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The United States is in the midst of a mental health crisis. In what will be a series of posts, I hope to offer some guidance to individuals who are concerned that someone they know will harm either themselves or others. Throughout these posts, I hope to discuss methods of broaching the difficult subject of inquiring into the mental health of someone you care about; to provide guidance on how to encourage those who have been prescribed medication to remain on medication; and to describe what happens when an individual is taken to a hospital to receive treatment either voluntarily or involuntarily. When possible, I hope to provide additional resources.
Ultimately, my goal is to equip friends and family members with a brief guide so they can anticipate the road ahead. In many cases, taking on a more active role may be challenging, but the costs of doing nothing can be far too high to ignore.
Though there is no way to properly quantify the magnitude of these costs, a report from the Centers for Disease Prevention and Control does give us an idea of how large the scope of the mental health crisis in this country is. The CDC found that, between 1999 and 2017, the suicide rate increased 33 percent—from 10.5 per 100,000 Americans to 14.0. More concerning is that the average rate of increase has accelerated in recent years. Between 1999 and 2006, the number of suicides in the US has increased by around 1 percent per year. Between 2006 and 2017, the average rate of change was closer to 2 percent. One of the most invaluable resources is the National Suicide Prevention Lifeline. You can visit their website (here) or you can reach them by phone at 1-800-273-8255. These resources will help you tailor a specific plan of action for how to speak with your friend or loved one. As you'll come to find, there are different ways to broach the subject and talk about it, and the best technique to employ will depend on circumstances unique to you and the person you care about.
In 2017 alone, 47,173 Americans took their own lives.
While this number is staggering, it is dwarfed by the number of people who attempted suicide. The American Foundation for Suicide Prevention estimates that that number was 1.4 million in 2017. To put that in perspective, that is roughly the entire population of the city of San Diego—the 8th largest city in the United States.
That such a large number of Americans not only feel such despair but decide to act on it should be a terrifying wake-up call to anyone who may have concerns about the mental health of a family member, loved one, or friend. However, suicide is not the only symptom of the nation’s mental health crisis that should be prompting a call to action. Nor is it the most visible symptom. That ignominy belongs to gun violence.
With shocking regularity, we receive news alerts on our phones informing us that yet again there is an active shooter terrorizing a school or a campus or a synagogue or a church or a movie theater or a bar or an office or a newsroom or a military installation. With almost equal regularity, we hear stories about missed opportunities to prevent the crisis and people who lament their hesitation or believe that their reticence caused lives. They noted the warning signs and saw a change in behavior that portended trouble but didn’t want to rock the boat.
Mental Disorders v. Unhealthy Mentalities
There are myriad reasons why so many Americans commit these violent acts. However, not all of them can be traced back to a mental illness. To be clear, people who walk into public places and open fire are not mentally healthy, but to automatically assume that they have a mental illness like schizophrenia or bipolar disorder is wrong. Similarly, to assume that someone who has suicidal thoughts has a mental illness is equally wrong. Just because a person is mentally unhealthy does not mean they have a mental illness.
To assume that a change in behavior or a sudden fixation on committing a violent act against others or to oneself is due to a mental illness is simply inaccurate. A study out of John Hopkins Center for Mental Health and Addiction Policy Research published in a 2016 issue of Health Affairs found that 9 percent of the perpetrators of mass shootings between 1994 and 2005 were described as being mentally ill, while that number increased to 22 percent between 2006. Making such assumptions also places additional stigmas on mental illness and overlooks the tremendous impact that large amounts of environmental stressors can inflict on a person’s mental well-being. It also uses individuals with mental illnesses as scapegoats and sweeps under the rug the social causes of violence.
There is a major difference between being mentally ill and mentally unhealthy. A mentally ill individual has a disorder that can be diagnosed and treated. It can oftentimes be caused by genetic factors, environmental factors, biological factors, or a combination of the three. Most symptoms can be mitigated with treatment, which oftentimes has a pharmacological component. There are millions of Americans with mental illnesses who receive treatment and live normal, healthy lives.
Conversely, a mentally unhealthy individual is someone who does not have a diagnosable condition but may be emotionally disturbed due to a variety of factors. In some cases, the disturbance may be linked to a substance abuse problem. Other common issues include childhood trauma or a developmental issue. This may lead them to have difficulties controlling their anger or refraining from impulsive and violent actions. These are clinically distinct from mental illnesses and require different kinds of treatment plans.
If you are concerned that someone may hurt themselves or others, it does not matter if they have a mental illness or not. Do not fall into the trap of thinking that they will snap out of it or that they do not pose a threat to themselves or others because they do not have a mental illness. You need to take an active role.
Taking the Initiative
People who are struggling with a mental illness or with their mental health very frequently do not solicit help from others. They may be embarrassed, they may not want to appear vulnerable, or they may not recognize that they have a problem. This means that you must take the first step.
This is not an easy task. The person you are hoping to help could vehemently deny that any problem exists, perceive your concern as a form of betrayal, accuse you of possessing ulterior motives, or even become violent at the suggestion that they are struggling with any issues at all. Then again, they may recognize that they have a problem and agree that they should seek help and will voluntarily begin treatment. The response depends upon a host of factors with which you may not be familiar when you decide to encourage them to seek treatment.
While there is no single guide that can fully prepare you for the experience, there are steps that you can take to prepare yourself. One of the most invaluable resources is the National Suicide Prevention Lifeline. You can visit their website (here) or you can reach them by phone at 1-800-273-8255. These resources will help you tailor a specific plan of action for how to speak with your friend or loved one. As you'll come to find, there are different ways to broach the subject and talk about it, and the best technique to employ will depend on circumstances unique to you and the person you care about.
The American Foundation for Suicide Prevention advises that you be blunt when you bring up the subject of suicide, but that you should not make it a public forum. By bringing in a group of people to discuss the matter, it may make them feel as though they are on trial, which can lead some to become more ashamed and more distant. Worse, it may cause them to camouflage the problem.
If someone you know and love appears as though they are considering suicide, speak to them in private, allow them to vocalize their feelings, tell that you care about them, and encourage them to make an appointment with a mental health professional. Avoid philosophizing about the meaning of life or giving advice. In the worst-case scenario, this may provide them with a perverse rationale for hurting themselves. They may also feel as though you are trivializing their suffering. When someone is seriously considering suicide, they should speak to a trained professional who can provide them with treatment options.
However, if you believe that your loved one is in imminent danger of hurting themselves or others, you should call 911 immediately or take them to a hospital. If you feel as though you will not be placed in imminent danger by doing so, you should stay with them to ensure that they are admitted by doctors successfully and be prepared to speak with doctors about your loved one’s condition.
If they refuse to go or give every indication that they will imminently harm themselves or others, you may have to call the police and request that they be involuntarily committed. Although the final decision to have someone committed against their will is ultimately the decision of the psychiatrist evaluating them, your words and experiences can have a significant impact on their assessment. Consequently, it is not a decision that you should take lightly. It is an absolute last resort when there are no other options.
In the next post, I will focus on methods of confronting a friend or loved one who may be considering violent acts to others.
Dr Ahmad reports no conflict of interest. He is not a speaker, advisor or consultant and has no financial or commercial relationship with any bio-pharmaceutical entity whose product/device may have been mentioned in this article.
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