Suicide as a Public Health Emergency

Introduction

Suicide, which is now the tenth leading cause of death in the United States, is a rapidly escalating public health emergency. (Puntil, York, Limandri, Greene, Arauz, & Hobbs, 2013). The suicide rate in the U.S. has increased by 33% over the past 20 years, yet attention to this growing health concern and funding for its research is significantly lower than for other leading causes of death and even many of those causes which are responsible for far fewer deaths than suicide (Godlasky & Dastagir, 2018). In Tennessee, the statistics are even more staggering. With a suicide rate 20% higher than the national average, it is the ninth leading cause of death in the state (Status of Suicide in Tennessee, 2019). On average, Tennessee loses three of its citizens each day to suicide, and the state recorded 1,163 suicide deaths in 2017 (Status of Suicide in Tennessee, 2019). As a psychiatric-mental health nurse practitioner student and a citizen of the state of Tennessee, this topic is of great significance and concern to me and is one that I will likely face throughout my career as a mental health care provider.

Suicide Prevention Policy

A policy related to the topic of suicide prevention in the state of Tennessee is the TN Suicide Mortality Review and Prevention Act of 2018 (S.B. 1949/H.B. 1961, Public Chapter 1005). The purpose of this policy is to identify contributing factors to suicide deaths in the state of Tennessee and develop state changes for prevention strategies to reduce the number of suicide deaths in the state. The policy addresses the need to establish a statewide program in accordance with recommendations from the U.S. Surgeon General to investigate all suicide deaths through mortality reviews conducted by a review and prevention team. The bill calls for the composition of the team to include the commissioner of health or their designee, the commissioner of mental health and substance abuse services or their designee, the executive director of the Tennessee Suicide Prevention Network, a physician and a nurse with training in suicide prevention, the chief medical examiner or their designee, the chair of the Health and Welfare Committee of the Senate or their designee, and the chair of the Health Committee of the House of Representatives or their designee (S.B. 1949/H.B. 1961, Public Chapter 1005). The policy outlines that the team shall hold quarterly meetings to review suicide deaths and identify trends, risk factors, response deficits, barriers to safety for persons at risk for suicide, and define strategies for prevention. Additionally, the team shall undertake the statistical studies of suicide patterns and mortality rates for the state and provide annual reports to the governor and general assembly concerning their activities and recommendations for law or policy changes that would promote the prevention of suicide deaths. Finally, the policy authorizes the team to inspect the hospital and outpatient records, laboratory data, police investigation data, and medical examiner data of persons who died by suicide to aid in their investigations (S.B. 1949/H.B. 1961, Public Chapter 1005).

Position

My position on this topic is that the state should formulate and implement state-level suicide prevention research and planning, and that adequate federal and state funding should be given to such efforts. As such, this position is in support of the TN Suicide Mortality Review and Prevention Act of 2018. According to the American Foundation for Suicide Prevention, suicide is preventable. The AFSP states that through research, prevention strategies can be identified and implemented, thus saving lives (Tietjen & Jobes, 2019). The AFSP notes that when Congress prioritizes funding for research on public health issues like heart disease, cancer, and diabetes, the mortality of these diseases decreases in relation to the research funding they receive. Suicide mortalities resulting from mental health issues, the AFSP posits, can be decreased as well if Congress prioritizes funding for research into preventative and treatment measures (Tietjen & Jobes, 2019). Tennessee Governor Bill Lee has proposed a $1.1 million investment to expand the state’s partnership with the Tennessee Suicide Prevention Network to establish a new outreach model and focus on evidence-based practice interventions (Cook, 2019).

Opposition

Some policy makers oppose provisions for funding of this and other mental health research and suicide prevention programs on the basis of cost and perceived lack of value or benefit of such programs. According to the CDC, while some states do receive funding for their suicide prevention programs, such support is not guaranteed, and most mandate that these planning groups come without funding, or funding comes with specific requirements that may affect participation on the committees or shift the driving force and control away from the issue’s advocates (Lubell, Harber Singer, & Gonzalez, n.d.). Budget cuts for mental health services in Tennessee resulted in a 10.1% decrease in funding between 2009 and 2011 (State Mental Health Cuts, 2011). According to The National Alliance on Mental Illness, the budget for the largest payers of behavioral health services in the U.S., Medicare and Medicaid, continues to be slashed, and funding for the Substance Abuse and Mental Health Services Administration’s Mental Health and Substance Abuse Treatment Programs has been reduced by approximately $600 million (Howard, 2018). Policy makers in opposition of mental health funding often cite savings to states and communities by cutting Medicaid funding. However, NAMI argues that rather than saving money, these cuts simply shift the financial responsibility to emergency rooms, community hospitals, and law enforcement agencies (State Mental Health Cuts, 2011). While some policy makers oppose the proposed $150 million a year that the American Foundation for Suicide Prevention advocates for to pay for suicide research, the cost of suicides and suicide attempts far exceeds that number at a price tag of $93.5 billion a year (Godlasky & Dastagir, 2018).

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Some experts posit that the lack of support for funding of state suicide prevention programs is a result of the stigma associated with mental illness and suicide. According to Godlasky and Dastagir, stigma is associated with fear, and suicide reflects one of our most primal fears – fear of death (Godlasky & Dastagir, 2018). Because of discomfort associated with emotion-driven misconceptions about mental illness and suicide, it may be that suicide prevention efforts do not get the attention or support they need because people choose not to think of mental illness and suicide in the same capacity they think of deaths related to other illnesses such as cancer and heart disease.

Conclusion

In conclusion, our state is facing a mental health crisis of completed suicides which affects over 1,000 citizens each year, and thousands more suicide attempts. As these numbers continue to rapidly climb, there is a call to action to address this public health emergency. Research and implementation of prevention programs are the keys to reducing suicide deaths in the state. It is imperative that the state answers this call to action by implementing the guidelines of the TN Suicide Mortality Review and Prevention Act of 2018 and that adequate funding for this legislation is provided in an effort to protect its citizens from preventable suicide deaths.

References

• Cook, M. (2019). Gov. Lee proposes new funding to expand access to mental health care, reduce suicide. Brentwood Home Page. Retrieved from https://brentwoodhomepage.com/gov-lee-proposes-new-funding-to-expand-access-to-mental-health-care-reduce-suicide/
• Godlasky, A. & Dastagir, A. E. (2018). Suicide rate up 33% in less than 20 years, yet funding lags behind other top killers. USA Today. Retrieved from https://www.usatoday.com/in-depth/news/investigations/surviving  suicide/2018/11/28/suicide-prevention-suicidal-thoughts-research-funding/971336002/
• Howard, C. (2018). How Trump’s budget cut will affect people with mental health conditions.Mental Health America. Retrieved from https://www.mentalhealthamerica.net/blog/how-trumps-budget-will-affect-people-mental-health-conditions
• Lubell, K., Harber Singer, H., & Gonzalez, B. (n.d.). State suicide prevention planning: a CDC research brief. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/state-suicide-prevention-planning-brief.pdf
• Puntil, C., York, J., Limandri, B., Greene, P., Arauz, E., & Hobbs, D. (2013). Competency-based training for PMH nurse generalists: inpatient intervention and prevention of suicide. Journal of the American Psychiatric Nurses Association. Retrieved from  https://journals.sagepub.com/doi/full/10.1177/1078390313496275
• State mental health cuts: a national crisis. (2011). National Alliance on Mental Illness. Retrieved from https://www.nami.org/getattachment/About-NAMI/Publications/Reports/NAMIStateBudgetCrisis2011.pdf
• Status of Suicide in Tennessee. (2019). Tennessee Suicide Prevention Network. Retrieved from http://tspn.org/wp-content/uploads/2019/06/TSPN-Status-of-Suicide-2019-v2.pdf
• Tennessee HB1961. (2019). TrackBill. Retrieved from https://trackbill.com/bill/tennessee-house-bill-1961-public-health-as-enacted-enacts-the-suicide-mortality-review-and-prevention-act-of-2018-amends-tca-title-68-chapter-3/1539688/
• Tietjen, N. & Jobes, C. (2019). Fighting for suicide prevention on capitol hill. American Foundation for Suicide Prevention. Retrieved from https://afsp.org/fighting-for-suicide-prevention-research-on-capitol-hill/