“We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
By the time students reach New York City’s Judith S. Kaye High School (JSK), multiple systems have failed them. As a public transfer school for students with significant barriers to their education, many of JSK’s students have faced significant adversity.
“All of our students have been disconnected from school at some point and many have experienced some trauma,” says school principal Andrew Brown. Mental health disorders and substance use problems are common, but linking students to traditional mental health services is nearly impossible. “Even for students who are ready to meet with someone, once they leave the building, the obstacles are frequently insurmountable,” Brown says.
Thanks to Mount Sinai’s UPRISE (Use Prevention Recovery Intervention Services & Education) program, students no longer have to leave school to get the care they need. “Rather than trying to get students to come to us, we provide services on-site,” says Rachel Weller, PsyD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and project manager and clinical supervisor for UPRISE.
The partnership, launched just before the COVID-19 pandemic, is helping students address their mental health problems and substance use, often for the first time. “Having access to this high-quality care, within the school building, is a game changer,” Brown says.
Youth Mental Health: An Unmet Need JSK, which serves about 145 students at their Manhattan site, is co-located within the School of Cooperative Technical Education (Coop Tech), a career and technical school that serves about 1,500 students. Students from both schools are offered access to mental health and substance use treatment through the UPRISE program.
UPRISE is an offshoot of the Comprehensive Adolescent Rehabilitation and Education Service (CARES), a program of the Addiction Institute of Mount Sinai that has served adolescents and young adults for more than 20 years. CARES provides a therapeutic high school environment that includes a range of targeted services for youth with complex mental health, substance use, and educational problems. While CARES has seen great success, the need for services among New York City youth remains significant. UPRISE is a new model that shows how mental health services can be integrated into a public school setting.
Both Coop Tech and JSK serve historically marginalized populations who have long been subject to systemic racism and discrimination, says Shilpa R. Taufique, PhD, director of the psychology division for the Mount Sinai Health System and director of CARES. “These students and their families have all had the experience of not being seen or heard, and of having institutions impose what they think is best for them,” she says. “There’s such a deep mistrust of the systems that are supposed to be helping them.”
As a result, students have often struggled for years with mental health problems — even before the COVID-19 pandemic made youth mental health a national crisis. “We see many kids present with PTSD, complex trauma, major depression, anxiety, and difficulty with substance use,” Dr. Weller says. “What’s most striking is the number of students who have a longstanding history of mental health difficulties, yet have never received any type of treatment.”
A New Model of School Mental Health UPRISE aims to give adolescents the tools to help them develop into healthy, functioning young adults. The clinical team is small but mighty: Dr. Weller is on-site in the school most days, along with part-time clinical staff including two postdoctoral fellows and a graduate student extern. They currently provide services for about 30 students, but Weller and her colleagues hope to double that number in early 2023.
UPRISE offers a range of services, including:
Psychoeducation
Individual therapy
Group therapy
Family therapy
Milieu therapy
Substance use treatment
Medication management
In addition to counseling and therapy services, the team helps students connect with prescribing providers via telehealth for medication management. All of these services are billed to students’ insurance companies, making it a model that is both sustainable and replicable, Dr. Taufique says.
Flexible Approaches to Teen Mental Health Plenty of schools have experimented with embedding social workers or mental health providers in school settings. But UPRISE goes further. Before launching the program, the team spent a year learning about the schools and their students’ unique needs. “People make a lot of assumptions about teenagers, especially young people who have been disconnected from school or who are in treatment,” Brown says. “[The UPRISE team] didn’t come in with any expectations about who these kids are.”
That open-minded attitude has led to several innovations. URPISE takes a novel approach to family therapy, incorporating school staff into students’ treatment plans much like parents or other family members might be included. “The school setting is a surrogate family for most of these students. The teachers, guidance counselors, and social workers are very involved in their students’ lives — these are the people students call in the middle of the night if they’re in crisis,” Dr. Taufique says. “We want to highlight the roles they play in students’ lives and also give school staff some therapeutic framework to draw on so they don’t get burned out.”
Clinicians provide services to students in school during the school day, but they also reach out to them in the community. If a student has a phobia of the subway or anxiety about coming to school, for instance, providers might arrange to travel to school with them to provide a form of exposure therapy. “We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
Services Without Stigma In addition to services for patients, UPRISE offers psychoeducation and outreach to the entire school community, such as school-wide presentations on topics related to substance use and mental health. The program is also open for a drop-in hour five days a week, so any student in either school can come in to talk whenever they need. “With the drop-in hour, we discuss things that are going on in students’ lives, provide some psychoeducation, and sometimes link students to services or provide referrals,” Weller says. “We want to make this accessible, even to kids we’re not directly serving.”
At a time when most of the news about teen mental health is bleak, UPRISE is making a positive difference in his students’ lives, Brown says. “We have students who are seeing counselors for the first time. They’re showing up to appointments, connecting with counselors. They’re more connected to school.”
“Students look at this as a tool to help them get better and help them transition into adulthood. There’s no stigma attached to it,” he adds. “It’s just become a part of our community.”
“Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
Stigma remains a big problem for psychiatry. Inpatient psychiatric care, in particular, has long suffered from unfair portrayal. The mere mention of an inpatient psychiatric unit conjures up images of Jack Nicholson in One Flew Over the Cuckoo’s Nest. This stigma is present not only among the public, but also among many doctors and medical providers. “There’s a certain amount of stigma and fear around the idea of being hospitalized in a psychiatric unit, but it’s a very different quality of care and treatment than what is typically portrayed in the media,” says Rajvee Vora, MD, MS, Associate Professor and Vice Chair of Clinical Affairs for the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
Forget the stereotypes, Dr. Vora says. The inpatient psychiatric facilities at The Mount Sinai Hospital are bright, welcoming, and beautifully designed, and patients receive high-quality care. “Patients are up and walking around, encouraged to be up and about, attend groups and sessions, and play basketball in our indoor court.”
Above all, hospitalized patients receive a range of evidence-based treatments to help them manage their mental illnesses. “Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
An Interdisciplinary Approach to Inpatient Mental Health In recent years, the field of psychiatry has moved most treatments to outpatient settings. Yet for some patients with severe mental illness and acute psychiatric needs, inpatient care remains critical. In fact, the need for such care has increased recently. “During COVID, many outpatient providers switched to remote services, which aren’t always accessible to people with serious mental illness,” says Danielle Campisi, LCSW, director of social work for the inpatient psychiatry service. “Now we’re seeing a big uptick in the number of patients that had been chronically well-managed, but lost access to care during the pandemic.”
The team at Mount Sinai’s inpatient behavioral health unit treats a variety of psychiatric illnesses, including:
Mood and anxiety disorders
Personality disorders
Psychotic illness
“Treatment isn’t something that happens to the patient. It happens with the patient,” says Dr. Rosenthal.
Patients don’t need to be severely incapacitated to benefit from hospitalization, says Blake Rosenthal, MD, Assistant Professor of Psychiatry and Inpatient Unit Chief at The Mount Sinai Hospital. “Sometimes our patients have developed psychotic symptoms for the first time. They may have a change in their ability to perceive reality or are developing hallucinations,” Dr. Rosenthal says. “They can come in without having a complete decompensation and loss of function, and we’re able to meet those needs really well.”
Cutting-Edge Psychiatric Treatments Inpatient treatments typically include medications and intense psychotherapy, including individual, group, and milieu therapy. As a cutting-edge research institution, Mount Sinai offers access to new and emerging treatments, including interventions such as electroconvulsive therapy (ECT) and esketamine for treatment-resistant depression. Patients also receive additional services such as art therapy, music therapy, dance/movement therapy, and substance abuse counseling. “Inpatient treatment is so much more than medication management,” Dr. Vora says. “The core of the work we do is ‘milieu therapy’ — what being in this environment does for patients.”
Patients are treated by an interdisciplinary team that includes an attending psychiatrist, psychiatric residents, nursing staff, creative arts therapists, assistive staff, and social workers. The team develops a comprehensive treatment plan for each patient, which describes the interventions and services they will receive as well as the plan for transitioning to outpatient care. That transition is important, since patients typically stay in the hospital just a week or two before being discharged to outpatient services or to higher levels of care, such as assertive community treatment (ACT).
Social workers work closely with patients to understand their psychosocial needs, connect them with appropriate services, and teach them about their illnesses. “When patients come in, they’re sometimes resistant to being treated. We do a lot of psychoeducation to improve patients’ understanding of their illness, the potential need for medications, and the importance of outpatient follow-up,” she says.
It’s a collaborative effort, Rosenthal adds. “Treatment isn’t something that happens to the patient. It happens with the patient,” he says.
Inpatient Mental Health at Mount Sinai While Mount Sinai provides access to the latest evidence-based treatments, its biggest asset is the people delivering those therapies, Dr. Rosenthal says. “What really distinguishes Mount Sinai’s inpatient program is our team. Our treatment team almost functions as a single provider,” he says. “It sounds cliché, but everyone on the unit cares deeply about how patients are doing.”
Mount Sinai has leading experts in schizophrenia, depression, and other psychiatric illnesses, who often consult on treatment. The team mentality extends to treating a patient’s non-psychiatric medical conditions as well. The inpatient psychiatry team collaborates closely with other service lines such as OBGYN and neurology to ensure all of a patient’s healthcare needs are met during their inpatient stay.
Most psychiatric inpatients are transferred from the emergency department, but individual cases are considered. Learn more about Mount Sinai’s Inpatient Behavioral Health Services, or contact the inpatient behavioral health admissions coordinator at 212-241-5675.
From left, Honoree David Sanborn, Shantelena Mouzon, administrative coordinator at the Louis Armstrong Center for Music and Medicine, and musician Paul Shaffer
The 17th annual “What a Wonderful World” gala benefiting the Louis Armstrong Center for Music and Medicine, was a festive evening of jazz and expressions of gratitude to three honorees for making the world more wonderful through their contributions to music and music therapy.
The event, held Monday, October 24, at the Angel Orensanz Foundation and hosted by the Wonderful World Friends of Music Therapy Inc., honors the legacy of the Louis Armstrong Department of Music Therapy and their commitment to music therapy at Mount Sinai hospitals.
The event recognizes a dynamic group of individuals chosen from a variety of fields including music, medicine, and patients who have benefitted from receiving music therapy at Mount Sinai hospitals.
This year’s honorees were Grant Mitchell, MD, Chair, Department of Psychiatry, Mount Sinai Beth Israel; David Sanborn, the multi-Grammy Award-winning saxophonist, who was presented the Phoebe Jacobs Award by Paul Shaffer (pianist of the former Late Night with David Letterman); and patient Rosemarie Greene.
From left, Honoree Grant Mitchell, MD, Joanne V. Loewy, DA, LCAT, MT-BC, Prameet Singh, MD, and Daniel S Safin, MD
The gala was hosted by Mercedes Ellington, dancer, choreographer, and granddaughter of Duke Ellington, and Bill Daughtry, the retired radio and TV host. The co-chairs were Karen and Doug Seidman from the Louis Armstrong Center for Music and Medicine’s Steering Committee. The event featured performances by Rema Webb from the Broadway production of The Music Man; Antoine Smith from the Broadway production of MJ: The Musical; saxophonist Erik Lawrence, Lou Marini, a saxophonist and an original member of The Blues Brother, and jazz pianist Garry Dial. Mr. Shaffer and Mr. Sanborn, along with Will Lee (bass), performed jazz and Louis Armstrong’s ‘Wonderful World’.
“We are proud to bring together members of the music, medicine, and patient community who through the gala learn of the breadth and scope of patients we serve and our research projects with doctors and nurses, from neonatal care to oncology, Alzheimer’s disease and psychiatry,” said Joanne V. Loewy, DA, LCAT, MT-BC, Founder and Director of the Louis Armstrong Center for Music and Medicine, which provides music therapy services throughout the Mount Sinai Health System.
The Department of Music Therapy, with support from the Louis Armstrong Educational Foundation and other grants, provides a range of clinical services for infants, children, and adults, and day treatment at the Mount Sinai-Union Square clinic and within the community. Its music therapists are licensed and board certified to provide care that complements medical treatment, assisting with sedation, pain management, and neurologic and respiratory function.
“With substance use disorders, there’s a huge issue of stigma that prevents a lot of women, and thus their children, from getting the care they need. If we want healthy children, we need healthy moms.” — Yasmin Hurd, PhD
Addiction is an all-too-common problem among pregnant people, with devastating results for parents and their children. Now The Bridge Program, a new initiative at Mount Sinai, is providing integrated prenatal care and substance use treatment.
Launched in September 2022, The Bridge Program is the first program of its kind in New York City, and it addresses an increasing need. “Until now, there was no place in all of Manhattan where a pregnant person with an addiction disorder could go for prenatal care or consultation. It’s a really overlooked area, and it’s so important for the health of pregnant people and their newborns,” says Joanne Stone, MD, Chair of the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai.
“With substance use disorders, there’s a huge issue of stigma that prevents a lot of women, and thus their children, from getting the care they need,” adds Yasmin Hurd, PhD, Director of the Addiction Institute at Mount Sinai. “If we want healthy children, we need healthy moms.”
Prenatal Care for an Overlooked Population Nearly 10 percent of pregnant women use substances during pregnancy. “This problem is just as common as many of the other issues that we test for during routine prenatal care, yet there are limited programs specifically targeting this population,” says Leah Habersham, MD, an Assistant Professor of Psychiatry and Obstetrics, Gynecology, and Reproductive Science at Icahn Mount Sinai. “And overdose deaths are steadily increasing among women of childbearing age.”
Dr. Habersham aims to use her dual training in obstetrics and addiction medicine to turn those trends around. She is currently the sole provider for The Bridge Program, offering varying levels of care depending on a patient’s needs. If a patient has already established prenatal care, Dr. Habersham will offer consultations or provide treatment and support for substance use disorders. Other patients may choose to come to her for both addiction services as well as obstetrical and gynecological services, including the full range of prenatal care. She also works closely with a social worker to provide additional care and psychosocial resources to her patients.
The Bridge Program sees pregnant patients who use or misuse any substances, including nicotine, alcohol, opioids, and other drugs. Dr. Habersham also welcomes patients who are not currently using substances but are at high risk, such as those with a history of addiction or those who may live with a partner who has a substance use disorder. “If there’s any concern, patients can be referred to this program,” she says.
A Nuanced View of Addiction in Pregnancy
While interventions are tailored to each patient, Dr. Habersham often uses motivational interviewing to meet patients where they are—and begin to move them toward accepting treatment. “There’s often a lot of ambivalence from patients who aren’t ready to take that next step toward recovery. Harm reduction is important in this setting,” she says.
As a specialist in addiction medicine and obstetrics and gynecology, she brings a more nuanced view to her care of pregnant patients. During pregnancy, for example, patients who receive medication for opioid use disorders (MOUD) will often need increases in their MOUD regimens to prevent cravings. She makes sure patients are aware of that possibility, and not afraid to speak up if they notice changes in how they are feeling. “Someone without an addiction background may see that as a sign the patient is going to go out and use opioids, though it’s not necessarily the case. Often, patients just need an increase in their doses,” she says. “A lot of times, patients withhold that kind of information from general providers.”
When it comes to prenatal care, Dr. Habersham also does things a little differently with this population. “A lot of patients with substance use disorders have trauma in their backgrounds, and many have distrust for their providers. It’s really important to build a strong foundation of trust in the doctor-patient relationship,” she says. That means she may not do a vaginal exam during the first visit, for instance, but wait until the second visit when the patient feels a bit more comfortable. “There are many biopsychosocial aspects involved,” she says.
Substance Use Screening & Methadone During Pregnancy
Because of stigma and stereotypes, there are often inequities in who is screened for substance use disorders during pregnancy and how they are screened. Even before The Bridge Program was conceived, Mount Sinai’s OB-GYN department began screening all pregnant people for possible substance misuse and addiction. “The implications [of substance use during pregnancy] are profound, and it’s important to make sure that screening is done in an unbiased way and in a manner that leads to better health care for pregnant people and their babies,” Dr. Hurd says.
She and her colleagues hope The Bridge Program will be a first step on that path to better and more inclusive health care. Initially, the program will be available to patients one day a week. Eventually, the team hopes to expand the services to reach many more patients in need. “We have all the parts of the toolbox here at Mount Sinai—a detox unit, rehabilitation, residential living, even a female-only methadone clinic. I hope we can become a center of excellence for women throughout the city with substance use and substance use disorders, and not just during pregnancy,” Dr. Habersham says.
The Opioid Treatment Programs at the Addiction Institute of Mount Sinai offer medications and a suite of services to help thousands of people with opioid use disorder reclaim their lives each year.
In 2021, drug overdose deaths in the United States surpassed 100,000 annually for the first time, according to CDC data. The vast majority — 75,673 —were caused by opioids, up from 56,064 the year before. One factor in those lost lives is fentanyl, a powerful opioid that is increasingly prevalent in the illicit drug supply.
Yet deaths due to opioid use disorder (OUD) are preventable, and effective treatments are available. The Opioid Treatment Programs at the Addiction Institute of Mount Sinai provides medications and other services to more than 3,500 patients with OUD at eight clinics in New York City.
“We treat the entire person. The first step is helping them to stop using opioids, then we start to work on recovery of all life areas,” said Teri Friedman, Senior Director of Addiction Services at Mount Sinai Beth Israel. “We try to help patients reach the highest level of functioning in all areas of their lives.”
Buprenorphine and Methadone Clinics Are Just the Beginning Mount Sinai has a long history of treating substance use. Its predecessors, Beth Israel Medical Center and, before it, Manhattan General Hospital, were pioneers in addiction treatment. Harold Trigg, MD, Marie Nyswander, MD, and Vincent Dole, MD, launched the Methadone Maintenance Treatment Program in 1965. More than half a century later, the program is now known as the Opioid Treatment Programs at the Addiction Institute of Mount Sinai, and it continues to help patients with opioid use disorder reclaim their lives.
Medication is the gold-standard treatment for OUD. Methadone and buprenorphine/naloxone are FDA-approved and able to decrease cravings and relieve withdrawal symptoms. Mount Sinai’s outpatient Opioid Treatment Programs provides those medications at outpatient clinics in Manhattan and Brooklyn.
Yet medications alone cannot restore lives. “As we embrace recovery, we come to an understanding that every recovery path is different from the next. We meet patients where they’re at,” said Cheryl Marius, Director of the Opioid Treatment Program clinics at Mount Sinai Beth Israel.
Those clinics also provide:
One-on-one therapy
Group counseling
Peer counseling
Case management
Educational and vocational counseling
Annual physicals and general medical care
Psychiatric evaluation and medication management
Referrals for mental health treatment
HIV counseling and testing
Hepatitis C testing and telemedicine
As part of Mount Sinai, the programs are well connected to help patients access the care they need, said Annie Levesque, MD, Medical Director of the Opioid Treatment Program at the Addiction Institute at Mount Sinai West. “We’re embedded in the Addiction Institute, so our patients have access to a greater level of care. We can easily refer them to other services as needed, such as more intensive group therapy or inpatient detox for other substances.”
Addressing Disparities in Addiction Treatment Methadone has been prescribed to people with OUD for decades. Buprenorphine/naloxone is a newer treatment, with a better safety and side effect profile than methadone, Dr. Levesque said. And because there is less regulation around buprenorphine, it can be prescribed in more settings, including doctor’s offices. Yet in many treatment programs, there are sharp racial and socioeconomic disparities in treatment. Patients with private health insurance are more likely to receive buprenorphine prescriptions from their doctor, avoiding daily visits to a methadone clinic.
At Mount Sinai’s opioid treatment clinics, all patients are given the option of treatment with either methadone or buprenorphine. Many patients who have been on methadone for some time prefer to continue with that medication, Marius said. But counselors and patients take many factors into consideration when determining the best path forward. “We provide individualized treatment for each patient,” Dr. Levesque said.
The frequency of a patient’s clinic visits depends on their progress through the program, regardless of which medication they choose. Early in the process, patients come to the clinic daily for their medication, which ensures that they are in regular contact with their counselor. Patients who are stable for some time and not using illicit drugs may progress to coming less frequently to pick up their medications, perhaps as infrequently as once a month. “Your recovery determines your schedule,” Marius said.
Rethinking Treatment for Opioid Use Disorder Treating OUD remains an uphill battle. Both the disorder and the medications prescribed to treat it are subject to significant stigma. “More people need to accept that this is a medical disease,” Marius said. One common misconception within the medical community is that patients who take methadone have just swapped one drug for another. “Methadone is a medication, just as insulin is a necessary treatment for diabetes,” Friedman says.
Another mistaken belief is that patients with OUD should be referred for short-term detox, or that they should eventually taper off treatments like methadone. “In fact, long-term maintenance treatment is considered the best quality of care,” Dr. Levesque said.
Dr. Levesque and her colleagues at the Opioid Treatment Program are pushing back against the stigma, training others in the medical field and conducting research to improve access to treatment — and save more lives.
“Despite the high number of deaths, opioid use disorder is highly undertreated,” Dr. Levesque said. “As physicians we need to be referring patients to treatment and making sure we connect them to these treatments that work.”
Suicide is a serious public health problem, one that affects a broad segment of the population, according to the Centers for Disease Control and Prevention. But it can be hard to talk about.
In fact, there is one suicide death every 11 minutes, and that does not reflect the number of attempts. The suicide rate had been rising dramatically prior to the pandemic, which is one reason why the federal government in July launched the 988 National Suicide & Crisis Lifeline, an upgraded hotline for those in crisis.
At the same time, it’s important to remember there are ways to mitigate the risk of suicide and specific things you can do if you are concerned about a friend of family member. In this Q&A, Marianne Goodman, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, offers some guidance on this sensitive topic.
“If we can help people identify suicide risks, limit access to ways that they could die by suicide, and use the crisis services that are now much more available, including the national 988 hotline, we can make a big difference,” says Dr. Goodman, acting director of the Mental Illness Research, Education and Clinical Centers at the James J. Peters VA Medical Center in the Bronx, who also co-leads a new initiative to help concerned family members speak to veterans about safely storing firearms and reducing the risk of self-harm.
How serious is the problem of suicide in the United States?
Suicide is the 12th leading cause of death. There are about 130 suicide deaths every day, and that’s one about every 11 minutes. In 2020, almost 46,000 Americans died by suicide, and this is twice as many as those who die in homicides. There were also 1.2 million suicide attempts. White males account for about 70 percent of the suicide deaths, and firearms are involved in more than half of these deaths. Unfortunately, in the past 20 years, the age adjusted suicide rate has increased 30 percent. This is a national crisis prompting a tremendous amount of research and clinical programming developed to target this elevating rate of suicide.
Who is most at risk, and why?
Certain populations have a particularly heightened risk. These include those encountering chronic stressors such as the elderly, veterans, lesbian, gay, bisexual, transgender, and queer populations, those with debilitating physical and mental illness, and especially those with a previous suicide attempt. Other risk groups include people with acute stressors such as a recent job loss, having been stigmatized, victimized, or traumatized, or who have experienced financial or relationship problems. But there’s not an equal risk at all times. It turns out that the rate of suicide is higher on Mondays and lower on the weekends; rates are higher during the spring and summer and after midnight.
What are some of the most common causes of suicide and suicidal thinking?
Suicide and suicidal thinking is prompted by many factors. In addition to the known risk factors, suicidal symptoms can be triggered by intense feelings of failure, shame, and being a burden to others. A deep sense of isolation, helplessness, and hopelessness leads to the belief that taking one’s life is the only answer to the misery they are feeling. However, there are also protective factors that actually lower the risk of suicide. These include bolstering coping abilities, having a purpose and reason for living; possessing a strong cultural identity; and a connection to others. If we can increase our protective factors, it actually mitigates some of the risks.
There are growing concerns about suicide among younger people. Why is that?
There is a tremendous and growing concern about suicide in younger people. Suicide is now the second leading cause of death among people aged 15 to 24. The highest rate of suicide death in youth are American Indians and Alaska Natives, with about 23 deaths per 100,000 people. White youth are second with about six suicide deaths per 100,000 people. While these numbers are certainly concerning, there’s a lot of recent evidence that suggests that youth suicide is a growing problem. A recent study that looked at just the past year found that 20 percent of high school students reported serious thoughts of suicide, and 9 percent made an attempt. Those are astronomical numbers. It’s not just high school students at risk; other concerning emergency room data of pre-adolescent children 10 to 12 years old document an increase in suicidal ingestion of substances, up four and a half fold in the past two decades. Also, reports of firearm use in youth is the highest in the past 20 years. During the pandemic, there was an increase in firearm suicide deaths of about 2 percent in adults, but 15 percent in young people. So clearly life stressors are affecting youth, and it’s being expressed through suicidal expression.
What has been the impact of the pandemic?
Suicide rates peaked in 2018. During the pandemic, suicide rates actually declined 3 percent in 2020. Pandemic related decreases could be explained by the notion that people pull together during a crisis. Some stressors were lessened during the pandemic, such as no longer needing to endure long commutes to work. The pandemic did draw attention to the importance of mental health. So while the pandemic was stressful, some of those forces were mitigated with the suicide rate coming down since 2020.
Has the new 988 National Suicide Prevention Hotline helped?
The 988 hotline is the 911 for mental health crises. The national hotline, accessed through calling 988, now connects people to the National Suicide Prevention Lifeline. This lifeline then connects individuals to various resources, including the Veteran’s Crisis Line, and a network of more than 200 state and local call centers services through the U.S. Department of Health and Human Services. The Biden administration invested a tremendous amount of money into this infrastructure. In fact, funding increased from $24 million to $432 million to address our mental health and suicide crises. In the year before the hotline, there were about three million calls, chats, and text to these centers. That’s expected to double within the first year of the national hotline.
What are some signs that someone may be in need of help?
Suicide prevention is everybody’s responsibility. There are warning signs that signal that someone is struggling. These include a preoccupation with death, comments about feeling trapped or a burden to others, or suggesting that people would be better off without them. Look for reckless behavior and impulsivity, such as driving at high speeds or enhanced use of alcohol and mind-altering substances. Mood swings, irritability, and worsening anger are concerning signs, as are changes in behavior including pushing people away, turning off phones, excessive sleep, or inability to sleep.
What should you do if you are concerned about a loved one or friend?
If you are concerned about a loved one or a friend, it’s important to reach out to that person. Talk to them and listen carefully. Encourage them to tell you what’s going on. Ask some difficult questions, such as: Are they feeling so bad that they want to think about ending their life? Do they have a plan to end their life? Don’t pass judgment about what they’re saying. Just be there to hear what they have to say. It’s important to empathize with the pain that they are going through. Help them to connect to either friends or support. If they are in crisis, use the 988 hotline, or seek professional help in a local emergency room. It’s very important to reassure the person that that they will not feel this bad forever and that negative feelings do get better over time.
What resources are available?
There are tremendous resources available. You can call the 988 hotline line 24/7. There are many organizations that offer assistance, including the American Foundation for Suicide Prevention, which has a website with lots of information. Another website, Means Matter, offers information about the importance of restricting access to a means to die by suicide, such as firearms. The Suicide Prevention Resource Center is another valuable resource.
Why is the issue of firearms so important?
When firearms are used, more than 85 percent of suicide attempts end in death. All other methods average about a 2 percent likelihood of death. More than 50 percent of people who die by suicide use firearms. If we can limit access to firearms, especially for those who are vulnerable, during high-risk times, we can meaningfully bring down suicide death rates. Promoting safe storage of firearms, and involving family in these decisions, is key. Pulling a trigger can happen so quickly with firearms—that urge, that impulse, once it is acted upon, you can’t take it back.
