In California Board of Psychology’s newsletter from Winter 2015, Richard McKeon, PhD, Chief of the Suicide Prevention Branch with SAMHSA presents stark facts of suicide. Suicide is the 10th leading cause of death in the United States: 41, 149 Americans died by suicide in 2013 with 4,025 of those deaths in the state of California. Suicide is the second leading cause of death for people aged 15 to 39. And 1.3 million Americans 18 and older made non-fatal suicide attempts. That is right, 1.3 million people attempted suicide. Only 56 percent of adults who attempted suicide in the past year received mental health treatment. These data, especially when knowing that only 56 percent of adults who attempted suicide in the past year received mental health treatment, underscores the vital need to train providers on prevention of suicide and implement effective practices for assessing and treating those at risk.
SAMHSA supports many prevention resources including the National Suicide Prevention Lifeline at (800) 273-TALK (8255) as well as a resource center at www.sprc.org. This support is very much based on the individual level. Soon, I will discuss a new, more macro level, approach to prevention.
Just last evening, 03/23/15, The Daily Beast posted an article looking at a silent epidemic. Doctors kill themselves at a higher rate than the general population. Up to 400 US doctors are killing themselves a year and no one is talking about it. One potential reason for the lack of coverage is that there may be push to rule the deaths as “unplanned.” Yet doctors know anatomy and have access to lethal doses of drugs. These deaths are not unplanned. From The Daily Beast: “A 2005 essay published in JAMA found that male doctors killed themselves at a rate 70 percent higher than other professionals; among female doctors, that rate ranged from 250 to 400 percent higher.” This is not being talked about. For license renewal, state medical boards seek information on mental health and substance use, diverting the individual to the state Physician's Health Program as necessary. But doctors are often reticent. Shame, stress, an expectation to appear stronger than the general public, can all serve to mask what is going on, both on the individual level and in the community of physicians.
A New Preventive Approach
The New York Times on March 10, 2015, published an article “Blocking the paths to suicide,” by Celia Watson Seupel. This article looks at how the majority of completed suicides are men, with guns. It has been thought that when someone is determined to kill him or herself, there is no way to stop it. But that discounts the frequent impulsivity of the act. Rather than focus on the individual, there is a new approach, “means restriction,” that focuses on the environment.
In my practice, I use the term “accessibility cues,” when I look to modify the environment to increase the likelihood of healthier behavior choices. An example is removing a susceptible binge food from the house; one is less likely to binge on chips if it is necessary to leave the house, walk to the store, and buy them. This provides the time needed to surf the urge.
In public policy, the terms "nudging" and "optimal defaults" refer to setting up a system that increases the likelihood of healthier choices. These examples include taxing unhealthy products or making fresh fruit accessible in bodegas or being automatically enrolled in the company 401K plan.
“Means restriction,” similarly, removes access to what is unhealthy. In this case, dire, such as guns. The article states that 90% of people who try suicide and live ultimately never die by suicide. Extrapolated, this means that if the people who died did not have access to lethal means, they could still be alive. “What people experience before attempting suicide is a combination of panic, agitation, and franticness, “ Dr. Galynker with Mount Sinai Beth Israel, quoted in the article. In a state of panic, dialing the suicide hotline might not be the first thought. But, if lethal means aren't immediately accessible, there may be sufficient time to navigate through the unbearable pain. "Means restriction" can prevent a permanent tragic escape that can never be rectified.