Our Silent National Crisis

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Our Silent National Crisis: How Rising Suicide Rates Have Slowly Become a Non-Discriminatory National Crisis

When the Interstate Compact on Mental Health was adopted in 1956, goals of the compact included improving response times and the quality of care in reacting to mental health issues. The compact itself lists humanitarianism and public safety as two of the guiding motivations for establishing the compact and for providing mental health services in general.1

In the 60 years since the adoption of the compact, funding for mental health has been the subject of debates and popular culture campaigns, and May is annually recognized as Mental Health Awareness Month. Yet, even as states continue to look for new ways to work collaboratively, through compacts and other means, to address issues such as opioid overdoses and deaths, rising suicide rates have once again elevated the mental health crisis.

In stark contrast from the preceding decade’s worth of data, the suicide rate from 1999 to 2014 increased by 24 percent, from 10.5 per 100,000 to 13 per 100,000 people, according to the Centers for Disease Control and Prevention, or CDC. That represents an increase of 1 to 2 percent per year, affecting almost every state and demographic.2

Suicide is now the 10th leading cause of death in the United States, according to the American Foundation for Suicide Prevention.3 The deaths represent on average 113 suicides per day and more than 41,100 lives each year, at a cost to the U.S. economy of more than $51 billion dollars annually in lost work and medical costs.4

According to the American Association of Suicidology, 33 states had suicide rates that exceeded the national average in 2014 with Montana, Alaska, New Mexico, Wyoming, Colorado and Nevada having the highest rates in the nation. Massachusetts, New Jersey, New York and the District of Columbia had the lowest rates of suicide in the country.5

Increases in suicides have been evident across the demographic spectrum.

Among women, the largest increases in suicide were among those between the ages of 45 to 64, an increase of 63 percent since 1999. The increase in suicides among women in this age group rose from 6 deaths per 100,000 women in 1999 to 9.8 deaths per 100,000 women in 2014.6

Among the most startling increases were suicides among young women ages 10-14. In the 15-year time period from 1999-2014, the suicide rate of young women aged 10-14 of all races rose by 200 percent and among young white women, suicides increased by 240 percent.7

The largest increases of suicide among men between 1999 and 2014 were those between the ages of 45 and 64, an increase of 43 percent. The suicide rate among men in this age group rose from 20.8 deaths per 100,000 men in 1999 to 29.7 deaths per 100,000 men in 2014.8

The Changing Faces of Suicide
The face of suicide has also changed in the 15-year period from 1999 to 2014.

While CDC analysis overwhelmingly identifies white men as the most likely demographic to commit suicide, suicides among white women increased by 60 percent in the 15-year study period.9 

From 1999-2014, those who identified as American Indian and Alaska Native saw a 38 percent increase in suicides among men and a staggering 89 percent increase among women.10

African-American men were the only group to see a decline in suicide deaths. In the 15-year study period, African-American male suicide deaths decreased by 8 percent, from 10.5 percent to 9.7 percent per
100,000.11

Seeing the Signs
The National Center for Injury Prevention and Control, Division of Violence Prevention, an organization affiliated with the CDC, estimated in a 2015 report that in the previous year, 9.3 million adults and 17 
percent of high school students either reported having suicidal thoughts or considered attempting suicide.12 

According to the American Foundation for Suicide Prevention, many factors account for thoughts of suicide and committing suicide. Mental health is a key factor and may include depression, substance abuse,
chronic health conditions or chronic pain.13 

Additionally, environmental factors such as stressful life events and historical factors such as a family history of suicide or previous attempts at suicide also contribute to recognized suicide risk factors and
warning signs.14

Katherine A. Hempstead, director of the Robert Wood Johnson Foundation, noted in a study of suicide trends in the United States published in the American Journal of Preventive Medicine in February 2015, that “the sharpest increase in external circumstances appears to be temporally related to the worst years of the Great Recession.”15

The Winnable War
The National Alliance on Mental Health, or NAMI, found in a 2014 report that 29 states and Washington, D.C., had increased funding for mental health services for the 2015 fiscal year. That number represented an eight-state decline from the previous year, when 37 states, plus Washington, D.C., had increased funding.16

Within the 15-year data period of the CDC study, NAMI estimates that mental health funding throughout the United States was reduced by $4.35 billion dollars between 2009 and 2012.17

These declines have come at a time when an estimated 43.8 million Americans experience mental illness in a given year,18 and of the 20.2 million adults who have experienced issues with substance abuse,
more than half--50.5 percent--had a co-occurring mental illness.19 

While the crisis of suicide deaths across the nation remains staggering, states are becoming creative in how to confront it, even in the midst of state economic woes.

The state of Iowa has created a database, CareMatch, that has real-time numbers of both private and public psychiatric beds20 and Portland, Maine offers transportation to mental health facilities in unmarked
vehicles in an effort to reduce the stigma of mental health treatment.21

More states have increased funding to provide mental health training for school employees and some have even gone so far as to provide schools with mental health professionals to deal with issues on-site
as they arise.22

Mental health providers are utilizing technology to reduce the response time for those seeking help. The Council of State Governments’ National Center for Interstate Compacts has worked on many compacts,
such as the Interstate Medical Licensure Compact, which among other advances, promotes the increased use of telehealth services. As psychologists and psychiatrists consider their own compacts, the use of
telehealth services ranging from 24-hour hotlines to web-based programs, have proven beneficial to providers seeking to expand the reach of their services and patients who may be seeking help discreetly or
may be one of the 91 million Americans living in an area in which there is a shortage of mental health service providers.23

The National Institute of Mental Health continues to offer the reminder that suicide is a preventable death. The old adage that “knowledge is power” is key to winning the war for lives throughout the nation.
Increased education on the warning signs and available treatments are a vital first step. 


References

1 Ohio Revised Code (July 01, 1980). Interstate Compact on Mental Health. 
2 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Increase in Suicide in the United States 1999-2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
3 American Foundation for Suicide Prevention (2016). Suicide Statistics
4 Centers for Disease Control and Prevention (2015). Suicide-Facts at a Glance
5 Drapeau, C. W., & McIntosh, J. L. (December 22, 2015). U.S.A. Suicide 2014: Official Final Data The American Association of Suicidology
6 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Increase in Suicide in the United States 1999-2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
7 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
8 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
9 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
10 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
11 Curtain, S., Hedegaard, H., and Warner, M. (April 22, 2016). Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2014. Centers for Disease Control and Prevention-National Center for Health Statistics. 
12 Centers for Disease Control and Prevention (2015). Suicide-Facts at a Glance
13 American Foundation for Suicide Prevention (2016). About Suicide: Risk Factors and Warning Signs
14 Ibid
15 Hempstead, K., & Phillips, J.(May 2015). Rising Suicide Among Adults Aged 40-64 Years. The Role of Job and Financial Circumstances. American Journal of Preventive Medicine.  (Page 498).
16 National Alliance on Mental Health (2014). State Mental Health Legislation 2014:Trends, Themes, & Effective Practices. (Page 7)
17 National Alliance on Mental Health (2014). State Mental Health Legislation 2014:Trends, Themes, & Effective Practices.  (Page 5)
18 National Alliance on Mental Health (2016). Mental Health Facts in America
19 National Alliance on Mental Health (2016). Mental Health By The Numbers
20 Jordan, Erin (June, 03, 2015). New Tracking System Reduced Hospital Wait Times in Iowa. Government Technology Magazine. 
21 Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (2004). Getting There: Helping People With Mental Illnesses Access Transportation  (Page 30)
22 Youth.Gov (February 2013). Youth Mental Health-School Based Supports
23 Hyde, P. (January 24, 2013). Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues. U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration.  Pg. 10