Yves here. Needless to say, with suicide now an even problem than ever, looking at places that are doing relatively well can help in coming up with prevention strategies. If nothing else, read this piece for the key factoid on the success rate of suicide by gun versus pills. For a more granular detail (warning, this is grim), see here. This Harvard study is dated but also germane.
By Michelle Andrews. Originally published at Kaiser Health News
“I just snapped” is how Jessica Lioy describes her attempt in April to kill herself.
After a tough year in which she’d moved back to her parents’ Syracuse, N.Y., home and changed colleges, the crumbling of her relationship with her boyfriend pushed the 22-year-old over the edge. She impulsively swallowed a handful of sleeping pills. Her mom happened to walk into her bedroom, saw the pills scattered on the floor and called 911.
In 2017, 1.4 million adults attempted suicide, while more than 47,000 others did kill themselves, making suicide the 10th-leading cause of death in the United States, according to the federal Centers for Disease Control and Prevention. And the rate has been rising for 20 years.
NY-suicide-rate-1/2: New York’s efforts to prevent suicides include testing a brief intervention program for people who have attempted suicide — because they are at risk for trying again. “They steal you for an hour from the universe and make you focus on the worst thing in your life and then coach you through it,” Jessica Lioy says. (Courtesy of Jessica Lioy)
Like other states, Jessica Lioy’s home state of New York has seen its rate increase. But New York has consistently reported rates well below those of the U.S. overall. Compared with the national rate of 14 suicides per 100,000 people in 2017, New York’s was just 8.1, the lowest suicide rate in the nation.
What gives? At first glance, the state doesn’t seem like an obvious candidate for the lowest rank. There’s New York City, all hustle and stress, tiny apartments and crowds of strangers. And upstate New York, often portrayed as bleak and cold, is famously disparaged in the Broadway musical “A Chorus Line” with the comment that “to commit suicide in Buffalo is redundant.”
Experts say there’s no easy explanation for the state’s lowest-in-the-nation rate. “I can’t tell you why,” said Dr. Jay Carruthers, a psychiatrist who is the director of suicide prevention at the New York State Office of Mental Health.
Guns And Urbanization Are Likely Factors
There’s no single answer, but a number of factors probably play a role, according to Carruthers and other experts on suicide.
Low rates of gun ownership are likely key. Guns are used in about half of suicide deaths, and having access to a gun triples the risk that someone will die by suicide, according to a study in the Annals of Internal Medicine. Because guns are so deadly, someone who attempts suicide with a gun will succeed about 85% of the time, compared with a 2% fatality rate if someone opts for pills, according to a study by researchers at the Harvard Injury Control Research Center.
“The scientific evidence is pretty darn good that having easy access to guns makes the difference whether a suicidal crisis ends up being a fatal or a nonfatal event,” said Catherine Barber, who co-authored the study and is a senior researcher at the Harvard center.
New York has some of the strongest gun laws in the country. In 2013 — after the mass shooting at Sandy Hook Elementary School in Newtown, Conn. — the state broadened its ban on assault weapons, required recertification of pistols and assault weapons every five years, closed a private sale loophole on background checks and increased criminal penalties for the use of illegal guns.
This year, the state enacted laws that, among other things, established a 30-day waiting period for gun purchases for people who don’t immediately pass a background check, and prevented people who show signs of being a threat to themselves or others from buying guns, sometimes referred to as a “red flag” or “extreme risk” law.
The population is also heavily concentrated in urban areas, including more than 8 million people living in New York City. According to the Census Bureau, nearly 88% of the state’s population lived in urban areas in the 2010 census, while the national figure is about 81%.
Suicide rates are typically lower in cities. In 2017, the suicide rate nationwide for the most rural counties — 20 per 100,000 people — was almost twice as high as the 11.1 rate for the most urban counties, according to the CDC. The trend is accelerating. While the suicide rate in the most urban counties increased by 16% from 1999 to 2017, it grew by a whopping 53% in the most rural counties.
Loneliness, isolation and access to lethal weapons can be a potent combination that leads to suicide, said Jerry Reed, who directs the suicide, violence and injury prevention efforts at the Education Development Center. The center runs the federally funded Suicide Prevention Resource Center, among other suicide prevention projects.
People in rural areas may live many miles from the nearest mental health facility, therapist or even their own neighbors.
“If your spouse passes away or you come down with a chronic condition and no one is checking on you and you have access to firearms,” Reed said, “life may not seem like worth living.”
Intervention Helps ‘Force You’ To Move Forward
New York’s efforts to prevent suicides include conducting a randomized controlled trial to test the effectiveness of a brief intervention programdeveloped in Switzerland for people who have attempted suicide — because they are at risk for trying again.
The trial has yet to get underway, but clinicians at the Hutchings Psychiatric Center in Syracuse were trained in the Attempted Suicide Short Intervention Program, as it’s called. They began testing it with some patients last year.
Jessica Lioy was one of them. After her suicide attempt, she spent a week at the inpatient psychiatric unit at Upstate University Hospital in Syracuse. A social worker approached her about signing up for that outpatient therapy program.
The program is simple. It has just four elements:
- In the first session, patients sit down with a therapist for an hourlong videotaped discussion about why they tried to kill themselves.
- At their second meeting, they watch the video to reconstruct how the patient moved from experiencing something painful to attempting suicide.
- During the third session, the therapist helps the patient list long-term goals, warning signs and safety strategies, along with the phone numbers of people to call during a crisis. The patient carries the information with them at all times.
- Finally, during the next two years, the therapist writes periodic “caring letters” to the patient to check in and remind them about their risks and safety strategies.
In the Swiss trial, about 27% of the patients in the control group attempted suicide again during the next two years. Only 8% of those who went through the intervention program re-attempted suicide during that time.
“The difference with ASSIP is the patient involvement. It’s very patient-centered,” said Dr. Seetha Ramanathan, the Hutchings psychiatrist overseeing the program. It’s also very focused on the suicide attempt, not on other issues like depression or PTSD, she said.
Lioy said that, at the beginning, she didn’t have high hopes for the program. She had already told her story to many doctors and mental health therapists. But this felt different, she recalled.
“They steal you for an hour from the universe and make you focus on the worst thing in your life and then coach you through it,” Lioy said. “They force you to feel something, and they force you to just reflect on that one situation and how to move forward to not end up back in that place. It’s very immediate.”
It hasn’t all been smooth sailing. Shortly after returning home, Lioy felt depressed and couldn’t get out of bed. But she had learned the importance of asking for help, and she reached out to her parents.
“I was able to talk with them, and it felt amazing,” she said. “I’d never done that before.”
There have been other changes. Since returning home, Lioy finished her bachelor’s degree in molecular genetics and is working as a pharmacy technician. She’s applying to doctoral programs and she has a new boyfriend, although she said she no longer needs a boyfriend to feel OK about herself.
“It’s been a really big journey,” Lioy said.
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
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I wonder if the actual city life where one has to make many transactions a week, are cheek by jowel with other people, and these interactions have a positive effect.
As opposed to being hermetically sealed a car and shopping in a supermarket where there is little if any interaction with other humans.
I think this part of the article highlights one of the key factors:
Often an unsuccessful attempt saves lives, because the attempt warns and mobilizes friends and relatives of the person in crisis. In a city this kind of help is much more direct, much more immediate, with medical help nearby as well, and the most reliable means of self-harm (which are guns) is far less accessible.
I always thought that one of the strongest arguments against ready access to guns is to (statistically) reduce the efficiency of first-time suicide attempts. The “tool” that might save your life in self-defense is the same tool that robs you of a second chance in life.
Since the most successful method of preventing a suicide is preventing the reason(s) a person is attempting it, and more and more are attempting quick. or slow, suicide as a consequence of a brutal US Austerity and AI/Social Media social scoring, along with an increasing loss of avenues to escape this reality and thrive – no matter how much one tries – outside of engaging in criminal, or amoral, behavior.
Reducing guns will still leave a person suicidal, and then possibly maimed for life and even more suicidal.
The US and its States and Territories need to start seeing to the basic needs and well being of its residents, that is the best prevention of the increasing numbers of attempts. And tracking attempts would be the best method of determining a given areas level of despair. Perhaps the CDC does this and keeps it from the public eye.
For instance, specific to the above article and New York’s lowest rate of overall suicides, this year has seen an explosion of NYPD suicides, ten active officers, three retired, by October 16th. I’d imagine that many of those officers witness many of the gruesome, unreported on, failed suicide attempts.
Hint to the US Government, and States, these (not all inclusive, the list is too long) are not winning solutions for this devastating tragedy: pointing a bizarre finger towards Russia; engaging in endless wars; normalizing an increasing homeless population; refusing to address increasingly unaffordable; or unavailable, healthcare; surveilling, or allowing the unwarranted surveilling of your own residents 24/7, like they’re insects; and allowing the likes of Amazon continually to subject workforces to extremely inhumane impoverished circumstances.
Suicide is just another symptom of a sick society and until we learn how to heal each others’ hearts it will continue unabated.
Agree, for the most part, though I would call it a deliberately sickened society, where only the amoral are allowed to survive, let alone thrive, in the now Matured Technocracy which horrid people have been pushing for decades. Any kind of altruistic action – such as Love – is brutally penalized, since it can’t be monetized.
I’m witnessing this firsthand currently (and previously, with my parent, whom I recently (this year) became the executor for), being a somewhat guardian for a loved one. I’ve been treated like an enemy due to a horrid Ho$pital Management $ystem and the $tate of California’s utterly broken and corrupted $afety Net, despite the fact that I am the person’s sole loved one able to attempt to keep them well, who is not on a paycheck. My name is on so many filed, permit to share information on a person’s medical and housing behalf forms it’s not even funny. Apparently those forms only work for those on a paycheck. Since I don’t live close by, I’m repeatedly told by Hospital Staff that we don’t have permission to give you that information (Despite a Medical Power of Attorney 1), when all they have to do is ask my loved one – whom they consider fully cognizant when it benefits them, and apparently not cognizant when it benefits the patient.
1 Which should be immediately accessible because it has been scanned into my loved one’s Electronic Health Records™ [EHR™], but nope, apparently EHR™ was only instituted for $coundrel’s, as many of us suspected from day one.
Synoia: I’d posit it has a positive counterbalancing influence against negative thoughts, yes. Humans are social animals and the need to communicate and feel, if not understood, then at least recognized is powerful and deep-seated. One reason why it’s important to maintain “front-facing” positions like store clerks, cashiers etc – a society where all transactions are conducted faceless-ly through a digital screen is one where I imagine rates of disassociation-fueled negative behaviors rapidly increase.
Yes, even though most people think of NYC as a place of anomie, most of the stores are small, even the grocery stores, so if you have a routine, you’ll see the same faces and be able to chat people up, or at least get a friendly nod.
According to this site
http://www.beckershospitalreview.com/population-health/us-states-ranked-by-suicide-rate
the fewest suicides per 100k are In states on the east coast
The most suicides are in states in the west, 8 out of 10
Re: Synoia’s comment. I don’t think interaction with lots of people every day has a preventive effect. But I am an introvert so of course have some bias.
Re: smoker’s comment last paragraph. Thumbs up 100%
The population of the Northeast, though declining, is nevertheless more stable and rooted than other parts of the country, a possible facet in lower suicide rates. That, and high immigrant populations in urban areas.
Thank you for the validation! It always helps in such bizarro worlld, cruel and bleak times.
Updated 2017 figures, with map, from the CDC.
https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm
If I had to move back to Syracuse, ……….
Truly, if I understand your gist correctly.
I live in the low suicide [gun] rate state of California, and the increasing level of despair (a third of the state on MediCal, and the Nations record for Unsheltered Homelessness) I witness every day, is a crime. But California is highly gun restrictive and spends countless millions attempting to prevent railway and bridge suicides. Given that, it indicates a huge level of despair when, increasingly (there’ve been 15 Silicon Valley Caltrain pedestrian deaths through October, despite the increased guard), residents are attempting to jump in front of an ongoing train, or off of a bridge, because they don’t own a gun and realize most attempts fail and will leave them maimed, and a ward of Nancy Pelosi’s adopted State of California, which allowed such Austerity and Inequality to reign; her 12th District being perfect example.
I’ve known four people who killed themselves here in the Bay Area (three in Silicon Valley, one in Berkeley). Two women who hanged themselves, one man who used his car’s exhaust, and one man who walked in front of the Palo Alto Caltrain. They did all succeed. I guess they were lucky not to end up in vegetative states.
The despair in Silicon Valley and the Bay Area in general, let alone countless other regions in California, is a near tangible force, the teen Suicidal Desire Rate in Silicon Valley is a crime against humanity.
So very sorry for your witnessing so many suicides.
I actually thought it was normal to know so many. I’m not even a social person at all. BTW, those are just the Bay Area people I’ve known who killed themselves.
This is a terrible area for teenagers. I don’t have kids; I suppose if I did I’d know more people who’d killed themselves. I have a neighbor whose son told her he planned to kill himself by dropping head first off their condo balcony, so she slept next to him (between him and the balcony) for six months until he was properly medicated. He’s okay now, fortunately. Well, his mother thinks he is, anyway; I hope he is.
I’m tempted to assume that the downcast in the Bay Area suffer from the despair of seeing wealth all around them, yet not being able to participate in the party. In places like rusted-out upstate NY, it’s more that the whole of the economy has drifted away. This has been true for decades, so we’re used to dealing with decline. Still, for many, hopelessness is a pervasive and corrosive force. We do benefit from what, compared to other states, is a decent public safety-net.
They have been hiding the official total number of suicides at the Golden Gate for about a decade and at the time have been about 1,100 (Known) suicides IIRC. It easy to miss a jumper and with the currents, winds, and frequent fog… It disturbed my brother’s wife that we were not disturbed by it. But we grew up in the Bay Area and the bridge has always been a favorite place to commit suicide.
I can understand why people might want to ban guns or drugs, but really their use are more of an end result and not the cause of the already living dead making themselves actually dead. Even if guns and opioids were to vanish, the decrease in suicides would only last until new methods became well known.
However, the uproar on guns and drugs are an effective means of distraction from the unprofitable, yet effective, ways of reducing the deaths from despair. If I was cynical enough, I would think that the supposed advocates of gun control and of gun rights wanted the uproar. It would be too good a catastrophe to profit from by leading organizations of both sides.
That would mark that utterly unnecessary Great Recession™ Reagan Democrat™, Obomber, sellout to the heinous Banking Oligarchy. Around that time, I had a conversation with a call person who worked at a San Francisco Suicide Hotline. They told me that a predominance of the calls were centered around Economic Despair. Sigh, isn’t even the word for it, so sickening and heart/gut rending.
I have a, just slightly longer, response in moderation, basically: for about a decade would mark that utterly unnecessary Great Recession™ Reagan Democrat™, Obomber sellout to the heinous Banking Oligarchy.
If I ever develop Alzheimer’s…
My father did. And one of the first things my mother did was lock the gun closet and hide the key.
Your father was lucky to have a spouse who would see to his care on his downhill slide. Not everybody can be assured of having family or a spouse that can commit to dealing with a person with Alzheimer’s and I’m sure that care or lack thereof (e.g., widow) factors into a person’s willingness to take their life if ever afflicted.
I can’t help but point to the irony of Lioy, having gone through a suicide intervention after having downed a copious amount of pills, finding closure to her anxiety(s) .. at eventually becoming a pharmacy technician !
cont.
.. which gave the conclusion to the article a somewhat Onionesque-like quality. I also have to side with smoker’s comment. Until there is real, quantitative change in how the public is treated/cared for in this country, then we’ll continue to spiral into nation-wide disfunction .. to be as a rhyme of the late USSR’s ‘dissolution’.
You’all pardon me if I don’t seem very optimistic, when the oily-garchic Orcs within Mordor-on-the-Potomic are constantly engaged in competing superfluous dress rehearsals ..
I made an earlier response that’s still in moderation. Short version: thanks for the supporting voice, I’m sure there are millions of us in the US,.
Thanks for the voice of support! I’m positive untold millions of us feel this way. We don’t want a gun ban and suicide hotline as the main, so called preventive™, we want to not want to commit suicide – in the first place – for deranged, utterly unwarranted, austerity and inhumane treatment reasons perpetrated by a Suicidally Militaristic, Fascist, Non-Representative, Immoral Governing, we keep being blocked from preventing because it has become so thoroughly corrupted.
(This comment was snagged up yesterday)
Sorry, about those italics, siiiiigh. This (hopefully) is clearer, I had only meant to italicize the word, “preventive™”:
Thanks for the voice of support! I’m positive untold millions of us feel this way. We don’t want a gun ban and suicide hotline as the main, so called preventive™, we want to not want to commit suicide – in the first place – for deranged, utterly unwarranted, austerity and inhumane treatment reasons perpetrated by a Suicidally Militaristic, Fascist, Non-Representative, Immoral Governing, we keep being blocked from preventing because it has become so thoroughly corrupted.
(This comment was snagged up yesterday)
I noticed one amazing thing about NYC. Everybody talks to each other. Nobody is too busy to stop and answer your question and give you advice. NYC communicates above and beyond anyplace else.
Yes, even though New Yorkers often do so in a highly efficient manner that can strike others from the rest of the country as brusque.
What if, as people are getting pushed out of NY through gentrification, there is a filtering effect whereby those who can stay are mentally healthier?
https://www.youtube.com/watch?v=0Z760XNy4VM