It takes a village to prevent suicides

Dwayne Johnson may look like the living embodiment of his nickname “The Rock.” But beneath his confident, charming exterior lay at one time an ocean of torment. He said this week that he suffered from years of depression following his mother’s suicide attempt when he was a teenager.

That was exacerbated when injuries cut short his prospective professional football career and a girlfriend broke up with him. His depression reached such a point that, he said, “I didn’t want to do a thing or go anywhere. I was crying constantly.”

What happened to the future megastar happens daily to thousands of ordinary young Americans. Depression has increased among teens ages 12 to 17 in the U.S.; the Substance Abuse and Mental Health Services Administration reported that 13% had at least one major depressive episode in 2016, compared to almost 8% in 2006 — and rates for ages 18 and 19 grew to 11%, up 2% from a decade ago.

So it comes as no surprise that, according to the World Health Organization, depression is the most debilitating disease globally in middle- and highincome countries. It doesn’t discriminate, touching the rich and poor, old and young, football player and computer scientist.

Sadly, however, our society has yet to think of depression — or mental illness more broadly — like we do other diseases.

That costs lives. Teen suicide recently reached a 40-year high, the Centers for Disease Control reports. Between 2007 and 2015, suicide rates doubled among American girls and rose by more than 30% among teen boys and young men. Suicide is now the leading cause of death among teenage girls worldwide and the second leading cause of death in individuals ages 13-17 in the U.S. (only motor vehicle crashes kill more).

Nine out of 10 youth who die by suicide have an untreated mental health condition, while four out of five give clear warning signs of their distress.

Yet despite all we know about the risks of depression and suicide, a discussion of mental health is not a standard part of the average health examination, an especially problematic fact given that almost 50% of suicide victims have seen their primary-care physician in the month before taking their own life.

Doing things the old way will cost more lives. First and foremost, we in the medical community must start asking about depression and suicide like we monitor for blood pressure or screen for vision problems. If not, we will not find people who are suffering in silence.

We must also recognize that those who are suffering may be seeking assistance in indirect ways and from people other than medical professionals. Which is to say, we need to equip more Americans to help.

That's why my colleagues and I developed the Columbia Suicide Severity Rating Scale, a simpleto-use risk assessment tool incorporating just a few questions that can be asked in a consistent way.

The questions help determine whether a person is experiencing suicidal thoughts and if so, whether the thoughts include method and intent. Importantly, a history of suicide attempts is the number one risk factor for suicide.

The power of this screening tool is that it is simple and accessible to anyone. Whether you are a doctor, teacher, parent, coworker, coach, friend, relative or anyone else, you can do the asking and make a life and death difference.

It works. My colleagues and I have done training with the military; veteran organizations; schools, colleges and universities; health care institutions; first responders; and government agencies, among many others.

Centerstone, the largest provider of community-based behavioral health care in the U.S., reports a reduction of suicides by 65% in just one state, just in the first 10 months of using the tool. And in the U.S. Marines, suicide rates dropped 22% after a total-force rollout that put the tool in everyone’s hands, from clergy to legal assistants.

By changing the way we speak and act — and expanding the expectation of who can ask and act — we can identify at-risk individuals and get them the help that they need. Dwayne Johnson said it took him a long time to realize it but the key is “to not be afraid to open up . . . You’re not alone.”