So many people at risk of dying by suicide are told “it’s all in your head.” Those words are never true, and they’re never helpful – but they’re perhaps never worse than for people living with chronic pain.

It’s a prevalent problem. The National Center for Complementary and Integrative Health (NCCIH) reports that 25.3 million American adults suffer from chronic pain. And the unfortunate truth is that people who are living in pain every day are at elevated risk of dying by suicide. A study in the United Kingdom found that nearly one in 10 deaths by suicide occurs in people with chronic pain.

It’s not just about the pain – it’s the impact on a person’s life

You might imagine that someone with chronic pain might die by suicide because suicide is a final means of making the pain stop. While there’s some truth to this idea, the pain per se is only part of the story. To see the full picture, we have to examine the full impact of chronic pain on a person’s life.

“It’s a matter of what chronic pain takes away,” writes Erin Midgol of The Mighty. Chronic pain can damage friendships and family relationships because the person with pain is not always able to spend time with others. It can restrict hobbies and activities, limiting enjoyment of life. For many people who live with pain, even getting out of bed in the morning is hardly a guarantee.

Often, people with chronic pain are failed first by the healthcare system. They may be shuffled from doctor to doctor before someone finally takes them seriously. Even then, it can take months or years to find a treatment plan that will make the pain bearable – and even then, the method that works may not be covered by insurance. Meanwhile, chronic pain can make it difficult or impossible to work and earn a living – and many conditions that cause pain do not qualify for disability benefits.

For some, the stigma can be life-threatening

Mental health should be thought of as part of our physical health, and taking care of it should be a priority. However, many groups suffer under the “it’s all in your head” stigma and go without treatment for whatever ailment may be the source of their pain. A staggering 25% of Americans experience chronic pain, and a large number of them are women, possibly due to a high number of autoimmune conditions that affect them more than men.

Members of the LGBT community, who already have a mind-blowing rate of depression and other devastating mental health concerns, may avoid doctors due to fear of discrimination or misgendering. People of color may suffer cultural stigma, particularly men, who tend to not seek out mental health treatment as frequently as their white counterparts.

Pain is not treated on a scale of believability. The way it is treated today echoes past centuries where women’s pain was treated as hysteria, and little was done about any of it. The physical and mental anguish leaves many patients wondering if their pain is simply imaginary, isolating themselves, and severely affects their mental health. We must do better. We must change.

We need to reform our attitudes toward people with pain

The opioid crisis, while certainly a major public health problem that needs to be addressed, has had the unfortunate side effect of exacerbating toxic attitudes toward people with chronic pain. People with chronic pain endure the constant message that they’re abusing their medications – when in fact they’re taking them responsibly.

Beyond that specific issue for this moment in history, people with chronic pain face generations of ingrained messages that they need to “toughen up.” They’re used to being dismissed by society, by doctors, and even by friends and family. It’s no wonder that when mental health issues co-occur with chronic pain, they’re hesitant to seek help. (Not to mention, seeking help for mental health issues carries its own stigma.)

It’s time to break this cycle and change the way we think about chronic pain. There should be absolutely no shame in seeking help for physical and mental health issues alike. We have the means and the capacity to take care of anyone in need of treatment for chronic pain. As we mark the end of Pain Awareness Month, let’s be reminded that the stakes couldn’t be higher.

Youth in our nation could lose their lives

Much has been made of the current administration’s decision to detain migrant children – in fact, the administration recently moved to detain children with their families indefinitely, according to ABC News.

That’s troubling for a host of reasons, the least of which is that putting children in detention facilities has been linked to depression, post-traumatic stress disorder (PTSD), and other mental health problems that can lead to an elevated risk of suicide.

There is much we don’t know – but what we do know isn’t good

As the New York Times reports, child psychologists and human development experts have raised the alarm about the conditions migrant children face in detention facilities. Even the best institutional setting, the Times says, is a poor substitute for a family.

Children need personal connections, stability and consistency in order to thrive, and a detention facility can provide none of those things. Turnover is high among the adult staff, who may be detached and impersonal. Each adult in such a setting is responsible for a large number of children, further limiting the amount of attention each child can receive. In short, detained children – especially migrants in an unfamiliar place and with potential language barriers – are left to long for the care they need, which may not come for a long time, if at all.

In addition to the pure psychological issues, being in a detention facility or institutional setting at an early age can lead to health issues, such as heart disease, later in life. Those physical health issues, in turn, can lead to co-occurring mental health problems such as depression, anxiety, deadly eating disorders, and elevated risk of death by suicide.

The true long-term consequences of being in detention facilities are harder to predict, but the damage is real. Research suggests that a longer stay at a later age may require the longest recovery period. Some children may prove to be more resilient than others, but every child who is detained is at risk.

A glimmer of hope: potential for growth

Shocking and terrible experiences, such as being placed in a detention facility, have a deep and profound effect on the mind. In far too many cases, that effect is permanently damaging, leaving scars that never fully heal – and may later be realized in a death by suicide. But there is potential for survivors to emerge stronger than before, and our hope is to see that potential realized.

Post-traumatic growth (PTG) is the idea that victims of trauma can discover new personal strength, deeper meaning in life and a stronger sense of purpose. According to an NBC News article on the topic, PTG is not the opposite of PTSD; rather, it can happen alongside post-traumatic stress as the victim finds new ways to cope. And it’s more common than you might think – one study showed that 30 to 70 percent of trauma survivors report at least one sign of PTG.

While post-traumatic growth still needs substantial additional research, research suggests that children as young as seven can and do experience PTG – and that there are practical steps adult caregivers can take to nurture them along the way, such as:

• Hearing out a traumatized child’s thoughts and feelings without judgment
• Helping them to understand and process the meaning of traumatic events in a supportive setting.
• Narrative exposure therapy – a clinical technique that encourages survivors to create personally meaningful stories of their experience – can also move children (and adults) on the road toward post-traumatic growth.

It’s possible, even in the darkest of times, to find opportunities to grow and build resilience that will protect the survivor against future mental health issues and the potential risk of death by suicide. But in order to protect these children and help them to find new meaning after trauma, we first need to stop subjecting them to additional trauma, either by reuniting them with their families or finding them new, supportive homes. And then we need to make an immediate and sustained investment in the mental health services and resources they need.

Early intervention is the key to suicide prevention, most of all among those who have experienced severe trauma. These children deserve nothing less.

The collective wisdom of this country knows everything detailed in this blog.  Why do stupid things that hurt children?  What is the point?