Elephant in the room: Suicide – by Deborah Levine

(Originally published in The Chattanooga Times Free Press)

DEBORAH LEVINEOf the top media stories, few mentioned the escalating rate of suicide. Adjusted for age, the annual U.S. suicide rate increased 24% between 1999 and 2014, the highest rate recorded in 28 years. Yet, despite about 129 suicides per day across the country, the topic remains in the shadows.

You may think that Tennessee is an exception, but we have twice as many suicides than homicides. With a suicide rate well above the national average, suicide is the tenth cause of death in our state. Tennessee averages one suicide every eight hours. And the situation continually worsens. The Tennessee Suicide Prevention Network reports that suicide deaths have steadily increased over the last 35 years since they’ve been monitoring suicide.

As horrible as these rankings are, we should be even more alarmed by the statistics for young people. Suicide is the 3rd leading cause of death for ages 15-24 and the 2nd leading cause of death for ages 25-34. And then there’s the mind-numbing numbers for kids ages 10-18, with one suicide death every week. Metro areas, including Hamilton County, are likely to see that number increase.

The problem hasn’t gone unnoticed. The Tennessee Suicide Prevention Networks a public-private partnership overseen by a gubernatorial appointed advisory council. Tennessee’s Youth Suicide Prevention Plan was revised in 2018 and Tennessee law requires that annual in-service training in suicide prevention required for teachers and principals. School districts are required to adopt a policy on student suicide prevention and intervention. The Department of Education is responsible for the establishment of a model policy to assist school districts in developing their own policies.

In addition to that policy, certified or licensed professional counselors, marital and family therapists, clinical pastoral therapists, social workers, alcohol and drug abuse counselors, and occupational therapists are required to receive at least 2 hours of training at least once every 5 years in suicide prevention, assessment and treatment. However, that requirement doesn’t kick in until after January 2020, which points to a larger problem.

As a nation, we haven’t been smart about mental health. State psychiatric facilities have closed in increasing numbers, but the challenge cannot be met by simply reinstating institutions. The lack of psychiatrists who specialize in treating children and adolescents that needs to be addressed. About 8,300 practicing child and adolescent psychiatrists are trying to serve 15 million youths in need of one. Why isn’t there a boom in this profession that surely provides long term security?

Medical students often aim for better paying specialties, but it’s not just money that causes them to dismiss psychiatry in general, and child psychiatry in particular. The profession is hard and demanding mentally and physically. It requires additional training which can complicate the high cost of medical education. And there’s more prestige given to non-mental health specialists. One third of fellowships in child psychiatry go unfilled for lack of applicants. The pipeline should be a steady flow, but it’s more like a slow drip.

There needs to be a cultural shift on mental health and psychiatry. Pay close attention to this year’s discussions of healthcare. Many changes will be debated and we need to insist that mental health be a priority. Whether its insurance companies, medical colleges, or government policies, mental health should be considered a national emergency. Understand the consequences of those policies on psychiatric care for children and adolescents. Lobby for the best possible outcome. Don’t let our youth, our future, slip away unheard and untreated.


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