Tuesday, November 12, 2019

Why US Suicide Rates are on the Rise While Western European Rates are Declining

by Nomad

Hard Cold Facts about a Difficult Subject 

Despite this public reticence, you might be surprised to learn that suicide now ranks in the top ten leading causes of death in the US. 
Each year 44,965 Americans die by suicide. Roughly 16 out of every 100,000 Americans will take their own life.
To put that in perspective, there were a total of 17,250 reported murder and non-negligent manslaughter cases in the U.S. in 2016. In fact, suicide is 250 percent more common than murder.

All those numbers, of course, cannot really reflect the pain. The effects of suicide go beyond the person who acts to take his or her life: it can have a lasting effect on family, friends, and communities.

Since around 1999, suicide rates in the US have been on the increase. According to the US Centers for Disease Control and Prevention (CDC), more than half of the US states have seen a 30% jump and the overall rise nationwide is around 25%.    

Behind these cold statistics, there's something else worth noting. This grim trend of self-destruction is unique to the US. The rates in other developed countries have, by and large, fallen. That's according to the World Health Organization.

For example, the suicide rates between 2001 and 2012, fell in 12 out of 13 Western European countries. And those rates dropped by 20% or more.
While three European nations still have rates above that of the U.S. (Belgium, Finland, and France) overall, the suicide rates in Europe have been on the decline.

This odd disparity leads us to a natural question. What could account for those numbers?
Well, researchers note that there may not be a single overriding factor to explain this paradox. Some researchers have their own theories and it has much to do with our national priorities.  

Living Without a Safety Net

Dr. Steven Stack, a professor of Criminal Justice at Wayne State University, has his own theories. As a researcher who studies the social risk of suicide, Stack speculates that there are two social factors at play here.
And both of them have a political aspect.

Professor Stack believes that there is evidence that rising suicide rates are associated with a weakening of the social support network, that is, government social programs aimed at helping the poor. The safety net that once protected Americans is failing.
While not conclusive, there is some evidence to support this theory.

A 2002 University of Minnesota study reviewed a 35-year period  (between 1960 to 1995) and found that suicide rates increased in states that reduced their per capita expenditures for public welfare during that period. In other words, when states spent less money on public welfare and relief programs, the suicide rate began to rise.   

A more recent 2016 study came to similar conclusions. Furthermore, researchers found reduced spending impacted health in other ways. State welfare and education spending predicted heart disease and all-cause mortality.
Stack observes:
When it comes to spending on social welfare, the U.S. is at the low end of the spectrum relative to Western Europe. For example, only 18.8 percent of the U.S. GDP is spent on social welfare, while most of the Organisation for Economic Co-operation and Development (OECD) nations spend at least 25 percent of their GDP. Our rates of suicide are increasing while their rates fall.
Continuing to slash the social safety net will only make matters worse.
In the name of “welfare reform” and deficit reduction, Republicans seem intent on, as The Nation puts it, "cutting the programs that help Americans experiencing financial hardship have at least some shot at affording basic necessities like food, housing, healthcare, education, and a little dignity in our later years."
Meanwhile, the GOP has given the super-wealthy a tax break that will add at least $1.5 trillion to the deficit.

In this way, the US is becoming more and more like some kind of horrific social Darwinist experiment where only the privileged survive.

Suicide in a Time of Income Inequality

Another factor cited by Stack (and supported by the 2016 study) was economic inequality. In the United States, income inequality, or the gap between the rich and everyone else, has been growing markedly, by every major statistical measure, for some 30 years.

State-level income inequality, particularly among low-income adults, has been linked to suicide mortality, (as well as heart disease.)
Stack explains:
Research has generally found that the higher the level of income inequality in the U.S. states, the higher the probability of death by suicide. According to social strain theory, when there’s a large gap between the rich and poor, those at or near the bottom struggle more, making them more susceptible to addiction, criminality and mental illness than those at the top.
While a direct relationship between income inequality and suicide is inconclusive, Stack believes that economic strain is a risk factor for suicide.

As U.S. income inequality has been increasingone study found an increasing percentage of midlife suicides reportedly associated with financial problems.
Middle-aged Americans are turning to suicide in alarming numbers with a 28 percent increase from 1999 to 2010.

In one of the few studies to track the health effects of income inequality over time, one Ohio State University (OSU) researcher has discovered that an increase in inequality leads mortality rates to begin rising after five years. Inequality-linked mortality peaks about two years later, before tapering off five years after that. All told, even a modest increase in American societal inequality more than doubles an average individual's cumulative risk of death over the next 12 years.
Studies have also suggested that income inequality damages social cohesion, an important factor in maintaining public health. 

But all the social cohesion in the world won't mean anything if state and federal funding to deal with this problem is cut and affordable health care is strangled.

Questions about the Quality of Care

There's another factor that would explain the differences between the US and European trends. Actually, it's the elephant in the room: the socialized model compared to a for-profit model.

Unlike the US, the EU has made access to mental health care a priority. The need to include mental health among the first priority of the public health agenda officially began in the European Union back in 2005.
According to a 2016 EU Commission report:
This recognition is based on the growing evidence and awareness about the magnitude of mental health problems in European countries: mental disorders are highly prevalent in Europe and impose a heavy toll on individuals, society and the economy..
But, talk is, of course, cheap. What does this mean in real terms?

Firstly, in the EU, there has been a change in the models of care, from traditional large psychiatric institutions to modern comprehensive community-based models of care.

Community-based services offer the patient many advantages. Those include:
  • greater user satisfaction, 
  • better participation in social life, 
  • increased met needs and 
  • adherence to treatment. 
Moreover, they promote:
  • better continuity of care and 
  • more flexibility of services. 
Community-based care also makes it possible to identify and treat more often early relapses and allow to fight stigma.
That is the polar opposite of the detached bureaucracy and the medicated outpatient care we too-often see in the US.
Perhaps this is one reason for the decline in suicide rates. At any rate, this fresh approach certainly couldn't hurt.

Meanwhile, back in the US, the situation is very different. In the age of merciless budget cutting, just obtaining the funding can be nearly impossible.   

Speaking to the BBC, Prof Julie Cerel, president of the American Association of Suicidology, noted that a lack of adequate funding for mental health research and preventative care simply compounds the problem. 
Suicide prevention and mental health screening is not, after all, something that can be treated in an emergency room.
"Our mental health systems are just really struggling across the country. In terms of training mental health professionals, we're not doing a great job."
The CDC study found that 54% of Americans who died by suicide had no known mental health illness. Yet that could be quite misleading. Does this mean that no illness existed prior to the suicide? Or does it mean that the victim had not been treated for mental health issues?    
It's difficult to know for sure. 

Short-Sighted Budget Cutting

We do know that, despite the climbing suicide rate, the priority with the Republican-led Congress has been to reduce spending when it comes to mental health, including suicide prevention. 

In 2009, mental health expenditures accounted for 6.3 percent of all health expenditures in the U.S. but were expected to account for only 5.6 percent by 2017. This decrease continued into 2018 and, with Trump's budget cuts, will continue beyond that.

In February, Bloomberg reported that the White House had requested a boost in mental health spending for veterans and increases in funding for agencies dealing with the opioid epidemic. That's great news.

However, like so much in this administration, there's more than what meets the eye.
[T]he president’s budget would also slash funding for the National Institute of Mental Health (NIMH) from $1.6 billion in the 2017 fiscal year to $1.1 billion in 2019 - a reduction of over 30 percent.
The NIMH is the lead federal agency for research on mental disorders which paves the way for prevention and proper and effective treatment. Reducing funding of the MIMH cannot improve the situation but it could conceal from public discussion and political debate.

On a state level, things are probably worse. Between 2009 and 2012, states cut a total of $4.35 billion in public mental-health spending from their budgets. Mother Jones reported:
According to a report by the National Alliance on Mental Illness, significant cuts to general fund appropriations for state mental health agencies have translated into a severe shortage of services, including housing, community-based treatment and access to psychiatric medications.
Even, as a cost-cutting measure, this makes no sense at all. It is not only heartless and reckless, it is extremely short-sighted. It is clear that suicide has economic costs for individuals, families, communities, states, and the nation as a whole.

  • The total cost of suicides and suicide attempts was $93.5 billion.
  • Every $1.00 spent on psychotherapeutic interventions and interventions that strengthened linkages among different care providers saved $2.50 in the cost of suicides.
Suicide is the leading cause of death for youth under the age of 24. Twelve teenagers die by suicide in the United States each day. It's heart-breaking- so long as you have a heart.

Ensuring that we take this problem seriously must be a priority. If we care about the future generation, we have to demand that, at the very least, our representatives recognize suicide as a major health concern. 

Until then, a fresh tragedy will occur every 12.3 minutes in America while the rest of the developed world moves on.

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If You Know Someone in Crisis: Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1–800–273–TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the NSPL’s website. The Crisis Text Line is another resource available 24 hours a day, 7 days a week. Text “HOME” to 741741.