March 26, 2017  

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Suicide Prevention Month is not nearly enough

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September marks National Suicide Prevention Month.  Although I am profoundly pleased that impactful people are calling such attention to suicide, I always find myself somewhat frustrated at this time each year.  Suicide prevention does not need a month – it needs a national movement commensurate with the public health crisis it represents. 

In 2014, the most recent year for which we have official data, just shy of 43,000 Americans died by suicide.   This means that substantially more individuals die by suicide each year than by homicide, auto accidents, acts of terrorism, and many other phenomena that receive year-round attention in the media.  Deaths by suicide – far more common and no less tragic than these other events – remain a topic discussed in hushed tones, if at all.  Even during its “national month,” you will hear less about suicide than you will about far less common but more easily discussed tragedies.  This is fairly astounding, given that our national suicide rate has increased nearly 30% since 1999 and there have been rate increases each year since 2005.  If this were the case with any other public health concern, the outrage would be palpable and the topic would be a unifying cause throughout the nation.  We would identify this situation as wildly inconsistent with American ideals, and we would celebrate large scale efforts to reverse the tide.

The tragedy of the silence surrounding suicide exists on multiple fronts.  First, where honest and accurate conversations about difficult topics are stunted, stigma flourishes.  As a result, those who have survived attempts and those who have lost loved ones to suicide are left wondering how best to mourn and recover, when and how or even if to tell their story, and unsure whether seeking help will result in improvement or regret.  Second, in the absence of education, myths abound.  Despite evidence that suicide is profoundly difficult, many continue to refer to it as cowardly or an easy way out rather than a tragic but also remarkably difficult pursuit of death.  Despite evidence that asking about suicide not only represents no danger, but actually diminishes suicidal thoughts among those most at risk, many still avoid the topic altogether, as though their silence somehow serves as a prevention tool.  Despite evidence that treatments such as dialectical behavior therapy and brief cognitive behavioral therapy result in meaningful reductions in suicidal behavior, many still believe that suicide is not preventable.  Despite that fact that half of all US suicides result from firearms each year – more than by all other methods combined – and promising evidence that efforts to decrease access to or increase the safe storage of guns result in lower suicide rates, there remains no systematic nationwide effort to promote means safety to prevent suicide. 

Suicide is a difficult topic – particularly when we also discuss the role of guns – so it is entirely understandable that most people would rather discuss something else.  Although I disagree with that impulse, I certainly can see why it exists.  We do not solve difficult problems through avoidance though, and we cannot look at the 10th leading cause of death in our country and see it as anything less than a pressing problem.  Suicide needs its own moonshot, its own media campaign aimed at increasing awareness, communication, and accurate media representations, and its own celebrity representatives. 

Suicide prevention, broadly speaking, needs a nation to awaken to the fact that many of those with the highest suicide rates – men, soldiers, and older adults for instance – are prone to avoiding mental health care altogether or underreporting suicidal thoughts if they do accept care.  As a result, our current infrastructure is ill equipped to identify these individuals as needing help before they die.  When these individuals die by suicide, we are left shocked, having not seen it coming either because the individuals hid their suffering or because we simply did not notice their cries for help.

So what can we, as a nation, do to take the honorable but minimally impactful notion of Suicide Prevention Month and translate it into tangible reductions in suicide?  The media can cover the topic year round in a manner consistent with its impact on the nation, being careful to avoid sensationalism while also ensuring that the public understands the scope of the problem. The mental health field can refer individuals experiencing suicidal thoughts to evidence-based treatments shown to reduce the likelihood of suicide attempts in well-designed clinical trials.  Local governments and beyond can mandate suicide prevention training in relevant fields and look to secure bridges with barriers. Gun owners and gun educators can reach across the aisle, put aside tangential discussions of the Second Amendment, and embrace the promotion of means safety. With support of the gun owning community, such efforts would encourage individuals to store their private firearms unloaded, separate from ammunition, and locked and to temporarily remove their guns from the home when they feel distress just as they give someone else their car keys when they have had too much to drink.

Survivors of attempts can publicly share their stories of survival and recovery while promoting resources such as the National Suicide Prevention Lifeline.  And on a fundamental level, we can all start caring more openly and earnestly about this topic that is claiming the lives of tens of thousands of our fellow citizens every single year.  Suicide is complex and difficult to predict, but it is not impossible to prevent. 

We consider ourselves a nation of problem solvers capable of overcoming daunting obstacles to accomplish great things.  Perhaps it is time we took on this problem.

Michael D. Anestis, Ph.D. is the Nina Bell Suggs Professor of Psychology and director of the Suicide and Prevention laboratory at the University of Southern Mississippi