We need to talk about suicide. It’s not easy, but it’s necessary.
Suicide is the third-leading cause of death for young people ages 15-24. Teen and young adult suicide rates have been rising for the past two decades. Eighteen percent of high school students and 13 percent of college students have had serious thoughts of suicide in the last year, with LGBTQ and American Indian/Alaska Native youth at especially elevated risk. Suicide rates have risen the fastest among Black youth, particularly Black girls.
Talking about suicide is the first step to combating it. On an individual level, that means bringing it up when you see someone struggling. Contrary to popular belief, asking about suicide does not increase the likelihood that a person will act on it. In fact, it often provides a sense of relief and may increase help-seeking. On a policy level, if we don’t talk explicitly about suicide, we fail to utilize proven methods for preventing it and may miss legislative opportunities for fighting it.
As a psychiatrist who works with young people in community organizations and emergency rooms, one of the main strategies I employ to decrease suicide is to identify those at risk and connect them to care. This work is important, especially given the many barriers that prevent young people from seeking help.
There are limitations, though, to relying solely on current methods for identifying those who may be at risk. Within psychiatry, there are frequent conversations about how hard it is to predict suicide. However, there are public health strategies that are proven effective in helping prevent suicide by targeting everyone, not just those identified as high risk.
Prior to 1986, the Duke Ellington Memorial Bridge was the site of half of D.C. bridge suicides. After a fence was installed, suicide deaths from the bridge were reduced by 90%. By decreasing access to lethal means, we can add more steps between suicidal thoughts and action. This can be especially important for young people contemplating suicide, as they are more likely than older people to act impulsively, and will often find reasons to live if they can get through periods of distress.
Lethal means restriction is also effective because method substitution for suicide attempts is rare. Someone who plans to use a gun in a suicide attempt and finds there is no gun available is more likely to abandon the attempt than to turn to another method.
Means restriction can be employed at a population level without knowledge of who is at risk. Safe pill storage and disposal ensure that medications end up in the hands of only those who need them. Safe gun storage can stop those at risk of harming themselves from accessing lethal means. Buildings with guard rails and anti-suicide windows prevent suicide deaths. So do breakaway closet rods that snap in half when too much weight is placed on them.
Not only does lethal means restriction work, it is cost effective and can be accomplished by creating awareness through educating health departments at the local level, partnership with care providers and advocacy groups, and public information campaigns. Because of their effectiveness, lethal means restriction measures should be expanded in municipal health departments and hospitals. Highlighting these important tools through education programs such as those included in the Garrett Lee Smith Memorial Reauthorization Act, will have a real impact and will save lives.
Another method of suicide prevention that targets everyone — and works hand-in-hand with lethal means restriction — is training news media staff to follow recommendations for reporting on suicide. Reporters and editors are encouraged to talk about the realities of suicide, to focus on treatable mental health conditions, and to avoid sensationalizing suicide or including specifics about method or location.
The messages we share about suicide have real-life consequences. In 1978, Vienna opened its new subway system and, soon after, deaths by suicide increased significantly, along with dramatic media reporting. After the development of Austrian media guidelines on suicide reporting in 1987, the number of deaths by suicide in the Vienna subway system dropped by 80%.
Finally, “a rising tide lifts all boats.” Deaths by suicide increase during financial crises. However, providing social safety nets like a livable minimum wage decreases suicide rates. Currently, nearly 3 in 5 college students face some sort of basic needs insecurity, including housing instability, food insecurity, or lack of access to affordable health care. When these issues are addressed, they will not only affect suicide rates, but will undoubtedly have positive impacts on all of society.
With policy leadership, suicide prevention strategies can be employed effectively, both locally and nationally. Ignoring suicide won’t make it go away. When we acknowledge and talk openly and honestly about suicide, including its devastating impacts and potential solutions, we can create public policies and pass effective legislation to decrease the number of lives it affects.
Laura Erickson-Schroth, MD, MA, (she/they) is the Chief Medical Officer at The Jed Foundation (JED), a nonprofit focused on emotional health and suicide prevention for teens and young adults. She has provided thousands of patients with crisis intervention and mental health support in over ten different emergency rooms in New York City, and continues to see clients at Hetrick-Martin Institute for LGBTQIA+ Youth.