Suicide rise worries Clark health officials

A 10-month local surge follows CDC tracking of striking national increase.Clark County group working on prevention and education efforts.

Twenty-five Clark Countians killed themselves from August 2012 through May 2013, according to Clark County Coroner Dr. Richard Marsh. A 25th case remains under investigation.

That total would top the number of local suicides for any full calendar year in the past 15 years.

Paired with national study showing Ohio’s suicide rate per 100,000 population was up 41.5 percent from 1999-2010, the spate is very much on the mind of the mental health community.

“One year does not make a trend,” said Kent Youngman, CEO of the Mental Health and Recovery Board of Clark, Greene and Madison Counties, “but … ”

Said Clark County Health Commissioner Charles Patterson, “We want to see if we can’t get this under control before it becomes a further problem in the community.”

That’s one of the goals of Jennifer Mansfield Price and the Excelsior Project, a Clark County suicide prevention program her mother-in-law and husband founded after her brother-in-law, Tim Price, committed suicide in 2009.

Cindy and Jennifer Price speak wherever they can to whomever they can about suicide.

“We have to live with Tim’s death each and every day. It will never go away,” Jennifer Price said. “But we want for something positive to arise from our affliction.”

A hunch and a study

“Suicide already had my attention,” said Patterson, who in compiling a Community Health Survey noted that suicide had risen from 17th among causes of death in Clark County in 2001 to 11th in 2005 and to 10th in 2010.

And there’s reason to believe the problem might increase here.

On May 2, the Centers for Disease Control announced that results of a study showing suicides are on a disturbing upswing nationwide, having passed motor vehicle crashes as a cause of death in the country.

The report said the 38,364 people who killed themselves in 2010 totaled nearly 5,000 more that died in accidents on the nation’s roads.

Suicides were up in all four regions of the nation, Ohio being one of 39 states with statistically significant increases.

From 1999-2010, the span of the CDC study, the suicide rate for ages 35-64 increased from 13.7 per 100,000 population to 17.6, a a rise of 28 percent. The increase was most pronounced in the sub groups ages 50-54, up 48 percent, and ages 55-59, up 49 percent.

This means the affliction once associated more with the young and old has established a strong foothold among the middle-aged.

There may be particular reason to worry about Clark County’s risk for joining the trend in one detail of the report. Of the recent rash of suicides here, the proportion of those who suffocated themselves was up dramatically, paralleling the increase of 115 percent reported in the CDC study.

White males at high risk

Slightly more than half of Clark County male suicide victims (53.4 percent) died of self-inflicted gunshot wounds and 29.4 percent by hanging. For women, the leading cause of death was overdose (35.9 percent) followed by gunshot wounds (25.6 percent) and hanging (12.8 percent).

In Clark County, death by suicide also tends to be an affliction of males and whites. Coroner Marsh’s 1998-2011 study found that 84 percent were male, 94.7 white and 79.8 percent white male.

The American Association of Suicidology adds this bit of context about the wider net of psychological suffering linked to suicide: “Four times more men than women kill themselves, but three times more women than men attempt suicide.”

Men die more often for two reasons: they tend to use more lethal means and they’re less likely to seek help.

Said Marsh, “Men don’t ask directions, don’t go to doctors and don’t seek help.”

Greta Mayer of the Mental Health and Recovery Board of Clark, Greene and Madison Counties added that there are clearly differences when they do.

“Men are more likely to seek help for an addiction and women for medical problems,” she said.

Why the increase?

Dr. Thomas Simon of the CDC said there are three apparent reasons suicide has risen from the 8th to the 4th cause of death among middle age Americans since 1999.

“One of them is the role of the economy,” he said. “Working age adults are most vulnerable to (the damages done by) a recession.”

Another is the suicide rate among Baby Boomers, which was higher in their adolescent years than past generations and continues to be higher now. Experts worry, in fact, that this will be a growing problem as Baby Boomers enter the traditionally highest risk period in old age.

A third reason, Thomas said, is that “middle age adults have the highest prescription pain killer overdose rate” at a time when overuse and abuse of them has soared.

But he emphasized there isn’t a single, simple explanation: “For most people who die from suicide, there’s multiple contributing factors.”

Some of the CDC’s recommendations for curbing the rise in suicides read like a description of the combined problems of middle age.

“Prevention strategies include programs to help those … struggling with financial challenges, job loss, intimate partner problems or violence, stress of care-giving for children and aging parents, substance abuse and serious or chronic health problems.”

Helping at-risk veterans

Many of those same problems appear in Marsh’s report as “apparent precipitating factors of suicide.” In combination, they are the same kinds of stressers the Veterans Administration looks for as it monitors the health and mental health of soldiers, sailors and Marines returning to civilian life.

The Dayton Area VA, which last year served 12,000 veterans in its 16-county, area has a Community Based Outpatient Clinic, or CBOC, in Springfield.

A measure of the importance the VA places on suicide prevention is a recorded message at the Springfield CBOC and every other one that tells people how to get help if they’re considering harming themselves.

With higher exposure to infantry units and combat, Marines and Army veterans suffer higher rates of Post Traumatic Stress Disorder and have the highest rates of suicide, said William Wall, program manager for the Dayton VA program caring for Iraq and Afghanistan veterans.

The rate for Marines is 24 per 100,000 and the Army 21.7. (The rate for sailors is 13.3 and Air Force veterans 12.5.)

“You think about being on active duty and deployed,” he said. “Somebody gets injured and you look at musculoskeletal injuries.”

Although the injury starts as acute pain, “by the time they get to us, they’re separated from the service and you’re part of a chronic pain scenario,” Wall said. And it may involve someone afflicted with post-traumatic stress disorder (PTSD) and traumatic brain injury.

If that pain is poorly managed “substance abuse goes along with that,” he said. That mixture of prescribed and other drugs with relationship problems that can come during the transition puts a person at risk, he said.

Getting people treatment

Whether a person’s distress is caused by PTSD or middle age struggles to keep afloat in a limping economy, “the biggest challenge once you identify someone at risk is getting them engaged in treatment,” Wall said.

Once that happens, “we do good work and we help people through these kinds of crises,” he said.

Said the CDC’s Simon, “it is a preventable public health problem.”

Because of that, getting people into treatment is the goal of both military and civilian mental health workers.

The VA screens all returning veterans for mental health and suicide risks when they sign up for VA health care, puts those identified at risk in a 90-day program to follow their progress, uses a red, yellow and green light triage system to signal their risk levels, and tries to make connections with family and friends to help monitor and support them through the transition.

Among the criteria for inclusion are multiple deployments and discharges from an inpatient psychiatric unit.

Through access to a common patient database, all those in the VA treatment system are aware of those at risk, and the VA has developed a red, yellow, green system to identify those at highest, moderate and lowest risks.

Clark County has a mental health outreach system and a Suicide Prevention Council that includes people from the full range of community’s health, mental health and social service agencies.

Often on the front lines are Springfield police and Clark County Sheriff’s deputies, who are dispatched on 600-700 potential suicide calls in a year.

Others keeping watch are deputies in the Clark County Jail, which has protocols at booking to screen for those at risk to harm themselves.

“There’s clinical signs, there’s verbal signs, there’s behavioral signs,” said Lt. Joy Danley Gilliland, jail administrator. “And intoxicated people are at risk, too.”

Said James Perry, CEO of Mental Health Services for Clark and Madison Counties (MHS), “A person can walk in between 7 a.m. to 11 p.m. seven days a week to access emergency services. Or they can go to the emergency room.”

Stigma and casseroles

Perry said depression that leads to suicide often has two basic roots.

“A person can just inherit too little of (certain) brain chemicals, and they will struggle with moods and depression all of their lives. But there is another side where people have such adverse life circumstances,” whether through deaths in the family or job or relationship loss, that it’s difficult to cope.

“The ones I (most) worry about are the combination,” Perry said.

He’s also concerned about attitudes toward suicide.

“To the (surviving) family, there is still a stigma” to suicide, Perry said. “To the public, I think there’s broader knowledge now this was the result of illness (and) depression and maybe substance abuse was a factor.”

But the Mental Health and Recovery Board’s Mayer acknowledges the difference in which it’s treated by saying suicide is “the only death that occurs when no one shows up with a casserole at your front door.”

Her boss, Youngman, says that chipping away at the stigma associated with suicide “takes time, so we really have to stick with it.”

Patterson said he hopes improving Clark County’s overall physical health may also help with suicide, “because our physical health has a lot to do with our mental health.”

The CDC also suggests improvements in another broad category, by “enhancing social support and community connectedness.”

Jennifer Price of the Excelsior Project agrees.

In a recent speech, she said: “I quote the 14th Dalai Lama: ‘Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.’”

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