Suicide Prevention: In The Real World

By Dr David Laing Dawson

Marvin and I have written blogs about the failure of current and proposed “suicide prevention programs”, the crisis line, the gatekeeper programs, the public awareness programs. He points out these programs make us feel like we are doing something, at least, but are a waste of money.

I would go further. I think they actually increase the number of people who use “suicide threats” as negotiating tools, and then through the intervention of family, counselors, and teachers find themselves in the Emergency Department of Hospitals being assessed by nurses, emergency doctors, social workers, and often the psychiatrist-on-call over a three hour to three-day period. This uses up our resources and poses the risk of inuring these front-line professionals to true suicide risk.

The number of people who actually kill themselves each year is remarkably stable. We know it goes down in wartime, increases in peacetime, and poor economic times. We know the demographics of suicide. We know the high-risk groups.

We know that a few of these suicides constitute rational, understandable, reasonable, sane and logical decisions to end one’s suffering in the face of incurable disease and disability. Hence the current move toward allowing some physician assisted suicides.

We also know that the suicide of someone in other circumstances (temporary distress, intoxication, treatable illness) can be devastating to family and friends. It may in fact be an event from which a sibling, a parent, a child never fully recovers.

We know that many social factors put people at higher risk:

  • inadequate housing,
  • inadequate support systems,
  • social isolation,
  • bereavement,
  • joblessness,
  • addictions.

These factors have no simple solutions but can be gradually improved through well-funded social programs, retraining programs, affordable housing.

We also know that many suicides occur in the population suffering from severe mental illness especially when:

  1.  Discharged from hospital prematurely,
  2.  Unable to be hospitalized in a timely fashion,
  3.  Drop out of treatment or go off medication,
  4.  Their illnesses are not identified nor adequately treated.

We also know a particularly tragic circumstance is the suicide of a teenager, often responding on impulse to something they see as catastrophic, life impairing, hopeless, even while we adults know the situation is transient and will get better.

So what should we do if we want to spend our money on programs that will ultimately make a difference to that completed suicide statistic?

I don’t think I can answer my own question in a blog, but I can start a grounded discussion.

  1. Easy access to family friendly mental health resources including hospital beds.
  2. Hospitals return to somewhat longer hospitalizations with discharge waiting until true stabilization and a good discharge plan. Stop the fast turnover and length of stay pressure.
  3. Better comprehensive outpatient programs for the seriously mentally ill (including PTSD), ensuring the best possible treatment and compliance with that treatment.
  4. Training, organization of services, physical environments that allow optimal detection and response to depression, anxiety and psychosis by family physicians and emergency doctors.
  5. Continue improving our alcohol and addiction programs.
  6. If there are to be government sponsored public education programs they need to counter the very loud voices denying the existence of mental illness, and denigrating medical treatment. They need to focus on parents monitoring their adolescents’ online activity. They need to focus on parents ensuring their adolescent does not have access to lethal weapons and substances.

As for the horribly high rate of suicides on our reserves and among our first nation peoples: I do not think they suffer from a higher rate of actual mental illness than the rest of our country. But all those social factors that increase risk are ubiquitous on many reserves:

  • Alcohol and drug abuse
  • Poor housing
  • Poverty
  • Severe unemployment and underemployment
  • Poor rate of attendance and completion of school.
  • Easy access to lethal weapons and lethal drugs.
  • Social disintegration and corruption.
  • The hopelessness and anger fueled by dependency.

We should study the reserves that are successful, and then work with the leadership of the first nations people to recreate these factors within less successful reserves. Throwing money at the problem does not help. Sending in more “mental health professionals” does not help. Responding to political whims and self-serving demands does not help. We need to help the leadership of these reserves find clear-eyed solutions or improvements to each of the social problems listed above.

 

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6 thoughts on “Suicide Prevention: In The Real World

  1. I just sent your blog url to the representastives in Oly Wa who are looking at a bill, unfortunately this very monday the 29th. Saturday I sent some info from california to them headlined HB 2793-S2.E and the California “$8,370 per suicide prevented” because that figure came out for the bottom line…for all the spending

    My info came from this heavily footnoted report http://mentalillnesspolicy.org/states/california/mhsa/statewide-mhsa-misspending.pdf

    This is our bill: I see so much the same as you and DJ and others have mentioned. Wish we looked for “hard” slow fixes and not fast, “feels like progress” patches.

    Washington HB 2793-S2.E – DIGEST
    (AS OF HOUSE 2ND READING 2/16/16)
    Creates the safe homes task force to raise public
    awareness and increase suicide prevention education among new
    partners who are in key positions to help reduce suicide.
    Requires the University of Washington school of social
    work to administer and staff the task force and convene the
    initial meeting of the task force.
    Requires the department of health to develop and
    administer a safe homes project for firearms dealers and
    firearms ranges to encourage voluntary participation in a
    program to implement suicide awareness and prevention
    strategies.
    Requires the department of fish and wildlife to update
    the pamphlet to incorporate information on suicide awareness
    and prevention.
    Requires a licensed pharmacist, a person holding a
    retired active pharmacist license, or certain other
    professionals holding a retired active license to complete a
    one-time training in suicide assessment, treatment, and
    management.
    Requires the schools of pharmacy at the University of
    Washington and Washington State University to convene a work
    group to jointly develop a curriculum on suicide assessment,
    treatment, and management for pharmacy students.
    Requires the department of health and the pharmacy
    quality assurance commission to jointly develop written
    materials on suicide awareness and prevention that pharmacies
    can post or distribute to customers.
    HB 2793-S2.E – DIGEST
    (AS OF HOUSE 2ND READING 2/16/16)
    Creates the safe homes task force to raise public
    awareness and increase suicide prevention education among new
    partners who are in key positions to help reduce suicide.
    Requires the University of Washington school of social
    work to administer and staff the task force and convene the
    initial meeting of the task force.
    Requires the department of health to develop and
    administer a safe homes project for firearms dealers and
    firearms ranges to encourage voluntary participation in a
    program to implement suicide awareness and prevention
    strategies.
    Requires the department of fish and wildlife to update
    the pamphlet to incorporate information on suicide awareness
    and prevention.
    Requires a licensed pharmacist, a person holding a
    retired active pharmacist license, or certain other
    professionals holding a retired active license to complete a
    one-time training in suicide assessment, treatment, and
    management.
    Requires the schools of pharmacy at the University of
    Washington and Washington State University to convene a work
    group to jointly develop a curriculum on suicide assessment,
    treatment, and management for pharmacy students.
    Requires the department of health and the pharmacy
    quality assurance commission to jointly develop written
    materials on suicide awareness and prevention that pharmacies
    can post or distribute to customers.

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  2. I am aware of an initiative that incorporated all four elements of suicide prevention that you and Marvin Ross so overtly criticize as “useless” and “a waste of money”. The initiative included the creation of a crisis line, a gatekeeper program, and a public awareness program that included both passive publicity and active 90 minute meetings with the targeted people, which all Montreal policemen. While perfect randomization with two perfectly comparable sample was not possible here, the initiative was nevertheless formally evaluated and the suicidal rate of the Montreal police squad was compared to the suicidal rate of the provinicial police squad, where this initiative was not undertaken. Before and after implementation of the initiative, the suicidal rate of the provincial police squad increased from 26 per 10000 to 29 per 10000 while the suicidal rate of the Montreal police squad went down from 31 per 10000 to 6 per 10000 after implementation of the initiative (can’t tell the year period). If you read french, I can try to find the evaluation report.

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  3. I think we need to look at suicide awareness and prevention as a lifelong process. We too often look at one’s immediate situation as to where this “intervention” is placed. I would contend for many of these individuals it wasn’t this one situation but instead a broader systemic context which lacked experiential opportunities for resiliency. I believe suicide prevention has to do with the social contexts we can create for learning, practicing, and mastering life and social skills (social & emotional learning) supporting increased mental health in youth. As one increases social competencies, experiences inclusion and a sense of purpose I think we begin to increase mental health and reduce suicide risk because we’ve changed the quantity and quality ingredients in the recipe for a new marinade/system of prevention, beginning with a different end in mind. Prevention vs. Reaction.
    Kenny Turck, MSW, LGSW
    Founder, CEO DIRT GROUP WORLD, Inc.
    Founder, CCO Crow River Family Services, LLC

    Like

  4. There is no scientific proof that “counselling” prevents suicides of the seriously mentally ill (SMI). It can be touching to read psychiatrists’ stories of the effects on them when their patients’ kill themselves. But it is even more sorrowful to hear a patient tell of the endless threatening audio hallucinations of ever-threatening, critical voices that schizophrenia brings every waking hour.

    Human kindness itself, or more staff will never alleviate symptoms of schizophrenia. That will take scientific disease research to bring amelioration and cures. Just as it has done with other physical illnesses. Why do we wait?

    Let’s use all our resources to eradicate schizophrenia. Let’s not keep using the same failed “treatments” for more and more decades with no benefit for the patients. We are like individuals who keep using the old ways, still expecting different results.

    Like

  5. Reblogged this on twopowers1 and commented:
    I found that peer-led therapy enabled me to secure my self image and improve my outlook! Peer-led therapy offers a more understanding listening and sharing of symptomatic experiences.

    Like

  6. Four teenagers recently have died by suicide in the Manitoba Native Community. Again a community is reeling from these tragedies……

    I have just watched, for the second time, a BBC Documentary on titled

    “Scientific Racism The Eugenics of Social Darwinism …

    I found this documentary helpful because it gave some context to the treatment of indigenous people throughout the world. Not just Canada. It seems that the high rate of suicides in Native Communities are, to some extent, an outcome of the Eugenics of Social Darwinism.

    Like

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