Let's Count On Each Other

Let’s Count On Each Other

I saw this article in Clinical Psychiatry News written by Dr. Carl Bell, MD about preventing suicide preceded by mass murder [1]. Dr. Bell is an expert in violence prevention and has been working in this area for about as long as I’ve been alive. OK, so that’s a little wide of the truth, but give a geezer a break. He shared wisdom about the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action, which essentially sends the message that we’re all accountable for suicide prevention. It’s up to all of us, family, friends, teachers, doctors, and others to be there for each other, to count on each other:

http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full-report.pdf

Dr. Bell points out the relative rarity of these types of events, though of course he and every other expert would acknowledge that while low-frequency, they are definitely high impact. He also acknowledges that the phenomenon of “suicides preceded by mass murder (mass murder defined as three or more people being killed)” is a theory for which “there is no solid evidence”. However, there’s no solid evidence that the sun is coming up tomorrow, either.

He makes an excellent point about the challenges of media reporting regarding these events, noting the tendency to convey the message that they’re common. There’s also a tendency to give them a lot of coverage, which can be followed by an unfortunate rash of “contagion” suicides.

In fact, there are guidelines that have existed for years to help the media report on these events in a way that significantly reduces the contagion effect. Two links illustrating such guidelines are listed below:

http://www.sprc.org/sites/sprc.org/files/library/sreporting.pdf

http://reportingonsuicide.org/

It’s easy to get freaked out about the intimidating length of the 2012 National Strategy report; hey, it’s 184 pages long. What I usually do with heavy documents like this is zip to the end and start scrolling backwards. This usually results in cutting away a lot of material like references and glossaries and other necessary, though not immediately practical information you always find in government documents. That eliminates over 40 pages alone.

Now start at the beginning and have a look at the Dedication on page 8, just to get you into the spirit:

To those who have lost their lives by suicide,

To those who struggle with thoughts of suicide,

To those who have made an attempt on their lives,

To those caring for someone who struggles,

To those left behind after a death by suicide,

To those in recovery, and

To all those who work tirelessly to prevent suicide and suicide attempts in our nation.

We believe that we can and we will make a difference.

Now skip to the Introduction, which you can comfortably read in its entirety. Take special note of:

Page 11: “Because suicide is closely linked with mental illness, in the past, suicide prevention was often viewed as an issue that mental health agencies and systems should address. However, the vast majority of persons who may have a mental disorder do not engage in suicidal behaviors. Moreover, mental health is only one of many factors that can influence suicide risk. For example, enhancing connectedness to others has been identified as a strategy for preventing suicidal behaviors and other problems. All of us can play a role in helping to make this protective factor more widely available.
Suicide prevention is not exclusively a mental health issue. It is a health issue that must be addressed at many levels by different groups working together in a coordinated and synergistic way. Federal, state, tribal, and local governments; health care systems, insurers, and clinicians; businesses; educational institutions; community-based organizations; and family members, friends, and others—all have a role to play in suicide prevention. The revised National Strategy reflects this understanding.
Suicide prevention efforts must involve a wide range of partners and draw on a diverse set of resources and tools. The National Strategy seeks to do so by integrating suicide prevention into the mission, vision, and work of a wide range of organizations and programs in a comprehensive and coordinated way.”

Page 19: This contains a box summary of the Warning Signs of Suicide and What to Do:

Warning Signs of Suicide

Talking about wanting to die;
Looking for a way to kill oneself;
Talking about feeling hopeless or having no purpose;
Talking about feeling trapped or being in unbearable pain;
Talking about being a burden to others;
Increasing the use of alcohol or drugs;
Acting anxious, agitated, or reckless;
Sleeping too little or too much;
Withdrawing or feeling isolated;
Showing rage or talking about seeking revenge; and
Displaying extreme mood swings.

The more of these signs a person shows, the greater the risk of suicide. Warning signs are associated with suicide but may not be what causes a suicide.
What To Do
If someone you know exhibits warning signs of suicide:

Do not leave the person alone;
Remove any objects that could be used in a suicide attempt;
Call the U.S. National Suicide Prevention Lifeline at 800–273–TALK/8255; and
Take the person to an emergency room or seek help from a medical or mental health professional.

Adapted from Recommendations for Reporting on Suicide website http://reportingonsuicide.org/

Page 21: This contains a summary of Evidence-Based and Promising Practices, including the U.S. Air Force Suicide Prevention Program (AFSPP), a community-based suicide prevention program which “reduced the risk of suicide among Air Force personnel by one-third.”

Page 25: See the box entitled “Themes Shared Across Strategic Directions”:

Themes Shared Across Strategic Directions
Suicide prevention efforts should:

Foster positive public dialogue; counter shame, prejudice, and silence; and build public support for suicide prevention;
Address the needs of vulnerable groups, be tailored to the cultural and situational contexts in which they are offered, and seek to eliminate disparities;
Be coordinated and integrated with existing efforts addressing health and behavioral health and ensure continuity of care;
Promote changes in systems, policies, and environments that will support and facilitate the prevention of suicide and related problems;
Bring together public health and behavioral health;
Promote efforts to reduce access to lethal means among individuals with identified suicide risks; and
Apply the most up-to-date knowledge base for suicide prevention.

Page 28: This has a box called “Lessons From the United Kingdom”:

“The adoption of a range of suicide prevention recommendations by mental health systems across England and Wales has been found to greatly reduce suicide rates among patients. A 2012 study examined changes in suicide rates as public sector mental health service settings began to implement the following nine suicide prevention recommendations:

Providing 24-hour crisis teams;
Removing ligature points (materials that could be used for suicide);
Conducting followup with patients within 7 days of discharge;
Conducting assertive community outreach, including providing intensive support for people with severe mental illness;
Providing regular training to frontline clinical staff on the management of suicide risk;
Managing patients with co-occurring disorders (mental and substance use disorder);
Responding to patients who are not complying with treatment;
Sharing information with criminal justice agencies; and
Conducting multidisciplinary reviews and sharing information with families after a suicide.

In 1998, few of the 91 mental health services in the study were carrying out any of these recommendations. By 2004, about half were implementing at least seven recommendations, and by 2006, about 71 percent were doing so. Over time, as more recommendations were implemented, suicide rates among patients declined. Each year, from 2004 to 2006, mental health services that implemented seven or more recommendations had a lower suicide rate than those implementing six or fewer. Among all recommendations, providing 24-hour crisis care was linked to the largest decrease in suicide rates.”

Page 101: Appendix D: Information about preventing suicide in certain high risk populations including but not limited to veterans, those struggling with mental illness, and the medically ill.

Page 133-137: Appendix E contains important information on media reporting on suicide, evidence based, best practices for suicide prevention, and lists of suicide prevention organizations.

Suicide prevention is everyone’s business. Let’s count on each other.