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

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

I also know its not enough.

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

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

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

Second, it’s the easiest.

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

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

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

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

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

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

 

Mental illness and gun violence are barely related – it’s just a convenient scapegoat for cowards

As you know, it was a bloody week in America, with a massacre in El Paso and Dayton leaving 22 and 9 dead, respectably. It’s been another awful year in America when it comes to mass shootings – 255 in 217 days by August 5.

As can be anticipated at moments like these, Democrats and Republicans turned to their expected policy solutions to stop the bloodshed. Democrats argued for stronger gun control laws, including reinstating assault weapons bans and Emergency Protective Orders which could get the guns out of the hands of those who seek to use them to kill people or hurt themselves. Republicans tried to pivot to mental health and argue that the problem is just too dang complex to solve. In a speech after the shootings, President Trump said, “Mental illness and hatred pulls the trigger, not the gun” (whatever that means).

Other Republicans echoed these comments. Ohio Senator Rob Portman said, “Look at the mental health crisis in our country today, there aren’t enough laws…” South Carolina Senator Lindsey Graham said:

Here’s the thing – the whole argument that this is a mental health problem, not a gun problem – is rank, stinking bullshit.

I’ll start by quoting those who make the argument far more eloquently than I ever could. In a blistering press release which gained national attention, Dr. Arthur Evans, CEO of the American Psychological Association, blasted the notion that perpetrators of mental illness were behind the spike in mass shootings. Said Dr. Evans:

Blaming mental illness for the gun violence in our country is simplistic and inaccurate and goes against the scientific evidence currently available.

“The United States is a global outlier when it comes to horrific headlines like the ones that consumed us all weekend. Although the United States makes up less than 5% of the world’s population, we are home to 31% of all mass shooters globally, according to a CNN analysis. This difference is not explained by the rate of mental illness in the U.S.

“The one stark difference? Access to guns…

As we psychological scientists have said repeatedly, the overwhelming majority of people with mental illness are not violent. “

Evans went on to say that America desperately needs more gun control.

Former Presidential candidate Hillary Clinton also chimed in with a similar comment:

Indeed, experts have repeatedly blasted the notion that mental illness is tied to a rise in mass shootings. According to Adam Lankford, a University of Alabama criminologist who reviewed gun violence in 171 countries, access to guns is a far better predictor of gun violence than mental illness. The Secret Service has said, “Mental illness, alone, is not a risk factor” for predicting violence. The Washington Post notes that, in a 2018 analysis, 25% of active shooters had some sort of mental illness. A 2015 study on the same subject had that number at 22%.

This notion that it’s the mentally ill are the perpetrators of mass shootings is, generally speaking, unmitigated crap. Indeed, multiple studies have shown that the mentally ill are far more likely TO BE VICTIMS of violence, and gun violence – not the perpetrators of it. According to one study, the mentally ill are 3.6 times more likely to carry out an act of violence than the general population, but 23 times more likely to be that victim. The same study said that the vast majority of violent behavior occurs “due to factors other than mental illness.”

But hey, why let a good soundbite get in the way of avoiding a solution to a problem, right?

Oh. And one more thing. Republicans in Congress and at the state level have said that this is a mental health problem. So, naturally, they want to address it by increasing funding and access for people who suffer from mental illness, right?

Hahahaha.

President Trump and his Republican allies spent the first two years of his Presidency trying to eviscerate the Affordable Care Act, which has done a few little things for mental health care, you know, like improve access and reduce costs for people with mental illness…small stuff, I guess….

Let’s stop the bullshit: Trying to blame gun violence on the mentally ill is a convenient excuse for those who don’t want to actually deal with gun control. It’s not based in reality. And the rhetoric certainly isn’t matched up by the actions taken when it comes to improving mental health care.

Be smarter than they think you are. Don’t fall for this lie.

 

Oregon students can now take mental health days

So, in my political world, I’m a pretty progressive guy. One of the states which I have always watched closely has been Oregon. Oregon has been a progressive success story of epic proportions: From the environment to minimum wage increases to abortion rights to gun control to expanding economic opportunity to all residents, Oregon has led the way. 1

And then, I came across this story: Teens in Oregon can now take mental health days as an excused absence from school. It was done largely to address the stigma which surrounds mental health. According to Debbie Plotnik of Mental Health America:

“The first step to confront this crisis is to reduce the stigma around it. We need to say it’s just as OK to take care for mental health reasons as it is to care for a broken bone or a physical illness.”

The law specifically states that students can have up to five absences in a three month period – and anything more requires a written excuse to the principal.

In response to concerns that the law would make it easier for students to get out of school, Haily Hardcastle, one of the teenagers involved with the lobbying for the law, said, that students would take time off with or without the law – but the new law may encourage students to take their own mental heath more seriously, and would require schools to recognize mental health in their attendance policies.

Oregon’s rate of suicide is 40% higher than the rest of the nation.

I’m…I’m really intrigued by this. It does seem like a lot of days. And I wonder how this effort would interact with other attempts to remedy chronic absences – something that we really struggle with in my home school district of Allentown. But, I believe that Mrs. Hardcastle’s comments are correct – a kid is gonna take a day off if they want to, and if we can encourage them to discuss why, maybe we can help save their life.

Regardless, I’m extremely intrigued, and I’m hoping to pursue this one more. And if you have any feedback, I’d love to hear it!

 

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.

 

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.