By Dave Ranney and Mike Sherry
Kansas Health Institute
OLATHE, KAN. — At least once a week, Kimberly Rowlands talks to someone contemplating suicide.
“It’s a big chunk of what I do,” she said.
Rowlands, 48, is what is called a mental health co-responder. When Olathe police respond to reports of someone threatening to kill himself or herself, she goes with them.
“I wouldn’t even guess how many times I’ve been called out,” she said. “I’m not on duty 24 hours a day, but when I’m working and a call comes in, I go out.”
Rowlands is on the front line of a problem that is growing nationally and in Kansas.
In the U.S., suicides have exceeded automobile deaths since 2009 to become the 10th leading cause of death. According to the Centers for Disease Control and Prevention, suicide accounted last year for more than 1.4 million years of life lost before age 85.
The number of Kansas suicides increased more than 31 percent between 2011 and 2012. According to the Kansas Department of Health and Environment’s recently released vital statistics report, coroner’s offices across the state reported a record-high 505 suicides last year.
There are significant regional differences in suicide rates. For the past decade or more, the rates typically have been highest in the states of the mountain west and lowest in the more heavily populated states of the northeast.
But with Kansas’ significant recent increase, it has moved into the rank of states with the highest rates. No one seems to know why, or whether the dramatic one-year increase was an aberration or the beginning of a disturbing trend.
Between 2011 and 2012, the state’s suicide rate went from 13.4 deaths per 100,000 population to 17.6 deaths per 100,000 population.
“The numbers are very troubling,” said Miranda Steele, spokesperson for the Kansas Department of Health and Environment. “We’ll be working with our partner agencies and with KDADS (Kansas Department for Aging and Disability Services) on seeing where we go next with our interventions.”
Funding an issue
Historically, much of the state’s response has been defined by its support for community mental health centers; the work of groups such as the Governor’s Mental Health Services Planning Council, and education campaigns.
“We’ve made a good start,” said Michael Garrett, chief executive at Horizons Mental Health Center in Hutchinson. “Every mental health center in the state puts on programs for educating the public about depression and how to recognize the signs that someone is contemplating suicide. We do training five or six times a year in Reno County.”
But the mental health centers’ initiatives, he said, have been squeezed by cuts in state spending.
“We haven’t been able to get the state to realize that demand for our services has increased considerably in recent years, and that much of the increase involves people who are self-pay or uninsured,” Garrett said.
In recent years, lawmakers have cut state-funded grants that mental health centers use to offset the costs of caring for the uninsured.
“Whenever you have an increase in demand and a decrease in funding, it doesn’t make for good outcomes,” he said.
There have been some advances on other fronts.
Last year, Headquarters Counseling Center of Lawrence received a federal grant — $480,000 a year for three years — to strengthen and develop suicide prevention efforts across the state.
Four counties have started suicide prevention coalitions: Harvey, Johnson, Sedgwick, and Shawnee. And there’s a prevention task force active in Barton, Pawnee, Rice, Rush, and Stafford counties that is based in Great Bend.
In Johnson County, officials met recently to discuss the possibility of broadening prevention training to include people from school, church and other community groups. They also are talking about setting up a crisis center to replace one that was closed down more than 10 years ago.
“It is surprising that we talk about suicide more and more,” said Tim DeWeese, director of clinical services at the Johnson County Mental Health Center, “but when you talk with individuals about the skills that they have, most people routinely don’t feel competent to address those suicide issues.”
More research needed
Despite the toll it takes, suicide is less understood than many life threatening illnesses and conditions.
Alan Berman, executive director at the American Association of Suicidology in Washington, D.C., said that since the early 2000s, the nation’s suicide rate has increased about 20 percent.
But “the reality is we don’t know” why, Berman said. “There’s so much research in this area that needs to done but there’s very little funding. And without that research it’s hard to defend any hypothesis, no matter how reasonable.”
According to the American Foundation for Suicide Prevention, “the stigma surrounding suicide has limited society’s investment in suicide research.”
National Institutes of Health funding for suicide research in fiscal 2012 was $49 million versus more than $1 billion for diabetes research and more than $3 billion for HIV/AIDS, according to the foundation.
Equally discouraging is that some studies of potentially promising responses to the problem have failed to detect effective results. For example, some experts have called for better screening of patients in primary care settings. But in 2004, the U.S. Preventive Services Task Force concluded there wasn’t enough evidence to recommend for or against routine screenings by primary care clinicians.
And an article in the Annals of Internal Medicine published in May reported that the evidence of effective results remained “insufficient.”
Barriers as a deterrent
There have been a few studies that have shown dramatic decreases in suicide — sometimes as an unintended consequence — when commonplace barriers or impediments to suicide have been put in place.
For instance, a much-cited study of the sharp drop in suicides in the United Kingdom between 1960 and 1971, revealed that it coincided with a reduction in carbon monoxide levels in household gas used for heating and cooking.
Another study showed a sharp decline in suicides after barriers were placed on a bridge in Washington state that was often used by people attempting to commit suicide.
In the U.S., firearms are the most common means of suicide. And some experts say it is therefore not surprising that the states with the highest rates of suicide also are the states with the highest rates of gun ownership.
That has prompted some prevention specialists to call for steps making it harder for a person to impulsively put a gun to the head and pull the trigger.
In some states, including Missouri, local public health departments have distributed trigger locks as part of suicide prevention efforts in keeping with the idea that ordinary or routine obstacles can reduce suicide.
Rowlands, the frontline worker in Johnson County, said she thought the county’s suicide rate had gone up, in part, because more women and teenagers were turning to the more lethal methods of hanging and gunshot.
In the past, both groups were more prone to try drug overdoses, wrist cutting, or carbon monoxide poisoning, she said.
“When someone shoots themselves or hangs themselves, there’s no time for rescue,” Rowlands said. “There is no time for changing your mind.”
Rowlands said she knew instances of people who had been rushed to an emergency room after a suicide attempt, stabilized, and then released after being encouraged to contact a local mental health center.
“After they’re released, they go straight to the sporting goods place, buy a gun and kill themselves,” she said.
“A high number of suicides occur within 48 hours of being released from an emergency room,” Rowlands said. “It’s just not good enough to release someone from an emergency room and tell them they need to check in with their mental health center.”
Many of these patients, she said, do not contact the mental health center.
“I’ve talked to people who were really hurting, and when I asked them if they know about Johnson County mental health (center), they say no, they’ve never heard of it – even though it’s three blocks from where they live,” Rowlands said.
“I find that so hard to believe,” she said, “but it’s like one of them said to me: ‘They’re a government agency and government agencies don’t advertise.’”