It’s on all of us to raise awareness about suicide
Over this past week we learned about the deaths by suicide of two celebrities, Kate Spade and Anthony Bourdain, while at the same time hearing startling new U.S. statistics showing a disturbing increase in the suicide rate over the past 16 years. For all of us, suicides like these are difficult to understand. Given the nature of celebrity culture we often feel that we know those who are famous intimately. But the simple truth is: no one knows what each of our inner worlds looks like. Struggles with mental health do not respect boundaries of class, ethnicity and income, and we know that the majority of people who die by suicide have a diagnosis of a mental illness. We also know that the majority of people who live with a mental illness do not die by suicide, and that suicide remains a rare occurrence. With all of the tools available to us, we still cannot answer the question of who, when and where as well as we need to.
Often, we discover that, despite the person having shown signs of mental illness, they were not in active treatment or did not find help. As mental health care providers, this is a painful fact. We know we have effective treatments for most people and we always hope to be in a position to at least offer treatments. Helping a person find hope and reasons to go on living are central to our daily work.
We also know that, due to the complex nature of suicide, we do not have all the answers. Sadly, we lose people who are involved in treatment, and that is devastating. We are often faced with the dilemma of balancing safety with a patient’s right and desire for autonomy. At what point should a person be in the community, with family and friends, versus in a treatment facility where they can be more closely monitored and treated, but lack access to certain freedoms and liberties that are so core to their quality of life?
Often family and friends will recognize signs of depression and anxiety but may be reluctant to ask if the person requires help. Listening can be the first step to recovery. The support of family and friends is so very important.
There is no one universal sign of a person struggling with mental distress, so what can you watch for? Sometimes a stressful situation may happen first. Much has been written about the isolation of our modern society, and we know that loneliness and a lack of purpose are significant risk factors for depression. Changes in a person’s sleep, appetite and motivation can be signs of depression along with expressing feelings of hopelessness. Those who are struggling with addiction or significant life changes may be at higher risk — for example retirement, loss of a loved one, relationship break-up, or financial difficulties.
Asking a loved one about thoughts of suicide can seem challenging. By asking, are we inciting the person to end their life? No. Talking about suicide doesn’t cause suicide, it may simply point out what was already there. Evidence tells us that addressing ideas about suicide saves lives.
It’s clear that, as mental health providers, and as a caring society, we have much more work to do. We need to reach the wider communities we serve to help identify those who are at risk of suicide and to improve access to treatment. We can offer interventions for these conditions if we know that a person is at risk for developing them. We need to establish connectedness and partnership with individuals at risk of suicide and their families and work together to develop safety plans aimed at reducing suicide risk factors and increasing hope.
At St. Joe’s we have made significant changes in how we assess and monitor suicidality. Whether this will work better at the community level is an open question, so we will measure results carefully. We know
that continuing to seek the best researched methods for prevention and treatment is essential. Reducing suicide is a guiding light for us.
More than anything, we need to find means to build resiliency and understanding. If you or someone you love is struggling, please look at the resources we have listed here. There are crisis telephone lines and services in this community. Family physicians are your best gateway to more specialized mental health supports. Trust someone, talk about it, reject stigma — this one life we all have is precious.