The video of a Sacramento police officer talking a woman off the ledge of a bridge last week is a stark reminder that September is National Suicide Awareness Month. And the woman, who was taken to a medical center for evaluation, a reminder that there are many souls among us who struggle with mental illness and thoughts of suicide.
This distressed population is also the subject of rapper Logic’s hit song “1-800-273-8255,” and the ones who accounted for a 50 percent increase in crisis calls to the National Suicide Prevention Lifeline last month after Logic performed his song during the Video Music Awards.
But crisis centers would be pivotal if we invested in more community support options for individuals experiencing a mental health crisis. Despite studies that show suicide is on the rise, we ignore the need to increase funding for community-based programs when they have been shown to provide cost savings.
Instead, all too often, patients facing mental health crisis end up in hospital emergency departments (ED) for treatment. Care in the ED is not the most appropriate or clinically indicated. Access to psychiatric professionals is limited, if not absent altogether. Suicidal patients are treated like prisoners being watched in a sterile room by security, while the nature of their crisis is not being addressed.
Patients describe feeling stigmatized, unheard, and as though their issues are not prioritized in an environment filled with life-threatening medical situations. More alarmingly, additional studies have found that individuals who commit suicide are likely to have had contact with a healthcare provider around the time of the attempt.
To add insult to injury, when there are no hospital beds available, mental health patients often end up in a jail cell.
Crisis respite programs, like The Living Room, which opened in 2011 in a Chicago suburb, have become treatment models because of promising outcomes. When someone comes to The Living Room they are immediately connected to a peer counselor who spends time talking with the person in crisis and works with them on coping skills and gaining access to critical resources and services. As a result of this type of intervention, 93 percent of individuals served by The Living Room require no additional emergency services. Given that administrative costs for The Living Room per visitor averages about $269 and an ED visit for a mental health reason averages nearly $2264, a significant cost savings of almost $2.8 million has been experienced by the State of Illinois since the program’s inception. Similar efforts are underway in Alaska and Massachusetts.
However, due to significant mental health funding cuts, community-based options are not always available. Between 2009 and 2011, $1.6 billion was cut from state mental health budgets across the country, and current budget discussions in Congress indicate the trend will continue.
True, funding as a whole is limited; there’s only so much money to go around. Establishing these programs can be costly. You could argue that the EDs should just hire psychiatric professionals. However, the very nature of the ED does not lend to appropriate care of individuals in mental health crises. Hospitals have tried to enact measures to improve psychiatric care in EDs. The reality is that the overhaul in infrastructure and staffing is not only expensive but also largely unrealistic given administrative agendas, space, staffing shortages, and a variety of other issues. Community-based crisis intervention programs have shown cost savings when the money goes towards preventive programming as opposed to ED treatment after the fact.
National Suicide Prevention Awareness Month encourages us to have a conversation about suicide.
The conversation needs to extend beyond the month of September, and the movement needs to go beyond just conversation.
Incidents such as the one in Sacramento serve as examples of the daily impact of suicide. The performance by Logic puts a spotlight on the number of Americans suffering from thoughts of suicide. After the performance, the hashtag #zerosuicide started trending on social media. It should encourage us as a society to look more honestly at what we have implemented to help people who are suicidal. Now is the time to focus on early intervention based in the community, so we don’t need to have acts of heroism such as the one in Sacramento and crisis lines aren’t the only means of support.
-Dr. Michelle Heyland
Dr. Michelle Heyland is an Assistant Professor of Community, Systems, and Mental Health Nursing at the Rush University College of Nursing, a practicing Psychiatric Nurse Practitioner, and a Public Voices Fellow.