Described as "battling demons" throughout his life, Robin Williams was among 38,000 Americans who committed suicide in 2011 (most recent data), an estimated 90 percent of whom have a diagnosed mental illness. This includes depression, bipolar disorder, schizophrenia, anxiety disorders, personality disorders and eating disorders.
Suicide is the 10th leading cause of death in the United States, affecting people across race, gender and socioeconomic lines. The Center for Disease Control and Prevention regards suicide as a public health problem requiring prevention strategies.
Although he was in recovery from drug and alcohol abuse, Robin Williams was reported to suffer severe depression. We cannot know the precise details of Robin Williams' suicide, but his death reinforces the pressing need for suicide prevention programs. Many suicide attempts are a search for relief without intent to die. The research is continuing, as several funding sources dominate the field in advancing suicide prevention.
In addition to increasing identification of people at risk and access to resources, part of suicide prevention may require changes in attitude and stigma for people seeking help. Worldwide, stigma is considered a major barrier in suicide prevention. This is shared by the National Council for Suicide Prevention. The US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, recognizes the need for programs to reduce stigma and start up grassroots efforts. The US Center for Disease Control and Prevention also recognizes the role of stigma in preventing people from seeking help. In the military, stigma is considered an obstacle for military in seeking help.
Keith O’Neill, a former NFL/Superbowl football player, was undiagnosed with bipolar disorder and, as founder of the 4th and Forever Foundation, is dedicated to eliminating stigma.
SUICIDE PREVENTION: RISK AND WARNING
The scientific community is challenged by suicide because, as a panel of experts on National Public Radio's "Diagnosing Destruction" revealed. the risk factors for suicide do not adequately explain the "why"
The American Foundation for Suicide Prevention is focused on learning why it happens. Suicide is complex. In addition to a diagnosable mental illness, the person at risk may be facing environmental factors, including long-term unemployment or the loss of a family member. About 50-75% of people who attempt suicide have told someone. Being male, between the ages of 15-24 or over age 65 with a mental health disorder increases risk.
The AFSP has funded $20 million in research and provides specific programs to raise public awareness assist practitioners in assessing risk and help the general public. It has identified risk factors and warning signs for suicide, noting that a combination of several risk factors simultaneously tend to increase the person's suicide risk. Based on its research, the AFSP recommends these interventions to prevent suicide:
- Educate the medical community to diagnose and treat depression
- Establish systemic suicide prevention programs, such as the US Air Force has implemented in its "buddy" system
- Educate the media about reporting on suicide, based on its finding that 10% of suicides are "contagion related"
- Follow up on those who attempt suicide with a consistent and personal approach. These include telephone contacts, letters and, least effective, postcard follow up.
- Psychotherapy that is targeted and provided by a therapist trained in Cognitive Behavior Therapy or Dialectic Behavioral Therapy. There is a shortage of trained therapists for this purpose.
- Medication, which may include antidepressants and mood stabilizers such as lithium
- Screening through online applications for people who are distressed and may be at risk for suicide.
IF YOU KNOW SOMEONE AT RISK
If someone knows a friend or family member is at risk, it is most important to take threats of suicide seriously. The American Association of Suicidology has a useful memonic to remember the risk factors: IS PATH WARM?
S Substance Abuse
M Mood Changes
It recommends quickly seeking the help of a mental health professional or calling 1-800-273-TALK (8255) for a referral.
The National Suicide Hotline is here.
The American Foundation for Suicide Prevention urges people not to "argue" the person out of suicide with clichés or pleas about how much the person has to live for or how much their death will hurt their family.
For veterans, there is an online resource to help the veteran or the person who knows a veteran at risk. The Veterans Crisis Line is designed to meet the specific needs of veterans in need of crisis resources, including facility locators.
SUICIDE PREVENTION: RAISING PUBLIC AWARNESS
The National Alliance on Mental Illness raises public awareness and educates the public through Suicide Prevention Awareness Month every September. It provides useful resources on its web site; including fact sheets about who commits suicide, and delivers services throughout the nation that include suicide prevention.
The American Foundation for Suicide Prevention holds the Out of the Darkness national walk to bring family, friends and the whole community together. Philadelphia was one of two sites at the recent event.
Social media has a growing role in suicide prevention efforts.
Is someone online writing about being a burden to others, wanting to die or seek revenge? If you are in contact with someone who expresses suicidal thoughts online, Facebook has a report site here. Twitter has a system in place through this link. Other social media sites provide similar means to report suicidal users.
Research funding dominates suicide prevention initiatives.
- The American Foundation of Suicide Prevention funds research studies in line with its mission.
- The Brain and Behavior Foundation is the largest philanthropic grant maker of its type, funding, among many mental health projects, scientific research into suicide prevention. Its has funded groundbreaking projects, including one which points to a blood test which may predict risk of suicide. The test identifies a gene which controls negative thought and impulses.
- The National Alliance for Mental Illness , while not providing direct financing to external projects, provides services, information for numerous resources and invests in suicide prevention through its September events.
- The Garrett Lee Smith Suicide Prevention grants are three year grants funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) for three year grants to support suicide prevention on campus and in communities.
- The National Institute on Mental Health funds suicide prevention research grants.
- In Colorado, the sixth highest location of suicide in the nation, private sector includes the Colorado Trust, a health equity foundation which includes suicide prevention among its priorities. efforts
- The Nick Traina Foundation was founded by author Danielle Steele to honor her late son, whose manic depression ended in suicide. It funds numerous suicide prevention efforts across the country.
In New Jersey, which has the second lowest rate of suicide in the nation (8.2 per 100,000), 60 % of violent deaths are suicide. The state has provided funding opportunities for suicide prevention, including expansion of a 24 hour a day telephone hotline to a single provider. The New Jersey, Core Curriculum requirements include suicide prevention instruction to better prepare students. Other information on local/state contacts are here. There is an active suicide prevention program at the UMDNJ Medical School at Piscataway, NJ, aimed at training practitioners statewide and reaching youth through social media.
In Pennsylvania, with a higher suicide rate (12.3 per 100,000) the Suicide Prevention Resource Center shows local contacts here. Pennsylvania passed a House Resolution in 2010 to affirm the Commonwealth's commitment to suicide prevention initiatives. It has completed an initiative to train providers in primary care settings to identify suicide risk and reduce suicide among youth.
DEPRESSION AND SUICIDE PREVENTION IN THE SPOTLIGHT?
Will Robins Williams' death put depression in the spotlight? As Melanie Haiken wrote for Forbes,
Robin Williams, with a life as successful as anyone could wish for, be depressed enough to take his own life? Or, put even more simply, how could someone who made us laugh so hard be so sad? The answer, of course, is depression. Depression is why someone could laugh and smile on the outside, and yet feel his life is not worth living.
His suicide is a reminder that there is much to be done in suicide prevention, including the training of therapists, treatment of the mental disorders most prevalent for persons at risk and the stigma that blocks them from seeking help.