Featured op-ed from the Courier-Journal.com website:
Like most Americans of a particular age, my heart sank when I heard about the death of Robin Williams. I felt like I grew up with him. As a suicidologist, I feared the worst: that he would be painted as a caricature, the sad clown and comic genius, who, in an ironic turn, could not save himself, and the opportunity for gleaning profound messages from his death would be lost.
I learned of Williams’ death as I departed a support group I help co-facilitate for individuals bereaved by suicide. In the days since, it has not been lost on me that the shock and grief I witness every week is a microcosm of the public’s current reaction to Williams’ death. The reactions I observe are private tragedies of “ordinary” people, yet today the disbelief and pain felt by those who are touched by suicide is painted across a much larger canvas because of Williams’ death. Suicide can and does happen to anyone.
Robin Williams was “ordinary” in the sense that he belonged to a group of Americans who are beginning to show some significant suicide risk.
Since 2010 there has been a sudden increase in suicide among men and women “in the middle” of their lives (35 to 64 years of age). Suicide death has risen by 28 percent among this group, and suicide has moved up the rankings for cause of death among Americans in this age range from the 10th-leading cause of death in 1999 to the fourth-leading cause of death in 2010. The rate for men in this cohort was three times that of women, suggesting that there is a particularly disturbing increase in suicide among men in this age range.
Researchers are left scratching their head to understand it. Is it a cohort effect? Is it the result of financial strain or substance use and abuse across the life span?
News accounts have speculated on every possible cause for Robin Williams’ suicide — from financial problems to his frustration over having to work for the paycheck to address them to his recurrent depression and substance abuse issues.
What most suicidologists know is that it is not that easy to deconstruct such a final act to one cause. It’s usually a combination of factors that are unique to the individual that contribute to the death, and the treatment to address what is driving a suicidal person’s thoughts, feelings, and behaviors must be as specific.
While questions remain about these overarching trends, the science of treating suicidality has improved. We know that untreated mental illness, such as depression or bipolar disorder, brings with it suicide risk. However, we also know that treating an underlying mental illness in a suicidal person will not necessarily address their suicidality. Suicide must be the focus of the treatment and that is done by addressing the unique “drivers” for an individual’s suicidal thoughts, feelings, and behaviors.
Kentucky has been a leader in the effort to disseminate the state of the art of this “suicide-focused” treatment.
With 675 Kentuckians dying by suicide every year, state suicide prevention leaders understand the urgency between the need for trained professionals and the demand for services from Kentuckians in crisis.
The Kentucky Department of Behavioral Health, Developmental and Intellectual Abilities has wisely focused limited resources on providing training to professionals in assessing, intervening and managing suicide risk.
This summer my Western Kentucky University colleague, Stephen O’Connor, and I introduced to small groups of community mental health clinicians across the state a novel treatment protocol, “The Collaborative Assessment and Management of Suicidality,” which does exactly that. It treats suicide, not just the factors that sit in the background.
The state of Oklahoma is rolling out this treatment protocol to every behavioral health provider in the state, which required top-down engagement and commitment from the highest levels of state government to saving lives.
Next year, Kentucky will mandate that all behavioral health providers have a certain number of hours of suicide assessment, intervention and management training. This mandate does not guarantee any competence to treat suicidal individuals, but more familiarity with approaches.
It is vital that clinicians be competent to assure that the people who need help are going to get it. Addressing suicide risk among the 675 Kentuckians who die by suicide every year is going to take a more systematic approach that nurtures competency among clinicians, if we are ever to make a dent in the numbers. Many of the 675 individuals who die by suicide each year in Kentucky may have been preventable deaths. However, without clinicians competent to treat these Kentuckians, we will never know.
Melinda Moore is an assistant professor and licensed psychologist in the Department of Psychology at Eastern Kentucky University. She is also chair of the statewide non-profit, The Kentucky Suicide Prevention Group Inc. Contact her at Melinda.Moore@eku.edu