In this issue: brief news items and a commentary on Mental Issues in the United States
News! We are pleased to announce a new, online suicide risk assessment training program for primary care physicians and allied healthcare professionals. Derived from our award-winning mental health and substance abuse professional training program, this medical version has been customized for the busy primary care professional. Click here for details.	News! The new Preventing Suicide: the National Journal, published by the Kristen Brooks Hope Center and funded by the federal government is now available online. The journal contains comprehensive articles on suicide prevention, cutting edge developments, updates on the Hopeline Network and a comprehensive listing of national events, workshops and other developments. You can download it at http://www.hopeline.com
NATIONAL SURVIVORS OF SUICIDE DAY is Saturday, November 22. There will be survivor conferences in over 50 cities throughout the country and the program will also be broadcast live on the web. This is an opportunity for survivors from across the nation to come together for support, healing, information, and empowerment. For more information to find a conference site near you, or to register for the webcast, please visit www.afsp.org. National Survivors of Suicide Day is sponsored by the American Foundation for Suicide Prevention (www.afsp.org).	News! The World Health Organization and the International Association for Suicide Prevention recently published their findings from the First World Suicide Prevention Day (held on September 10, 2003). As a member of the International Association, the QPR Institute wishes to pass along this announcement and highlight the following edited excerpts: In the year 2000 an estimated 815,000 people died from suicide around the world Between ages 15-44, self-inflicted injuries are the fourth leading cause of death worldwide and the sixth leading cause of ill health and disability (WHO, 1999) The economic costs associated with suicidal behavior runs into the multiples of billions of dollars While suicide rates vary from country to country (e.g., higher in Eastern European countries and lower in Latin American and Muslim countries), the loss of life worldwide can no longer be ignored and a call to action is emerging Suicide risk and protective factors have been identified through increasingly sophisticated research, but among the top tasks to be undertaken worldwide is the early identification and appropriate treatment of those conditions know to put people at elevated risk for suicide, e.g., mood disorders. In many ways the World Health Organization’s global initiative is similar to the U.S. Surgeon General’s National Strategy for Suicide Prevention, but it also differs in certain areas. For a full review of the WHO strategy, please visit their web site at http://www.who.int
Clinical tip: We often hear that a prior suicide attempt is a strong predictor of eventual death by suicide. While many people die in their first attempt, those who don’t remain at high risk. To confirm the clinical lore, the team of Harris & Barraclough conducted a meta-analysis of suicide studies on this topic. They found that individuals with a prior suicide attempt were 38 times more likely to complete suicide. Source: Harris, E.C., & Barraclough, B. (1997), Suicide as an outcome for mental disorders: A meta-analysis. British Journal of Psychiatry, 170, 205-228.
Suggested reading: For a useful review of how a lawyer specializing in suicide malpractice litigation educates family members about the potential for a lawsuit following the death of a loved one by suicide, visit www.skipsimpson.com and read the FAQ section. Every mental health professional needs to “know the drill.”
Practitioner tip #2 (please share with others with attribution to the QPR Institute) When deciding not to hospitalize a patient assessed to be at risk for suicide, it is important that the clinician conduct a risk-benefit analysis. The reasons for hospitalization include the relative assurance of a safer, more controlled environment, a beneficial milieu, multidisciplinary staff evaluation, initiation of stabilizing medications, etc. The reasons against hospitalizing a suicidal person might include potential loss of self-esteem, stigmatization, risk of losing a job, fostering unwanted dependency, failure to benefit from prior hospitalizations and/or an expressed willingness to participate in outpatient treatment together with a demonstrated ability to comply with a medication regimen or other safety recommendations. Whatever your reasons to not hospitalize a consumer who has expressed a history of frank suicidal ideations, prior plans or attempts, it is strongly recommended that the primary care provider seek consultation and/or supervision regarding the decision and to carefully chart the reasons for this decision. In a world of increasing litigation for suicide malpractice - and if a bad outcome is experienced - an uniformed jury will need to be convinced that you 1) thought the problem through, 2) weighed the risks and benefits carefully with the patient and his or her family, and 3) took a reasonable and prudent course of action, including talking your decision over with a colleague or supervisor. The QPR Institute
U.S. Must Quit Dodging Its Mental-health Issues Paul Quinnett, PhD The Spokesman-Review We who study self-destruction for a living know that homicide is sometimes followed by suicide. That the innocent are killed before a final act of self-destruction only adds to our sense of confusion and helplessness. To better understand this most senseless manifestation of human despair, a few facts may prove helpful. First, only the utterly hopeless kill themselves. The majority of suicidal people are suffering from serious untreated psychiatric illnesses, illnesses that can be reasonably detected, diagnosed and treated. The euphemism and slang of a so-called "disgruntled lover" who "goes postal" does nothing to enlighten our understanding of the underlying mental states of those who kill others and then themselves. Second, it is important to understand that the homicidal person's decision to die by his or her own hand (or in a hail of police gunfire) is made well before the shooting begins. Since you cannot arrest, humiliate or punish a dead man, these acts are not indiscriminate, impulsive or random, but rather planned and premeditated. Almost always preceded by suicide warning signs, these fatal plans are often detectable and therefore preventable. Third, to carry out a murder-suicide, the perpetrator must answer several questions before initiating the plan. These include why, who, with what and where? The motive (unendurable psychological pain and perceived injustice by others), the means (firearms) and the opportunity (bar, workplace, home) are at once understandable and knowable. Just as solving a "Murder She Wrote" whodunit, answering these few questions solves the mystery. But we don't have a mystery in Friday's incident in Old Town, Idaho. The facts are before us. As the psychological autopsy unfolds over the next few weeks, the press will remind us of what has become an increasingly familiar list of "probable causes." These causes will be familiar because we've heard them before. And if we are little comforted by what we learn, we should remember that the families of the victims (and I mean all who died) will suffer for their rest of their lives. What can we do? In 2001, America launched a new national strategy to prevent suicide. Led by the surgeon general of the United States, and now fully supported as the No. 1 goal in the president's recently released report from the Freedom Commission on Mental Health, preventing suicide is a national priority. What most don't realize is that the majority of those who kill themselves and others are working people. In June 2003, the University of Rochester's Center for the Study and Prevention of Suicide held a national consensus conference in Washington, D.C., on preventing suicide among men aged 25 to 54. In attendance were several major U.S. corporations, leadership from the National Institutes of Health, the U.S. Air Force, Employee Assistance Society of North America, National Institute for Occupational Safety and Health, researchers and representatives of the health-care industry. Keynoters highlighted a stark and alarming fact: Men in their middle years kill themselves at twice the baseline rate of other Americans. By and large, these victims are working men. Unaddressed in the conference -- but known to anyone who reads the newspapers -- is the demographic profile of those most likely to kill their wives or lovers, fellow workers or innocent bystanders in a bar before killing themselves: a white male in his middle years. While definitive studies on the cost of suicide and violence are incomplete, the recently published Reducing Suicide, A National Imperative by the prestigious Institute of Medicine, calculated the economic cost of suicide to society at "$11.8 billion (in 1998 dollars)." These costs are shared by us all, but disproportionately by employers, insurance companies and families. Suicide claims approximately 30,000 lives per year, or 10 times the number of citizens lost on 9/11. Too many of these suicides are preceded by a homicide and, in the Oldtown case, multiple homicides. The overlap between suicide and violence to others is dramatic and undeniable, especially as it occurs in conflicted domestic relationships. Is suicide preventable? Yes. According to the surgeon general, suicide is "our most preventable form of death." Studies indicate that at least half of all suicides need not occur. If we could prevent suicide, could we prevent some homicides? Yes. U.S. Air Force data suggest that a successful suicide prevention program reduces other kinds of violence. The good news is that we have effective interventions and powerful medicines to treat the underlying psychiatric conditions that, in the minority of persons, fuel violence and self-destruction. The bad news is that the people in need of treatment can't or won't get it, especially in what fragments remain of a chronically under-funded system of mental health care. If America should be ashamed of itself, it need look no further than at how it treats its mentally ill, and especially those of advanced years. Each of us has a road to travel. Each of us has much to learn. Stigma, taboo and ignorance about mental illness and suicide are, literally, killing us and those we love. Pogo said, "There is no problem too big you can't run away from it." Well, America, it's time to stop running, turn around, and face this one.