People who die by suicide don’t always give warnings or show signs of suffering. They can appear healthy to others while concealing emotional pain, mental illness, or a personality disorder. According to Harvard Health, those who take their own lives often do so due to:

• Episodes of depression, psychosis, or anxiety
• A major loss in life
• A major life event that leads to stress or isolation
• Social isolation or loss of social support
• Changes in mood due to illness or medication
• Exposure to suicidal behavior in others

When suicide comes as a shock

The New York Post reports that a young woman from Manhattan, who worked as a dietitian, died by suicide after hanging herself in her West Village apartment.

Prior to her death, the woman posted a suicide note and apology to her mother online. In the opening line of the note, she said, “I have written this note several times in my head for over a decade, and this one finally feels right. No edits, no overthinking. I have accepted hope is nothing more than delayed disappointment, and I am just plain old-fashioned tired of feeling tired.”

Police were called for a wellness check after concerned co-workers reported that she didn’t show up for work. Another suicide note was found in a folder in her living room.

Like many suicides, the death of this young woman came as a shock to those that knew her. She clearly lived a life considered ideal by most people. She had a good career, social life, and seemed otherwise to be in good health.

So how do you recognize when a loved one or friend is suffering? How do you pick up on the subtle signs of potential areas of concern in someone who appears well on the surface?

When you casually ask “how are you doing?”, be alert to answer when your gut tells you something may be amiss. Don’t be afraid to talk to your loved ones and others for whom you really care about sensitive subject matters.

Overcoming the stigma

Many people who suffer from these feelings avoid expressing them or reaching out to others for help, not just because they don’t want to reveal their own vulnerabilities, but because they don’t want to burden others.

When an individual takes his or her own life, it can leave loved ones and friends with a sense of guilt, that there was something they should have done to prevent it.

At times suicide notes, when they are left, give us a glimpse into what research has shown. Psychology Today cites research into the notes left by both those who attempted suicide and those who died by suicide.

Among those who died by suicide, the most common factor was a sense of burden on other people. In addition, they had a history of being impervious to physical pain such as violently engaging in extreme sports, receiving multiple tattoos and body piercings, shooting guns, and fighting. They are typically not afraid of enduring the pain and intense emotions that come with completing the act.

Creating culture of suicide prevention

Not all individuals who die by suicide exhibit the same patterns of behavior or express the same signs. Suicide prevention shouldn’t merely be approached when we notice signs of suffering in a friend or loved one. It must become an active conversation in our culture. Those suffering from mental and emotional illness should be able to seek help without the fear of facing social stigma.

For many years, the Law Offices of Skip Simpson has witnessed the hold this stigma has on our society. Our firm seeks to help families and friends find closure and answers. If you lost a loved one due to suicide, we would like to discuss your matter and explore your legal options.

Perhaps the individual who died by suicide didn’t receive appropriate medical care prior to his or her death. Perhaps a thorough investigation into events leading up to the individual’s death could reveal other factors. Contact us today to find out what we can do for you.

Knowing what to do when dealing with a family member or someone else considering suicide can be overwhelming for anyone involved. Unfortunately, this issue doesn’t seem to be going away anytime soon. Recent data from the Centers for Disease Control and Prevention (CDC) shows a continued increase in suicide rates over the last 18 years.

That’s why organizations like the Suicide Prevention Resource Center are constantly searching for solutions aimed at preventing people from dying by suicide. One of the latest approaches includes talking about “lethal means counseling,” or safety in a health care setting.

What is lethal means counseling?

Elly Stout, director of the Education Development Center for the Suicide Prevention Center, recently wrote about the importance of reducing the lethal means in health care settings as an effective suicide prevention method.

Lethal means are anything commonly used by someone to end their life, such as medications or guns. Stout wrote that there’s “significant evidence of effectiveness” when it comes to “lethal means counseling in health and behavioral health care settings.”

“It’s up to all of us to promote these conversations as a critical part of safer suicide care around the country,” Stout wrote.

In addition, lethal means counseling should be a “key part of safety planning, which is a collaborative process between patients or clients and clinicians to create a written list of coping strategies and supports to use when suicidal thoughts arise,” Stout wrote.

What is an effective safety plan?

Along with removing lethal means from someone seeking help for suicide prevention, many health care workers and clinicians who deal with such issues believe that creating a safety plan can be an effective tool for someone at risk of suicide.

The Suicide Prevention Resource Center created a video outlining the importance of creating a collaborative safety plan. Such a plan should “identify specific behaviors, actions, and situations that help them stay safe,” according to the center’s website.

“It needs to be clear to the patient that this is something that’s being done collaboratively with them,” Vince Watts, MD, MPH, director, VA Interprofessional Fellowship in Patient Safety, VA National Center for Patient Safety, said in the video. “It’s really them identifying things that help them and then the staff trying to write those down, maybe give hints from their prior experience with other patients. But the patient safety plan is not something the staff would come up with. It’s something that the patient comes up with.”

Health care facilities need to take suicide prevention seriously

Attorney Skip Simpson has seen over and over again what happens when medical facilities do not take proactive steps to prevent deaths by suicide. When patients come to a hospital, the first priority should be to make sure they are in a safe environment. Removing lethal means is a critical step in that direction.

Seeking help for suicide prevention is difficult enough. The least hospitals can do for patients who do so is to remove risks from their environment.

You may have seen him on Saturday Night Live, cracking jokes and sporting a jokers’ grin. You may have heard of him in the tabloids after a highly public split with pop sensation Ariana Grande. And, if you are familiar with the trademarks of borderline personality disorder, you aren’t surprised by the whirlwind romance that came to an abrupt end.

Pete Davidson has taken the internet’s attention once again after the end of the relationship, but this time with a series of words on Instagram that brought out just how deadly the disorder can be.

“I really don’t want to be on this earth anymore.
I’m doing my best to stay here for you but I actually don’t know how much longer I can last.
All I’ve ever tried to do was help people.
Just remember I told you so.”

Ending the message with a heart emoji and deleting his Instagram, the celebrity drew concern from all corners of the globe. Some blamed Ariana, his recent ex (who herself just lost a former boyfriend to drugs) as if women are rehabilitation centers for troubled men, and as if her decision to leave a relationship was worth blaming another death on. Pete Davidson was accounted for, unharmed. And he was speaking up. Approximately 5.9% of adults in the US has BPD, according to NAMI. It’s time we learned about it.

What is Borderline Personality Disorder?

Profoundly misunderstood by the healthcare community, BPD is not an abbreviation for bipolar disorder, which is a severe disorder mostly affecting moods, but is a personality disorder that can change someone’s very worldview. Often described as unpredictable (and also often co-morbid in those with bipolar disorder) this disorder takes life away from sufferers. They view things in extremes, their hobbies and interests can flip at a moment’s notice, and their lives are a rollercoaster of unstable relationships.

How they view themselves and others is a constantly changing, never settling process.

Thought to stem from childhood abandonment, abuse, unstable relationships or other adversity such as poverty or an unstable home, BPD is deadly and acts quickly. Symptoms may include:

• Chronic feelings of emptiness
• Inappropriate, intense anger
• Difficulty forming bonds and trusting
• Self-harming behavior such as cutting, picking, or substance abuse
• Recurrent suicidal thoughts or threats
• Dissociative feelings, feeling cut off from reality
• Sudden, severe mood swings
• Sudden, fast moving relationships that end just as quickly
• Pushing people away intentionally, only to cling to them

People with BPD are often vilified. Seen as abusive, uncontrollable and people to stay away from, Pete Davidson has done the community a sincere service by addressing his illness. He’s spoken about his time in rehab, in which he thought that drugs induced moments of blind rage and breakdowns which impaired his memory. After first receiving a diagnosis for bipolar disorder, and another mental breakdown, he was properly diagnosed with borderline personality disorder.

How different are bipolar disorder and BPD?

Pete had been tweeting his support for Kanye West in speaking about his mental health, which had been a hot topic as the celebrity stumbled through the political sphere and often seemed like a puppet to some. His internet presence made very little sense. His grandiose behavior and recent history with extreme debt seemed like red flags to some, but humor for others. Kanye spoke up finally about his history with a bipolar diagnosis, making a dent in the stigma against mental illness (especially for men, and men of color) and it had given Pete the courage to talk about his own struggles.

Bipolar Disorder and BPD can be housed in the same brain, creating what must only be a truly painful daily experience for a sufferer, but their key differences are:

• Shorter, more frequent mood swings for BPD-a bipolar person can be hypomanic or manic or exhibit depression symptoms for weeks to months, BPD exists on a constant swing
• BPD produces more feelings that have the sufferer question who they are, and a fear of abandonment. This severely affects familial bonds, close friendships and relationships
• Borderline is a personality disorder, affecting some parts of the brain separate from a mood disorder like bipolar. Recovery and maintenance can be different.
• Fear of abandonment and unstable personal relationships are more unique to BPD as a symptom, whereas bipolar patients can have them as a product of their disorder.

Suicidal Ideation and Passive Suicidal Thoughts

Many people with various mental health conditions exist in a permanent state of wanting death. This can take the form of an ideation, almost like a yearning daydream, or a reoccurring thought that the sufferer simply wants life to end. This may not be accompanied by a plan or action, or even self-harm, but as a welcome intrusive thought that has made itself home among day to day activities.

Imagine every waking moment gagged by wanting life to end. Every anniversary dinner, every birth of a child, every morning coffee is dull and flat because you are alive and hate every moment of it. This is merely another symptom of BPD that is incredibly hard to control, as it can occur in any mood. Living in the public light has given Pete Davidson the opportunity to do several things that put a dent into the stigma around mental illness: ask for help, voice his feelings, and freely share his diagnosis while lifting up another performer.

Finding Hope

Though Ariana Grande begged fans to “be gentle” with her ex after he cited online bullying as a trigger for his disorder, Davidson has been publicly struggling. Ironically, that publicity has reached thousands diagnosed with the disorder, thousands more wondering if they’ll soon join statistics. Men especially are not encouraged to show mental “weakness” and too often live in a culture that would rather see them dead than in therapy.

Pete Davidson, Kanye West and many others are challenging that. Davidson himself wrote:

“I’ve spoken about BPD and being suicidal publicly only in hopes that it will help bring awareness and help kids like myself who don’t want to be on this earth…to all those holding me down and seeing this for what it is – I see you and I love you.”

Currently, the go-to therapy method for addressing BPD is DBT-dialectical behavioral therapy. Unlike CBT or cognitive behavioral therapy, which helps people identify  and change core beliefs and behaviors, DBT is skills-based.  Learning how to cope, and learning how to live, are two things that some patients may need to learn.

Offering a message of hope from such a large platform to anyone struggling with their mental health or suicidal thoughts is something that an entire massive online audience needed to hear. Thank you, Pete Davidson for your humor, entertainment, and helping your brothers and sisters of the world in a way only you could do. Don’t go anywhere; we desperately need you.  You are giving folks hope where there was none, and left us laughing too. What a gift to us.

Mental Healthcare for Healthcare Workers

Nurses take our lives into their hands daily. Thousands of patients pass through bustling hospitals waiting to address their various ailments with one of the world’s most in-demand professions. Doctors rely on them, clinics and hospitals can’t operate without them. Nurses deserve our appreciation, gratitude, and proper access to mental healthcare to address their own needs.
Suicide is an epidemic among healthcare workers, especially nurses. Long hours on their feet, limited breaks, and plenty of time spent in a stressful environment away from anything of comfort may be a necessary part of the profession, but it is costing them their lives.

The Picture of a Nurse

The words that the American Journal of Nursing use to describe the suicide epidemic among nurses are cold and stale. The prevalence is described as “disturbing.” Its study is “inadequate.” Often, we see nurses roles outlined as being overworked, yet never without a smiling face in a crowded waiting room. However, they are under mass amounts of stress. A medical environment, and partially one that could contribute to medical errors such as “never events”, surgical errors, and other forms of malpractice, often carries severe emotional stressors such as:

• Being a witness to human death and dying
• Inadequate equipment
• Excessive Workload
• Ethical conflicts
• Inadequate breaks

Many nurses are falling into “Nurse fatigue”, which can directly affect the quality of their work. In turn, using caffeine or energy drinks/pills to make it through another double, another night shift on less than 4 hours of sleep severely impairs mental health. One study showed that: “Sleep loss is cumulative and by the end of the workweek, the sleep debt (sleep loss) may be significant enough to impair decision making, initiative, integration of information, planning and plan execution, and vigilance.”

The problems faced at work caused by a lack of sleep and stress do not simply end there.

A balance of work, life, and death

Over 44,965 people died by suicide in 2016, making it the 10^th leading cause of death in the nation. There were 395,000 self-inflicted injuries and 1.3 million suicide attempts. Nurses were often at the forefront of helping save lives, processing attempts in the emergency room. But how many of us have brushed off scars as patient-inflicted injuries, or teary, sullen eyes as “hazards of the job” while under a nurses care?

Not even the CDC has cared to accurately measure the dangers nurses face. They have families, a demanding job, and little time for solace during their long shifts. Risk factors for nurse suicide include:

• Past attempts
• Mood disorders
• Access to means, such as prescription medication, sharp implements and toxic substances
• Feelings of inadequacy in their role
• A lack of culture that promotes safety and wellness (especially in mental health)

Without hard data to determine how many nurses fall victim to a lack of action in a culture of silence, we must focus on prevention. A study on workplace wellness reported that nurses felt cared for when their leaders saw them as whole people, not simply a tool in the workplace. To an employee already facing an uphill battle with mental health, this could be the difference between life and death.

Workplaces need to show nurses that they are just as valuable when they become patients as they are as workers. They need compassion, suicide screenings, positive reinforcement and shorter shifts with proper breaks so a lack of sleep doesn’t affect their mental health further.

Nurses are people, just as mortal as anyone in the Emergency Room. Healthcare providers should take heed to care for their employees in order to keep beds empty, nurses happier, children with parents and most importantly: to save lives.

Nurses do so much for us. They deserve to have the favor returned.

Youth in our nation could lose their lives

Much has been made of the current administration’s decision to detain migrant children – in fact, the administration recently moved to detain children with their families indefinitely, according to ABC News.

That’s troubling for a host of reasons, the least of which is that putting children in detention facilities has been linked to depression, post-traumatic stress disorder (PTSD), and other mental health problems that can lead to an elevated risk of suicide.

There is much we don’t know – but what we do know isn’t good

As the New York Times reports, child psychologists and human development experts have raised the alarm about the conditions migrant children face in detention facilities. Even the best institutional setting, the Times says, is a poor substitute for a family.

Children need personal connections, stability and consistency in order to thrive, and a detention facility can provide none of those things. Turnover is high among the adult staff, who may be detached and impersonal. Each adult in such a setting is responsible for a large number of children, further limiting the amount of attention each child can receive. In short, detained children – especially migrants in an unfamiliar place and with potential language barriers – are left to long for the care they need, which may not come for a long time, if at all.

In addition to the pure psychological issues, being in a detention facility or institutional setting at an early age can lead to health issues, such as heart disease, later in life. Those physical health issues, in turn, can lead to co-occurring mental health problems such as depression, anxiety, deadly eating disorders, and elevated risk of death by suicide.

The true long-term consequences of being in detention facilities are harder to predict, but the damage is real. Research suggests that a longer stay at a later age may require the longest recovery period. Some children may prove to be more resilient than others, but every child who is detained is at risk.

A glimmer of hope: potential for growth

Shocking and terrible experiences, such as being placed in a detention facility, have a deep and profound effect on the mind. In far too many cases, that effect is permanently damaging, leaving scars that never fully heal – and may later be realized in a death by suicide. But there is potential for survivors to emerge stronger than before, and our hope is to see that potential realized.

Post-traumatic growth (PTG) is the idea that victims of trauma can discover new personal strength, deeper meaning in life and a stronger sense of purpose. According to an NBC News article on the topic, PTG is not the opposite of PTSD; rather, it can happen alongside post-traumatic stress as the victim finds new ways to cope. And it’s more common than you might think – one study showed that 30 to 70 percent of trauma survivors report at least one sign of PTG.

While post-traumatic growth still needs substantial additional research, research suggests that children as young as seven can and do experience PTG – and that there are practical steps adult caregivers can take to nurture them along the way, such as:

• Hearing out a traumatized child’s thoughts and feelings without judgment
• Helping them to understand and process the meaning of traumatic events in a supportive setting.
• Narrative exposure therapy – a clinical technique that encourages survivors to create personally meaningful stories of their experience – can also move children (and adults) on the road toward post-traumatic growth.

It’s possible, even in the darkest of times, to find opportunities to grow and build resilience that will protect the survivor against future mental health issues and the potential risk of death by suicide. But in order to protect these children and help them to find new meaning after trauma, we first need to stop subjecting them to additional trauma, either by reuniting them with their families or finding them new, supportive homes. And then we need to make an immediate and sustained investment in the mental health services and resources they need.

Early intervention is the key to suicide prevention, most of all among those who have experienced severe trauma. These children deserve nothing less.

The collective wisdom of this country knows everything detailed in this blog.  Why do stupid things that hurt children?  What is the point?

According to the CDC, suicide rates have increased in every state across the US except for Nevada from 1999 to 2016. In 2016 alone, almost 45,000 Americans as young as 10 years old lost their lives to suicide.

Mental health statistics

According to National Institute of Mental Health (NIMH):

• In 2016, roughly 44.7 million adults in the US aged 18 or older (18.3 %) suffered from mental illness. However, only 19.2 million (43.1 %) received treatment.
• Serious mental illness affected 10.4 million adults in the US aged 18 or older (4.2 %), about 6.7 million (64.8% ) of whom received treatment.

Mental illness also affected these adult age groups:

• 1 % of adults aged 18-25, 35.1% of whom received mental health treatment
• 1 % of adults aged 26-49, 43.1% of whom received mental health treatment
• 5 % of adults aged 50 and older, 46.8% of whom received mental health treatment

Roughly 49.5% of adolescents in the US aged 13-18 suffered from mental illness. Among the age groups, mental illness affected:

• 3 percent of adolescents aged 13-14
• 3 percent of adolescents aged 15-16
• 7 percent of adolescents aged 17-18

Suicide prevention starts with education and early intervention

New York and Virginia have tackled the mental health epidemic through education. Both states have enacted laws mandating that mental health education be implemented in the school system. Frankly, it is disturbing to know other states have not taken the same or similar steps.

The New York law will require that mental health is included in curriculums in grade levels K-12. The law was passed and signed in 2016 but did not take effect until July 1, 2018. The law is intended to bring awareness to the issues and risks faced by those who suffer from mental and emotional complications. Those for the law believe that mental health education can prevent substance abuse and suicide.

Glenn Liebman, chief executive officer of the Mental Health Association in New York State, explained why mental health education is so important: “If you look at the statistics about mental health-related issues, it creates a very compelling case as to why this is so important.”

Virginia’s law (Senate Bill 953), which also took effect on July 1, 2018, will require that mental health topics be included in physical education and health for 9th and 10^th grade students.

With greater implementation of mental health education into New York and Virginia’s school systems, children who suffer from mental illnesses may have a myriad of resources for early intervention.

Recognizing the warning signs and taking action

The National Alliance on Mental Illness (NAMI) identified the early onset and warning signs of mental illness in children. About half of lifetime mental illness starts in adolescents around the age of 14, 37 percent of which are at risk of dropping out of school.

The warning signs that a child may be suffering from mental illness may include:

• Sadness and socially withdrawn behavior that persists for more than 2 weeks
• Self-destructive or suicidal intent
• Erratic and compulsive risk-taking or unruly behavior
• Unpredictable fear and anxiety which may cause physical symptoms: rapid heartbeat and shortness of breath
• Refraining from eating, eating too much, anorexia or bulimia
• Intense anger, sadness or unstable moods
• Drug or alcohol abuse
• Disruptions in sleeping patterns, irritability and other behavioral changes
• Difficulty in staying focused and academic problems in school
• Fears and worries that affect daily life and impair social function

These early signs of mental illness are not to be ignored. Bringing awareness to students, teachers and parents can make a difference in preventing substance abuse, destructive behavior or suicide. If you notice these warning signs in your child, NAMI suggests talking to a pediatrician, getting a referral to a mental health specialist, becoming active with your child’s school, and connecting with other families. A healthy network of social links not only keeps parents informed of their child’s behavior, progress, and in a support network should they need it.

Justice is possible

The new laws passed in New York and Virginia may provide a ground-breaking basis for suicide prevention, but more needs to be done. It’s important that the perception of mental health changes in our society. Children who may otherwise feel overwhelmed and hopeless may receive the support they need from educators and their peers.

But when responsible parties fail our children, they can be held accountable for negligence. Losing a child or loved one to suicide is a devastating experience. That’s why you should speak to an attorney experienced in helping families of suicide victims seek answers and justice.

Contact us today for a free consultation. We can help.

The winter blues are a false advertisement when it comes to suicide statistics

For as long as we can remember, wintertime has been pictured as the bleakest season. Indeed, Seasonal Affective Disorder (SAD) is often triggered by the dark and cold times. However, the popular myth that suicides are worst around the holiday season simply is not true. Seasonal landscapes don’t always line up with emotional ones. Time moves slower in spring and summer, and those plagued by mental illness may experience a type of melancholy that goes beyond simple summer nostalgia. Mental illnesses are real, and they can end lives. Without proper medical, therapeutic and interpersonal monitoring, patients are at risk of dying by suicide.

The Law Offices of Skip Simpson is dedicated to finding justice for the victims of suicide and the families left behind by their tragedy. We have years of experience holding negligible parties accountable for their actions that, if prevented, could have kept a mother, father, brother, daughter or son alive.  Families and loved ones should not have to worry about whether those they care about will survive the spring.

Seasonal change and mood disorders

Studies dating as far back as the 1800s show that suicides peak in the spring, and are actually lowest during the wintertime. This has puzzled scientists for decades. Most people will experience springtime highs and wintertime lows, but when the angle is taken from one of mental illness, everything is in hyperfocus. Springtime highs can mean manic or psychotic episodes, followed by earth-shattering bouts of depression.

People with mood disorders such as major depression, dysthymia and bipolar disorder are at extreme risk for triggers during the warmer months. Bipolar people, in particular, are more prone to mania (and its lesser form, hypomania) – an extreme, destructive elevated mood state that brings with it unhealthy behaviors and even possible psychosis. These states can even require hospitalization due to how disconnected the sufferer is from reality.

Delusions of grandeur may impair proper thinking, causing people with bipolar disorder to make rash and possibly life-threatening decisions like walking into traffic or jumping from heights, believing themselves invincible. Behaviors associated with hypomania and mania can include:

• Spending too much money, extreme amounts in the case of true mania
• Substance abuse
• Risky behaviors, such as careless driving, sexual activity or fighting
• Hallucinations
• Delusions of grandeur – believing themselves to be infallible
• Aggression and agitation
• Short-term memory loss

A study showed that people with a history of prior hospitalization were at higher risk for suicide attempts and death by suicide, which is associated with bipolar disorder and major depression.

Springtime is a time for close monitoring

Improper suicide watch is a leading cause of death within inpatient facilities, and a lack of education among staff only adds fuel to the fire. Some patients at risk of suicide are only monitored every 15 minutes. This simply is not enough. Roughly 6 times a day, in “secure” inpatient units, suicide occurs under the watch of medical professionals. Already at high risk due to seasonal changes, those with mood disorders and other forms of mental illness deserve better.

Outside of facilities, the headlines’ detailed suicides occurred in the spring, especially those of celebrities. Chris Cornell of the band Soundgarden was found deceased in his hotel room following a concert. While the loss devastated fans, it brought true attention to the issue: suicide in the springtime is too common to ignore. A study published in JAMA Psychiatry found that the risk of suicide increased with the number of daylight hours.

Those who were too physically depressed in the wintertime could feel energized by the increased sunlight, giving them the motivation to attempt suicide. Without proper monitoring by their care team and loved ones, these attempts could turn fatal. Healthcare providers should be at attention when the spring season comes about, and medication may have to be tweaked to accommodate a mentally ill person’s needs.

We can help

There were 44,965 suicides in 2016 in the United States; approximately one third of those suicides occurred while folks were in health care.  Improper and negligent behavior in monitoring or treating those with mental illnesses can lead to death by suicide. Every small change we go through – such as a seasonal change – is magnified for someone suffering, and must be addressed.

Every day, the families and loved ones of victims of suicide speak out to obtain justice. We help them. If you or someone you know has lost a loved one to suicide, contact us today.

Patients at risk for suicide after hospitalization

Inpatient psychiatric care treats and rehabilitates patients so they can return to life and live it fully, without the burden that mental illness imposed upon them. Mental health issues can be suffocating to those who suffer from them, preventing them from engaging in the day-to-day activities most of us take for granted. While outpatient therapy, medication and a strong support system have proven to be beneficial for those with mental illness, additional steps to ensure their wellness sometimes must be taken.

Psychiatric hospitalization is a double-edged sword. Reputable providers and facilities are often successful in stabilizing a patient’s mental state and illness. But diseases run deep, and not all hospitals are created equal. Patients in such delicate conditions must be kept for the right amount of time, in the right care, not left to make it on their own afterwards. The Law Offices of Skip Simpson knows all too well what the consequences can be after hospitalization under poor care. And we demand justice for those affected by death caused by suicide where negligent health care can be proven.

When is it safe to go home?

Getting people with mental illnesses to a hospital is hard enough . We hug and kiss goodbye. We hope and pray that our loved ones learn strategies for dealing with life and can sleep through the night in the care of skilled medical providers. Psychiatric hospital stays can range from five to seven days, the average time most people stay.

Shorter inpatient stays seemed to carry the greatest risk for suicide attempts post-discharge. Fifty years of data synthesized in JAMA Psychiatry noted that the suicide rate of patients in the first three months post-discharge was 100 times the global suicide rate of 11.4 per 100,000 patients per year in 2012. Suicidal thoughts and behaviors also were reported 200 times the global rate. Years later, the suicide rate in the United States continues to increase, especially among the young population and marginalized communities.  But what factors lead to this startling figure? Declining numbers of beds, funding for psychiatric treatment and access to affordable follow-up treatment (including at-home care) have dwindled. A number of patients tend to be homeless, with little to return to and no supportive care.

Mark Olfson, M.D., M.P.H, wrote in an accompanying editorial that “transitions from inpatient to outpatient care are often poorly managed,” and there is resounding truth in this statement. The strict routines and constant access to therapy and medical treatment are easily disrupted after patients are discharged. Other findings from this study include:

• -The 90-day rate of suicide was twice as high for men as for women
• -Psychiatric patients who received no outpatient care six months prior to hospitalization were at increased risk for short-term suicide
• -Efforts aimed at suicide prevention were lacking

Information from patients with mental disorders with a high rate of suicide as their cause of death such as schizophrenia, bipolar, and major depressive disorder were included in the study, which left us all asking the question: “what can we do”?

Stigma is society’s illness, and we aren’t treating it

In 2016, there were 44,936 recorded suicides. According to the American Foundation for Suicide Prevention, there are 123 suicides per day. And for every death by suicide, 25 people attempted suicide. Where is short-term psychiatric stay in this sea of numbers?

The practice itself has negative associations, and some who are admitted have little choice or autonomy in their own healthcare. “Instead of being understood as a valid medical procedure, taking someone to a hospital because of disorders of the mind might sound to the patient as a defeat, a failure…and thus, returning to the community after a psychiatric admission can become a difficult task…” Noted one study from Psychology Research and Behavior Management.

Transitioning from a hospital setting to one outside the hospital may make the patient feel “burdened” by the weight of their own disorder, seen by society and rejected as a failure. Most psychiatric disorders are chronic, the study emphasizes, and hospitalization simply cannot cure them. A database from the Oxford Regional Health Authority area in Oxford, England found that 14,240 patients over the age of 15 had 26,864 psychiatric admissions. Out of these patients, 134 died by suicide within the year after they were discharged.

Where is our healthcare system failing our mentally ill patients? One commonly cited issue involved a “revolving door” of patients: those readmitted to psychiatric facilities within a year after their discharge date, often not by their free will. Giving a mentally ill person the control and autonomy they need to manage their condition is essential to their health, and their life. They simply cannot be fed medication and forced to sit down in groups. The personhood of each individual must be acknowledged. But, in a healthcare system where the number of beds is rapidly dwindling and compassionate staff are stretched thin, more work must be done to insure the health and well-being of patients.

Mentally ill patients need support

An involved, caring team of providers is essential to the treatment and rehabilitation of a psychiatric patient, and the quality of life for a person suffering from mental illness. Upon discharge, there often is little follow-up involved to guarantee the survival of a patient. Unlike other illnesses, psychiatric disorders are often swept under the rug; hospitalization is a taboo, and family and friends may respond to cries for help with “get over it, it’s all in your head.”

These hurtful messages often echo a cruel, inhumane portrayal of the mentally ill in society. They also often undo whatever progress was made within the hospital. Society must understand that the brain is a living, complex organ that can become ill and requires treatment.

Dissolving family structures were attributed to frequent hospitalization in the Olfson study, and among those patients with schizophrenia, medication noncompliance was a serious issue. Why aren’t there more doctors, therapists and live-in nurses who can catch the suffering when they fall?

The meta-analysis of 50 years of data mentioned, conducted by Daniel Thomas Chung, of University of New South Wales in Australia, and colleagues, found that prevention efforts were lacking in hospital care. “Discharged patients have suicide rates many times that in the general community. Efforts aimed at suicide prevention should start while patients are in the hospital, and the period shortly after discharge should be a time of increased clinical focus,” he observed.

The first three months after discharge proved to be the most vulnerable. What can be done to help a person suffering from mental illness stay on track? Recommendations include:

• -Access to affordable mental healthcare
• -Supportive loved ones who can aid in home wellness checks if they live alone
• -An understanding society that normalizes mental health treatment
• -Regular check ins with therapists and psychiatrists to ensure treatment is continuing
• -Step-down programs, such as inpatient to intensive outpatient before full discharge
• -Live-in nurses
• -Compassionate, attentive hospital care

Justice must be found

Within those first three months to a year after discharge, too many lives are lost. Too many families and friends wake up to find their loved one is no longer with them, and it could have been avoided. Suicide is not a random act. It causes death from an illness that doctors and other medical professionals failed to treat appropriately and monitor after attempts at treatment. Understaffed, overworked hospital employees are constantly changing sheets on too few hospital beds. Medication prices are too high for too little effect. Health insurance often runs out before hospital stays are completed. Families and employers would rather see the mentally ill simply snapping back to “normal” instead of treating them with the compassion and care they deserve.

Too many parties fail to ensure the health and survival of the mentally ill. When death by suicide occurs after short-term psychiatric hospitalization, negligent parties must be held accountable for their actions or inaction.

Contact us for a free consultation if your loved ones have found yourselves searching for answers and justice.

Gun Storage, Youth Suicide And Reducing Risk for Children Prone to Self-Harm

Most often, the weapons are left unlocked, within reach, or loaded. If a child with very little knowledge of what it means to hold a gun can fire and harm themselves, what damage could be in easy reach for a child at risk for self-harm? Depression and other mental health conditions affect thousands of children and adolescents. According to the National Alliance on Mental Illness, 1 in 5 children between the ages of 13-18 have, or will have, a serious mental illness. A two year Suicide Prevention Resource Center study of firearm suicides in victims under 17 found that 82% of those who had died from suicide had used a firearm that belonged to someone in their family. A significant amount of those firearms had remained unlocked. Even with locked safes, many youths knew the combination or had the key to access their contents.

The Law Offices of Skip Simpson has helped many families in the wake of tragedy. These losses are preventable, and we aim to shed light on the factors that contribute to them, namely negligence.

Home Alone: At Risk Youth

Guns and mental health often intersect in a nationwide conversation. Who should or shouldn’t have access? What of our amendments? How do we keep our children safe in their own homes? The rate of youth firearm suicide has only increased over the years, and firearms in the home only create a larger risk of death by suicide to all who reside in it. Parents and caretakers have a unique responsibility in keeping their weapons out of reach from children. Any adult with access to where guns are kept should ensure that it is locked, and codes should not be revealed with children. A study in a recent issue of Pediatrics addressed whether or not gun storage differed between homes with at-risk youth, and those without. According to its findings, firearms were present in roughly 42 percent of households surveyed, and the ownership prevalence did not differ between homes with at-risk youth, and homes without at-risk youth. One third stored their guns locked and unloaded, and the storage methods didn’t seem to differ between households of various risk status, either.

This means that a child or teenager with serious mental health concerns has a fair chance of accessing a weapon, which could then kill them. A chilling story from Michigan in 2013 details how one thirteen-year-old child died by firearm suicide in a school bathroom with a handgun found at home. Though legally owned by the family, the question of whether or not the gun was stored properly comes into play.

Hanging, exsanguination, and other forms of suicide death can take minutes, sometimes hours to take a victim’s life. A firearm leaves little hope of survival. 90 percent of firearm suicide attempts end in the victim’s death.

Loaded, Improperly Stored Potential

Five-hundred and sixty-five children and adolescents died by firearm suicide in 2015. These deaths were preventable. Being able to assess and raise awareness for the presence of at-risk youth in the home should play a deciding factor in gun storage, or gun ownership to begin with. These deaths beg the question: why do caretakers not show a higher rate of safe gun storage when they house at-risk youth? Recognition of behaviors that could indicate a mental illness such as depression or early onset schizophrenia could save a life. Perhaps they believe their children or dependents simply won’t touch firearms as a house rule, or their knowledge of safe gun storage is out of date.

Currently, there are no federal laws for Child Access Protection, another issue that could lead to a death toll. In addition, storage laws vary from state to state, with common ground being that a firearm not in use should be stored unloaded, separately from ammunition, unassembled, and locked in a secure location such as a safe. When caretakers are lax with these regulations, or if they are not enforced in a particular state, the unthinkable can happen.

Accidental youth shootings are on the rise as well, some involving a home weapon and some involving a family member’s weapon. Children and firearms do not, and should not, mix.

Our Children Are Sick

Child suicide occurs more frequently in rural areas of the country, where a lack of access to mental healthcare has been noted. Adolescents in rural areas are far less likely to receive mental healthcare than those in urban areas, according to the U.S. Department of Health & Human Services. This could mean that at-risk youth aren’t even being identified at school, by a family physician, or by their caretakers. Our healthcare systems are failing our youth, and we are going to funerals as a result. Even in families with at-risk youth who store their firearms properly, there is no guarantee that a child can access one at a friend’s house, or another place where their access remains more open than it should be.

Suicide is the third leading cause of death for young people between the ages of 10-24. Cultural, environmental and mental factors all come into play when evaluating risks, and none should be ignored. Signs of depression in children and teens can include:

• Withdrawal from social activities
• Loss of appetite and increased fatigue
• “emotional flatlining”
• A preoccupation with death
• Hostile behavior
• Neglecting hygiene
• Risk-taking behaviors such as crossing the street without looking, or the use of substances
• Giving away belongings, especially those with sentimental value

 We’re Here For You

Responsible gun-owning families and caretakers should take precautions in how they store their firearms, specifically in restricting their access to children. However, we cannot know for certain that a friend or family member who is hosting the youth is storing their firearms properly. Caretakers may not know how to spot risky behavior and red flags for one’s mental health.

We do know that these fatal injuries are still a leading cause of death, and that they are preventable. Negligence on a caretaker’s part must be addressed. If you or a loved one are in need of legal support after a devastating loss, contact us today. We can help.

An epidemic bridging the generation gap

The mental health of the elderly often falls to the wayside in our conversations about the current crisis surrounding suicide. While the focus has lately been on the younger generations, who are seeing a rising number of deaths, we should never turn a blind eye to our elders. Sadly, that seems to be the case. Elderly people account for less than 10% of community mental  health services even though they represent 15% of the population, a number that could begin to dwindle if we do not take their health, mental as well as physical, into serious consideration.

The Law Offices of Skip Simpson knows how important taking care of loved ones is. We all age, and we all want a quality of life for our loved ones that is comfortable and safe. Achieving this takes more than buying a room, a bed and a caregiver; it means seeing ourselves as caregivers to our elders’ mental health. It could mean saving lives.

Brain Age: Loss of Stability Can Lead to Loss of Life

There is a common misconception that getting older means growing content with an emotional state of nostalgia, and this misconception easily leads to the dismissal of elder mental health care. According to statistics from the CDC, depression affects up to 5% of our elderly population, and their suicides represent 16.6% of the tragic total amount in the United States. What leads to the decline in mental health that seems to plague our elder population?

As we age, we begin to lose parts of our lives that have kept us stable, or remained part of our version of normal life for as long as we can remember. Age contributes to fragile health and can lead to a diagnosis of Parkinson’s, Alzheimer’s, dementia, cancer, or general deterioration of the body that many find hard to cope with. To callous and busy medical staff, these may just be diagnostic codes, but to the patients behind the files, they mean the collapse of a lifestyle they’ve built and been accustomed to for a lifetime. Other triggers for geriatric depression include:

• The loss of a spouse, immediate family member or close friends.
• Financial difficulties.
• Loss of ability to work.
• Loss of independence due to need for caretaking, inability to work, and adult children who do not depend on them anymore; this often leads to the elderly feeling “worthless.”
• Medication side effects, as from anti-inflammatory or cardiovascular drugs.
• Isolation: As we age, socializing may become more difficult. Older patients may be in hospitals or assisted living, away from family and friends. In addition, illness prevents the elderly from living their lives with the clarity and independence that they deserve.
• Slow-acting conditions such as arthritis and macular degeneration.

All of these factors play into the rapid decline of a senior person’s mental and physical health. While we may often see older folks as infantile (a view that is often considered offensive) and simple, they have mental health needs that are overlooked on a consistent basis.

Recognizing the Signs: Red Flags in The Elderly

Older white males are at a higher risk for completed deaths by suicide in this age demographic, 29 per 100,000 and over 47 per 100,000 if over the age of 85.  Due to cultural stigma trickling down from a past generation where men were not encouraged to speak about their feelings, and the systemic societal and medical problems that the elderly face, many feel silenced. They feel trapped, without the support of their families who are off living their lives while they remain stuck living alone, or in assisted living where the assistance is too often minimal. In some homes, registered nurses aren’t even on the premises most of the time, leaving patients without critical care. This problem led to the filing of a very self-explanatory bill: “Put a Registered Nurse in the Nursing Home Act of 2014.”

The statistics for elder suicide may in fact be under-reported. Very little focus is on their demographic, and the United States already suffers a startling lack of mental health support for its overall population. While it may seem difficult to recognize the signs of mental deterioration within our aging loved ones, red flags associated with the depression and loneliness that they feel are not so different than the ones we see in younger people:

• Withdrawal from social life
• Lack of interest in daily activities such as eating, socializing or basic hygiene, and a general lack of interest in life.
• Giving away prized possessions; this may seem normal as people advance in their age, but is hallmark behavior of the suicidal.
• Verbal signs such as “You would all be better off without me”
• Feeling a loss of independence
• A medical condition that could affect their impulsivity
• A recent death in the family, especially a spouse, sibling, child or pet.
• Sudden personality changes, especially with impulsive behavior

Missing the signs can mean the eventual loss of a life. Nurses and caretakers should be properly trained in recognizing when a patient or resident’s mental health begins to decline. The elderly population is often thought of as wanting to be alone, or desiring solitude to find calm. This mindset can come with a heavy penalty: death. “The proportion of older people who take their own lives without a diagnosable mental illness is very, very small,” says Dr. Conwell, a psychiatrist at the University of Rochester Medical Center.

Medical Complications: One of These Conditions is Not Like the Other

In yet another blow to the myth that aging is a peaceful and simple process, physical medical complications can contribute to the deterioration of one’s mental health. As previously discussed, the diagnosis of a medical condition can easily cause a rapid spiral into depression. However, some conditions like dementia and Parkinson’s disease can directly contribute to a lack of cognitive and emotional stability.

According to studies, the link between depression and Alzheimer’s disease is well-established. However, diagnosis may prove difficult, given that the presentation of dementia greatly varies. In one study, 11.8% of surveyed seniors with dementia lived with major depression, compared to 3.9% of seniors without dementia.

As with any condition that affects the brain, emotions can suffer. Factoring in the feelings of isolation, loss of independence and loneliness that seniors often feel can show an easily visible cocktail for major depression. Healthcare providers should take careful note to survey seniors using the Geriatric Depression Scale. Answered with a YES/NO format, these 15 questions are meant to be used as a screening for depression and depressive symptoms: 10 indicate depression when answered positively, and 5 can be indicative of depression when answered negatively. Screening, especially when a person already has a neurological condition, can help to assess the best course of action for treatment.

Medicare does cover mental health services, including prescription drugs. With not all seniors aware of their coverage, they could be missing life-saving treatment. In fact, 18 to 25% of elderly people need mental health care, but only roughly 3% of Medicare reimbursement is for mental health and psychiatric treatment.

Addiction: The Hidden Figures

Someone’s mother, grandmother, uncle, cousin or brother is caught up in the claws of addiction at this very minute. The opioid crisis is ravaging the United States, leaving no demographic untouched. With community agencies not equipped to take care of the needs of seniors, elder suicide is not often seen or dealt with by them. This leaves homeless and low-income seniors without many options for coping with their mental health. Sadly, some turn to substances in the absence of professional help.

Currently, widowers over the age of 75 have the highest rate of alcoholism in the United States. This seems to occur after the sudden loss of a partner or child, or unchecked trauma. An entire generation before us did not have access to the mental health care or even proper diagnosis for the effects of trauma or mood disorders. In an age where physical, sexual and emotional abuse were swept under the rug with most mental problems, older adults are left with untreated Post-Traumatic Stress Disorder, depression, and more.

Painkillers are an unfortunate second source of addiction. Relatively accessible for most seniors, the emotional high and relief from physical discomfort the drugs bring can be addicting at the first try.
“Chronic pain as a result of age, past injuries and other medical illnesses is certainly present in the older adult population,” said Dr. Wang of Caron Treatment Center, “It leads to prescribing painkillers for years, if not decades. “

According to research by Caron Treatment Centers, 39% of older adults entering treatment there come with a chronic pain diagnosis.

The signs of substance abuse disorder can be confused with those of aging by healthcare professionals who miss their mark. Thankfully, older adults are more likely to be willing participants in their own recovery, especially with the support of family or loved ones.

Nursing Home Protections Rolled Back

Under the new administration, the use of fines against nursing homes that harm residents has been greatly scaled back. Four of every ten nursing homes since 2013 have been cited for violations, often serious ones. While Medicare has fined two-thirds of the offending homes, the problems still exist. Failure to protect residents from circumstances that could cause injuries, neglect and bedsores are among the list of offenses.

New fining regulations in place discourage regulators from levying fines even in fatal situations. A promise to reduce the government’s presence in businesses has left many seniors at risk.

Hold Healthcare Accountable

With the demand for registered nurses to have a 24/7 presence at nursing homes, it is safe to say that at least some problems and gaps in our healthcare system have been identified. Seniors are a particularly vulnerable demographic that can easily fall between the cracks and go ignored, but they suffer surprisingly high rates of suicide. As our loved ones age, their needs for care change along with their bodies and minds. We entrust them to facilities and primary caregivers who should be screening them for depression, paying attention to changes in their behavior, offering accessible mental health, and being present when the elderly are ready to use resources available for them.

Most late-life deaths by suicide are completed, even though older adults do not attempt as often as their younger counterparts. This is largely attributed to an increased access to firearms or other lethal weapons. In some populations such as older veterans, detailed knowledge in operating them is a key factor in death by suicide. We as a society have the capacity to reduce these numbers, and we must hold the responsible parties accountable. Our healthcare has too little to offer our seniors, from the inconsistent presence of nurses in homes to the confusion of dementia and depression symptoms. Screening is in order. Proper care is in order.

If you or a loved one has lost an elder due to suicide, you aren’t alone. Help is closer than you think-contact The Law Offices of Skip Simpson today.