Public health steps up to curb rising suicide rates: New data alarming
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* Lindsey Wahowiak

Suicide is a sad and often difficult topic. But as suicide rates rise significantly in the U.S., are public health workers ready to address the problem?

Public health leaders are asking that question, and looking to resources to better prepare workers and communities in light of research showing growing suicide rates.

Almost 45,000 people died by suicide in 2016, the most recent year with complete data, according to a June Vital Signs report in the Centers for Disease Control and Prevention’s *Morbidity and Mortality Weekly Report.* Research in the report showed that suicide rates have increased by more than 30 percent in half of states since 1999.

As alarming as the increasing number of suicides is that more than half of people who died by suicide did not have a known mental health condition, according to the report.

Research from a June data brief by CDC’s National Center for Health Statistics shows that suicide rates are also rising more quickly among women than men, but both groups are showing an increase.

Experts say there is no clear reason for the rising trajectories.

“There’s lots of things that we know historically have impacted the suicide rate: access to health care, economics, access to lethal means,” Doreen Marshall, PhD, a licensed psychologist and vice president of programs at the American Foundation for Suicide Prevention, told *The Nation’s Health*. “Certainly, you could argue that there are more stressors in current life.”

Marshall also said that the rise in opioid addiction and abuse could be related to increasing suicide numbers as well. Research in the October issue of APHA’s *American Journal of Public Health* has shown that particularly among white Americans, diseases of despair — suicide, accidental poisonings, liver disease deaths and chronic behavioral health disease, compounded by family dysfunction, poor social support or addiction — are also on the rise.

Because suicide is often an acute risk — meaning someone who is considering suicide or who has attempted suicide needs immediate help from health professionals — people at highest risk are seen in emergency department settings. But detecting risk much earlier, before people are in crisis, would be a more efficient way for health workers to help reduce suicides, said Jane Pearson, PhD, chair of the National Institute of Mental Health Suicide Research Consortium.

“Treating risk factors for someone’s suicidal thoughts, depression, anxiety, PTSD…it’s not simple, like a virus or infection,” Pearson told *The Nation’s Health.* “It’s got so many components to it, and potentially different trajectories. It’s taking time to figure out what might work best.”

Suicide is almost never caused by a single factor, according to CDC. Current suicide prevention efforts focus mostly on identifying and providing treatment for people with mental health conditions. But a June *AJPH* study found only 20 percent of states have laws mandating health care professionals complete suicide prevention training, and just 14 percent have policies encouraging such training.

The gap is especially notable because both a former surgeon general and suicide prevention organizations have called for training for all health professionals and for incorporating suicide prevention competencies in undergraduate and graduate health professional education.

“Suicide is a leading cause of death for Americans — and it’s a tragedy for families and communities across the country,” said CDC Principal Deputy Director Anne Schuchat, MD, in a news release. “From individuals and communities to employers and health care professionals, everyone can play a role in efforts to help save lives and reverse this troubling rise in suicide.”

Public health workers could be the key. Pearson noted that comprehensive preventive care, such as efforts used to curb behavioral health risks, could be used in health care settings, schools and community organizations to address risk and reduce deaths. The National Violent Death Reporting System is one such tool for public health. The surveillance system provides data to help researchers better understand the context surrounding a suicide death. Equipped with that information, public health leaders are better able to build public health prevention efforts, said Mighty Fine, MPH, CHES, director of APHA’s Center for Public Health Practice and Professional Development.

“We have seen success in using a traditional public health approach where programs and strategies were aimed at reducing risk factors while enhancing protective factors,” Fine told *The Nation’s Health*. “Using this approach, we recognize that there are opportunities to intervene at various levels of risk and work to mitigate them accordingly.”

The Vital Signs report offers steps communities can take to address suicide, including identifying and supporting people at risk, offering coping and problem-solving skills to help people manage challenges, offering community-building connection and activities and connecting people to coordinated mental and physical health care.

In health settings, screening for suicide risks could make big gains — research published in 2014 in the *Journal of General Internal Medicine* showed that more than 80 percent of people who die by suicide see a health care professional in the year before their death.

The National Institute of Mental Health offers its “Five Action Steps for Helping Someone in Emotional Pain” as a guideline for providers and others to help prevent suicide. The steps include asking, “Are you thinking about killing yourself?” as research shows that asking at-risk people if they are suicidal does not increase suicides or suicidal thoughts. It is also rare that someone will say that they are considering suicide without prompting, Marshall said.

Other steps include listening carefully; connecting them with resources such as the National Suicide Prevention Lifeline, 1-800-273-8255; and staying in touch after a crisis. A 2001 study in Psychiatric Services showed the number of suicide deaths drops when someone follows up with people who are at risk.

Mental Health First Aid USA is a nonprofit organization that offers an eight-hour course called “The Awkward Conversation,” which gives providers and others tools to safely and helpfully respond to someone having a mental health crisis.

Public health can also take action to limit access to the most lethal means of suicide. In the midst of the U.S. opioid crisis, that can mean narcotic drugs. But more than half of suicides are done with a firearm — and suicides account for two-thirds of all gun deaths in the U.S.

Some states have enacted efforts to help address guns’ role in suicide. In Indiana and Connecticut, for example, “red flag” laws enable law enforcement to remove a firearm from a home for a short period of time if someone in the home is in crisis. Research published in June in *Psychiatric Services* showed suicide rates dropped substantially in those states when the laws were enforced.

“If you can reduce access to the most lethal methods, you can reduce suicide rates,” Pearson said.

In April, the University of California-Davis Violence Prevention Research Program introduced its What You Can Do campaign, which offers health workers information on identifying patients with a high risk of gun injury. It includes tools for preventive counseling and a list of resources for providers.

Public health workers and advocates can also work to improve policy addressing and reducing stigma around suicide and mental health. For example, this year, New York mandated mental health education in all classrooms from kindergarten through 12th grade.

While public health is making strides, the rising number of suicide deaths means efforts must be multiplied and diversified, Fine noted.

“It is important to stay steadfast in working to destigmatize suicide and build healthy communities where safety, belonging, connectedness and other elements of strong social networks are the norm,” he said.

APHA has a new fact sheet addressing suicide and how public health advocates can help in their communities. Get the fact sheet and other tools at [www.apha.org/topics-and-issues/suicide](http://www.apha.org/topics-and-issues/suicide).

*   Copyright The Nation’s Health, American Public Health Association