Author: Victor Josifovski
Mentor: Dr. Tyson Smith
Los Gatos High School
Suicide rates have risen in the last two decades and the endemic remains a pressing social concern. There are nearly 45,000 suicides and 1.2 million suicide attempts per year in the United States. Current mitigation efforts are generally focused on mental health and subsequent psychiatric analysis. They have largely been ineffective in reversing the rise in suicide rates. However, suicide remains a significant problem that can be approached with a new lens. Social factors such as the prevalence of guns, media reporting, and classification systems are still poorly understood, especially when compared to conventional mental health strategies. This paper analyzes how the individualistic concept of suicide produces misunderstandings, how these misunderstandings hinder progress, and how solutions that acknowledge the public and social factors controlling suicide can help mitigate the growing suicide crises.
When twenty-eight-year-old Kevin Baldwin released himself off the side of the Golden Gate Bridge, he felt the shocking reality that “everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped.” Baldwin represents one of the millions of Americans who attempt suicide each year. In 2020, according to the CDC, there were 45,979 suicides and nearly 1.2 million suicide attempts in the United States, while suicide rates had slowly risen to 13.5 suicides per 100,000, making it a leading cause of death and a prominent social issue within the nation. Nevertheless, Baldwin’s attempt and his subsequent survival also reflect key misunderstandings about suicide that reveal the potential for new mitigation approaches.
There are several fundamental misunderstandings of the suicide endemic which shape the public understandng of the problem. These include the following: the belief that suicides are long thought-out, premeditated actions, that people who attempt will inevitably reattempt, that mental illness is always tied to suicide, that we can best predict (and understand) suicide from a psychopathological perspective, and lastly, that suicide is an issue predominantly tied to the individual. As such, mitigation efforts, which are often focused on the examination of individuals and individual mental health issues, remain limited given these misconceptions. They continue to fixate on individual assessment, when in reality, the suicide endemic is more nuanced and complex than this conventional approach proposes. Furthermore, the over-fixation on an individualistic lens distracts the public from a relatively feasible, attainable, and immediate set of strategies for mitigating suicide, ones that are often overlooked in the vast response to a national mental health issue.
Given this, a reconsideration of suicide mitigation efforts is necessary. Rather than fixate on individual-level approaches, we can better tackle the problem with a broader understanding of the larger social factors that are at play. this paper explores the misconceptions surrounding suicide and their realities using a thorough analysis of the research on suicide. It details how misconceptions inhibit mitigation strategies, and how more immediate and sensible strategies can be instituted through a better understanding of crucial social determinants of suicide.
Contemporary Misconceptions Regarding Suicide
A mere google search, using keywords, can quickly reveal public misconceptions regarding suicide; A browser finds images focused on individuals, often contemplating on their own, and displaying mental distress. There is rarely acknowledgment of public or social factors that may be involved, and the concept of individual mental illness is the dominant framing.
Suicides are Long Thought Out and Inevitable Events
Whether it is Vanity Fair describing Robin Williams’ suicide as the result of a “long and difficult decline” or the Rolling Stone describing Kurt Cobain’s from the perspective of a “downward spiral”, conventional knowledge surrounding suicide and its most famous cases displays a perspective of deliberation, decline, and inevitability. While mental health struggles often precede suicides, a hindsight bias is employed in the aftermath of a suicide attempt. Mental health issues are prescribed as superordinate, or lone, causes of prolonged and unavoidable paths to suicide. Therefore, working with the mental health model, individuals are thought to engage in a prolonged or continued contemplation stage before moving towards suicidal behaviors. This idea creates the conception of inevitable and elongated decline, often presenting as the cause surrounding celebrity and community suicides. On the contrary, there is nothing inevitable about a suicide attempt. Many attempts unfold in short periods and out of temporary crises that provoke immediate and impulsive suicidal actions. (Deisenhammer et al., 2009) analyzed eighty-two patients admitted after a suicide attempt and found that nearly 74% of patients had found the jump from a decision to an attempt to be short (10 minutes or less) and 47% traversed the entire suicidal process (including consideration, decision, and action) within ten minutes of first consideration. Furthermore, researchers concluded, “The process from the emergence of suicidal thoughts to the accomplishment of a suicide attempt, and thus the time for intervention, generally is short”. Another study (Williams et al., 1980 ), analyzing visits to Australian hospitals, noted that a considerable majority of suicidal behavior was impulsive and that nearly 40% of analyzed subjects had acted within five minutes of suicidal premeditation.
These studies provide insight into the impulsive and erratic nature of suicides that is not recognized within mitigative and informational discussions surrounding suicides and suicide attempts. Instead of a calculated decision, a suicide attempt can be characterized by a temporary heightening of turmoil and vulnerability. Interestingly, suicide notes, another concept behind the idea of thought-out suicides, are indeed more rare than conceded by popular understanding. Of nearly 3,000 suicides analyzed in a six-year study by the American organization of suicidology, a small proportion, slightly above 18%, left a suicide note (Cerel et al., 2014). Serving as an indicator of a thought-out process, the lack of suicide notes highlights a propensity for rapid decision-making concerning suicide. As such, suicide attempts are often impulsive, arrive at times of heightened susceptibility and vulnerability, and are all but inevitable. This evidence opposes the common conception of deliberate suicidal processes. It is one of the central realities facing one of the more significant misconceptions surrounding suicide and hindering its mitigation strategies.
More Attempts Will Follow Suicide Failures
In a Harvard opinion survey published in 2006, nearly 74% of respondents believed that if individuals who attempted suicide via jumping off the Golden Gate Bridge had been deterred, they would have been able to complete suicide at another time and through other means regardless. This survey points to another misunderstanding surrounding suicide, the belief that individuals who attempt suicide will often reattempt if their first attempt is non-fatal. In this fashion, this understanding suggests that suicide mitigation can be a futile and overwhelming process. By extention, it follows that treatment should occur within the context of repeated attempts by individuals who continue to present suicidal behaviors and who may inevitably reach a fatal attempt by sheer force of will, regardless of mitigation strategies. However, within the knowledge that suicides are oftentimes impulsive decisions, the realities presented can compound into a more nuanced and hopeful understanding. Nearly nine of every ten individuals who attempt suicide but survive will not die of suicide at a later date. A study ( Owens et al., 2018) affirmed this understanding when it found that in nine years following a suicide attempt, only 7% of patients within a series of studies and databases had fatally relapsed, and nearly 70% never reattempted.
Coming back to the topic of Golden Gate attempters, an analysis (Seiden, 1978) found that of five hundred and fifteen individuals who attempted suicide at the Golden Gate Bridge but had been deterred or survived, only about 10% (35/515) had gone on to die by suicide at a later date. This study supposes a near 90% post-attempt survival rate, one which the public, and respondents in the survey mentioned above, do not acknowledge. As such, it can be supposed that with proper rehabilitation and support, individuals who attempt suicide, survive, and progress past the lapse of vulnerability will be less likely to reattempt than common knowledge suggests and unlikely to reattempt at large. Therefore the mere idea of suicidal inevitability within individuals who have attempted is inaccurate and detrimental to mitigation strategies, and the assumption that reattempts are common distracts from the necessity of preventing suicide means and attempts on hand, as well as from other mitigation strategies.
Mental Health is the Only Factor in Suicide
While there are ties between mental health and suicide, and mental health approaches remain necessary, they are not the only routes toward mitigation. An undivided fixation on specific mental health issues in suicide prevention can be misguided and ineffective. Nevertheless, in common understanding and mitigation efforts, suicide and mental health are often conjoined in an unbreakable manner, and as such, mitigation efforts lack diversity under the mental health context. For example, an overwhelming majority of suicide charities are centered on a mental health approach, and some of the most popular online communities can demonstrate this phenomenon. The With Hope Foundation is focused on “suicide prevention through improving mental health awareness.” At the same time, the Alliance of Hope Community Forum is a forum monitored by “Mental Health Professionals”, and the Morgan Meier foundation describes suicide as “the reaction of extremely intense feelings of loneliness, worthlessness, hopelessness, or depression” to name a few.
Of course, these approaches or claims are not wrong, but these approaches are limited. There is a stark over-fixation on mental health within these communities and little acknowledgment of more nuanced realities surrounding suicide and its prevention. In fact, for many mental health issues, there is a lower prevalence of suicide than accepted, with disorders like substance abuse, schizophrenia, and depression featuring a suicide risk assessment of around 5-8%. This finding, in contrast to an approach fixated on mental health alone, encourages a stress-diathesis model, which analyzes both individual disposition and environmental influence, suggesting that suicide is more multi-factorial than common perceptions around mental health suggest (Brådvik, 2018). Furthermore, in a study of suicidal ideation in psychiatric patients, researchers (Burgess & Hawton 1998) concluded that “the suicidal wishes of psychiatric patients are not always the result of an easily treatable and reversible mental illness or necessarily of any mental illness at all,” making clear that within these psychiatric patients, other factors influenced suicide to create a more nuanced basis for suicide prediction. Further studies (Brent et al., 1993), (Brent et al., 1993), discover a strong link between suicide and the presence of firearms, and highlight instances of suicide victims without psychiatric conditions, but who are most influenced in their decision to attempt suicide by the presence of firearms rather than mental illness. Therefore, while mental health remains a significant and robust connection with suicide, there remains space for analyzing other factors. This conception becomes especially apparent when constructing predictive and preventive measures, in which the connection between suicide and mental health has not been transferred, and the usage of mental health strategies lacks efficacy. This understanding leads us to the next major misconception.
We can best predict and mitigate suicide through psychiatric or mental health analysis alone
Since mental health is the primary fixation within the study of suicide, predictive and preventative measures are generally focused within the same context. This fixation can be seen through the statements of the organizations above and many organizations in general, in which mental health and the amelioration of mental health crises galvanize their efforts. These are sound efforts toward a broader attack on the suicide endemic. However, within the scope of predictive measures, which are necessary for ameliorating the suicide endemic, psychiatric and individual analysis, contrary to how they are commonly seen, are ineffective in predicting suicidal behaviors. In a meta-analysis of nearly three-hundred and sixty-five studies (Franklin et al., 2017), researchers found that predictive measures based on common risk factors (mental health issues, mental disorders, etc.) were only slightly better than chance for all outcomes and that no broad category could accurately predict far above chance levels. Furthermore, studies rarely examined the combined effect of multiple risk factors, and the researchers found that risk factors analyzing internal psychopathology accounted for a dominant 25% of all risk factor analyses. This led the researchers to suggest a multi-factor approach via algorithmic methods. As such, current single-factor prediction methods, structured mainly on mental health practices, are not effective alone, and there remains a necessity for multi-factor analysis to supersede a fixation on psychiatric analysis. Continuing, another study (Noch et al., 2022) analyzed clinician assessments, predicting one-month and six-month risk factors of a little over eighteen-hundred patients admitted to an emergency department, and found that clinician prediction was little better than chance at anticipating which of the patients would go on to attempt suicide within the time frame. It therefore becomes problematic to endorse mitigating efforts on the single factor analysis of individuals’ mental and psychiatric status, which has been fixated on in both research and shared understanding, and has distracted from other efforts through its sheer domination of the study of suicide. Instead, a multi-factored and open approach, acknowledging public and social causes of suicide, can be used in conjunction with preexisting strategies to access more immediate and attainable solutions.
Suicide is a problem tied to the individual
The effects of the various misconceptions above compound into a general focus on the individual, and the absolvement of the public, within a suicide endemic that can also be approached through a community lens but is often not. Risk factors, predictive measures, and treatment generally rely on individual examination and individualistic context. This focus manifests in focus on individual assessment and sometimes individual blame. Often, treatment and prediction efforts will include examinations of psychiatric conditions, recent life events, substance use habits, relationship happenings, job loss, family history, and more. On the other hand, aggregate suicide statistics, patterns, and trends indicate that suicide can be considered a public and social problem and can be mitigated as such. For example, per 2020 NCHS data briefs, stark disparities remained within suicide rates regarding demographic factors such as location and gender. Rural male suicide rates rose to 30.7 per 100,000 by 2018, while urban rates were at 21.5 per 100,000. Female rural and urban suicide rates reached 8.0 and 5.9 suicides per 100,000, respectively. As such, there remain significant social and demographic disparities within the suicide endemic along both geographical and gendered lines. Further, as a 2019 NCHS data brief highlighted, disparities exist along racial and ethnic lines. Suicide rates for American Indian and Alaskan Native populations (33.8 per 100,000 for men and 11.0 per woman), as well as for Whites (28.2 per 100,000 for men and 7.9 per woman), proved to be significantly higher than figures for other racial and ethnic populations such as Hispanic populations (11.2 per 100,000 for men, 2.6 for women) and African American populations (11.4 per 100,000 men, 2.8 for women). Another study ( Ellison et al., 1997) found a religious homogeneity index to be inversely related to suicide rates, while further studies (Baller & Richardson, 2002) found evidence suggesting that the geographical clustering of suicides in France and the United States was caused by the influence of both social integration and imitation factors. These studies support the understanding that suicide prevalence depends on compounding circumstances much more significant than just the individual, such as culture, social networks, access to means, environmental influence, geographical situation, gender socialization, and more. As such, there is strong evidence suggesting that suicide is influenced on a social and public level and can therefore be treated on a social and public basis. Furthermore, an over-fixation on an individualistic lens in the analysis and mitigation of suicide can be misguided, and distract from more attainable public solutions, such as the ones we will discuss below.
The Shortcomings of Current Mitigation Strategies
The suicide endemic is growing, and current understandings and strategies, often solely fixated on individual analysis and ignorant of social and public factors, have not been practical enough. From 2000 to 2020, suicide rates in the United States rose nearly 30%, per the CDC. Not only have current mitigation efforts failed to minimize the existing suicide endemic, but they have also failed to prevent its growth; there remain difficulties that encumber mitigation efforts. Current strategies constructed on the common misconceptions outlined above are faced with mitigation difficulties that face these misconceptions. Furthermore, limitations of healthcare infrastructure within the privatized systems of the United States limit the efficacy of strategies solely based on the prediction and treatment of suicide through a psychiatric approach or the assessment of a mental health crisis. As such, on an aggregate level, the current, overly individualistic approach to suicide research, treatment, and prediction struggles to slow and reverse the suicide endemic due to difficulties we will discuss below.
Despite the more than one thousand suicides at the Golden Gate Bridge since its opening, its only recently approved suicide barrier is yet to be completed. As mentioned in the expository New Yorker article ‘Jumpers,’ when a then engineer, Roger Grimes, protested along the Golden Gate Bridge in 1976 for the construction of a suicide barrier, his sign was met with flying soda cans and people telling him to jump himself, even in what can still be described as among the most progressive cities in our nation. Thus, the collection of misconceptions and the individualistic approach towards the suicide endemic produce a stigma that significantly impairs national mitigation efforts. As the British Journal of Psychiatry lamented, “the stigma around suicide remains just high enough to discourage people from discussing their suicidal thoughts” (Jadros & Jolley 2018). Ultimately, this runs in conjunction with the individualistic approach; when the roots of suicide are said to come from the individual, whether spoken or unspoken, the individual becomes partially culpable by societal standards.
Furthermore, alongside the discussion of suicide, moral weakness remains an understanding held by common thought, while individual pathology might be the equivalent in the more educated realms of research. Ultimately, stigma is harmful to the cultivation of public interest in mitigating suicide and treating suicide patients. In an analysis of public opinions, researchers have found the stigma toward Non-Suicidal Self Injury (NSSI) within sample populations to be significant to the extent that it may impact help-seeking behavior (Lloyd et al., 2018).
Furthermore, social acceptance of suicide is negatively correlated with suicide rates, in which nations and regions where suicidal behaviors are stigmatized have been found to maintain higher suicide rates (Schomerus et al., 2014). As such, the stigma around suicide is harmful to the broader treatment of the suicide endemic and is also largely present in our society. If mitigation efforts are to be reformed, public responsibility and involvement in the suicide endemic must be analyzed and accepted to relieve the blockading influence of stigma on the individual, and allow for the crafting of more immediate solutions.
Alongside stigma, there remain practical limitations plaguing the current models and approaches to suicide. As outlined, beliefs that suicidal individuals often have a mental illness, engage in the process of deliberation, and progress through a state of inevitable deterioration do not run in conjunction with reality. As such, mitigating efforts that solely dedicate themselves to these conceptions, such as those focused on clinical prediction and analysis of the individual, have failed to prevent the growth of the suicide endemic. Practical limitations include the lack of preventative measures in the context of the rapid suicidal decision, the inability of physician-based prevention, and the ineffectiveness of general medical and clinical approaches toward the unique case of suicide. To start, the impulsive disposition of suicide, as discussed above, means that preventative measures would be most successful if focused on aiding the individual during crises rather than the more complex undertaking of ameliorating suicide in its early stages. Since, per the CDC, firearm deaths make up nearly half of all suicides, this could include reducing access to means in our social environment, like firearms, in order to block an individuals ability to attempt suicide while in a temporary crises. Currently, many preventative measures involve medical prediction that employs earlier mitigative strategies. However, as noted before, psychiatric practitioners are largely ineffective when asked to stretch their disciplinary limits and predict suicidal behaviors that are often the product of temporary crises. General practitioners prove to be similarly ineffective; Of 286 cases of suicide examined in a study (Pearson et al., 2009), 91% of individuals contacted their general practitioner within a year of committing suicide, but in only 27% of cases were concerns reported prior to the suicide, leading researchers to conclude that “Consultation prior to suicide is common but suicide prevention in primary care is challenging.” As such, while there remains a focus on psychiatric prevention of suicide, the medical professionals most often contacted by suicidal patients have not produced ameliorating results within the strategies of suicide prevention in the earlier stages. Continuing further, the use of psychiatric strategies (Mehlum et al., 2006) and psychological treatments (Brown, Jager-Hyman 2014), including therapy and pharmaceutical treatments, are either ineffective at mitigating suicide or in need of further improvement, leading further researchers (Large, 2018) to conclude that “Refraining from the temptation to predict suicide in clinical psychiatric practice might even assist suicide prevention.” In this sense, the commonly accepted notions of suicide and its prevention, including the processing of patients through routinized healthcare avenues, and mediums of individual prediction, consultation, and treatment, prove to be limited by a series of practical limitations that drawback to the realities behind the misunderstood suicide endemic. As researchers (Cole-King, Lepping) have enunciated, we need to ask ourselves ‘What can be done to prevent this person harming themselves today, this week, this month?” and move past the desire for an outright and clinical “cure” toward suicide when there are approachable and multidisciplinary methods available.
The Inadequacies of the Public Health Care System in Mitigating Suicide
Another, albeit less mentioned, question behind the mitigation of suicide through an individualistic and psychiatric lens would be our nation’s ability to provide widespread access to the clinical methods necessitated by such a model. Nearly one in every five (53 million) Americans suffer from varying mental illnesses. Nevertheless, studies analyzing the National Comorbidity Survey indicate that only 15.3% of respondents received minimally adequate treatment for severe mental illness (Wang et al., 2002). Meanwhile, in a report on suicide mitigation strategies, the CDC laments that “relatively few people in the US with mental health disorders receive treatment for those conditions.” Furthermore, a large proportion, two-thirds, of physicians reported that they could not get outpatient mental health care for patients, which is nearly two times that of other services, due to inadequate insurance coverage (Cunningham et al., 2009). As such, there remain healthcare and insurance barriers to providing mental health care at a rate that current strategies necessitate. Even further, in an aggregate analysis, our current healthcare system, even if made available to all, may not have the capabilities to combat a national mental health crisis; over 155 million Americans, often in low-income communities, live in Health Professional Shortage Areas (HPSAs), or areas with inadequate mental health infrastructure and capabilities. It seems unfortunately and unjustly predictable that treatments would tend not to reach those of lower socio-economic status, especially in our privatized healthcare system, but even more jarring is the fact that treatments are not reaching the severely mentally ill patients who would be at the highest risk for suicide. These are two glaring wrongdoings within the broader incapabilities of our healthcare system and its necessity for suicide prevention. Therefore, if current strategies necessitate large-scale mitigation of the suicide endemic through a parallel, clinical movement against the mental health crises, they remain hindered by our inability, through coverage and healthcare delivery difficulties, to provide access to clinical treatment and prevention of suicide for all. This understanding further necessitates the need for more diverse and attainable prevention methods outside of the current model.
Immediate and Practical Prevention Methods
We live in a society with several complex social problems, but suicide does not have to be one. There are many attainable and immediate ways to prevent and mitigate suicide and circumvent the debilitating circumstances around the suicide endemic. In this paper, we have discussed the presence of a harmful over-fixation on individualistic, psychiatric approaches to suicide mitigation; however, through a public and social lens, we can create a multidisciplinary approach and achieve more immediate gains in suicide mitigation. Continuing on the theme of public responsibility, we will discuss the following immediate and practical solutions toward suicide mitigation that move past the individualistic view and incorporate the realities behind the suicide endemic.
Reducing Means Toward Suicide
To most immediately combat the suicide endemic, restricting means remains the most viable pathway. This strategy aligns with the argument we have laid out; if suicides come at impulsive moments of vulnerability, and are unlikely to be followed by further attempts, then restricting an individual’s ability to attempt or complete suicide on hand becomes incredibly important to mitigative efforts. Most importantly, limiting access to firearms, which prove to be tools of no return, would prove the most effective policy for reducing suicide rates. Of all suicides in 2020, nearly 53 % involved a firearm (CDC). Furthermore, of all suicide methods, firearms remain the most lethal, at around an 83% fatality rate as opposed to lower rates for suffocation/hanging (61.4%) and significantly lower rates for Poisoning (1.5%) and cutting/piercing (1.2%), which represent the other most common means toward suicide (Spicer & Miller, 2000). Continuing, several studies show that the presence of firearms can have an inflating effect on suicide rates; in case-control studies, guns were twice as likely to be found in the homes of those who had made fatal attempts (Brent et al., 1991), and further research finds that the relationship between suicide and the presence of any firearm within a household are significant (Brent et al., 1993). On an aggregate level, regions of the United States with high gun ownership were found to possess suicide rates nearly 14% higher than regions with low gun ownership (Miller et al., 2002), while studies controlling for regional culture variation found that short-term exposure or visiting regions with high gun ownership, by outside residents, was found to have a positive effect on suicide rates (Shrira & Christenfield, 2010). As such, we know that guns have a significant, and potentially causal, effect on suicide on an individual and aggregate level— as the Harvard School of Public Health states, “Every study that has examined the issue to date has found that within the US, access to firearms is associated with increased suicide risk.” In regards to the progression from restricted methods to available methods, it has been further demonstrated that many individuals will not progress past or substitute their favored method, which often exists, if they find it restricted (Hawton, 2007). Furthermore, it is known that restriction of means has proven successful at reducing suicide rates in the past; suicide rates fell with the restriction of access to carbon-monoxide methods via charcoal in Hong Kong (Yip et al., 2010), regulation of lethal pesticides often used in Sri Lanka (Gunnell et al., 2007), and the decades’ long progression from monoxide usage in domestic gas in the United Kingdom (Kreitman, 1976). The restriction of means, mainly firearms, remains a necessary strategy in suicide prevention through both quantitative and qualitative understandings of suicide. If our nation is willing to reduce means, such as by taking steps to reduce firearm access or building suicide barriers in places like the Golden Gate Bridge, it can incorporate an understanding of the public power and responsibility within the suicide endemic. Its subsequent recognition of suicide means can be an effective preventative strategy, which accepts the overwhelming numerical and contextual evidence toward a more holistic approach regarding suicide prevention.
Optimizing Media Output and Suicide Contagion
Media reporting on suicide has been demonstrated to strongly correlate with suicide rates. As such, the optimization of media output concerning suicide contagion is necessary. Generally, suicide contagion can be understood within social learning theory, in which individuals are influenced by imitation effects and social tides larger than themselves, and can produce suicide clusters as a result. In this sense, regulating media output can be a powerful mitigative tool. In a 1979 study, to be followed by further studies (Kuezz et al., 1986), (Michel et al., 1995), Dr. David D. Phillips found a positive correlation between front-page or marked reporting styles of suicide and an increase in suicide rates, an effect he dubbed the “The Werther Effect” (Phillips, 1974). The Werther Effect remains the basis for suicide contagion theories and can be accessed for mitigative strategies. Meanwhile, in an international comparative study, nations where suicide is reported in a more discouraging light (The United States, Finland, and Germany), have been found to have lower suicide rates than nations that portray suicide in a more open light (Hungary and Japan) (Fekete et al., 2001). Furthermore, researchers (Niederkrotenthaler et al., 2010) have found that repetitive reporting of suicides and suicide myths also correlates with increased rates, while reporting of suicidal thoughts that are not followed by a suicide attempt correlates with decreased rates. Therefore, there remains an influence of media reporting on suicide contagion, but there is further evidence supporting the fact that reporting guidelines can prove beneficial. During a spike in suicide attempts on Viennese subways in the 1980s, the implementation of media reporting guidelines and restrictions proved successful at reducing subway suicides by nearly 75% over several years (Sonneck et al., 1994). In the opposite fashion, when California Highway Patrol and local newspapers used to keep a running suicide count for the Golden Gate Bridge, landmark numbers like 500 and 1000 were met with cases of suicide frenzy. As a result, many organizations, including charities and the CDC, have offered guidelines for newspapers and media corporations to use to aid media regulations. Nevertheless, in a study analyzing the acceptance of basic guidelines set forth by the Samaritans, an organization from the UK that deals with mental health and suicide, it was deduced that 199 of the 229 articles examined failed to comply with one of the said guidelines, such as mentioning support sources or avoiding excessive or influencing details (Utterson et al., 2017). Thus there remains room for improvement within the reporting of suicide. Media reporting has been demonstrated to positively and negatively influence suicide rates, depending on how it is displayed. The narrative surrounding individuals within our societies can influence their suicidal vulnerability. Therefore, we must accept the public responsibility of establishing proper reporting and journalistic guidelines, via the acceptance of suggestions put forth by knowledgable organizations, to combat another of the many social influences on suicide effectively.
Creating More Standardized Data Collection and Classification Methods
Another difficulty that plagues suicide mitigation efforts is the struggle that our society experiences in tracking and classifying suicide cases. If suicide efforts are to be adequately addressed and organized, data sets behind suicide research, and further action, must be accurate and standardized. Lack of resources, lack of information, communal stigmas, ambiguous classification systems, and the perplexing nature of suicide are all barriers that can hamper the classification of individual suicides and create inaccuracies in aggregate measures of suicide. (Silverman, 2016) captures the difficulties of suicide classification systems in the face of widespread moral and procedural ambiguity in the field of suicidology. Meanwhile, on an aggregate level, African American and Hispanic suicide rates have been found to experience excessive rates of suicide misclassification due to cultural differences in classification, explaining the misleading gap in White and African American suicide rates ( Wang et al., 2010). In the past, studies have indicated a social construction of suicide rates and a range of misclassification. (Pescolindo & Mendelsohn, 1986) Highlighted the influence on suicide rates by the social organizations or groups tasked with counting them and the presence of widespread and consistent miscalculation at the hands of responsible agencies. Furthermore, (Douglas, 1967) demonstrated the principle that suicide rates are often constructed by external social factors, while statistics experience widespread error as a result. For example, From 1985 to 1989, suicide rates in New York City fell substantially due to policy changes in the New York City Chief Medical Examiner’s Office, which was engaging in preservative practices in the face of backlash and criticism at the time (Witt, 2006). These shifts affected efforts to measure or quantify suicide behavior or approach mitigating strategies, and demonstrate the malleability of suicide statistics in the face of broader social movements. As such, even the most advanced nations struggle to compose suicide statistics. To better understand or approach the suicide endemic, we must accept standard approaches to classification and provide practitioners with the resources to properly examine cases of suicide. It is imperative to construct an objective classification and nomenclature system, which currently does not exist, that can avoid the variation present in suicide classification systems.
Reform of Cultural Influences Behind Suicide Ignorance:
Everything from the language we use to the narratives we create can impact our ability to mitigate suicide rates in the United States. In an expressly individualistic culture, our understanding of and interactions with suicide can become harmful. As we have seen earlier, there are many specific misconceptions surrounding suicide, but our society also engages in broader malpractice as a whole. The obsessive individualism that the United States has grown around makes it almost inevitable for our strategies against suicide to be so focused on the individual and mental health strategies. As such, the difficulty of releasing this rugged individuality disposes us to focus our efforts on the individual’s well-being, not the communities and demographics that encircle them. Much in the American tradition, each individual is seen as a carrier of their outcome, and each instance of suicide is seen as its outlying case. Whether spoken or unspoken, individuals are cast off, blamed even, for what is seen as a pathology of their mind or weakness of their disposition. Because social solutions do not fall within the cultural paradigm of individuality, they are often displaced by a hyper-fixation on the individual, which does run in conjunction with our societal values. Nevertheless, as we have argued, suicide is as much an affliction of the individual as it is a social failure, and suicide is a unique tragedy that the United States cannot force its cultural values upon. If we can find the humility to deviate from our cultural values when approaching its suicide endemic, we can more effectively combat a social issue of our time. We could do this by providing social support, easy access to crisis management, restricting suicide means, creating more accepting discussions on suicide, and more. However, while there are many solutions available, to approach them or move on to the solutions we have highlighted in this paper, we must start by reforming our nation’s thoughts on the individual and suicide. We must absolve the individual of its scrutiny in the suicide endemic and move past our cultural beliefs to craft a more knowledgeable and viable strategy against suicide.
The suicide endemic and our efforts to mitigate it remain oriented around individuals and individual-level approaches. Moving forward, we must first adjust and update our understanding of the suicide endemic; contrary to the individualistic fixation on mental health, the individual is not culpable in the broader social patterns that influence their propensity for suicide, and current approaches reveal how suicides are regulalrly misunderstood. Our current mitigation strategies, bogged down by practical limitations and stigma, must be reformed to accept the broader social responsibility and act accordingly by accessing strategies that challenge the current methods. We can do this by accepting the realities and strategies we have displayed behind our theme of societal solutions. If we broaden our view of suicide and its mitigation, we can approach a public health issue that has too often been considered intractable, and make progress towards reform and change. In this sense, we can persevere in the face of what might feel like an overwhelming number of social problems today.
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