Donna Holland Barnes, PhD
President/Co-Founder, National Organization for People of Color Against Suicide
Howard University, Department of Psychiatry
Now is a frustrating time to be working in suicide prevention. While death rates for the other leading causes of death are mostly decreasing or holding steady, death rates for suicide continue to climb. In 2000, the U.S. suicide rate was 10.4 deaths per 100,000 people, according to the Centers for Disease Control and Prevention (CDC). By 2011, the rate had climbed to 12.3 deaths per 100,000 people. Suicide rates among middle-age adults rose at an even higher rate, jumping nearly 30 percent between 1999 and 2010, according to the CDC.
These statistics speak for themselves: Our current approach to suicide prevention simply is not working. The problem is the majority of prevention and treatment efforts focus on addressing a person’s underlying mental disorder, not his or her suicidal behavior. We need to rethink suicide prevention and change the conversation. It is time we stop viewing suicide as a symptom of a mental health disorder and begin seeing suicide as a behavior—a behavior that must be addressed independently of any underlying disorders.
What’s wrong with how we treat suicidal people
More than 90 percent of the people who die from suicide have depression or another mental disorder. Yet millions of Americans suffer from depression and the vast majority of them are not suicidal. Clearly, it is more than just depression that leads to suicidal thoughts and actions. If we treat a suicidal person’s depression before we address the suicidal behavior, we do not adequately address the thought process that led to suicidal thinking; consequently, the person remains at risk.
I am not suggesting that we ignore an underlying disorder like depression; I am saying that we need to re-prioritize our treatment approach so that we begin by addressing suicidal behavior. Only after the behavior subsides should we focus on treating the disorder.
Unfortunately, this is not what our health system is structured to do, and it is not how our providers are trained to respond. Our psychiatrists are trained to diagnose and treat disorders. As a result, when people are found to be suicidal, they are usually admitted to a hospital and treated for a mental health disorder.
However, there is absolutely no evidence that admitting suicidal patients is an effective way to prevent suicide. Admission (and the medication that usually accompanies it) doesn’t eliminate the behavior; it simply masks it because the person is calmer.
How we should treat suicidal people
The more appropriate and effective way to treat suicidal behavior is with crisis support. Often, support is as simple as listening to a person in crisis. You say, “I am here to help you. Tell me what’s going on.” Then listen without interjecting. Don’t try to come up with solutions. A suicidal person doesn’t want to hear that in the moment of crisis.
It’s best to stay with the person and talk to him or her. The goal should still be getting them to help; but that might happen two or three hours later. Calling 9-1-1 does not need to be the first response.
That said, if the person keeps talking about suicide and remains anxious and irritated, you may need emergency help right away. You have to go with your gut. If you feel like you can talk with this person and give them some emotional support, then you do that; if you feel that there is imminent danger, you need to call for emergency help.
Where we should treat suicidal people
The key to this type of crisis approach is making it available where people are, in the community. We, as mental health professionals, need to get out of our offices and research labs and into the community. We need to be out in the streets, working in the weeds, staying in touch with the community.
With the National Organization for People of Color Against Suicide (NOPCAS), we do a lot of community training in how to recognize signs and how to talk to someone in a crisis situation. Just like people are trained in CPR, we can train people to respond to a suicidal crisis.
The QPR Institute for Suicide Prevention is another organization that is focused on community-based prevention. For more than 30 years, it has been training community institutions, including law enforcement and religious leaders, in three simple steps to help prevent suicide. QPR stands for Question, Persuade, and Refer. People trained in QPR learn how to recognize the warning signs of a suicide crisis, and how to question, persuade, and refer someone to help.
Where our prevention dollars should go
This type of community-based approach requires funding and support, and funding currently is focused elsewhere. If we want to decrease deaths by suicide, we need to invest in direct services, and we need to shift more dollars from research into direct services. How much research do we need on suicide? Despair is despair. What we need are services to help people in despair.
Until we shift our focus to suicide as a behavior—and correspondingly increase funding for services and training in this area—we will not see suicide rates and deaths decline.
- How should we re-direct services to better address the increasing suicide rate in the U.S?
- What can you do in 2015 to support implementation of policies that more adequately address suicide prevention within your community?
Dr. Barnes is an Associate Professor at Howard University’s Psychiatry Department in Washington, D.C. and an active advocate for suicide prevention and intervention. She teaches suicide risk management to psychiatric residents and third year medical students. She is well published in the area, is a master trainer for QPR Institute, trains groups and individuals on how to recognize the signs when someone is in a crisis, how to manage the situation, is certified in grief recovery, and works with support groups suffering from a loss. Barnes is co-founder and President of the National Organization for People of Color against Suicide (NOPCAS) and a founding member of the National Council for Suicide Prevention (NCSP).