It’s Time We Treated Suicide Like a Public Health Crisis
How we can better address the mental-health needs of suicidal patients.
Posted Mar 02, 2018
by John V. Campo, MD
Imagine, for a moment, an epidemic that claimed more than 42,000 Americans each year, and that killed more young people, aged 10 to 24, than cancer, heart disease, liver disease, stroke, meningitis, and HIV combined. Now imagine hearing that, for some reason, public funding for researching and battling this epidemic was so tiny it represented about a quarter of the money we spent on curing inflammatory bowel disease. It may sound absurd, but that’s precisely the case when it comes to suicide.
It’s time we started paying attention. According to a recently released data from the Centers for Disease Control and Prevention, deaths from suicide increased by a whopping 24 percent between 1999 and 2014 among Americans age five and older. While the CDC did not point to definitive reasons for the spike, suicide is now the tenth-leading overall cause of death in the United States.
Despite these rattling statistics, we’re still far from offering patients optimal treatment. To understand why, consider the following quote from the French neurologist Jean-Martin Charcot, whose work in the late 19th century on hypnosis and hysteria broke ground for us today. “In the last analysis,” Charcot wrote, “we see only what we are ready to see, what we have been taught to see. We eliminate and ignore anything that is not a part of our prejudices.”
Mental health, sadly, is a case in point.
A Case Study: Social Isolation and the Need for Intervention
Consider the case of Kevin Hines. Nineteen years old and suffering from bipolar disorder, Kevin left his home in San Francisco one day and walked over to the Golden Gate Bridge in order to end his life. On the way, he resolved that if only one person stopped him and asked him how he was feeling, he would refrain from jumping and struggle with his illness instead. No one did. One woman did tap him on the shoulder, but all she wanted was for Kevin to take her photo with the famous landmark. Kevin took the leap, but as he was falling he realized he did not want to die and asked God to spare him. Miraculously, he survived, and has since become an outspoken advocate for mental health interventions. Kevin’s message is simple but powerful: Pay attention.
Addressing the Suicide Treatment Crisis
Sadly, when it comes to suicidal patients, it’s a message that physicians in particular should heed. Step in to any emergency department in the nation, and you’ll find that when a suicidal patient arrives, the default attitude, most likely, is dispositional — namely, wondering where might the patient be sent instead of asking how best to treat him or her. That’s because most physicians, unfortunately, still conceive of health care and mental health care as disparate fields, a perception that impacts not only hearts and minds but bottom lines as well: If you look at the gap between the levels of physician compensation on the private and public side, you’ll find it’s much wider in mental health than it is in other forms of medicine — concrete proof that we, quite literally, undervalue mental health.
Stigma plays a key role in keeping us from properly addressing this crisis. Even communities that enjoy access to good, affordable health care are vulnerable when it comes to suicide and access to mental health services. You hardly have to be a psychiatrist to have an idea why. Few people suffering from cancer are accused of a moral or spiritual failing, and families of stroke victims are considerably less likely than families of suicide victims to torment themselves by wondering if anything they could’ve done to save their loved ones.
How, then, to approach it? First, we should understand it as what it so clearly is: a public health disaster of the first order. Once we look at it that way, as a public health problem rather than an affliction that’s hard to understand and impossible to treat, we could begin offering suicidal patients the help they need by targeting risk factors that may be both causal and remediable. We can invest widely in prevention efforts targeting the population at large, and screen to identify high-risk individuals. Most importantly, perhaps, we can train primary care physicians to adopt an integrated approach that puts no barriers between mental and physical health. By embedding mental health professionals in general medical settings, we can better educate doctors, patients, and families alike, challenging misguided beliefs and offering better and more efficient care alternatives.
These, to be sure, are formidable challenges, but we have no choice but to take them on. And when we do, we’ll discover that sometimes, saving lives involves not designing new tools but devising new ways to look at the world and at each other.
Dr. John V. Campo is Chair of the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center. He serves on the executive committee for the Stanley D. and Joan H. Ross Center for Brain Health and Performance.