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Suicide and COVID-19: The time for suicide prevention is now

Highlighting an interview with the American Association of Suicidology (AAS), Beacon Health Options posted a blog in September about the potential impact of COVID-19 on suicide rates in the United States. The blog pointed out that suicide data from 2018 — the most recent we have on suicide trends — can tell us little about anything today, such as a reaction to the pandemic, making it difficult to inform prevention efforts.

Japan has made recent headlines regarding its suicide rate in October of this year: more people died from suicide in that month than from COVID-19 over the entire year to date. However, it’s more than a very high monthly suicide rate that makes Japan stand out. Japan is one of the few major countries to release timely suicide data, which means that this information could provide global insights on the pandemic’s effect on our mental health.

In the AAS interview, Colleen Creighton, CEO of AAS, stated: “We need to see trends before they happen. That means we need a coordinated national strategy to get that real-time data,” an important goal of the AAS. Here we have hard proof of those trends, and there’s no time to be lost in accelerating that national suicide prevention strategy.

More about suicide in Japan

Japan historically has had high suicide rates, often explained by long work days, social isolation, academic pressure, and the stigma associated with mental health. Consequently, some people might argue that Japan may not be the best barometer to gauge possible global suicide trends due to COVID-19. However, for the 10 years leading up to 2019, Japan’s suicide rate had gone down. Last year, the country recorded approximately 20,000 suicides, the lowest number since Japan started to track this data in 1978.

Interestingly, COVID-19 reversed that downward trend, with women disproportionately affected. Explanations include women holding more part-time hotel, food service and retail positions, positions most affected by layoffs. Additionally, childcare burdens and worry over their children’s wellbeing often fall on women.

Children in Japan are affected as well. Suicides among youth younger than 20 have been increasing since before the pandemic, and the pandemic has only increased pressure on youth. Many suffer abuse at home as they quarantine and feel the burden of falling behind in school work. Children as young as 5 are calling a crisis hotline started by a 21-year-old college student in March, which gets approximately 200 calls a day.

What can we learn from Japan?

Presumably, the United States has to wait until 2022 to understand the pandemic’s effect on suicide rates in this country. In the meantime, many lives will be lost. However, we can safely assume – based on Japan’s experience and the experience of past pandemics such as the Spanish Flu – that suicide rates will rise due to COVID-19.

Now is an opportunity to refocus our conversation around suicide. Below are a few thoughts to help jumpstart that conversation.

  • Take a deeper look at the dynamics of suicide. We make a lot of assumptions about suicide, such as the long-established belief that there is a linear relationship between mental illness and suicide. Several years ago, the CDC released a report indicating that many people who had attempted or died by suicide did not have a known pre-existing mental health condition at the time of death. A similar dynamic is playing out during the pandemic. For example, there has been a rise in suicide ideation among youth but not a rise in suicide deaths for this age group. Youth are feeling particular stress during the pandemic, and anxiety is a realistic reaction to stress, stated Dr. Jonathan Singer of the AAS in Beacon’s September blog.
  • Start collecting real-time data. Real-time data is critical to understanding people at suicide risk. Research is focusing on the role of technology to retrieve that real-time data, which is starting to challenge long-held assumptions about suicide, says Dr. Singer. For example, Ecological Momentary Assessment technology has helped us to learn that someone with a recent history of suicide attempt can fluctuate between no risk and high risk several times in a 24-hour period, important data that inform our efforts to understand the role of impulse and planning in suicidal behavior.
  • Include all voices to understand suicide. Suicide ideation and impulse are not necessarily the same for all demographic groups. The reasons for suicide attempts and deaths among older White males may well be different than for young Black females. In order to understand the gaps in care and suicide prevention efforts, we need to understand the different trends as experienced by different groups of people, especially those people who have survived suicide attempts.
  • Rethink how we deliver crisis services. Suicide by its very definition is a crisis. Communities must ensure they have a behavioral health crisis system that acts as more than a safety net. An effective crisis system supports individuals through all phases that lead up to and follow a crisis. The five phases of system involvement include prevention, early intervention, acute intervention, crisis treatment, and recovery and reintegration. (To learn more about a reimagined behavioral health crisis system, read Beacon’s blog on the topic here.)

We can’t let the two-year data lag stop our suicide prevention efforts. Japan is a current reminder of the urgency of those efforts during these unusual times.


11 Comments. Leave new

Let’s start with ACCESS to AFFORDABLE mental health care by the large insurance companies like Beacon, especially during the Covid 19 pandemic. Actively recruit mental health providers to provide services, that in over 90% of the time will be via telehealth. Encouraged primary care physicians to monitor for depression and suicidality, and to refer patients to psychotherapy–not just prescribe psychotropic medications. Lower the threshold for free or low cost health care. Eliminate the barriers of high deductibles and expensive copays that prevent folks from seeking mental health care.

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Annie Kalotschke
December 16, 2020 5:06 pm

I’m sure I am not alone when I report that, as a mental health counselor, I am seeing a drastic increase in mental illness and an exacerbation of existing illness during this epidemic.
Suicidal ideation has increased across populations. Factors include the isolation, lack of stimulation, anger at noncompliance of PPE, anger at having to wear PPE, loss of pleasurable activities and family time.
The US needs to release data like Japan does.

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Kristie Carlini
December 16, 2020 5:13 pm

Thank you for this update. There have been a couple of times in my life when I have been impacted by the suicide of others…..a brother of a close friend, a person who sat in the desk behind me at my job died by suicide in his home by hanging himself. Those impacted me greatly in that even though I had interaction and conversations with these people, I had no idea that they were in that much emotional trouble. In these days of increasing isolation, and sickness along with all the other stressors in life, it’s good to be aware of how fragile the human soul really is. We need to treat each other with intentional kindness and know the resources of how to obtain help if the need arises.

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The Jason Foundation has lots of free information and resources to help prevent youth suicide, including an app:
https://jasonfoundation.com/get-involved/student/a-friend-asks-app/

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Very informative thanks

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I appreciate the update. Sadly, I’m not surprised that the number of suicides in Japan have increased this year and agree with the concern the US may not be far behind. Many facets of the US population mirror the challenges being faced in Japan such as long work hours, social isolation, and stigma regarding mental health issues. I agree with previous comments that making counseling more affordable and available would be helpful. I’m often faced with clients who have a $75 copay for counseling where the insurer caps the rate at $80 leaving the insurance company to only pay $5 per session. Co-pays should be less for behavioral health services in view of the fact that most counseling sessions at full-fee are only a small fraction of the cost of most other medical procedures. For example, my personal insurance (not Beacon) has a $40 copay for counseling which at full fee would only generate a bill of $125 for the average therapist. On the other hand, my co-pay for an ER visit is the same $40 for a billable service that could be thousands of dollars. Another issue is that I find the majority of individuals referred to my practice have been on meds first for months or more before someone finally suggests seeking counseling. Is it possible that cost is a factor for many of these clients, one copay (usually lower for PCP’s since therapists are considered specialists and usually have a higher copay) and a generic psychiatric medication could be $10 – $20 where one counseling session could cost $50 or more. Unfortunately, it seems the stigma of mental illness in the US is more related to seeking counseling than seeking medications. The growing trend toward partnership with primary medical care is a hopeful sign of future collaboration in addressing mental health issues. Since the number of suicides in the US have been trending upwards over the last few years, I will not be surprised to see the total number for 2020 to exceed 45,000. Let’s keep the conversation going.

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Suicide, as many know, can be a very complicated subject. As such, much more education needs to be provided along with better resources. There still remains a large stigma regarding mental health in this country. As some of my colleagues point out, insurance reimbursement rates for mental health care seem dismal and copays even more cost prohibitive for the patient. Simply handing out more state and federal aid to mental health centers is not the answer (because of the trickle down effect for actual client care). It might be wise to simply have insurance companies cover mental health care without any copay for the first few sessions. Maybe tax dollars might be better spent on media advertisements that provide psychoeducation on the subject (provided multiple agencies provide the education, not just one successful bidder). Lastly, there is more and more emphasis on providing Short Term, Solution Focused Therapy. While it has it’s place, there are much deeper issues that require more long term, multi therapy model approaches. Under many insurance programs offered to their consumers the longer approaches don’t seem to be an option.

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Marianne Reid Schrom
December 18, 2020 11:51 am

THANK YOU for having this difficult conversation. As a long-time survivor of suicide loss and now on the front lines leading suicide prevention efforts, it’s discussions like this that lead to change. Like Maya Angelou said “when we know better, we do better”. THANK YOU for “doing better” by shedding light on this dark topic .

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The following is my experience since 2020 March. ‘ Let us “rethink” this.’
I remind people of the following:

(1) FREE WILL-I have freedom of choice.
(2) IN MY CONTROL-I am responsible only for things I say and do. (a) I canNOT control others or events.
(3) 99.7 %–the recovery rate of virus.

People go from ‘fEaR’ to RELIEF and HOPE

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Everyone’s responses are spot on and what I would say. I appreciate the information and the comments. Let us all be aware and willing to ask the hard questions even with those who seem to be “coping”. Develop relationships with your local doctors and psychiatrists so they will be more likely to refer for counseling in addtion to the medication they prescribe.

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