Suicide Prevention Awareness Month, observed annually in September, serves as a crucial reminder of the importance of promoting mental health, offering support, and fostering hope to prevent the tragic loss of lives to suicide. Death by suicide among service members, veterans, and their families is becoming a national crisis. This population is at higher risk for common risk factors, including experiencing a mental health condition and having a physical health problem.

On Thursday, September 7^th, Magellan Federal hosted a webinar, “Suicide Prevention Strategies and Resources for Military Families” focused on the prevalence of suicide in the military and the resources and strategies that can be used to reduce military suicides.

In this Q&A, webinar panelist Jason Kuttner, Magellan Federal’s supervisor for the Adolescent Support and Counseling Service, shares insight into his work with suicide prevention.

Q: What is your role with ASACS and how were you able to develop the Suicide Risk Assessment protocols?

Jason Kuttner: I have been the ASACS Program clinical supervisor for Hawaii since 2018. I’ve been with the program since 2012, first as a counselor in Japan and Germany, then as a clinical supervisor for Asia from 2015-2018. Prior to working with ASACS, I worked in crisis mental health services in Oregon where I had a variety of roles including conducting involuntary commitment investigations, providing emergent crisis counseling services, and helping train law enforcement professionals as part of the CIT (crisis intervention training) program. In these roles, I have worked with countless individuals in mental health crises. I’ve had extensive training in best practices for working with suicidal individuals and I’ve been able to learn from first-hand experience what works to de-escalate crises including implementing wrap-around support to keep people safe in the short and long term.

Q: When discussing suicide prevention how are the needs of a service member or a veteran differ from a civilian?

Kuttner: Suicide rates among veterans are significantly higher than in the civilian population. Veterans are 1.5 times more likely to die by suicide than non-veterans.[1] Reasons for this include high exposure to trauma, stress and burnout, isolation and loneliness, easy access to and familiarity with firearms, and difficulties integrating into civilian life. Active-duty service member suicide rates have been climbing in recent years and are now on par with the general population. One of the most significant challenges with service members is reducing the culture of stigma to access mental health services. There is a perception that accessing mental healthcare may jeopardize a service member’s career opportunities. All the branches of service are working to try to reduce this stigma and to make it easier for service members to seek help when they need it.

Q: In your webinar presentation you mention the need for more community-based prevention. What does community-based prevention look like and why is it needed?

Kuttner: Community-based prevention means simply helping and encouraging people to find ways to connect with others. The most effective of these are not framed as ‘suicide prevention’ per se but are ways for people to find others with common interests to engage with. This can include hiking, recreational sports leagues, motorcycling groups, service work and volunteering, music and arts, spiritual and religious organizations, and basically any kind of hobbies and interests that people can do with others. In person, social connection is an important antidote to mental distress which is often exacerbated by isolation. Increasingly people are connecting online through social media, multiplayer gaming, and other ways. While this seems like a good idea and can be a way to connect with like-minded people, research has been showing a correlation between increasing use of social media with higher rates of depression, anxiety, and loneliness.

Q: Where can a service member, a veteran, or their family go if they feel depressed or are having thoughts of committing suicide?

Kuttner: There is good help there! The 988 mental health crisis and suicide lifeline was rolled out a little over one year ago. The lifeline connects people to local mental health support services including veteran-specific services. You can call or text and help is prompt, confidential, and professional. It is so important to know that there is no shame in having depressed and even suicidal thoughts; these are very common, and most people will have times in their lives when they experience dark thoughts including morbid ruminations. We need to reinforce the message that none of us are alone. Talking to somebody about these thoughts actually helps. The more people who are trained as peer supports to be able to know how to listen and talk to a person who is depressed and possibly suicidal the better. Many communities have access to free suicide prevention training such as ASIST and SafeTalk which are intended to train regular, non-mental health professionals to know how to be there for family members, friends, colleagues, and others who may be experiencing mental distress.

For service members who are worried about the stigma of accessing mental health support, chaplains are professionally trained to provide help and can help service members navigate their thoughts and feelings and help them determine what the next steps are to keep them safe. Also, the MFLC program- military family life counselors- are licensed mental health counselors contracted to provide non-medical counseling to service members and their families. MFLCs provide experienced guidance to help people resolve issues and access additional support if necessary.

Q: What are some barriers that might prevent a service member or a veteran from seeking help?

Kuttner: The most significant barrier is stigma- being worried that asking for help is a sign of weakness or might jeopardize their career or status in some way. It is so important to recognize that life is so much more than this present moment. Most suicidal crises are centered on the view that the circumstances that have led to this moment are not resolvable without an immediate and permanent way out. Sadly, the consequences of suicide have a ripple effect that can profoundly affect hundreds or more people in a person’s life. The crisis that a person is experiencing in the present moment can be overcome and the first step in doing so is letting it out, talking to somebody, and letting another person in to help bring some light into the darkness.

Who should watch this webinar and what would they gain?

Kuttner: Anyone who is interested in learning more should attend. Suicide has impacted or will impact most people at some point in their lives. All of us have times of difficulty and have people in our lives who suffer mental distress. The more we can do to get the word out that help is available and there are things that all of us can do to help ourselves and others in our lives, the better.

If you missed this important webinar, click here to watch the replay: https://www.magellanfederal.com/whats-new/mfed-inform/suicide-prevention-strategies-and-resources-for-military-families/

[1] National Veteran Suicide Prevention Annual Report,  September 2022

Talking about suicide is very important if you are worried about someone who may be struggling, or you feel suicidal. Discussing suicide does not make it more likely to happen. Showing you care helps reduce the risk of suicide.

If you are worried about someone who may be feeling suicidal or you are having suicidal thoughts, consider these tips.

You can also register for our upcoming webinar, “Say more, save a life” on September 29, 2023.

How you can help someone who may be feeling suicidal

Having an open, supportive conversation can be a lifeline for a person who’s thinking about ending their life.

Don’t be afraid to be direct.

You might say, “I’m concerned about you, have you had thoughts about harming yourself?” The person may be relieved to talk about it. Try to stay calm and not seem too shocked. Do not be judgmental. Accept that their feelings are real and let them know you care.

Be a good listener.

Pay attention and take them seriously. Make eye contact and don’t interrupt. Be alert for any reasons they give for wanting to live. When they’re finished, ask questions to ensure you understand what they said. Repeat what you heard, including anything they mentioned about what makes their life worth living.

Encourage and help them to seek support.

Tell them they deserve support and the most important thing they can do is speak to someone. You can say, “I know there are hotlines with trained counselors you can talk to confidentially. Would you like me to stay with you while you contact one?” Ask them if they have a plan. It may be scary to talk about, but a detailed plan contributes to a higher risk. Even if they don’t have a plan, take all talk of suicide seriously.

Follow these tips to help someone get support

• Offer to text or call 988, the Suicide and Crisis Lifeline, together.
• Call or text 988 yourself if the person is unwilling to.
• Call 911 if there is an immediate risk of harm and tell the operator you need support for a mental health crisis.
• Stay with them until they are connected to help.

If you are having suicidal thoughts

You are not alone. People from all walks of life have had suicidal thoughts at some point in their lives. While the pain may seem overwhelming and permanent, remember that crises are usually temporary. Give yourself the time necessary to allow things to change and the pain to subside.

Five steps to follow if you are feeling suicidal

1. Promise not to do anything right now. Thoughts and actions are two different things—your suicidal thoughts do not have to become a reality. Give yourself some distance between thoughts and actions.
2. Avoid drugs and alcohol. Suicidal thoughts can become more intense if you have taken drugs or alcohol.
3. Make your home safe. Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you can’t do that, go to a place where you feel safe.
4. Do not let fear, shame or embarrassment prevent you from seeking help. The first step in coping with suicidal thoughts and feelings is sharing them with someone you trust, (i.e., a family member, friend, therapist, clergy member or an experienced helpline counselor).
5. Have hope. People DO get through this. Even people who feel as badly as you do survive these feelings. No matter what you are experiencing, give yourself time to move through it, and don’t try to go it alone.

Additional emotional support resources

For more on suicide prevention, visit our website for September Suicide Prevention Awareness Month, MagellanHealthcare.com/Prevent-Suicide, and be sure to check out the suicide prevention tip sheets and awareness campaign toolkit.

You can also register for our upcoming webinar, “Say more, save a life” on September 29, 2023.

Suicide claimed the lives of almost 46,000 people in the United States in 2020.[1] It is the second leading cause of death for children aged 10–14 and adults aged 35–44, and the third leading cause of death for young people aged 15–24.[1]

Now is the time to raise awareness and reduce the stigma surrounding suicide. Learn more about the warning signs and what you can do if you suspect someone is thinking about suicide. Be the one to save a life.

Know the warning signs

• Hopelessness
• A negative view of self
• Aggressiveness and irritability
• Making suicide threats
• Increased alcohol or drug use
• Withdrawing from friends, family and society
• Trouble sleeping or sleeping all the time
• Changes in mood or behavior
• Feeling like a burden to others and giving things away

Take time to reach out

You can help give someone hope by showing that you care. Notice what is going on with people in your life—a family member, friend, colleague or even a stranger. By stepping closer and reaching out, you can become aware of those around you who may need help. You do not need to tell them what to do or have solutions. Simply making the time and space to listen to someone talk about their experiences of distress or suicidal thoughts can help.

Don’t be afraid to ask someone if they are suicidal

You may not think it is your place to intervene, you may be afraid of not knowing what to say and/or you may be worried about making the situation worse. Offering support can reduce distress, not worsen it. When someone is upset, they are often not looking for specific advice. What you can do is listen without judgment, be compassionate, and know about resources to get help like the 988 Suicide and Crisis Lifeline (call, text or chat).

Additional suicide prevention resources and upcoming webinar

Register for our free webinar, “The role of mental health recovery in suicide prevention,” on September 22 to hear the inspiring recovery story from Stacey Volz, CPRP, CPS, Magellan Healthcare family support coordinator and a person who lives with mental health challenges and has lived through multiple suicide attempts. I will also be on the panel to share my knowledge and professional experience in addressing mental health and substance use challenges to prevent suicide, along with Andrew Sassani, MD, Magellan Healthcare chief medical officer, California, HAI and MHS, and Samuel Williams, MD, MBA, FAPA, Magellan Healthcare medical director.

Visit Magellanhealthcare.com/Prevent-Suicide for more information and materials to learn more and spread awareness about suicide prevention.

[1] National Institute of Mental Health, “Suicide” information

For Greg Dicharry, his work at Magellan Healthcare is not just a job, it’s a passion. Filming and directing documentaries highlighting suicide awareness has been a welcome side gig of Dicharry’s job as national youth empowerment director at Magellan. For the past 14 years, Dicharry has been connecting with people affected in some way by suicide, substance use and other mental health concerns. From those experiences, he launched the MY LIFE (Magellan Youth Leaders Inspiring Future Empowerment) program. MY LIFE provides various activities and workshops for youths ages 13 to 23-year-olds nationally who have experience with mental health, substance use, juvenile justice or foster care-related issues or have a friend or family member coping with these issues. Dicharry’s latest documentary project, “My Ascension,” shows the crippling effects suicide can have on families while telling the captivating personal story of a suicide survivor. Continue reading to learn more about the MY LIFE program and Dicharry’s upcoming documentary.

What sort of projects are you currently working on?

My main responsibility at Magellan is overseeing our MY LIFE program, which we created in 2008 as part of our Maricopa County, Arizona contract. Since 2008, MY LIFE has been leading the way nationally for youth involved in behavioral health and foster care systems. Through regular meetings, special events, performances, social media, and local and national presentations, youth share their stories and support each other in their recovery goals. In response to the COVID-19 pandemic, Magellan launched the Stay Home for MY LIFE virtual youth fest series in 2020. I also do a lot around suicide prevention for the Company and am a part of the new Suicide Center of Excellence. In my spare time, I create documentaries. Over the last three years I’ve been working on a documentary called “My Ascension.” Prior to that I had done another documentary called “Suicide: The Ripple Effect” but this new one is on teen suicide. I made it with a young lady who is a suicide attempt survivor. She attempted to take her life by gunshot and the result was that she is now paralyzed. She had this rebirth through that and now uses her experience to help others via speaking and advocacy, so the story is largely her story but also of other young people in the community who were successful in their suicide attempts and the aftermath of how that has affected their families.

“My Ascension” will premiere nationally on PBS (Public Broadcasting Service) in September. The primary distribution method has been virtual community screening around the country. We’ve done screenings with a couple of universities and several advocacy and mental health groups.

What inspires you to create these documentaries?

I dabbled in film and media throughout high school and college. When I moved to Los Angeles I started working on projects like movies, award shows, commercials and music videos and learning that way.

With the MY LIFE program, I had gotten a camera through Magellan and was able to start producing videos with the youth group so that got me back into filming and then I met a man through work, who’s a suicide attempt survivor, we became friends and he approached me wanting to make a documentary and I helped him with producing and directing. I didn’t plan on doing another documentary, but the opportunity came to tell this very compelling story for “My Ascension” that could reach a lot of young people and empower them in helping them to share their stories.

I also have a personal connection to this where I’ve found myself struggling with suicidal thoughts, and my cousin who was bipolar with a substance abuse issue and died by suicide about 20 years ago. I saw the impact that had on his family and that inspired me to be interested in the topic.

Why is Magellan the best place to do this project?

Magellan is open to innovation, even though it’s a big company everyone is open to new ideas to help better serve our members and customers. For example, with MY LIFE I came up with the idea to do this, it wasn’t something that was a part of my job description or something Magellan had ever done. But they let me run with it and it was successful. People saw the value of it and saw that the opportunity to serve our members and provide them with something in a different way.

With the documentaries, my job had allowed me to be able to do that kind of stuff on the side and it ended up being another way to connect with people differently way and blend the work I’m doing here.

What are your thoughts on the culture here at Magellan? How has the culture at Magellan impacted your project?

It’s a culture that’s open to innovation and that’s open for doing unique things that are engaging for our customers. It’s very supportive, encouraging, and positive work happening here.

• Learn more about MY LIFE here.

New data from the Centers for Disease Control and Prevention shows that suicide rates have risen to over 30% in the US since 1999.[1] Since COVID-19 began, suicidal ideation in the US has more than doubled, with younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers experiencing disproportionately worse effects.[2] As suicide has reached crisis-level proportions in our nation, it’s time to recognize suicide as a public health crisis and learn about the warning signs and the skills needed to save a life.

Know the warning signs of suicide

It is hard to tell whether a person is thinking of suicide. Most people who take their own life show one or more warning signs, either through what they say or do.

• Feelings: Expressing hopelessness, talking about suicide or having no reason to live, showing moods such as depression, anxiety, irritability
• Actions: Showing severe/overwhelming pain or distress, using drugs or alcohol, searching for ways to end their life
• Changes: Withdrawing from activities, isolating from friends and family, sleeping more or less
• Threats: Talking about, writing about or making plans to kill themselves
• Situations: Going through stressful situations including loss, change, personal humiliation or difficulties at home, school or with the law

Take action to prevent suicide

Suicide remains the second leading cause of death among Americans between the ages 10 and 34, according to the CDC.[3] It is a major health crisis—and preventable. When someone says they are thinking about suicide or says things that sound as if they are considering suicide, it is important to pay attention and take action. Suicide is often preventable.

• Ask and listen: “Are you thinking about killing yourself?” is not an easy question, however, a study by the National Institute of Mental Health shows considering suicide may reduce rather than increase suicidal thoughts. Be willing to listen and discuss their feelings.
• Keep them safe: Reducing a person’s access to highly lethal objects or places is an important part of suicide prevention. Asking if the at-risk person has a plan and removing access to lethal means can make a difference.
• Get them help: Connect with a trusted family member, friend or mental health professional. Call the National Suicide Prevention Lifeline’s (1-800- 273-TALK (8255)) and the Crisis Text Line’s number (741741). Save these numbers in your phone so they’re there when you need them.
• Stay connected: Staying in touch after a crisis or discharge from care can make a difference. Let them know they matter and you care. Leave a message, send a text or call them.

For more information and helpful resources, visit MagellanHealthcare.com/Prevent-Suicide.

If you are in crisis or considering suicide, or if someone you know is currently in danger, please dial 911 immediately.

[1] https://www.nimh.nih.gov/health/statistics/suicide

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

[3] https://www.nimh.nih.gov/health/statistics/suicide

Depression is a disease. It’s caused by changes in chemicals in the brain that are called neurotransmitters. Depression isn’t a character flaw, and it doesn’t mean you are bad or weak. It doesn’t mean you are going crazy.

People who are very depressed can feel so bad that they think about suicide. They may feel hopeless, helpless, and worthless. But most people who think about suicide don’t want to die. They may see suicide as a way to solve a problem or end their pain.

What to watch for

It is hard to know if someone is thinking about suicide. But past history or events may make suicide more likely.

Things that can make suicide more likely for those suffering from depression include:

• Being male
• Having had a family member attempt suicide or kill himself or herself
• Having access to a firearm
• Having been sexually abused
• Drinking a lot of alcohol or using drugs
• Having attempted suicide before
• Feeling hopeless
• Other mental health problems, such as bipolar disorder or schizophrenia

Warning signs of suicide include someone:

• Planning to or saying he or she wants to hurt or kill himself or herself or someone else
• Talking, writing, reading, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives, especially if this behavior is new
• Saying he or she has no hope, feels trapped, or sees no point in “going on”

Find additional information and resources on suicide prevention here.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated and Magellan Health disclaim any warranty and all liability for your use of this information.

Written by Thomas Lane, NCPS, CRPS

Every 40 seconds someone dies by suicide somewhere in the world.[1] The human tragedy of death by suicide is getting worse, with global suicide rates increasing 60% in the past 45 years.[1] Most people reading this article will know someone who has been impacted by suicide. One group of folks especially at risk for a suicide attempt are those who have tried to complete suicide previously. Data suggests that 20% of attempt survivors will make another attempt.[2]

I am one with personal experience. I am part of that 20%. As a double attempt survivor, I have haunting memories of those periods in my life when I was more fearful of living than I was afraid of dying. For me, those were the darkest, loneliest, and longest days of my life. After my second attempt in the winter of 1998, I wound up on a ventilator. I was in a coma for 12 days and when I woke up, I felt like someone was choking me. And I was angry. At the time, when I was literally regaining consciousness and coming back to the land of the living, my mom was downstairs with hospital administrators signing an agreement to discontinue life support for me.

As the saying goes, timing is everything.

After a lengthy and very shaky period, I began to get better. I was receiving good mental healthcare, redefining my circles of support, and I had a purpose. I came to believe I still had work to do. Now. On this planet. I had twice crossed the line of deciding I could not be here. Despite my best efforts, I was still here, facing my life. I decided I would seek meaning from as many of my experiences as I could. For the past 20-plus years, I have worked to build and advance peer support, particularly within the context of publicly funded healthcare systems, but also at the grassroots level and through public/private partnerships. I am more convinced than ever of the value, importance and unique perspectives folks with lived experience bring to the table, specifically those who choose to pursue careers as peer specialists. It has been and continues to be a transformative movement, even more so when we understand that many folks who make a choice to work in the peer support field, in the same delivery systems that may not have served them well, do so out of a passion for the work and to give back, to pay it forward.

I share this very personal experience as context for my next point.

In a 2016 survey of Magellan members receiving peer support services, 98% reported their certified peer specialist helps them to, both, improve their quality of life, and feel hopeful about their recovery.[3] Knowing what we do now about the effectiveness of peer support, and understanding the value of lived experience, I believe we can agree about the importance of connecting attempt survivors with peer supporters who have had similar experiences. For most, if not all, attempt survivors, there is a crucial time period after an attempt; I needed intensive support in the days following my second attempt. Sadly, intensive support is not always available, let alone offered by a peer who is also an attempt survivor. I can’t help but wonder, what would universal referral to, or at least an orientation about, peer support opportunities by and for attempt survivors, look like? Considering the COVID-19 pandemic, we have seen a rapid, albeit sometimes rocky, migration to technology-enabled service delivery. Interestingly, peer support has been “technology-enabled” for years in the form of peer-operated warmlines. If you’re not familiar with warmlines, check out the National Empowerment Center at https://power2u.org/peer-run-warmlines-resources/ for great information.

When we consider suicide, we know it is all about prevention, that is, preventing people from attempting to take their own lives. I don’t believe there is a higher calling. Many of my peers with the shared experience of being an attempt survivor have expressed to me this is the most important work they do. We see the positive impact of attempt survivors speaking out about their experiences. We see the importance of eliminating shame associated with the topic of suicide. We know suicide is preventable. We understand that prevention requires dialogue, and dialogue isn’t always comfortable. Nonetheless, the topic of suicide must be brought out of the shadows and recognized as the public health crisis it is, one that we can do something about through evidence-based prevention and education practices. We know it does not increase a person’s likelihood of attempting suicide to talk with them about what they’re feeling. Fortunately, there are many, many organizations pledged to this work. From grassroots organizations founded by survivors of suicide loss to nationally recognized organizations, the conversation is changing. We must continue to be intentional in our approach.

National Suicide Prevention Awareness Month helps shine a light on this often misunderstood and taboo topic. Let’s keep the conversation going for the other eleven months of the year. As peers, let’s renew our commitment to offering support, speaking out and holding the hope for someone until they are able to hold it for themselves. As fellow human beings, let’s take inspiration from Emily Dickinson, and tap the eternal hope perched in all of us.

“Hope is the thing with feathers, that perches in the soul

And sings the tune without the words

And never stops…at all.”

For information about Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

[2] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1317-z

[3] Magellan Peer Support Services Outcomes in Pennsylvania, 2016

In 1989, one survey of the general public found that more than half of respondents believed lack of discipline was a possible cause of mental illness. The survey found that, at that time, Americans were more likely to receive information about mental illness from mass media than from medical providers or psychologists. Thirty years later, with the availability of information on the internet, the public should theoretically have a more accurate and balanced perspective of mental illness. But is the public obtaining their information from science-based sources? While there is still much to learn about mental illness, scientists have identified several factors that can play a role in mental health, including genetics, environmental exposure, altered brain chemistry, significant stress, and comorbid medical conditions. With the availability of misinformation on the internet and on social media websites in particular, are we really any better educated on mental health than we were 30 years ago?

The National Institute of Mental Health (NIMH) reports that approximately 1 in 5 adults experiences mental illness annually, with approximately 1 in 25 experiencing mental illness that substantially interferes with or limits 1 or more major life activities. Based on data from the 2018 National Survey on Drug Use and Health, approximately 19% have an anxiety disorder, 2.8% live with bipolar disorder, and fewer than 1% have schizophrenia in the United States (US) adult population. In addition, 7.2% of adults have experienced at least 1 major depressive episode in the last year. Unfortunately, only about 43.3% of adults with a mental health condition received mental health services within the past year, and of those with a serious mental illness, only 64.1% received mental health services within the past year. Even the indirect costs of mental health have a significant impact. Serious mental illnesses have been estimated to cost over $193.2 billion in lost earnings per year in the US, and mental illness has been predicted to cost the global economy $16 trillion by 2030.

Much has changed in the treatment of mental illnesses in the past 30 years. Key treatments for depression, such as selective serotonin reuptake inhibitors (SSRIs) and newer serotonin-norepinephrine reuptake inhibitors (SNRIs), have mitigated some of the limitations of earlier antidepressants (e.g., drug-food interactions or select adverse effects). Even in the past year, novel approvals for treatment-resistant depression (TRD) and postpartum depression (PPD) have emerged. For those with schizophrenia, the availability of newer generation antipsychotics has significantly altered care as well. Although testing for genetic alterations to better identify the best medication choice for a patient is in its relative infancy, the role of pharmacogenomics is rapidly expanding, too. These advances offer promise for individuals with mental illness, but no medication is without risks, and a discussion with a licensed medical provider is essential to establish an appropriate treatment regimen. In addition to medications, the role of nonpharmacologic treatment has expanded in the past 30 years as well, with additional treatment modalities beyond the advancements in psychotherapy alone (e.g., modern cognitive behavioral therapy, interpersonal therapy). A more holistic approach, incorporating lifestyle changes (e.g., diet, exercise) and non-traditional medicine (e.g., meditation, acupuncture), is also gaining in popularity; however, it is critical to understand that herbal or “natural” treatments can have adverse or toxic effects and drug interactions. These should only be used in consultation with a healthcare provider.

Mental illness can contribute to the risks for suicide. Unfortunately, the Centers for Disease Control and Prevention (CDC) reports that suicide rates have increased by approximately 30% from 1999 to 2016. Notably, suicide is rarely caused by a single factor, and the National Alliance on Mental Illness (NAMI) reports that approximately 54% of those who die by suicide do not have a diagnosed mental health condition. Regardless, this leaves a significant portion of patients with known mental health conditions where intervention may have been helpful. Moreover, NAMI also reports that approximately 90% of those who die by suicide show symptoms of a mental health condition. The CDC includes several warning signs on their website and offers advice to several groups ranging from laypersons to the government to healthcare providers. One component the CDC emphasizes to healthcare systems is the need for affordable and effective mental and physical healthcare where people live. In addition, the Zero Suicide Institute provides a framework for continuous quality improvement in health and behavioral healthcare systems aiming to prevent suicide.

Of late, the public seems particularly concerned with the risk of violence in those with a mental illness. A 2006 survey found that 32% and 60% of Americans thought people with depression and schizophrenia, respectively, were likely to act violently toward someone else; however, research has demonstrated that there are several factors that contribute to violence, and that when accounting for these additional factors, the presence of a mental illness is only a modest contributor (at best) to violence. According to the 2018 National Survey on Drug Use and Health, approximately 19.4% of those over 12 years of age have used an illicit drug in the past year and 3% had at least 1 illicit drug use disorder. Additionally, 3.7% of adults reported dual diagnosis (both any mental illness and substance use disorder). Studies of patients with substance abuse or dual diagnosis have found higher correlations with violence compared to mental illness alone. Most importantly, adequate treatment has demonstrated improved outcomes.

With the discussion of mental health in the press and the plethora of inaccurate information on mental health online, it is difficult for the public to develop a truthful foundation on mental illness. While public access to information and scientific discovery have advanced in the past 30 years, the most critical component for the proper diagnosis, effective treatment, and safety of those with mental illness remains consultation with a healthcare provider and/or team.

If you or someone you know may be at risk for suicide, contact the free and confidential Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available to anyone 24 hours a day, 7 days a week.