0516 Diane Roston

Diane Roston

By Diane Roston

We have personal protective equipment (PPE) for physical protection from the coronavirus. But what about mental protection?

The word is out: the coronavirus pandemic is linked to an increased risk of anxiety, depression, PTSD and suicide.

Every day we read about more deaths by suicide – a doctor, two nurses, a financial prime minister. At a recent virtual meeting I attended of the American Psychiatric Association, Joshua Morganstein, M.D., chair of the committee on Psychiatric Dimensions of Disaster, said that the crisis is shaping up to be “a marathon, not a sprint,” and that “if history is any predictor, we should expect a significant ‘tail’ of mental health needs that extend for a considerable period of time.”

This pandemic has touched us all. We have experienced heightened anxiety, grief, sadness, sleep disturbance, irritability and fatigue. These can be normal responses to a crisis.

Suicide is an extreme response.

Those likely to be at highest risk of suicide related to the pandemic include: health care workers, especially those on the frontline; essential workers; people who get sick with the virus and those close to them; and people with pre-existing mental health or addiction conditions.

All of us, not only those trained in a mental health field, can work together to prevent suicide.

So what can we do when concerned about someone’s risk of suicide?

Ask. And tell.

We can ask directly: “Are you feeling hopeless? Are you thinking about ending your life? Are you thinking about suicide?”

When I was in medical school, I worried that by asking these questions I might hear, “no, I haven’t thought of suicide before, but now that you mention it...”

In my years of experience, I have never heard that response. In fact, people are relieved to be asked, even if the answer is no.

Keep in mind that if someone is serious about suicide, they might not answer a direct question directly. Still, we ask.

Another option is to ask indirectly. Thomas Joiner, Ph.D., a leading researcher in the field of suicidology, identified characteristics common to people who die of suicide.

First, the person might feel that people would be better off without them, or what Joiner calls “perceived burdensomeness.” The pandemic’s toll of unemployment, health problems, financial distress, increase the risk of someone feeling burdensome to others.

We can ask: “Do you feel people would be better off without you? Do you feel I would be better off without you?”

Another characteristic associated with likelihood of suicide is that the person feels that they don’t belong, or Joiner’s term, “thwarted belongingness.” The pandemic’s toll of social isolation, loneliness, reduced connection with others through “social distancing” are a set-up for feeling disconnected.

We can ask: “Do you feel a part of any group? Of your family? Of your work? Your neighborhood? Of an online group?”

While asking questions, ask whether the person has a gun. With the sale of guns on the rise and guns being the number one means of suicide – enough said.

Then tell.

If after asking these questions you are still worried about a person’s mental state, tell. Tell the person him/herself that you are concerned. Ask them to tell someone else – a family member, health care professional, friend, pastor. And tell someone else yourself: someone else in the family, a friend, a professional, a pastor, anyone.

For those of us who have lost someone to suicide, the current media focus on this topic might increase the intensity of our remembrances. This is a time to be gentle and kind to ourselves. Remind yourself that you did not cause the suicide and could not have prevented it. We all do the best we can.

For those of us who are worried now about someone, be gentle with yourself. Know that even if you ask, the person might not answer. We are all doing the best we can.

As I write this, Congress is considering passing a bill to institute a suicide/mental health emergency number, 9-8-8, the mental health equivalent of calling 9-1-1 for a physical health emergency. U.S. Sen. Jean Shaheen, a supporter of this bill, quoted a letter to congressional leadership prepared by members of Congress: “As our country is facing an unprecedented challenge in responding to COVID-19, this three-digit hotline would play a critical role in saving the lives of many vulnerable Americans who are facing mental health emergencies during this period of isolation and uncertainty.”

We are fortunate that there is an abundance of resources for suicide prevention.

Beyond these resources, simple interventions can be powerful. Research has shown that a daily phone call or card from a mental health counselor can reduce the risk of suicide. It follows that a regular connection with anyone, not just a mental health professional, can potentially reduce a person’s sense of the world being better off without them and their sense of not belonging.

Each connection is a thread.

Together, these threads make a rope.

A strong rescue rope can save a life.

Diane Roston, M.D., is the medical director at West Central Behavioral Health, the nonprofit community mental health care provider for Sullivan County and the Upper Valley.

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