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.