September is Suicide Prevention Awareness Month

Between 2015 and 2017, Mendocino County experienced an average of 21.3 deaths by suicide (see average age-adjusted death rate per 100,000 population by suicide indicator). While that number has decreased slightly from the last measurement period, it is more than double the state’s average and significantly higher than the national average per 100,000 people.

Suicide is a leading cause of death in the United States, presenting a major, preventable public health problem. Nationally, more than 33,000 people kill themselves each year according to the Centers for Disease Control and Prevention, but suicide deaths only account for part of the problem. An estimated 25 attempted suicides occur per every suicide death, and those who survive suicide may have serious injuries, in addition to having depression and other mental problems. The numbers for suicide related deaths are particularly high for Native American populations and adults over the age of 75.

So why do people commit acts of suicide self-directed violence? One must first comprehend the risk factors-- a combination of individual, relationship, community, and societal factors that contribute to the risk of suicide. Risk factors are the characteristics associated with suicide; they might not be direct causes. According to the CDC, risk factors include family history of suicide and/or child maltreatment, previous suicide attempts, history of mental disorders, history of substance abuse, isolation, loss (relational, social, work or financial), or physical illness.[1]

Protective factors, personal or environmental characteristics that help protect people from suicide, are key for reducing the risk of suicide or suicidal self-directed violence. For youth, protective factors include parent engagement, school connected-ness, and positive parenting practices. Parents of teens can improve protective factors by taking an active role in their teen’s life. For example, monitoring youth’s activities, ensuring fathers are involved and talking to their teen about how to avoid risky sexual behavior, improving quality of information relative to raising lesbian, gay or bisexual youth, learning how to have meaningful discussions about sex, relationships, and the prevention of HIV, STIs and pregnancy, and connecting youth to a trusted primary care provider to talk about sensitive subjects like mental health.[2]

For the general population, protective factors include effective clinical care for mental, physical, and substance use disorders, easy access to a variety of clinical interventions and support, family and community support (connected-ness), support from ongoing medical and mental health care relationships, self-esteem and sense of purpose, life skills including problem solving skills and coping skills, and cultural and religious beliefs that discourage suicide and support instincts for self-preservation.[3] For the elderly, the most valuable protective factor to prevent suicide is social connected-ness.

Suicide disproportionately affects American Indian and Alaska Native populations. According to the CDC, in 2015 these groups experienced 21.5 suicide deaths per 100,000 population, 3.5 times higher than other racial/ethnic groups with the lowest rates.[4] The Native American Suicide Prevention Act of 2019 introduced by Senator Elizabeth Warren last winter would require States and their designees receiving federal grants for development and implementation of statewide suicide early intervention and prevention strategies to collaborate with each Federally recognized Indian tribe, tribal organization, urban Indian organization, and Native Hawaiian health care system in the State.[5] However, the bill is still in the introductory stage and has not yet passed in the Senate.

There are some innovative changes currently trickling down from the state level. In 2016, California Assembly Bill 2246 was passed requiring school districts serving 7th-12th graders to implement a Suicide Prevention Policy by the beginning of the 2017-2018 school year. The Bill was inspired by a national survey conducted by the Jason Foundation that found the primary person a student would reach out to if they were having thoughts of suicide is a teacher. The Suicide Prevention Policy focuses specifically on suicide prevention, intervention, and postvention (activities which reduce risk and promote healing after a suicide death) for at-risk student groups such as LGBTQ, disabled, mentally ill or homeless youth. Teachers and school staff all over California were trained to ensure they have the knowledge, tools, and resources to respond appropriately. [6]

The California Department of Education has amassed a list of suicide prevention resources and publications, including a Comprehensive Suicide Prevention Toolkit with real-life application compiled by the Palo Alto Unified School District. This toolkit is available for school districts that do not have resources to create their own set of policies, programs and protocols.

Mendocino County agencies and organizations are making efforts to put effective tools in the hands of our community members. This year a series of QPR (Question, Persuade and Refer) trainings , a national evidence-based mental health intervention and prevention program, were held throughout the county and sponsored by organizations such as Adventist Health Ukiah Valley and Mendocino County Public Health HHSA. QPR is like CPR in that anyone, not just healthcare professionals, can be trained in it. Both interventions are part of systems designed to increase the chance of survival in the event of a crisis—CPR as an emergency medical intervention and QPR as an emergency mental health intervention. Just as people trained in CPR and the Heimlich Maneuver help save thousands of lives each year, 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.[7] 

As part of Suicide Prevention Awareness Month, The Healthy Mendocino North Coast Mental Health Action Team hopes to bring this QPR training to the Coast, and provide skills to all types of Mendocino Coast residents: mental health service providers, parents, teachers and even hairdressers. The North Coast Team is also assiduously working to collect information on the local school district policies and programs implemented succeeding the AB-2246 in order to bolster their suicide prevention outreach and awareness on the Coast.

Suicide is preventable. It takes an entire community to understand the signs, react swiftly and compassionately, support the programs that enhance protective factors and enhance networks of support.

If you suspect someone you love is suicidal, below are some helpful tips provided by Suicide Prevention Mendocino:

DO

• Ask direct questions, don't be afraid to ask directly if they want to kill or hurt themselves
• Listen to the person
• Get professional help; even if the person resists
• Take it seriously
• Stay calm and safe
• Remove means (dangerous objects of self-injury) from household; pills, firearms, knives, etc.

DON’T

• Swear to secrecy
• Leave the person alone
• Act shocked or judgmental
• Counsel the person yourself
• Ignore threats or warning signs

SAY

"I hear you..."
"I love you."
"You're not alone..."
"Would you like me to get you help?"
"Are you feeling like hurting yourself?"
"Do you feel suicidal?"
"Do you have a plan?"

DON’T SAY

"It's not that bad..."
"You'll snap out it..."
"Stop being so selfish/whiney."
"You're just trying to get attention."
"You have to pull yourself up by your boot-straps."
"Go ahead!"

Help is available…

Redwood Community Crisis Center: 1-855-838-0404
Crisis Text Line: Text “home” to 741741 anywhere in the United States for any type of crisis. A live, trained crisis counselor will respond.
Life Line Chat:  https://suicidepreventionlifeline.org/chat/
National Suicide Hotlines:  http://www.suicidehotlines.com/california.html

[1] Center for Disease Control and Prevention. Underlying Cause of Death 1999-2017. Retrieved from: https://wonder.cdc.gov/ucd-icd10.html

[2] Govtrack.com. S 476 Native American Suicide Prevention Act of 2019. Retrieved from: https://www.govtrack.us/congress/bills/116/s467

[3]California Legislative Information. Assembly Bill 2246 Pupil Suicide Prevention Policies (2015-2016).  Retrieved from: https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201520160AB2246

[4] Center for Disease Control and Prevention. Violence Prevention. Suicide Prevention—Risk and Protective Factors. https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html

[5] Centers for Disease Control and Prevention.  Adolescent and School Health.  Protective Factors.  Retrieved from: https://www.cdc.gov/healthyyouth/protective/index.htm

[6] Centers for Disease Control and Prevention. Suicide Risks and Protective Factors. Retrieved from:https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html

[7] QPR Institute. What is QPR? https://qprinstitute.com/about-qpr

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Molly Rosenthal is the  North Coast Action Team Coordinator for Healthy Mendocino. She has a BA in Journalism from San Francisco State University and has worked in legal services, volunteer management and non-profit development.