Centerstone Works to Make Suicide a Never Event
Some myths become so much a part of the cultural fabric that they are elevated to indisputable fact. One such legend is that suicides are most prevalent during the winter holiday season. In reality, statistics show March, April and May are the peak months for an individual to take his or her own life.
Crisis Call Center: 800-681-7444
Online Crisis Chat: www.crisischat.org
Nashville Mobile Crisis Team: (615) 726-0125
National Suicide Prevention Lifeline: www.suicidepreventionlifeline.org
Crisis Line: 800-273-TALK (8255). Note, although national, Stoll said local providers answer calls.
Suicide Hotline: 800-SUICIDE (784-2433)
Tennessee Suicide Prevention Network: www.tpsn.org
Main Line: (615) 297-1077
While there isn’t hard and fast research to explain the spring suicide peak, Becky Stoll, LCSW, director of Crisis Services for Centerstone, said there are consistent opinions among experts. “Sometimes,” she explained, “when people are so incredibly depressed, which we do see a lot in the winter months, they just don’t really have the energy to make plans to even take their life.” She added, “People can be too depressed to kill themselves.”
Instead, when the weather begins to warm and the depression lifts slightly, Stoll said those who are considering suicide enter a ‘red zone’ where they now have the requisite energy to formulate a plan. “There’s a window there that is really dangerous,” she said of that time period.
Stoll added that for most, spring is a time of rebirth. “I think oftentimes people look around, and they don’t feel that way; or they think things will get better if (they) can just hold on … and then it doesn’t get better. One word we really hone in on in the field is ‘hopelessness.’”
When there is no sense that things will ever get better, that is a huge risk factor for suicide. “These folks, in my experience, are just in so much pain they want it to end. Whatever the stressors are, they don’t see them going away,” said Stoll.
Centerstone has adopted the philosophy that suicide should be a ‘never event.’ Although some people might ultimately opt for suicide, Stoll said it shouldn’t be because they simply fell through the cracks. She believes the overwhelming majority of people could and should be identified as ‘at risk’ well before they reach the point of no return. To achieve that goal, Centerstone has focused attention on the clinical pathway to suicide prevention and is increasing training and education for both behavioral health and physical health providers.
“We really have to be assessing for suicide at every contact you have with someone,” she said.
Stoll added the Columbia Suicide Severity Rating Scale is an excellent evidence-based tool being used internationally. “It drives us down a certain path,” she explained. “Number one, are you suicidal … yes or no?” If the answer is yes, she continued, then the next step is to ascertain just how suicidal someone is … was it a vague thought a couple of weeks ago or has the person taken concrete steps, like securing a gun, to carry out the plan?
When asked if individuals are honest about feelings of suicide, Stoll replied, “In my experience, surprisingly, incredibly honest.”
While Centerstone staff and those at other crisis intervention centers are well trained in assessing risk factors for suicide, Stoll said it’s important that other providers also raise their awareness level. “It’s almost like a touch point we’re missing if the primary care provider doesn’t ask that question,” she said.
According to recent national statistics, she continued, 58 percent of people who committed suicide had seen their primary care provider within a month of the suicide, and 77 percent had seen their physician within a year prior (including 100 percent of the women who committed suicide). In contrast, only 8.5 percent had visited a mental health professional in the prior year.
For those who might be uneasy with approaching the subject, Stoll advised, “Honesty and directness is the best medicine. ‘Have you ever had any thoughts of killing yourself?’” she suggested a provider ask. “I really haven’t had people be offended by that. They’ll either go ‘oh no, things aren’t that bad’ or they’ll say, ‘yes, yes I have.’”
If the answer is the latter, then primary care providers need to be prepared to respond. “Who are your go to mental health professionals … just like who are your go to cardiologists or urologists? If this symptom pops up, you need to have (an answer) ready to go,” she said.
Stoll added Centerstone Research Institute has collaborated with other behavioral health stakeholders on the Tennessee Gatekeeper Training Implementation Support System, which lays out the steps to execute a suicide prevention training program. She also said Centerstone could help physician practices interested in training their clinical staff on suicide screening.
Those who would like to learn more about screening and prevention should call Centerstone Tennessee or go online to www.centerstone.org. Tennessee Suicide Prevention Network, www.tpsn.org also offers training programs.
Middle Tennessee has been the site of several teen suicides in recent months that have garnered media attention. Suicide is the 10th leading cause of death for all Americans and the ninth leading cause of death overall for Tennesseans. Among adults ages 24-34, suicide is the second leading cause of death; and among teens and young adults ages 15-24, it is the third leading cause of death.
In 2010, the Tennessee suicide rate was 14.7 per 100,000, which resulted in 932 reported suicide deaths. While that number was down from 2009, it still puts Tennessee above the national average of 11.5 per 100,000 as reported by the CDC in 2008.
The most recent rankings of state suicide rates by the American Association of Suicidology placed Tennessee ninth out of all 50 states and the District of Columbia.
For additional facts and figures, visit the Tennessee Suicide Prevention Network to download the Status of Suicide in Tennessee 2012 at www.tspn.org/status-of-suicide-2012.