What we are still not getting about preventing suicide, its contagion

Deaths of fashion designer Kate Spade and chef Anthony Bourdain are spurring more discussion of suicides and our limited knowledge of prevention.
Deaths of fashion designer Kate Spade and chef Anthony Bourdain are spurring more discussion of suicides and our limited knowledge of prevention. Associated Press

Celebrity chef Anthony Bourdain’s and fashion designer Kate Spade’s untimely deaths have been covered heavily by the media. And while lifesaving resources like the National Suicide Prevention Lifeline have gotten more recognition than ever, we still seem to be missing some significant points.

Just one day before Bourdain’s death, the Centers for Disease Control reported significant suicide rates rising across the United States,with more than half of the 45,000 people who died by suicide in 2016 having no known mental-health condition.

I tell clinicians who I train to treat suicide that knowing all the warning signs and risk factors does not replace being able to articulate the most important, and sometimes difficult, question, “Are you having thoughts of suicide?” And, then knowing what to do next.

Bourdain was apparently flourishing in spite of his age (people age 45 to 54 account for the highest suicide rate), gender (males die by suicide four times more than females), his relationship losses and addiction history (some would say his 250-plus days on the road a year also signaled an “addiction”).

Some people stay afloat; others do not. What upsets that balance? What makes someone more death-oriented one moment rather than life-oriented the previous moment is a mystery.

What is not a mystery, but a misfortune, is that we are not arming ourselves with the knowledge to be able to respond appropriately to individuals in crisis. Part of preventing further suicide is talking about the effect this death has on us. It’s called suicide postvention and, like suicide prevention, it aids in helping to address those unique contributors to risk for suicide attempt and death.

Research at the University of Kentucky shows that individuals exposed to suicide have statistically higher levels of depression, anxiety, suicidal ideation than those who did not know someone who died by suicide. Another study in England showed higher levels of suicide attempt among those who were suicide exposed.

“Suicide affects us all,” says Julie Cerel, who led the study at the University of Kentucky and is the current president of the American Association of Suicidology, “Each person who dies by suicide leaves behind so many loved ones with the question, ‘Why?’”

By observing and experiencing suicide through the lens of another, we loosen our fear and strengthen our ability to engage in self-harm.

UK research also demonstrates that for every individual who dies by suicide there are about 135 individuals who are exposed to that death. Of those who are exposed, about 48 may experience significant impact from that death. And, yet, people who are seriously impacted, often called “suicide bereaved,” are not recognized as trauma survivors by almost anybody.

Connecting the dots between suicide exposure and potential for self-harm has yet to penetrate the medical community. The behavioral health care community isn’t doing much better. Consistent with other research, the Kentucky Behavioral Healthcare Workforce Survey indicated that 57 percent of surveyed clinicians indicated that they did not have the skills needed to engage those with suicidal intent; 43 percent blamed it on insufficient training.

The current gold standard for treating suicidal individuals is treating them on an outpatient basis and working with the patient and their family to manage their suicide risk. Very few graduate programs in psychology, social work and counseling in the United States offer this training.

At Eastern Kentucky University, we train doctoral-level clinical psychology students in these skills. It flies in the face of conventional training to allow graduate students to treat suicide, but, like medical trainees who are permitted to treat people who are actually sick, we take the same kind of incremental, closely supervised training approach.

Just as the “Act Up” Movement changed the stigma around HIV/AIDS testing and treatment and the Susan G. Komen’s “Race for the Cure” changed how our culture thinks about breast cancer treatment and surveillance, we must change the silence, stigma and lack of conversation around suicide.

Recent celebrity deaths and the landmark CDC study have put a spotlight on the fact that we know very little about the causes of suicide. Federal and state funding, significant community efforts and wide-scale acceptance of means safety (storage of prescription medications and firearms) can lead to lowering the rates of suicide. Training of professionals who are expected to be able to treat suicidal people is paramount in this effort.

Melinda Moore is an assistant professor of psychology at Eastern Kentucky University and clinical division director of the American Association of Suicidology.

More on suicide: Herald-Leader contributing columnist Tom Martin will host Melinda Moore in a discussion on WEKU’s “Eastern Standard” program, 11 a.m. to noon Thursday, June 21, on 98.9 FM. It is also live-streamed on https://esweku.com/live-stream-weku and rebroadcast on Sundays at 6 p.m.