Nevada addressing suicide as public health crisis

Suicide has reached epidemic levels in Nevada, according to numbers from the Nevada Division of Public and Behavioral Health (DPBH), and the state has been stepping up efforts in recent years to combat the problem.

"We lose more than 500 Nevadans and 100 veterans to suicide per year," said Luana Ritch, Ph.D., a Community Health Planner with the Nevada DPBH. "It's really looking at this now as a public health crisis for Nevada."

Data collected from the National Institute of Mental Health (NIMH) shows the Silver State had the highest rate of suicide of all 50 states for more than a decade before the year 2000. After the turn of the century, Nevada found itself tied for the second-highest suicide rate in the country in 2004 at 18.9 percent, a rate nearly double the national average of 10.8 percent.

NIMH data shows that a suicide takes place about every 18 minutes, and a suicide attempt is made about every 60 seconds.

Although suicide is a non-discriminatory public health problem, it has grown to alarming levels among our nation's military veterans.

More than 8,000 veterans took their own lives last year, a number that equates to about 22 suicides committed every day in America.

Kevin Burns, Chair of the Nevada United Veterans Legislative Council (UVLC), calls suicide among service veterans "an insidious disease" that deserves more attention.

"We lose a Nevada veteran every 2.75 days," said Burns, also the coordinator and student veteran faculty advisor at the Western Nevada College Veterans Resource Center in Carson City. "22 is 22 too many."

He cited data collected from the Nevada Office of Suicide Prevention, which the UVLC used in the 2015 legislative session to push bills aimed at targeting the suicide epidemic among Nevada veterans.

Burns said about three-quarters of those bills were passed, a success that Burns feels is a step in the right direction for Nevada veterans.

"Our organization advocates for veterans at the Legislature," Burns said. "We had a 75 percent success rate last sessions of bills that we pushed."

One of the bills passed by the 2015 Nevada Legislature, Assembly Bill 93, included suicide prevention training requirements for the mental health community.

But Burns said the bill did not address training for medical health providers, who end up treating most veterans in distress.

"The concern, however, is that veterans in distress are more likely to see a medical health provider than a mental health provider," he said, citing data from Science Daily. "Sixty-four percent of people who attempt suicide visit a doctor in the month before their attempt, and 38 percent in the week before.

In addition to lobbying the Nevada Legislature, Burns said the UVLC works in conjunction with the Nevada Department of Veteran Services to conduct statewide information symposiums for veterans. So far in 2016, two symposia have already been held; the first in Reno on March, and a second in Las Vegas on April 16.

"The biannual events serve as an opportunity to bring together various perspectives from the veteran community," Burns said, "and to develop legislative recommendations for the upcoming legislative session to develop our agenda and prioritize our goals ahead of the upcoming session."

Veterans at these last two symposia agreed that the training mandate from AB 93 needs to be expanded.

"The UVLC and many other participants felt that health care providers and service officers who routinely come in contact with veterans should receive training relating to suicide assessment," Burns said. "They recommended that legislation unsuccessfully proposed under AB 294 during the 78th Legislative Session requiring certain providers of health care to receive training should be reconsidered and expanded to included veterans service officers and other service providers."

Burns said the UVLC's top priority entering next year's legislative session will be to mandate suicide prevention/awareness training for those who most commonly might come in contact with at-risk veterans, including medical professionals, first responders, and veteran service officers.

Misty Vaughan Allen, Suicide Prevention Coordinator with the Nevada Office of Suicide Prevention under the DPBH, agreed that the language mandating who should be trained in suicide prevention and awareness needs to be expanded to include others in the medical community.

"The majority of people get their mental health care in a primary care setting," she said. "Over 45 percent of those who took their lives had contact with their primary care provider a month before committing suicide."

She also said 67 percent of those attempting suicide received primary care services before their suicide attempt. Around 50 percent of those hospitalized following a suicide attempt are released without follow-up care after discharge, she said.

Despite these numbers, Vaughan Allen said there is room for optimism in the fight against suicide.

“We are still one of the higher rates in the nation, but we are moving in the direction of improvement and stabilization,” she said. “Nevada has decreased its veteran suicide rates since 1999, and maintained the rate during our most challenging economic times. Preliminary results are that we will drop again.”

DPBH data released from 2013 showed the ratio of veterans committing suicide was 1 in 4, or 23 percent. This was a little bit higher than the national average of 1 in 5.

But due to partnerships with the Veterans Administration, the Nevada National Guard, and other organizations, the state's numbers are looking better.

"We have reduced those rates," Vaughan Allen said. "We have increased communication through collaboration."

She said her office has been working on a strategic plan to target veteran suicides since 2013. Part of that plan, she said, is putting together a policy academy to help service members and their families focus specifically on suicide prevention.

"It's important for veterans to know the resources available to them," Vaughan Allen said. "As training teams, we have reached out to the Nevada National Guard on how to get help. We’ve achieved an incredible goal of reaching 10 percent of service members and their families."

Dr. Ritch said starting a dialogue about suicide is crucial toward its prevention, and maintaining communication is probably the single best defense.

“Because of the dynamics of it, each and every person has to be involved in the discussion,” she said. “And there's no boundaries on what that discussion should be about."

But talking about suicide is also where progress toward its prevention tends to stop, primarily because of existing cultural stigmas about suicide.

“Where we still struggle is reaching families on how to help and what to look for, because of stigma,” Vaughan Allen said. “We still see mental health, addictions, and suicide as things to keep hidden in secret.”

Through outreach efforts, Vaughan Allen said the Nevada Office of Suicide Prevention is trying to change popular perceptions of suicide and provide a more accurate understanding of the problem.

“What we are trying to shift is that it’s part of overall wellness,” she said. “When people get the help they need, then they can live well in recovery.”

Unfortunately, stigmas contribute to feelings of shame, embarrassment and judgment among those who struggle with suicidal thoughts or who have attempted suicide in the past.

Vaughan Allen said these stigmas only serve to further discourage a person struggling with suicide.

“They need the hope that help is available,” she said. “That in its own right can reduce stigma.”

People with suicidal behaviors, including military veterans, also need a healthy support system around them to reinforce hopefulness and create a sense of connection with others, Vaughan Allen said.

“It takes collaboration,” she said. “Suicide prevention is everyone’s business, and connection is important.”

Dr. Ritch agrees, adding that there needs to be at least one individual in a suicidal person’s life who can cue into the behaviors that may lead to suicide.

“The main key is to have someone in their lives who can identify what may be going on and caring enough to seek help for that person,” she said.

There are red flags associated with suicidal behaviors that those in a support network need to be cognizant of, Dr. Ritch said.

Some behaviors to look and listen for include expressions of hopelessness and making like statements, as well as fatalistic statements in which a person may say they are unable to carry on or that things will never get better.

Sudden changes in mood, behavior or appearance could also be indicators, Vaughan Allen said.

“If they don’t sleep at all, but are sleeping constantly. If they are normally depressed and are suddenly very happy, it may be an indication that they have found a way to end their pain,” she said. “Even with one change, we can intervene and get that person help.”

Previous suicide attempts are also clear indicators that significantly increase a person’s risk for trying it again, Dr. Ritch said.

“It’s a matter of taking action when you encounter someone who is having these thoughts and feelings,” she said.

When suicidal behavior is encountered, Dr. Ritch said establishing direct communication with the person in crisis is the first step toward prevention.

“It’s not a time to be vague,” she said. “Ask the person if they are thinking about hurting or killing themselves, and if they have a plan.”
Next, the individual needs to be removed from access to any lethal means, such as weapons or substances.

When it comes to military veterans, this usually means removing firearms, something Vaughan Allen said can be challenging because the fear of losing weapons is actually a risk factor among the veteran population.

“For veterans, there’s a real fear that their firearms will be removed,” she said.

Veterans know about weapons and know how to use them, Dr. Ritch said. If a suicidal individual has access to lethal means, they are more likely to be successful.

The last step toward preventing a suicidal person from acting on their impulse is to stay with them until either help arrives or they can be transported to a hospital, Dr. Ritch said.

“Stay with the person, stay calm, actively listen, stay safe, and get the individual to help,” she said.

Military veterans aren’t at any higher risk of attempting or committing suicide as any other demographic, statewide data shows, and many of the risk factors are the same for both veterans and non-veterans alike.

“It’s an incredibly complex problem,” Dr. Ritch said. “There is no single cause of suicide.”

Social isolation, chronic pain, and difficulty with interpersonal relationships tend to put individuals most at risk, she said, while harboring feelings of failure, low self-worth, being burdensome to others also contribute.

Associations with others who have committed or attempted suicide tend to place people at increased risk, Dr. Ritch said, because death is viewed as an acceptable solution to how they are feeling.

Veterans, in particular, tend to become desensitized to death, Vaughan Allen said. Their protective sense of self-preservation becomes eroded, and along with that, their fear of death when surrounded by death and loss.

Risk factors more specific to veterans include coming home from deployment to a personal or financial crisis, or losing the sense of support and connectedness they had while on duty.

“They may find that sense of hopelessness and loss can come on quite quickly,” Dr. Ritch said. “When they find they no longer have those supportive factors around them, it can lead to isolation.”

Knowing these risk factors, as well as the early warning signs of suicide behavior, will both empower and equip those in a suicidal person’s support network to be more proactive in their intervention efforts.

“We see much more success when our friends, families and colleagues reach out for help on behalf of the veterans,” Vaughan Allen said.

But none of that will mean much if there is no conversation about suicide to begin with.

“Being straightforward with friends and family members, talking about death and talking about suicide is a very difficult thing for a lot of people,” Dr. Ritch said. “But in the case of suicide, and among veterans particularly, we can't afford not to have that conversation.”

If you know someone who is struggling with suicidal thoughts or behaviors, there are local resources available to help.

Besides medical personnel, hospitals and emergency rooms, there is a statewide suicide hotline to call for immediate help.

The Crisis Call Center, based in Reno, can be contacted by calling 775-784-8090 or through the National Suicide Prevention Lifeline at 1-800-273-8255. If a veteran, press 1 to be transferred to the veterans call center.

Volunteers manning the phone lines are specially trained in de-escalation techniques and can provide significant relief both for the suicidal individual and the supportive person intervening on their behalf.

Visit the Nevada Office of Suicide Prevention online here for more information and resources to help with suicide.

For veterans, there is a host of information available through the Veterans Administration web site here.