Crisis and suicide prevention services struggle with demand after celebrity suicides NIH study identifies importance of support for critical suicide prevention services.

Thoughts about this article? "The United States may lack the resources needed to meet increases in demand for suicide prevention services that occur after celebrity suicides, according to a recent study of crisis mental health services. The study, conducted by a team of researchers, which included scientists from the National Institute of Mental Health (NIMH), part of the National Institutes of Health, highlights the need for suicide prevention hotlines to procure additional funds, allocate existing funds more efficiently, and develop contingency plans to accommodate increases in call volumes, particularly for the first two days after a celebrity suicide. The findings appear in the journal Psychiatric Services. “Suicide prevention is a significant public health concern and a top priority for NIMH,” said Joshua A. Gordon, M.D., Ph.D., director of NIMH. “This study highlights the importance of the National Suicide Prevention Lifeline and other crisis mental health services, and the need to build surge capacity of these services that could help save lives.” 

Suicide is the second leading cause of death for people in the U.S. between the ages of 10 and 34, and the suicide rate continues to rise. Suicide rates generally follow predictable patterns, with increases in the spring and a second, smaller increase in early summer. But certain events, like highly-publicized celebrity suicides, can serve as “shocks” that cause a sudden spike in suicide deaths. To test the ability of crisis mental health services to meet a sudden increase in demand for help, this study looked at increases in suicide rates within 30 days of Robin Williams’ suicide on Aug. 11, 2014. It also looked at changes in help - and information-seeking related to suicide, and changes in the percent of calls the National Suicide Prevention Lifeline (NSPL) was able to answer after Williams’ death. Daily calls to the National Suicide Prevention Lifeline (including Veterans Crisis Line) initiated and answered, August 3 to September 7, 2014. Daily calls to the National Suicide Prevention Lifeline (including Veterans Crisis Line) initiated and answered, August 3 to September 7, 2014. American Psychiatric Association. The researchers used data from the Centers for Disease Control and Prevention National Center for Health Statistics’ Compressed Mortality File (link is external) to compare the number of suicide deaths and the method of suicide in the 30 days before and after Aug. 11, 2014, and for the same time period in 2012 and 2013. In 2012-2014, there was an average of 113-117 suicide deaths per day; after Williams’ suicide, the average rate increased to 142 suicide deaths per day, something not observed in 2012 or 2013. Approximately two-thirds of the people who died by suicide immediately after the actor’s death used the same method of suicide as Williams. The study also examined the number of calls placed to NSPL immediately before and after Williams ended his life to measure whether media coverage of his death prompted more people to reach out for help. The day after he died, the number of calls increased by up to 300 percent - from between 4,000 to 6,000 calls per day to 12,972. However, without capacity to respond to this increased demand for crisis services, the fraction of answered calls decreased from an average of 73 percent to 57 percent, which highlights a gap in the ability of the NSPL to respond to surges in calls for help. To measure information-seeking behavior, the study looked at visits to the Suicide Prevention Resource Center (SRPC) (link is external) and Suicide Awareness Voices of Education (SAVE) (link is external) websites. In the week before Williams died, the SPRC website averaged 2,315 visits per day. The day after his death, there were 5,981 visits to the site. The SAVE website averaged 4,239 visits per day in the week before he died, and 24,819 visits on August 12. Average daily visits to both sites remained consistently higher for the rest of the month of August. The study suggests that both efficient allocation of existing funds and procuring new funding will be critical to continue meeting the demand for crisis mental health services, including surge capacity.> “Crisis mental health services, such as suicide prevention hotlines and websites, provide effective counseling and vital resources for people in suicide distress. We need to ensure these services have sufficient resources to serve the public 24/7, especially in times of increased demand,” said Jane Pearson, Ph.D., chair of the Suicide Research Consortium in NIMH’s Division of Services and Intervention Research. “Shocking events, like Mr. Williams’ suicide, disrupt normal patterns in suicide rates, and cause an increase in both calls for help and imitative suicides,” said lead researcher Rajeev Ramchand, Ph.D (link is external)., of the Cohen Veterans Network. “This highlights the need for additional and consistent support for crisis mental health services, including hospital emergency departments, law enforcement, poison control centers, and health departments, as well as the mental health resources that serve as referral sources.” " Reference Ramchand, R., Cohen, E., Draper, J., Schoenbaum, M., Reidenberg, D., Colpe, L., Reed, J., & Pearson, J. (in press). Increases in demand for crisis and other suicide prevention services after a celebrity suicide. Psychiatric Services in Advance. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900007 (link is external). For more information on this and other mental health continuing education, please visit, Psychologist Continuing Education

Paradox of aging: The older we get, the better we feel?

Presently, there are about 40 million Americans over the age of 65, with the fastest-growing segment of the population over 80 years old. Traditionally, aging has been viewed as a period of progressive decline in physical, cognitive and psychosocial functioning, and aging is viewed by many as the "number one public health problem" facing Americans today. But this negative view of aging contrasts with results of a comprehensive study of 1,006 older adults in San Diego by researchers from the University of California, San Diego School of Medicine and Stanford University. Results of the Successful Aging Evaluation (SAGE) study – comprising a 25-minute phone interview, followed by a comprehensive mail-in survey – will be published in the December 7 online issue of the American Journal of Psychiatry. "While there is a growing public health interest in understanding and promoting successful aging, until now little published research has combined measures of physical health with cognitive and psychological assessments, in a large and randomly selected sample," said principal investigator Dilip V. Jeste, MD, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of UC San Diego's Stein Institute for Research on Aging, and the current President of the American Psychiatric Association (which was not involved in this study). The SAGE study included adults between the ages of 50 and 99 years, with a mean age of just over 77 years. In addition to measures which assessed rates of chronic disease and disability, the survey looked at more subjective criteria such as social engagement and participants' self-assessment of their overall health. "Sometimes the most relevant outcomes are from the perspective of the subjects themselves," said Jeste. The study concludes that resilience and depression have significant bearing on how individuals self-rate successful aging, with effects that are comparable to that of physical health. "Even though older age was closely associated with worse physical and cognitive functioning, it was also related to better mental functioning," said co-author Colin Depp, PhD, associate professor of psychiatry at UC San Diego School of Medicine. After adjusting for age, a higher self-rating of successful aging was associated with higher education, better cognitive function, better perceived physical and mental health, less depression, and greater optimism and resilience. Participants were asked to rate the extent to which they thought they had "successfully aged," using a 10-point scale and using their own concept of the term. The study found that people with low physical functioning but high resilience, had self-ratings of successful aging similar to those of physical healthy people with low resilience. Likewise, the self-ratings of individuals with low physical functioning but no or minimal depression had scores comparable to those of physically healthy people with moderate to severe depression. "It was clear to us that, even in the midst of physical or cognitive decline, individuals in our study reported feeling that their well-being had improved with age," Jeste said. This counterintuitive increase in well-being with aging persisted even after accounting for variables like income, education and marriage. Jeste suggests there's a take-away message for clinicians, which is that an optimistic approach to the care of seniors may help reduce societal ageism. "There is considerable discussion In public forums about the financial drain on the society due to rising costs of healthcare for older adults – what some people disparagingly label the 'silver tsunami.' But, successfully aging older adults can be a great resource for younger generations," he said. The findings point to an important role for psychiatry in enhancing successful aging in older adults. "Perfect physical health is neither necessary nor sufficient," Jeste said. "There is potential for enhancing successful aging by fostering resilience and treating or preventing depression." Aging and Long Term Care (Abridged) CE Course (3 hours) ### Additional contributors to this study include Gauri N. Savla, PhD, Wesley K. Thompson, PhD, Ipsit V. Vahia, MD, Danielle K. Glorioso, MSW, A'verria Sirkin Martin, PhD, Barton W. Palmer, PhD, David Rock, BA, and Shahrokh Golshan, PhD, UC San Diego; and Helena C. Kraemer, PhD, professor of biostatistics in psychiatry at Stanford University. This work was supported, in part, by NIMH grants T32 MH-019934 and P30 MH-066248, by NIH National Center for Research Support grant UL1 RR-031980, by the John A. Hartford Foundation, and by the Sam and Rose Stein Institute for Research on Aging.