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.

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.

A mental health hero: Jason Kander

Last week, a brave politician made national news by dropping out of a high profile Mayoral race. That man is Jason Kander, and he’s someone worthy of our attention and praise.

Kander is the former Missouri Secretary of State. In 2016, he ran for the U.S. Senate as a Democrat, and in a tough year for Democrats, he came within three points of defeating incumbent Senator Roy Blunt. Kander ran an amazing campaign and aired one of the best ads of 2016, in which he talked about his army background and support for universal background checks while assembling a gun…blindfolded.

Kander’s military story is equally impressive: He volunteered for the Missouri and volunteered for a tour in Afghanistan in 2005, serving as an intellegence officer.

Kander’s political star was on the rise, and until last week, Kander was a candidate for Mayor in Kansas City. That changed with this heartbreaking note, in which Kander discussed his battle with depression, PTSD and suicidal ideation:

About four months ago, I contacted the VA to get help. It had been about 11 years since I left Afghanistan as an Army Intelligence Officer, and my tour over there still impacted me every day. So many men and women who served our country did so much more than me and were in so much more danger than I was on my four-month tour. I can’t have PTSD, I told myself, because I didn’t earn it.

But, on some level, I knew something was deeply wrong, and that it hadn’t felt that way before my deployment. After 11 years of this, I finally took a step toward dealing with it, but I didn’t step far enough.

I went online and filled out the VA forms, but I left boxes unchecked — too scared to acknowledge my true symptoms. I knew I needed help and yet I still stopped short. I was afraid of the stigma. I was thinking about what it could mean for my political future if someone found out.

Kander dropped out of the race and has since been silent on social media. I assume – and sincerely hope – he is getting the care he needs and deserves.

Broadly speaking, the stats on veterans, mental health and suicide are horrifying:

  • According to a 2014 report by the Department of Defense, there were 1,080 suicide attempts (245 suicides) among active-duty service members for all armed services in calendar year 2013.

  • A recent study of 52,780 active-duty members of the U.S. Air Force found that 3 percent of male participants and 5.2 percent of female participants reported suicidal ideation in the previous year. Of the participants that reported suicidal ideation, 8.7 percent also reported a recent suicide attempt.

  • Veterans who screened positive for PTSD were 4 times more likely to report suicidal ideation than veterans who did not, and the likelihood of suicidalideation was 5.7 times greater in veterans who screened positive for PTSD and two or more comorbid disorders.

Those who take care of us – our first responders and military veterans – deserve better. And I sincerely hope that Kander’s story helps to push this issue.

It takes people like Kander – national political rock stars – discuss their pain, to destigmatize an issue, and to help more people get help. I can only imagine how many veterans are looking at Kander and thinking, “Me, too,” and then hopefully getting the help they need. Kander’s words will have a larger impact than I think most of us could ever hope to have.

Most importantly, best wishes to Kander. I cannot imagine what demons he faces – what pain he took on – in the name of protecting America. He, and countless other veterans and first responders – deserve our love, and our resources, to heal. I am so grateful to all of them for their bravery.

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.

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.

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:

Op-Ed: Suicides of Bourdain, Spade remind us troubles many face

As last week’s entry showed – and as I know far too many of you can understand – last week’s suicides of Anthony Bourdain and Kate Spade shook me. Celebrity suicides always do. But, sadly, we know that the suicide contagion effect is real. I wanted to try to do something to stop it.

My local paper, the Morning Call, was kind enough to let me write this op-ed. I’m copying the text below, but if you can click on the link, please do.

We all have to speak up about this issue if we’re going to do anything about it.

When I opened Facebook on Friday morning, there was one sentence that I kept seeing, over and over again: “Not Anthony Bourdain!”

On Tuesday, it was: “Not Kate Spade!”

The death of two people who seemed to have it all was exceptionally tragic in and of itself. Unfortunately, the problem is so much more severe than that.

There is something particularly painful about suicide. Thankfully, most of you cannot fathom how someone could kill themselves, and that is a blessing.

But, please remember: Suicide and mental illness are disconnected from reality. People like Anthony Bourdain and Kate Spade seemed to have it all. But if you have some sort of mental illness, your brain and your heart may not recognize happiness or joy. It doesn’t matter who you are or how much joy you may seem to have — if you are mentally ill, your brain will not enjoy a life that “should be happy.”

Unfortunately, there is a suicide contagion affect: People are more likely to kill themselves after a high-profile suicide, and that risk is heightened among similar demographic groups. This may be a very dangerous time for people who face an increased risk of suicide.

To those of you who view suicide as an option, allow me a few words. They come from times in my life where I was so depressed I viewed suicide as an option. Give me the chance to talk to you as someone who spent hundreds of hours I’ve spent in therapy and takes anti-depressants to start every morning.

I beg you: Please remember that there is more than the pain of this moment. It’s a cliché, but it’s accurate: Suicide is a permanent end to a temporary problem.

I’ve written about this in The Morning Call before, but it’s worth telling you about my personal story again. My own suicidal moments came in college. I was a new student and scared out of my mind. I barely had any friends and I had been torn from everything I knew and loved. A bad roll of the dice in terms of genetics already predisposed me to depression, and I began to sink. I began to sink so badly that thoughts and plans of suicide began to float around in my battered brain.

Thankfully, I recognized I had a problem. I sought counseling and medication. Depression is part of my story. It always will be. I have struggled, but I have survived.

I am using myself to make a point. I was driving the other day, thoughts wondering, and my mind drifted back to this low point in my life. I was struck by this sudden realization: What would have happened if I had killed myself 17 years ago?

The answer is simple: My family and my closest friends would have been left with a hole in their heart, one which would have never really healed. Meanwhile, someone else would have lived my life, married my wife, had my kids. Someone else would have had the jobs I’ve worked and be representing the people of the 132nd District. Everything that should have been mine would be lived and loved by someone else.

And I was struck by what a waste that would have been. And what a tragedy. Choosing to end my life would have been an especially premature decision. My life is not free of pain, but by and large, it’s a good one. I wake up every day grateful for the decision I didn’t make.

I’ve had access to the treatment that I need. Everyone should be as fortunate.

Suicide is not an isolated problem. There were 45,000 suicides in 2016 in the United States — more than twice the number of homicides. That’s roughly 123 a day. Five an hour. One every 12 minutes.

Suicide is the 10th leading cause of death in the United States. It is the second leading cause of death among those aged 15-34. In Pennsylvania, it’s increased 34 percent since 1999. In Lehigh County, we’re losing roughly one person a week to suicide.

The money we spend in this area means something. Repealing Obamacare would have cut off mental health care access to millions of Americans and unquestionably increased suicide rates. We have a major mental health care practitioner shortage in this country. Millions upon millions of Americans cannot afford their prescription drugs. These things matter.

But I’m tired of hearing elected officials say that mental health matters. Don’t show me your words, show me your budget. Show me what programs you are creating to address suicide. Show me how you are dealing with the suicide among veterans and first responders. Show me what programs you are funding to ensure that we are caring for all Americans, no matter what they look like, where they come from and how wealthy they are.

Don’t give me your thoughts and prayers. Give me the money and the means to actually stop suicide.

To those who are afraid — to those who are anxious, addicted or alone — please know that there is hope. You may not be able to feel it, see it or believe it. But I suppose I am asking you to have faith — faith in yourself, in God, and in those who love you now or will love you in the future. As my own story exemplifies, there is always a reason to live, even if you may not know it at the time. As long as you breathe, you have hope.

Mike Schlossberg of Allentown is state representative from the 132nd District. If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline, 800-273-8255; in Spanish, 888-628-9454; for the deaf and hard of hearing, 800-799-4889; or by text, 741741.