Suicide ends a life and breaks the hearts of many from loved ones to the community at large. Most people who die by suicide exhibit warning signs in advance. And that’s why the hardest emotion for most people to process in the aftermath of a suicide is the thought that someone could have prevented it.
Health professionals need to consider today’s anxiety-filled daily life as a potential catalyst for any number of behavioral health issues, including suicidal thoughts and ideation. Appropriate screening is a good place to start, but it’s more than that. Understanding a patient’s complete picture of mental well-being can often identify treatable conditions that act as possible risk factors for suicide.
Every September, Americans observe Suicide Prevention Awareness Month. It’s a time for examining this difficult topic and opening up frank discussions to reduce the risk and lessen the stigma. In addition to influencing perceptions, advocates are also offering hope and education this month for anyone affected by suicide.
Suicide rates remain high
According to the Centers for Disease Control and Prevention (CDC), 47,500 people died by suicide in the United States in 2019, and it was the 10th leading cause of death. Similar research reveals that 90 percent of people who die by suicide have a treatable underlying behavioral health condition.
SAMHSA also points out that people who die by suicide represent a fraction of the 12 million Americans who considered or attempted suicide in 2019.
These thoughts and actions are experienced by people all ages, races, and ethnicities. The highest suicide rates are among American Indian/Alaska Native and non-Hispanic White populations, according to CDC. Additionally, veterans are at-risk, as are young people in the LGBTQIA+ community, who have a higher rate of suicidal ideation and behavior compared to their peers who identify as straight.
These facts alone paint a grim picture of the urgency with which health professionals must approach suicide and the wide range of factors that contribute to thoughts and ideation. Specific treatments such as cognitive behavioral therapy and dialectical behavioral therapy have been proven to help people, thus reducing their risk.
COVID’s effect on suicide
Many have speculated that the global pandemic has caused a rise in suicides. It stands to reason that might be true considering the collateral job losses, social isolation, disruption to routines, and flat out fear that so many have experienced for months on end with no absolute answer for when life might seem normal again.
Researchers have identified indicators of increased suicides occurring during the pandemic months. One CDC report found ED visits for suspected suicide attempts began to increase among adolescents 12 to 17 years old — especially girls — in May 2020.
An international study, however, found that suicide rates remained stable or declined across the globe. And a recent JAMA article featuring provisional data places suicide as the 11th leading cause of death with more than 44,800 people dying in 2020 — a number lower than any of the previous four years.
Regardless, one suicide death is always one too many.
What providers can do to prevent suicide
Typically, suicide is a step taken when the person sees no other solution. Prevention, therefore, requires a comprehensive approach involving health professionals, communities, and loved ones.
Routine screening is the most important step toward prevention that providers can take. After all, you can’t address an issue if you aren’t aware of it, and research shows asking individuals whether they might be thinking about suicide or making plans to carry it out doesn’t create added risk, according to the American Foundation for Suicide Prevention.
In reviewing historical Tridiuum data from about 50,000 assessments through the first week of August 2021, we find that the percentage of patients with suicide alerts at intake tends to fall between 8 percent and 9 percent. That represents thousands of people who should be engaged in appropriate treatment for suicide specifically. A suicide alert is generated through the Tridiuum ONE platform when a patient’s assessment responses suggest risk of suicidal ideation, intent and/or behavior, based on the Columbia Suicide Severity Rating Scale (CSSRS).
We project that providers using Tridiuum ONE might see a total of as many as 60,000 suicide alerts at intake by the end of this year. A suicide alert indicates greater urgency and possibly greater severity of underlying conditions, making screening not only a life-saving tool but also a tool that facilitates decisions about the most appropriate level of care for each patient.
Prevention at the population level
On a larger scale, providers can take advantage of the many tools and resources for suicide prevention now available through national agencies such as the Substance Abuse and Mental Health Services Administration or the National Institute of Mental Health. Consider posting visible signs to raise awareness of the National Suicide Prevention Lifeline — 800-273-8255 (TALK). This 24/7 lifeline answered more than 2.1 million calls and 234,671 chats in 2020 alone.
By July of 2022, a new hotline number will make the connection even easier for anyone in crisis. A recent law designated the three-digit phone number 9-8-8 as the direct number to reach the Lifeline for immediate counseling or referrals to local mental health services. When the switch is made, providers can share this more-memorable phone number with patients and the community.
In the meantime, providers should seek opportunities to lessen harms and prevent future suicide risk by identifying underlying behavioral health issues as early as possible and connecting patients to the most appropriate treatment. Once patients are engaged, clinicians should assess their progress frequently to ensure treatment is moving toward positive outcomes and improved well-being.