Posts tagged Suicide
Posts tagged Suicide
[In the News] Inside the National Suicide Hotline: Preventing the Next Tragedy
By Josh Sanburn
As U.S. suicide rates rise, experts are divided over which strategies save more lives
Kevin Hines paced along the Golden Gate Bridge, trying to figure out whether to obey the voices in his head urging him to jump. Anyone paying the slightest attention to Hines should’ve seen that something was horribly wrong. Sure enough, after about a half-hour, a woman approached him. Hines thought she was there to save his life.
Instead, she was a tourist wanting Hines to take her picture. The look of desperation on his face apparently didn’t register. Elation crumpled into despair. “Nobody cares,” he thought. “Absolutely nobody cares.”
Hines soon hurdled a railing, stepped out onto a ledge 25 stories above San Francisco Bay and jumped. He immediately regretted it. Falling 75 miles an hour headfirst toward the water, Hines realized that if he was going to save himself, he had to hit feet first. So he threw his head back right before he plunged 80 feet into the cold waters, shattering two of his lower vertebrae. He eventually surfaced and was rescued by the Coast Guard. Only one out of 50 who jump survive.
Thirteen years removed from his attempt, Hines is now an author and lecturer, and doing quite well considering his experience. Hines frequently travels around the country talking about what happened on September 25, 2000. Diagnosed with bipolar disorder, he still has auditory and visual hallucinations as well as paranoid delusions. But today, he has a support network of family and friends that check up on him and identify early warning signs that could lead to Hines harming himself again. He logs his symptoms into an online document he shares with others so they can keep an eye on him. Hines says that’s what separates him from so many others who have suicidal thoughts.
“When you learn to be self-aware with mental illness, you can save your own life,” Hines says.
In May, the Centers for Disease Control released data showing that in 2010, 38,364 people weren’t able to save themselves. For the first time, the number of suicides surpassed deaths from motor vehicle accidents and most researchers believe that number is low, if anything, because many suicides go unreported. The suicide rate for Americans aged 35 to 64 rose 28.4 percent from 1999 to 2010. According to the CDC, $35 billion is lost due to medical bills and work loss costs related to suicide each year. And while suicide rates are not as high as they were in the early 1990s, they’ve climbed steadily upward since 2005.
As more Americans commit suicide, some in the field question the effectiveness of current prevention programs. Over the last 15 years, public policy and federal funding have shifted toward a broader mental wellness movement aimed at helping people deal with anxiety and depression that could eventually lead to suicidality. But that shift may have left those most at-risk of suicide, like Hines, without the support they need.
One program sits at the intersection of those two approaches. The National Suicide Prevention Lifeline, which expects 1.1 million to 1.2 million calls this year and receives about 15 percent more callers each year, is broadly marketed to the general public through billboards and ads that reach those suffering from anxiety, depression and loneliness but are often not actively suicidal. At the same time, it’s an emergency resource for those who are at immediate risk of killing themselves and who struggle with chronic mental illness. But some in the field question its effectiveness, along with the effectiveness of many other services and programs funded and promoted on a national scale. Those in the field often use the metaphor of a river to illustrate the divide: Is it worth getting to more people upstream or narrowly targeting those like Hines downstream?
At the Waterfall
The bridge phone inside New York City’s suicide prevention call center only rings about once a month. But when it does, often in the middle of the night, it emits distinct, deep chirps – as if the phone itself is in distress. The operators manning the 24/7 LifeNet hotline recognize the ring immediately. It means someone’s calling from one of the area’s 11 bridges, and they’re likely thinking about jumping.
LifeNet, a suicide prevention hotline servicing New York’s metropolitan area, also serves as one of 161 call centers that make up the National Suicide Prevention Lifeline network, headquartered in the same building. During its busiest hours from 9 a.m. to 7 p.m., the hotline has roughly 20 operators working the phones inside their unassuming L-shaped office space in lower Manhattan. The operators could easily be mistaken for a collection of telemarketers. The large computer screen at the head of the call center showing the number of lines being processed could easily reside inside QVC’s customer service center.
You don’t get a sense of what truly happens in this room until you run across the bridge phone, which is a direct line to the call center. It’s LifeNet’s equivalent of the Oval Office’s mythical red phone. On the wall above it, black Ikea picture frames display detailed information for each bridge and the locations of its call boxes: “Northbound 3rd Avenue Exit,” “Westbound Light Pole 60.” If someone calls, they can use the caller ID, check the information above the phone and immediately locate the caller and send help.
If it were up to those who work at LifeNet, however, they would get rid of the bridge phone altogether. “What we want is to get people upstream,” says John Draper, director of the National Suicide Prevention Lifeline. “We don’t necessarily want to get people who are on the edge of the waterfall. If they are, we can help them. But it’s a huge cost savings for the entire mental health system if you can get people further upstream.”
Draper is the National Suicide Prevention Lifeline’s soft-spoken, goateed, pony-tailed director and a whole-hearted advocate for early treatment. Talk to him and you realize why he’s in this field, something, he says, chose him. Draper speaks calmly but with purpose. He looks you in the eye. He routinely uses your name in conversation.
In the 1980s, Draper was part of a mobile crisis team, a group of clinicians that goes into the homes of people who are psychiatrically ill but unable or unwilling to get help. He says he soon came to the realization that the country’s mental health system operated behind bricks and mortar, “where it waits for people.”
“It says, ‘Ok, you’re mentally ill?’ I’ll see you Tuesday at 9 a.m. Hope you can make it.’ The system is not set up for the convenience of the user,” he says. “And as a result, two-thirds of the people with mental health problems in this country never seek care. So here was this program that goes into people’s homes. I was like, man, this is the way it should be.”
A decade later, the Mental Health Association of New York City established a 24/7 crisis information and referral network and hired Draper. Several years later, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services and now partially funds the national lifeline, assessed callers who had contacted crisis centers like New York’s and found that most of them felt less distressed emotionally and were less suicidal after the call. Draper calls it a groundbreaking finding.
LifeNet came into its own in 2001 when it became a central resource for those affected by the Sept. 11 terrorist attacks, which in New York City was just about everybody. People were reporting depression, anxiety and other traumatic responses in massive numbers. LifeNet’s call volume and staff doubled, and it’s never gone down. That time in the spotlight positioned the hotline to administer the national suicide prevention lifeline starting in 2004.
Today, Draper and his staff oversee more than 160 networked call centers around the country. Call 1-800-273-TALK, and you’ll be routed to the call center closest to the phone number from which you’re calling. The staff, funded with $3.7 million a year by SAMHSA, helps develop risk assessment standards for operators around the country so they can consistently and quickly determine the seriousness of a situation over the phone.
Draper expects call volume to increase again this year. About 8 million adults in the U.S. are thinking seriously about suicide, but only 1.1 million actually attempt it. So when Draper sees the volume actually reaching that 1.1 million number, which he expects it to this year, he views it as a good thing.
“If your calls are increasing, does that mean more people are in distress?” he says. “That’s not necessarily true. It means more people may have been in distress all along but didn’t know this resource was there. So the more we promote awareness of this resource, once it gets out, then it stays out there.”
The problem for people like Draper is definitively determining whether suicide prevention efforts are working. The only way you ever know if you’re saving someone’s life is if they come out and say so, and that makes it difficult to truly gauge the effectiveness of the lifeline or any other prevention program or service.
“The lifeline is a valuable addition to our efforts,” says Dr. Lanny Berman, executive director of the American Association of Suicidology (AAS). “It’s indeed a resource for people in suicidal crisis to reach out immediately and get help. Whether it is effective in saving lives remains to be seen.”
But some of the available data seems to indicate that the lifeline is having a positive effect. Studies done by Columbia University’s Dr. Madelyn Gould have found that about 12 percent of suicidal callers reported in a follow-up interview that talking to someone at the lifeline prevented them from harming or killing themselves. Almost half followed through with a counselor’s referral to seek emergency services or contacted mental health services, and about 80 percent of suicidal callers say in follow-up interviews that the lifeline has had something to do with keeping them alive.
“I don’t know if we’ll ever have solid evidence for what saves lives other than people saying they saved my life,” says Draper. “It may be that the suicide rate could be higher if crisis lines weren’t in effect. I don’t know. All I can say is that what we’re hearing from callers is that this is having a real life-saving impact.”
You may think that a suicide prevention office would be a dreadful place to work, but it’s really just like any other around the country: idle chatter near the water cooler, lunch breaks with co-workers, cinnamon rolls in the break room. It’s just that from this room, lives are being profoundly affected every day. And even though the exact number of people who have truly been helped will never be known, the lifeline has very strong advocates, including Kevin Hines.
Hines’ story is not merely dramatic; it’s a test case in how the mental health system broke down. There are essentially three main ways to prevent suicide: treatment; means prevention; and access to prevention resources. At the time, Hines wasn’t properly being treated for bipolar disorder; the Golden Gate Bridge has no physical barriers to prevent suicide attempts; and as for the bridge’s suicide prevention call box, Hines didn’t know it was there.
“Had I known, I’m sure I would’ve called,” he says, “because I desperately wanted to talk to somebody.”
Back in New York City’s suicide prevention call center, I ask Draper if it’s difficult to come in to work each day, to motivate his employees to take another call and assure them that what they’re all doing is actually working.
“When I tell people what I do, they say, ‘Oh, Draper, that must be really depressing,’” he says. “And I say, man, I’m in the suicide prevention business, not the suicide business. What I see every day and what our crisis center staff hears every day is hope. And they know that they’re a part of that.”
He says it’s important to remember that 1.1 million adults are attempting suicide every year, but 38,000 are actually dying by suicide.
“What that is telling us is that by and large, the overwhelming majority of suicides are being prevented,” he says. “And those stories are not being told.”
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[Film of Interest] "Running from Crazy"
Mariel Hemingway Tackles Family History of Suicide, Mental Illness in New Doc
The new documentary “Running from Crazy” chronicles the life of actress Mariel Hemingway, the granddaughter of the great novelist Ernest Hemingway. The film focuses on Mariel’s family history of mental illness and the suicides of seven relatives, including her grandfather and her sister, Margaux.
iThe film is directed by the two-time Academy Award-winning filmmaker Barbara Kopple, whose documentary “Harlan County U.S.A.” has become a classic and won an Oscar in 1977.
[Article of Intesest] Anatomy of a Murder-Suicide
By Andrew Solomon
Suicide is not as newsworthy as homicide. A person’s disaffection with his own life is less threatening than his rage to destroy others. So it makes sense that since the carnage in Newtown, Conn., the press has focused on the victims — the heartbreaking, senseless deaths of children, and the terrible pain that their parents and all the rest of us have to bear. Appropriately, we mourn Adam Lanza’s annihilation of others more than his self-annihilation.
But to understand a murder-suicide, one has to start with the suicide, because that is the engine of such acts. Adam Lanza committed an act of hatred, but it seems that the person he hated the most was himself. If we want to stem violence, we need to begin by stemming despair.
Many adolescents experience self-hatred; some express their insecurity destructively toward others. They are needlessly sharp with their parents; they drink and drive, regardless of the peril they may pose to others; they treat peers with gratuitous disdain. The more profound their self-hatred, the more likely it is to be manifest as externally focused aggression. Adam Lanza’s acts reflect a grotesquely magnified version of normal adolescent rage.
In his classic work on suicide, the psychiatrist Karl Menninger said that it required the coincidence of the wish to kill, the wish to be killed and the wish to die. Adam Lanza clearly had all three of these impulses, and while the gravest crime is that his wish to kill was so much broader than that of most suicidal people, his first tragedy was against himself.
Blame is a great comfort, because a situation for which someone or something can be blamed is a situation that could have been avoided — and so could be prevented next time. Since the shootings at Newtown, we’ve heard blame heaped on Adam Lanza’s parents and their divorce; on Adam’s supposed Asperger’s syndrome and possible undiagnosed schizophrenia; on the school system; on gun control policies; on violence in video games, movies and rock music; on the copycat effect spawned by earlier school shootings; on a possible brain disorder that better imaging will someday allow us to map.
Advocates for the mentally ill argue that those who are treated for various mental disorders are no more violent than the general population; meanwhile an outraged public insists that no sane person would be capable of such actions. This is an essentially semantic argument. A Harvard study gave doctors edited case histories of suicides and asked them for diagnoses; it found that while doctors diagnosed mental illness in only 22 percent of the group if they were not told that the patients had committed suicide, the figure was 90 percent when the suicide was included in the patient profile.
The persistent implication is that, as with 9/11 or the attack in Benghazi, Libya, greater competence from trained professionals could have ensured tranquility But retrospective analysis is of limited utility, and the supposition that we can purge our lives of such horror is an optimistic fiction.
So what are we to do? I was in Newtown last week, one of the slew of commentators called in by the broadcast media. Driving into town, I felt as though the air were full of gelatin; you could hardly wade through the pain. As I hung out in the CNN and NBC trailers, eating doughnuts and exchanging sadnesses with other guests as we waited for our five minutes on camera, I was struck by a troubling dichotomy. People who are dealing with a loss of this scale require the dignity of knowing that the world cares. Public attention serves, like Victorian mourning dress, to acknowledge that nothing is normal, and that those who are not lost in grief should defer to those who are. When I stopped in a diner on Newtown’s main drag, I did not sense hostility between the locals and the rest of us but I did sense a palpable gulf between us. We need to but cannot know Adam Lanza; we wish to but cannot know his victims, either.
In a metaphoric blog post called “I Am Adam Lanza’s Mother,” a woman in Boise, Idaho, who clearly loves her son but is afraid of him worries that he will turn murderous. Many American families are in denial about who their children are; others see problems they don’t know how to stanch. Some argue that increasing mental health services for children would further burden an already bloated government budget. But it would cost us far less, in dollars and in anguish, than a system in which such events as Newtown take place.
Robbie Parker, the father of one of the victims, spoke out within 24 hours of the shooting and said to Adam Lanza’s family, “I can’t imagine how hard this experience must be for you, and I want you to know that our family and our love and our support goes out to you as well.” His spirit of building community instead of reciprocating hatred presents humbling evidence of a bright heart. It also serves a pragmatic purpose.
My experiences in Littleton suggest that those who saw the tragedy as embracing everyone, including the families of the killers, were able to move toward healing, while those who fought grief with anger tended to be more haunted by the events in the years that followed. Anger is a natural response, but trying to wreak vengeance by apportioning blame to others, including the killer’s family, is ultimately counterproductive. Those who make comprehension the precondition of acceptance destine themselves to unremitting misery.
Nothing we could have learned from Columbine would have allowed us to prevent Newtown. We have to acknowledge that the human brain is capable of producing horror, and that knowing everything about the perpetrator, his family, his social experience and the world he inhabits does not answer the question “why” in any way that will resolve the problem. At best, these events help generate good policy.
The United States is the only country in the world where the primary means of suicide is guns. In 2010, 19,392 Americans killed themselves with guns. That’s twice the number of people murdered by guns that year. Historically, the states with the weakest gun-control laws have had substantially higher suicide rates than those with the strongest laws. Someone who has to look for a gun often has time to think better of using it, while someone who can grab one in a moment of passion does not.
We need to offer children better mental health screenings and to understand that mental health service works best not on a vaccine model, in which a single dramatic intervention eliminates a problem forever, but on a dental model, in which constant care is required to prevent decay. Only by understanding why Adam Lanza wished to die can we understand why he killed. We would be well advised to look past the evil against others that most horrifies us and focus on the pathos that engendered it.
[Article of Interest] Death with Honors: Suicide among Gifted Adolescents
By James R. Delisle, Ph.D.
Department of Teacher Development and Curriculum Studies, Kent State University, Kent, Ohio.
Abstract: The incidence of suicide and suicide attempts among adolescents has increased markedly during the past two decades. Gifted adolescents, often perceived by others as being immune from problems of depression and emotional upheaval because of their high intelligence, have also shown increases in suicidal behaviors. On the basis of current research, the author contends that gifted young people are especially susceptible to suicide attempts.
Testimony by Peter Hawes, a genuine hero of the Hearing Voices movement
"So a couple of years ago before I got control of my voices and became this public speaking guy, back when I was still very much scared of my voices, I was having a lot of trouble with them and I remember all of them screaming at me to kill myself and I was going to do it. I picked up a razor blade and was lying there on the floor crying as they yelled at me to kill myself - I was going to do it for real. I raised the blade to end my life but then through my tears I noticed the blade had stainless steel written on it."
"Suddenly my mind kicked into gear and I remembered reading an article about stainless steel’s melting point being above 1200c, already a glass artist at that stage, I started thinking I only ever take the kiln up to 900c tops for my glass. I got up and grabbed my visual diary and started calculating the idea of putting the razor blade in glass."
"I spent 4 hours that night working out kiln schedules and possibilities and designs and for those 4 hours I was so distracted the voices didn’t bother me. I come up with the metaphor for life that night and I live by it to this day."
"Like glass life can be broken
But if you sit and think about it
And rearrange the pieces
You can still create something beautiful.”
"I later found out the voices telling me to kill myself was actually a metaphor for that I needed to change my life and stop being a victim and start working on a few of my issues such as my anger problem."
"I have now recovered and all my voices speak respectfully to me and I do writing and public speaking on recovery and run my own business and have set up my own mental health center for voices hearers where I teach them glass and implement HVN’s powerful methods of recovery as well as my own."