Coronavirus in Context: Suicide on the Rise amid COVID: How You Can Help

You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. We have a mental health pandemic as well as an infectious disease pandemic. And in some ways, it's only been getting worse. My guest today is Dr. Christine Moutier. She is the chief medical officer for the American Foundation for Suicide Prevention. Dr. Moutier, thanks for joining me.

Thank you, Dr. Whyte, for having me on.

Let's start off with some sobering statistics. 48,000 people died of suicide in 2018. 1.4 million attempted suicide in 2018. What's your reaction when you hear those statistics?

Well, Dr. Whyte, the sad news is actually that suicide has been at a level of prevalence that has really been in a state of public health crisis for a long, long time in this nation and even globally. And the trouble is, though, that it is moving in the wrong direction. We know through the CDC's tracking of suicide that since 1999, suicide rates around the country have risen by 35% over the last 20 years.

And the thing is, though, that science is shedding so much light on what not only drives suicide risk, but what can prevent suicide. And we're realizing that suicide, while complex, is a complex health outcome. And that means that there are prevention strategies and moments in time when it's really important to intervene, to support a loved one, to see a mental health professional. So we're learning so much more about that, and now it's time to implement more of that.

Well, how has the COVID pandemic impacting efforts at Suicide Prevention, including people's thoughts around suicide? There was a statistic reported today about suicide climbs much higher in rural communities right now than urban communities. Is it this feeling of helplessness, hopelessness, loneliness? What do you think is driving it with the COVID pandemic?

Right. I mean, suicide, as we know from the science, is multi-factorial. And so that means that there are always going to be several things that come together almost like a perfect storm that lead people to feel hopeless and desperate and potentially suicidal. And with COVID, what we know are the likely sort of obvious threats to a population's suicide risk and also to vulnerable individuals as well and those are, in fact, as you mentioned, things like being isolated, even if it's physically, that presents new challenges, right? To feel connected and to stay connected to loved ones and a sense of purpose and meaning.

But there are so many other things, too. The virus itself began as a unclear but then increasingly clear threat, and-- but we didn't understand everything about the virus, from a scientific and clinical standpoint. And so that level of uncertainty about what it could mean for my community, my family, my future-- all of that level of uncertainty has raised the level of anxiety for many, many Americans. And of course, some of us have a tendency already to let moments like this that are extremely challenging-- that it goes to a place of anxiety that can start really spiraling and actually affecting our health. It can affect our mood, our sleep, and really just a very, like, physiological change in the body and in the brain.

What are the warning signs that you should look out for-- for some-- and then how do you talk to someone that you're worried about?

Yeah, great question because the truth is, we all have the ability to notice things about each other. And you know, you don't have to be a trained mental health professional to detect when people's behavior starts to veer off course. Now, keep in mind, it might be subtle. Because remember, we are all really overly practiced at keeping our distress under wraps. And we actually are changing-- we need to change that culture, and it is changing. Stigma around mental health is going down, and that's a great thing.

But it does mean that if somebody is sleeping more, is withdrawing more, is speaking in ways that even their tone, they seem to feel more overwhelmed, trapped, desperate, or like they're feeling like they're a burden to others, those would all be signs that suicide risk could actually be emerging in that person. And that would be time to have a caring, supportive conversation with that individual.

So how do you start that? In medicine, you know, we're trained to talk about ideations. You know, even the terms don't even sound right. But we're trained to ask people, do you have thoughts of hurting yourself? But if you're a friend or a loved one, you might feel like, you know, should I ask it that way? And you know, I don't want to offend someone. You know, that-- that's sometimes what people are fearful about. So How do you-- how do you talk about it to someone?

You know, I think what you can do is start with your real relationship with the person and where it is natural. Now, you might exactly feel those ways. You're so right. People worry about offending or being incorrect. But look, a caring, loving, supportive conversation is going to be a good thing if the person is even just feeling a little extra stressed and they're-- they turn out not to be suicidal. That is fine. Then-- now they know that you care about them.

So I start the conversation privately. I try to make sure that it's not in passing through the hall or in front of other people.

Sure.

CHRISTINE MOUTIER: But to-- to engage them in a private conversation and say, you know, thank you for meeting with me. I'm noticing some things that have me worried about you, and this is not about judging you. In fact, it's because I care about you, and I want to support you. And in fact, there will be no judgment. But I'm wondering if there have been moments lately that you've been feeling overwhelmed or feeling stressed about things?

And you can ask the question in a very open-ended way to start-- in fact, that's very encouraged-- just so they have space and a platform to share. And even that very act of sharing some of their stresses and burdens can actually help them to feel more grounded, more supported. And for some who turn out to be truly at risk or having suicidal thoughts, it could be their first step in getting professional help that they're actually disclosing it to someone they trust.

Well, what's that next step? How do you connect someone to help?

Because now you've opened the door, and now they say they need help or you think they may need help. We're all not equipped to do that. So help our listeners figure out, how do we then connect them to help? I would encourage everyone to think about it in a-- like a-- think about a different type of situation where we're well practiced at it. If they had a broken leg or had some other major health issue or life stressor going on, you wouldn't feel obliged to solve that problem for you, but you would say, I want to help you in any way that I can. And when it comes to people who are feeling suicidal, just the very act of showing up and saying those words.

And-- and then, very importantly, as you're alluding to, is to introduce the idea of them seeing a mental health professional or starting with their primary care doctor, if that's the easiest way for them to get started with talking to a professional. And you can do that in a variety of ways. You could just simply say, have you-- have you ever met with a therapist or a mental health professional?

If you happen to be somebody who has, now would be a great time to just mention that because that takes all the stigma out of that kind of help-seeking. And you know, you'd be surprised that the people in your life-- you have no idea-- who have all been the therapy, who may have been on antidepressants.

And you know, mental health is a part of human health. So you can actually play a role with destigmatizing these issues. And if you haven't, that's fine, too. And what I would say is, is there some way that I can help you find the right kind of help? And you can go on our website, ASFP.org, to help you find that kind of treatment, give you some ideas about linking up.

Right now, during COVID, many mental health professionals and clinics have begun to offer teletherapy, even if they hadn't before COVID. And so now is actually a great time to start accessing mental health care.

Is it different if someone has attempted suicide versus someone who's only thinking about it? There are people that attempt suicide that never get into the health system because they don't, you know, end up in the emergency room lobby or somewhere else. So how is it different in that situation, if a loved one, close friend, maybe even a co-worker has attempted suicide?

Yeah, great question. Because the truth is, many, many people will have suicidal thoughts at times, but fewer people go on to attempt. And so having already attempted, if that's someone in your life, that should tell you that their risk of suicide is higher than the average person out there. And we always take suicidal thoughts seriously. But for a loved one or friend who has already attempted, I would just have it even more a sense of urgency and importance for them to engage in mental health care, if they haven't yet. And if they are already in care, it's just important that they're keeping in close contact and making sure that their provider is aware.

You know, I do want everyone to know, too, that the National Suicide Prevention Lifeline, which anyone can access 24/7-- 1-800-273-TALK-- is not only available to people who are in distress but to the people who are helping them and in that conversation. So you can get guidance anytime of day if you find yourself in a conversation where you realize, oh gosh, they're-- they are having suicidal thoughts, but I'm not sure if it's truly urgent. Because again, someone having suicidal thoughts is absolutely to be taken seriously and it's concerning, but it does not mean they are necessarily about to act on those thoughts. In fact, the likelihood is low, just odds wise, because of how common suicidal thoughts are.

Tell us what you're hopeful for.

Well, during COVID, I mean, there-- all of our lives have been turned upside down. And for some people in the population, this has meant an extreme stress load, extra trauma. But what we also see, and the things that, to me, are the most hopeful aspects of what we see happening, are that because of how ubiquitous this experience is, different for different people but nevertheless, hard for most, we are all talking about mental health and experiences of, you know, changes in mood and anxiety and drinking more that-- that-- that we didn't always feel comfortable talking about before. Now it's so common that that has normalized the dialogue. And believe it or not, just talking about it, again, can help.

The other thing is that, as I mentioned earlier, telehealth services became-- suddenly exploded, widely available because of the virus itself and the need to be able to treat patients safely. But that has also revolutionized mental health care in a very good way. That's a super positive thing as well.

And I guess the last thing is just the sense of community cohesion that we're experiencing. And I hope-- I hope everyone can tap into that because, again, it comes with something that is on a global level where none of us are alone in whatever we're experiencing. But to realize that, believe it or not, for some people who have suicide risk, that alone, that sense of togetherness and connection can be lifesaving. So there are some reasons to hope, but it is certainly a time that more than ever, suicide prevention is a priority and needs to be a priority, you know, at the national level.

Well, Dr. Moutier, I want to thank you for sharing your insights. I want to thank you for raising awareness and also letting us know about some resources that are available.

Absolutely. Thank you, Dr. Whyte, for-- for featuring this segment on suicide prevention. It is so very important, and everyone has a role to play in preventing suicide.