How mental health is – and isn’t – figuring into the 2020 Presidential race (yet)

One of the great thrills of my political career was when I had the opportunity to meet Virginia Senator Tim Kaine. This was in 2016, about two and a half weeks before the November election, when he was Senator Clinton’s running mate. I spoke at the rally and got to shake his hand, but in the brief time we had together, I told him how much I appreciated their campaign releasing a mental health plan, as that was an issue important to me. He said thanks and agreed – he thought it was necessary.

My own political experience has made me realize that mental health is a deeply salient issue in politics – and one which can have a very serious political impact, and one which is often underestimated. I’ve used these statistics before and I will say them again: 1 in 5 Americans actively suffer from some sort of mental illness, and one in two will over the course of a lifetime. This means that virtually everyone in this country knows someone – or is someone – who suffers. For those reasons, and many more, I wish that more people spoke about mental health. We need to do a better job of addressing this issue, particularly given the way rates of mental illness are rising.

As you may know, there are now north of twenty Democrats running for the Democratic nomination for President. These candidates have a wide, wide range of plans and proposals for what they would do if they occupied the highest office in the land. But, as politics is my life, I got to thinking: Of the candidates, who has any sort of mental health plans, and who doesn’t? The answers of the major candidates:

No specific mental health plan

Actually has a specific mental health plan:

  • Former Congressman John Delaney: Hey, we found one! Among the highlights are enforcing mental health parity, expand access to at-risk populations and increasing reimbursement rates.
  • Andrew Yang: Yang specifically calls for better integration of physical and mental health, anti-stigma campaigns and an increase in access to mental health resources.

A word of caution: It’s still early. Really, really early. As in the first Presidential primary is about seven months away, and the Presidential election itself is slightly less than seventeen months away. The Clinton/Kaine mental health plan which I referred to above didn’t come out until October 2016, so there’s plenty of time left. It’s also worth noting that mental health care is likely in many of these candidate’s healthcare pages, not it’s own subheading – a mistaken, in my opinion.

Still. Kind of a bummer. I was hoping that more elected officials would be willing to specifically highlight mental health.

More in the future, I hope!

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My most-read blog entries of the year

I have to say, I really enjoyed the blog this year. After letting it go for months, I picked it up again and have consistently tried to create useful and interesting content. It’s also helped me expand my horizons and think about mental health in a different way.

This year also saw the publication of Redemptionan experience which has given me more joy than I ever could have realized – and an experience which was borne of my own depression. Take note, reader: You can get immeasurable joy out of sadness.

That being said, most importantly, I hope what I wrote has helped you.

So, here’s a look at the five blog entries I wrote which seemed to be the most popular. My year in review, if you will.

5) Ties That Bind: Liberals, Conservatives & Mental Health: This is the only “top five” entry which dealt specifically with public policy. It dealt with the challenges facing Democrats/Republicans, urban/rural areas and how mental health remains a huge challenge in all of these sections of the country.

4) Redemption, by Mike Schlossberg, is Almost Available: Alright, this one was blatantly self-promotional 🙂

3) The Tragic Suicides of Kate Spade & Anthony Bourdain: Within a few days, Kate Spade and Anthony Bourdain killed themselves. I wrote this blog entry just after the news broke about Bourdain, largely motivated by a very real fear about the contingent effect when someone does kill themselves. It was my immediate thoughts on what to do and how to help those who are suffering.

2) How To Stay Hopeful in a World Filled With Darkness: This entry was one of the most painful ones I have ever done, and like the one above, it was in the immediate aftermath of a tragedy – specifically the Tree of Life shooting in Pittsburgh. The crux of this entry was how anyone can stay hopeful and optimistic in a world where gloom and doom have become so powerful.

1) How Vacation Can Make You Depressed, and What You Can Do About It: This entry was inspired by my own upcoming vacation – and the depression which often accompanied it. What was most interesting about this one to me is that this one has seen a slow and steady increase in hits after the entry was posted back in late July. It did okay at first, but then the views just grew and grew. I suppose it’s good to know that I’m not the only one who sometimes feels this way.

It has been a wonderful year, and thank you for giving me the opportunity to talk to you. I wish you a happy, peaceful and restorative New Year. See you in 2019!

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.

Ties that bind: Liberals, conservatives and mental health

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

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

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

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

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

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

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

 

 

 

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

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

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

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

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

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

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

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

Nope. It was economic supports.

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

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

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

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

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

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

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

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

Depression is massively, frighteningly increasing

Some frightening news last week, according to health insurance data from Blue Cross Blue Shield:

  • Major depression has a diagnosis rate of 4.4 percent in the United States, affecting more than 9 million commercially insured Americans.

  • Diagnoses of major depression have risen dramatically by 33 percent since 2013. This rate is rising even faster among millennials (up 47 percent) and adolescents (up 47 percent for boys and 65 percent for girls).

  • Women are diagnosed with major depression at higher rates than men (6 percent and nearly 3 percent, respectively).

The report also found that younger generations are seeing the largest increase ind depression rates:

Image: Major depression report

By the way, keep in mind that this data is from among those who have health insurance – and we know that there are millions of Americans who do not, and those in poverty are more likely to be depressed…so this is an underestimation.

This is a genuinely terrifying. We should all be deeply, deeply worried about the findings of this report, findings that, unfortunately, ring true.

Also worth noting: Rates of major depression vary significantly on a state by state basis:

Image: Major depression report

The NBC article on the subject referred to a variety of potential causes for the increase, including:

  • An increasing sense of business in our day to day lives and a loss of community that comes with it.
  • Overall world events and our increasing awareness of the trauma that exists…everywhere.
  • Social media.
  • Overdependance on smart phones.

We’re going to have to start treating depression for what it is: A major public health crisis. I won’t pretend to be fully capable of developing every solution – and certainly not solutions which are politically viable (treating mental health for everyone requires infusing billions of dollars into the mental health system, and we’re not doing that anytime soon, sadly). And I’ll add this: Many of the items which would really reduce depression are societal and cultural changes that are largely beyond the reach of government. They include things like slowing own our daily lives, increasing family and community bonds, and taking our phones and throwing them out the window.

But the fact is this: We have to do better. As I write this entry I am staring at my children and I worry, given this world and their genetic predisposition, that this will be them one day. Families have to now constantly be on the lookout for potential mental health problems. They have to teach coping skills and resilience, and they have to be willing to seek treatment when symptoms of mental illness/depression begin to display themselves. I wish I’d realized this when I was younger – early treatment for mental illness – like for most illnesses – is critical.

My mission with this blog is largely to discuss mental health and raise awareness. It’s becoming apparent that this awareness is more needed now than ever.