Archive for March, 2016

Why Mental Illness Treatments are Ineffective at Treating Depression & Preventing Suicide

When patients seek either inpatient care or outpatient treatment for mental illnesses including depression, the treatment they receive is often inadequate. Depression is one of the greatest risk factors for suicide, especially among severely depressed patients who are hospitalized due to suicidal ideation. Unfortunately, even in inpatient settings where patients are supposed to receive treatment from consummate professionals, mental healthcare providers are often left guessing, because of poor training, on what treatments will be effective with no actual scientific method of helping patients.

Sad senior

Scientific America calls the current approach to treating mental illnesses, including depression, the “shotgun approach,” and describes the shortcomings of this treatment method. The term refers to the fact psychiatrists often try many different types of medications in a very imprecise manner.

When patients receive inpatient treatment or outpatient treatment and the wrong medications are provided to treat depression, some of these medications can actually increase the risk of suicide- especially if patients end up having to stop taking the drugs and going through a withdrawal process. Mental health professionals may sometimes be held accountable for the harm their failed treatment efforts can cause, including when a patient attempts to die by suicide. This is especially true in an inpatient setting where care providers should quickly be able to identify when a medication is doing more harm than good.

Improving Mental Healthcare in Inpatient and Outpatient Settings To Prevent Death by Suicide

Centers for Disease Control and Prevention list a history of mental disorders, and particularly clinical depression, as among the top risk factors for suicide. Unfortunately, while there are many medications to treat mental disorders, a trial-and-error approach is usually taken to decide which of these different drugs to try.

Scientific America gives an example of one patient who had been in and out of intensive psychiatric care over close to two decades. She had been diagnosed with bipolar disorder and had experienced periods of suicidal depression.  She had been prescribed antipsychotics, antidepressants, anticonvulsants, mood stabilizers, and anticonvulsants. She had also undergone group and individual therapy, cognitive therapy, and behavioral therapy- but none of the treatments received had made any lasting impact.  The medication she’d been prescribed did lots of different things, from blocking dopamine to focusing on norepinephrine.

Her story was common, as mental illnesses are frequently treated based on guessing which medications will affect observable symptoms, rather than based on getting a correct diagnosis of an underlying cause and treating that specific condition. Genetics and brain imaging in the future could provide clearer answers regarding what is actually going wrong in the brain structure or brain function so more accurate treatments could be provided, and there has been extensive research in this area. Unfortunately, there are continued challenges in finding common markers within different diagnoses.

While treating with medication and experimenting with different drug therapies is challenging and imprecise, it is likely to be the most common method of providing care until research advances. When a patient is in an inpatient setting and different medications are being experimented with, it is imperative for care providers to ensure they are monitoring the effects of medication and are alert for any potential risk of suicidal ideation.  When nothing is working,  Electroconvulsive therapy (ECT) should quickly be considered and carefully explained to the patient and the patient’s family.

The Link Between Cancer Diagnosis and Suicide

Study shows that the first week and first year after diagnosis have elevated risk

While it’s well-known that people suffering from cancer also face high levels of distress and psychiatric symptoms, some research indicates a specific link between the cancer diagnosis itself and death by suicide.

In one study, researchers reviewed medical records on 14,000 people, 786 of whom had been diagnosed with a type of cancer. The study found that among those with a cancer diagnosis, the overall suicide rate doubled compared to the cancer-free population – with significant increases beyond that in the time immediately following the diagnosis.

According to the study results, the risk of suicide increased by a factor of 12 within the first week after diagnosis. That risk tapered off over time, but remained high, as patients diagnosed with cancer were five times more likely to die by suicide within 12 weeks of the diagnosis and three times more at risk within the first year after diagnosis.

Significantly, the research also found a link between prognosis and suicide risk. Those patients who were diagnosed with more deadly cancers, as well as those who were also suffering from another medical condition, were more likely to die by suicide. That suggests that a feeling of hopelessness was partially to blame for their deaths.

Intervention after diagnosis can prevent suicide

One of the most persistent suicide myths says that when people want to attempt suicide, nothing can be done to stop them.  The reality is that a person’s urge to end his or her own life will pass with time. The study results bear this out, as the suicide risk was observed to be strongest right after diagnosis – when the situation seemed most dire – and tapered off substantially as people went on living after being diagnosed with cancer.

Suicide prevention attorney Skip Simpson knows that compassionate—don’t gloss over the word; it is important—intervention can make all the difference for a suicidal person, even someone suffering from a disease as grave as cancer. Most people who are prevented from dying by suicide recover from their impulses to take their own lives. Even someone who seems hopeless still has the capacity to face cancer with determination and a will to live.

Sadly, too many patients never have that chance. Doctors who specialize in treating cancer rarely have the mental health training or experience needed to recognize the warning signs that a patient may be at risk of dying by suicide. Too many patients die while their lives are in the hands of people who are supposed to protect them.

Friends and family members need to be aware of the heightened risk of death by suicide in the weeks and months following a cancer diagnosis. By proactively intervening and encouraging people to seek help, it’s possible to protect patients when they are at their most vulnerable.

Preventing Suicide Through Early and Universal Mental Health Training

Montana universities are taking steps to address suicide epidemic

At the first ever Montana Suicide Prevention Summit last month, advocates for suicide prevention called for mental health and emotional education for the general public, starting at the grade school level.

Marny Lombard, the mother of a Montana State University student who died by suicide in 2013, and Karl Rosston, the suicide prevention coordinator for Montana’s Department of Health and Human Services, were among the key speakers at the summit. Both emphasized the need to prepare ordinary people to recognize and appropriately address suicide risk factors rather than relying exclusively on mental health professionals.

Montana has the nation’s highest suicide rate, nearly double the national average. Every other state in the Rocky Mountain region is close to the top as well. And while some suicide risk factors, such as altitude, are geographically fairly unique to the Rockies, most hold significance nationwide.

Rosston cited several suicide risk factors common in Montana and the surrounding states, including social isolation, easy access to firearms, high rates of alcohol consumption and a social stigma against mental illness. Many people in the West, particularly men, are uncomfortable seeking professional help for depression or emotional health – and that’s true in other parts of the country as well.

That means friends and family must play a key role in encouraging, supporting and protecting people at risk of suicide. Lombard pointed out that at-risk college students are much more likely to turn to their friends than professors or mental health professionals.

Friends and family members can help to prevent inpatient suicide

Even in cases where at-risk persons are already receiving professional help, friends and family play a hugely important role in preventing suicide. The unfortunate reality is that many mental health professionals lack the training and experience to recognize and appropriately address the warning signs that a person is at risk of death by suicide.

Friends and family members who know a person’s interests, background and personality are especially well-equipped to recognize early signs that a person may be at risk. Even when mental health professionals have the necessary training – and, again, many do not – there is no substitute for actually knowing the person.

Relatives and close friends of people in inpatient care need to be their advocates and their support system. Frequent visits and phone calls not only reduce the feeling of isolation that leads to many suicides, but also provide opportunities for loved ones to recognize those warning signs and work with caregivers to appropriately intervene.

Unfortunately, many mental health professionals fail to take appropriate steps to help patients at risk of suicide, even when they are warned of the danger. When that happens, friends and family members with some training in mental health are well-equipped to hold negligent caregivers accountable.

Skip Simpson has a couple of recommendations to understand what a friend or loved one can do to better understand how to help.  First, obtain training from the QPR Institute. There are three steps anyone can learn to help prevent suicide: Question, Persuade, and Refer.  See https://www.qprinstitute.com

Also, there is a quick read called “The Suicide Lawyers: Exposing Lethal Secrets” wherein Skip Simpson and his then partner were interviewed about what Skip Simpson had learned in his years of litigating suicide cases. Skip heard many clients say after starting litigation “if I had only known.” Skip Simpson wanted everyone to know what to look for and what to do before tragedy hit a friend, loved one, business colleague or anyone.