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Suicide prevention in the age of COVID-19

The summer edition [July 2020; Volume 50, Issue 5] of the American Public Health Association’s newsletter, The Nation’s Health, features experts concerned about potential increases in suicide and deaths of despair due to the COVID-19 pandemic. Prevention professionals working in upstream substance use prevention among youth may not realize that these concepts are often directly related to alcohol and drug use. The newsletter reports data on “deaths of despair,” which are defined as deaths by suicide or associated with alcohol or drug use, at nearly 182,000 people in 2018.

A May 8 report from the Well Being Trust foundation with the Robert Graham Center for Policy Studies in Family Medicine and Primary Care estimated 75,000 additional U.S. deaths of despair over the next decade. The projection was based on a model of the socioeconomic fallout from the coronavirus pandemic and continuing paucity of mental health services. The researchers acknowledged that if they had also modeled the mental stresses of social isolation and economic uncertainty, the estimate would have been higher.

But prevention can help intervene with effective policies and practices to forestall such outcomes.

Health care settings—whether virtual or face-to-face--offer prevention opportunities

While effective policies exist that show suicides can be reduced through gun safety laws and other means, new research indicates that health care settings offer an opportunity for increased surveillance of at-risk people. And technology can be harnessed by holding virtual office visits and group therapy sessions on conferencing sites to connect people with mental health professionals, expanding care.

In addition, the Coronavirus Aid, Relief and Economic Security Act, signed into law in March, includes $425 million for mental health services and provisions for expanding telehealth for those who qualify. But much more is needed.

One promising national initiative is Project 2025, started five years ago by the American Foundation for Suicide Prevention. The project includes a dozen partners pursuing a 20% reduction in suicides by 2025. Suicide prevention methods are being piloted and implemented across the country, including universal screening in health care settings for suicidal ideation. Research funded by the National Institute of Mental Health, a project partner, shows that asking health care patients if they are suicidal is an effective intervention. Questions have been created for health care workers to ask patients, regardless if they show suicidal signs.

Since studies show that the majority of people who have attempted or died by suicide visited a health care system in the weeks or months prior to their deaths, so it can be an important site for suicide prevention interventions.

Lisa Horowitz, PhD, MPH, staff scientist and clinical psychologist at NIMH said it is a myth that asking about suicidal ideation plants a dangerous seed. “It is actually the opposite,” she said. “The best way to keep someone from killing themselves is to ask directly, ‘Are you thinking of killing yourself?’ Then listen when they answer, and get them help. Asking also de-stigmatizes suicide because it becomes part of the conversation.”

Project 2025 also supports “red flag” laws, which give police authority to remove firearms from high-risk people, and tougher background checks and licensing processes for firearm purchases. Guns are used in nearly half of all suicides, which have increased 35% over the last two decades to about 47,000 annually, according to the Centers for Disease Control and Prevention.

“Suicide and guns share a fatal link,” Mighty Fine, MPH, CHES, APHA’s director of public health practice and professional development, told The Nation’s Health. “While we must work to address the root causes of suicide, we have to acknowledge the role of gun access to truly curb this major public health issue.”

APSI will be hosting a Prevention Talk on suicide prevention in March, 2021. Subscribe to our website to receive more information.

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