Christine Yu Moutier, MD, could have launched her session on suicide prevention at the AAMC annual meeting from any professional perspective: psychiatrist, researcher, US government consultant or chief medical officer. of the American Foundation for Suicide Prevention, among others.
Instead, she chose to share her personal story.
“First, I’m a human being,” she told listeners of Learn Serve Lead 2022: The Annual Meeting on Nov. 13 in Nashville. “[I] had my own genetic load and environmental influences that led to my lived experience of life-threatening mental health issues” while in medical school, she said. “When your cultural environment doesn’t give you the ability, the language, or the permission to talk about the things you’ve been through…it’s an experience you’ll never forget.”
In a session titled “Preventing Suicide During COVID and Beyond: Science, Culture, and Solutions” and moderated by Sarah Vinson, MD, Associate Clinical Professor of Psychiatry and Pediatrics at Morehouse School of Medicine, Moutier then shared thoughts additional information from its travel staff, as well as factual information to save lives from suicide.
After her own painful experience, Moutier took a year off and received what she called life-changing treatment. Eventually, as she became more open about what she had been through, more people shared their own stories with her. “I knew that the experience I had been through where I thought I was so alone wasn’t really that,” she said.
In fact, from 1999 to 2018, the suicide rate in the United States increased by 35%. And while there has been a slight decline in recent years, early data for 2021 from the Centers for Disease Control and Prevention also shows an increase. In addition, certain groups have been exposed to greater risks, including youth and young adults and black and brown populations.
The pandemic has also taken a massive toll on mental health. More than 2,000 children have lost a parent or caregiver, alcohol consumption has increased – “the list goes on and on,” Moutier said.
But science has shed light in recent years on the detection and prevention of suicide risks. Now the medical world – and the nation – must redouble its efforts to apply this science to save lives, Moutier said.
A key way to do this is to increase understanding of what leads to suicide risk. Significantly, she noted, no incident or trait is the cause.
There may be a triggering event, but other risk factors are also at play, including genes and epigenetics, mental health issues, and lethal means. “Lethal means are important,” she noted.
Suicide is first and foremost a health problem. Faced with this fact, certain terms, such as “commit suicide”, are meaningless, Moutier argued. “We don’t say, ‘commit cancer.’ It comes from a time when suicide was seen as a morally wrong act or a characterological weakness.
Moutier went on to outline specific actions that health care facilities can take to advance suicide prevention.
On the one hand, leaders must provide education to all staff members. If a patient is at positive suicide risk, providers should ensure they have a plan to stay safe and provide them with resources in a crisis.
Ideally, facilities would also connect patients with an approach called Caring Contacts that facilitates connection with others. Initiated in the 1970s, patients receive personal follow-up contact with a provider or other relevant person, such as someone with their own experience of suicide. Moutier pointed to research showing that someone at risk of suicide who receives attention cards, calls or texts is 40% to 70% less likely to attempt suicide.
But while providers focus on patient care, they also can’t overlook the mental health issues of those working right next to them, Moutier said.
Ironically, many of the traits that make good doctors also increase suicide risk. These traits include perfectionism, self-sufficiency, and an exaggerated sense of responsibility.
Referring to a 2022 study, Moutier noted that suicide among physicians is different from that of the general population. For example, physicians who died by suicide were three times more likely to have had a work-related problem at the time of their death.
Doctors also tend to avoid mental health treatment, instead prescribing themselves or obtaining psychiatric medication from a colleague. Part of that motivation comes from fear of stigma or losing one’s medical license. “We are depriving ourselves of potentially life-saving treatment,” she said.
Moutier then urged listeners to contact any colleague they fear is in trouble.
“You don’t have to be a mental health professional to be a caring colleague, to notice it, and to trust your instincts.” Also, those affected need not worry that asking will increase the risk of suicide, as a number of studies indicate otherwise.
If possible, a conversation about suicidality should help the person involved take the next step, such as starting mental health treatment. But any compassionate, non-judgmental interaction is important.
“A supportive conversation can be a game-changer,” Moutier said. “Something very liberating is happening.”