By Kathryn Kehoe-Biggs, L.C.S.W, Ph.D.
On June 8, 2018, the front page of The New York Times announced, “Suicide Rate Climbed 25 Percent Even as Prevention Efforts Grew.” Although studies show that white males between the ages of 45 and 65 are the demographic most at risk, suicide rates are increasing in almost all ages and ethnic groups. While treatment of mental illness is also on the rise, gaps still exist. Women tend seek out mental health treatment more often than men. Sadly, people with the most serious mental health disorders such as psychotic disorder, bipolar disorder and substance abuse are less likely to have a primary care doctor compared to those without mental disorder. Lack of insurance coverage is often the main reason for not obtaining mental health treatment (APA, 2012). Doctors, researchers and mental health providers are faced with the daunting task of creating prevention and treatment programs that connect with the people who need them the most. Unfortunately, most people who die by suicide do not have a diagnosed mental illness, indicating that prevention; detection and treatment initiatives for a disease, which is the 10th leading cause of death in this country, have been woefully inadequate.
Logic and morality must guide open and honest discourse. Shame and misinformation regarding the causes of suicide remains an obstacle to this process. Bullying does not cause suicide, nor does job loss, divorce or other common life stressors. Unfortunately, the media and television programs like ‘Thirteen Reasons’ promote this concept while trivializing a serious health problem. When explaining suicide I use this analogy: A middle age man is shoveling his driveway after a snowstorm and suddenly dies of a heart attack. Over the past few weeks he did not feel well, but never sought out treatment. Clearly the man had an undiagnosed heart condition, which was exacerbated by the stress of shoveling the snow. But it is not the snow’s fault that this man died. Most middle age men can shovel a driveway with no ill effects. Clearly the organ in this man’s body was sick, resulting in his death. Similarly, people who die by suicide have an organ, the brain, which is sick. Stressors can tax that organ. Human brains are built to withstand a certain amount of stress, but if the brain is sick it’s ability to mange may be compromised. External factors such as chronic trauma can change the brain’s chemistry, and, like many illnesses, a combination of genetics and environment can also hasten impairment. The brain is the organ responsible for making choices; when this organ is not working properly suicide may seem like the only sensible choice. There are NOT “thirteen reasons” why someone dies by suicide, a health problem with genetic and biological components. It is simply unethical and irresponsible to promote this type of information. Simply put, suicide is a death caused by mental illness. Until we stop blaming the person who died or those around them we will continue to be distracted by misinformation, which is not backed by research. This misinformation promotes fear, and, of course, once fear enters the conversation it inhibits communication, which is the key to education.
Until the health care system makes mental health treatment more accessible, we need to start taking care of one another. Here are some ways to help:
Be Brave and Present -- Being with someone who is clinically depressed means moving toward pain without attempting to take it way by offering advice or telling the person to “cheer up.” Bravely acknowledge their pain and resist the temptation to look away. Be with the person and remind them that they are special to you, and that they are not alone. Reminding a depressed person to be grateful for the good things they have often comes across as insensitive.
Ask about suicidal thinking -- Most people who have depression do not have suicidal thoughts. Among those who do have such thoughts, the majority never acts upon them. Talking about suicide does not trigger suicidal actions. In fact, telling someone about such thoughts actually, decreases the likelihood toward action. Ask follow-up questions to determine whether there is a specific plan in place. The answers to these questions will determine whether immediate intervention is necessary. It is important to note that many people have passing thoughts of ‘not wanting to be here”. Remember, thoughts are just that – thoughts. It is actions that are dangerous and hurtful. Try to be less judgmental in terms of the thoughts and feelings of others, for when we judge less we are open to hearing more. Supportive, nonjudgmental listening can make a big difference.
What to do if you believe a depressed person is not safe -- Take the person to an emergency room! Explain to them that this is the logical step when a life is in danger. Another option is to call 911 and request a crisis intervention team. This is a team of mental health professionals who will come to your home, assess the situation and determine whether a trip to the hospital is necessary. Suicide hot-lines (1-800-273-TALK) can assist those who are alone and in need of support. If you are a teenager and are concerned about your own safety, or the safety of a friend or family member, inform a responsible adult.
Do not sacrifice your health for another -- Mental illness can cause a change in behavior. If that behavior becomes verbally or physically abusive, your own safety must come first. Set boundaries, with an emphasis on the importance of seeking out professional help. This may mean helping the person find affordable treatment, or accompanying them to an appointment with a mental health professional. If you are feeling overwhelmed by the demands which result from assisting someone with mental illness, it is ok to set limits regarding how much and what type of support you provide.
There are no quick fixes -- Be patient with yourself and others. The treatment of a mental illness takes time, energy and hard work. Like many other illnesses, some types of mental illness are chronic, and while they may require ongoing treatment, they can be managed. While some can be treated to the point where symptoms are barely present. Unfortunately, there are those rare cases when, even with treatment, hard work, love and patience, people still die of this illness.
We still have a lot left to learn about the brain and how to help a person whose brain is sick. As a society and individuals the first step toward exploring the unknown is to avoid looking the other way in fear.
Dr. Kehoe-Biggs, is a psychotherapist in Pelham, email: firstname.lastname@example.org