came within three points of defeating incumbent Senator Roy Blunt. Kander ran an amazing campaign and aired one of the best ads of 2016, in which he talked about his army background and support for universal background checks while assembling a gun…blindfolded.

Kander’s military story is equally impressive: He volunteered for the Missouri and volunteered for a tour in Afghanistan in 2005, serving as an intellegence officer.

Kander’s political star was on the rise, and until last week, Kander was a candidate for Mayor in Kansas City. That changed with this heartbreaking note, in which Kander discussed his battle with depression, PTSD and suicidal ideation:

About four months ago, I contacted the VA to get help. It had been about 11 years since I left Afghanistan as an Army Intelligence Officer, and my tour over there still impacted me every day. So many men and women who served our country did so much more than me and were in so much more danger than I was on my four-month tour. I can’t have PTSD, I told myself, because I didn’t earn it.

But, on some level, I knew something was deeply wrong, and that it hadn’t felt that way before my deployment. After 11 years of this, I finally took a step toward dealing with it, but I didn’t step far enough.

I went online and filled out the VA forms, but I left boxes unchecked — too scared to acknowledge my true symptoms. I knew I needed help and yet I still stopped short. I was afraid of the stigma. I was thinking about what it could mean for my political future if someone found out.

Kander dropped out of the race and has since been silent on social media. I assume – and sincerely hope – he is getting the care he needs and deserves.

Broadly speaking, the stats on veterans, mental health and suicide are horrifying:

  • According to a 2014 report by the Department of Defense, there were 1,080 suicide attempts (245 suicides) among active-duty service members for all armed services in calendar year 2013.

  • A recent study of 52,780 active-duty members of the U.S. Air Force found that 3 percent of male participants and 5.2 percent of female participants reported suicidal ideation in the previous year. Of the participants that reported suicidal ideation, 8.7 percent also reported a recent suicide attempt.

  • Veterans who screened positive for PTSD were 4 times more likely to report suicidal ideation than veterans who did not, and the likelihood of suicidalideation was 5.7 times greater in veterans who screened positive for PTSD and two or more comorbid disorders.

Those who take care of us – our first responders and military veterans – deserve better. And I sincerely hope that Kander’s story helps to push this issue.

It takes people like Kander – national political rock stars – discuss their pain, to destigmatize an issue, and to help more people get help. I can only imagine how many veterans are looking at Kander and thinking, “Me, too,” and then hopefully getting the help they need. Kander’s words will have a larger impact than I think most of us could ever hope to have.

Most importantly, best wishes to Kander. I cannot imagine what demons he faces – what pain he took on – in the name of protecting America. He, and countless other veterans and first responders – deserve our love, and our resources, to heal. I am so grateful to all of them for their bravery.