Monday, December 23, 2013

Suicide as a major Colorado public health problem: Guest column in the Boulder Daily Camera

Suicide is a major, almost invisible, public health crisis in Colorado; it is the seventh leading cause of death. Our state has consistently been among the top 10 states in terms of high rates, ranking 8th in the country in 2010. In 2012 the number of suicide deaths reached an all-time high, with 1,053 Coloradans completing suicide (a rate of nearly 20 persons per 100,000); this represents an increase of 15.8 percent over just one year. While these high rates are not fully understood, some causes are the recent economic downturn, the stigma that prevent this health problem from being openly discussed, a lack of funding for suicide prevention efforts at the state and local levels, a lack of access to mental health services, and a lack of education of mental health professionals as well as of the public about suicide and how suicide can be prevented.
Suicide affects persons of all ages, ethnic/racial groups, gender or sexual orientation, social classes and areas of residence in the state. Suicide can have a devastating impact on family and friends, school and the workplace. However, some of the facts about those most likely to die of suicide are both alarming and often unknown to the community: men are far more likely to die of suicide (accounting for 77 percent of the 2012 suicide deaths) while women are more likely to attempt suicide; there were 2,777 hospitalizations from suicide attempts in 2012 (about 52 out of 100,000 persons); men of working age account for the highest number of suicides; over three-quarters of firearm deaths in Colorado between 2004 and 2011 were suicides; suicide is the leading cause of death in Colorado among youth and young adults (aged 10 to 34.) Rural and frontier areas of the state have higher rates than urban areas as people are more isolated and care is less accessible.
How does suicide compare to other major causes of death reported by the Colorado Department of Health and Environment (CDPHE)? The comparisons are shocking. Over 1,000 persons died of suicide in 2012. That is more than double the number of Coloradans (457) who died in motor vehicle crashes that year; 585 died of breast cancer and 430 of prostate cancer; 798 died of diabetes and 524 from influenza/pneumonia. Suicide is by far the major killer in Colorado, yet we hear so little about it and efforts to prevent these deaths in our state are relatively small and uncoordinated. Most public health and mental health centers do comparatively little to address this major problem, and these agencies should be working cooperatively to address this major health issue. At the state level, CDPHE/ the State Legislature fund the Office of Suicide Prevention (OSP) at a very low level in comparison to other initiatives, and OSP has only one professional staff. One of the reasons our state now has such a low rate of traffic fatalities is because of the amount of funding and related media attention focused on auto accidents as a public health problem. Perhaps it is time to focus more resources and public attention on the problem of suicide.
About a third of those who die of suicide have had some kind of contact with the mental health system. Thus, mental health professionals (and other health providers) are often on the front line in preventing suicide. Yet their training and skills regarding the assessment, treatment, and management of suicidal persons is often very limited. Sen. Linda Newell (D-District 26) has decided to address this major weakness in the system to prevent suicide. Sen. Matt Jones (D- District 17) and other Boulder area legislators have also been supportive of suicide prevention legislation. Senator Newell has been working for months with the Suicide Prevention Coalition of Colorado and other stakeholders to create a bill that would add to existing continuing education hours now required of certain mental health professionals specific language about clinical training in the assessment and treatment of suicidal clients. The groups who, hopefully, will be included in this bill are: addiction counselors, professional counselors, family and marriage counselors, and social workers. These are crucial groups because, taken together, they account for 94 percent of Colorado's mental health professional workforce, and they are most dispersed geographically across the state. Over time, it is hoped that other health professions (including primary care physicians) will become involved in future suicide prevention education legislation.
Note: the data contained in this report has been obtained from CDPHE and OSP.
Susan Marine is the advocacy chair of Suicide Prevention Coalition of Colorado and on the Mental Health Partners board of directors.