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

If you find yourself grappling with feelings of anxiety, irritability or depression amid scorching and unrelenting heat, you’re not alone. Sweltering heat can destabilize mood, exacerbate existing mental health conditions and complicate psychiatric drug treatment. Elevated temperatures have also been linked to surges in suicide rates. Finding ways to stay cool can be a good starting point to help reduce the impact of periods of intense heat on your mental health.

Tips for Coping with Extreme Heat

Below are simple yet powerful ways to help you and others manage extreme heat and stay mentally well during periods of extreme heat.

• Stay hydrated—Adequate hydration, including restoring electrolytes, is vital for maintaining mental and physical wellbeing during heat waves. Sodium, potassium, calcium and magnesium are key electrolytes, or charged minerals. They help balance fluids, nerve-muscle functioning and hydration. Keeping them balanced is key for your overall health and bodily functions.
• Manage medications—If you take medications, consult with your provider before combining your dose with excessive heat. Some mental health medications, like lithium for bipolar patients, might not be suitable for high temperatures. Since lithium affects the kidneys and sweating can alter its levels, it’s crucial to exercise caution when exposed to heat. Adjusting the dosage or avoiding heat altogether might be necessary to ensure your wellbeing and medication effectiveness.
• Cover your head—Wearing a hat, cap or other head covering can prevent heat-related illnesses like heat exhaustion and heatstroke by helping you maintain a cooler body temperature. It can also reduce sweating which decreases the likelihood of excessive fluid loss and dehydration.
• Wet your head— Pouring water on your head offers immediate relief by absorbing heat and evaporating and cooling your skin. This helps regulate body temperature and prevent overheating. The sudden coolness also improves alertness and cognitive function in hot conditions.
• Seek shade—Exposure to direct sunlight, especially during peak heat hours, also increases the risk of heat-related illnesses. Seeking shade reduces these risks and can help you maintain a comfortable body temperature.
• Stay cool—Embracing cooling strategies like taking cold showers, using fans or placing cold compresses on pulse points helps regulate your body temperature, prevent heat-related issues and promote positive mental health despite challenging weather.
• Exercise inside—If you normally go for walks outside, move them inside a mall or other large space with air conditioning. This change protects you from the heat and offers a controlled space for physical activity, improving your mental wellbeing and keeping you cool and comfortable. If this isn’t possible, change your exercise routine to exercise in the early morning or late evening to avoid the midday heat.
• Practice mindfulness—Engaging in mindfulness exercises like deep breathing and meditation can help you manage heat-related stress and anxiety. These practices not only promote mental clarity and emotional balance but also help in reducing the psychological impact of extreme heat, allowing you to navigate through challenging conditions with a sense of calm and resilience.
• Check-in—Regularly reach out to vulnerable family members, neighbors or friends, offering support and assistance as needed. This act of care can strengthen bonds and provide a sense of purpose and connection, benefiting both your mental wellbeing and the wellbeing of those you care about.
• Visit Heat.gov—With proper planning, education and action, many of the impacts of extreme heat can be prevented or reduced. Heat.gov provides valuable guidance, including information, tools and resources to help you stay safe before, during and after a heat wave and understand the impact of extreme heat on vulnerable populations.

Remember, staying proactive and well-prepared is key to maintaining your mental health during periods of extreme heat.

For more mental health resources, visit MagellanHealthare.com/bh-resources.

Sources:

• Excessive heat and its impact on mental health | BCM
• Heat Health Awareness: Why it’s Important for Persons with Substance Use Disorders and Mental Health Conditions, Caregivers and Health Care Providers
• Heat Singes the Mind, Not Just the Body
• Psychiatry.org – Extreme Heat Can Take a Toll on Mental Health
• Understanding effects of heat on mental health – Mayo Clinic News Network

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

The new 988 Suicide and Crisis Lifeline launched on July 16, 2022. With 988, it’s now easier than ever for anyone experiencing mental health-related distress–whether that is thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress–to seek immediate help.

The new 988 dialing code operates through the existing National Suicide Prevention Lifeline (the Lifeline) network of over 200 locally operated and funded crisis centers across the U.S. People can now access a strengthened and expanded Lifeline via 988 or the existing 10-digit number (which will not go away).

In this post, we’ll continue the introduction of the new 988 Suicide and Crisis Lifeline and provide additional resources for you to learn more and be prepared if you or someone you know experiences a mental health crisis.

What is 988?

Beyond being an easy-to-remember number, 988 provides a direct connection to trained, compassionate and community-based crisis counselors for anyone experiencing mental health-related distress–whether that is thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress.

Who can use 988?

988 services are confidential, free and available 24/7/365 for anyone experiencing a mental health, substance use or suicidal crisis. And 988 isn’t just for you. People can also dial 988 if they are worried about a loved one who may need crisis support.

How are 988 services accessed?

The 988-dialing code is available for call (multiple languages) or text (English only), and chat services (English only) can be accessed at 988Lifeline.org. 988 services are available through every landline, cell phone and voice-over-internet device in the U.S.

 How is 988 different from 911?

The focus of 988 is to provide easier access to the Lifeline network and related crisis resources, which are distinct from 911, where the focus is on dispatching Emergency Medical Services, fire and police, as needed.

Why was 988 created and where can I get more information?

Congress designated the new 988 dialing code in 2020 to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the lead federal agency, along with Vibrant Emotional Health (operational home of the National Suicide Prevention Lifeline), in partnership with the Federal Communications Commission and Department of Veterans Affairs, to make 988 a reality in the U.S.

SAMHSA provides comprehensive resources for anyone to learn more about 988, suicide prevention and mental health crisis services at   SAMHSA.gov/988.

Is my state ready for 988?

States are at varying degrees of readiness for the volume increases expected from moving to the 3-digit code, 988. The federal government is responding to resource challenges with unprecedented levels of funding and an all-of-government approach to partner with state and local leaders to improve system capacity and performance.

Find additional information and materials on suicide prevention at MagellanHealthcare.com/Prevent-Suicide, and stay tuned for our September Suicide Prevention Awareness Month campaign and free webinar.

Sign up to receive updates a few times a month from Magellan on free behavioral health resources you can use and share with family, friends and colleagues here.

Sources: SAMHSA and the National Action Alliance for Suicide prevention

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.

Even before the COVID-19 pandemic entered our world, the prevalence of mental illness and suicidal ideation in the US was increasing. In 2019, 61.2 million American adults (24%) had a mental illness and/or substance use disorder, an increase of 5.9% over 2018.[1] Depression – a sad mood that lasts for a long time and interferes with normal, everyday functioning – for those under age 50 increased steadily from 2016 to 2019:[1]

• 6% increase among those aged 12-17
• 1% increase among those aged 18-25
• 6% increase among those aged 26-49

From 2009 to 2019, suicidal thoughts, plans and attempts increased among:[1]

• Young adults aged 18-25, 95%, 98.8% and 62.4%, respectively
• Adults aged 26-49, 23.3%, 50% and 24.5%, respectively

Increased stressors brought about by the pandemic – grief and loss, social isolation, financial instability, fear, etc. – have exacerbated the state of mental health in the US. More people from January – September 2020, compared to all of 2019, sought help for anxiety (93% increase) and depression (62% increase).[2] 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.[3]

Recognizing the symptoms of depression

Depression can have different symptoms depending on the person, but in most people, a depressive disorder changes how they function day-to-day, and usually for more than two weeks.

Learn the FACTS:

• Feelings: Being extremely sad and hopeless, losing interest or enjoyment from most daily activities
• Actions: Exhibiting restlessness or feeling that moving takes great effort, having difficulty focusing, concentrating on things, or making decisions
• Changes: Gaining or losing weight due to changes in appetite, changing sleep patterns, experiencing body aches, pain, or stomach problems
• Threats: Talking about death or suicide, attempting suicide or self-harm
• Situations: Experiencing traumatic events or major life changes, having a medical problem or family history of depression

A serious symptom of depression is thinking about death or suicide. If you are in crisis or considering suicide, or if someone you know is currently in danger, please dial 911 immediately.

We encourage you to watch a recording of our webinar, “Depression is more than just a rough patch,” and find additional resources addressing depression at MagellanHealthcare.com/Mental-Health.

Jamie Hanna, MD, serves as the medical director for the Magellan of Louisiana Coordinated System of Care (CSoC) program. She is board certified in Psychiatry and Child and Adolescent Psychiatry. Prior to joining Magellan in 2020, Dr. Hanna served as an assistant professor and assistant training director with Louisiana State University School of Medicine, working with the acute behavioral health unit, and leading the psychiatric consultation-liaison service and emergency psychiatric services at Children’s Hospital of New Orleans. Dr. Hanna completed medical school at the University of Alabama School of Medicine and a subsequent internship in Pediatrics, residency in General Psychiatry, fellowship in Child and Adolescent psychiatry, and fellowship in Infant Mental Health with Louisiana State University in New Orleans.

[1] https://www.samhsa.gov/data/sites/default/files/reports/rpt29392/Assistant-Secretary-nsduh2019_presentation/Assistant-Secretary-nsduh2019_presentation.pdf

[2] https://mhanational.org/issues/state-mental-health-america

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

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

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.