Suicide is never “gotta set myself free” – a letter to Epic Rap Battles and a discussion on how we talk about suicide

Sunday entry instead of a Monday one, but it’s an important and timely one.

If you are a nerd like me, and you’ve spent any time on YouTube, chances are you have come across Epic Rap Battles of History. They are a YouTube channel which hosts rap battles between historical or celebrity figures. They lampoon everyone, and they are so, so clever and funny. I’ve always loved them and get excited when they publish a new video.

Early this morning, they premiered their latest battle between George Carlin and Richard Pryor. The battle, as usual, was hilarious. This one featured guest appearances be Joan Rivers and Robin Williams. Williams appears last, and it’s his last line which causes the problem:

Again, that last verse:

“I love the prince
but you’ll never have a friend like me
Thanks folks that’s my time
Gotta set myself free”

And Williams disappears into the top of the screen.

That last line is clearly a reference to William’s suicide in August 2014. And that line is a huge problem. Suicide should never, ever be discussed as a freeing option, one which somehow frees people from the bonds of pain and life. Suicide is not an option. Discussing it as a positive thing frames it in a positive way, and that encourages others to look at suicide as if it should be considered.

Some of you may remember that this isn’t the first time that William’s suicide was displayed this exact way, using the same language (which is a reference to both the suicide itself and Genie’s desire to be free in Aladdin). After William’s suicide, The Academy of Motion Picture Arts and Sciences put out this tweet:

The tweet was criticized by suicide prevention activists. It made suicide appear celebratory, a victory over depression and pain, and a viable option for anyone who hurts. This can never, ever be the case.

From the article:

  • Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention: “If it doesn’t cross the line, it comes very, very close to it. Suicide should never be presented as an option. That’s a formula for potential contagion.”
  • Ged Flynn, chief executive of the charity Papyrus: I am particularly concerned that use of the ‘Genie, you’re free’ tweet could be seen as validation for vulnerable young people that suicide is an option.”
  • Jane Powell, director of the support group Calm, “We all want Robin to be in a happier place but it’s not a good message for people feeling suicidal, because we want them to stay with us and not go find some starry night escape with genies,” she said.

This is needed largely because suicide contagions are real: After William’s suicide, suicides increased by 10%. And, as the study I linked to notes, media coverage of suicide can be critical to how the coverage of suicide influences suicidiality in others. There are media recommendations for how to cover suicide (I actually tweeted it yesterday, before this video, in reference to an ongoing situation in my home region which thankfully ended well).

One of the key recommendations is not to glamorize suicide or present it as an option. The media has failed that before: Epic Rap Battles failed it here. Do I think they did this on purpose? No, absolutely not. I think it’s an honest mistake. But I hope it’s one they correct.

Again, here are the facts:

  • In 2017, over 47,000 Americans took their own life. These are the highest rates of suicide since World War 2.
  • Suicide is the 10th leading cause of death in the United States, and the 2nd leading cause of death for 10-24 year-olds.
  • Suicide rates have increased 33% since 1999.

We have an epidemic, or, in the words of Congersswoman Susan Wild (D-PA), a national emergency. National emergencies require being addressed on all fronts. One of those is cultural and communication. No one with a platform over over fourteen million subscribers should make such a casual reference to suicide and describe it as “gotta set myself free.” I’m hoping this was unintentional. And I hope that ERB will consider changing the video.

And to everyone else: Please watch how you discuss suicide. Please take it seriously. And please use person-first language which ensures that we let people know they are loved and cared for, and that we never, ever, ever want them to “set themselves free.”

4 Quick Tips to Break You Out Of Your Funk

My wife and I spent a lot of time this summer at the our local parks. We’re lucky – we live in Allentown, and we have this ridiculous park system. One of the closest to our house – and the largest – is Trexler Park, a gorgeous park with a lake, ample green space and a few paths. Every night last week, we’ve grabbed the kids and hopped down to Trexler. It’s been wonderful.

And I always feel better when we get back.

Look, one of the many problems with depression is that it totally locks you in. You do the same things because you simply do not have the time or mental energy to do anything else. That, of course, can only lead to more depression issues, and that’s something which you have to try and break if you’re ever going to make a recovery.

There are ways, however. The next time you feel stuck, consider doing any of these 5 activities.

Go to the park

Forget your troubles, try to forget everything. Go for a nice walk and lose yourself in nature.

Yes, this does help – and there’s research to prove it. It’s 8am on Sunday as I am writing this, and I just took the dog for a walk around my nearly deserted block. It felt so nice. The best way I can describe how I feel is more centered.

Volunteer at a nearby animal shelter

Our family just adopted a pupper again, and it’s been very nice so far. We took our time making the selection from the Lehigh County Humane Society, and one of the things which struck me when we were there was that they had a slew of volunteers walking in and out of that place, caring for the animals, taking them for walks, etc.

Look, puppies and kitties are more than just adorable: They help you fight depression. Combine that with the general mental health benefits of volunteering, and this one is well worth it. If you’re an animal person, go check out your local shelter and see what volunteer options there are.

Exercise

I’ve written about this one before so I am repeating myself, but exercise when you are depressed can be very beneficial, and again, there’s research to prove it. Depression is fundamentally biological, and exercise can change your biology and physiology, making you feel better.

Take care of yourself

When I think of myself in my most depressed state, it’s this: Covered in a hoodie, unshowered, hair uncombed and unshaven. Sound familiar? When you’re depressed, you lack the energy or mental strength to do even the most basic things, like take care of general hygiene. That, of course, is largely a mental trick, but it works both ways. Doing something small – even if it’s just brushing your teeth -can signal to your body that this is not where you want to be right now. So, to that end, when you’re down, make sure you take care of your body. Do the basics – shave and comb your hair. If you don’t think you have strength for that, try something small – take a warm shower. Try to fool your body into thinking you are okay – and then look the part.

These are four things which work for me and others, but they may not for you. What does work for you? Let us know in the comments!

 

An in-depth look at America’s suicide numbers

This Bloomberg story came out about two weeks ago and reviewed America’s rising suicide numbers. It’s findings, as you can imagine, are damning. Some of the salient points:

  • In 2017, 47,000 people died by suicide – and 1.4 million made attempts.
  • From 2000-2006, the suicide rate increased by 1% annually. From 2006-2016, that increased to 2%.
  • Life expectancy has fallen for three straight years – the first three consecutive year drop since 1915-1918.
  • Suicide is the 2nd leading cause of death for 10-34 year-olds.
  • Suicides cost U.S. businesses between $80-100 billion annually.
  • A lack of resources is to blame for many of these issues. According to some experts, the United States needs 50 mental health beds for every 100,000 people – but some states have numbers as low as 5 per 100,000.

The article goes on to say something I’ve discussed in the past – part of the intractability of our mental health and suicide crisis is the intertwined nature of the problems. Health care, genetics, finances, social support, culture – they all interact to influence mental health. As the article notes, combine that with a rapidly changing economy, advances in technology and a changing cultural scene, and you have a recipe for the disaster we’re currently experiencing.

Mental Health parity (reimbursing physical and behavioral health care at the same rates) and a lack of doctors play a role as well. As recent court cases have noted, many insurers still aren’t adequately reimbursing for mental health services, or they are resorting to alternative methods (such as steering patients to doctors who are no longer even in their network) in order to keep people out of treatment.

The story also noted that changing the way we gather data could lead to additional insights which may result in better treatment of mental health disorders: In 2010, England started measuring overall life satisfaction and recently created a “Minister of Loneliness.”

So, what’s the conclusion of this article? Besides “holy crap this is bad”?

I think I’m gonna be repeating myself a bit here. But the conclusion is that addressing suicide for real will require a huge investment of resources and an acknowledgement that it’s more than just mental health. We have to address insurance and fiscal policies. Create a culture which is more accepting of mental health challenges. Understand that the challenges of mental health are comprehensive ones which tie a variety of areas together.

And I think we have to be willing to pay. For care. For insurance access. For bed space in the event that there are emergencies.

I hated reading this article because it was painful. But we need to know the truth about mental illnesses. And the truth is that this problem will take a long, long time to fully address.

 

The importance of inclusion – for everyone

I caught this article on Facebook the other day – it’s results caught me by surprise (to an extent) but it has a key finding that I really wanted to go over.

In 2014, the University of British Columbia examined the connection between suicide rates and having a Gay-Straight Alliance at High Schools in Canada. The results showed that students were less likely to feel discrimination, experienced lower suicidal thoughts, and have lower rates of suicide attempts.

Just gay students, right?

Wrong. All students.

This is a pretty striking finding. Not only are GSAs positively related to the mental health of gay students, but if the findings of this study are correct, they can also positively impact the mental health of students whose lives would (theoretically) not be impacted directly by the Gay-Straight Alliance.

This is great for many reasons. First, as I discussed last week, LGBT Americans sadly have significantly higher rates of a slew of negative mental illnesses, including suicide. Clubs like GSAs can provide safe places for LGBT teens to congregate, build vitally necessary social relationships and learn they aren’t alone. All of these are mitigating factors against mental illness and suicide.

Intuitively, this makes sense. But the finding that I think is more worth examining is why GSAs are potentially tied to lower suicide rates in heterosexuals. First, a disclaimer: It is worth noting that this study is correlational, not causational. In other words, while lower suicide rates and GSAs appear to be related, the lower suicide rates may not be a direct result of GSAs. Indeed, it is possible that there are more GSAs because of lower suicide rates, or that a third factor (such ass wealth of a school district, education attainment of parents, etc) is tied to both GSAs and lower suicide rates.

However, the fact that both of these items seem related (regardless of the relationship) begs the question: What is the relationship between a more tolerant society for everyone, not just the directly affected groups?

This is one worth thinking about, because it can help change the frame of how we view ideals like inclusion an tolerance. We often have conversations about how they can positively impact effected groups – how marriage equality leads to better lives for LGBT individuals, how a lack of racism can improve the lives of impacted groups, etc.

But I want to change that perspective for a second.

I certainly think I’m not a racist person, and I can’t imagine what it is like to be that way. Being racist means you walk around which large chunks of anger, bitterness and resentment inside you all the time. Doesn’t that lead to higher levels of depression, of anxiety, and self-destructive behaviors?

That’s what I want to know. And it makes me wonder if more studies like this aren’t available – ones which show that a more tolerant and more inclusive society is better for everyone, not just affected groups.

As always, I’d love to hear your thoughts, your experience and if more research is available which proves or disproves this theory. Please let us know what you think in the comments below!

 

The disproportionally high levels of suicide among (some) minority groups

It’s been written repeatedly, and it’s true: One of the most likely demographic to die by suicide are middle aged, white men. But, as a recent report in USA Today helps illuminate, we shouldn’t confuse this reality with the notion that white men are the most at risk – or that other groups don’t need very real assistance.

USA Today’s story, which was published earlier in the week, came with this stark headline: Suicide Rate for Native American Women is up 139%. Native American and Alaska Natives have a suicide rate 3.5 times higher than the lowest group – an astonishingly high number.

The story highlights a very, very ugly truth: In mental health – just like in health care generally speaking, unfortunately – minority communities have it worse. But, in the case of suicides, not every minority community is this way. For example, suicide rates among African Americans and Pacific Islanders have increased, but remain roughly half the rate of suicides as whites, according to the American Foundation for Suicide Prevention:

suicideRatesByEthnicity.png

Meanwhile, according to the Suicide Prevention Resource Center, rates of suicides among Hispanics also remain far below the United States average, with Hispanics dying by suicide at a rate of slightly more than half of the rest of the United States population.

This is good news, of course, and a very rare bit of good news when it comes to health care for black and Hispanic communities. What drives these rates lower? There are many theories, primarily the idea that strong family and community support provide a degree of resilience not available in other cultures, as well as the idea that self esteem and religiosity rates are higher among African Americans.

All of these factors may tie into why other minority groups have higher rates of suicide. LGBT community members are three times more likely to die by suicide. On average, LGBT members as well as Native Americans, have lower levels of self esteem, community support and family bonds.

In total: The minority suicide rates are not what they would reflexively seem to be. That’s something for all of us to keep in mind as we deal with public policy and suicide.

Why you should take Mental Health First Aid

I’ve been over the numbers more times than I care to think about: Roughly one in five Americans actively suffer from some sort of mental illness. Statistically speaking, every time you are in a room with five people, at least one of them is in the middle of some sort of mental health challenge.

That, in my mind, means all of us have to do a better job of being able to help care for our friends who are in pain or undergoing an acute mental health crisis. I’d argue to also means you should investigate taking a Mental Health First Aid class.

What is Mental Health First Aid?

Mental Health First Aid is a formal program, run by the National Council for Behavioral Health. According to its website, Mental Health First Aid “teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders in your community.”

The website wants to make Mental Health First Aid “as common as CPR.” And that’s a great idea, and a necessary one.

What does the course involve?

Per the website, Mental Health First Aid will teach participants “risk factors and warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and non-crisis situations, and where to turn for help.”

Mental Health First Aid covers a variety of topics, including depression, anxiety, trauma, psychosis and substance abuse orders, and how you, as a normal person, can help someone who is experiencing some sort of mental illness.

There are actually different course types for adults and youth, which can be very helpful for young people who want to learn how to do more.

Who should take it?

Anyone who interacts with people!

Yeah, okay, that might be a little broad. Narrowing the range a bit, I’d argue that this course should be taken by anyone who regularly interacts with people that may be experiencing some sort of mental health crisis. This includes social workers, teachers. customer service representatives and more.

Of course, it goes beyond that. If you have family or friends who suffer, and often find yourself feeling completely powerless, this course can help you learn the skills necessary to help your loved ones get through whatever they are experiencing.

Where can I find a course?

How convenient!

The course isn’t a small commitment – it’s usually around eight hours, so it requires some time. That being said, is it worth it? Yeah, I think so. All of us probably know what it’s like to have a friend who is in agony that we can’t touch. Mental Health First Aid can help people learn the tools necessary to get their friend or family member through that hard moment. For those of us who hate that helpless sensation, this can be a useful tool that will give us the power and skills to care. If that’s something you’re interested in, I’d say this is well worth it.

 

Does CBD help with depression or anxiety?

In 2018, Donald Trump signed the Farm Bill into law. Among other things, this piece of legislation made legal much of the sale of CBD and hemp, as well as research into this area. – This opens up an array of new potential research, but CBD may have a positive impact on depression and anxiety.

What’s CBD, you ask? First, what it’s not: Marijuana. It is not marijuana. CBD is short for cannabinoid oil, and it became legal to be sold after the 2018 Farm Bill was signed into law.

Specifically, CBD is extracted from hemp plants. It works be manipulating your Endocannibinoid System, a part of your body which regulates a variety of bodily functions, including, potentially, your mood.

Here’s an important point though: While some research has been done, more research is DESPERATELY needed in order to determine CBDs usefulness, effectiveness, proper dosages, long-term impact, etc. At the moment, it is not widely regulated by the FDA, though the FDA has sent out cease and desist letters to some companies which have falsely marketed benefits yet to be proven by research.

Indeed, as of yet, there is no formal regulation when it comes to CBDs marketing or ensuring the quality of ingredients. For example, a 2017 Penn State study surveyed 81 CBD products and found that 70% were mislabeled. As such, if you’re going to purchase CBD, your best bet is to ensure that the label notes it has been independently tested. This means that a product has been evaluated by a 3rd party, and that 3rd party has determined that’s it’s labeling is accurate.

Okay. Enough about the legal disclaimers and warnings. What does the research show?

According to one 2014 study, CBD and Marijuana may show anti-depressant like effects. That finding was replicated in 2018, when a study showed that CBD has “anxiolytic, antipsychotic and neuroprotective properties” and may be useful in fighting a slew of problems, including PTSD and depression.

There’s additional research available, but it does seem clear: There’s opportunity here.

While CBD is not marijuana, and will not get you high like marijuana, some forms of CBD (namely Full Spectrum CBD) do contain trace amounts of marijuana. As such, if you ingest this type of CBD, you may feel some effects. Furthermore, it is possible for Full Spectrum CBD to show up on a drug test – so DON’T TAKE IT if that’s an issue for you.

Furthermore, you should not take any CBD product without consulting with your Doctor or medical professional first. While common side effects of CBD are relatively minor, there can be more problematic impacts for people with Parkinson’s, liver issues, or pregnant/nursing women.

Now that we’ve gotten the warnings out of the way: Is their potential for people with mental illness and CBD? I’d say yes. Anecdotal evidence and some research seems to indicate the potential for relief. Again, more research is needed. Again, don’t do anything without talking to a Doctor or medical professional first. But, yes. More research is now being conducted, this area does prove promising.

 

“Deaths of despair”

I wrote last week about how the particularly sharp rise in suicide and mental illness among our youngest is particularly alarming, arguing it doesn’t bode well for our society if our youngest are becoming so sick so young.

USA Today ran a related story last week about a similar topic, making an argument which has been made repeatedly – that the rise of mental illness, suicides and drug overdoses are all tied to the same basic cause – they are “deaths of despair.” From the article:

“Drug-related deaths among people 18 to 34 soared 108% between 2007 and 2017, while alcohol deaths were up 69% and suicides increased 35%…The analysis of Centers for Disease Control and Prevention data found the increases for these three “deaths of despair” combined were higher than for Baby Boomers and senior citizens.

It’s also worth noting that mental illness, drug and alcohol deaths are higher in certain states than others, and within those states, higher in areas which are struggling economically and offer less hope for the future.

I’ve said it before, and I’ll say it again – the rise of mental illness and suicides goes deeper than brain function and chemistry. We now live in a society where young adults – and younger – are losing hope and increasingly turning to substance abuse to cope. This portends poorly for the future.

What’s the solution? Part of it, of course, has to involve dealing with mental health. As I’ve written about in the past, there is a critical need for more mental health practitioners, fairer insurance practices and targeted programs which seek to destroy mental health stigma. These are answers which I often gravitate towards, as they’re public policy related. They have been studied. There are best practices with answers that, while maybe not “concrete,” can reasonably be expected to make a difference in the problem.

The truth – the full solution – is far more complicated than that.

If we’re using phrases like “deaths of despair” in casual conversation, something is fundamentally broken in our society. We now have entire generations of young adults and kids who are growing up in a world that they simply cannot handle. It goes deeper than mental health, and while all the solutions above that I mentioned are real, they can only address a problem after it has arisen. The preferential way of dealing with deaths of despair is to stop someone from ever reaching that point.

What’s causing these deaths? My random musings, based on available research and the commentary of those far smarter than me: An economy which leaves too many Americans out in the cold, smothering student loan debt, an overwhelming degree of information which leads to a pervasive sense of hopelessness about current affairs and the state of our planet, technology which gives the illusion of connections while pulling us further apart, overwhelming demands on our limited time and resources, a lack of physical activity…I mean, where do you want to start or stop?

The whole concept behind “deaths of despair” are instructive in my mind, because they make it clear that depression is about so much more than mental health. It’s about the state of the family, the economy, the world, and we’re never going to be able to adequately get our arms around this problem without dealing with it holistically.

I wish I could answer in an upbeat way, but this concept is terrifying. We’re poisoning the well, and it’s up to all of us to try to change the universe in which we live to make it a better place, not just for ourselves, or for our family, but for everyone on this planet.

The Canary in the Coal Mine: Mental Illness in College Students

NPR has great article on the mental health “epidemic” in colleges, inspired by The Stressed Years of Their Lives by Dr. Anthony Rostain, which looks at the mental health crisis among college students.

College students, like other demographics, are seeing major increases in mental illnesses. Among the rather depressing (no pun intended) statistics:

  • 44% of college students report symptoms of depression, but 75% of those students do not seek help.
  • Suicide is the 3rd leading cause of death among college students.
  • 80% of students report that they feel stressed on a daily basis.
  • 9% contemplated suicide in the past year.

Why is this jump so acute among college students? In the NPR interview, Dr. Rostain notes that there are a variety of new stresses an impacts on college students today, including a post 9/11 world, the remnants of the great recession, the rise of social media, school shootings, etc. These have all led to an explosion in depression and anxiety, as has the increased pressures which college students face to succeed.

Speaking broadly, I think, unfortunately, that this rise in mental illness among college students is reflective of what is to come. We know that mental illness rates are rising across the board – but we also know that those increases are sharpest among young adults, and sharper still among the youngest of those surveyed.

This has potentially devastating implications as this generation continues to shift into the real world and the workplace. Combine this with the rapidly exploding shortage of mental health practitioners, and the unabated rise of suicides…and we’ve got a big problem. One which will dramatically effect all of our lives.

Fundamentally, I continue to believe that this is a problem which goes well beyond the boundaries of normal public policy. There are things we absolutely must do to expand treatment, access and affordability so that Americans can get the help they need and deserve, no question. But we have to ask ourselves the broader questions: What is causing this rise of depression and anxiety?

These are real issues, and important questions, and ones which must be addressed if we are ever to truly be able to reduce the rates of mental illness and stress which are so prevalent in modern society today. Do I have the answers? Hell no. But I know it’s a question we have to ask.

Bringing this back to where we started: We shouldn’t look at the rising rates of mental illness in college students as something which is occurring in isolation or among a generation which simply hasn’t entered the real world. Given the rise of mental illness across the board, and particularly among young adults, we have to acknowledge that rising mental illness rates in younger demographics has the potential to effect this entire world. What kind of pressures will my children face? Your grandchildren?

Pay attention to this one. It will effect all of us in the future.

 

The biggest reason it’s so hard to find a mental health practitioner

We don’t have enough of them.

As I run around in my real job discussing mental health, I consistently come back to this one central truth: The biggest issue in the area of mental health is that we simply do not have enough people to provide care, or who take Medicare or Medicaid. This means that, when you call a psychologist or psychiatrist, the most likely response is, “I’m sorry, but the Doctor is not accepting patients at this time.”

Consider this: According to a 2016 study, the supply of mental health practitioners by 2025 is expected to be 250,000 short. This disturbing trend is occurring despite the fact that rates of mental illness and suicide continue to increase, and increase alarmingly among the youngest members of our society.

Interestingly, the above article notes that a big part for the rise in demand of mental health practitioners has been a lessening of the stigma which surrounds mental health. As more people become more comfortable with seeking treatment, they put a greater strain on the need for mental health providers.

The problem is particularly bad in rural areas, where, according to this 2018 CNN article, “a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.” This shortage contributes to higher rates of mental illness, addiction, and suicide in rural communities. Indeed, it helps explain why rural areas typically have higher suicide rates than their urban counterparts.

So, what can we do about this?

I’d argue the biggest challenge is the need to increase mental health reimbursement rates, which are historically lower for mental health services. These low rates typically steer prospective doctors away from mental health specialties and into more lucrative practice areas like cardiology and oncology. Increasing these rates would help recruit more practitioners.

Additional funding is also needed for recruitment and loan forgiveness programs. Many states – including Pennsylvania – have begun enacting these programs in an effort to increase access.

Private practitioners and hospital systems also need to step up their game when it comes to this area, but according to the article above, the good news is that they are doing just that. I know that both of the major health networks in my area have said they are looking to expand capacity and recruitment when it comes to psychologists and psychiatrists, and they aren’t the only ones

If you are interested in the interaction between mental health and public policy, you really should pay attention to this space. There will be a lot more in this area in teh next few years.