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.

 

Medication is Not Addiction: A response to a misinformed column

I spent way too much time on Sunday on Twitter, joining a chorus of voices who were yelling at David Lazarus, a columnist or the Los Angeles times. Lazarus wrote a column in which he discusses his own experience at trying to withdraw from anti-depressants. The title of the column? “Hi, I’m David. I’m a drug addict.”

Yep. Only went downhill from there.

Ironically, Lazarus discussed important issues like the over prescribing of medication, failure to adequately warn patients about side effects and discontinuation syndrome. These are real, important issues. They merit serious, thoughtful consideration. Instead, Lazarus decided to call millions of Americans (like me) drug addicts. He esoterically wondered “Who am I, really?” about taking anti-depressants. It’s a tragic, misguided view, one which reinforces stigma and will prevent people from getting help they need. And the language used by Lazarus is just appalling. If I’m a drug addict, so is everyone else who uses medication to survive for any other condition.

Really, this is just an ugly article.

I wrote a response which the Los Angeles Times did not accept, citing their policy to not run op-eds in response to other op-eds. Fair enough. My response, then, is below.

Don’t believe crap like what Lazarus decided to spew. Medication can be a vitally important part of any therapeutic regimen. It has saved thousands of lives.

Let’s say you are a diabetic and require insulin to live. One day, a friend tells you to quit insulin. Stunned, you ask why. Your friend responds: “Well, you can’t live without insulin. That makes you a drug addict.”

That’s absurd, right? Taking a prescribed medication in recommended doses doesn’t make you a drug addict. That makes you a responsible adult.

But the above scenario would never really happen, right? No one would ever claim that taking medication to treat diabetes, Parkinson’s or Alzheimer’s would make you a drug addict.

But, apparently, such an understanding does not apply to the millions of Americans who take medication to manage mental illnesses. To Americans like me.

For eighteen years, I’ve been diagnosed with a major depressive and generalized anxiety disorder. I’ve been suicidal. The medication which I take, in conjunction with therapy and lifestyle changes, has saved my life.

About five years ago, I made the decision, as a Pennsylvania State Representative, to start discussing my battles with depression, anxiety and suicidal ideation. I did so in response to the stigma which surrounds mental illness. Depression isn’t a weakness. It can’t be willed away. Taking medication doesn’t say anything about one’s character any more than having heart disease indicates a moral failure.

That’s why I was so disheartened to read Mr. Lazarus’ column: It took serious issues like over-prescribing  and discontinuation syndrome – issues which deserve thoughtful, reflective discussion – and conflated them with drug addiction. To be sure, medication is not a panacea. It often takes months, if not years, to find appropriate medication and dosage. Prescribers sometimes fail to appropriately monitor their patients. Side effects are real and dangerous. All of these issues demand thoughtful consideration and conversation.

However, such problems exist in virtually all areas of medicine, and no one would reasonably or seriously suggest that we should stop prescribing scientifically proven medication to people in need. Yet, that is exactly what some suggest when it comes to mental health.

Mr. Lazarus refers to himself as a “drug addict” for taking anti-depressants. Yet, he also discusses being a diabetic who takes medication for chronic Type 1 diabetes. Strangely, he declines to refer to himself as a “drug addict” for requiring insulin to manage his blood sugar levels. I wonder why.

We should never, ever be so foolish as to conflate appropriate use of anti-depressants with drug addiction. To do so makes people who take anti-depressants to live sound like sound like a caricature of a drug addict, desperate for their next hit of smack…or, as I like to call it, the pills which help me not want to kill myself every morning.

Contrary to what some believe, anti-depressants are not happy pills which whisk you away on a cotton-candy cloud, carrying you to Lollipop Island to float with gumdrops all day long. What they do is help you control symptoms, improve your mood and make other forms of change – like psychological therapy and lifestyle changes – easier to obtain.

Taking medication for mental illness doesn’t change who you are. It allows you to be who you are.

Far too many Americans have ignored their own minds and medical advice, choosing to try and “tough out” spells of depression, to “man up” or ignore these painful and rehabilitating symptoms. Too many Americans have powerful fears that taking anti-depressants makes you weak. This stigma must be crushed and rebutted in the same way intelligent society has pushed back on those who attack vaccines.

Anti-vaxxers and those who deny the positive impact of anti-depressants are flip sides of the same coin: They seek to use pseudoscience and stigma. Science has given us incredible tools which can be used to our great physical and emotional benefit. To ignore those tools, or to somehow wrap their use in shame, serves only to pull us into a darkness which we should have left behind decades ago.

The nearly 1 in 5 Americans who suffer from mental illness – including me – deserve to have our challenges discussed with respect and a comprehensive understanding of mental health treatment options. This discussion is simply incomplete without discussing the importance, effectiveness and risks of medication. No one who takes an anti-depressant is a drug addict, any more than a person who takes Prilosec for heartburn is addicted to not having their chest feel like is on fire.

The facts are stark. Depression rates are skyrocketing, rising sharpest among today’s youth, who have seen nearly 50% increases in rates of depression. 47,000 Americans – and 2,000 in my home state of Pennsylvania – died by suicide last year, an increase of 34% since 1999.

We need serious, sober conversations about mental illness and how to treat it. There are many concerns with anti-depressants. These are valid, serious concerns which must be addressed. But these conversations must occur using words and arguments which shatter stigma and support science. To do otherwise does an incredible disservice to those of us who suffer.

 

The news isn’t completely terrible: 3 Reasons to be hopeful in our ongoing mental health crisis

I’ve written a lot about just how bad things are in the universe of mental health. Rates of depression and anxiety illness are rising, particularly among our youngest and college students, and suicide rates are hitting highs which haven’t been seen since World War II. This, of course, is terrible.

Still, life could be a lot worse when it comes to the mental health universe. Here are three reasons to be hopeful in the long-run.

Stigma is decreasing

According to multiple articles, the stigma which surrounds mental health is slow decreasing, but particularly for those who are younger. Many in a younger generation view seeking therapy and getting help as normal – as such, they don’t hesitate to do so. All of these articles note – correctly – that will still have a long way to go before we can consider stigma to be truly “defeated,” but it is worth noting and celebrating that significant progress has been made. Furthermore, the slew of celebrities who have openly discussed their own struggles has furthered humanized the issue and made others realize that suffering from mental illness doesn’t have to hold you back.

The Affordable Care Act is Helping People Get Treatment

The ACA – or Obamacare – has been subjected to no shortage of controversy. However, some things about it are indisputable. One such example is that more people are getting the mental health treatment that they need and deserve – and that they are getting better. ObamaCare required that all individual and small coverage plans offer mental health care, and that the coverage of mental health be similar to what it was for physical coverage. This alone has helped to increase the amount of plans which offer mental health care. The percentage of young people without health insurance dropped from roughly 22% (2013) to 13% (2016), and since young people were more likely to first experience a mental health challenge, this meant that more people had access to the care that they needed.

There’s more, of course. States which expanded Medicaid saw sharper decreases in mental illness than states which hadn’t, resulting in more care, more treatment and a lower financial burden.

There is no doubt: ObamaCcare has helped those with mental illness.

Social Media Has Tremendous Potential For Good

Alright, so I’ve been a bit harsh on social media in my time as a blogger in the mental health world. Just a bit. But it really isn’t all bad. Social media has the potential to be very helpful – and indeed, has been very good for mental illness…if used properly.

Social media, even if it’s just digital, can help promote a sense of connectedness. Sufferers of various mental illnesses can connect with more people and find the assistance that they so desperately need. If it’s users are mature enough, they can provide goals to aspire to and help to push creativity. By keeping users abreast of social opportunities and events, it can help maintain social relationships.

Indeed, for all of the negative press which social media has gotten on mental illness, there is at least one study (which examines adults, not just college or high school students) which shows that it can be positive and result in less psychological distress.

All kidding aside, I think social media can be good for metnal health…but requires literal mental training that I don’t think we possess as of yet. People have to use social media to supplement their social life, not supplant it. They need to recognize that it’s a curated form of life, not real life. And they need to remember that they have plenty of things to feel joyful and proud about, and to not feel jealous of what others put on their newsfeeds. That can be a real challenge, to say the least!

As always, I’d love to hear your thoughts. What else has been good news in the world of mental illness? Let us know in the comments below!

 

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.

 

Netflix removes controversial suicide scene from 13 Reasons Why

13 Reasons Why is a Netflix series based on the popular book by Jay Asher. The book deals with the aftermath of the suicide of Hannah Baker, who then sends tapes to people involved in her life, detailing the reasons behind her suicide.

The show was then turned into a hit Netflix series, which generated a ton of controversy for a variety of reasons, chief among them being the graphic depiction of Baker’s suicide, which features Baker, in the bathtub, slitting her wrists, crying in pain and ultimately bleeding to death.

I’d written about the show before, and mainly in terrible terms: It’s premier had been tied to a rise in suicide among 10-17 year olds, and the graphic depictions of Baker’s suicide seemed to violate every best practice of reporting on suicide.

Netflix – in response to the controversy – has changed the season finale of Season One, which featured this scene: It has now been been completely removed. In a statement, Netflix said:

“We’ve heard from many young people that 13 Reasons Why encouraged them to start conversations about difficult issues like depression and suicide and get help — often for the first time. As we prepare to launch season three later this summer, we’ve been mindful about the ongoing debate around the show. So on the advice of medical experts, including Dr. Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, we’ve decided with creator Brian Yorkey and the producers to edit the scene in which Hannah takes her own life from season one.”

As the Hollywood Reporter noted, a variety of anti-suicide groups praised the removal in a joint statement.

The damn shot should never have aired. In prior statements, show creator Brian Yorkey had said that they didn’t want to make suicide look peaceful and thus glamorize it. I get that. And – if you assume that they were operating with the best of intentions – I get that they were trying to make it seem realistic and less abstract.

But, as Vox notes, that’s exactly the problem:

The theory is that for people who struggle with suicidal ideation, anything that can make suicide feel more familiar to them and cause them to keep thinking about it can be dangerous. That’s part of what leads to suicide contagion, the phenomenon in which media coverage of a death by suicide can lead more people to die by suicide.

As I argued in my entry earlier in the week, we have to be very, very careful with how we discuss suicide, lest we inadvertently plant the idea in someone’s head that suicide is somehow acceptable or “freeing.” While the type of discussion which occurred here is different than the blog entry I was writing about, the concept is the same: Be careful in how you discuss suicide, particularly given the way it could impact the most vulnerable of people.

I’m glad Netflix did this. But the show has generated controversy because their is evidence to suggest that it is correlated with more people dying by suicide. That’s a major problem, and they need to do better.

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.”

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!