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Could Policeman’s Suicide Have Been in the Line of Duty?

In Grief, Policy, Stigma on January 29, 2010 at 4:34 am
100129-McCarthyFamily

Paul and Janice McCarthy pose with their children for a family portrait.

In “The Police Suicide Problem” in the Boston Globe Sunday Magazine, freelance reporter Julia Dahl probes the connection between trauma on the job and suicide by telling the story of Janice McCarthy’s crusade to have her husband’s suicide classified as a death suffered “in the line of duty.”

Janice took her case to the state retirement board, and in June 2007 her husband’s death was ruled “accidental.” The decision meant she would collect 72 percent of his pension (an “in the line of duty” death would have meant 100 percent and an additional one-time payment of nearly $100,000), but more important, it drew a line connecting his on-the-job injuries to his suicide, opening the door for what Janice McCarthy really wants — her husband’s death to be ruled “line of duty” and his name added to the National Law Enforcement Officers Memorial in Washington, D.C.

The issue is both complex and emotional on all sides, for in police culture giving one’s life “in the line of duty” is the highest sacrifice an officer can make.

Most of the police mental health workers [the reporter] spoke with thought the idea of a “line-of-duty suicide” was intriguing, but they weren’t exactly ready to sign on to a new classification. [Kevin Gilmartin, a retired police officer and clinical psychologist in Portland, Oregon], says he think it could create a victim mentality, and Dr. Audrey Honig, who is a former chair of the international chiefs’ association’s Psychological Services Section, says she thinks the better tack would be to lobby for recognition of some suicides within existing line-of-duty classifications …

Almost no one seems to think that there is much chance of getting the federal government to alter line-of-duty qualification rules any time soon. Partly, it’s a financial issue; more line-of-duty deaths would mean bigger payouts to surviving families. And then there’s the stigma of suicide.

[John Violanti, a former New York trooper who is now a professor at the State University of New York at Buffalo], says that in police culture it’s considered a “coward’s way out,” and line-of-duty benefits are reserved for “heroic” deaths.

Janice McCarthy, though, sees a clear connection between on-the-job injuries her husband suffered when a stolen bus was driven into his cruiser years ago, the post traumatic stress from that incident, and the emotional and mental downward spiral that ended in Captain Paul McCarthy’s suicide.

“The line-of-duty designation should be sacred,” she [says]. “For an officer to give his life is the ultimate sacrifice, but for a suicide to be categorically eliminated from consideration is unjust. Paul’s legs healed, but his brain did not. Instead, he suffered for 13 more years. His memory deserves to be honored for that struggle, and his children deserve to see their father’s name in its rightful place on that wall.”

Captain McCarthy is survived by three children, ages 12, 17 and 19.

[The abridged URL for this post is http://tinyurl.com/LineOfDuty .]

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Sen. Franken Says Service Dogs Might Prevent Veteran Suicide

In Policy, Prevention on July 20, 2009 at 9:51 pm

Al Franken’s first legislation as the newly-sworn-in Senator from Minnesota proposes providing hundreds of service dogs to veterans, which he writes in a column in the Minneapolis Star Tribune, “can be of immense benefit to vets suffering from physical and emotional wounds.”

There is evidence to suggest that increasing their numbers would reduce the alarming suicide rate among veterans, decrease the number of hospitalizations, and lower the cost of medications and human care. Veterans report that service dogs help break their isolation.

Franken is proposing the service-dogs-for-veterans program not as an arbitrary, “feel good” initiative, but as an honest-to-goodness scientific study, piloted in such a way as to prove its effectiveness and expand its reach if it measures up.

It costs on average about $20,000 to train a service dog and another $5,000 to place the dog with the veteran. It is my strong belief that a service dog will more than pay for itself over its life, and my bill is designed to determine the return on investment with a pilot program that provides service dogs to hundreds of veterans. My bill will help train a statistically significant number of dogs to measure the benefits to veterans with physical and emotional wounds. The program would be monitored and refined over a three-year period to optimize its effectiveness.

Whatever one can say about the viability of his proposal, it would be difficult to quibble with his earnestness–or to take issue with the the genesis of his idea, which came from meeting a wounded Iraq veteran who depends on his service dog in fundamental ways.

This January, I met Luis Carlos Montalvan and his service dog named Tuesday, a beautiful golden retriever, at an inaugural event in Washington. Luis had been an intelligence officer in Iraq, rooting out corruption in Anbar Province. In 2005, Capt. Montalvan was the target of an assassination attempt. Now he walks with a cane and suffers from severe post-traumatic stress disorder. Luis explained that he couldn’t have made it to the inauguration if it weren’t for his dog.

And, even if nothing comes of his first attempt at legislating, Franken should get credit for “thinking outside of the box” in support of suicide prevention for a population that merits extra attention.

[The abridged URL for this post is http://tinyurl.com/DogsForVets .]

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Suicide Prevention Action Alliance Seeks Grassroots Input

In Advocacy, Policy on July 17, 2009 at 8:33 pm

The Suicide Prevention Action Network (SPAN USA) invites you to participate in this survey if you are among “the grassroots network of survivors of suicide loss, suicide attempt survivors, national, state and community leaders, public and mental health providers and officials, coalition members and leaders, and researchers” involved in suicide prevention.

The survey is designed, according to Bob Gebbia, Executive Director of the
American Foundation for Suicide Prevention (AFSP) “to assist our staff and volunteer leadership as we prepare a summary of the progress made in preventing suicides since the National Strategy for Suicide Prevention was launched in 2001.” Gebbia wrote in an email invitation to fill out the survey,

Perspectives from you … are essential to understanding the accomplishments and challenges of the suicide prevention movement. The information we collect will be used to guide the continuing development of a National Action Alliance for Suicide Prevention, in collaboration with the Suicide Prevention Resource Center (SPRC), and to inform decisions on key priorities for the Action Alliance to address.

The National Action Alliance for Suicide Prevention is the leadership group that was called for in 2001 in the National Strategy for Suicide Prevention:

Objective 2.2: By 2002, establish a public/private partnership(s) (e.g., a national coordinating body) with the purpose of advancing and coordinating the implementation of the National Strategy. Leadership and collaboration are the keys to success of the National Strategy. The establishment of a public/private coordinating body will stimulate the requisite national attention to the issue. Such a body will help to ensure that suicide prevention is perceived as a national problem and the NSSP as a national plan. The partnership will help establish momentum for the plan and will provide continuity over time and legitimacy through the involvement of key groups. And finally, the coordinating body will oversee the implementation of the National Strategy.

[Editor’s note: Please respond to the survey if you’d like to add your voice to the process. It will be available online only until midnight ET on July 27. Also, please pass this URL — http://tinyurl.com/NSSPsurvey — along to anyone you know who is a member of the suicide prevention network described above. FJC]

[The abridged URL for this post is http://tinyurl.com/NSSPsurvey .]

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“Cyberbullying not epidemic … not killing our children”

In Media, Policy on July 15, 2009 at 8:43 pm

Larry Magid, a journalist whose roles include Technology Analyst for CBS News, has weighed in with a thought-provoking blog post on legislation that has come to the foreground recently to counter cyberbullying. Here’s his opening paragraph:

The first things you need to know about cyberbullying are that it’s not an epidemic and it’s not killing our children. Yes, it’s probably one of the more widespread youth risks on the Internet and yes there are some well publicized cases of cyberbullying victims who have committed suicide, but let’s look at this in context.

On the topic of cyberbullying “killing our children,” Magid writes that “bullying has always been a problem among adolescents and, sadly, so has suicide.”

In the few known cases of suicide after cyberbullying, there are other contributing factors. That’s not to diminish the tragedy or suggest that the cyberbullying didn’t play a role but — as with all online youth risk — we need to look at what else was going on in the child’s life. Even when a suicide or other tragic event doesn’t occur, cyberbullying is often accompanied by a pattern of offline bullying and sometimes there are other issues including long-term depression, problems at home, and self-esteem issues.

His argument against classifying cyberbullying as an epidemic is that the numbers describing “the extent of the problem [are] all over the map.”

I’ve seen some reports claim that up to 80 percent of online youth have experienced cyberbullying, while two national studies have put the percentage closer to one-third … A recent study by Cox Communications came up with lower numbers, finding that approximately 19 percent of teens say they’ve been cyberbullied online or via text message and 10 percent say they’ve cyberbullied someone else.

His post, titled “How To Stop Cyberbullying” was published yesterday on Magid’s blog at safekids.com, a site he founded to promote Internet safety. He offers these solutions to the problem of cyberbullying:

  1. Identify the children doing the bullying, then work with them on their behavior and on “their needs — including problems at home.”
  2. Deliver to children who bully “educational programs that stress ethics and cyber citizenship.”
  3. Teach “kids … what to do if they are victims of bullying.” He offers, for instance, these safety tips.

Magid advises that “we need to be careful about any legislation that outlaws cyberbullying.” Using the Megan Meier Cyberbullying Prevention Act (H.R. 1966) as his example, he repeats UCLA law professor Eugene Volokh’s criticism of the bill, which, in brief, is that the behavior it criminalizes is stated in such an overly broad way that a lot of behavior that is not targeted by the law would also be criminalized.

There is a bill before Congress, as well — the School and Family Education about the Internet Act” (S. 1047) — that emphasizes the educational approach to the cyberbullying problem that Magid favors.

[The abridged URL for this post is  bit.ly/bullyingnot .]

Related SPNAC posts:

“Children’s Deaths Cause Anti-Bullying Outcry” at http://tinyurl.com/ChildrensDeaths
“Father Crusades against Cyberbullying after Son’s Suicide” at http://tinyurl.com/FatherCrusades
“Cyberlaws Are Coming into Play around Internet Safety” at http://tinyurl.com/NetSafetyLaws
“Obama Urged To Take the Lead on Internet Safety” at http://tinyurl.com/ObamaInternet
“Verdict Shows Parents, Internet Should Both Protect Kids” at http://tinyurl.com/ProtectChildren

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U.S. Suicide Prevention Oblivious to Working-Age Men

In Policy, Research on May 11, 2009 at 4:02 pm

By Franklin Cook, SPNAC Editor

Men and Mental Health: Get It Off Your Chest,” a study just released by Mind, the leading mental health charity in England and Wales, deserves attention in the United States, where what is known about suicide and men lines up very well with what is known in Great Britain.

Here’s what the study, in which 2,000 men and women were surveyed about their mental health, says about men and suicide. These survey results explain some of the reasons why 75 percent of suicide fatalities are men in England and Wales (79 percent of suicides in the United States are men).

When it comes to risk factors and thoughts of suicide:

  • Men are twice as likely as women to have suicidal thoughts when they are worried (seven times more likely for men age 45 to 54).
  • Young men (18 to 24) are five times as likely to take recreational drugs when worried as young women, and almost twice as many men overall as women drink alcohol to cope with feeling down.
  • Almost twice as many men as women get angry when they are worried.
  • Forty-five percent of men think they could fight off feeling down by themselves.

When it comes to getting help:

  • Only one-fourth of all men would see their physician if they felt “low” for more than two weeks, and only 14 per cent of men age 35 to 44 would do so.
  • Men are half as likely as women to go to a counselor or therapist to talk about their feelings.
  • Men are also about half as likely to talk to friends about their problems as women, and only about three out of 10 men are likely to talk to a friend about feeling low (and young men are the most likely to tell a friend to “pull themselves together”).

The Mind report makes several specific recommendations that address the mental health and government institutions in Great Britain, and several more general recommendations that could be translated to U.S. suicide prevention efforts for men:

  • Commissioners of health services should identify the need for and plan accordingly for male-specific mental health services.
  • The criteria used by health professionals for diagnosing mental health problems should include all indicators of a condition, including the more traditional male symptoms of “acting out.”
  • Health professionals should take gender into account when discussing treatment options with men.
  • Employers should learn to recognise the symptoms of men’s mental distress and introduce mental well-being policies.
  • Core education/training and continuing professional development of health and social services professionals should cover the relationship between gender, sexuality, and mental well-being.
  • Race equality and the needs of black and minority ethnic men should be made a priority …
  • Commissioners of mental health services and public health professionals should take into account the different needs men can have at different ages and plan services accordingly.

Most importantly, the leadership of the suicide prevention movement in America ought to be asking (and answering) these questions:

  • Since four out of five U.S. suicide deaths are by men, what is being done to institute a public health strategy for suicide prevention that specifically targets that obviously high-risk group (including in the areas referenced by the recommendations above)?
  • Since nearly two-thirds of all suicides in the United States are by men between the ages of 20 and 64 (precisely during their working years), shouldn’t suicide prevention for those people be one of the highest health-care priorities for employers and the institutions supporting employees throughout the country (such as the Department of Labor and the AFL-CIO, just to name a few)?

These questions are–and have been for a long time–knocking about in the background of  discussions about suicide prevention in the U.S., but developing the strategic answers is on no one’s radar that I know of. Yet there are a number of realities that indicate the need and opportunity for action:

  • The National Strategy for Suicide Prevention marked its eighth year in existence on May 1st, and while it still is an excellent blueprint for the public health response to suicide in America, it is now unquestionably overdue for an overhaul.
  • The national coordinating body intended to help guide the suicide prevention movement that was called for in the NSSP (which was to be instituted by 2002, in fact) is still not in place (although the Substance Abuse and Mental Health Services Administration, SAMHSA, several years ago indicated it was taking steps to organize such a group under the name “Action Alliance”).
  • The lessons being learned from four years of community-level suicide prevention work targeting youth and college students with funding from the Garrett Lee Smith Memorial Act are ripe for translation into programs for suicide prevention across the lifespan.

If suicide prevention is to be effectively based on the public health model, then the highest number of individuals in the population identified as a group that is most affected by the malady ought to be reached through intensive preventative measures. The time for making suicide prevention a priority in the United States among working-age men has come.

[The abridged URL for this post is http://tinyurl.com/ObliviousToMen .]

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Military, Veteran Stories Focus on Personal Impact of Suicide

In Policy, Prevention on April 5, 2009 at 7:51 pm
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At the DOD/VA Suicide Prevention Conference in January, Maj. Gen. Mark Graham, who lost a son to suicide and another to an IED, embraces Christopher Scheuerman, who says his son died of suicide after military supervisors ignored his request for help. (By John Davenport, San Antonio News-Express)

By Franklin Cook, SPNAC Editor

I am a Vietnam-era veteran (U.S. Army field artillery, 1972-1975), my father was a Korea-era veteran (we each remained stateside during the wars that helped shape especially the young adults of our two very different generations), and my grandfather served in France during WWI. I think there is something about being a soldier–even if one never sees combat–that stirs a tribal feeling in a person, and I have always thought of especially young soldiers, in a way, as my brothers and sisters. As I have watched the suicide crisis in the U.S. military unfold during the Iraq War, that feeling of kinship has sometimes touched me deeply.

Perhaps in part because of that feeling, I have posted on SPNAC a good number of items about suicide among the military and veterans. In fact, I believe the concluding paragraph of my most recent posting on the topic, “Culture of Stigma Is a Key Cause of Military, Veteran Suicides,” poses one of the most important–and not satisfactorily answered–questions that needs to be asked about preventing suicide in the military.

Today, I simply want to highlight two recent news reports that do a good job of putting military/veteran suicide in personal terms. I’m not going to quote from the reports or discuss them but simply recommend them to SPNAC readers.

The first, “A General’s Personal Battle,” by reporter Yoshi Dreazen in the Wall Street Journal, tells the story of Gen. Mark Graham and his wife, Carol, who lost their two sons seven months apart, one to suicide and the other to an IED in Iraq. The story artfully interweaves reportage on the facts of the matter with poignant storytelling about a family’s indomitable spirit in the face of tragedy.

The second, “Answering Veterans’ Calls for Help,” by reporter Jon Wilson of KELO TV in Sioux Falls, S.D., uses the story of “Bob,” a Vietnam Veteran who called the VA and got help when he was about to kill himself, as the backdrop for showing how the VA’s response to suicide is being carried out in one city in America. Wilson’s report is a reminder of the power of a well-chosen example when it is shared without frills or sensationalism.

[The abridged URL for this post is  http://tinyurl.com/PersonalImpact .]

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Culture of Stigma Is a Key Cause of Military, Veteran Suicides

In Policy, Prevention, Stigma on March 24, 2009 at 11:32 am

singleace_card-back1By Franklin Cook, SPNAC Editor

Ever since the Army announced that suicide in its ranks was at an all-time high last year, news outlets have been brimming with coverage about the causes and solutions for the tragedy unfolding among America’s active military and veterans. Several of the latest installments covered testimony before the Senate Armed Services Committee by some of the military’s top brass (SPNAC readers may refer to the transcripts,  or a webcast of the hearing). According to a Stars & Stripes report on the hearing, it “was designed to address plans to deal with the rate of military suicides, which is above the national average.”

Gen. Peter Chiarelli, vice chief of staff for the Army, called the suicide figures for his service “unacceptable” and fixing them “the most difficult and critical mission” of his military career. “The reality is, there is no simple solution. It is going to require a multi-disciplinary approach, and a team effort at every level of command and across all Army components, all services and jurisdictions, as well as partners out of our organization.”

An article on the hearing in Air Force Times summarizes the statistics that are behind the military’s and Veterans Administration’s alarm about suicide:

The Air Force lost 38 airmen to suicide in 2008, a rate of 11.5 suicides per 100,000 airmen. … In 2008, the Army reported 140 confirmed or suspected suicides. That’s 20.2 suicides per 100,000 troops — an all-time high that is nearly twice the national average of 11 suicides per 100,000 … The Navy reported 41 suicides in 2008, a rate of 11.6 per 100,000. The Marine Corps lost 41 Marines last year to confirmed or suspected suicides — up from 25 two years earlier — a rate of 19 per 100,000.

The hearing included testimony from Kathryn Power, director of the Center for Mental Health Services in the Department of Health and Human Services, who shared another potentially troubling indicator with the Senators:

More ominously, 780 callers to a national VA suicide prevention hot line in fiscal 2008 identified themselves as active-duty troops, [she] said. Since Oct. 1, an average of three hotline callers per day have identified themselves as being on active duty, Power said.

Sen. Lindsey Graham, R-S.C., said that indicates many conflicted troops continue to feel a sense of stigma over reporting suicidal thoughts to superiors or military mental health officials.

“When you’ve got this many people feeling they can’t talk to someone within the system, that’s a problem,” Graham said.

Another aspect of the challenge facing those who care for military personnel and veterans was highlighted at the hearing by Brian Altman of the Suicide Prevention Action Network (SPAN USA):

[He] said the services have made improvements on the issue in the last year. But they still need to hire more medical professionals to handle troops suffering from depression — a promise they’ve been making for several years, he said — and to do a better job educating about signs of suicidal thoughts.

“They’ve done a good job with troops … but many times those who commit suicide are not in theater,” he said. “So we would like to see them try and educate spouses and other family members, too, so they can identify the warning signs.”

A recent news release from U.S. Army Forces Command, reprinted in a “Special Report” at the blog Veterans Today, shows how ambitiously Army leadership is responding to suicide (and similar lists of programs are being implemented in the other military branches and in the VA):

On February 15, an Army stand-down began and continues through March 15 … The stand-down teaches peer-to-peer recognition of suicide warning signs and is available to all Army components and Department of the Army civilians … Phase I, an interactive video “Beyond the Front,” allows participants to choose options throughout the film, with the outcome based on their choices … Phase II of the training, also a video, “Shoulder to Shoulder,” reinforces the Army credo of “No Soldier Left Behind” and ties it to helping a Soldier in need …

One of the programs chaplains use is ACE, which stresses the “battle buddy” system. ACE [is] a mnemonic that represents the phrases, “Ask your buddy, Care for your buddy, Escort your buddy” …

[Also,] ASIST (Applied Suicide Intervention Skills Training) program … trains leaders on intervention and working with distressed Soldiers and Families. Army policy requires one ASIST-trained representative in every battalion.

Even with all of the programs coming down the line, Sen. Graham’s observation about stigma is emerging as the key roadblock for troops and small-unit leadership at the operational level. The power of stigma over help-seeking in military culture, in fact, may be the battle upon which winning the war against suicide depends. As Christopher Weaver points out in a post at ProPublica,

It’s a familiar refrain. Since 2003, yearly reports on the Army’s suicide rates have spurred similar news stories and similar reactions by Pentagon officials. Suicide-prevention initiatives — such as the “battle-buddy” program, which relied on ordinary soldiers to keep an eye on each other — have spawned in the wake of the grim statistics, but the numbers have only worsened.

Referring to a Jan. 29 article in the New York Times, Weaver writes,

[It] is absolutely critical to reach out to soldiers and tell them it is not wrong to reach out for help,” [Gen. Peter] Chiarelli told the Times. “We have to change our culture.”

The call for a change in culture also has echoes. A March 2008 report by the Army’s inspector general suggested a new “culture of support for psychological health.” And in April 2005, the Marine Corps Times reported that the Army’s surgeon general, Lt. Gen. Kevin Kiley, told a House Appropriations subcommittee, “That’s still part of our culture: Real men don’t see [mental health counselors]… I would like to see a culture that resets the force mentally.”

If stigma ingrained in military culture is a force that is stopping suicide prevention programs from working effectively, then the vital question to answer is, What is military (and civilian) leadership doing –besides issuing orders, which is a necessary but not sufficient step — to decisively lessen the stigma against help-seeking that is killing so many of those whose sacrifices make our freedom possible?

[The abridged URL for this post is  bit.ly/culturestigma .]

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All Recruiters To “Stand Down” One Day in Wake of Investigation

In Policy, Stigma on January 22, 2009 at 5:53 pm

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Army recruiter Nils “Aron” Andersson--who served two combat tours in Iraq--died by suicide in 2007.

ORIGINAL REPORT — A report yesterday by Catherine Abbott of the Army’s Office of Public Affairs details the conclusions from “a two and a half month investigation into the suicides of four Soldiers assigned to the Houston Recruiting Battalion … between January 2005 and September 2008.”

The investigation concluded that there was no single cause for these deaths. Relevant factors included the command climate, stress, personal matters, and medical problems …

As a result of the findings, Secretary of the Army directed a USAREC command-wide “stand down” day focused on leadership training, suicide prevention [and] resiliency training and recruiter wellness … The Army is also reviewing recruiter screening and selection processes, the provisions of care for Soldiers who need mental health care, Army-wide suicide prevention training, and access to care and peer support networks for geographically dispersed Soldiers.

In an article in the Houston Chronicle yesterday, the Associated Press reports that

Brig. Gen. Dell Turner, who conducted the investigation, … said the one-day stand-down is a significant action. “It’s rarely implemented, and typically only after some significant event. It’s a day for the unit to stop what it’s doing on the mission side and review policies and practices.”

In a separate AP story late today in the Chronicle, it is being reported that U.S. Sen. John Cornyn of Texas, who was instrumental in initiating the original investigation “on Thursday called for a congressional hearing on suicides among Army recruiters, saying a recent group of deaths in an East Texas battalion show the strain on an all-volunteer force fighting two wars.”

“As you might imagine, corners might have been cut — and they were — given the exigency of recruiting for war,” Cornyn said in a conference call with reporters. “The concern is that this is not isolated to a single battalion.”

For the Cornyn story, AP reporter Michelle Roberts also spoke to “Charlotte Porter, the mother of recruiter Sgt. Nils “Aron” Andersson”:

“There’s so much pain still,” she said. “It’s not only the Army that’s going to have to take a stand. Other people are going to have to take a stand. These young men fought for our rights to speak out. When they come home, we have to find a way to listen.”

For more in-depth coverage of yesterday’s breaking news, see the article by Chronicle staff writer Lisa Wise.

[The abridged URL for this post is  http://tinyurl.com/Recruiters1Day .]

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Blogger Issues Call to Action for “Mental Health New Deal”

In Advocacy, Mental Illness, Policy on January 14, 2009 at 12:16 am

ORIGINAL POSTMichael Sigman–Chairman of the Board of the Wright Institute of Los Angeles, a postgraduate clinical training institute that provides psychotherapy to economically disadvantaged people–started the New Year with a piece on Huffington Post titled “Time for a Mental Health New Deal.”

America’s economic health is inextricably intertwined with its citizens’ psychological well-being. The very language we use to describe our financial plight — insanity, depression, panic, insecurity, trauma … To give short shrift to mental health programs would geometrically compound the insanity; over and above the humanitarian cost, the financial losses in productivity and from increased crime rates are incalculable.

Sigman recommends a decisive, grassroots response to people’s mental-health-care needs in America:

“We’ve got to organize and lobby hard for a mental health ‘New Deal,’ in which the Feds immediately restore funds for decimated state and local treatment programs, and then create a national mental health safety net so no one falls through the cracks … Let’s take a page from Obama’s grass roots Presidential campaign. Start or join a group at the local level to lobby the president-elect and incoming HHS Secretary Tom Daschle. Bombard your legislators with emails and phone calls. If you’re not an activist, become one. If you can give even a few dollars, donate to a mental health-oriented charity or non-profit.

Yes, these proposals will cost more money and mean more borrowing. But if we don’t act now, the tragic fallout will reverberate throughout society for decades.

By callling for action to promote a Mental Health New Deal, Sigman has highlighted the need to build political will for the next phase of mental-health-care reform now that mental health parity legislation has passed Congress. The importance of building political was clearly articulated when the national suicide prevention movement began to gain traction in 2001 with the publication of the National Strategy for Suicide Prevention, which states

For any preventive action to go forward, three ingredients are necessary: a knowledge base, the public support for change, and a social strategy to accomplish change. [Emphasis added.]

SPNAC readers can refer to the Suicide Prevention Action Network’s (SPAN USA) Legislative and Media Action Center to learn how they can help build the political will to advance suicide prevention in America and in their home state.

[The  abridged URL for this post is  http://tinyurl.com/MH-NewDeal .]

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Several Mental Health Champions Missing from 111th Congress

In Advocacy, Policy on January 2, 2009 at 1:58 pm

ORIGINAL REPORT — In the edition of Psychiatric News published online today, reporter Rich Daly highlights the loss of mental health champions in the 111th Congress, noting that “the departure of several of Capitol Hill’s strongest mental health advocates will be felt by APA [American Psychiatric Association] and other like-minded advocates when the new Congress convenes later this month.”

Several longstanding mental health advocates retired at the end of the 110th Congress, including Rep. Jim Ramstad (R-Minn.), and Sen. Pete Domenici (R-N.M.), while Sen. Gordon Smith (R-Ore.) lost his bid for reelection … In 2007 Ramstad and Rep. Patrick Kennedy (D-R.I.) embarked on a nationwide tour to highlight the importance of mental health insurance parity that used a series of field hearings to galvanize support for legislative action … Domenici’s accomplishments include extensive leadership on mental health parity, as well as legislation to fund more mental health services for public school children … Smith is most known for sponsoring the Garrett Lee Smith Memorial Act, to create screening programs to identify and help youth at risk for suicide.

Smith and his wife Sharon’s son Garrett–who is memorialized through the legislation Sen. Smith sponsored–died by suicide in 2003 when he was 21 years old. The Smiths have provided leadership through avenues such as Sharon Smith’s service on the board of directors of the Suicide Prevention Action Network (SPAN USA), and they have gained the respect and admiration of the national suicide prevention community. It is widely hoped among suicide prevention proponents and survivors of suicide loss that their influence will continue to be seen and felt even though they no longer represent Oregon in the U.S. Senate.

The report in the Psychiatric News also points to some of the strong proponents of mental health care who remain in Congress, including

[Rep. Patrick] Kennedy and his father, Sen. Edward Kennedy (D-Mass.) … [who] has … dropped his chairmanship of the powerful Judiciary Committee to focus full time on health care reform … Continued support also is expected from … Rep. Chris Van Hollen (D-Md.), chair of the Democratic Congressional Campaign Committee; Rep. Steny Hoyer (D-Md.) the House majority leader; and Sen. Harry Reid (D-Nev.), the Senate majority leader. Reid, who lost his father to suicide, and the other Democratic leaders were supportive of a mental health parity law and a law to end Medicare’s discriminatory copayments for outpatient mental health care.

And several new members of Congress are expected to add their energies to advancing the cause of improved mental health care in America:

Rep. Paul Tonko (D-N.Y.), a former New York State Assembly member who was a sponsor of New York’s mental health parity law, “Timothy’s Law,” enacted in December 2006.

Rep. Jon Adler (D-N.J.), supported several issues of concern to APA and other mental health advocates as a state senator including a state mental health parity bill, youth suicide prevention programs, and postpartum depression awareness campaigns.

[The abridged URL for this post is  http://tinyurl.com/MHChampions .]

[Related SPNAC post: “Suicide Prevention Champion Not Re-elected To Senate” ]

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Recruiters’ Stress, Army’s Response Are Issues in Investigation

In Grief, Policy, Stigma on January 2, 2009 at 9:29 am

ORIGINAL REPORT — [Editor’s note: The original report includes brief descriptions of several suicides.] NPR’s “Morning Edition” today added an in-depth report to the coverage of a series of suicides that are being investigated in a U.S. Army recruitment battalion in Houston, Texas (see http://tinyurl.com/RecruiterSuicides).

NPR reporter John McChesney interviews several survivors, including the father of  Aron Andersson, who died by suicide in March 2007.  Bob Andersson had told his son’s chain of command about his suicidal thinking five months before Aron Andersson killed himself.

“I don’t know if that was the right thing to do, but I called a major and told him [Aron’s] girlfriend had said he threatened to commit suicide, and she told me he was going through night terrors and a bunch of other things.”

Andersson says his son had trouble delivering the required two recruits a month, especially after his experience in Iraq.

“How could you be over there and see some of the things he saw and dealt with, and try to hire people to go over there and do that?” he says.

The report highlights the pressures under which Army recruiters work:

“I believe that short of being shot at — you know, risking your life — that recruiting is the toughest job in the Army,” says James Larsen, a retired senior policy analyst for the Army Recruiting Command.

Whether or not recruiters have the highest stress level, there’s little doubt they are under extraordinary pressure to sell the Army to a small number of reluctant consumers. Add to that the marital stress brought on by 12- to 14-hour workdays, the isolation of being stationed in small towns far from a base — and in the Houston battalion’s case, alleged abusive treatment of those who didn’t produce their quota — and you have a potentially toxic cocktail.

Texas Sen. John Cornyn called for the investigation that is under way into the deaths, and he has indicated that his concerns go beyond the particulars of the suicides in question.

“I hope we’ll hold [Senate] hearings.”

One of the questions the senator wants answered is whether it is wise to order combat veterans to take recruiting jobs. Most of them don’t volunteer …

[And] Cornyn is concerned about another matter.

“Part of this that was troubling was the suggestion that there was pressure being put down the chain of command to keep this quiet,” he says.

The “Morning Edition” report provides links to the Houston Chronicle’s coverage of the issue, including

[The abridged URL for this post is  http://tinyurl.com/RecruiterStess .]

[Related SPNAC post: “Single Battalion’s 4 Recruiter Suicides Result in Army Probe” ]

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Cyberlaws Are Coming into Play around Internet Safety

In Policy, Prevention on December 22, 2008 at 2:58 pm

ORIGINAL REPORT — Reporter Joel Currier writes in the St. Louis Post-Dispatch on Dec. 17., 2008, that prosecutions are beginning to be filed using an updated Missouri law addressing “threats or communication that causes emotional distress, including electronic messaging on computers, text messaging and e-mail.”

A 21-year-old St. Charles woman … is charged with misdemeanor harassment. She is accused of sending harassing text messages to [a] girl and letting friends use her cell phone to leave threatening voice messages. Her case is one of at least seven involving adults in the St. Louis area filed since Missouri’s new cyber-bullying law took effect Aug. 28.

Some are calling the Missouri legislation “Megan’s Law,” in memory of Megan Meier, who died by suicide in October 2006 after being taunted on MySpace.

The National Conference of State Legislatures lists summaries of state laws in the United States related to cyberbullying or cyber-harrassment* that have been enacted. According to the Post-Dispatch report,

Some experts say that even though cyber-bullying laws establish a framework for punishing those who use the Internet to harass others, those laws probably do little to deter such behavior. Others say it will take a combination of the law, parental involvement and raising awareness to curb cyber-bullying.

“The laws will make a difference once people understand that there are laws and once
prosecutors start using them,” [said Parry Aftab, executive director of WiredSafety]. “We need to teach (people) that what you do online matters as much as what you do in real life, because the Internet is real life now.”

SPNAC readers can listen to a recent discussion among experts on cybersafety for children, “Protecting Kids in the Digital Age,” a roundtable from the 2008 Tech Policy Summit.

*[Editor’s note: Because a distinction is not always clearly drawn in news coverage about the issue, it is important to say something about definitions and language. SPNAC agrees with those who distinguish adult behavior (cyber-harrassment or cyberstalking) from children’s behavior (cyberbullying), as do the folks at stopcyberbullying.org:]

“Cyberbullying” is when a child, preteen or teen is tormented, threatened, harassed, humiliated, embarrassed or otherwise targeted by another child, preteen or teen using the Internet, interactive and digital technologies or mobile phones. It has to have a minor on both sides, or at least have been instigated by a minor against another minor. Once adults become involved, it is plain and simple cyber-harassment or cyberstalking.

[The abridged URL for this post is  http://tinyurl.com/NetSafetyLaws .]

[Related SPNAC post: “Verdict Shows Parents, Internet Should Both Protect Kids“]

Signs on N.J. Bridge Are a Reminder of Hard Choices

In Advocacy, Policy, Prevention on December 13, 2008 at 2:47 pm

ORIGINAL REPORT — A report today in the New York Times highlights the issue of constructing suicide barriers to prevent people from jumping off of high places to kill themselves. The issue has been in the public eye recently because of a decision to build a barrier for the Golden Gate Bridge, famous for its architectural beauty and infamous as a suicide destination.

The report is about signs for a crisis line’s phone number that have been posted on New Jersey’s Victory Bridge, along Route 35 between Perth Amboy and Sayreville, from where “so far this year, there have been seven suicides and one attempted suicide.”

The issue that comes to the foreground is cost vs. effectiveness:

The New Jersey Department of Transportation paid $5,300 to install the signs on the 150-foot-tall Victory Bridge, which arches over the Raritan River. A spokeswoman for the department, Erin Phalon, said that it considered erecting a barrier, but the $2 million cost was prohibitive.

The report quotes John Draper, executive director of the National Suicide Prevention Lifeline (NSPL, a federally funded suicide prevention crisis line answered nationwide at 800-273-TALK), highlighting the hard choices being faced by government agencies and the public over bridge barriers:

While barriers on bridges have proven to be effective in preventing suicides, no studies have looked directly at whether suicide-prevention signs work, he said.

“In some jurisdictions, there is not enough money or political will to invest in bridge barriers. The next best thing would be to do whatever you can.”

NSPL’s Steering Committee, in fact, states in a paper written by Draper “that the use of bridge barriers is the most effective means of bridge suicide prevention.”

In addition to “reducing access to lethal means” (barriers), the Lifeline recognizes that “promoting access to lifesaving means”—such as signage or other public education media near bridges that promotes awareness of hotlines (such as 273-TALK) or other suicide prevention services—is a supplement to bridge barriers. [Emphasis is in the original.]

The San Francisco Chronicle recently completed an in-depth series that comprehensively covers the decades-long debate about suicide and the Golden Gate Bridge. The series features audio podcasts and video recordings as well as reader comments from November 2005.

[The abridged URL for this post is  http://tinyurl.com/HardChoices .]

Experts Weigh In on Suicidal Behavior in LGB Youth

In Policy, Prevention, Stigma on December 12, 2008 at 2:28 pm

The Suicide Prevention Resource Center (SPRC) announces the release of a paper titled “Suicide Risk and Prevention for Lesbian, Gay, Bisexual, and Transgender Youth,” which “highlights the higher risk of suicidal behavior among lesbian, gay, and bisexual (LGB) youth,” noting that “this higher risk may well extend to transgender youth.”

A variety of studies indicate that LGB youth are nearly one and a half to three times more likely to have reported suicidal ideation than non-LGB youth. Research from several sources also revealed that LGB youth are nearly one and a half to seven times more likely than non-LGB youth to have reported attempting suicide … Most mortality data do not include sexual orientation. However, based on the higher rate of suicide attempts among LGB youth and the relative seriousness of their suicide attempts, it is likely that LGB youth experience higher rates of suicide deaths than their non-LGB peers.

Based on their conclusions about suicide risk and protective factors for LGB youth, the authors list more than 20 recommendations” targeted at “three venues for providing services to youth [that] can make vital differences in the lives of LGBT youth–schools, mental health and social services, and health care services–by increasing safety and inclusion.”

Among the recommendations, several focus directly on responding to suicidal youth, for instance ..

Implement training for all staff members to effectively serve LGBT youth by including recognition and response to warning signs for suicide and the risk and protective factors for suicidal behavior in LGBT youth;

several focus on LGBT youths’ access to care, for instance …

Assess and ensure that youth services and providers are inclusive, responsive to, and affirming of the needs of LGBT youth, and refer youth to these services and providers;

several focus on cultural issues affecting LGBT youth, for instance …

Use an LGBT cultural competence model that enables individuals and agencies to work effectively with LGBT youth cultures;

and several focus on the development and implementation of prevention programs, for instance …

Address explicitly the needs of LGBT youth in school-based programs and policies to prevent violence and bullying.

[The abridged URL for this post is  http://tinyurl.com/LGB-Youth .]

TV’s Airing of Suicide Evokes Prime Minister’s Comment

In Media, Policy on December 10, 2008 at 8:36 am

ORIGINAL REPORT — British media have been covering for several days the decision by Sky TV to broadcasat the 2006 assisted-suicide death of a 59-year-old American man who was living in the United Kingdom during the time of his illness and death.

The London Evening Standard reports on the comments made last night by Prime Minister Gordon Brown on the matter:

Asked whether he thought the documentary was in the public interest or “distasteful voyeurism”, Mr. Brown said: “I believe that it’s necessary to ensure that there is never a case in this country where a sick or elderly person feels under pressure to agree to an assisted death, or somehow feels it is the expected thing to do.

“That’s why I have always opposed legislation for assisted deaths.”

Turning to whether the programme should be broadcast, the Prime Minister said: “It’s very important that these issues are dealt with sensitively and without sensationalism. I hope broadcasters will remember that they have a wider duty to the general public.”

On a Sky News blog, Executive Editor Chris Birkett, states that the main point of the broadcast is getting lost in an uproar over broadcasting a person’s “moment of death”:

At its most basic the documentary asks the question: Is there a right to die? It’s not a new debate but the film’s emotional intensity ensures it gets another airing.

There is a second issue: Should the moment of an individual’s death be broadcast on television? And it’s this question that seems to have got the media so steamed up.

[The abridged URL for this story is  http://tinyurl.com/PM-Comment .]

College Sanctions Student for Talking about Suicide

In Mental Illness, Policy, Stigma on December 4, 2008 at 10:51 pm

ORIGINAL BROADCAST — A story broadcast on NPR’s “All Things Considered” on Tuesday offers a troubling example of the challenges colleges and families face when it comes to meeting the mental health needs of students.

In the NPR story, reporter Larry Abramson talks to the parents of Jeremy Jackson, who was suspended this spring from the College of Mount St. Joseph in Cincinnati, Ohio, the day after he told his parents (and they in turn let college officials know) that he was thinking about killing himself.

A letter to Jeremy delivered to him the day after he had spoken to his parents said that his talk about suicide “was in violation of the college policy,” and he was given “a disciplinary suspension.”

A blogger at MentalHelp.net responded later on Tuesday, capturing both the rationale for and the irrationality of the expulsion:

What these college administrators were likely trying to do was to play it safe and limit the potential liability that a suicidal (and possibly homicidal, who knows really) student might pose to their larger student body. It is arguably a college’s right to bar a student from attending classes who is likely to become disruptive or a threat.

… [but] the decision to expel a student for admitting he was in need of help is nevertheless a wrong decision, and for a simple reason. When you offer rather extreme negative consequences for seeking mental health help (such as getting kicked out of school), you discourage students from seeking help, and thereby cause them to be likely to not get help.

The blogger also posted an update on Jeremy’s status, that he is “on involuntary leave until January 2009 at the earliest.”

As a postscript, it is noteworthy that a recent SPNAC post titled “College Mental Health Legal Guide Published,” points to a new manual that is available, “Student Mental Health and the Law.” And the Bazelon Center for Mental Health Law has developed “Supporting Students: A Model Policy for Colleges and Universities” “to help colleges and universities develop a non-discriminatory, non-punitive approach to students in crisis because of mental health problems.”

UPDATE (12/5/2008): In addition, Bazelon provides a comprehensive “Campus Mental Health: Know Your Rights!,” a guide for students who want to seek help for mental illness or emotional distress.

[The abridged URL for this post is http://tinyurl.com/SanctionsStudent.]

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British Parliament Taking Action on Pro-Suicide Websites

In Media, Policy, Prevention on December 3, 2008 at 8:26 pm
Imogen D'Arcy

Imogen D'Arcy

ORIGINAL REPORT — The Yorkshire Evening Post reports that the Queen’s Speech on Wednesday includes evidence that the newspaper’s longstanding campaign to shut down so-called pro-suicide websites might be getting a foothold in Parliament.

The Government has announced that new legislation will help to crack down on Internet sites which promote suicide and carry suggestions on how people can kill themselves.

Queen Elizabeth II, in her address announcing upcoming legislative initiatives, referred to the Coroners and Justice Bill, which includes a mandate to

Modernise the law on assisting suicide to help increase public understanding and reassure people that it applies as much on the Internet as it does off-line …

The Evening Post has been following the case of 13-year-old suicide victim Imogen D’Arcy, who died by suicide after viewing Internet sites on the subject.

[Leeds North West MP Greg] Mulholland said: “It simply cannot be right that impressionable young people like Imogen are able to visit websites which actually promote suicide and provide advice on how people can take their own life. I warmly welcome the fact that the issue was mentioned as part of the Queen’s Speech today, and that change should occur within the year, but we must continue to press the Government to ensure that this is the case.”

[The abridged URL for this post is http://tinyurl.com/ParliamentAction.]

Child Death Review Offers Insight, Recommendations

In Intervention, Policy, Prevention, Research on December 3, 2008 at 6:56 pm

lookingforsomething1ORIGINAL ARTICLE — An article in the Vancouver Sun summarizes a report issued today by the British Columbia Coroners Service titled “Looking for Something to Look Forward To -– A Five-Year Retrospective Review of Child and Youth Suicide in B.C.,” which “highlights the need for better recognition of the signs of a child at risk of suicide.”

The report was done by the coroners’ Child Death Review Unit, which studied the files of 81 children who died by suicide between Jan. 1, 2003 and Dec. 31, 2007.

A 23-member special review panel then issued a set of 17 recommendations for action on a variety of suicide prevention strategies, including mental health promotion, early intervention and targeted clinical interventions.

The newspaper story focuses on the report’s findings about risk factors and warning signs …

“Although it’s a topic that people find uncomfortable and distressing, we need to talk about it,” said Kellie Kilpatrick, executive director of the Child Death Review Unit. “Parents and caregivers need to be aware of some of the signs of a child who may be at risk of suicide and be prepared to [respond] if it appears a youth is in distress.”

… and a summary of the report provides a very helpful overview of those topics.

The summary doesn’t include any detail about the recommendations, which in fact are comprehensive and insightful as well as being an excellent example of suicide prevention planning that is based on data from the study of actual fatalities. SPNAC has put together an excerpt of the recommendations that you can download here.

The recommendations call for action along a continuum of suicide prevention strategies … It is important to remember that suicide is a complex problem that will not be addressed by any single intervention or through the actions of any individual agency. The recommendations … are, in many cases, focused on long-term outcomes and hence should not be understood as providing an immediate solution to child and youth suicide.

At the website of the Child Death Review Unit, you can download a copy of the complete report, or you may view it online, along with other resources and information related to the unit’s work.

[The abridged URL for this post is http://tinyurl.com/OffersInsights.]

Grieving Mom Recounts Saga of Working with “The System”

In Grief, Mental Illness, Policy, Stigma on November 30, 2008 at 10:21 am

ORIGINAL STORY — A story in the San Angelo Standard-Times recounts the experience of a San Angelo, Texas, mother whose son died of suicide on Nov. 3. She writes in order “to reach out to other frustrated families that have been unable to find beneficial mental health treatment from what we trust to be ‘The System.'”

She tells of her son being “too disturbed to be accepted in any of the residential treatment facilities” and how the family “dedicated our lives to learning all we could and setting up 24-hour care for him at home, in shifts.”

People asked us, “Why don’t you just commit him somewhere?” Well, folks, let me tell you, it is never that simple.

We were told … that the MHMR [Texas Department of Mental Health and Mental Retardation] system was limited on what they could do. And we would not be able to get any real help for him until he entered the criminal justice system as an offender and they could help get him diagnosed and rehabilitated … Even worse, a Texas Youth Commission counselor, after listening to our quandary and lack of resources, advised us that we could give up custody of Andrew to the state of Texas, which could take over his care and put him into intensive treatment that would not be available to us as his parents and custodians.

The mother gives examples of “The System” being helpful, including referral to a medical clinic that resulted in diagonosis of “several disorders, including rapid cycling bipolar, rage/aggression and oppositional/defiant conduct disorders … [and a doctor] also made medication and school recommendations on his learning disorders based on his findings.”

Tragically, her son’s treatment remained suboptimal, he had repetitive nonfatal suicide attempts, he continued a pattern of aggressive and maladaptive behavior, and by the age of 17 he was “in the adult criminal system”–and a few weeks ago, he died by suicide.

As for things that help those of us with seriously mentally ill loved ones, I registered online with NAMI, which is the National Alliance on Mental Illness … You can pay an annual fee of $35 and get additional services, but all of the basic services are free. NAMI has been instrumental in getting the new mental health parity legislation moved forward.

Please, please, don’t give up, and keep searching for answers. Somebody, somewhere, has a referral that will help you.

Verdict Shows Parents, Internet Should Both Protect Kids

In Media, Policy, Prevention on November 27, 2008 at 12:40 pm

Lori Drew

Lori Drew

ORIGINAL REPORT — The jury in the Lori Drew case involving the death of Megan Meier did not convict Drew of the “felony counts of accessing computers without authorization to inflict emotional harm” but rather found her “guilty of three misdemeanor offenses of accessing computers without authorization.”

Each count is punishable by up to a year in prison and a $100,000 fine. Drew could have gotten 20 years if convicted of the four original charges … [U.S. Attorney Thomas O’Brien, chief federal prosecutor in Los Angeles] pronounced the case the nation’s first cyberbullying trial, [saying] the jury’s decision sent a worthy message: “If you have children who are on the Internet and you are not watching what they are doing, you better be.”

A follow-up post on the Los Angeles Times technology blog says, furthermore, that “the jury is still out on whether social networks are doing enough to protect consumers on their sites, say technology and safety experts.”

Social networks are a vulnerable place for children, with cyber-bullying becoming increasingly prevalent, technology consultant Rob Enderle said. One-third of U.S. teenagers have been victims of it, according to a Pew Internet Project study released last year. About 39% of social network users reported being bullied in some way, compared with 22% of teens who did not use social networks.

[The abridged URL for this post is  http://tinyurl.com/ProtectChildren .]