“I knew he was depressed, but I never thought it was serious enough he would kill himself.” The decision to take one’s life is excruciatingly personal, often leaving loved ones with unanswered questions and a need to know why. It’s common to second-guess and wonder if warning signs were missed.
The unsatisfying answer is that, despite what’s known and understood about the reasons people hurt or kill themselves, suicide remains a complex issue. There are almost always multiple causes, and research continues to avail itself of how various factors contribute.
For instance, a new report from the Centers for Disease Control and Prevention shows that mental health conditions – often seen as the cause of suicide – can rarely be attributed as a singular cause of suicide. In fact, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death.
Understanding these contributors and any trends in data can help our community address this public health issue together, especially as national, state and local rates continue to rise. That same CDC report shows suicide rates increased in nearly every state from 1999 through 2016 – Washington state saw an almost 19 percent increase. Locally, the Spokane County Medical Examiner’s 2017 Annual Report found a 31 percent rise in suicides between 2016 and 2017. While any increase is of concern, these recent data require a deeper look and a more immediate call to action.
In looking at causes, in addition to mental health issues, other known contributors to suicide include relationship problems, substance use, physical health challenges and job, money, legal, or housing stress. Again, though, sometimes the whys are never known. Here’s what we can do with what we do know:
Identify and support people at risk of suicide.
Teach coping and problem-solving skills to help people manage challenges with their relationships, jobs, health or other concerns.
Offer activities that bring people together, so they feel connected and not alone.
Expand options for temporary help for those struggling to make ends meet.
We can also all be promoting safe and supportive environments. CDC data show that states with higher suicide rates also have high rates of firearm ownership. If there’s a prototypical pattern among the CDC data, it would be a white middle-age or older man living in a rural area who owns a gun. With nearly half of Spokane’s suicides in 2016 involving a firearm, there is an immediate call to action to reduce access to firearms among people at risk. Prevention is the ideal here.
Means reduction (or means safety) is an approach to preventing suicide by affecting a suicidal individual’s access to lethal means. Putting “speed bumps” in the path of someone considering suicide may provide sufficient time for an intervention or for the person to think otherwise.
Beyond individual prevention efforts, we must also ensure government, public health, health care, employers, education, the media and community organizations are working together to prevent suicide. Public health departments like Spokane Regional Health District are best suited to bring together these partners and that’s where we’re headed. It’s work that underlies our thinking that, while September is National Suicide Prevention Month, every month should represent our community-wide effort to address this issue.
Dr. Bob Lutz is a board-certified family medicine physician who is currently the health officer for Spokane Regional Health District and Asotin County Public Health.
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