Challenges of suicide prevention Recent celebrity deaths highlight the difficulties
Watertown TAB & Press - 6/22/2018
Not much time passed in the lead-up to Ron Linari's attempted suicide in 2009.
He had recently purchased a new condo after a successful career in academia, but fell quickly into a state of depression when he suddenly lost hundreds of thousands of dollars in a scam. He started hearing voices inside his head and eventually made an attempt on his life.
"The tailspin wasn't years, it was months," Linari said. "I saw no way out."
Linari's story echoes thousands of others throughout the commonwealth and across the United States, and illustrates why suicide prevention is in many ways difficult because it's not always connected to mental illness. Indeed, more than half -- 54 percent -- of people who die by suicide have no known mental health condition, according to the U.S. Centers for Disease Control and Prevention.
And while federal, state and private entities have spent hundreds of millions of dollars on trying to understand suicide and suicide prevention, suicide attempts and deaths continue to climb.
In Massachusetts, 631 people killed themselves in 2016, which is about 165 more deaths than what was counted in 1999, according to the CDC.
Nationwide suicide rates, meanwhile, increased 30 percent during the same period, and it's likely the numbers are understated. Absent specific evidence, such as a note describing one's intentions, determining suicide deaths can be tricky for medical examiners. Additionally, many believe a portion of fatal overdoses happen on purpose, but are not counted as suicides. In Massachusetts, there were 2,227 overdose deaths in 2016, according to the CDC.
"We think probably between 25 to 40 percent of drug overdoses may be suicides, but it's hard to quantify," said the Rev. David A. Lima, chairman of Greater New Bedford Suicide Prevention Coalition.
Suicide is now a leading cause of death in the United States and -- as the Patriot Ledger reported in an extensive report in March -- Massachusetts residents are now more likely to die by suicide than by homicides and car crashes combined.
"Suicide rates have increased in nearly every state from 1999 through 2016," according to CDC.
The upward trend is clear. Less clear is why it's happening.
Some health professionals argue not enough money is being allocated toward answering the question, and that too much is spent on widespread public awareness campaigns, which are less effective than more direct outreach to known, at-risk individuals, including those with mental illnesses and direct relatives of people who have died by suicide.
"Despite their popularity as a public health intervention, the effectiveness of public awareness and education campaigns in reducing suicidal behavior has seldom been systematically evaluated," according to an often-cited 2005 study in the Journal of the American Medical Association. "Such public education and awareness campaigns, largely about depression, have no detectable effect on primary outcomes of decreasing suicide acts or on intermediate measures, such as more treatment seeking or increased antidepressant use."
The Massachusetts Coalition for Suicide Prevention, however, released a separate report in 2015 taking a slightly different view, saying awareness makes people feel more comfortable to report suicides, which could be contributing to the increasing number each year.
"As suicide and suicidal behavior become more recognized and is reported more frequently, rates will actually increase for a time," according to the coalition.
Massachusetts is one of a few states to spend money directly on suicide prevention, allocating about $4 million per year toward statewide and community-based programs. But the funding hasn't changed much since an influx in fiscal 2009, despite the relatively consistent climb in suicides.
Contributing to the uncertainty surrounding suicides and suicide prevention is widespread disagreement about how it should be discussed. Historically, suicides haven't been discussed much in public, which many argue perpetuates the issue. Nonetheless, talking too much about suicide, or glorifying it, can result in an uptick in suicides.
The latter is known as "suicide contagion," which is often raised as a concern when there are a string of similar suicides. Last year, a Wicked Local report showed a surge in the number of suicides and accidental deaths on Massachusetts train tracks, which left transit officials searching for answers.
Similarly, when well-liked public figures and celebrities kill themselves, including the recent deaths of international superstar DJ Avicii, famed designer Kate Spade and renowned TV chef and advocate Anthony Bourdain, health professionals become concerned the widespread reporting and subsequent fanfare can result in more suicides.
In 1989, a group of journalists, public health professionals and the CDC developed a set of guidelines about how suicides should be covered in a way that minimized suicide contagion. The concerns raised nearly three decades ago sound similar to what's still being discussed today.
"All parties should understand that a scientific basis exists for concern that news coverage of suicide may contribute to the causation of suicide," according to the report.
There's some evidence to suggest the guidelines yielded success, and the CDC still promotes it useful today. But the rise of the internet, and the ability to share feelings, thoughts and tributes across social media platforms, makes some of the original guidelines somewhat antiquated.
"News coverage is less likely to contribute to suicide contagion when reports of community expressions of grief are minimized," according to the CDC report. "Such actions may contribute to suicide contagion by suggesting to susceptible persons that society is honoring the suicidal behavior of the deceased person, rather than mourning the person's death."
The social media factor is especially difficult for teenagers and younger adults, who already face bullying nonexistent in a pre-internet world, according to Lima.
"I'm 60 years old, and I was bullied at school. I was called 'Tinsel-teethed, four-eyed, skinny kid.' But when I went home I was in a safe place," Lima explained. "Now, with social media, texting and all the other things, bullying is 24/7 and shame is worldwide."
The clergyman, who is also the executive minister of Inter-Church Council of Greater New Bedford, advocates more community-based communication and training related to suicide and suicide prevention needs to happen. The strongest approach for him, anecdotally speaking, is consistent outreach, collaboration across sectors and community support.
His efforts have been recognized by the state and seem to carry some weight on an issue where answers are seemingly scant. The CDC recommends similar actions, including identifying and supporting people at risk, connecting such individuals to coordinated mental and physical health care and preventing future risk of suicide among those who have lost a friend or loved one to suicide.
Linari, a Mansfield resident, celebrated his 75th birthday this June. He counts himself lucky to be alive, but he also feels a responsibility to share his experience with others, especially those who may be feeling -- like he once did -- that there's no way out.
"To end everything is not a way out, it's just a termination of your purpose and life," he said. "If you're in trouble, and feeling suicidal, there is help."
Eli Sherman is an investigative and in-depth reporter at Wicked Local and GateHouse Media. Email him at firstname.lastname@example.org, or follow him on Twitter @Eli_Sherman.