If you or someone you know is at risk of suicide or experiencing a mental health crisis, call or text the (new) Suicide and Crisis Lifeline at 988 or call 911. Please note that the content of this blog may be triggering; if you need to step away, or read it with the support of a loved one, please do so.
Every September, I write a revised version of this blog for our club. While many practical aspects remain the same, I look to update the statistics and resources in the name of creating the most accurate and highest-quality piece for our members and staff. And, no matter how many editions I pen, it still hurts. It’s still hard. Suicide is – and in many ways should be – a tough topic. It certainly isn’t one that people naturally itch to discuss. It’s uncomfortable. It’s scary. For many of us, it’s personal. I know that is the case for me. But even against the backdrop of that fear and discomfort, the cost of not writing, reading, and talking about suicide is far too high. Just how high, you ask? Well. In the time it has taken you to read this far, two individuals in the United States have attempted suicide. So…I’d say pretty high.
As with most of my blogs, this is by no means exhaustive; if you’re looking for more information, check out the resources list at the bottom of the page. This blog was written to give us all a starting point; to help us feel a bit more equipped to do our part in supporting those at risk of suicide. As you read, know that suicide prevention is not solely the job of counselors, therapists, or emergency response teams. While seeking support from such practitioners is an integral part of suicide prevention, so are all of us; every person who interacts with other people is in a position to save a life. With that in mind: Let’s get to work.
Suicide in Recent Years
Before addressing action steps for risk identification and suicide prevention, it is crucial to have an understanding of the worldwide threat that suicide poses, especially in the context of the past two years. In the U.S. alone, 2020 yielded 1.2 million suicide attempts from adults and nearly 46,000 deaths by suicide. These staggering numbers equate to roughly one suicide attempt every 23 seconds, one death by suicide every 11 minutes, and 130 deaths by suicide every day in America alone.
Until recent years, the picture of suicide in America was a consistent (albeit upsetting), one. From 2000-2018, the U.S. saw a relatively steady increase in suicide rates, peaking at a 36% total uptick. In 2019, the country saw the first decline in decades of about 2%. Many entered 2020 with bated breath, eager to see if 2019 was a true indication of a reversing trend. We all know what happened next. In many ways, the COVID-19 pandemic was a perfect storm of suicide risk factors; the widespread stressors brought on by the pandemic, coupled with social distancing, led to an overall increase in mental health issues and substance use. Studies suggest that thoughts of suicide as much as doubled amidst the pandemi, and calls to suicide hotlines increased by as much as 800%. And yet: Suicide rates in the U.S. declined by 3% in 2020, leaving many experts scratching their heads.
Interestingly, this hopeful trend was not only reflected in other countries, but also was found amidst other historic disasters. There are a number of working hypotheses for this counterintuitive decline. Some point to the practical increased access to therapeutic services at the height of the pandemic, others to a more existential shifting of views on mortality and the precious nature of life. Or perhaps it was the simple reality that many of us were stuck at home with other people, and less alone time meant less time for unobserved suicidal action. The hypothesis with the greatest support has been termed the “pulling-together effect”; in essence, the knowledge that everyone was going through a similarly hard time made us feel particularly connected through our shared stress and lessened suicidal action.
No matter the underlying cause, the decrease in suicide rate is certainly cause for hope. With that, bear in mind that this overall decline in average rates was driven by what happened with the majority group (i.e. non-Hispanic white adults) and therefore can be a bit misleading. With that, here are a few crucial facts to note when we further examine recent trends:
- Suicide was the 2nd leading cause of death for those aged 10-34 in 2019-2020
- Despite the recent decline, suicide rates remain historically high: 30% higher, today, than in 2000
- By state, Colorado has the seventh highest suicide rate in the country at 21.53 (per 100,000 deaths) compared to the national average of 13.48
- 2020 saw suicide rates increase among minority populations and young people aged 10-34
- Per the 2019 Youth Risks Behaviors Survey, 8.9% of youth in grades 9-12 reported having made at least one suicide attempt in the past 12 months
All of this to say: While the overall average decrease is cause for hope, it doesn’t tell the whole story. Only time will tell if this recent trend reflects true progress in the case of suicide prevention, or if the temporary positive momentum will be undone as the long-term effects of the pandemic unfold (as was the case with Hurricane Katrina). Regardless of what clarity the future may bring, it is important to recognize that suicide is a complex, multi-faceted public health issue that remains a very real threat to all, and an increasing threat to young people and minority populations, especially in the state of Colorado.
Suicide Prevention
Suicide is a worldwide pandemic, and it is our collective responsibility to be proactive when it comes to suicide prevention. After all, September is Suicide Prevention – not intervention – Awareness Month. Various organizations have crafted detailed community-level plans to maintain the downward trend of suicide rates, most of which tend to focus on alleviating pain, building hope, strengthening connections, and restricting access to lethal means in order to mitigate conditions that increase suicide risk. With that, there are also a number of simple actions we can take on an individual level to enhance resilience, improve overall well-being, and better protect our loved ones:
- Teach Problem Solving Skills: People who are able to effectively solve problems and resolve conflict in a non-violent way are at a lower risk of suicide.
- Develop Healthy Coping Strategies: Individuals that can confidently, consistently, and effectively implement a variety of healthy coping skills (exercising, listening to music, talking with a friend, meditating, praying, writing, drawing, etc.) better manage stress and experience lower rates of suicidal thoughts and behaviors.
- Promote Connection: People who report a network of supportive relationships, and feel a greater degree of connection to their friends, family, and community, are less likely to experience suicidal thoughts and exhibit self-harming behaviors.
- Normalize Discussion Around Mental Health: 90% of people who die by suicide experience adverse mental health symptoms. Individuals who regard mental health as stigmatic are far less likely to actively attend to their mental health and seek out support when needed, placing them at a greater risk of suicide.
- Ensure Availability of Physical and Mental Health Care: People who have easy and reliable access to physical and mental health care report lower rates of suicidal thoughts and exhibit fewer suicidal behaviors.
Create Protective Environments: While it is impossible for us to create environments completely free of lethal means, we can certainly make it more difficult for individuals to access materials they can use to end their lives. Ensuring firearms (which accounted for nearly 53% of all suicide deaths in 2020) and medications are appropriately secured is imperative.
Risk Factors & Warning Signs
Possibly the most impactful action we can take in preventing suicide is to be able and willing to identify and support persons at risk of suicide. Though any individual – regardless of age, socioeconomic status, race, gender, etc. – can struggle with suicidal thoughts or engage in suicidal behavior, there are a handful of factors that place specific individuals at particular risk. Such factors include:
- Previous Suicide Attempts: A prior suicide attempt is the single most important risk factor for suicide in the general population.
- Diagnosed Mental Illness: Though a diagnosable mental illness is not a prerequisite for suicidal thoughts or behaviors, 46% of people who die by suicide have a diagnosable mental health condition (including substance use disorders).
- History of Trauma or Abuse: Individuals who have experienced violence, neglect, bullying, or any form of abuse are at a greater risk of suicide.
- Recent Tragedy or Loss: People who have recently experienced the death of a friend, family member, or other notable individuals (by suicide or other causes) are at an increased risk of experiencing suicidal thoughts or engaging in self-harming behaviors.
- Personal Demographics
- Gender: Though women are more likely to attempt suicide, males are 3-4x more likely to die by suicide.
- Race/Ethnicity: The highest suicide rates are among American Indian/Alaskan Native and non-Hispanic White populations.
- LGBTQ+: Young people who identify as LGBTQ+ are 4x more likely to attempt suicide than their straight peers, with evidence for greater risk in bisexual youth, transgender and nonbinary youth, and LGBTQ youth of color.**
Bearing these factors in mind, our next goal is to be able to identify warning signs of suicide. Despite how it may appear, few suicide attempts happen without indication; often, we are simply not aware or attentive enough to recognize the warning signs of suicide. While these signs can be explicit (talking about suicide or self-harm, making comments like “I wish I wasn’t here”, a preoccupation with dying or death, etc.), a number are less direct, such as:
- Withdrawal from family, friends, and community
- Sudden and/or significant changes in sleep patterns, eating habits, alcohol/drug use, mood, or personality
- Apparent loss of interest in activities previously enjoyed
- Feelings of helplessness or hopelessness
- Aggressive, impulsive, or reckless behavior
Though some of these warning signs overlap with symptoms of depression, remember that individuals need not be struggling with depression to be at risk of suicide. Beyond these warning signs, specific behaviors such as buying a weapon, collecting pills, saying goodbye, giving away possessions, or making final arrangements should be considered an emergency. If you see an individual engaging in such behaviors, call 911 or a mental health provider.
Taking Action
Now comes the crucial question: If we suspect an individual is struggling with suicidal thoughts, what do we do? First and foremost, the best way to find out if someone is contemplating suicide is to ask them directly: Are you thinking about suicide? Do you have a plan? Contrary to popular belief, research has repeatedly shown that asking at-risk individuals if they are suicidal does NOT increase suicide risk. In fact, doing so serves to show the person that they are cared for and may reduce suicidal thoughts. If you suspect someone is struggling, start a conversation; it, alone, could save a life.
If an individual is experiencing suicidal thoughts, but lacks a plan or is not in immediate danger, take action to reduce their access to lethal means, listen, show support, and connect them with a mental health professional. Alternatively, if an individual has made a previous suicide attempt, has a plan in place, or appears to be an imminent threat of harm to themselves, the situation should be considered an emergency. In such cases, the behavior of an at-risk individual can be unpredictable and change dramatically without warning. To support an individual amidst a mental health crisis:
- Have someone call 911, or another emergency response resource, and stay with the individual.
- Remove lethal means from the individual if it is safe to do so. Be sure to ask permission before attempting to touch the person.
- Maintain a calm voice and avoid overreacting. If you are in a group, have one person speak up at a time.
- Do not argue, threaten, or debate if suicide is right or wrong.
- Express support and concern. The at-risk individual’s struggles may be compounded by feelings of vulnerability, guilt, and shame in the moment. Be compassionate.
- Ask simple and direct questions about how you can help; offer options instead of attempting to take control of the situation.
- Engage in active listening through nonverbal attending behaviors, reflections, and summarizations of what the individual is sharing. Make them feel heard.
- Do not leave the individual alone until emergency assistance arrives.
After ensuring an individual is connected with appropriate resources, be sure to follow-up with them. Whether it be with a text, call, or coffee date, checking in demonstrates to the individual that you are a present source of support in their lives. Doing so will not only show that you care, but also foster greater feelings of connection, which we know to reduce future suicide risk.
Though suicide is an intimidating topic, it is preventable. If we, on the community and individual level, ensure to take all suicidal threats seriously and are willing and able to quickly and appropriately respond to mental health crisis situations, we can save countless lives. If you have one take away from this blog, let it be the knowledge that if you – a single person – pay attention, and are willing to ask a single question, you can save a life.
And finally, for those of you reading this who may be struggling, know that you are not alone. Have the courage to reach out. You are seen, you are loved, and you are enough just as you are. I, personally, am very, very glad you are here.
-Katie Pagel
*All statistics are based on the data from the Center for Disease Control’s 2020 WISQARS Fatal Injury Data
**It is worth noting that LGBTQ+ youth are not inherently prone to suicide risk because of their sexuality or gender identity, but rather placed at higher risk because of how they are mistreated and stigmatized in society. [Data: The Trevor Project]
