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Suicide in the United States The basics From Reducing Suicide: A National Imperative Risk Factors Treatments that work Genetic component (30-50%): Lithium treatment of bipolar Serotonergic function reduction, disorder significantly reduces abnormal function of suicide rates. hypothalamic-pituitary-adrenal (HPA) axis Psychotherapy is also a Political and cultural necessary therapeutic relationship environment: Political disorder. that reduces the risk, cognitive- Stigmas and cultural norms behavioral approaches that Childhood trauma: sexual abuse include problem-solving training accounts for 9-20% of suicide seem to reduce suicidal ideation attempts (strong risk of developing and attempts more effectively than mental disorders). other types of therapy. Lack of social support Mental illness: 90% of all suicides in America are among the mentally ill. Populations with highest rates From Reducing Suicide: A National Imperative Native Lack of resources Americans: 1.7 times the national average. White males over Shame: Stigma of mental illness 75 is exceptionally high. Youth: third Compulsive behavior leading cause of death among 90% of suicides Suicide & Mental Disorders in the United States are completed by 100 individuals with 90 80 mental or 70 substance abuse Percentage 60 disorders 50 40 30 Between 30 and 20 90 percent of 10 these 0 individuals have r r er ity se ve a la de ni rd po bu si al a depressive re or so es on la bi ph is pr di rs D ho zo disorder. de pe no co hi sc al Disorder Suicide rates increase in rural America From Reducing Suicide: A National Imperative (1996-1998) Per 100,000 people 1) Wyoming (21.1) 2) Alaska (20.3) 3) Montana (20.2) 4) Nevada (19.5) 5) New Mexico (18.8) Mountain region (16.9) Firearm suicide decreases with urbanization From Reducing Suicide: A National Imperative „ Prevalence of guns cannot be the only factor, or necessarily the most important factor in suicide. „ Guns are a means but not the reason a person decides to kill themselves in the first place. „ Question? What about rural versus urban life is so decidedly hopeless? Scarce health resources in rural areas limited access to mental “There is too much discrimination. We are not getting the treatment to people, health services and especially children, especially emergency care minorities, especially poor, especially higher overall mortality rural areas, especially seniors. At minimum, we ought to end that rates from accidents and discrimination, and make sure there is injuries of all intents the coverage for the treatment. To end because of isolation from the discrimination, for those who care facilities cannot afford any coverage at all, we have got to make sure there is some mental health services are coverage” poor in many rural areas ~Assistant Surgeon General of the travel distance to mental United States health treatment impedes (Hearing Before A Subcommittee of the Committee on Appropriations United States Senate. 106th Congress) use by rural residents (Reducing Suicide: A National Imperative) In 2003, there were 43.3 million people without health insurance Higher rates of suicide occur in rural versus urban areas worldwide. In rural China the Country Total Year Country Total Year rate is two to five Armenia 1.8 1999 Mexico 3.1 1995 times greater in Austria 19.2 1999 Norway 12.1 1997 Azerbaijan 0.7 1999 urban areas. Belarus 34 1999 Philippines 2.1 1993 Higher rural rates Brazil 4.1 1995 Poland Republic of 14.3 1996 are reported in Canada China 12.3 14.1 1997 1998 Korea 13 1997 young males in (rural Russian Federation 35.5 1998 Australia and areas) 23.3 1998 Singapore 11.7 1998 Ukraine. (urban areas) 6.8 1998 Sri Lanka 31 1991 Greece where the Finland 23.8 1998 Sweden 14.2 1996 overall suicide Georgia Greece 4.3 3.8 1992 1998 Tajikistan 3.5 1995 rate is relatively Hungary 33.1 1999 Thailand 4 1994 Ukraine 29.1 1999 low, urban areas India 10.7 1998 Great Britain report Italy 8.2 1997 and Northern Ireland 7.4 1998 significantly lower Japan 18.8 1997 United rates than rural Kuwait 2.2 1999 States 10.7 1999 areas.” Lithuania 41.9 1999 Suicide and Cultural Stigma From Reducing Suicide: A National Imperative 40 percent of suicide victims had contact UNITED STATES: with their health professional within a “There is a shameful stigma that exists in our month of their death society that treats mental Even when depression is accurately illnesses like personal diagnosed, only a minority of patients weaknesses or character receive adequate treatment flaws rather than real, Different stigmas propel suicide in different disabling illnesses just like heart disease or countries. Widowed Hindu women are diabetes, for which there expected to kill themselves and in China are extremely effective suicide is a means of coping with treatments.” ~US humiliation. Assistant Surgeon The most encouraging aspect of this stigma General is that while societal attitude is such a powerful force, it is also realistically malleable†there is potential for modification US Air Force Suicide Prevention Program In 1995, the suicide in the Air Force was nearing record heights at 15.8 per 100,000 persons annually. In reaction, with collaboration from the US Surgeon General, the Air Force implemented a comprehensive community suicide prevention plan and by 1999, the annual rate fell Best Practice Initiative from the Assistant. (2002). Secretary for below 3.5/100,000 Health, US of Health and Human Services persons, a 80 percent Blueprints of the US Air Force Plan 1. Identify risk factors and hurdles that discourage help- seeking behavior (stigma towards mental illness, cultural norms, and beliefs). 2. Change cultural norms and educate. 3. Database established to capture demographic, risk factor, and protective factor information pertaining to individuals who attempted or completed suicide 4. Deployable teams available to provide additional resources to installations hard hit by potentially traumatizing events as an integrated delivery system for human services. Adapting Air Force Prevention Plan to a Civilian Context Politicians are the quasi-military commanders of the civilian communities, granted with much less influence and less effective methods to elicit change. The military provides universal availability of housing and healthcare. A huge component of the civilian suicide problem is inadequate or no mental health insurance. How the plan would look De-stigmization and changing cultural norms: Suicide is the 3rd leading cause of death among youths. Comprehensive suicide education and prevention program in schools that breeds a new generation of de-stigmatized adults and clearly identifies viable resources. Research studies demonstrate while impulsivity is linked to suicide among youth, coping skills and resiliency can be taught. Politicians and community leaders must change cultural norms by collaborating with public health services to consistently speak de-stigmatized language of mental health and the realities of suicide and suicide prevention. Suicide prevention must become a community priority and responsibility. Providing resources: Politicians also have the responsibility of addressing one of the key differences between the civilian and military suicide prevention programs†the availability of health services to all community members. Also, insurance coverage equal to that of general health services should be extended to mental health services. Detecting suicide risk: Civilian physicians must be thoroughly trained in general suicide risk identification and mental illness treatment, adopt a easy, routine screening process for every patient they see, and act as educators about the stigma of mental illness. Crisis Intervention Teams: In civilian terms, critical stress management teams look like “Crisis Hotlines”†sites with non-judgmental trained personnel who serve as compassionate listeners and knowledgeable intermediaries to mental health resources. These services require more government funding so they can more effectively assist their clients with treatment options. Crisis and Information Hotline Accredited by American Association of Suicidology Certified by JAKO. Only 7% of social services nationally are certified by JAKO. The Salem Hospital is the only other certified entity in Salem. Primary focus is suicide intervention Hotline is also skilled at providing Critical Incident Stress Management services, teaching people how to deal with immediate trauma and stress. Hotline also provides limited financial assistance for issues covering housing, utility emergencies, medication assistance, and miscellaneous emergency needs, i.e., car repairs, etc. The Hotline provides 24/7 access, including an 800#, a TDD number, and interpreters for over 130 different dialects and languages. Number of calls A lc 0 1 2 3 4 5 6 7 oh Ab o l us R e el at M e ar Br d io id n g Co es C . ou DH ns S el in g D C ep VM re s St si o at n D e ru DH g S D R om ela Vi ted Bart ol G e E Fo nc In e fo od H ea & R Bo rin e x Connie g fer Im ra pa l r H ied o Type of Call In usi te n g rp re My first shift: Sat 4pm to 12am t M er Saturday, March 12 Pa ed re n ica Jessica/Melissa R ts A l ea ss no ur n an Se Ru ce xu na al wa A y Se ss x aul Re t la Housing: xx te Tr d Depression: x an Sui State DHS: xx sp ci d or e ta Info & Referral: xx tio n Reassurance: xxxxxxx How to talk with a suicidal caller: Are you thinking of killing yourself? Do you have a plan? What is your plan? Do you have the means (pills, weapons, etc) to carry out your plan? Educate the suicidal caller Nobody knows what happens when you die. A person probably is more negative about life than positive about death. Often callers don’t associate death with suicide. As a last ditch effort, the hotline utilizes SHOCK THERAPY: SHOCK THERAPY If you die at home, who’s going to discover the body? If you shoot yourself, who do you think is going to clean up that mess? The police and cornor won’t do it†your family and friends will be responsible. If you die and nobody finds you for several days, what do you think your dog is going to eat? When you overdose, it’s not peaceful; you could have seizures, or die choking on your own vomit. When you die, your bladder and bowels release; is that the final picture you want to leave the world? Your family and friends will have to clean that up also. To be a mental patient is to… live on $82 a month in food stamps to act glad when you’re sad, and calm and watch your shrink come back when you’re mad. to his office from lunch, driving a participate in stupid groups that call Mercedes Benz. themselves therapy; music isn’t music, never be taken seriously. it’s therapy; volleyball isn’t a sport, it’s to be a statistic. therapy; sewing is therapy; washing to watch TV and see shows about dishes is therapy. how violent, dangerous, dumb, is not to die†even if you want to†and incompetent, crazy you are not to cry, and not to hurt, and not to be a resident of a ghetto, be scared, and not to be angry, and not surrounded by other mental to be vulnerable, and not to laugh too patients, who are scared and loud ‟because, if you do, you only hungry, and bored, and broke as prove that you are a mental patient you are. even if you are not. tell your psychiatrist he’s helping you, even if he’s not.
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