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.

 

Means Matters: Why conversations about reducing access is so important – with a very personal example

I came across this very insightful article on three methods of suicide prevention the other day. If this is an area of interest to you, I highly recommend you check it out. Anyway, one of the many things the article discussed was the importance of reducing access to deadly methods (or means) of suicide. The article made some points which I’d barely or never heard. In Sri Lanka, suicide numbers absolutely tanked after common types of pesticides (which were also common suicide methods) were banned. Suicide rates also dropped in England and Wales in the 1960s when domestic gas was switched to a formula with less carbon monoxide, and when more restrictions were placed on sedatives in Australia during the 60s and 70s.

From the article:

Those early observations are backed by a growing body of research that counters the popular misconception that people who attempt suicide once will keep trying, through whatever means necessary. The reality is that those in the grip of a suicidal crisis often can see only one way out—and if that route is barred, they’re unlikely to turn to another, says Jill Harkavy-Friedman, a clinical psychologist and vice president of research at the American Foundation for Suicide Prevention (AFSP) in New York City.

In my legislative career, I was able to get an amendment passed to a bridge reconstruction bill which required that the Pennsylvania Department of Transportation consider adding protecting fencing to suicide hot spots during reconstruction or bridges or other high points. This was done for the exact reasons listed above – means reductions.

It seems as if every community has that place which is known for suicides – in Allentown, my home, it was the 8th Street Bridge. We lost one person every 1-2 months from that location. Then, during reconstruction a few years ago, protective fencing was added – and we haven’t lost a person at that spot since.

This is why there are so many legislative initiatives to reduce gun access for suicidal people via Red Flag laws. I don’t want to get into a debate about gun control, but the science on this issue is clear: Having a gun in a home is more likely to lead to suicides.

For those of you who are lucky enough to not understand, on an emotional level, what it is like to be depressed or suicide, allow me to try to explain. When you’re depressed, you are more than just sad or tired or miserable. Depending on your exact mood or the exact moment, you lose the ability to think clearly. Furthermore, depression isn’t a constant state – like any other emotional feeling, it ebbs and flows. There are moments it is manageable, and then, ten minutes later, you forget your wife, your kids, your loved ones, your career, your successes…you just want to end the pain. And in a bad moment, with the right triggers, yeah, you may grab whatever is easily accessible. If deadly means are available (and guns are the deadliest – 85% of all suicide attempts with a firearm result in a completed suicide), that may be the moment where you end your life.

My worst moment was in college. It was Freshman year, a few weeks back into my 2nd semester. I was a few weeks into anti-depressants for the first time in my life (which can be a moment where suicide risk increases – something I wish I had known then) and had just been rejected by a girl (appropriately on her part, as I wasn’t in a mental state in which I could handle a relationship at the time). The first semester had been a disaster for me – it resulted in an explosion of depression and anxiety attacks, my first time seeing a counselor, and my first experience with anti-depressants.

The night I got rejected by this girl. It was two in the morning or so, and I called my ex-girlfriend (who I was very close with, and in a complicated relationship with), crying. And in my hands, I had a bottle of my new anti-depressants and a glass of water. And I asked her why I shouldn’t end my life then and there.

I feel terrible about that moment. It was such an unfair burden to put on a 16 year old young woman. But she handled it gracefully and like someone with maturity well beyond her years, and she got me to put the pills down, and as I recall, refused to get off the phone with me until I got into bed. I think she actually had the number of our campus safety but couldn’t find it at that moment. And I think I fell asleep with my phone in my bed that night.

The purpose of this story isn’t just to thank my ex (though, as long as I’m on the subject, thanks very much!), but to prove a point. That moment was the worst in my life. That’s the closest I’ve ever come to suicide: Staring at a bottle of polls, and a glass of water, and wondering.

And I can’t help but wonder what would have happened if I’d had a gun. Because getting through that moment – and it was just a moment, a bad one, but not one to be repeated – gave me my life. My wife, my kids, and decades of joy and hope.

Means matter. Access to deadly means matters. And efforts to reduce suicide must incorporate means reduction. Doing so can help get a person through the most difficult moment in their life. And that may save a life.

 

 

Suicide Prevention Hotline appears set to get a three digit number

Some ridiculously good news out of the federal government (yes, really) when it comes to mental health:

The Federal Communications Commission plans to move forward with establishing a three-digit number for the federally-backed hotline.

Thursday’s announcement from FCC Chairman Ajit Pai signals the culmination of one of the final legislative priorities of former Senate President Pro Tempore Orrin G. Hatch of Utah.

Pai said that he intends to follow a staff recommendation for establishing a three-digit dialing code, likely to be 9-8-8, to reach the network of the National Suicide Prevention Lifeline, currently 1-800-273-8255 (TALK). That program is funded through the Health and Human Services Department.

Why is this so important? Two things.

First is the obvious: It makes it easier for people to get the help that they need. A 1-800 number – even one with “TALK” in it – can be too easy to forget. The Suicide Prevention Hotline is a critical resource for people who are in crisis. Elevating that number, and making it easier for people to call, can help to direct people to the care that they need. This is particularly important for someone who is in a state of mind where suicide seems to be an option. A 1-800 number may be too difficult to dial. A three digit number – one like 911, which has been drilled into our brains since we were kids – is easier.

This is even more important because of the frequent conversations around suicide prevention whenever there is a high-level suicide. In the aftermath of one of these tragedies, there is often an increased effort to make people aware of this number. Think about it. How many times have you heard someone say words to the effect of, “You’re never alone. If you or someone you love is in crisis, call 1-800-273-TALK.”

Let’s keep in mind that this number is a national resource, and the volume of calls it receives is reflective of that. The national hotline will actually route your call to the nearest available center. For information on how many calls your state hotlines received, you can check out this report, which has statistics from July 2018- December 2018. For example, during this period, there were 30,346 calls made from Pennsylvania residents. For added context: In a three month period, .0023% of the state’s 12,810,000 residents called. Folks, that’s not a small number.

Second, and maybe more importantly: This decision elevates the national conversation about suicide prevention. Only important causes get three digit numbers: Emergency services (911), directory assistance (411) and local services (211) are the only ones in Pennsylvania. Making suicide prevention a three digit number will help to push suicide prevention to the top of the public agenda, and this is something we absolutely, desperately need to do. This is a good decision, and I cannot wait to see it finalized.

Any thoughts you want to add? Let us know in the comments below!

 

The importance of the human touch to prevent suicides

I wanted to talk a little more today about a study which – if the findings are replicatable – could go a long way towards proving that the best way to prevent suicide may be simply showing that you are someone who cares.

The study itself took place in Australia and was run by Dr. Gregory Carter of the University of Newcastle. Carter and his team sent suicide-attempt survivors a postcard eight times over a 12 month period.

The postcard didn’t say much, and it wasn’t fancy. On the front, it had a cartoon dog with a letter in its mouth. On the back was this message: “Dear X, It has been a short time since you were here at the Newcastle Mater Hospital and we hope things are going well for you. If you wish to drop us a note we would be happy to hear from you.” the card also had contact information for two doctors and the hospital.

The results? The group who received the card showed a 54% reduction in future suicide attempts, but the effort worked only for women.

Intuitively, this makes sense, of course. It’s no surprise that social contact and relationships are a preventative factor when it comes to suicides. And showing someone that you care can, of course, make a huge difference. How many times have you heard of a case where someone came back from the edge simply because there was one person who cared deeply about them?

This isn’t a silver bullet, of course. But it does reiterate a basic and sensible human truth: We can pull people back from the edge if we just show them that they care, that they matter, and that there are ways to get help if they are feeling down.

I’d also argue that this shows that all of us have a role to play when it comes to suicide prevention and helping people get through their darkest moments. To be clear, again, none of us are responsible for someone who ends their own life – but all of us can be part of a solution. Care for each other. Follow up with friends who are showing warning signs of depression or suicide. Ask if they are okay. You don’t have to have the solution. But just being a caring human can, apparently, go a long way towards preventing someone from taking their own life.

 

When discussing suicide: Sharing stories of hope and recovery

I talked a lot last week about the CDC Technical Packet I read on suicide, and I have one more item in it that I want to discuss.

There’s a section in the packet (“Lessen Harms and Prevent Future Risk”) which applies to anyone who has ever walked down the dark path of suicidal ideation – or even suicide attempts – and come back. Under the approaches subheading, the report says:

Safe reporting and messaging about suicide. The manner in which information on a recent suicide is communicated to the public (e.g., school assemblies, mass media, social media) can heighten the risk of suicide among vulnerable individuals and can inadvertently contribute to suicide contagion. Reports that are inclusive of suicide prevention messages, stories of hope and resilience [italics added by me], risk and protective factors, and links to helping resources (e.g., hotline), and that avoid sensationalizing events or reducing suicide to one cause, can help reduce the likelihood of suicide contagion.

Later, in the evidence section, the report notes:

Finally, research suggests that not only does reporting on suicide in a negative way (e.g., reporting on suicide myths and repetition) have harmful effects on suicide, but reporting on positive coping skills in the face of adversity can also demonstrate protective effects against suicide. Reports of individual suicidal ideation (not accompanied by reports of suicide or suicide attempts) along with reports describing a “mastery” of a crisis situation where adversities were overcome [italics added by me] was associated with significant decreases in suicide rates in the time period immediately following such reports

So, let’s talk about that for a second, because this is important. Many have discussed suicide, and whenever there is a high profile suicide in the media, reports often discuss specific methods and details. That’s bad.  As the report above clearly demonstrates, the way in which suicide is discussed in society can have an extremely positive or negative affect on impact rates.

And here’s the part which specifically touches all of us who have been there: There’s something potentially life saving about sharing your story.

Describe it. Tell people about your darkness. Tell them how suicide was something you considered. Maybe even attempted. Tell them the truth – be open and honest with your experiences. But don’t just emphasize the sadness. Talk about how you found your way back. Talk about how you fought your demons, and thanks to X, Y and Z, are now in recovery. You don’t have to pretend that everything is perfect – in that, that likely won’t ring true. But what I think people can and should say is that they no longer want to end their lives – that they want to live, to fight on, and to lead a good life. This is what I tried to do when I shared my specific story of suicidal ideation in the aftermath of the Anthony Bourdian and Kate Spade suicides.

If you can, I’d encourage you to tell your story, and do so as noted above. I truly believe that doing so can save lives.

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.

The incredibly sweet tribute to a mental health hero in Zelda: Breath of the Wild

I’ve written about video games before, but never quite like this.

Yesterday, I was watching this video on Zelda: Breath of the Wild (awesome game, by the way). In the course of watching, I came across this:

For those of you who don’t watch the video, here’s the basic gist: Link, the game’s hero, walks to the edge of a Proxim Bridge in the game. He is confronted by a character named Brigo, who stops you from jumping off of the bridge and says things to get you to stay put. He even offers to stay with you to keep you company.

Okay, kind of random, right? Brigo is likely inspired by Kevin Briggs:

Kevin Briggs.jpg

Briggs is a fascinating man: He spent decades working for the California Highway Patrol, which he retired from in 2013. During much of that time, he patrolled the Golden Gate Bridge, and by his estimates, stopped over 200 people from jumping to their death.

This is a truly kind tribute to a man who clearly deserves it.

If you want to watch the entire scene, it’s below: