Pet lovers have long believed that the companionship that comes with having a pet has real benefits from the owner. Now, a systematic review of research puts hard evidence behind that belief.

The review, led by Dr. Helen Louise Brooks of the University of Liverpool and published in BMC Psychiatry, suggests that pets do indeed provide benefits to people with mental health conditions.

A distraction, a sense of purpose, unconditional support – how pets benefit people at risk of suicide

Americans were estimated to have spent over $69.35 billion on their pets in the year 2017, reaching a new high. While the love for our furry friends is well acknowledged, their services can make the difference between life and death for some.

In the review, “pets were perceived as providing unconditional love and support” – something that people struggling with mental health issues often cannot get from friends and family. In the face of the often overwhelming challenges that come with living with a  mental illness, that level of love and support is invaluable.

Pet owners were also found to draw strength, self-worth and meaning from their pets. Multiple pet owners said that taking care of their pets gave them something to like about themselves. Another spoke directly about an experience with suicidal ideation: “The thing that made me stop was wondering what the rabbits would do.”

One of the most persistent myths about suicide is the idea that a person who is determined to die by suicide is inevitably going to do so. The reality is that the suicidal urge is an acute problem that does not last forever. Pets have been shown to provide an important distraction, a grounding that allows suicidal people to step outside their own thoughts and focus on caring for or interacting with the pet. That’s often enough to save a life.

Some pets, such as dogs, were also shown to force positive behavior from their owners. Simple acts necessary to dogs such as going outside, engaging with the community and participating in physical activity are all known to have significant mental health benefits. For a person struggling with depression or another mental health issue, the simple fact that the dog has to go outside is a powerful source of motivation. Many people that struggle with taking care of themselves often find solace in taking care of another.

Different animals serving different purposes

Hospitals frequently utilize the talents of therapy dogs, who offer calming presences and physical affection to patients in care. This unconditional love can make a world of difference to someone with a psychiatric disability, especially when navigating often cold and unfamiliar settings of an inpatient unit, especially to those who may not have any visitors otherwise.

Psychiatric service dogs come with their own set of legally protected regulations. Specially trained to assist one person, these dogs can enter areas that regular pets cannot (such as restaurants and establishments that have a “no pets” rule in place) and usually wear identifiers such as tags, collars and vests to let others know they are “on duty.”

Emotional support animals can include dogs and often do, but could theoretically be any animal that offers an ailing owner comfort in their time of need. Deeply attuned to their owners moods and behaviors, these animals can be allowed (with a “prescription” note from a psychiatrist) to live in places with a “no pets” policy and are protected under the ADA. However, they do not have the training of a service animal and are not allowed to enter the same spaces as designated service dogs.

The benefits of tackling mental health treatment with animal assistance are documented through research, and patients often feel more at ease with a furry companion than an all-too-often unfamiliar and anxiety inducing environment of a hospital.

Patients who disassociate or hallucinate can be calmed and grounded with animal intervention, whether it comes from a trained service dog or engaging tactile grounding techniques petting the family cat. Depression and anxiety can be calmed, and traumatic episodes can be interrupted by the unconditional bond between humans and pets or service animals.

Pets need to play a role in care plans for people at risk of suicide

While further research is clearly needed into the specific benefits of pet ownership and the types of interventions that are most effective, the evidence clearly shows that pets have an important role to play in mental health care. As one of the researchers pointed out, introducing pets is potentially a very powerful intervention because it invites patients to get involved in their own care, creating an opportunity to have an open discussion about what works best for the individual patient.

Obviously, not every patient will respond well to pets, but for those who do, having an animal companion can be the difference between life and death. This is an avenue of treatment that family members, friends and mental health professionals alike need to explore to make sure that people struggling with mental health problems have access to all of the resources and support they need.

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?

According to the CDC, suicide rates have increased in every state across the US except for Nevada from 1999 to 2016. In 2016 alone, almost 45,000 Americans as young as 10 years old lost their lives to suicide.

Mental health statistics

According to National Institute of Mental Health (NIMH):

• In 2016, roughly 44.7 million adults in the US aged 18 or older (18.3 %) suffered from mental illness. However, only 19.2 million (43.1 %) received treatment.
• Serious mental illness affected 10.4 million adults in the US aged 18 or older (4.2 %), about 6.7 million (64.8% ) of whom received treatment.

Mental illness also affected these adult age groups:

• 1 % of adults aged 18-25, 35.1% of whom received mental health treatment
• 1 % of adults aged 26-49, 43.1% of whom received mental health treatment
• 5 % of adults aged 50 and older, 46.8% of whom received mental health treatment

Roughly 49.5% of adolescents in the US aged 13-18 suffered from mental illness. Among the age groups, mental illness affected:

• 3 percent of adolescents aged 13-14
• 3 percent of adolescents aged 15-16
• 7 percent of adolescents aged 17-18

Suicide prevention starts with education and early intervention

New York and Virginia have tackled the mental health epidemic through education. Both states have enacted laws mandating that mental health education be implemented in the school system. Frankly, it is disturbing to know other states have not taken the same or similar steps.

The New York law will require that mental health is included in curriculums in grade levels K-12. The law was passed and signed in 2016 but did not take effect until July 1, 2018. The law is intended to bring awareness to the issues and risks faced by those who suffer from mental and emotional complications. Those for the law believe that mental health education can prevent substance abuse and suicide.

Glenn Liebman, chief executive officer of the Mental Health Association in New York State, explained why mental health education is so important: “If you look at the statistics about mental health-related issues, it creates a very compelling case as to why this is so important.”

Virginia’s law (Senate Bill 953), which also took effect on July 1, 2018, will require that mental health topics be included in physical education and health for 9th and 10^th grade students.

With greater implementation of mental health education into New York and Virginia’s school systems, children who suffer from mental illnesses may have a myriad of resources for early intervention.

Recognizing the warning signs and taking action

The National Alliance on Mental Illness (NAMI) identified the early onset and warning signs of mental illness in children. About half of lifetime mental illness starts in adolescents around the age of 14, 37 percent of which are at risk of dropping out of school.

The warning signs that a child may be suffering from mental illness may include:

• Sadness and socially withdrawn behavior that persists for more than 2 weeks
• Self-destructive or suicidal intent
• Erratic and compulsive risk-taking or unruly behavior
• Unpredictable fear and anxiety which may cause physical symptoms: rapid heartbeat and shortness of breath
• Refraining from eating, eating too much, anorexia or bulimia
• Intense anger, sadness or unstable moods
• Drug or alcohol abuse
• Disruptions in sleeping patterns, irritability and other behavioral changes
• Difficulty in staying focused and academic problems in school
• Fears and worries that affect daily life and impair social function

These early signs of mental illness are not to be ignored. Bringing awareness to students, teachers and parents can make a difference in preventing substance abuse, destructive behavior or suicide. If you notice these warning signs in your child, NAMI suggests talking to a pediatrician, getting a referral to a mental health specialist, becoming active with your child’s school, and connecting with other families. A healthy network of social links not only keeps parents informed of their child’s behavior, progress, and in a support network should they need it.

Justice is possible

The new laws passed in New York and Virginia may provide a ground-breaking basis for suicide prevention, but more needs to be done. It’s important that the perception of mental health changes in our society. Children who may otherwise feel overwhelmed and hopeless may receive the support they need from educators and their peers.

But when responsible parties fail our children, they can be held accountable for negligence. Losing a child or loved one to suicide is a devastating experience. That’s why you should speak to an attorney experienced in helping families of suicide victims seek answers and justice.

Contact us today for a free consultation. We can help.

While celebrity deaths by suicide dominate the headlines, the United States is in crisis

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

-Johann Wolfgang von Goethe

In the past several years, notably the past several months, the world has lost a brilliant mind almost every day of the week. Here are some of their names:

• Robin Williams: Monday, August 11, 2014.
• Kate Spade: Tuesday, June 5, 2018.
• Chester Bennington: Thursday, July 20, 2017.
• Anthony Bourdain: Friday, June 8, 2018.

But we don’t know the vast majority of the names of the 123 people who die by suicide daily. It should not feel uncomfortable and strange to talk about mental health issues in a first-world country where we should have access to quality mental health care, but here we are as a nation, tongues tied. We are constantly awestruck when a celebrity name crosses our newsfeed followed by a comment stream of virtual mourners.

Make no mistake, celebrities are important people. Anthony Bourdain inspired countless viewers and followers of his work to be themselves and cross cultural borders. Kate Spade gave hope to women entrepreneurs and immortalized her name in the world of fashion. Robin Williams touched millions of hearts, and his voice can still be heard on treasured VHS copies of Aladdin. Chester Bennington of the band Linkin Park gave hope to the hopeless through compelling lyrics and was outspoken about his battles with depression. But equally important are the thousands of others who die by suicide every year.

So, what went wrong? America sees 25 suicide attempts for every completed tragedy and subsequent loss of life. And the numbers are only increasing. According to findings published in the CDC’s Morbidity and Mortality Weekly Report, Americans are dying faster than ever before—by a completely preventable cause. And how the media covers high-profile deaths may very well influence the next attempt.

The CDC’s report looks grim

The introduction to the study coldly informs us that suicide rates in the United States “have risen nearly 30% since 1999.” These deaths have become more frequent since events like the 2016 election. They are happening more frequently than before among people who were not previously flagged for a mental health disorder. Celebrities’ mental health struggles, even those discovered after the fact, shed light on a continuing issue. People are dying due in part to high access to lethal means such as guns. Firearms account for 51% of all suicides just in the year of 2016.

Who is dying?

As always, those marginalized by class, race, level of disability, gender or sex suffer the most.

• In the Native American community, suicide is a major leading cause of death and has been on the rise since 2003, according to the CDC.
• LGBTQIA+ identifying people are also at risk, with youth contemplating suicide at almost 3x the rate of heterosexual, cisgender youth.
• Those with access to lethal weapons, like guns, are more likely to act on their impulses and complete a suicide.

Across all demographic groups, men die at greater rates than women. This is largely due to the stigma against mental illness that prevents men from seeking help. However, the proportion of women committing suicide is increasing.

What is killing them?

Job stress has been cited as a frequent factor in suicides, with some studies even showing that the deadliest day of the week was Wednesday, when the demands of a harsh work environment in a country that still stigmatizes mental health prove to be too much. The physical effects of mental stress can cause anything from Raynaud’s Syndrome to a devastating depressive episode in someone genetically predisposed to a mental health disorder.

Untreated mental health issues, especially in areas of little to no access to providers such as rural areas, or for sufferers with fewer resources such as the uninsured, underinsured or homeless, can easily lead to death. Bad treatment, or no treatment at all, can quickly extinguish the life of someone who never got the chance to be famous, to make headlines, to have a comment section mourn for them. At best, their families will receive “thoughts and prayers.” Not peace.

Copycat deaths

When the media covers a celebrity suicide, there’s a well-documented impact on the public. Suicide hotlines see a surge of calls come in from people seeking help, as the public shares their numbers across social media like wildfire. However, these “contagion” deaths show what is known as a “dose effect.” The larger doses of tragic news we expose the public to, especially youth, the more the thought lingers in their minds. After the recent loss of designer Kate Spade, hotlines were bombarded with calls. But for every call answered, one wasn’t made.

Youths are impressionable. High-profile suicides give them a look at someone who is like them who, as the thinking goes, found a way out. The celebrity death may quickly inspire their own actions. In fear of “suicide contagion,” a set of media reporting guidelines was set up in order to help curb the kind of graphic coverage death is given. And yet, thousands of people will die by suicide this year, partially due to online news outlets and social media that either don’t have to or simply don’t want to adhere to these guidelines.

Healing the divide

How can we help? From becoming an advocate for suicide prevention to practicing listening and empathy with your loved ones, your role in lowering the number of suicides must be an active one. We must collectively take it upon ourselves to give names to suicide victims, and advocacy cannot be silent. Suicide is a leading cause of death in America. The nameless victims that the media do not reach number into the muffled, screaming thousands, and still we do nothing.

Our healthcare system does not reach potential victims. Our culture still stigmatizes mental health as weakness instead of treating the brain like another sick organ in the body. Our work lives will continue to act as if more work is the solution to mental health, and employees will never use a sick day for a mental illness without the temptation to call in with flu instead. It’s more believable than this invisible plague. More accepted. Covered by insurance. Less likely to put your job in jeopardy. That’s true despite the physically debilitating effects that come with mental illness. The aches, pains and brain fog of depression and anxiety make it impossible for a mentally ill person to throw themselves into their work and forget about their troubles.

And so, we as a country are quick to cast light on mental illness for a few brief moments of thoughts and prayers before we close our eyes again and shut out the cries of the other 25 attempts for that one death. We act as though they’re a burden that needs to be shut away.

Our culture is sick, and mental healthcare is one of its festering wounds. Healing the divide requires not only remembering the names of Anthony Bourdain and Kate Spade, but also asking the names of others—and then asking how we can prevent more.

If you are unsure of how to become a force against suicide, the Suicide Prevention Lifeline has several easy-to-follow tips and guides for you. We should all begin with empathy for our fellow beings.

The Law Offices of Skip Simpson represents the loved ones of those who have died by suicide due to negligence. Our firm stands by each and every victim and the ones who mourn them, and seek justice in their names.

The winter blues are a false advertisement when it comes to suicide statistics

For as long as we can remember, wintertime has been pictured as the bleakest season. Indeed, Seasonal Affective Disorder (SAD) is often triggered by the dark and cold times. However, the popular myth that suicides are worst around the holiday season simply is not true. Seasonal landscapes don’t always line up with emotional ones. Time moves slower in spring and summer, and those plagued by mental illness may experience a type of melancholy that goes beyond simple summer nostalgia. Mental illnesses are real, and they can end lives. Without proper medical, therapeutic and interpersonal monitoring, patients are at risk of dying by suicide.

The Law Offices of Skip Simpson is dedicated to finding justice for the victims of suicide and the families left behind by their tragedy. We have years of experience holding negligible parties accountable for their actions that, if prevented, could have kept a mother, father, brother, daughter or son alive.  Families and loved ones should not have to worry about whether those they care about will survive the spring.

Seasonal change and mood disorders

Studies dating as far back as the 1800s show that suicides peak in the spring, and are actually lowest during the wintertime. This has puzzled scientists for decades. Most people will experience springtime highs and wintertime lows, but when the angle is taken from one of mental illness, everything is in hyperfocus. Springtime highs can mean manic or psychotic episodes, followed by earth-shattering bouts of depression.

People with mood disorders such as major depression, dysthymia and bipolar disorder are at extreme risk for triggers during the warmer months. Bipolar people, in particular, are more prone to mania (and its lesser form, hypomania) – an extreme, destructive elevated mood state that brings with it unhealthy behaviors and even possible psychosis. These states can even require hospitalization due to how disconnected the sufferer is from reality.

Delusions of grandeur may impair proper thinking, causing people with bipolar disorder to make rash and possibly life-threatening decisions like walking into traffic or jumping from heights, believing themselves invincible. Behaviors associated with hypomania and mania can include:

• Spending too much money, extreme amounts in the case of true mania
• Substance abuse
• Risky behaviors, such as careless driving, sexual activity or fighting
• Hallucinations
• Delusions of grandeur – believing themselves to be infallible
• Aggression and agitation
• Short-term memory loss

A study showed that people with a history of prior hospitalization were at higher risk for suicide attempts and death by suicide, which is associated with bipolar disorder and major depression.

Springtime is a time for close monitoring

Improper suicide watch is a leading cause of death within inpatient facilities, and a lack of education among staff only adds fuel to the fire. Some patients at risk of suicide are only monitored every 15 minutes. This simply is not enough. Roughly 6 times a day, in “secure” inpatient units, suicide occurs under the watch of medical professionals. Already at high risk due to seasonal changes, those with mood disorders and other forms of mental illness deserve better.

Outside of facilities, the headlines’ detailed suicides occurred in the spring, especially those of celebrities. Chris Cornell of the band Soundgarden was found deceased in his hotel room following a concert. While the loss devastated fans, it brought true attention to the issue: suicide in the springtime is too common to ignore. A study published in JAMA Psychiatry found that the risk of suicide increased with the number of daylight hours.

Those who were too physically depressed in the wintertime could feel energized by the increased sunlight, giving them the motivation to attempt suicide. Without proper monitoring by their care team and loved ones, these attempts could turn fatal. Healthcare providers should be at attention when the spring season comes about, and medication may have to be tweaked to accommodate a mentally ill person’s needs.

We can help

There were 44,965 suicides in 2016 in the United States; approximately one third of those suicides occurred while folks were in health care.  Improper and negligent behavior in monitoring or treating those with mental illnesses can lead to death by suicide. Every small change we go through – such as a seasonal change – is magnified for someone suffering, and must be addressed.

Every day, the families and loved ones of victims of suicide speak out to obtain justice. We help them. If you or someone you know has lost a loved one to suicide, contact us today.

Patients at risk for suicide after hospitalization

Inpatient psychiatric care treats and rehabilitates patients so they can return to life and live it fully, without the burden that mental illness imposed upon them. Mental health issues can be suffocating to those who suffer from them, preventing them from engaging in the day-to-day activities most of us take for granted. While outpatient therapy, medication and a strong support system have proven to be beneficial for those with mental illness, additional steps to ensure their wellness sometimes must be taken.

Psychiatric hospitalization is a double-edged sword. Reputable providers and facilities are often successful in stabilizing a patient’s mental state and illness. But diseases run deep, and not all hospitals are created equal. Patients in such delicate conditions must be kept for the right amount of time, in the right care, not left to make it on their own afterwards. The Law Offices of Skip Simpson knows all too well what the consequences can be after hospitalization under poor care. And we demand justice for those affected by death caused by suicide where negligent health care can be proven.

When is it safe to go home?

Getting people with mental illnesses to a hospital is hard enough . We hug and kiss goodbye. We hope and pray that our loved ones learn strategies for dealing with life and can sleep through the night in the care of skilled medical providers. Psychiatric hospital stays can range from five to seven days, the average time most people stay.

Shorter inpatient stays seemed to carry the greatest risk for suicide attempts post-discharge. Fifty years of data synthesized in JAMA Psychiatry noted that the suicide rate of patients in the first three months post-discharge was 100 times the global suicide rate of 11.4 per 100,000 patients per year in 2012. Suicidal thoughts and behaviors also were reported 200 times the global rate. Years later, the suicide rate in the United States continues to increase, especially among the young population and marginalized communities.  But what factors lead to this startling figure? Declining numbers of beds, funding for psychiatric treatment and access to affordable follow-up treatment (including at-home care) have dwindled. A number of patients tend to be homeless, with little to return to and no supportive care.

Mark Olfson, M.D., M.P.H, wrote in an accompanying editorial that “transitions from inpatient to outpatient care are often poorly managed,” and there is resounding truth in this statement. The strict routines and constant access to therapy and medical treatment are easily disrupted after patients are discharged. Other findings from this study include:

• -The 90-day rate of suicide was twice as high for men as for women
• -Psychiatric patients who received no outpatient care six months prior to hospitalization were at increased risk for short-term suicide
• -Efforts aimed at suicide prevention were lacking

Information from patients with mental disorders with a high rate of suicide as their cause of death such as schizophrenia, bipolar, and major depressive disorder were included in the study, which left us all asking the question: “what can we do”?

Stigma is society’s illness, and we aren’t treating it

In 2016, there were 44,936 recorded suicides. According to the American Foundation for Suicide Prevention, there are 123 suicides per day. And for every death by suicide, 25 people attempted suicide. Where is short-term psychiatric stay in this sea of numbers?

The practice itself has negative associations, and some who are admitted have little choice or autonomy in their own healthcare. “Instead of being understood as a valid medical procedure, taking someone to a hospital because of disorders of the mind might sound to the patient as a defeat, a failure…and thus, returning to the community after a psychiatric admission can become a difficult task…” Noted one study from Psychology Research and Behavior Management.

Transitioning from a hospital setting to one outside the hospital may make the patient feel “burdened” by the weight of their own disorder, seen by society and rejected as a failure. Most psychiatric disorders are chronic, the study emphasizes, and hospitalization simply cannot cure them. A database from the Oxford Regional Health Authority area in Oxford, England found that 14,240 patients over the age of 15 had 26,864 psychiatric admissions. Out of these patients, 134 died by suicide within the year after they were discharged.

Where is our healthcare system failing our mentally ill patients? One commonly cited issue involved a “revolving door” of patients: those readmitted to psychiatric facilities within a year after their discharge date, often not by their free will. Giving a mentally ill person the control and autonomy they need to manage their condition is essential to their health, and their life. They simply cannot be fed medication and forced to sit down in groups. The personhood of each individual must be acknowledged. But, in a healthcare system where the number of beds is rapidly dwindling and compassionate staff are stretched thin, more work must be done to insure the health and well-being of patients.

Mentally ill patients need support

An involved, caring team of providers is essential to the treatment and rehabilitation of a psychiatric patient, and the quality of life for a person suffering from mental illness. Upon discharge, there often is little follow-up involved to guarantee the survival of a patient. Unlike other illnesses, psychiatric disorders are often swept under the rug; hospitalization is a taboo, and family and friends may respond to cries for help with “get over it, it’s all in your head.”

These hurtful messages often echo a cruel, inhumane portrayal of the mentally ill in society. They also often undo whatever progress was made within the hospital. Society must understand that the brain is a living, complex organ that can become ill and requires treatment.

Dissolving family structures were attributed to frequent hospitalization in the Olfson study, and among those patients with schizophrenia, medication noncompliance was a serious issue. Why aren’t there more doctors, therapists and live-in nurses who can catch the suffering when they fall?

The meta-analysis of 50 years of data mentioned, conducted by Daniel Thomas Chung, of University of New South Wales in Australia, and colleagues, found that prevention efforts were lacking in hospital care. “Discharged patients have suicide rates many times that in the general community. Efforts aimed at suicide prevention should start while patients are in the hospital, and the period shortly after discharge should be a time of increased clinical focus,” he observed.

The first three months after discharge proved to be the most vulnerable. What can be done to help a person suffering from mental illness stay on track? Recommendations include:

• -Access to affordable mental healthcare
• -Supportive loved ones who can aid in home wellness checks if they live alone
• -An understanding society that normalizes mental health treatment
• -Regular check ins with therapists and psychiatrists to ensure treatment is continuing
• -Step-down programs, such as inpatient to intensive outpatient before full discharge
• -Live-in nurses
• -Compassionate, attentive hospital care

Justice must be found

Within those first three months to a year after discharge, too many lives are lost. Too many families and friends wake up to find their loved one is no longer with them, and it could have been avoided. Suicide is not a random act. It causes death from an illness that doctors and other medical professionals failed to treat appropriately and monitor after attempts at treatment. Understaffed, overworked hospital employees are constantly changing sheets on too few hospital beds. Medication prices are too high for too little effect. Health insurance often runs out before hospital stays are completed. Families and employers would rather see the mentally ill simply snapping back to “normal” instead of treating them with the compassion and care they deserve.

Too many parties fail to ensure the health and survival of the mentally ill. When death by suicide occurs after short-term psychiatric hospitalization, negligent parties must be held accountable for their actions or inaction.

Contact us for a free consultation if your loved ones have found yourselves searching for answers and justice.

When we send our children off to school in September, we don’t expect every day of this new year to end perfectly. We expect them to sigh and grumble about a teacher or assignment. We expect complaints. But sometimes, those complaints are really cries for help. Bullying at school is far too common, despite multiple programs and training sessions that hope to turn kids around.

The Law Offices of Skip Simpson is fiercely dedicated to seeking justice for those left behind after a victim dies of suicide. These deaths and tragic losses are preventable, and more must be done to hold involved parties accountable for negligent or harmful behavior that has ended a life. Thankfully, one law has been introduced that may help. The bill is named in memory of David Molak, a 16-year-old student in San Antonio who died from suicide after excruciating amounts of online bullying. David’s Law hopes to save lives by holding bullies accountable. Starting September 1^st, cyberbullying in Texas schools is now illegal.

No Escape For Today’s Youth

These days, almost every child has access to the internet, text messaging and/or social media. This means that even after the school’s doors are shut, bullies can still access their targets on a cell phone, tablet or laptop. Cyberbullying is brutal. As it stands, 15% of school absenteeism is directly related to fears of being bullied at school.

Schools have been accused of not taking enough preventative action, or indeed action at all when it comes to dealing with bullying. Recently, a 12-year-old cheerleader suffered extreme amounts of cyberbullying up until her life ended in June. Her mother cited Snapchat, texts and Instagram as just a few of the platforms used to harass her daughter. However, the school filed no harassment or bullying reports, even though the student’s mother contacted them about the bullying when it began at the beginning of the year.

David’s Law Brings Hope

David Molak, a Alamo Heights student, was a high achiever, close with family, and an active Eagle Scout. He was also the target of fierce bullying. It crushed his spirit, and he even transferred schools to try and avoid the bullying, but that only lasted a month and the damage was already done via a group text set on ridiculing and mocking David. He died by suicide soon after his transfer. His family was not quiet. A bill was put into action and passed in his honor. Built to take action against cyberbullying, which was previously not a targeted cause for concern, “David’s Law” targets school districts levels of responsibility as well as the definition of bullying.

Cyberbullying is defined as bullying via an electronic device such as phone, computer, camera, messenger apps, texts, social media platforms and websites. Examples include:

• Creating fake profiles of students
• Gossip and harmful rumors spread by social media
• Spreading embarrassing pictures of a student taken without permission
• Hurtful and menacing text or instant messages about someone

The Texas Education Code defines bullying as an action or pattern of behavior against a student that “exploits an imbalance of power and involves written or verbal expression, expression through electronic means or physical conduct.” Physical harm certainly falls under this definition, but so does any severe and persistent behavior that disrupts education for the student and harms their rights. Bullied students often miss school to avoid their tormentors, interrupting their education.

This bill does not apply to workplace bullying, only to:

• Bullying on school property
• During a school activity on or off school property
• On a school bus

In addition, off-campus cyberbullying is covered if it:

• The act disrupts a student’s access to education; or
• The act disrupts activities related to the school, such as class or a sponsored activity or trip.

School Districts must be held to higher standards

In order to protect the lives of students, schools must acknowledge and address bullying problems as they arise. Lack of attention, and intervention, can easily lead to death. David’s Law requires the inclusion of cyberbullying in schools’ individual policies as well as implementing policies that:

• Stop a student who is the victim of bullying from being punished when they have acted in self defense
• Implements greater discipline for bullying a disabled student
• Prohibits action retaliating against a person giving information about bullying
• Making a way for students to anonymously report bullying incidents
• And more

Parental notification is also written into the law. The involvement of aware parents is crucial to supporting a bullied student, and provides a larger aid network for them. With this law, cyberbullies can  face expulsion from school and even jail time. Restraining orders may also be granted.

Hope for Students

David’s Law is an incredibly important and necessary part of keeping students safe. Starting this September, bullies will have to think twice before terrorizing other students. In 2012, 88% of social media users in their teens have seen someone be cruel to another user, and 1 in 6 parents knew their child has been bullied. With how far technology has advanced in the past 5 years, we can only imagine the future of those statistics. And with David’s Law in place, we can only imagine how they might fall.

Hospitals responsible for multiple inpatient suicides are shielded by 1999 law

Just before last Thanksgiving, a Vermont family lost their son, a patient at the renowned Menninger Clinic in Houston, to suicide. A.G. was 25 years old when his parents sent him to Menninger after he had presented at acute risk of suicide. After a few weeks in care, his parents told his doctor he wasn’t getting better – that on the phone, he sounded more hopeless than ever. The psychiatrist assured them that the facility was doing everything possible to help him.

One day later, even though his condition had clearly not improved, the facility allowed A. G. to go to a restaurant with other patients. While at dinner, he stood up, asked to use the bathroom, left the table – unsupervised and unaccompanied – and then walked out the back door. Seventeen hours later, he had died by suicide.

A state investigation revealed what should have been obvious to Menninger staff: A. G. should never have been allowed to go into the community by himself. The clinic failed to meet its duty of care by not doing enough to protect him. But the results of that investigation were not made public.

That’s because The Menninger Clinic, like most other inpatient facilities in Texas, is protected by an unintended consequence of a 1999 law.

1999 legislation bars state department from releasing investigation results

The law at the center of the issue, which went into effect on September 1, 1999, was intended to give subpoena powers to state licensing boards that oversee medical providers such as family therapists and dietitians and was created at the request of the Texas Department of Health. The Texas Hospital Association, an organization that represents hospitals and healthcare providers statewide, requested an amendment requiring those investigations to be secret.

Former state Rep. Patricia Gray, who authored the law, has stated that she never intended the law to be used as it is applied today. The secrecy regulations serve only to protect the reputation of hospitals – at the expense of patients’ safety and families’ right to justice.

At Menninger alone, at least four incidents in which patients died by suicide or made suicide attempts went unreported in the decade prior to A. G’s death. Had his parents had access to that information, they may not have decided to place him at a clinic 1,600 miles away from their home – a decision driven by the clinic’s sterling reputation that is protected by Texas law. His mother, D. L., herself a psychiatrist, spent days vetting the clinic and saw plenty of positive information, but none of the deadly safety concerns.

Lack of access to information puts thousands of patients at risk

And given that Menninger is a nationally known and well-funded facility, the risks to patients at other hospitals and clinics throughout Texas are likely even greater.

“If these kinds of safety lapses are happening at the much-celebrated Menninger Clinic,” said inpatient suicide attorney Skip Simpson, “can you imagine what’s happening out of the public eye at facilities that operate on a fraction of their budget?”  Skip knows too well how and why hospitals hide the ball from families—never disclosing to families how their loved ones died; especially in a place with one primary duty: to protect the patient.

A touted reason behind not disclosing the facts to families about their loved one’s suicide is so staff and doctors can openly address their poor decisions—behind closed doors—with no one being blamed for the death.

The proper purpose for studying hospital suicide is to employ the Stop-It-Next-Time rule. When a hospital, has something go wrong which allows a suicide, the hospital must investigate why – and then try to keep the same thing from going wrong and injuring someone again.  Instead, hospitals are not learning—just hiding. Families learn nothing about the details of the suicide unless a lawsuit is filed.

The truth is that so many families are left with unanswered questions; A. G.’s parents were explicitly told by a DSHS employee that the information they needed was in a report they would never see because of the state law. And this isn’t just a concern for a few families—it’s a major public health concern that puts thousands of patients in Texas and nationwide at risk.

Families have a right to accurate safety information about the facilities they will entrust with their loved ones’ care. Dangerous clinics and hospitals must be held responsible for the injuries and deaths they cause. And that means critical information about tragedies such as A. G.’s death cannot be hidden behind a veil of secrecy, always serving the hospital and doctors but rarely the public.

Patients, and the public, deserve better.

Death by suicide is a substantial public health problem, as more than 40,000 Americans commit suicide every year. Unfortunately, the efforts being made to reduce the risk of suicide- including commitment of patients with suicidal ideation- do not seem to be effective. Increased efforts must be made both to prevent inpatient suicide and to reduce the chances of suicide among individuals experiencing mental health issues who have not been committed to an inpatient facility.

The Cap Times recently reported on the Zero Suicide movement, which is developing a new approach to suicide prevention. The goal of the movement is to lower the number of suicides to zero. The founders of the initiative believe it is possible to prevent every suicide where patients are in the care of health providers.  At a two-day conference, the theory behind zero suicide was explained and a plan was outlined for preventing both inpatient and outpatient suicides within healthcare systems.

The concern from one of the leaders of the Zero Suicide movement is the insufficient progress being made in controlling the growing number of deaths by suicide.  As the rate of deaths by suicide climb, the responses of healthcare providers and healthcare facilities has been to make incremental change or to stay the course. This is clearly not having enough of an impact, as suicide rates continue to rise.

The goal of Zero Suicide is to make wholesale change in order to ensure no person at risk of suicide goes untreated or uncared for. The focus is also on providing more comprehensive treatment, rather than just addressing depression, and on enlisting the broader community in an effort to help people who may be considering death by suicide.

Community and health organizations can and should both play an important role in helping to reduce suicide, according to the theories of the Zero Suicide organization.  The program was first started at a health system where the leader of Zero Suicide worked as a vice president.  Suicide experts pushed back on the approach initially, arguing the goal of eliminating all suicides set the healthcare organization up for failure.  Despite the criticisms on the part of suicide experts, the healthcare center overhauled its systems of patient feedback, made timely access to care a priority, and demanded a complete modification of cognitive behavior therapy methods across all departments.

It became the policy at the organization to ask the patient if they had visualized death by suicide and to describe the method. The family and patient were then told they should remove the means which would make it possible for the patient to suicide using this desired method. This became a surprisingly effective deterrent.  With the efforts made by the health center, there was an 80 percent reduction in patient suicides over 10 years and there was one year in which no deaths by suicide happened.

The airline industry has a good handle on safe flying because it thinks about ways the system could fail and corrects the problem before it happens; the health care industry, on the other hand, does not have a black-box mentality; instead the healthcare industry evades, covers up, and spins every failure it has. As a consequence hospital errors are now the third leading cause of death in America. The health care industry does not want the public to know this fact.

Other health institutions may wish to consider following the lead of the Zero Suicide group and incorporating at least some of their techniques to try to bring down death rates.