Are protective laws really working?

Over 700,000 LGBT adults and more than 158,000 LGBT youth live in Texas. They are doctors, store clerks, parents and students. Just as many are in shelters, estranged from family and friends and at extreme risk for the tragedies of a harsh and often short life. All face challenges based solely on who they love, and who they are.

Some lawmakers want to pass bills dictating public bathroom use in public schools and strip protections from LGBT students. Their health and sex education needs are not being met in school, and that’s true in the adult world as well, where there is a severe shortage of accessible mental and physical healthcare for trans and queer individuals. A bill introduced in 2016 even suggested that outing LGBT+ students to their families and peers should go hand in hand with one that previously allowed students’ concerns relating to gender identity (like bathroom use to be addressed) privately on a case-by-case basis.

The problem is, if students are not out on their own terms, there is most likely a good reason for it. As it stands, 40% of homeless youth report as LGBTQIA identifying. According to a 2015 GLSEN study on National School Climate, 66.2% of queer students felt discriminated against at school due to their orientation. Students who face these high rates of discrimination are more likely to miss school as a result.

They want to avoid bias, harsh language, bullies, and the mental anguish that should never jeopardize education. As they are tormented, we lose them. LGBT+ identifying youth are five times more likely to attempt suicide than their straight peers. The Law Offices of Skip Simpson advocates for all who have sadly died by suicide, and the loved ones left behind.

Sticks and Stones: The Effects of Bullying

Recently, David’s Law was put into effect. Following the tragic death of a student from Alamo Heights due to bullying, the law is meant to hold school districts responsible for the abhorrent and deadly behavior of students on campus, and online. Cyberbullying kills: it has taken the life of a 12-year-old cheerleader, among too many others.

The law, decided upon after the main source of bullying was discovered to be via text messages, covers bullying on a cell phone, computer, camera, messenger apps, texts and social media. If this occurs on school property, during a school activity or on a school bus, punishments can be meted out. In addition, if such actions disrupt a student’s access to education or disrupts school activities, the measures of the law can be applied.

LGBT youth are at risk

Without a society that accepts who they are, many youth and young adults who are discovering their identities may find themselves met with more opposition and anger as they dare venture into expressing and embracing their honest selves. Using the bathroom if not given a unisex option can become a matter of personal safety. Students affected by harmful legislature will see headlines like this one from USA Today: “In Texas: ‘It’s an all-out assault on LGBT people’“ detailing the conflicting bathroom bills that would affect the trans population tremendously. This is the material our queer youth have to look up to, the future they’re presented.

The mental health of LGBT youth requires special attention, but not all have access to counseling, or remain in the closet out of fear. Without help, many families are left wondering what went wrong, what could have been prevented, and why schools took such little action. Recently, advocates for LGBT youth and rights have spoken out in Connecticut after suicides by trans and gay teens this summer.

One activist was quoted as saying: “To sit in front of a child who looks you in the eye and says, ‘I just want to die. Why should I live? The bullying is not going to stop.’ It is heartbreaking.”

The numbers only get higher

The National Transgender Discrimination Survey showed that about 41% of the trans population attempt suicide.

• The CDC presented research on students in grades 9-12 and found that LGBT students experienced higher rates of physical and sexual violence than straight students. Bullying was also found to be higher. Other findings of the study concluded that LGB teens were:
• Twice as likely to experience physical and sexual dating violence
• Twice as likely to experience online and school bullying
• Four times more likely to attempt suicide
• Five times as likely to have reported usage of illegal drugs and substances to cope

One Ohio college sophomore was punched in the face for kissing his boyfriend. The same student had almost died by suicide at the age of 16 after attempting to crash his car. In discovering his sexuality, he became afraid of the teasing and bullying that would follow when his peers found out. “That was the only way out…” he was quoted as saying in an article by NBC.

According to The Trevor Project, an outreach program for suicidal and troubled queer youth, each episode of LGBT harassment increases the likelihood of self-harming by 2.5 times, and one out of six students between grades 9-12 contemplated suicide seriously in the past year.

“I actually thought I was inhuman.”

Salem Whit, a teen from Spring Grove, Pennsylvania, recounted their experience with bullying surrounding their gender identity with those chilling words in an article published by The Atlantic. Coming out as transgender in high school was not easy, and they barely managed to graduate after skipping classes and dropping extracurricular activities in order to avoid the bullying. They even stopped speaking for a while, when dysphoria (extreme disconnect from body, gender, voice, presentation) triggered a hatred of their own voice. Their story is not unfamiliar.

The GLSEN report titled “Teasing to Torment: School Climate Revised,” pointed that LGBT youth have lower grades in middle and high school, and are not as likely to complete their education as their straight and cisgender (non-transgender) peers. Trauma, including PTSD, is not uncommon in these children who grow up in a world that, despite some improvements, still feels hostile towards them.

Recently, at a Houston bus stop, a poster was put up at a bus stop that encouraged LGBT+ people to kill themselves. The graphic included a hanging cartoon body with a rainbow heart on its chest, citing suicide statistics of gay, bisexual and trans people and encouraging others to “follow.” It is easy to see why youth would not feel welcome or comfortable when hate speech and bullying is so blatant.

Bullying Kills

A student at Robert E. Lee High School in Tyler died by suicide, previously asking to be home-schooled because the bullying he endured was too intense to endure at school.

David’s Law should provide some relief for families of bullied teens, given that it targets one of the most vicious forms of attack: cyberbullying. However, queer teens are still unlikely to speak out to friends and family, and schools do so little to prevent harassment. There are an increasing number of children involved in the current youth suicide epidemic – in 2016 there were 11 suicides that took the lives of those younger than 25 in Pennsylvania. Several of the victims cited bullying as what tainted their mindset in notes, social media, or it was heard from those who witnessed bullying in action. Social media is a particularly toxic environment that David’s Law hopes to help address. Going home and logging on to your own corner of the internet is no longer an escape or stress relief tactic for youth. It can be a death sentence. For queer youth, the odds of being victimized are even higher.

We can help

Struggling youth deserve to know that they belong, they are loved, and they have worth in the face of a society that hasn’t yet fully accepted them. Death by suicide is an epidemic among youth, and LGBTQIA+ youth are on the front lines of assault. With a large gap in access to healthcare, homelessness brought on by rejection, and even educations in jeopardy due to bullying, young people need to be protected and spoken for. At the Law Offices of Skip Simpson, our mission is just that-to bring justice to those who have suffered a loss that could and should have been prevented. Contact us today.

Trevor Project Lifeline for LGBT youth: 866-488-7356

We lose more of our teen girls every day

For every natural death, there are many that could have been prevented with proper professional intervention and medical treatment. Across the country, youths entering adolescence barely have time to cross into this crucial developmental period without encountering obstacles. Bullying at school. Troubles at home. Early onset of mental illness – or misdiagnosis that leads to treatment for a condition that doesn’t exist. Unfortunately, many of our teens slip through the cracks when it comes to mental healthcare. Conditions at school, and in healthcare facilities consistently fail to prevent suicides.

As a consequence, the suicide rate for teens has skyrocketed. This is a problem that not many know how to address, but suicide lawyer Skip Simpson knows it needs to be addressed. Our youth are dying; action must be taken.

“I tried to kill myself three times”

The powerful words of a West Philadelphia teenager sadly aren’t unfamiliar to many in her age group. Teens, especially girls, attempt suicide at an alarming rate. The Center for Disease Control and Prevention found in a recent study that the rate of suicide among teen girls reached a forty-year high as of 2015. Between 2007 and 2015, teen boys and young men saw a 30% increase in suicide rates as well. Many survivors’ narratives relate back to bullying, and begin with self-harm as the start of a deadly journey to try and cope with life’s events.

Cutting, burning, skin picking, hitting and starvation are common forms of self-harm. They are meant to alleviate the pressure of being unwell, or unable to cope with events inwardly. Self-inflicted pain is a grounding practice for many teens who otherwise feel “numb” or overwhelmed. Identifying and addressing these habits is critical to saving a life, but many go overlooked by school psychologists and healthcare providers. A cry for help is often dismissed (especially in the case of women) as a cry for attention.

Often, the response is too late.

Dying younger, faster

An increase in admissions to hospitals due to suicidal thoughts or self-harm has cut a path across the nation. At thirty-two children’s hospitals between 2008 and 2015, numbers went up and the number of healthy and happy youth went down. The associated study (covering children between the ages of 5 and 17) showed that the largest increases were with teenage girls. Our nation’s hospital beds were overflowing with children who dreamed of ending a life that had barely begun. What was being done to prevent this?

One case of a fourteen-year-old girl rocked the state of Texas. Overwhelmed by bullies, Brandy Vela shot herself in front of her family. Shockingly, the harassment only continued after her death with horrific comments on a memorial social media page that her family had to deal with.

In Ohio, an 11-year-old girl who had survived brain cancer died by suicide in her family home after enduring relentless teasing and taunts.

Bullying is especially prevalent among LGBT youth, who have already statistically experienced more violence than the average teen. According to the CDC, out of LGB youth surveyed:

• 10% were threatened with a weapon at school
• 34% were bullied
• 28% had experienced cyberbullying
• 23% had experienced sexual dating violence in the prior year
• 18% had experienced physical dating violence
• 18% had experienced non-consensual intimate relations during their lives

Transgender youth, as cited in a study by the Cincinnati Children’s Hospital Medical Center, experience a devastating rate of suicide attempts and self-injury. Thirty percent reported a history including at least one attempt. Girls in the LGBT community are often marginalized by society, peers and family. As a result of marginalization and lack of intervention, we lose them.

The Substance of Suicide

Teens are no stranger to the national opioid crisis, and a common method of suicide involved overdose. Teen drug overdose deaths rose from 3.1 deaths per 100,000 teens in 2014 to 3.7 per 100,000 in 2015. A 19% increase in just the span of a year is not just a problem, but an epidemic. Many teens use drugs to self-medicate, or overdose on ones that they have been prescribed. Some have been prescribed drugs that have come with black box warnings from the FDA.

Intervening sooner rather than later

Completing a suicide involves a series of steps. Which one is being missed? School counselors may miss signs of self-harm, therapists may quickly dismiss ideations as idle thoughts and attempts gain attention instead of indicators of a serious problem. Being admitted to hospital inpatient units is no guarantee that the healing process will take place. After all, improper suicide watch is a prevalent problem in hospitals. Every year, approximately 1800 patients are dying in these facilities because patients are not being carefully watched. Suicidal patients are consistently placed on observation levels which give the patient plenty of time to hang themselves.

Where do we turn for help?

Every day we are given opportunities to show kindness to people around us. Our friends and family members need a word of encouragement or just a smile will help—instead of scowls. One powerful antidote to suicide is hope—hope that someone cares for and loves us.

Suicide lawyer Skip Simpson has dedicated his career to identifying and holding responsible parties that do not adequately provide proper healthcare in these crucial times. Our teens are a thriving generation who should live their lives fully. If you or someone you know has experienced a loss due to suicide that could have been prevented, contact us.

The dangers of mixing opioids and benzodiazepines in prescriptions

Psychiatric medication and treatment for disorders have come a long way since the days of crude lobotomies and other primitive forms of treatment. Medications and therapy treatments are constantly evolving, being tested, and being put on the market for those with brain disorders to be prescribed hoping to alleviate their suffering. However, the field of medicine has a long way to go.

A brain disorder is not a common cold. It cannot be cured with a simple order to take medication twice daily for a week, and there is no aisle for it in the local drugstore. A complex cocktail of drugs is often given to the suffering party and, over time, is updated and adjusted. Many folks are on multiple drugs at once, and many prescribing parties do not always make a combination safe for the patient. This type of malpractice can be fatal in the worst of ways: an attempt at treatment ending in an attempt at (or completed) suicide. A common, deadly happening is when opioids (painkillers) and benzodiazepines (anti-anxiety drugs) are mixed.

The loved ones of those left behind go through unimaginable suffering and pain when a suicide occurs. The loss is a profound and deeply felt one, especially when it could have been prevented with proper prescribing and care.

The FDA’s Pandora’s Box

A “black box” warning is FDA language for the strictest warning that can be placed on a prescription drug, meant to draw direct attention to a serious risk. Here, these labels should be affixed to popular painkillers such as OxyContin and Vicodin (opioids) and anti-anxiety drugs known as benzodiazepines such as Ativan, Klonopin and Xanax. It has been said by the director of Rhode Island’s Department of Health there is a “moral and professional obligation to be transparent about the risks and be cautious when prescribing the drugs to patients” as mixing the two can have fatal consequences.

Informed patient consent is vital when treating any illness, and mental health is a fragile umbrella that encompasses many disorders extremely sensitive to medication. It is the provider’s responsibility to know what medications their patient is taking, understand how they interact, and make sure they fully know of the risks . Failure to do so could cost a patient’s life.

Depressing the Central Nervous System

The main problem with mixing these two drugs comes from the fact that both act as CNS type medications-central nervous system depressants. This means that both can slow down heart rate and breathing. Many people who take these drugs are sensitive to their effects, which decreases the amount needed for a fatal overdose.

This warning would affect hundreds of products for patients trying to manage pain and anxiety, seizures and insomnia. Besides being a deadly combination on their own, the two categories of medication are highly addictive. In treatment, a provider may make an at-risk addict out of their patient who may ultimately die by suicide.

Finding help

Guidelines warn doctors of the dangers of prescribing the drugs together. Substantial increases in overdoses and suicide should be warning enough. Some prescribers do not heed the warnings, meaning that many families are left with empty seats at the dinner table, and patients with easy access to a dangerous combination of drugs that can all too easily lead to overdose.

I formerly was a federal prosecutor for the department of justice specializing in organized crime-narcotics. I learned that some physicians joined big Pharma in raking in profits not to help patients, but to help themselves.  I am pleased that the Drug Enforcement agency is working hard every day and night to put these crooks in jail.

Loved ones may be asking themselves where to turn next, and thankfully the answer is simple. Contact us at the Law Offices of Skip Simpson today to schedule a free consultation about your loss, your case, and your first steps towards recovery.

As the rate of veteran suicide rate increases, awareness and action are slow to follow.

Post-Traumatic Stress Disorder affects scores of Americans, a hefty number of them veterans. The severity of the disorder can range from flashbacks, panic attacks triggered by sounds, tactile sensations, or even certain words to insomnia and self-destructive behaviors. PTSD, as it is commonly known, is harsh on the life of a homebound veteran, and often requires therapy and/or medication to assist in rehabilitation—and NOW.

Holding a job can be difficult, and this affects income and ability to provide oneself with housing and proper accommodations. This is why many people with PTSD, especially veterans, are at risk for homelessness. Among mental illnesses plaguing the homeless, PTSD is one of the most common. When left improperly treated, or not treated , self-destructive behavior caused by PTSD can cause suicide.

At least 22 veterans are lost to suicide daily according to 2014 studies, especially young males under 30. Young veterans are twice as likely to have their lives ended by suicide than civilian men in the same age range.

What is PTSD?

Mental illnesses manifest physically and through behavioral symptoms. To properly treat Post-Traumatic Stress Disorder, it must be understood by professionals. It usually comes from a traumatic event, cluster of events, or prolonged trauma that severely affects natural stress responses. It is often a lifelong problem and can affect a veteran’s life from the moment they return home. Symptoms include:

• Flashbacks
• Insomnia and nightmares relating to the event
• Agitation and hostility
• Hypervigilance
• Unwanted thoughts
• Some may even experience hallucinations and hear voices

When veterans are exposed to high-stress situations or witness a devastating event (especially if they are already predisposed to anxiety or stress responses) they become at risk for developing PTSD. In flashbacks, they may physically or emotionally relive the event, or disassociate and believe they are back at the scene. In severe cases, patients may hear intrusive voices that promote self-destructive and out of character behavior.

How does it affect the brain?

When stressed, our brain signals our body to respond. Pupils dilate, muscles become stiff, and we think faster while becoming more vigilant. For most people, this is a temporary state. But for people with PTSD, the brain can almost constantly be in a state of “fight or flight” thanks to the release of the stress hormone cortisol. Chronic stress can even damage the physical brain structure.

The amygdala is a part of the brain that contributes to the control of a fight or flight response. Normally, parts of our brain that contribute to higher, more logical ways of thinking can calm us down. For example, thunder might frighten some with its sudden noise, but logic may calm us by remembering that thunder is just a noise that does not pose direct harm. In someone with impaired access to that thinking with an overactive amygdala and PTSD, the noise may remind them of the sound of combat and trigger a flashback.

PTSD also affects the memory. The hippocampus is another part of the brain involved in memory. It can help provide some logical context to the current stressful circumstances and calm the stress response. Affected by the disorder, it may not be able to perform those duties. In younger veterans, the brain may still be developing, making this impact even more powerful and dealing a harsh blow to readjusting to civilian life. This is one reason the young veteran suicide rate is so high.

Veterans’ Health

Returning troops suffer from PTSD at a rate of 15%, and have to wait to see specialists. The VHA currently has hundreds of thousands of claims left unprocessed as a backlog, making access to much needed treatment incredibly difficult. Private practitioners, if veterans can reach them, may not be able to properly treat the unique experiences of veterans, and inpatient units may not prevent an attempted suicide due to lack of quality care, poor staffing and leadership. Without proper coordination, attention and compassion, veterans in inpatient units can die a preventable death. Failing to prevent suicide is something providers must be held accountable, especially for veterans returning from duty.

Action can prevent suicide. Enrollment in the VHA has proven to help, as veterans have access to support and care, and a community. But funding and direction towards these resources is still lacking. Some veterans are simply brought home and left without direction, or on a long waiting list. Action can save lives, and our veterans deserve the treatment they need to make up for what they’ve lost in the line of duty. Some veterans have even died by suicide while waiting to receive mental health treatment. The lines are simply too long, and the stigma surrounding mental illness remains a problem. Work must be done to dismiss the myths that PTSD is a form of weakness and fragility-it is a wound that must be cared for. Many veterans are falling through the cracks of the mental health system, resulting in suicides.

VA’s have attempted to help the overload problem with access to crisis centers and community service boards, but these treatments are inadequate to address a long-term problem, and even they have a backlog. They are understaffed and underfunded, and as a result, veterans suffer and die.

Skip Simpson says “there is no urgency to fix the mental health problems for our vets.  The delays our vets experience exacerbate PTSD—stress does that. Trying to navigate a system while suffering from a mental illness is tough. Lots of ‘happy talk’ about the vet’s welfare is disgusting.  One can imagine what the young man or woman– fighting to live– thinks when he or she watches the confusion in Washington D.C. It seems the politicians think only of themselves and not those they are sworn to serve.”

We can help

If you or someone you know has lost a loved one to veteran suicide, we’re here for you. Suicide is preventable with the right care, and failing to provide it can cause tragedy. At the Law Offices of Skip Simpson, we offer a free case evaluation to survivors suffering and looking for answers for those held accountable. Help should be given, not chased down with no results. Our veterans have protected us, and now it is the system’s responsibility to give back. How many times have we heard those words?   When the vet hears them with no action, it is just another reason to give up. Contact us today to take the first step towards justice.

A patients’ view of their quality of care is linked to fatalities

We expect inpatient facilities to offer a high quality of care and focus on healing for the patients placed in their charge. Under any circumstance, a patient deserves to have a successful recovery, and not have to worry about their mental state deteriorating while in medical care. Unfortunately, that is not the reality often, and facilities need more eyes on the patient. Many are underfunded, staff underpaid and not motivated to perform delicate tasks that could mean life or death for a patient. A staff with a cold demeanor, a “locked” versus “unlocked” facility, and an overall level of safety have been shown to contribute to the level of suicides in inpatient units.

For every suicide, there is a family suffering the effects. One less seat at the dinner table, one less presence around the holidays. Our psychiatric healthcare system is advanced in some ways, but much still must be done, especially to address staff not fully engaged with patients. That’s where The Law Offices of Skip Simpson can help. Every patient and their loved ones have the right to be compensated for their losses due to malpractice.  Skip Simpson says: “Money is not the only issue; it is also holding health care providers accountable. Clients want to know what went wrong and why no one will tell them what went wrong—why do they cover up their bad decisions about protecting their loved ones?  What steps are being taken to fix the problem so it does not happen again?”

What responsibilities do staff undertake?

Keeping a patient stable and in sound mind as well as body is crucial to preventing a death by suicide while in the care of America’s nurses and psychiatric staff. As it stands, the American Psychiatric Nurses Association has care guidelines that outline the expectations and goals of each nurse in relation to their treatment of a patient. These are all integral to stabilizing someone at the risk of suicide, or suffering from a psychiatric condition . The goals include:

• Manages their own personal reactions, attitudes and beliefs.
• Is authentic in their intent to help
• Recognizes the barrier between a patient’s desire to end pain via suicide and the nurse’s desire to help.
• Views each patient as an individual
• Makes a realistic assessment for the care of a suicidal, or potentially suicidal patient.

Nurses and healthcare staff take on quite a large role when they work in an inpatient unit or psychiatric facility. Someone’s life is literally in their hands. And how the patient interprets the level of care given to them is critical.

How do patients view their safety?

A suicidal, or potentially suicidal patient can easily be left behind in recovery if the proper care isn’t administered. A patient may want to end their psychological pain, which has become unbearable and affected their life to where every waking moment is sheer torture. This can be prevented if we recognize mental health as on par in the need for proper care as physical health. Patients with severe illnesses, such as schizophrenia, bipolar disorder, PTSD, and eating disorders (the mental aspect of which must be addressed to protect the physical) deserve treatment personalized, and demonstrates true care and compassion.

In a study from 2012, there were 35,000 or more suicides per year in the US, with about 1800 being inpatient suicides; the CDC does not count these inpatient suicides, so only guesses are made. Of those, 75% occurred in the patient’s bedroom, a place where they are afforded a little privacy. Suicide watches are implemented, but without proper preventive care, a patient may still feel unsafe and isolated. When one feels this way, alone and in pain, a compassionate staff can make a huge difference in their recovery. What is worrisome is these suicides usually play out near the staff.

Bonds with staff and nurses are also important to help the patient regain and retain a state of mind conducive to mental healing. When provided with a “care team” (usually comprised of medical staff and a therapist, among others) or even caregivers they feel they can turn to in times of need, patients may turn to them for much-needed aid instead of a closed door. Feeling safe is imperative. A psychological issue or mental illness often contributes to a feeling of loneliness. When your mind plagues you, and you are hospitalized, you are entitled to the chance to feel safe. With a gap in this much-needed care, recovery can be difficult. And this slipup by the care system can prove fatal.

A patient’s needs

According to another study, the data extracted from surveys and record pulls showed that patients had a specified set of needs, most of which matched up with the list of care guidelines provided by the American Psychological Nurses Association. The sick must be tended to for them to recuperate and live productive lives, and their needs must be acknowledged.

• “Lack of acknowledgment from observers” – a cold and neglectful staff can give the impression (often correctly) that the patient is not cared about, and further deepens their mental wounds. They may see themselves as a burden, or as if they deserved to be ignored. This only worsens suicidal thoughts.
• Feelings of objectification – being observed without actual interaction can further impede a patient’s feeling of borderline imprisonment. Being poked and prodded at does nothing for their health. Without support, patients’ conditions may worsen.

According to Today’s Hospitalist, making a standard assessment, checking in on patients, not being distracted during work (reading books, writing, seeming disinterested, etc.) and making a joint effort between all providers can save lives. Placing patients on a medical unit where they can receive two forms of support and care at the same time may also be an incentive worth pursuing. Caregivers must uphold their titles and provide adequate care to the sick.

Don’t lose any more

A patient’s safety is a patient’s life, and they must view it as worthy of care and protection. When this is taken from their care, or neglected altogether, it can cause fatal consequences. Inpatient units see too many suicides that could be prevented by a caring staff, a bond with someone who feels alone and without compassion they may have been lacking for a long period of time. Suicidal patients are in pain, and the job of a caregiver is to help treat that pain, not make it worse.

Leaders set the tone and are directly responsible for poor care in their facilities.

If you or a loved one have suffered a loss as the result of negligence of malpractice in an inpatient unit, let us know. Contact us for a free case evaluation, and we will help you get the justice you deserve.

Suicides are on the rise nationwide, and have been for some time. But no other part of America feels that increase quite as much as rural America.

A recent study published by the Centers for Disease Control and Prevention examined suicide rates throughout the United States between 1999 and 2015. While suicide rates increased nationally during this time period and reached their highest overall rate in 2015, smaller communities and rural areas saw the acceleration beginning in 2007-2008.

Rural areas have long had higher suicide rates than urban areas, and that trend has only gotten worse in the last decade. In order to protect the lives of people at risk of dying by suicide, we need to understand the risk factors that contribute to suicide rates in rural areas.

Lack of access to care, limited resources put rural residents at risk

Nationwide, we have an under-funded and under-equipped mental health system that fails to adequately care for people at risk of suicide. In rural areas, where the healthcare system is stretched thin to begin with, competent psychiatrists and mental health professionals are almost non-existent.

Politico recently reported on this lack of service with an account from an emergency room doctor in a small, rural community in Georgia, who often needs to care for patients at risk of suicide while also attending to those with acute medical issues. Because psychiatric hospitals rarely have beds available, these patients are left to board at the ER for days or weeks on end, receiving little if any treatment from medical professionals who are undoubtedly well-intentioned, but not trained or equipped to adequately care for individuals in crisis.  Good intentions don’t count; solid training in suicide prevention does.

And even when care is available, many people in rural communities find that it is inadequate to meet their needs. For example, many rural residents are still without health insurance and are unable to afford medications or follow-up care. Time and distance can also be prohibitive, as even if the patient can get an appointment, the nearest specialist may be hours away.

Telecommunications is part of the answer

In the day of telecommunications, it is troubling that lack of access to care is a problem for the mental health industry. Imagine you or your loved one is suicidal somewhere in rural America.  You are taken by paramedics or police to the nearest ER, where you are told that there are no mental health providers around. But luckily, the ER has videoconferencing equipment connecting it to psychiatry departments based in larger hospitals in other cities. These mental health providers are then able to screen for suicide and recommend proper interventions, all from a distance. In this way, telecommunication technology in healthcare or “telemedicine” could play a key role in saving the life of someone who needs to be protected from suicide, but is too far away from mental health specialists to physically reach this needed critical care.

How about proper training for emergency department physicians?

Telecommunications may not even be needed if the rural emergency room physician is properly trained in screening for suicide; they should be. If they are not they should demand the training from their medical schools.  What part of “emergency” do the medical schools not understand? The Suicide Prevention Resource Center has made training easy for the emergency physician. There is a “Consensus Guide for Emergency Departments” which trains the emergency doctor on what to do when a patient at risk for suicide presents at the emergency department.  Google it!

A comprehensive approach is needed to help prevent rural suicides

Other factors not directly related to medical care can also contribute to risk of suicide. Historically, rural residents have depended on friends and family for support; as families grow further apart, they may be left with increased stress and fewer options, especially in an economy that is increasingly unfavorable. There’s a strong stigma against seeking help with mental health issues in many rural areas that can be a further impediment to treatment, even when treatment is available. Moreover, there is a perception that inhabitants of rural communities are still acceptable targets for disrespect from city dwellers, which can add literal insult to injury in too many cases.

Because so many risk factors contribute to rural suicides, there is no single solution that can be identified to protect the lives of people at risk. Rather, a comprehensive strategy is needed to improve access to care, provide adequate training and resources for care providers, and encourage community engagement and social connectedness to help rural residents access the resources they need to mitigate the risk of dying by suicide.

In places where mental health resources are limited, friends and family members of people struggling with suicidal ideation need to be the first line of defense. They need to understand the warning signs, be vigilant, and advocate for their loved ones – and understand that there is no shame in seeking help.

An awesome place for gate-keeper training is the QPR institute. See http://www.qprinstitute.com. The QPR training will give you and your loved ones a great chance to live until professional help arrives, like CPR. By “professional help” I mean professional trained in suicide prevention; those who know how to properly assess for suicide and take the correct interventions to protect life.

Suicide has become a top cause of death for middle schoolers

Youth is supposed to be bright, radiant, full of opportunity and self-discovery. In middle school, this journey is often just beginning, and it can be an incredibly challenging one to undertake at such a young age. Children are introduced to a new social dynamic in middle school, one that has made itself notorious for bullying, cliques, and social pressure all while students undergo the changes that come with puberty. Not all of those changes are welcome.

The CDC reported that in 2014, more middle school students died by suicide than in car accidents. Car accident fatalities have been on a steady decline, with a few hiccups here and there, but the suicide rate among youth ages 10-14 has set itself to a painful beat, increasing steadily year by year. In the 7-year span before the CDC report, 425 children within that age bracket were victims of suicide. What went wrong, and what is currently wrong, with treatment and acknowledgement of mental health?

What causes suicide?

Teen and youth suicide is a growing health concern. As recently as January, two girls aged 12 and 14 leapt to their deaths from the top of a parking garage, with the reasoning surrounding the incident left unclear. According to the Jason Foundation, an organization devoted to addressing and preventing youth suicide, there are over 5,000 suicide attempts daily among young people from grades 7-12.

Many youth who feel like social outliers are often targets for bullying, a theme so ingrained into our society that it’s hard to find any form of entertainment with a middle or high school setting that doesn’t include the token “outcast”, often a “geeky”, “alternative”, or otherwise non-conformant youth. However, they aren’t the only targets. LGBTQIA youth are often preyed upon by cruel peers, and even teachers. Religious and ethnic minorities, along with troubled or disabled students often fall into their sights as well.

High Speed Connection to Harassment

Whether it be by personal computer, tablet or phone, access to social media and the internet as a whole is widespread and often unsupervised. Cyberbullying is a particularly potent form of harassment: the anonymity provided by the Internet gives bullies more freedom to inflict pain on their victims, and students often feel like there is no escape because the harassment follows them home after school hours. One victim died from suicide after enduring years of online harassment, her weight being the target for torment.

In Alamo Heights, a 13 year old girl died from suicide, harassed by classmates on an anonymous Instagram account. It wasn’t the community’s first encounter with youth suicide, with a previous loss leading to the implementation of “David’s Law.” Anti-bullying seminars are being held and bills passed, counselors are available, but the continuing epidemic has yet to be solved. Even emergency room providers sometimes fail to stop what is an exceptionally preventable cause of death.

Addressing Mental Health

Due to neglect from schools to fully address the problem, mental health issues in youth are often on the back burner, if addressed at all. Identifying at-risk students is critical to preventing youth suicide. Middle school students aren’t too young to develop serious mental conditions that often have high suicide rates, such as:

• Bipolar Disorder
• Eating Disorders
• Anxiety Disorders
• Depression

In addition, ADHD and autism spectrum disorders may go unchecked, and have the potential to impact grades and a student’s social life during a critical development period. The services students have access to at school, including academic and counseling resources, are often too few and under-utilized due to stigmas surrounding mental illness.

Look for the Signs

Parents, educators, friends-everyone involved in a student’s school life should be willing and able to spot warning signs of potentially life-threatening behavior in youth. “Picky eating” or “moodiness” due to oncoming or onset puberty are common dismissals of problematic behavior in youth, especially in girls. Talk of death, a disrupted sleep pattern, loss of appetite, sudden fears and social withdrawal are all common identifiers and red flags that may be easier to spot if adults combined seminars and programs with listening.

Survivors Aren’t Alone

Where the mental health system falls short, families of victims are left with few answers. The public is left with mounting concerns for the care of the suicidal, and those who may be inching closer to being at risk.  The last group anyone wanted to consider a risk pool is undoubtedly our youth. The Law Offices of Skip Simpson take every case seriously. Children should not only have access to adequate mental health care, but to understanding support networks and opportunities to flourish academically and socially. Suicide prevention attorney Skip Simpson is dedicated to this cause, and to finding justice for survivors who have been let down by flaws in the system. If this tragedy resonates with you or someone you know, contact us today.

More than 60% of the United States’ 30,000 annual gun-related deaths are due to suicide, outnumbering homicides. This is a startling statistic, one that leaves countless families with empty places at the dinner table and loved ones with questions that can never be answered. What caused this? What could have been done to stop it? And why is it often too late?

While most of us are concerned about the grim daily news reports and the safety of our communities from firearms (and rightfully so), there is also a population at risk of suicide, and access to a gun increases the risk of death. Suicide rates have increased over the years, becoming the 10^th leading cause of death in the United States in 2013.

Are we equipped to deal with this? We’re told to watch for warning signs of active suicidal ideation that might become reality such as a loss of interest in activities, talking about death, and withdrawal from socializing. Mental illnesses, especially bipolar disorder, schizophrenia, anorexia nervosa, and major depression can make everything more complex as they are at a much higher risk for suicide attempts. In addition, a sudden negative life event like a breakup, loss of a job, or financial crisis, can trigger thoughts of self-harm.

One key to understanding suicide risk is to realize that decisions to end one’s life are often, even if they’ve been planned, impulsive. Given time, the acute desire for suicide will pass. This means that anyone with access to a fast way to end their life is in far more danger.

Guns provide the means for many deaths by suicide

A gun in the home provides a lethal, and accessible, means of carrying out suicidal thoughts. Currently, there are an estimated 55 million Americans who own guns, and there are about 21,000 suicides by firearms yearly.  In April 2009, the eased process of becoming one of those millions of gunowners proved itself to be deadly with the purchase of a gun in New Hampshire. A young man visited a gun shop near Manchester, and within hours of leaving, had died by suicide. He was one of three people that week who had done the same thing after buying guns from the same store.

This prompted a nationwide movement, Means Matter, to partner suicide prevention with gun shop owners. There was, and still is, no telling what reason someone has to buy a gun. However, there is now a national call to attempt to educate shop owners on how to potentially spot a suicide risk in their business.

• Providing pamphlets and posters advertising suicide hotlines and help centers for shop owners to keep in the open. Hopefully, these materials will catch the attention of at-risk buyers.
• Dialogue: if a customer says they only need a small amount of ammunition, or that they’re not particular about a certain gun or learning about its use, this should send a red flag to the clerk to try and dissuade a purchase. Engaging in targeted dialogue can also cause a person to think twice; again, suicidal ideation usually passes with time.
• Distribution or encouragement to purchase gun locks. Access to firearms is all too easy. The more protection a gun has, the longer it’ll take to access, and the more time there is to prevent suicide.

Minors are especially at risk for suicide. Texas has seen too many youth gun-related suicides where the gun was already in the home, easy to access. Many were the result of bullying, one even prompting the passing of “David’s Law” that made cyber bullying a misdemeanor. In one such case, a Texas girl died by suicide in front of her family after relentless cyber harassment. Why was that gun so easy to access?

Texas has no state registry for firearms, and there is no waiting period to purchase one. While guns must be locked and kept away, that initial access needs to take less than a walk-in visit to a gun store, and homeowners need to keep an eye on their loved ones, another on the gun safe. This is a long process, involving the action of the public—gun owners and not, medical staff and psychiatrists, and the de-stigmatization of mental illness so people can find help.

There are too many questions, but there can be answers.

Contact the Law Offices of Skip Simpson for a free case evaluation if suicide has affected you or your loved ones, and if it could’ve been prevented by better action of practitioners. Accessing the means to self-harm is one step, ensuring the safe care of suicidal patients and at risk people is another. Give us a call today.

For years, facilities operated by the Department of Veteran’s Affairs have seen an epidemic of inpatient suicides. Over the last decade, an initiative taken to address suicide risks in patients’ physical environments has done a great deal to curtail that danger.

The VA is leading the way for civilian facilities in many different ways and I commend them for doing so. I hope the new commander-in-chief will keep up the good work—I am optimistic.  Patient safety starts with excellent leadership—that means from the very top.

Introduced in 2007, an “environmental checklist” was meant to help secure safer surroundings for those veterans placed in inpatient care to help curb the persistent suicide epidemic. The “checklist” has 114 items for VA hospitals and inpatient centers to tick off when identifying environmental risks that would pose opportunities for an attempt to complete a suicide. Items such as hooks, clothing rods in closets, door knobs and electrical sockets can be more than part of standard furnishing in a patients’ room; they can pose a deadly opportunity for veterans already at risk to act on ideations.  If the patient is psychotic, the patient must be observed line of sight or one to one. If not the patient can stuff food, clothing, toilet paper, or anything down his or her throat.

Thankfully, more than 150 VA hospitals have sought to implement the checklist; installing shelving and cubbies that lack sharp edges, removing hooks from walls and backs of doors, and moving towards making electrical outlets tamper proof. Eliminating these physical hazards takes stress off of hospital staff and allows them to focus on direct patient care; checking on the patients more frequently and receiving more elaborate training on how to identify, care for, and report patients at a risk for suicide. With the high turnover of staff and without the physical change of the patients’ environment, some precautions might be overlooked. Dr. Vince Watts, leader of a study on the checklist, commented that “hardwiring” changes into the facilities means that new or rotating staff couldn’t be forgetful regarding modifications.

Thankfully, the program seems to have had some success. During the duration of Dr. Watt’s study, the average length of stay in VA mental health facilities dropped from 11 days to around 7 days.

Has this method made a significant impact on veteran suicides?

While completed suicides among veterans remain far too prevalent in our society, the evidence shows that this is beginning to change. Prior to the checklist being implemented, the National Center for Patient Safety’s database reported a rate of 4.2 suicides per 100,000 admissions. Without such precautionary measures such as the checklist system in place, every patient could be one step away from taking their life. After the checklist was put into place, the suicide rate plummeted to 0.74 suicides per 100,000 admissions, showing that there is hope for the mental health care that our veterans deserve after their dedicated service.  However environment of care is just one part of the triad to protect patients: the other two parts are proper observation levels and medication.

The risk of suicide for veterans is currently 21% higher than the civilian population, but preventative measures are steadily helping to decrease that number. Crisis lines are actively hiring new responders and putting them through extensive training to properly handle the calls and issues they will face, measures to identify high risk veterans are being taken so a crisis can be stopped before it even takes place.

The VA’s example shows that something as seemingly trivial as a checklist for inpatient facilities to follow can save lives, and civilian hospitals ought to follow suit. By removing physical dangers from a patients’ presence and replacing them with more continuous, educated and accessible care, we can hope to see more lives continue and zero end too soon.

Inpatient psychiatric care is supposed to keep patients at acute risk of suicide safe and provide them with the assessment and standard of care they need to recover. But often, the nurses responsible for caring for these patients lack the training and proper experience needed to prevent suicide.  Hospital leaders, including all physicians, must ensure all staff—including psychiatric nurses– are trained and properly supervised to protect patients from injury or death. Sadly some hospitals put profits before safety and training takes from the bottom line.  Nurses, who believe they are not competent to protect patients must obtain proper training to become competent and not attend to patients until they are properly trained.

According to a report published in the Journal of the American Psychiatric Nurses Association, there are no standard competencies for assessing and managing the suicide risk for psychiatric mental health (PMH) nurse generalists – even though the majority work with acutely suicidal patients in inpatient psychiatric settings.

The language used in this report is chilling for anyone with an interest in the well-being of patients at risk of suicide. The APNA’s report indicated there are “serious gaps in nursing education” in suicide risk assessment, prevention and intervention, and there are “no developed structures and processes” for these generalist nurses who provide care and treatment to patients at risk of suicide.  Hospitals, to their detriment, are often relying on nursing schools to properly train nursing students on patient safety as it relates to suicide prevention.  The nursing schools don’t know what they don’t know about patient safety for suicidal patients. Consequently nursing students are being graduated not equipped for their duties in psychiatric hospitals.  Furthermore licensing boards are not properly testing nurses for suicide prevention in hospitals.

Other care providers in these same inpatient settings, such as most psychiatrists and some—but few– mental health clinicians, have specific training in suicide prevention. But because generalist nurses have, according to the APNA report, “the greatest contact with suicidal patients,” their lack of training exposes these patients to significant risk. The warning signs of suicide are often subtle and intermittent, and they can easily be overlooked by a psychiatrist or clinician who spends limited time with the patient. Meanwhile, the nurses who provide at-risk patients with direct care rarely understand how to recognize those warning signs – or how to appropriately intervene.  Most inpatient nurses do not know that death by hanging is the number one way patients die in psychiatric hospitals; nor do they know that patients will have irreversible brain damage in just a few minutes when brains are deprived of oxygen by hanging.  If nurses knew these facts they would resist any physician order requiring a suicidal patient to be watched only every 15 minutes.

Psychiatric nurses themselves identify a significant risk to patients

Perhaps most concerning of all, these PMH generalist nurses have self-identified the issue as being dangerously unprepared to work with suicidal patients. In one study cited in the APNA report, not one of the PMH nurses interviewed believed they were adequately educated to work with suicidal individuals. Most stated that they felt a “sense of inadequacy” when caring for patients at substantive risk of suicide – and those feelings of inadequacy could well cause those nurses to fail to intervene at critical moments.

Yet despite these significant warning signs, too many inpatient care facilities throw these generalist nurses, who will work with their most vulnerable patients, into a so-called “baptism by fire.” They are expected to learn on the job with little continuing education or support – and that dangerously inadequate level of care puts their patients at extreme risk of dying by suicide.

Fortunately, the APNA has stated that it will take steps to train psychiatric nurses in suicide assessment, prevention and intervention to provide a higher standard of care to future patients. However, inpatient care facilities are responsible for the safety of their patients. When patients at acute risk of suicide come to inpatient care, their care cannot be left in the hands of medical professionals not adequately trained in suicide prevention. And when patients die by suicide after not receiving adequate care, those negligent inpatient facilities must be held accountable.