>>> THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION FOUND
THAT SUICIDE RATES INCREASED SIGNIFICANTLY IN 44 STATES FROM
1999 TO 2017.
AND MASSACHUSETTS WAS AMONG 25 STATES WHERE THE INCREASE WAS
MORE THAN 30%.
I DISCUSSED THESE FINDINGS WITH DR.
LISA WEXLER AND DR.
BARRY SARVET OF BAY STATE MEDICAL CENTER.
>> IT CONFIRMED WHAT WE'VE KNOWN FOR A LONG TIME, IS THAT WE
ACTUALLY HAVE A PUBLIC HEALTH CRISIS THAT'S REALLY UNFOLDING
IN SLOW MOTION, WE BASICALLY HAVE BEEN NEGLECTING TO ADDRESS
DEPRESSION.
>> SO WE OFTEN HEAR ABOUT THE OPIOID CRISIS, OTHER TIMES OF
PUBLIC HEALTH CRISES THAT ARE OUT THERE.
AND WE'RE DISCUSSING ACTIVELY.
WHY DO YOU THINK, DR.
WEXLER, THIS HAS BEEN SORT OF UNDERNEATH
THE RADAR AND NOW ALL OF A SUDDEN, YOU SAY, IT IS A PUBLIC
HEALTH CRISIS?
>> I THINK IT'S BEEN A PUBLIC HEALTH CRISIS FOR QUITE A WHILE.
THERE HAVE BEE INCREASING RATES, AND I THINK THERE'S
MULTIPLE FACTORS THAT GO ALONG WITH IT.
SO DEPRESSION, MENTAL HEALTH IS ONE OF THE FACTORS.
I WOULD TAKE A STEP BACK ASK LOOK AT PUBLIC HEALTH AT LARGE,
AND IF WE THINK ABOUT THE FACT THAT MORE THAN HALF THE PEOPLE
THAT DIE BY SUICIDE DO NOT HAVE A DIAGNOSED MENTAL HEALTH ISSUE,
AND SO THERE'S THINGS LIKE UNEMPLOYMENT, THERE'S THINGS
LIKE VOLATILITY, HOUSING, THERE'S THINGS LIKE CRIMINAL
JUSTICE THAT'S UNFAIR.
THERE'S THINGS LIKE GUN CONTROL.
MORE THAN HALF THE PEOPLE THAT DIE BY SUICIDE DIE BY GUNS IN
THIS COUNTRY.
AND OTHER COUNTRIES THAT HAVE LIMITED ACCESS TO GUNS HAVE
ACTUALLY REDUCED SUICIDE RATES.
SO I THINK WE TEND TO THINK OF IT ONLY AS A MENTAL HEALTH
ISSUE, WHEN IT'S SO MANY OTHER THINGS THAT OUR SOCIETY AND OUR
POLICIES CAN ACTUALLY CONTROL AND REDUCE THE RISK.
>> I WOULD ADD, THOUGH, THE PIECE THAT EVEN THOUGH HALF OF
THE PEOPLE WHO DIE FROM SUICIDE DON'T HAVE A KNOWN MENTAL HEALTH
DIAGNOSIS, THAT WE ACTUALLY KNOW THAT MANY PEOPLE WITH DEPRESSION
AND OTHER MENTAL HEALTH CONDITIONS ARE UNRECOGNIZED AS
SUCH BECAUSE OF THE DIFFICULTIES IN ACCESSING MENTAL HEALTH
PROBLEMS AND ALSO THE SHAME AND THE STIGMA THAT'S ASSOCIATED
WITH COMING FORWARD AND ASKING FOR HELP.
>> DO YOU THINK THESE PEOPLE ARE NOT SEEKING TREATMENT FOR THEIR
MENTAL HEALTH CHALLENGES THAT THEY'RE STRUGGLING WITH?
OR THEY CAN'T AFFORD TO STICH THAT TREATMENT?
>> WELL, I THINK IT'S A LOT OF FACTORS, AND I THINK MANY OF THE
FACTORS THAT HAVE BEEN MENTIONED AROUND ALL THE SOCIAL
DETERMINANTS OF HEALTH, THE STRESS PEOPLE ARE GOING THROUGH,
IT NOT ONLY COSTS TOO MUCH MONEY TO GET MENTAL HEALTH TREATMENT,
BUT THERE'S LOTS OF BARRIERS THAT PEOPLE HAVE TO OVERCOME IN
ORDER TO SEEK TREATMENT.
THEY HAVE TO TAKE TIME OFF FROM WORK, AND THE NEED FOR PEOPLE TO
ENGAGE IN TREATMENT ISN'T SUPPORTED WELL BY SOCIETY.
THERE ARE ALL KINDS OF TRANSPORTATION ISSUES, HOUSING
ISSUES.
BUT I THINK THE POINT IS REALLY, I DO WANT TO AGREE WITH THE
POINT THAT SUICIDE IS NOT A SIMPLE MATTER OF JUST AN OUTCOME
OF PURELY A MENTAL HEALTH CONDITION, THAT IT'S REALLY A
CONFLUENCE OF RISK FACTORS THAT COME TOGETHER, MANY OF WHICH ARE
ONES THAT HAVE BEEN MENTIONED AROUND ALL THE STRESS THAT
PEOPLE ARE FACING WITHOUT ANY BUFFER OR CUSHION OR SOCIAL
SAFETY NET THERE.
ARE SO MANY PEOPLE IN SOCIETY THAT ARE
LIVING ON THE EDGE WHERE IF ONE THING GOES WRONG IT'S LIKE A
HOUSE OF CARDS AND THEY'RE LEFT HELPLESS AND HOPELESS AND
DESPERATE.
>> THE ONLY THING THAT'S ACTUALLY WORKED ON A SOCIETAL
LEVEL OR A COUNTRY LEVEL, FOR SUICIDE PREVENTION, IS A
MULTILEVEL APPROACH.
SO IT IS DEALING WITH THE SOCIAL DETERMINANTS OF HEALTH THAT HAVE
BEEN MENTIONED, AND MAKING MENTAL HEALTH TREATMENT
ACCESSIBLE, ALSO RELEVANT AND CULTURALLY RESPONSIVE.
ALL OF THOSE THINGS ARE REALLY IMPORTANT.
>> CAN I STOP YOU, THE CULTURALLY RELEVANT BEINGS OF
THAT, CAN YOU SPEAK TO MORE OF THAT?
>> EVEN WHEN PEOPLE ARE IDENTIFIED AS AT HIGH RISK OF
SUICIDE, IF YOU ARE INDIGENOUS, IF YOU'RE AN INDIGENOUS YOUNG
PERSON WHO ARE AT THE HIGHEST RISK, YOU'RE LESS LIKELY TO SEEK
MENTAL HEALTH RESOURCES AND TREATMENT.
SO NINE OUT OF 10 PEOPLE THAT ARE REFERRED, IF THEY'RE ALASKA
NATIVE OR AMERICAN INDIAN, DO NOT SEEK THAT TREATMENT.
SO THAT TO ME SPEAKS OF SOMEWHAT SOME ACCESS, A LOT OF CULTURAL
RESPONSIVENESS KNEES TO BE CONSIDERED IN THAT.
SO OUR TREATMENT THAT'S DONE IN A ROOM OUTSIDE OF PEOPLE'S EVERY
DAY LIVES, OUTSIDE OF FAMILY CONTEXT, OUTSIDE OF SOCIAL AND
RECIPROCITY FRAMEWORKS, THOSE THINGS, IT'S HARD TO MAKE
MEANING OUT OF THOSE THINGS FOR MANY DIFFERENT KINDS OF PEOPLE,
IT'S A VERY WESTERN PERSPECTIVE.
I THINK WE NEED TO THINK ABOUT MENTAL HEALTH TREATMENT AND
WELLNESS INVOLVING A LOT OF ELEMENTS OF PEOPLE'S LIVES, NOT
JUST THEIR PSYCHOLOGY.
AND THERE'S BEEN SORT OF TWO TRACKS OF THINKING IN SUICIDE
PREVENTION.
ONE COMES FROM SOCIOLOGY, ONE FROM MENTAL HEALTH AND WE TEND
TO EMPHASIZE THE MENTAL HEALTH, INSTEAD OF THE SOCIOLOGICAL
WHICH LOOKS AT ALL THE DIFFERENT SOCIAL FACTORS THAT INFLUENCES
PEOPLE'S SENSE OF PURPOSE, SENSE OF CONTROL OVER THEIR FUTURE,
PEOPLE'S SENSE OF SELF EFFICACY, ALL THOSE THINGS WHICH SOCIETY
CAN CONTROL.
>> SO YOU THINK IT'S IMPORTANT TO LOOK AT THAT MORE GLOBAL
PERSPECTIVE.
BUT I ALSO WANT TO DISCUSS SIGNS PEOPLE CAN BE LOOKING FOR.
BECAUSE IF THIS IS A CRISIS SOMEONE IS DEALING WITH TODAY,
WE WANT TO HELP.
SO WHAT ARE THE SIGNS PEOPLE SHOULD BE LOOKING FOR?
>> IT'S TRUE THAT ONE OF THE RISK FACTORS OF THE ONES THAT
WE'VE BEEN REVIEWING IS SOCIAL ISOLATION.
SO PEOPLE WITH -- >> NOT ENOUGH INTIRN PERSONAL
CONNECTION?
>> REFERRING SPECIFICALLY TO TECHNOLOGY, BUT THE WAY THAT
MARRIAGE RATES ARE DECLINING, CONNECTIONS OF PEOPLE IN SOCIETY
IN THE CULTURAL SENSE THAT PEOPLE ARE HERE TO TAKE CARE OF
EACH OTHER IN COMMUNITIES.
>> THE BROADER SOCIAL FABRIC.
>> YES, SO YOUR QUESTION ABOUT WHAT CAN PEOPLE DO IS RELEVANT
TO THAT, BECAUSE MANY PEOPLE WHO ARE SUFFERING FROM DEPRESSION
ARE SUFFERING ALONE, AND OTHER PEOPLE DON'T KNOW AND THEY MAY
ACTUALLY BE HAVING IRRITABILITY OR NEGATIVE BEHAVIOR SOMETIMES
THAT ENDS UP PUSHING PEOPLE AWAY.
SO WE NEED TO INCREASE AWARENESS OF SOME OF THE SYMPTOMS OF
DEPRESSION AND HELP PEOPLE TO SHIFT THEIR PERSPECTIVE AND
UNDERSTANDING OF WHAT THEY'RE SEEING WITH THEIR LOVED ONES AND
FRIENDS AS NOT SIMPLY A BEHAVIORAL PROBLEM OR SOMEONE
WHO IS NOT SUCCEEDING IN THEIR GOALS, BUT SOMEONE WHO IS REALLY
SUFFERING AND NEEDS HELP.
SO SOME OF THE SIGNS ARE PEOPLE WHO ARE EXPRESSING FEELINGS OF
HOPELESSNESS, PEOPLE WHO ARE HAVING DIFFICULTY WITH SLEEP,
APPETITE, PEOPLE WHO ARE NOT ABLE TO CONCENTRATE, PEOPLE WHO
ARE ISOLATING THEMSELVES.
SO THERE ARE LOTS OF DIFFERENT SIGNS.
IRRITABILITY IS A HUGE SIGN, WHICH OFTEN AGAIN LEADS PEOPLE
TO SORT OF WITHDRAW FROM THEIR LOVED ONES BECAUSE THEY'RE
GROUCHY AND NEGATIVE AND THEY WANT TO STEER CLEAR OF THAT
NEGATIVITY.
SO IT'S A MATTER OF TRYING TO ENCOURAGE PEOPLE TO PAY
ATTENTION TO EACH OTHER, TO REACH OUT TO THEIR LOVED ONE AND
TO BE SYMPATHETIC AND COMPASSION AT, AS OPPOSED TO JUDGING AND
BLAMING WHEN PEOPLE ARE HAVING DIFFICULTIES LIKE THIS.
>> ANYTHING YOU WANT TO ADD?
>> YES, I THINK THAT IT MIGHT BE MORE USEFUL, INSTEAD OF THINKING
ABOUT SIGNS AND WARNINGS AND THAT SORT OF THING, IF WE CAN
THINK ABOUT DOING SMALL ACTS OF KINDNESS, REACHING OUT, GIVING
SUPPORT THAT'S NOT DEMANDING OF SOMETHING IN RESPONSE.
THOSE THINGS HAVE ACTUALLY BEEN SHOWN TO REDUCE SUICIDE RISK.
LIKE SENDING A TEXT THAT'S JUST LIKE, I'M THINKING ABOUT YOU,
HOPE YOU'RE HAVING A GOOD DAY, SOMETHING VERY SIMPLE THAT CAN
ACTUALLY CHANGE PEOPLE'S EXPERIENCE OF THAT MOMENT.
AND OFTENTIMES IT'S LESS THAN 10 MINUTES BETWEEN SOMEBODY HAVING
A SUICIDAL IMPULSE AND ACTING ON IT.
LESS THAN 10 MINUTES.
SO IF YOU CAN CHANGE THAT TRAJECTORY, MAKE IT HARDER TO
GET A LOADED GUN, OR HARDER TO GET ACCESS TO SOME MEDICATION OR
WHATEVER, IF YOU CAN MAKE THAT HARDER, THAT IN AND OF ITSELF IS
SUICIDE PREVENTION.
BUT YOU CAN ALSO MAKE IT LESS DESOLATE, MEANING YOU CAN DO A
SMALL ACT OF KINDNESS.
>> IF YOU OR SOMEONE YOU KNOW NEEDS HELP, THE SUICIDE
PREVENTION LIFE LINE IS 1-800-273-TALK.
OR GO ONLINE TO CDC.GOV.