Read on Twitter
Sitting through an AFSP Talk Saves Lives training, and it's as problematic as I suspected it would be.
Despite CDC data indicating that 54% of Americans who died by suicide did not have a history with mental health conditions, AFSP continues to push MENTAL ILLNESS as a necessary precursor to suicide.
I got distracted by life. Anyway, time for more ranting!
In recent weeks, folks in the suicidology field called these CDC statistics into question. It's easy to call research into question, and part of the scientific process! But while we did that, we missed an important thing:
this report indicates that we should be paying attention to social determinants of suicide. As coroners and LEO investigated suicide deaths, some themes came up in terms of what suicide decedents had been experiencing prior to their deaths.
https://www.cdc.gov/vitalsigns/suicide/index.html
https://www.cdc.gov/vitalsigns/suicide/index.html
Relationship issues, recent crises, substance use, healthcare, job/financial issues, housing issues. Regular ol' life shit! Not just mental health shit!
Obviously, they intersect. But constantly reducing suicide to a mental health issue means that we're not getting our message to enough people. Allowing our communities to continue to think that suicide only affects those with mental health issues is harmful. Period.
Because every single person sure does deal with things like relationship issues, recent crises, substance use, healthcare, job/financial issues, housing issues.
Dr. Moutier of AFSP recently published this paper—I haven't read all of it, but this stuck out: "More than 30 studies using psychological autopsy methods have found that among suicide decedents, 85% to 95% had likely been experiencing psychiatric illness...
that may or may not have been recognized or treated and which likely contributed to the death."
FUN FACT: When I opened the link to this paper, I literally got an ad for fucking psych meds (should be illegal): https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772135
FUN FACT: When I opened the link to this paper, I literally got an ad for fucking psych meds (should be illegal): https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772135
For those unfamiliar with psychological autopsy, "a psychological autopsy is an in-depth reconstruction of an unclear suicide death. A trained mental health expert interviews family members, friends, and others...
who are able to provide relevant information about the victim, and the behaviors and events which led up to the death." SOURCE: http://riversidetraumacenter.org/our-services/psychological-autopsy/
Now, for a field to call CDC findings into question while constantly chattering about the importance of psychological autopsies...I just.
Let's think about this.
In a psychological autopsy, our sources are family, friends, medical professionals, & maybe social media or other personal ephemera.
The CDC's data came from reports written by LEOs/coroners who also obtained information from those around the decedent.
In a psychological autopsy, our sources are family, friends, medical professionals, & maybe social media or other personal ephemera.
The CDC's data came from reports written by LEOs/coroners who also obtained information from those around the decedent.
The sources used in both cases are secondary and tertiary sources. The closest we can ever come to a primary source is personal communications left behind by the decedent.
The CDC says 54% did not have a known mental health history. These 30 psychological autopsy articles indicate that decedents "had likely been experiencing psychiatric illness" at time of death.
Full disclosure: I haven't looked into the CDC's methods, but if I'm dissecting the language, I'd bet that the CDC used information that was documented while the decedents were alive.
On the other hand, it seems a lot like, when performing a psychological autopsy, we're using information from secondary sources WHO ARE LIKELY GRIEVING to... diagnose a dead person?
WE CANNOT DIAGNOSE DEAD PEOPLE. WTF, Y'ALL?!
So, look, I guess I'm more likely to trust information gathered about a person while they were alive (though, of course, psychiatry has a bad track record of diagnosing people properly, anyway).
I'm also more likely to trust information put out by the CDC (well, prior to 2020, anyway) than a bunch of articles written about a practice in the suicidology field that isn't scientific and is aggressively subjective.
TL;DR: For me, it makes more sense to trust the 54% CDC statistic over the arbitrary 85-95% psychological autopsy statistic. It also serves my purpose, which is to open suicide education up to a broader community, and to find ways to engage.
This is weird, but if people think something might effect them, and they can connect with that thing on a personal level, they're more likely to engage!
Standard suicide prevention messaging: Suicide affects so many people! So sad, so scary!
Public:
omg!
SP: All of those people are mentally ill, though.
Public: Oh. Phew. Not me. Cool. BYEEEEEEE!
Public:
omg!SP: All of those people are mentally ill, though.
Public: Oh. Phew. Not me. Cool. BYEEEEEEE!
Given that approach, who's shocked that the suicide rates have been rising for 30 years?
What about this alternate message, instead: Suicide affects so many people! So sad, so scary! Some of those people have a history of mental health struggles, but really, anything that could cause a person to feel despair and hopelessness might lead them to think about suicide.
Some of those things could be breakups, grief, financial troubles/job loss/eviction, houselessness, legal issues...
See what I did there?
See what I did there?
Some of those things could be the experience of racism, the experience of watching your community being murdered in the streets with no repercussions, familial rejection, sexual assault.
Hit the point home by showing folks the @lttphoto website, a big ol' grid of hundreds of amazing people who have attempted suicide. https://livethroughthis.org
Public: OMG! Wow, those things happen to people all the time! I thought suicide was about mental illness. I guess I should pay more attention. How can I help?
OMG! Wow, those things happen to people all the time! I thought suicide was about mental illness. I guess I should pay more attention. How can I help?
The training, of course, only covered warning signs and risk factors that have to do directly with the person, their actions, their behaviors. Indicating that suicide is a problem within, rather than a reaction to the world around them (and maybe something within, too).
I also take issue with discussion around "impulsivity" in suicide, because it's never done right. There's nuance here. When we talk about "impulsivity" in suicide, what we're usually talking about is actually DURATION. https://www.hsph.harvard.edu/means-matter/means-matter/duration/
Once a person decides they're going to end their life, they move quickly—almost 25% act within 5 minutes, nearly 50% act within 20 minutes, and about 75% act within an hour.
Again, full disclosure: I don't know if these researchers asked folks about their history of suicidal ideation. But I DO know what I've lived personally, and I know that, when I made the decision to kill myself, I'd been thinking about it pretty consistently for 2 years.
So, is that true impulsivity? I don't think so. It's simply acting on a decision.
When we share information like this with audiences who aren't well-informed, it can cause problems.
When we share information like this with audiences who aren't well-informed, it can cause problems.
Hitting the pause button: I have to go do some stuff for a bit.
Making my lunch and thinking: man, AFSP is getting so much free consultation from me right now.
Holla at your girl, AFSP! My consulting fee is $250/hr. [email protected]
Holla at your girl, AFSP! My consulting fee is $250/hr. [email protected]
