U.S. Needs to Have an Ongoing Conversation About Suicide


More than 45,000 Americans died by suicide in 2016. It is the 10th leading cause of death in the U.S. KatarzynaBialasiewicz

Americans have come, grimly, to grudgingly abide — if not necessarily accept — the idea of suicide. We understand that it's a national problem, a dangerous and growing one. We whisper reverentially about it. We shake our heads. But then, sadly, we simply move on.

To be sure, there are many who spend their lives trying to help those who struggle with suicide. For the rest of us, though, it may be time — it is, in fact, probably well past time — to recognize that suicide in America is both serious and solvable.

It's time to stop moving on and start speaking up, experts say.

"I think we need to be having a national conversation," Jennifer Payne, the director of the Women's Mood Disorders Center and an associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore, says.

"Suicide prevention requires a comprehensive approach that addresses risk and protective factors ... at multiple levels including societal, community, relationship and individual levels," Deb Stone, a behavioral scientist in the Center for Disease Control and Prevention's (CDC) Division of Violence Prevention and the lead author on a sobering new study on suicide, writes in an email. "There's a role for everyone in the community."

Cold, Hard Facts on Suicide in the U.S.

The recent high-profile suicides of chef and journalist Anthony Bourdain and fashion designer Kate Spade have, at least for the time being, roused a sleepwalking public and brought some alarming statistics to light. Spade died in her New York apartment on June 5, 2018, Bourdain in a hotel room in France days later on June 8.

On June 7, the CDC released the findings of a study that illuminates the scope of the suicide issue in the U.S. Among the facts:

  • Overall, the American suicide rate grew by more than 25 percent from 1999 to 2016.
  • Forty-nine of the 50 states saw an increase in suicides. Nevada was the lone exception.
  • Half the states saw an increase of 30 percent or more.
  • More than 45,000 Americans died by suicide in 2016.
  • It is the 10th leading cause of death in the U.S.

"[I]t's a tragedy for families and communities across the country," Anne Schuchat, the CDC's principal deputy director, said in a statement.

Mental health officials are quick to ask the media to avoid using sensationalistic wording like "skyrocketing" or "epidemic" to characterize the rise in suicides. Still, suicide is a clear, serious, growing public health issue. Facing that might be the first step in combatting it.

But facing it means acknowledging something else, too. Though researchers found that more than half of those who die by suicide don't have a diagnosed mental health condition, mental illness remains a huge factor in suicides.

It's not the only factor. But it's an important one that needs to be addressed.

Suicide rates increased in every U.S. state except Nevada between the years 1999 and 2016.
CDC

Mental Health and Other Factors

"I think there's a stigma associated with psychiatric illness that really needs to go away," Johns Hopkins' Payne says. "It's one of the most common illnesses that people have. People are reluctant to get treatment and seek out care partially because of that stigma.

"If we got rid of the stigma associated with psychiatric illness then I think that would result in people getting better mental health treatment and hopefully a lowering of the suicide rate."

It's hard to determine just how much mental illness is at fault for the rising rates of suicide. Experts caution that it's likely only one of many aspects that may be influencing the statistics.

"I do think it's possible that we have some under-recognition on mental health conditions in our data, both because conditions haven't been formally diagnosed and because those left behind may not have been aware of the mental health diagnosis that an individual carries," the CDC's Schuchat said on a conference call after the agency's report was released. "But I think a very important point is that if we only look at this as a mental health condition or mental health issue we won't make the proper diagnosis that we need."

The CDC points to a variety of other possible factors, including relationship problems or loss of a loved one, substance abuse, physical health problems, money woes and employment stress. Relationship problems, for example, accounted for 42 percent of suicides among those with and without known mental health conditions. Other reasons people are killing themselves in increased numbers are widely cited, from a general downturn in civility (think social media) to the opioid crisis.

Warnings and Prevention

The National Suicide Prevention Lifeline lists warning signs that may signal a person might be contemplating suicide. They include:

  • Talking about wanting to die or to kill themselves
  • Looking for a way to kill themselves, like searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or isolating themselves
  • Showing rage or talking about seeking revenge
  • Extreme mood swings

If you know someone exhibiting any of those signs, experts say, it's best to approach the situation head on.

"One of the simplest ways to determine this is to ask directly, 'Are you thinking about suicide?'" Stone says. Asking is the first of five steps that the Suicide Prevention Lifeline, funded by the Substance Abuse and Mental Health Services Administration, suggests anyone trying to help should know.

  • Ask
  • Keep Them Safe
  • Be There
  • Help Them Connect
  • Follow Up

"Asking the question won't put the thought in someone's head who wasn't previously thinking about suicide, and it can be a relief for the person to open up about their struggles," Stone says.

"What you don't want to do is play the 'Don't ask, don't tell' game. You're not going to regret getting someone the appropriate care," Payne says. "I think that if you really care about someone, and you're really concerned, then you do everything that you can to get them to treatment, including insisting on it."

The Big Picture

On a macro level, slowing the rate of suicides falls largely on public health agencies. But they can't turn the tide alone. From the CDC's "Preventing Suicide: A Technical Package of Policy, Programs, and Practices":

"Other sectors vital to implementing this package include, but are not limited to, education, government (local, state, and federal), social services, health services, business, labor, justice, housing, media, and organizations that comprise the civil society sector such as faith-based organizations, youth-serving organizations, foundations, and other non-governmental organizations. Collectively, these sectors can make a difference in preventing suicide by impacting the various contexts and underlying risks that contribute to suicide."

The CDC, under Stone's Technical Package, has instituted a seven-step strategy to help the different sectors build programs to prevent suicides:

  • Strengthen economic supports
  • Strengthen access and delivery of suicide care
  • Create protective environments
  • Promote connectedness
  • Teach coping and problem-solving skills
  • Identify and support people at risk
  • Lessen harms and prevent future risk

"Government remains a bit of a mystery to me. But someone needs to make it their passion." Payne says. "Someone in the national viewpoint needs to take this on."

In the end, solving such a complex public health issue will demand a lot of work from a lot of people. And all of them will have to be stubbornly unwilling to simply move on.

If you or someone you know is having thoughts about suicide, call the National Suicide Prevention Lifeline at 800-273-TALK (8255).


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