I don’t think there is a dry eye or a non-stunned heart in the house when it comes to thinking about the recent sudden passing of Stephen “tWitch” Boss. We are all saddened and stunned. We are all wondering how we missed the signs. We are all asking the question ” How could we prevent this from happening?” Instead of continuing to ask these questions after the fact, it is time to talk about it and get educated for the future. I know I need to.
I recently read an article from the CDC about suicide. I realize that a lot of you may not put value in anything that the CDC says right now, but I am using this as just a resource for some definitions, etc.
First of all, let’s define what suicide is. Suicide is defined as death caused by injuring oneself with the intent to die. A suicide attempt is defined as when someone harms themselves with an intent to die, but they do not die as a result of their actions. It is a serious, devastating, personally intimate, and also public health problem. It is the leading cause of death in the United States, causing up to 45,979 deaths in 2020. This literally translates to one death about every 11 minutes. The numbers of people who think about suicide or attempt it is even higher! In 2020, approximately 12.2 million Americans thought about suicide, 3.2 million planned an attempt, and 1.2 million actually attempted.
Suicide does not discriminate for age. It affects all ages. It was in the top 9 leading causes of death in 2020 in people ages 10-64. It was the second leading cause of death for people ages 10-14 and 25-34.
These statistics are overwhelming. Suicide causes emotional, physical and economic devastation. Survivors may have long term injuries or suffer long term depression. It affects friends, family, co workers, and the community at large. Emotional distress pervades the lives of the victim’s family along with shock, guilt, depression, etc. Sometimes family members can begin to think about suicide. Suicide is also devastating from a financial standpoint. in 2019 suicide and non-fatal self harm cost about 490 billion in medical costs, work loss costs and quality of life costs.
So, what can we do about this? Is there anything? Let’s talk about that. I have been through this before with a friend in high school. We did not reach her in time and I have missed her ever since. I remember being wracked with guilt and self blame, on top of the sadness. Why didn’t I see this coming? What should I have done? The questions kept coming and still do. Let’s talk about some strategies that might help. We’ve got to try something.
It is said that suicide is preventable. I am not sure that is true in every case. I worry that this kind of statement may only lead to more self blame for everyone left behind. Having said that, I do truly believe that everyone has a potential role to play to save lives. We need a comprehensive public health approach as well as a family and friends approach.
The CDC has developed the Suicide Prevention Resource for Action https://www.cdc.gov/suicide/resources/prevention.html
This resource explains strategies to reduce suicide with the best evidence that is available at this point. The intent is to help states and communities to prioritize suicide prevention strategies that could potentially have the most impact. The strategies it focuses on the most are 1) strengthening economic supports, 2) Creating protective environments 3) improve access and delivery of suicide care, 4) Promote healthy connections, 5) teach coping and problem-solving skills, 6) Identify and support people at risk, 7) Lesson harms and prevent future risk
Let’s break each of these down.
Strengthening economic supports- This means strengthening household financial security and stabilizing housing
Create protective environments- This means reduce access to lethal means among persons at risk for suicide. Create healthy organization policies and culture. Reduce substance use
Improve access and delivery of suicide care- This means we need health insurance coverage for mental health issues. We need more providers in underserved areas. We need to provide rapid and remote access to help. We need safer suicide care.
Promote healthy connections- Focus on healthy peer norms and engage members of a community in shared activities that are positive.
Teach coping and problem-solving skills- This means teach parenting skills to improve family dynamics. Support emotional resilience through education. Support social and emotional learning.
Identify and support people at risk- The first challenge for this is to be able to identify who is at risk. We will talk about that in a minute. We need to be able to respond to crises and have safety plans and follow up after attempts. OUr job is not done after an unsuccessful attempt. Multiple therapies must be available
Lessen harms and prevent future risk- Again, our job is not done after an unsuccessful attempt. Postintervention is extremely important to prevent future attempts
Now that we have talked about these strategy categories, lets talk about what contributes to risk of suicide. What are we looking for? We need to keep in mind that suicide is rarely if ever caused by a single event or circumstance. It is a range of factors at all levels: society, relationship, community, and individual.
Let’s look at some individual risk factors.
History of depression or other mental illness
Previous attempt
Criminal or legal problems
History of child abuse
Financial or job problems
Violence victim or perpetrator
Hopelessness
Chronic illness or pain
Aggression
Let’s look at Community Risk Factors
Suicide cluster in the community( a pact, etc)
Community violence
Discrimination
Lack of healthcare access
Historical trauma in a community
Let’s look at Relationship Factors
Bullying
Loss of relationship
Violent relationships
Social isolation
Bullying
Family history of suicide
Last, but not least, let’s look at societal factors
The stigma and labels attached to getting help for mental health issues
Unsafe media portrayal of suicide
Easy access to lethal methods
So, what are the warning signs? Look for things like someone talking about being a burden. Look for isolation. watch for increased anxiety. Listen for talking about unbearable pain or feeling trapped. Mood swings are a concern. Watch for too much or too little sleeping. Listen and pay attention if someone talks or posts about wanting to die. Watch out for increased rage. People that are at higher risk include veterans, people in rural areas, mine workers, and construction workers. The LGBTQ population is also at higher risk of suicide.
When we see or hear those warning signs, what do we do? We can use all the strategies we already talked about above: financial support, better access to care, create protective environments, connect people with each other and their community, teach coping and problem solving, identify those at risk and prevent further risk. More immediately, if you think someone is at risk, talk to them. Have them contact the 988 Suicide and Crisis Lifeline. There are two options
Call or Text 988
Chat at 988lifeline.org
This is 24 hour, confidential support with a trained crisis counsellor.
The bottom line of all of this is, keep an eye on the people you care about. Ask questions. Have frank discussions. Seeming OK on the outside does not always mean they are ok on the inside.
Dr. Katz
