September is National Suicide Prevention Awareness Month.  Dr. Carlin Barnes and Dr. Marketa Will are Harvard-trained psychiatrists  co-authored a book titled “Understanding Mental Illness: A Comprehensive Guide To Mental Health Disorders For Family And Friends.”

IF TWICE AS MANY PEOPLE DIE BY SUICIDE THAN THOSE WHO DIE BY HOMICIDE WHY AREN’T WE HEARING ABOUT THIS MORE?

That’s a great question.  We believe the reasons are complex and multi-factorial.  First and foremost, we believe the stigma surrounding mental health issues makes suicide a difficult topic to discuss.  Secondly, suicide events are often mired in secrecy.  Families do their best to protect the confidentiality and privacy of the individuals involved – often times this secrecy is related to guilt and shame associated with the stigma of mental illness.  And lastly we believe there is a media bias towards homicides.

IF A PERSON HAS EVER THOUGHT ABOUT SUICIDE, BUT NEVER ACTUALLY ATTEMPTED IT, IS THERE CAUSE FOR CONCERN?

Yes.  If is someone is having thoughts about suicide there is cause for concern.  Having suicidal thoughts is a pre-cursor to a suicide attempt or a completed suicide.

 WHAT ARE THE SOME OF THE COMMON WARNING SIGNS OF SUICIDE?

  • Threats or comments about killing themselves – “I wish I wasn’t here”
  • Increased alcohol and drug use
  • Aggressive behavior
  • Social withdrawal
  • Dramatic mood swings
  • Preoccupation with talking, writing or thinking about death
  • Impulsive or reckless behaviors
  • Putting affairs in order, saying goodbye, giving away possessions

 ARE THERE ALWAYS SIGNS? OFTEN FRIENDS AND FAMILY MEMBERS REPORT HAVING NO IDEA THEIR LOVED ONE WAS SUFFERING.

There are not always warning signs.

 WHAT ARE THE RISK FACTORS OF SUICIDE?

  • Having an underlying mental illness
  • A family history of suicide
  • Substance abuse and intoxication
  • Access to firearms
  • A serious or chronic medical illness
  • A history of trauma or abuse
  • Prolonged stress
  • Recent tragedy or loss
  • Gender (men are four times as likely to commit suicide than women)
  • Advancing age
  • Race (Native Americans and Caucasians more likely than other races to complete suicide)

WHO’S MORE AT RISK OF SUICIDE – MEN OR WOMEN? ANY PARTICULAR RACE?

Women are more likely to attempt suicide while men are more likely to complete suicide. Whites and Native Americans are more at risk for suicidality than other races.

 WHAT CAN WE DO TO IMPACT SUICIDE PREVENTION?

  • Ask- Research shows that people who are having thoughts of suicide feel relief when someone asks about this in a caring manner. Acknowledging and talking about suicide may reduce rather than increase suicidal ideation.
  • Keep the individual safe- Do this by removing lethal means.
  • Be There- Individuals are more likely to feel less depressed and less suicidal after speaking to someone who is supportive and listens without judgment.
  • Help the individual stay connected- Studies indicate that helping someone at risk create a network of resources and supportive network can help towards reducing feelings of hopelessness.
  • Follow up- Establish ongoing supportive treatment which is an important part of suicide prevention.

WHAT TREATMENTS OPTIONS ARE AVAILABLE?

90% of people who have suicidal thoughts have an underlying mental illness.  Mental illnesses can be safely and effectively treated with medications and/or talk therapy.

ONCE DIAGNOSED, WILL YOU HAVE TO TAKE MEDICINE FOR THE REST OF YOUR LIFE?

Not necessarily but sometimes yes.  The real answer is – it depends on your underlying diagnosis.  That determination would be made with the help of a trained psychiatrist.

IS MENTAL ILLNESS HEREDITARY?

Yes, mental illness tends to run in families.  That being said, mental illness can happen in individuals without family history, as well. 

CAN CERTAIN MEDICATIONS BE THE CAUSE OF SUICIDAL THOUGHTS?

Yes, there are certain medications (especially in children) that can cause suicidal thoughts.

WHAT CAN BE DONE ABOUT THE STIGMA ASSOCIATED WITH MENTAL ILLNESS?

We believe the most important to do about the stigma associated with mental illness is to arm people with clear information.  At the end of the day, increasing empathy towards people who have mental illness is critically important.  There is so much fear and shame surrounding mental illness.  Having conversations like this one are important in ending the stigma.

 HOW CAN A PERSON HELP A FRIEND OR LOVED ONE WITH A MENTAL ILLNESS?

We think the number one way to help a friend or loved one with a mental illness is just to be there in an open, non-judgmental way.  That often times just means listening to and validating their feelings.  Don’t try to solve their problems, don’t try to tell them to just “get over it”, don’t try to tell them how they should think.  Just be there and listen.   Offer assistance and be available as you would with a physical illness (e.g. a loved one may need a respite break from parental caregiving or a person might want a parent or spouse to attend an appointment with them).

HOW CAN YOU HELP A PERSON WITH A MENTAL ILLNESS THAT WILL NOT ACKNOWLEDGE THE FACT THEY HAVE AN ISSUE AND WILL NOT TAKE THEIR MEDICINE?

This is a tough one. Many people who have mental illness have little to no insight into their disorder.  That means they have no idea that they even have an issue.  Ironically, that can actually be part of the disease process itself.  Many times people feel comfortable with their PCP or primary care provider and will talk about various symptoms with their PCP that they won’t discuss with their family.  If behaviors are so out of control that it is impacting a person’s safety or the safety of others, an intervention with a professional or taking the person to the ER is a good option.

This is a great question and also a tough question to address with a short explanation.  There are systems in place in these instances, e.g. a primary care provider (or pediatrician) may play an important role in helping a child get the mental health treatment needed.  Additionally, in extreme cases, agencies such as Child Protective Services, may be called upon if the child’s mental health needs are not being met and treatment is not being sought  (with the intent to not be punitive but rather to act in the best interest of the child and empower the family member to take action).

WHERE CAN PEOPLE GET MORE INFORMATION?

Our book, “Understanding Mental Illness:  A Comprehensive Guide to Mental Health Disorders for Families and Friends.

Hotlines:

Your “Text Tom”  questions answered below:

At what age does suicide start to become a concern?

Unfortunately, suicide can be a concern for very young children, even as young as age five.  New data shows that suicide rates for Black children (ages five to twelve) are roughly two times higher than those of similarly aged white children.

GM, what signs do you look for in children? I know there’s a rise among children because of online bullying. Have a great day!

Many of the signs of suicide in children are similar to those in adults and include the following:

Talk about or threatening to harm or kill oneself; looking for ways to kill oneself

Substance abuse or increase in substance use

Purposelessness

Anxiety-worry, fear, agitation, or changes in sleep pattern

Feelings of being trapped or like there is no way out of a situation

Hopelessness

Withdrawal from family, friends, activities

Anger

Impulsivity and recklessness

Mood changes-depressed mood, pervasive sadness

Decline in school performance

School avoidance, school refusal

I just left a friends’ house. She actually left me a weird message at 3:30 am this morning explaining her discontent with her life. She seemed okay but I left feeling unsure. What should I do? 

Immediately, call the National Suicide Prevention Lifeline at 1-800-273-8255.  This number is staffed by trained professionals and available 24 hours per day. In a situation such as this, it is important that the person is not left alone until the situation has been assessed as safe.

Is self-medicating a good thing to do when dealing with anxiety issues?

No, self-medication is not a good option to address mental health conditions, including anxiety.  A person experiencing mental health conditions should seek an evaluation and treatment by a licensed healthcare clinician, preferably a therapist and/or psychiatrist.  Anxiety is a very treatable condition with therapy and/or medications.

How should we go about getting reliable doctors to treat mental illness, i.e. suicide?

If a person is experiencing suicidal thoughts, this is a crisis and should be evaluated immediately by doctors and clinicians experienced in managing mental health crises. In non-emergent mental health conditions, a person can access reliable mental health providers a number of ways.

If uninsured, a person can contact their local community mental health center for affordable (oftentimes free of cost) quality mental healthcare.  If a person has insurance coverage, a person can access quality mental health providers by referrals from his/her primary care provider or by obtaining mental health provider referrals by contacting the insurance provider customer care line.

What are the statistics for White/Black service members that are serving or have served committing suicide?

Historically, there has been limited data regarding these statistics.  However, data from the 2017 veteran suicide by Race/Ethnicity study reveals that U.S. veterans accounted for 14.3 percent of all deaths by suicide in the U.S. in 2015 (although U.S. veterans are only 8.3 percent of the U.S. population).  Data from this study further reveals that from the 2001-2014, 82.3 percent of veteran suicides were White veterans, 8.1 percent were American Indian veterans, 4.7 percent were of Black veterans.

How do you start a conversation about suicide when there’s already been an attempt of suicide?

Start the conversation from a place of compassion, empathy, and non-judgement. Check your own emotions and feelings about suicide and death. It is quite common that the person who is experiencing suicidal thoughts or has a previous suicide attempt, feels shame, guilt, or embarrassment about this.

Be willing to offer assistance or be available if the person asks for help in this way. Encourage the person to call the National Suicide Prevention Lifeline and/or seek help from a licensed mental health provider.

The important thing is to start the conversation. Ask the person, “I notice you have been down lately, have you had thoughts of dying or wanting to hurt yourself?” Studies show people who are having thoughts of suicide feel a sense of relief when someone asks them about this in a caring manner. Acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.

 Carlin Barnes, MD, is a board-certified psychiatrist and behavioral health medical director at a Fortune 250 managed care company. She trained in the specialty of psychiatry at programs affiliated with both Harvard University and Emory University Schools of Medicine and attended Texas A&M University College of Medicine, where she received a Doctor of Medicine degree. She is an alumna of the University of Virginia.  Dr. Barnes is a member of   professional organizations including the National Medical Association, the Black Psychiatrists of America, and the American Academy of Child & Adolescent Psychiatry. Originally from Hillside, New Jersey, she currently resides in Houston, Texas, with her son.

Marketa Wills, MD, MBA, is a board-certified psychiatrist with a master’s in business administration from the Wharton School of Business and serves as a physician executive at a Fortune 500 health insurance company. Dr. Wills earned her medical degree from the University of Pennsylvania School of Medicine, and completed a residency in adult psychiatry at Harvard’s Massachusetts General Hospital/McLean Hospital program. She has received numerous accolades and awards highlighting her clinical and community achievements. Originally from Dayton, Ohio, she currently resides in sunny Tampa, Florida.

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