Wednesday, March 11, 2015

Preventing Suicide

Blocking the Paths to Suicide:

Every year, nearly 40,000 Americans kill themselves. The majority are men, and most of them use guns. In fact, more than half of all gun deaths in the United States are suicides.

Suicide can be a very impulsive act, especially among the young, and therefore difficult to predict. Its deadliness depends more upon the means than the determination of the suicide victim.

Now many experts are calling for a reconsideration of suicide-prevention strategies. While mental health and substance abuse treatment must always be important components in treating suicidality, researchers like Ms. Barber are stressing another avenue: “means restriction.”

Instead of treating individual risk, means restriction entails modifying the environment by removing the means by which people usually die by suicide. The world cannot be made suicide-proof, of course. But, these researchers argue, if the walkway over a bridge is fenced off, a struggling college freshman cannot throw herself over the side. If parents leave guns in a locked safe, a teenage son cannot shoot himself if he suddenly decides life is hopeless.
The article discusses the contrarian research which shows that suicide is not always the methodical, deliberate act it's been portrayed to be, but instead is often a sudden impulse and split-second decision made by the eventual victim.
About 90 percent of the people who try suicide and live ultimately never die by suicide. If the people who died had not had easy access to lethal means, researchers like Dr. Miller reason, most would still be alive.

The public has long held the opposite perception. In 2006, researchers at the Harvard center published an opinion survey about people who jump from the Golden Gate Bridge. Seventy-four percent of respondents believed that most or all jumpers would have completed suicide some other way if they had been deterred.

“People think of suicide in this linear way, as if you get more and more depressed and go on to create a more specific plan,” Ms. Barber said.

In fact, suicide is often a convergence of factors leading to a sudden, tragic event. In one study of people who survived a suicide attempt, almost half reported that the whole process, from the first suicidal thought to the final act, took 10 minutes or less.
As I and others have been writing for years, prevention is the key. And while you can't "suicide-proof" a society, as the article notes, we have come a long way in many areas/methods over the years. Bridges are increasingly being made more difficult to jump from, prescription drugs more difficult to stockpile, etc.

We're even recognizing that the correlation between mental illness and suicide is not a good, preventative indicator. In most cases, the potential suicide victim is not clinically depressed, is not in treatment, or if they are, usually not judged to be a suicide-threat risk.
Dr. Igor Galynker, the director of biological psychiatry at Mount Sinai Beth Israel, noted that in one study, 60 percent of patients who were judged to be at low risk died of suicide after their discharge from an acute care psychiatric unit.

Sometimes, depression isn’t even in the picture. In one study, 60 percent of college students who said they were thinking about ways to kill themselves tested negative for depression.

“There are kids for whom it’s very difficult to predict suicide — there doesn’t seem to be that much that is wrong with them,” said Dr. David Brent, an adolescent psychiatrist who studies suicide at the University of Pittsburgh.

Dr. Brent’s research showed that 40 percent of children younger than 16 who died by suicide did not have a clearly definable psychiatric disorder.
In other words, trying to prevent suicide at the mental health/psychiatric level is simply not as reliable as trying to suicide-proof the available means of suicide.

Kind of ironic, isn't it? The psychiatric-industrial complex promises to be the happy elixir for society and its problems, yet drugging everyone in the culture via Big Pharma is still going to miss a significant portion of the potential suicide population.

So where does that leave us? The thousand pound elephant in the room...the last great frontier: guns.
“You can reduce the rate of suicide in the United States substantially, without attending to underlying mental health problems, if fewer people had guns in their homes and fewer people who are at risk for suicide had access to guns in their home,” said Dr. Matthew Miller, a director of Harvard Injury Control Research Center and a professor of health sciences and epidemiology at Northeastern University.

Availability is a consistent factor in how most people choose to attempt suicide, said Ms. Barber, regardless of age. People trying to die by suicide tend to choose not the most effective method, but the one most at hand.

“Some methods have a case fatality rate as low as 1 or 2 percent,” she said. “With a gun, it’s closer to 85 or 90 percent. So it makes a difference what you’re reaching for in these low-planned or unplanned suicide attempts.”

Statistically, having a gun in the home increases the probability of suicide for all age groups. If the gun is unloaded and locked away, the risk is reduced. If there is no gun in the house at all, the suicide risk goes down even further.
It's a simple, well-known fact: more than 60% of gun-related deaths in the U.S. every year are suicides. They're mainly male (thus why males account for more than 70% of completed suicides annually), and interestingly, older Americans (the gun-related suicide rate for 65+ is triple the national rate).

But we are on the opposite trajectory when it comes to guns and gun control in this country. With the passage of "guns everywhere" laws, "stand your ground" laws, "shoot first, ask questions later" laws, "let God sort 'em out" laws, and "from my cold, dead hands" laws, we are saturated in guns to the point of drowning.

And meanwhile, those who spontaneously exercise the ultimate option of suicide will continue to enjoy the availability of quick and easy access to ending their lives via firearm.

No, you can't prevent everyone from wanting to end their own life. And no, banning guns is not the answer to stop gun-related suicides, just as banning belts isn't an option to stop hangings. 

But imagine how many suicides would be prevented if we made firearms more rare and their access more difficult.
Ken Baldwin, who jumped from the Golden Gate Bridge and lived, told reporters that he knew as soon as he had jumped that he had made a terrible mistake. He wanted to live. Mr. Baldwin was lucky.

Ms. Barber tells another story: On a friend’s very first day as an emergency room physician, a patient was wheeled in, a young man who had shot himself in a suicide attempt. “He was begging the doctors to save him,” she said. But they could not.

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