The Suicide Emergency

As part of my schoolwork this term, I’ve been doing a lot of research into suicide in the United States. It’s a delicate subject in my family because of events in the recent past, but, like any other fear of mine, I’ve decided to grab it by the horns, look it in the eye, and try to understand it. The first step toward understanding it came from talking to my wife. She is finishing her master’s degree in mental health, and she has a ton of information on why people commit suicide. Guess what? They don’t do it because they’re cowards or because of all those other things that popular culture tells us. They do it because of mental health distress. For the most part, they don’t want to live with the thoughts going through their head as a situation in their lives goes out of control.

As an epidemiologist, I’ve been looking into the numbers when it comes to suicide. According to the Centers for Disease Control and Prevention (CDC), the latest data (for 2010) show that 38,364 people were reported to have died from suicide. This doesn’t take into account those “accidents” where someone died by their own hand, like driving onto oncoming traffic, “accidental” overdoses, or shooting at cops so they’ll shoot back at you and kill you. Those deaths break down into once suicide about every 15 minutes, four per hour, 105 per day.

That number of deaths is more than the number of people who fit into Fenway Park (37,400, per MLB.com). We have a very powerful activist organization called MADD, and they hold rallies and petition government for new laws because of the deaths and disabilities from impaired drivers (alcohol or otherwise). Guess what? We could triple the number of deaths from DUI (10,228) and still not have as many as there are from suicide. Heck, we could double the homicide rate (16,259 per year) and still not be at the level of the number of suicides.

As if the loss of life was not enough, suicides cost the US economy $13 billion dollars in lost earnings each year. The attempted suicides alone cost $3.8 billion to the healthcare system, also each year. All in all, suicides take away 1.3 million years of life lost each year. That’s the number of years that all those people won’t be around to love and be loved, to create and take part in society.

So what are people using to commit suicide? It should be no surprise that it’s firearms. A little over half of all suicides in 2010 were completed by a gun. (I’ll leave the policy discussion for later.) However, in children ages 10 to 14, the most common mode of suicide was suffocation. On average, women were more likely to use poisoning to commit suicide. American Indian / Alaska natives had the highest rate of suicide in 2007, followed by non-Hispanic Whites, Asian / Pacific Islanders, Hispanics, and Blacks. Non-Hispanic White men aged 85 and older had a suicide rate of 47 deaths per 100,000 people of that age.

The risk factors for suicide? Number one was depression and other mental health disorders. Number two was substance abuse disorders. These two causes made up over 90% of all cases in 2007. The other 10% were made up by family history of mental health disorders or substance abuse, family history of suicide, family violence or abuse, firearms in the house (which is more of a confounder, really), incarceration, and exposure to suicidal behavior of others.

All this barely scratches the surface of the problem. It is estimated that there are 11 attempted suicides per each completed one. In 2010, that was about 422,004 people attempting suicide and surviving. And all that doesn’t take into account the friends and family who are affected by those attempts and those completed suicides. That’s a whole other blog post.

So… The policy discussion. It’s no secret that the mental health system in the United States is very, very weak. It’s also no secret that matters of mental health are taboo. Statements like “You’re crazy!” or blaming “the crazies” for the ills of society are commonplace. So it’s going to be darn near impossible to get anything of substance done right away. It’s going to take “baby steps” to inch us closer and closer to a time when people with a mental health disorder can go to their healthcare provider and have that taken care of, just like we take care of a broken bone or a sore throat right now.

This is going to take a lot of work. We have to change the culture of healthcare, where physicians, physician assitants, and nurses are all trained to patch the wound and get the patients out the door. Public Health is moving away from disease prevention and into studying and understanding chronic disease, with mental health only as an afterthought. We have urgent care centers popping up all over the place, but mental health facilities?

And it’s not like we need fll-fledged “facilities” to take care of mental health problems and substance abuse. A lot of mental health problems can be taken care of with just talking to someone, a counselor, who knows how to ask the right questions to get you to deal with the thoughts in your head and the feelings that can be overwhelming. Medication is not always the answer, but it has become safer and safer and easier to use.

It’s no secret that my wife is a physician assistant. She realized early on in her career that a lot of physical ailments her patients were presenting with were due to a mental health component. The kid who punched the wall punched it because he couldn’t control his anger. The woman who felt pressure in her chest, once everything else was ruled out, felt it because it was the anniversary of the death of her husband of decades. Women with genitourinary problems are being sexually abused by their husbands or boyfriends. Men with erectile dysfunction were under a lot of pressure at work. And so on and so forth… It wasn’t the case with all patients, but it was the case with enough patients to make her work very, very hard for the last four years (plus) to get her second master’s, this one in mental health counseling.

And it may not be an accident of history that she and I met and got married… I’m getting this public health doctoral education, which is golden, and I hope that together we can contribute to doing something about all this. Because we need to do something, a full-court press, a “war” on mental health disorders in general and suicide in particular. After all, we lost 3,000 people on 9/11 and went to war in Afghanistan and Iraq. We lose over 35,000 per year to suicide, and it seems that no one in our political leadership bats an eye.

I'm a fourth-year doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

2 thoughts on “The Suicide Emergency

  1. If our national health care system as it stands is an embarrassment to the world, our mental health care system is a full fledged disgrace.
    When I was young, we still had mental hospitals in large numbers. These were rather grim institutions, there were some spectacular abuses that had occurred in the past and some were ongoing when the decision was made to close the facilities and move toward community based mental health care.
    As most of the involuntarily committed patients could have been cared for in a functioning community based care system, it seemed like a great idea. Patients would be near family and friends, providing additional support and the patients could become contributing members of the community.
    Regrettably, that did not occur. Instead, in some cases, patients were quite literally discharged onto the street! Byberry comes to mind in that latter case. Some of the patients tried to find the mythical community based mental health care services, but those were never funded and hence, were never established.
    During that debacle, a new social problem was suddenly noticed. Homelessness.
    Yes, the two were linked. Lacking treatment, those who it was hoped would be treated at the community level and contribute were not able to do so, as their treatments halted abruptly. They could no longer function, plus those already literally discharged onto the street became the “plague” of homeless persons.
    Our good political leaders did what political leaders do, shifted the problem, ordering the police to force the homeless to another area.
    I’d be curious to examine data from that time to see how many died as a result of abrupt discontinuation of their medications, as really, really bad things can happen when some medications are discontinued abruptly.
    Regardless, we still have a significant homeless “problem” where many are mentally ill persons who are untreated, as they were to rely upon the unicorn for treatment. Yes, the unicorn. The mythical creature that was the unfunded, uncreated community based health care system.
    Meanwhile, some patients *could* be better served by inpatient stays of short duration as medications are balanced to meet their biological needs. But, we no longer have the facilities to do so.
    So, we have homeless mentally ill persons on the street and we have mentally ill persons going without treatment in our neighbors homes.
    Now, let’s add in confounding factors.
    A firearm in those homes. Some money readily available.
    Now, look up Jared Loughner. That was a failure of our society, as our society knew quite well he was mentally ill and never saw to his needs, now he’s in prison and our ill educated populace is actually happy!
    James Eagan Holmes. Another failure, this time, even more bizarre and with improvised explosives. He’s in prison now, our populace is happy!
    Adam Lanza. He had documented problems, his mother apparently had some issues as well, as those who are well mentally balanced do *not* prep for a mythical doomsday.
    But, our EMT’s are trained in mental health issues. They’re trained to never let anything get between them and the door in case a patient “goes off” and that is essentially the extent of it, save to let the police handle the emergency then. Of course, the situation escalates, as law enforcement officers are not trained well in handling the mentally ill when they are having a significant break with reality, resulting in injury at best, death at worst. The populace is happy!
    Well, until it is a family member, then they’re out for blood.
    Meanwhile, our society still has a Victorian view on mental illness, it’s a character flaw.
    Diabetes isn’t a character flaw. Coronary artery disease isn’t a character flaw. Kidney disease isn’t a character flaw. Arthritis (pick your flavor) isn’t a character flaw. But, mental illness magically is.
    Our society wants to punish the mentally ill person, such as a recent instance where someone taped razor blades onto playground equipment. Thankfully, alert maintenance crews noticed the razors and called police. The populace is more than happy to incarcerate the person who did that, regardless of it being obviously a mental illness issue.

    What is needed is to undermine that Victorian outlook on mental illness and educate our populace that mental illness isn’t some punishment from God, it isn’t a character flaw, it is a real, medical illness and it requires treatment. We need for our populace and political leaders to understand that heart disease isn’t a crime, mental illness isn’t a crime and brains are a *lot* more complicated than a simple organ like a heart!
    Then, we can address the issue of treating mental illness and I’m willing to bet that suicide will decrease drastically. For, with many suicides, clinical depression was the precursor.
    And the societal “cure” is “shake it off”.
    Which is rather like shake off the crushing chest pain while you’re suffering a myocardial infarction.

    I’ll not even go into chronic pain patients and depression. That is a topic I could write books on, as both my wife and I are chronic pain patients. Our only real advantage is that we know that depression can be caused by chronic pain and we look for symptoms to begin and help each other through it early, interrupting that which would otherwise become a spiral downward.

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