The Middletown Press (Middletown, CT)
Suicide on the rise By Ed Stannard
Direct intervention considered critical
The most important thing is, if you fear someone is thinking about killing themselves, say something to that person.
The second most important thing is to know the number to call: 911 is always a good choice; 211 (Lifeline) is good; and so is the National Suicide Prevention Lifeline, 800-273-8255 (273-TALK). You can even text “CT” to 741741.
“If you think someone is thinking about suicide, assume you’re the only one who will reach out, because it’s really important,” said Michelle Peters, director of the Connecticut chapter of the American Foundation for Suicide Prevention, “A lot of people, they think someone else will reach out to them and they may not.”
Suicide has come to the front of the national consciousness this month, since fashion designer Kate Spade and celebrity chef Anthony Bourdain died by suicide earlier
this month. More people are reaching out for help for themselves or others.
According to Frances Gonzalez, spokeswoman for the National Suicide Prevention Lifeline, calls increased 25 percent on June 6-7, after Spade took her life June 5 at 55 years old.
Calls spiked 65 percent on June 8-9 after Bourdain was found dead in France on June 8 while filming his CNN series “Anthony Bourdain: Parts Unknown,” which will continue to be available on Netflix.
Death by suicide — it’s considered disrespectful to say someone “committed” suicide — is on the rise nationwide and in Connecticut.
The Centers for Disease Control and Prevention reported this month that suicide rates have risen in every state but Nevada between 1999 and 2016, with nearly 45,000 deaths in 2016. According to the CDC, Connecticut had a 19.2 percent increase during that period.
Suicide is the 10th leading cause of death nationally, and in Connecticut, it’s the No. 2 cause for the 15- to 34-year-old age group, according to Michelle Peters, of the Connecticut chapter of the American Foundation for Suicide Prevention, and Pam Mautte, division director for the Alliance for Prevention and Wellness, run by BHcare.
BHcare has been designated by the state Department of Mental Health and Addiction Services to provide those services for many towns from the lower Naugatuck Valley to the Connecticut River Valley, to Cromwell.
“We’ve seen an increase of calls of people looking for suicide-prevention resources or asking how to talk about the topic,” Mautte said. “How do we speak to our children about the news?”
According to the state Office of the Chief Medical Examiner, 402 people age 10 and older died by suicide in 2017, three-fourths of them male. That’s up from 332 in 1990.
No age or ethnic group immune
Barbara DiMauro, president and CEO of Bridges Healthcare in Milford, which offers mental health and addiction services to that area, said, “We are an agency that routinely gets calls from people themselves that are struggling” with the idea of suicide or from family and friends. “I consider it as approaching epidemic proportions.”
DiMauro said while the biggest increase is among younger teens and college students, suicide is a concern “across age groups and across socioeconomic standing.”
She said while the reasons for younger people taking their lives are not fully known, “one of the things that people in the field speculate about is the influence of social media,” which is believed to increase rates of depression, isolation and substance abuse.
Andrea Duarte, suicide prevention program director for the state Department of Mental Health and Addiction Services, said the agency administers federal grants to support agencies such as Bridges.
“One of the federal grants is focused on 10- to 24-yearolds (to) develop a stronger infrastructure for that population,” she said. The Garrett Lee Smith grant, first awarded in 2015, is a $700,000 annual grant for five years. The state Department of Children and Families shares responsibility for administering it.
The important thing is not to avoid the subject, Mautte said. “We need to talk about suicide,” she said. “Many people are afraid of the ‘Sword,’ but … talking about suicide will not put the idea into somebody’s head.
“The correct way is to ask them directly,” she said.
“‘Are you thinking about killing yourself ? Are you thinking about suicide?’ When you ask the question directly (to) the person who has been thinking about this or has been planning … suicide, many times it’s the first time someone has asked them.
“With suicide prevention, the first thing we want to provide is hope. By asking the question, you’re reaching out to let them know it’s OK” to talk about it, “and you’re connecting them to resources,” Mautte said.
DiMauro said “if you’re not comfortable yourself with addressing it with the person, then find someone who the person is connected to” who can talk to him or her. “You should not be confrontational; you should not be judgmental,” she said.
But anyone can help save a life.
One way to be prepared is to take a course called Mental Health First Aid, a national program that “teaches you how to identify, understand and respond to signs of mental illnesses and substanceuse disorders in your community,” according to its website. It’s an “evidencebased nationwide model and Bridges has been engaged since 2013 in teaching that model to lay persons in the community,” DiMauro said. The 8-hour course will be offered again in September, she said.
People can call Bridges or other mental health agencies if they’re unsure. “We’re here for someone to say, ‘I have a friend or colleague or whatever and this is what I’m seeing. What should I do?’ … We can get someone in within the hour,” DiMauro said. Bridges has a mobile crisis unit to meet the possibly suicidal person at home.
Risk factors for suicide
There are many risk factors and signs that someone may be considering killing themselves. Mautte said one is “a traumatic loss — it could be loss of a loved one, loss of a job … alcohol or drug abuse, impulsive or aggressive tendencies. Also, humiliation, loss of status, relationship breakups, arrests.”
An obvious signal is if someone is seeking “access to means to kill themselves,” Mautte said, but other less noticeable signs might be “withdrawing from friends, family or society,” feeling trapped, acting recklessly, showing great anxiety or agitation, sleeping excessively or suffering from insomnia.
DiMauro said clues such as “obvious changes in behavior, a person whose selfcare begins to go down — personal hygiene and appearance — a person who begins to do things very much out of character.”
Also, notice if someone never talks about plans for the future or starts giving away possessions, she said.
Mental health workers look at what protective factors a person has available, according to Dr. Frank Fortunati, associate chief of psychiatry at Yale New Haven Hospital, “Things like being connected to others, connected in treatment, looking toward the future … the feeling that they have others to care for, largely a feeling of connectedness is important,” as is access to treatment.
“They can be resilient under stress,” he said of those who are at less risk of suicide. “They’re demonstrating that they’re able to manage those changes in stress.”
Helping to prevent suicide
BHcare offers a 90-minute training program known as Question, Persuade, Refer. “It’s a gatekeeper training, which means anybody can take the training and reduce suicidal behaviors by providing practical skills,” Mautte said.
Learning how to talk about someone’s suicide is important, she said. “We don’t want to glorify suicide as normal behavior. … We don’t need to go over details, because it’s not helpful to survivors. We don’t need the descriptions because that can be a factor for people who are vulnerable,” she said.
“People experience grief in different ways and many times when someone’s died by suicide there’s a lot of unanswered questions for the people that are left,” Mautte said. “It is complicated. It affects more than just the immediate family, so it needs to be talked about because it has an effect on multiple people,” including those from school, the workplace, faith communities and the neighborhood.
Once the subject is in the open, learning to persuade “is knowing how to offer hope and knowing how you can help bridge them to appropriate help. It teaches you to recognize the warning signs of suicide,” Mautte said. Finally, “you know what resources are available to refer someone for help.”
There are numerous resources, both for helping someone who is considering suicide and for survivors of those who have taken their life, at .preventsuicidect.org. BHcare runs training sessions in libraries, houses of worship and other group settings.
Assessment and treatment
Once someone seeks help — or is ordered by police to undergo an assessment — mental health professionals will interview that person, choosing from among “hundreds” of interviewing tools available, DiMauro said. There are specific questions for children, adolescents and adults. “The ones we use are particularly effective in outpatient settings,” she said. “Some of them may be administered at every visit that you have with the client.”
According to the CDC report, 54 percent of those who died by suicide in 2016 “did not have a known mental health condition.” Fortunati said what that reveals “is a really large number of folks are taking their life and didn’t have any mental health contact.” It’s likely they suffered from a disorder such as depression, anxiety, bipolar disorder, schizophrenia or addiction, “and we didn’t know what it was,” he said.
“If someone comes for an evaluation of suicidal ideation, our job is to really try to get to the bottom of the cause of that suicidal ideation and look at the things that are going on in a person’s life,” Fortunati said.
Professionals at Yale New Haven Psychiatric Hospital then can seek to treat the underlying mental health disorders that lead to suicide.
“Treatment would be targeted on those symptoms that are interfering with their ability to problemsolve,” Fortunati said. Antidepressants or mood-stabilizing medications for bipolar disorder or schizophrenia might be prescribed, “coupled with talk therapy to learn how to problem-solve and help to give them the skills to cope with stressful events and to cope with suicidal thoughts should they return in the future.
“Family involvement is critical,” Fortunati said. “First with providing more information about the patient in terms of symptoms, how they manage stress, how they interact with family and others.”
Family and friends can “help the patient stay in treatment and help the patient avoid substance use and help the patient better manage their anxiety,” Fortunati said.
In addition to anti-depressants and mood stabilizers, Yale New Haven psychiatrists are studying the use of ketamine to reduce depression. The drug may be approved by the Food and Drug Administration within a year.
Also, electro-convulsive therapy “is the single most effective treatment that we have right now for depression,” Fortunati said. “It’s not first-line treatment, but it’s being used more and more.”
Raising awareness
Among the focuses of the American Foundation for Suicide Prevention is to publicize the need for prevention and care of those in danger of suicide. One event is called Walk Out of the Darkness. “There’s seven walks in Connecticut and at least three of them have more than 1,000 people attending,” Peters said.
There are also schoolbased programs — one is called Talk Saves Lives — including a firearms-safety version and programs to train those who can train others. A website called seizetheawkward.com helps young people learn how to approach their friends.