Commentary
COVID-19 and suicide prevention: Parallel public health strategies for veterans and service members
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American public health organizations have been in place since the 1870s, but they barely register in everyday life. COVID-19 has changed this. This pandemic demonstrates that public health approaches save lives.
Consider the use of social distancing and face masks in reducing new infections. Researchers from the University of Washington have noted that near-universal mask-wearing could prevent 30,000 deaths in the U.S. this fall. Public health approaches work.
Why, then, are we not applying public health approaches more broadly when they have been used to solve other past crises? When automobile deaths became unbearable, we mandated seat belts, air bags, and other measures. The Federal Cigarette Labeling and Advertising Act of 1965 required warnings on cigarette packages on the health hazards of smoking. These measures have proven effective.
Therefore it is inexplicable that we lack a coordinated public health approach for one of America’s leading causes of death, and one that is increasing among all age groups during the pandemic. Suicide is now the second leading cause of death in 10- to 24-year-olds.
COVID-19 is exacerbating the suicide crisis. Calls to suicide hotlines have increased by 800 percent, according to some estimates. Texts to crisis lines have seen a similarly alarming spike, doubling in some cities.
A public health approach that includes real-time data and surveillance, universal screening, mental health literacy, and new interventions, are key to reducing these epidemic-like statistics.
Care for veterans is no different. We know that if not identified early and treated comprehensively, the mental-health challenges aggravated by COVID-19 will become chronic and life-altering. We need a national standard of care that leverages bundled public health strategies. Like COVID-19, screening is a critical component of identifying those at risk. Unfortunately, suicide screening is atypical during most routine physicals. Why? We would never assume cholesterol is in normal range without testing blood for triglycerides. So, why would we assume patients are not at risk for suicide? There are tools available to remedy this public health shortcoming, including the Columbia Protocol. Asking simple questions about suicide risks saves lives.
We also need to expand our sensors beyond the medical community. Only half of people who die by suicide visit their primary care doctor within a month of dying. This means we must rely on others: family, friends, employers are all important. In the military and veteran community, the benefits of peer support cannot be overstated. In fact, peer support may be the foundation that cements good public health approaches to hope and healing during times of crisis. A study of best practices by the Tragedy Assistance Programs for Survivors (TAPS) indicated that the most impactful peer support begins with closely matching people that have experienced similar trauma. Intentionally connecting peers who have common traits provides an opportunity to build trust and to develop a sense of belonging — critical paths to saving lives.
Data analysis is also key to preventing suicide. In the current pandemic, daily statistics illustrate the spread and impact of the coronavirus. We know how many Americans die each day and how many new infections are diagnosed at the national, state, and local levels. We know “who is at risk” and what precautions high-risk populations should take. We know what symptoms to look for and when we should seek testing and treatment for COVID-19. And our public health leaders provide all of this data to us in near real time.
Imagine if suicide risk were treated in the same manner. It isn’t. Our current data surveillance system includes a two-year lag — totally unacceptable.
Health-care literacy, media attention, and advocacy are also incredibly important. We are learning quite a bit about COVID-19, how it originated, and how to protect ourselves. This information comes from public service announcements, advertisements, social media, and elected officials. Suicide requires the same emphasis and leadership attention if we are to stem the tide. To this end, the National Action Alliance (NAA) has released a “Framework for Successful Messaging.” This framework offers a guide to balancing safety, strategy, positive narratives, and guidelines for all those speaking publicly about suicide. This is a good start, but it needs to be disseminated widely.
Finally, just as the national response to COVID-19 has included billions of dollars for vaccines and clinical treatments, a national suicide prevention plan must include evaluation of new and promising interventions. We must push harder for both community-based and clinical trials to test interventions for those most at risk while at the same time advancing non-medical pilots focused on community care, technology-driven interventions, and peer support.
The suicide epidemic will not end overnight, but by employing a comprehensive public health approach, we can better identify those at-risk and get them the help they need. Like any other public health crisis, it is a matter of life and death.
Dr Keita Franklin is the Chief Clinical Officer at Loyal Source and Co-Director of Columbia Lighthouse Project. Kim Ruocco is Vice President of Suicide Prevention and Postvention at TAPS.
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