Two extremely sad stories in the media caught my attention recently, each of which highlights something that our communities should take very seriously.
A Kansas teen on an apparent “suicide mission” was gunned down by police on August 23rd. The police were called to help recover the young man, who had been home only 6 hours after a 2-day hospitalization, a result of an overdose attempt. I don’t know the extent of the psychiatric care he received while in the hospital, if any. What stands out is that someone felt he was safe to return to the community, which ended in the young man attempting to take his life again, this time with tragic results due to the police involvement.
Closer to home for me is the story of two incarcerated youths who committed suicide in a youth development center in East Tennessee. With only 3 weeks separating the two suicide deaths, systemic issues were apparent, and it was discovered that the understaffed facility was woefully deficient in providing supervision and dispensing medications.
There are common characteristics between the 3 young men in these news stories that placed them at higher risk of committing suicide:
- Previous suicide attempts
- Current or recent treatment for mental health problems
- Social isolation
- State custody/family disruption
One risk factor that most people do not take into consideration is that people, youths or adults, are more susceptible to suicidal thoughts, attempts, or completion following treatment than they were prior to treatment. In a recent managed care provider meeting I attended, it was stated that there is a 30% increase in suicidal risk following contact with a medical provider, whether inpatient or outpatient. This article highlights increased post-discharge suicide completions occur with 2 weeks of inpatient psychiatric care, the majority of which occur on day 1.
Furthermore, people incarcerated in jails or prison are at higher risk of suicide than the general population. The APA states in its practice guidelines on suicide that “suicides among youths in juvenile detention and correctional facilities are about four times more frequent… than the suicide rate in the general population.”
Tennessee is taking part in implementing the Zero Suicides initiative through the Tennessee Suicide Prevention Network. This slide from a recent webinar shows the differences between a suicide-safe system and a system that is not suicide safe:
I have worked with young people at risk of suicide my entire career. There is always deep psychological pain in these youths, too often the result of adults who were supposed to care for them, but didn’t. Behaviors manifest, the result of depression, low attachment to others, or just poor decision-making, and assumptions then are made on the part of us adults that ultimately does not relieve the pain. Relative to suicide, the worst of these assumptions is that these young people will be safe if they are in a facility, if they see a psychiatrist, if they are on suicide watch. Being isolated from suicidal means may prevent a suicide completion, but it does not alleviate the pain that drives suicidal thoughts or actions.
Only involvement, engagement, and treatment for suicide will be effective in reducing needless deaths in our communities:
- Parents, teachers, therapists, and anyone responsible for youths in foster care, residential facilities, or detention centers, need to have the awareness and skills to recognize and intervene in potential suicides.
- Medical, mental health, and correctional facilities need a comprehensive approach, like Zero Suicides, to ensure that suicide risk is consciously addressed, effectively treated, and responsibly monitored after discharge.
- Caregivers, correctional staff, and mental health professionals in the community need a solid plan following inpatient treatment of immediate suicide risk so they can provide treatment and supervision during the high-risk period following discharge.
Restrictive measures may be a necessary step in preventing suicide in some cases. But what will really save lives is when everyone has a stake in alleviating suicide risk, before, during, and after inpatient or restrictive treatment for suicide.