Suicide is a global phenomenon. According to the World Health Organisation, about 800,000 people die by suicide every year: one person every 40 seconds. It is the 17th leading cause of death worldwide. Many more attempt suicide. That’s a stunning number of people dying by their own hand. In addition to galvanizing public health prevention efforts, these statistics pose an urgent need to identify root causes and more effective treatment systems.
In Boston – where I am a psychiatrist at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School – I see firsthand the pain and anguish that families face when a loved one dies by suicide. Treatment works, but beyond having access to appropriate medical and psychological help, social environment is critical to creating successful recovery opportunities for people suffering from mental health and substance use disorders. I ask readers to commit to help prevent these unnatural deaths.
We can make a difference if we each commit to one opportunity for improvement… ones that are in our homes, our schools, our worksites and our communities. This article offers a few suggestions based on evidence of what we understand contributes to self-harm deaths. Do not stand by and accept the premature loss of another father, mother, sister, brother or child.
Avoid treating persons with mental health or substance use disorders with negativity.
I’m talking about stigma. Understand that brain diseases are chronic medical illnesses that respond to safe, effective medications and scientifically demonstrated therapies. If you know someone who appears to be suffering, be compassionate, and help them find treatment options. Most people suffering from depression or addiction who don’t ask for help report that they were afraid of being viewed negatively by others or they weren’t sure they needed help, believing that they are able to solve their issues or that they will solve themselves over time. This is a tragedy. We saw it in the past with HIV/Aids and cancer, and we see it still all the time with mental health and substance use disorders.
Be careful with your own medications.
Prescribed medications are under regulatory oversight because they are dangerous if misused. This is true not only for controlled substances, like prescription opioids, stimulants, and sedatives; it is also true for medications like antibiotics. Research on attitudes in the US suggests that people grossly underestimate the dangers of medication-sharing, which include but are not limited to: development of addiction, lethality of overdoses, and injuries related to interactions with alcohol and other medications. Store medications safely and out of reach from children, take only as prescribed, don’t share with family and friends, and dispose safely of medications you no longer need.
If someone is talking about death or suicide, do something.
People who talk about thoughts of death or suicide are at increased risk for each, even when they say it in a casual way. Take action. Check in with that person, be brave enough to ask if they’re doing OK, or if you can help. Your concern can save a life.
Be part of the solution reducing barriers to treatment.
Especially at the beginning, and sometimes for longer periods, people in treatment for mental health and substance use disorders need to attend frequent treatments, such as weekly prescriber appointments, weekly therapy, and peer support/mutual help groups several times per week. This is not easy to accomplish and can cause financial strain, as many people have competing responsibilities. Volunteer babysitting and/or transportation, be part of civic committees focused on making treatment more family-friendly and affordable. Start peer support groups, mentor groups and safe/sober leisure activities. Ask local fitness and yoga clubs to give discounts for those in need of stress reduction services.
Make sleep a cultural priority.
There is a sleep deficit epidemic which is not getting the attention it deserves. Healthy sleep patterns are essential not only for mental health but also for physical health, education and general wellbeing. Take care of yourself, practice good sleep habits, and insist that those around you do the same. It’s free, and it matters much more than you’ve been told.
Don’t allow people who have been seriously depressed to be alone with lethal means.
Prescriptions, drugs and alcohol are often as lethal as a gun. If you’d feel uncomfortable with someone being alone with a gun, then think again about pills, alcohol, and drugs. Many deaths by suicide involve substances or prescription medications. For example, in the US an alarming 86% of prescription opioid deaths among those aged 60 and older between 2006-2013 were suicides. Among UK drug deaths, 23% of women and 11% of men committed suicide.
If you are a member of a faith organisation, pray for health and healing.
Many of the most successful community innovations and family protective structures have roots in acts of faith and spiritual communion. Connection matters.
It’s an old message, but friends don’t let friends drive drunk or high. And don’t do it yourself.
Honour our veterans and first responders.
We are shamed by the tragic problems of service men and women who returned from honourable service to homelessness, inadequately treated post traumatic stress disorder, substance use disorders – and suicide as a favourable option. Our veterans and first responders are often quietly suffering instead of being supported. The continuous exposure to tragedy and the “dark side” of life creates vulnerability to stress disorders of all type, physical and emotional. Sleep disorders are endemic. Let’s proactively support those who make our lives safer.
Talk clearly with your children and loved ones, even when you worry that it doesn’t make a difference. It does: it’s one of the most protective factors known.
We urgently need to reassess how we think about substance overdose deaths in general, to include greater focus on self-harm prevention and education efforts for prescribers, patients, families and community stakeholders.