Suicide in the United States

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Suicide in the United States
REMOVING THE BARRIERS TO TREATMENT
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The basics From Reducing Suicide A National
Imperative

• Risk Factors
• Genetic component (30-50) Serotonergic function
  reduction, abnormal function of
  hypothalamic-pituitary-adrenal (HPA) axis
• Political and cultural environment Political
  disorder. Stigmas and cultural norms
• Childhood trauma sexual abuse accounts for 9-20
  of suicide attempts (strong risk of developing
  mental disorders).
• Lack of social support
• Mental illness 90 of all suicides in America
  are among the mentally ill.

• Treatments that work
• Lithium treatment of bipolar disorder
  significantly reduces suicide rates.
• Psychotherapy is also a necessary therapeutic
  relationship that reduces the risk,
  cognitive-behavioral approaches that include
  problem-solving training seem to reduce suicidal
  ideation and attempts more effectively than other
  types of therapy.

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Populations with highest rates From Reducing
Suicide A National Imperative

• Native Americans 1.7 times the national average.
• White males over 75 is exceptionally high.
• Youth third leading cause of death among

Lack of resources Shame Stigma of mental
illness Compulsive behavior
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Suicide Mental Disorders

• 90 of suicides in the United States are
  completed by individuals with mental or
  substance abuse disorders
• Between 30 and 90 percent of these individuals
  have a depressive disorder.

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Suicide rates increase in rural America From
Reducing Suicide A National Imperative
(1996-1998)
Per 100,000 people

• Wyoming (21.1)
• Alaska (20.3)
• Montana (20.2)
• Nevada (19.5)
• New Mexico (18.8)

Mountain region (16.9)
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Firearm suicide decreases with urbanization From
Reducing Suicide A National Imperative

• Prevalence of guns cannot be the only factor, or
  necessarily the most important factor in suicide.
• Guns are a means but not the reason a person
  decides to kill themselves in the first place.
• Question? What about rural versus urban life is
  so decidedly hopeless?

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Scarce health resources in rural areas
There is too much discrimination. We are not
getting the treatment to people, especially
children, especially minorities, especially poor,
especially rural areas, especially seniors. At
minimum, we ought to end that discrimination, and
make sure there is the coverage for the
treatment. To end the discrimination, for those
who cannot afford any coverage at all, we have
got to make sure there is some coverage Assistan
t Surgeon General of the United States (Hearing
Before A Subcommittee of the Committee on
Appropriations United States Senate. 106th
Congress)

• limited access to mental health services and
  emergency care
• higher overall mortality rates from accidents
  and injuries of all intents because of isolation
  from care facilities
• mental health services are poor in many rural
  areas
• travel distance to mental health treatment
  impedes use by rural residents
• (Reducing Suicide A National Imperative)

In 2003, there were 43.3 million people without
health insurance
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Higher rates of suicide occur in rural versus
urban areas worldwide.

• In rural China the rate is two to five times
  greater in urban areas.
• Higher rural rates are reported in young males in
  Australia and Ukraine.
• Greece where the overall suicide rate is
  relatively low, urban areas report significantly
  lower rates than rural areas.

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Suicide and Cultural StigmaFrom Reducing
Suicide A National Imperative

• 40 percent of suicide victims had contact with
  their health professional within a month of their
  death
• Even when depression is accurately diagnosed,
  only a minority of patients receive adequate
  treatment
• Different stigmas propel suicide in different
  countries. Widowed Hindu women are expected to
  kill themselves and in China suicide is a means
  of coping with humiliation.
• The most encouraging aspect of this stigma is
  that while societal attitude is such a powerful
  force, it is also realistically malleablethere
  is potential for modification

UNITED STATES There is a shameful stigma that
exists in our society that treats mental
illnesses like personal weaknesses or character
flaws rather than real, disabling illnesses just
like heart disease or diabetes, for which there
are extremely effective treatments. US
Assistant Surgeon General
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US Air Force Suicide Prevention Program

• In 1995, the suicide in the Air Force was nearing
  record heights at 15.8 per 100,000 persons
  annually.
• In reaction, with collaboration from the US
  Surgeon General, the Air Force implemented a
  comprehensive community suicide prevention plan
  and by 1999, the annual rate fell below
  3.5/100,000 persons, a 80 percent plunge from the
  mid-90s.

Best Practice Initiative from the Assistant.
(2002). Secretary for Health, US of Health and
Human Services
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Blueprints of the US Air Force Plan

• 1. Identify risk factors and hurdles that
  discourage help-seeking behavior (stigma towards
  mental illness, cultural norms, and beliefs).
• 2. Change cultural norms and educate.
• 3. Database established to capture demographic,
  risk factor, and protective factor information
  pertaining to individuals who attempted or
  completed suicide
• 4. Deployable teams available to provide
  additional resources to installations hard hit by
  potentially traumatizing events as an integrated
  delivery system for human services.

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Adapting Air Force Prevention Plan to a Civilian
Context

• Politicians are the quasi-military commanders of
  the civilian communities, granted with much less
  influence and less effective methods to elicit
  change.
• The military provides universal availability of
  housing and healthcare. A huge component of the
  civilian suicide problem is inadequate or no
  mental health insurance.

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How the plan would look

• De-stigmization and changing cultural norms
• Suicide is the 3rd leading cause of death among
  youths. Comprehensive suicide education and
  prevention program in schools that breeds a new
  generation of de-stigmatized adults and clearly
  identifies viable resources. Research studies
  demonstrate while impulsivity is linked to
  suicide among youth, coping skills and resiliency
  can be taught.
• Politicians and community leaders must change
  cultural norms by collaborating with public
  health services to consistently speak
  de-stigmatized language of mental health and the
  realities of suicide and suicide prevention.
  Suicide prevention must become a community
  priority and responsibility.
• Providing resources
• Politicians also have the responsibility of
  addressing one of the key differences between the
  civilian and military suicide prevention
  programsthe availability of health services to
  all community members. Also, insurance coverage
  equal to that of general health services should
  be extended to mental health services.
• Detecting suicide risk
• Civilian physicians must be thoroughly trained in
  general suicide risk identification and mental
  illness treatment, adopt a easy, routine
  screening process for every patient they see, and
  act as educators about the stigma of mental
  illness.
• Crisis Intervention Teams
• In civilian terms, critical stress management
  teams look like Crisis Hotlinessites with
  non-judgmental trained personnel who serve as
  compassionate listeners and knowledgeable
  intermediaries to mental health resources. These
  services require more government funding so they
  can more effectively assist their clients with
  treatment options.

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Crisis and Information Hotline

• Accredited by American Association of Suicidology
• Certified by JAKO. Only 7 of social services
  nationally are certified by JAKO. The Salem
  Hospital is the only other certified entity in
  Salem.
• Primary focus is suicide intervention
• Hotline is also skilled at providing Critical
  Incident Stress Management services, teaching
  people how to deal with immediate trauma and
  stress.
• Hotline also provides limited financial
  assistance for issues covering housing, utility
  emergencies, medication assistance, and
  miscellaneous emergency needs, i.e., car repairs,
  etc.
• The Hotline provides 24/7 access, including an
  800, a TDD number, and interpreters for over 130
  different dialects and languages.

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My first shift Sat 4pm to 12am
Depression x State DHS xx Info Referral
xx Housing xx Reassurance xxxxxxx
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How to talk with a suicidal caller

• Are you thinking of killing yourself?
• Do you have a plan?
• What is your plan?
• Do you have the means (pills, weapons, etc) to
  carry out your plan?

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Educate the suicidal caller

• Nobody knows what happens when you die.
• A person probably is more negative about life
  than positive about death.
• Often callers dont associate death with suicide.
• As a last ditch effort, the hotline utilizes
  SHOCK THERAPY

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SHOCK THERAPY

• If you die at home, whos going to discover the
  body?
• If you shoot yourself, who do you think is going
  to clean up that mess? The police and cornor
  wont do ityour family and friends will be
  responsible.
• If you die and nobody finds you for several days,
  what do you think your dog is going to eat?
• When you overdose, its not peaceful you could
  have seizures, or die choking on your own vomit.
• When you die, your bladder and bowels release is
  that the final picture you want to leave the
  world? Your family and friends will have to clean
  that up also.

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To be a mental patient is to

• live on 82 a month in food stamps and watch your
  shrink come back to his office from lunch,
  driving a Mercedes Benz.
• never be taken seriously.
• to be a statistic.
• to watch TV and see shows about how violent,
  dangerous, dumb, incompetent, crazy you are
• be a resident of a ghetto, surrounded by other
  mental patients, who are scared and hungry, and
  bored, and broke as you are.
• tell your psychiatrist hes helping you, even if
  hes not.

• to act glad when youre sad, and calm when youre
  mad.
• participate in stupid groups that call themselves
  therapy music isnt music, its therapy
  volleyball isnt a sport, its therapy sewing is
  therapy washing dishes is therapy.
• is not to dieeven if you want toand not to cry,
  and not to hurt, and not to be scared, and not to
  be angry, and not to be vulnerable, and not to
  laugh too loud because, if you do, you only
  prove that you are a mental patient even if you
  are not.