By Dr. Beall-Wilkins and Dr. Jamie Hanna

Magellan Health hosted a free webinar for September Suicide Prevention Awareness Month. If your question wasn’t answered during the webinar, or if you would just like to learn more about suicide prevention, read on for information shared by our webinar presenters, Dr. Rakel Beall-Wilkins, MD, MPH, and Dr. Jamie Hanna, MD. For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

Question: Please say more about the interplay between chronic pain and suicide risk.

Dr. Beall-Wilkins: It is estimated that the prevalence of suicidal ideation is roughly three times greater in people living with chronic pain compared to those who do not have chronic pain, and chronic pain is linked to higher rates of not only suicidal ideation but also suicide attempts and completed suicides.[1] When coupled with impaired functionality and disability, chronic pain can result in socioeconomic hardships and limitations in access to care that further exacerbate both physical and mental health symptoms. Chronic pain and depression often go hand-in-hand, and clinical studies have shown that upwards of 85% of people with chronic pain have experienced severe depression.[2] It is essential that patients with chronic pain be routinely screened for psychiatric symptoms and acute safety concerns, and that they be referred to treatment if issues arise.

Question: Is a person really considered suicidal if they have considered it a lot but have never acted on their thoughts? What measures can we put in place for individuals with a baseline of passive suicidal ideation who are in outpatient therapy?

Dr. Hanna: Understanding the risk factors that can lead to suicidal behavior provides an opportunity to identify and support people at risk for suicide. Risk factors include a previous suicide attempt, diagnosis of mental illness/substance use, isolation, social/legal problems, trauma in childhood, a family history of suicide, recent stressors and access to lethal means. Learn more about suicide risk and protective factors from the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention. Suicidal ideation – or thoughts about suicide – is also an important risk factor and can be a warning sign of imminent suicidal behavior. There is greater risk when suicidal thoughts occur more often, over greater time periods or are more challenging to control; there are fewer barriers to acting on the thoughts; and the reason for the suicidal thoughts is to stop the pain. Identifying suicidal ideation and implementing treatment strategies are critical in preventing suicide.

It is always the goal to treat suicidality in the least restrictive setting and subsequently, treatment of suicidal ideation often occurs in the outpatient setting. There are a variety of measures that can be put in place to assess and treat suicidal thoughts in the outpatient setting. Some of these include screening, crisis intervention, and evidence-based and research-informed interventions.

One example of a screening tool is the Columbia-Suicide Severity Rating Scale (C-SSRS). This scale focuses on evidence-based metrics to assess the severity of suicidal ideation and behavior. Items on the scale also serve to differentiate between suicidal and non-suicidal self-injurious behavior.

Crisis intervention assistance is typically provided by connecting a person in crisis to trained staff for support and referral to additional services. The goal is to impact key risk factors for suicide, including depression and hopelessness, increase future mental healthcare access, and put space and time in between suicidal thoughts and action. Examples of crisis intervention services include the National Suicide Prevention Lifeline (1-800-273-8255) and Crisis Text Line (text HOME to 741741).

There are only a small number of evidence-based treatment interventions directly targeting suicide risk. These include cognitive behavioral therapy for suicide prevention (CBT-SP), dialectical behavior therapy (DBT) and Collaborative Assessment and Management of Suicidality (CAMS). Additional research-informed interventions include collaborative safety planning and reducing access to lethal means. These interventions are emphasized in both the CDC suicide prevention strategy and the Zero Suicide approach to suicide prevention.

Question: What do you say to someone who says they want to die and that life is torture, and asks why they were born? What types of things can you tell the person going through this, and how do you do it without sounding judgmental?

Dr. Beall-Wilkins: Feelings of despair, hopelessness, worthlessness and helplessness are commonly experienced by people who are in the midst of a mental health crisis. During episodes of emotional distress, it can be very difficult for some people to think positively or constructively, and this can manifest itself in the form of self-deprecating statements and thoughts of self-harm. When someone is feeling this way, it can be helpful to reassure them that things can get better, and that comprehensive treatment can improve how they feel. It’s also very important to assess their safety, inquire about any thoughts they may be having of hurting themselves or someone else, and encourage them to seek immediate professional help if they’re feeling unsafe.

Question: I had a family member take her life on 9/7. She went about her day as normal, and then chose to take her life that evening after placing her kids down for the night. As a family member, we are still trying to figure out why. Is this a normal feeling? Similarly, for people attempting to support those with suicidal thoughts, or who have tried to support someone who died by suicide, what suggestions do you have to help them find the balance between supporting the suicidal individual and feeling overly responsible for the suicidal individual’s choices, behaviors, etc.?

Dr. Hanna: When a loved one dies by suicide, intense emotions – such as disbelief, anger, guilt, isolation and despair – can become overwhelming, and there is no right or wrong way to feel. Many people will feel confused as they try to understand why their loved one chose suicide. And it is likely there will always be unanswered questions. The events which lead to suicide are often complex and most commonly there are many factors that contribute to a person ending their life.

The feeling of guilt can lead suicide survivors to blame themselves for the death of their loved one. It is critical that survivors do not blame themselves, and that they seek support and engage in self-care. Support and self-care can include reaching out to community members, such as friends, family, co-workers and mental health providers. Both in-person and online support groups are available specifically for suicide survivors. The American Foundation for Suicide Prevention provides resources to find a support group. It can also be beneficial to seek professional help with a licensed therapist or psychiatrist, especially for symptoms of depression and thoughts of suicide.

Question: The hardest part about helping someone who is suicidal is the concern that the police will be called, and the person will end up in handcuffs. How can we change this?

Dr. Beall-Wilkins: It is often the case that family and friends of those who are experiencing acute mental health crises face the prospect of summoning law enforcement to assist in maintaining safety and facilitating transportation to care. This can be a very daunting prospect and a growing movement of advocates, policymakers and mental health providers are now pushing for reforms that would reduce the likelihood of adverse outcomes in these circumstances.[3] One such reform involves greater collaboration between police departments and mental health clinicians, including training, education and joint response to crisis calls. Preliminary data indicate this approach can be a very effective means of reducing adverse outcomes, increasing public safety and strengthening trust within communities.[4]

Question: Is being suicidal hereditary? Are the mental/emotional issues that caused a previous suicide in a family hereditary?

Dr. Hanna: There is clear evidence that suicide can run in families, and family history of suicide has been identified as a significant risk factor for suicide. Studies show that individuals who have a parent or sibling die by suicide are two and a half times more likely to die by suicide than those without a family history of suicide. Research has identified a number of genes that appear to be associated with suicide risk. Psychiatric illness has also been shown to run in families and is a risk factor for suicide. Depression plays a role in over half of all suicide attempts. Children of parents with depression are three times as likely to develop major depression, anxiety disorders and substance use – all of which increase the risk of suicide.

While family history of suicide and psychiatric illness are important risk factors of suicide, other risk factors include previous suicide attempts, depression, substance use, stressful life events, physical illness and access to lethal means, among others. Suicide occurs as a result of many interacting genetic and environmental factors. Family members share genes, and they often share experiences – they eat together, live together and face economic stressors and loss together. These shared experiences may combine with genetics to increase an individual’s vulnerability to suicide. This does not mean that everyone with a family history and increased risk of suicide will have suicidal behavior, but that they could be more vulnerable and should take steps to reduce their risk. These may include early evaluation and treatment of mental illness and building protective factors to buffer against suicidal behavior.

Question: Could you speak to the legalities of those who need help but are past the age of responsibility, and family members and friends are told there is nothing they can do if the person refuses the help or that we can’t keep them somewhere against their will?

Dr. Beall-Wilkins: In most jurisdictions, the ability to commit an individual to treatment against their will is typically conferred by the courts based upon three guiding principles: harm to self, harm to others and evidence of significant mental deterioration that renders an individual unable to practice self-care in their own best interest. If an adult person is explicitly stating an intention to hurt themselves or others, or exhibiting grave mental disability, they can be involuntarily committed for observation, evaluation and acute stabilization.

Rakel Beall-Wilkins, MD, MPH, served as a medical director for Magellan Healthcare. Prior to joining Magellan in 2018, Dr. Beall-Wilkins assisted in the launch of an addiction psychiatry clinic embedded within Harris Health System’s Healthcare for the Homeless Program, to combat local impacts of the nationwide opioid and synthetic cannabinoid (“K2”) epidemics. Dr. Beall-Wilkins also served as a member of the Baylor College of Medicine faculty with clinical duties at both the Ben Taub General Hospital Psychiatric Emergency Center and the Thomas Street Health Center. There she helped to expand behavioral health services by launching a neurocognitive clinic collaborative to better screen, diagnose and treat individuals with HIV/AIDS-associated neurocognitive disorder and psychiatric comorbidities. She is a graduate of the University of Texas at Austin and the Johns Hopkins School of Public Health, where she obtained a Master of Public Health degree. She obtained her medical degree from Baylor College of Medicine. 

Jamie Hanna, MD, serves as the medical director for the Magellan of Louisiana Coordinated System of Care (CSoC) program. She is board certified in Psychiatry and Child and Adolescent Psychiatry. Prior to joining Magellan in 2020, Dr. Hanna served as an assistant professor and assistant training director with Louisiana State University School of Medicine, working with the acute behavioral health unit, and leading the psychiatric consultation liaison service and emergency psychiatric services at Children’s Hospital of New Orleans. Dr. Hanna completed medical school at the University of Alabama School of Medicine and a subsequent internship in Pediatrics, residency in General Psychiatry, fellowship in Child and Adolescent psychiatry, and fellowship in Infant Mental Health with Louisiana State University in New Orleans.

For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

[1] Pergolizzi JV (2018) The risk of suicide in chronic pain patients. Nurs Palliat Care 3: doi: 10.15761/NPC.1000189.

[2] Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural plasticity, 2017, 9724371. https://doi.org/10.1155/2017/9724371

[3] https://www.npr.org/2020/09/18/913229469/mental-health-and-police-violence-how-crisis-intervention-teams-are-failing

[4] https://www.apa.org/monitor/2021/07/emergency-responses

New data from the Centers for Disease Control and Prevention shows that suicide rates have risen to over 30% in the US since 1999.[1] Since COVID-19 began, suicidal ideation in the US has more than doubled, with younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers experiencing disproportionately worse effects.[2] As suicide has reached crisis-level proportions in our nation, it’s time to recognize suicide as a public health crisis and learn about the warning signs and the skills needed to save a life.

Know the warning signs of suicide

It is hard to tell whether a person is thinking of suicide. Most people who take their own life show one or more warning signs, either through what they say or do.

• Feelings: Expressing hopelessness, talking about suicide or having no reason to live, showing moods such as depression, anxiety, irritability
• Actions: Showing severe/overwhelming pain or distress, using drugs or alcohol, searching for ways to end their life
• Changes: Withdrawing from activities, isolating from friends and family, sleeping more or less
• Threats: Talking about, writing about or making plans to kill themselves
• Situations: Going through stressful situations including loss, change, personal humiliation or difficulties at home, school or with the law

Take action to prevent suicide

Suicide remains the second leading cause of death among Americans between the ages 10 and 34, according to the CDC.[3] It is a major health crisis—and preventable. When someone says they are thinking about suicide or says things that sound as if they are considering suicide, it is important to pay attention and take action. Suicide is often preventable.

• Ask and listen: “Are you thinking about killing yourself?” is not an easy question, however, a study by the National Institute of Mental Health shows considering suicide may reduce rather than increase suicidal thoughts. Be willing to listen and discuss their feelings.
• Keep them safe: Reducing a person’s access to highly lethal objects or places is an important part of suicide prevention. Asking if the at-risk person has a plan and removing access to lethal means can make a difference.
• Get them help: Connect with a trusted family member, friend or mental health professional. Call the National Suicide Prevention Lifeline’s (1-800- 273-TALK (8255)) and the Crisis Text Line’s number (741741). Save these numbers in your phone so they’re there when you need them.
• Stay connected: Staying in touch after a crisis or discharge from care can make a difference. Let them know they matter and you care. Leave a message, send a text or call them.

For more information and helpful resources, visit MagellanHealthcare.com/Prevent-Suicide.

If you are in crisis or considering suicide, or if someone you know is currently in danger, please dial 911 immediately.

[1] https://www.nimh.nih.gov/health/statistics/suicide

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

[3] https://www.nimh.nih.gov/health/statistics/suicide

By Varun Choudhary and Greg Dicharry

The impacts of suicide on population subsets

Suicide is a leading cause of death in the US.[1] It has become the hidden epidemic in our society that is spreading with the COVID-19 pandemic. Statistics show certain populations are more vulnerable than others. While a recent study shows that 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%), Hispanic people (19%), Black people (15%), unpaid caregivers for adults (31%) and essential workers (22%).[2]

Medical professionals have historically been at higher risk for suicide than those in most other professions.[3] Over 400 physicians a year commit suicide, yet the cause for such tragedy is not addressed.[4] A recent example was the suicide of Dr. Lorna Breen, the 49-year-old medical director of an emergency department in New York, who felt like she was drowning amid trying to save lives during the COVID pandemic. She had no history of mental illness and was considered an exemplary physician before succumbing to trauma of witnessing so much death.

Suicide has also been a silent killer within our military for several years, as troops dealing with trauma are unable to get the care they need. This was the case with the recent suicide of 34-year-old Master Sergeant Andrew Christian Marckesano, who had served six full tours in Afghanistan and was nicknamed the real “Captain America.” We must take a proactive approach to suicide prevention so we can help these heroes before they become tragic statistics.

Magellan’s approach to suicide prevention

Magellan is a national leader in suicide prevention and is addressing this health crisis that is devastating so many individuals, families and communities. We believe the first and foremost action that must be taken is to destigmatize the need to ask for help. There is still an ingrained culture in medicine and the military, as examples, that it is a weakness to address mental health needs. We need to build a culture of acceptance and promote the concept that reaching out is a strength, not a weakness. Changing this paradigm will take the effort of many mental health agencies and organizations.

Magellan is here to lead the initiative and use our expertise to bring awareness and training through a preventive model that pushes a zero-suicide approach. We were very successful in launching this campaign in Maricopa County, Arizona, and received international recognition for its effectiveness in reducing suicide. We are working with other organizations to promote this approach, so communities are aware of the signs and warnings of potential suicide, know how to engage suicidal individuals and are able to address the acute mental health needs of these individuals before they escalate.

In recent years, we have had the privilege of hosting a series of suicide prevention summits in Pennsylvania, Florida and Idaho. These events have brought together over 1,000 local and national leaders to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. In addition to this work, Magellan regularly supports local suicide prevention efforts in communities we serve, including sponsoring and participating in annual American Foundation for Suicide Prevention (AFSP) Out of the Darkness Walks around the country.

The Hope Rising for Suicide Prevention virtual summit, September 26, 2020

Most recently, we have established an internal suicide prevention innovations team to develop and implement a plan to enhance our suicide prevention efforts to create more awareness, training opportunities and support for our employees, members, providers, customers and the communities we serve.

Magellan is officially launching the initiative this month for National Suicide Prevention Awareness Month with the Hope Rising for Suicide Prevention virtual summit. This event is being planned and hosted in partnership with the nation’s leading suicide prevention organizations, including the National Suicide Prevention Lifeline, LivingWorks, American Association of Suicidology, Zero Suicide Institute, and numerous other national and international suicide prevention and mental wellness experts, lived experience advocates and people new to suicide prevention to share inspiration, information, wellness techniques and best practices.

This uplifting virtual event will empower attendees with the motivation, skills and resources needed to positively impact suicide prevention efforts in their communities.

Hope Rising for Suicide Prevention is just the beginning, as Magellan continues to create and support impactful suicide prevention initiatives that will help people find the hope and help they need to stay alive and thrive.

For more information about this and other Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.cdc.gov/vitalsigns/suicide/

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

[3] https://www.healthline.com/health/mental-health/healthcare-workers-suicide-covid-19#3

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526882/

One suicide is too many. Yet more than 47,000 Americans die each year as a result of suicide. Because suicide is the 10th leading cause of death in our nation, we at Magellan Health believe it is nothing short of a public health crisis. Thankfully many experts and organizations agree.

Recently, Magellan had the privilege to host a suicide prevention conference in Boise, Idaho. The free conference brought almost 200 local and national leaders together to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. Suicide is a topic that’s difficult, but we must talk about it and deal with it by creating an environment for genuine caring for one another. To have the greatest impact possible, this should start by encouraging those who are struggling to ask for help, and we need to remind one another to watch for signs and signals with our family, friends and colleagues.

The suicide crisis is particularly impacting the state of Idaho. In 2017, Idaho’s suicide rate was 22.9 per 100,000 residents. The state’s suicide rate is 58 percent higher than the national rate and reflects a 44 percent increase over the past 10 years.

During the conference, Dr. Michael F. Hogan, principal, Hogan Health Solutions, LLC, gave one of three keynote addresses. He spoke about opportunities to prevent suicide in all healthcare settings. As I shared in my remarks at the conference, I wholeheartedly agree with his perspective. From the examination room to the boardroom, healthcare leaders and executives play a critical role in helping solve this crisis. We must lead the charge—drawing in other key stakeholders like providers, lawmakers, teachers and family members to support efforts to make this crisis visible, reduce stigma and drive solutions.

One important place to start is by ensuring people understand the signs of suicide. First, we must increase education and awareness and promote community and statewide educational programs. We should focus on an audacious goal, a path to zero suicides, to drive the sense of urgency needed to get community-wide buy-in. In addition, we should invest in suicide training for family members and peers of those with a mental health diagnosis. Such training fosters early detection and, in the case of peer support, provides a common frame of reference, making individuals more likely to engage.

Second, we must work to break the stigma around mental health issues — and normalize the need for care. As Dr. Thomas Joiner, The Robert O. Lawton Distinguished Professor of Psychology at Florida State University, said during his keynote address, “Reach out and tell someone when you see that someone is desperate. These person to person connections as we look out for each other can have such a significant impact in reducing suicides. It is important to keep in mind that all of us hold an important role in caring for one another.” Creating opportunities for open dialogue in the community, like the workshops during our Boise conference, helps shine a light on the problem and engages more people in helping others before it’s too late.

Finally, improved access to care and early screening will go a long way toward reducing the risk of suicide. Ensuring people of all economic status and backgrounds have access to behavioral healthcare is key. However, finding specialists who are skilled in suicidology isn’t easy. One study in Maricopa County, Ariz., determined that only 30 percent of behavioral health professionals in the county believed they had the necessary skills and support to treat at-risk patients. We need increased funding for suicide training among all medical professions.

As many as 38 percent of people making a suicide attempt did so within a week of a healthcare visit. Our healthcare system must look for ways to support early detection by making depression screenings part of every primary care visit. To help identify patients with mental health conditions, Magellan Healthcare has developed SmartScreener^SM. SmartScreener is a digital application that contains standard screening tools used by behavioral health professionals like counselors, psychologists and psychiatrists. While the patient waits to be seen by the physician, he/she completes the screener. Answers are confidential and only shared with the physician, who will discuss the patient’s results during the appointment and can help with next steps.

This routine screening is making a difference in identifying patients with behavioral health concerns. In a six-month primary care SmartScreener implementation, approximately half of the patients screened positive for a behavioral health concern. About 38 percent were deemed appropriate to be referred to digital cognitive behavioral therapy (DCBT). Fifty-four percent of these appropriate patients then enrolled in DCBT, getting help for which they may otherwise never have been referred.

The path to zero suicides requires that healthcare leaders—and the nation as a whole—treat suicide as a public health crisis and that we normalize discussions about mental health, suicide and treatment. I hope everyone who attended our Boise conference left as inspired about the urgency of this issue as I did. Let’s all commit to strategies that involve our communities in suicide prevention and draw upon multiple resources for continuing education and improved access to treatment.

 For more information about suicide prevention, read our other blog articles here.

Many people who die by suicide leave loved ones behind who suffer from a range of painful emotions.

When it happens to someone you know

Losing a loved one to suicide can be overwhelmingly painful for family members and friends. Unlike a death that occurs naturally from old age or illness, a death by suicide is usually sudden, unexpected, and sometimes violent. The shock and trauma for survivors is further complicated by the social stigma of suicide, possible police investigations, media coverage, lack of privacy, and judgment of others in the community.

How many people it impacts each year

Research shows that at least six people are directly affected by the death, including immediate family members, relatives, neighbors, friends, and co-workers.

Given that more than 43,000 people take their lives each year, approximately a quarter million survivors are left behind, traumatized by the loss.¹

Many people who die by suicide suffered from clinical depression or other mental health disorder. The survivors may also be at risk for depression and anxiety.

Common responses

The emotional pain of survivors can be complicated, intense, and prolonged. People may feel a sense of guilt and responsibility and blame themselves for not seeing the warning signs. They may feel a profound sense of betrayal, rejection, and abandonment. Other common responses are:

• Feeling a need to make sense of the death and understand why the person made the decision to die. Even if the person left a note or a message, there are often unanswered questions that can persist for years.
• Replaying the events that took place before the person’s death and constantly second-guessing different outcomes.
• Experiencing symptoms of post- traumatic stress disorder such as flashbacks and anxiety, particularly if they witnessed the suicide or discovered the body.
• Shame and anger due to the stigma of suicide and mental illness, and possible negative community responses.

Some individuals experience intense grief that does not heal with time.

The bereaved person may feel empty, preoccupied with the death and unable to resume the activities of daily life. This type of grief, known as complicated grief, can affect from 10 – 20% of the survivors of suicide loss. If left untreated, complicated grief often persists, resulting in significant impairment and poor health outcomes.

How you can help

Sometimes people struggle with what to say or how to help a family who has lost a loved one by suicide. Helping the survivors means being a good listener and avoiding any criticism or judgments. Try to:

• Be present and listen attentively without feeling the need to provide answers.
• Avoid speculating on the reasons for the suicide or the person’s state of mind.
• Be sensitive about what you say. Avoid clichés such as “I know how you feel” or “time will heal all wounds.”

Helping the survivors means being a good listener and avoiding any criticism or judgments.

• Be compassionate and understanding, and remember that grieving takes time.
• Take the initiative to be helpful. Bring a meal, mow the lawn, or pick up groceries for the family.
• Be aware of support groups and offer to find one if the family is interested.

The grief of suicide survivors is unique and complicated by the circumstances of the death. You can help by being present as a caring friend and sounding board. Let the family know you’re ready to listen if and when they want to share their thoughts and emotions.

Help is available. For additional information, visit MagellanHealth.com/MYMH

1. 2014 data, released December 2015, CDC Web Based Injury Statistics Query and Reporting System (WISQARS)

Sources: American Association of Suicidology; American Foundation for Suicide Prevention; Harvard Health Publications

Common warning signs for suicide include:

• Making suicidal statements.
• Being preoccupied with death in conversation, writing, or drawing.
• Giving away belongings.
• Withdrawing from friends and family.
• Having aggressive or hostile behavior.

It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help.

Other warning signs can include:

• Neglecting personal appearance.
• Running away from home.
• Risk-taking behavior, such as reckless driving or being sexually promiscuous.
• A change in personality (such as from upbeat to quiet).

Suicidal thoughts and suicide attempts

Certain circumstances increase the chances of suicidal thoughts in children and teens. Other situations may trigger a suicide attempt.

Circumstances that increase the chances of suicidal thoughts include having:

• Depression or another mental health problem, such as bipolar disorder (manic-depressive illness) or schizophrenia.
• A parent with depression or substance abuse problems.
• Tried suicide before.
• A friend, peer, family member, or hero (such as a sports figure or musician) who recently attempted or died by suicide.
• A disruptive or abusive family life.
• A history of sexual abuse.
• A history of being bullied.

Circumstances that may trigger a suicide attempt in children and teens include:

• Possession or purchase of a weapon, pills, or other means of inflicting self-harm.
• Drug or alcohol use problems.
• Witnessing the suicide of a family member.
• Problems at school, such as falling grades, disruptive behavior, or frequent absences.
• Loss of a parent or close family member through death or divorce.
• Legal or discipline problems.
• Stress caused by physical changes related to puberty, chronic illness, and/or sexually transmitted infections.
• Withdrawing from others and keeping thoughts to themselves.
• Uncertainty surrounding sexual orientation.

Depression

Signs of depression, which can lead to suicidal behavior, include:

• Feeling sad, empty, or tearful nearly every day.
• Loss of interest in activities that were enjoyed in the past.
• Changes in eating and sleeping habits.
• Difficulty thinking and concentrating.
• Complaints of continued boredom.
• Complaints of headaches, stomachaches, or fatigue with no actual physical problems.
• Expressions of guilt and/or not allowing anyone to give him or her praise or rewards.

Take any mention of suicide seriously. If someone you know is threatening suicide, get help right away.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Source: Healthwise

Myth: It’s best not to plant the idea of suicide by talking about it with someone who seems depressed.

Fact: Talking about suicide provides the opportunity for communication. Fears that are shared are more likely to diminish. The first step in encouraging a suicidal person to live comes from talking about those feelings. The first step can be the simple inquiry about whether or not the person is intending to end their life.

Myth: Only crazy people commit suicide.

Fact: Everyone has the potential for suicide. While many people who kill themselves are clinically depressed, most are in touch with reality and not psychotic.

Myth: Suicide happens more often during the holidays, such as Christmas and Thanksgiving.

Fact: Suicide rates are lowest in December and peak during the spring.

Myth: If a person is determined to commit suicide, nothing will stop them.

Fact: Suicides can be prevented. People can be helped. Suicidal crises can be relatively short-lived. Suicide is a permanent solution to what is usually a temporary problem. Most suicidal people feel ambivalent and are torn between the desire to live and the desire to die. They just want the emotional pain to stop and see no other way out.

Myth: If a person attempts suicide and survives, they will never make a further attempt.

Fact: A suicide attempt is regarded as an indicator of further attempts. It is likely that the level of danger will increase with each further suicide attempt.

Myth: Teens are the greatest risk to commit suicide.

Fact: Adults are more likely to take their own life. At particularly high risk are adults between 45 and 54, who had a suicide rate of 19.72 deaths per 100,000 people, compared with about 19 per 100,000 in people over 85, and 13 per 100,000 in the general population. Still, teenagers remain a high-risk group. The percentage of emergency room visits related to suicidal thoughts or attempts among children and teens more than doubled from 2008 to 2015. (The suicide rate for 15- to 24-year-olds is 13.15 per 100,000.)

Help is available. For additional information, visit www.magellanhealth.com/mymh

Sources: American Foundation for Suicide Prevention; CDC.gov; Nevada Division of Public and Behavioral Health Office of Suicide Prevention

Contemplating life and death is probably common when in the midst of a natural disaster. As the eye of Irma passed over me on September 10, I was thinking about suicide and suicide prevention. September is Suicide Prevention Awareness Month, and Magellan Complete Care, our health plan for individuals living with serious mental illness in Florida, had been busy preparing for summits to draw attention to and dialogue around suicide prevention to local communities. Two days before Irma hit, I was busy canceling vendors for the summits. The day before Irma, I was dealing with a surprise, last-minute mandatory evacuation order while trying to locate a friend who was experiencing homelessness and depression, and who had expressed a desire to let the storm take his life instead of seeking shelter.

As the winds howled, windows rattled, and rain pounded against the home I had evacuated to, I sat on a closet floor thinking about how much I wanted to live and how that desire to live had not always been there. There were years where, like my friend, I was lost in my own storm. Depression had flooded my soul, my thoughts were battered by negativity and I never felt safe. The aftermath, similar to a hurricane, was a life left in shambles, just wishing for normalcy.

Recent hurricanes, earthquakes and wildfires remind us of the value of life. Suicide Prevention Awareness Month provides another reminder. Every 13 minutes that the winds and rain of Irma pelted my home state, someone in this country was ending their life too soon by suicide. With a completed suicide happening in Florida every three hours , the death toll from suicide may end up being higher than that from Irma’s destruction.

Natural disasters and the realities of suicide provide the same call to action to communities. We have a responsibility to watch out for each other and take care of each other. When the power is out, you share the food and batteries you have and a reminder to hold on. When someone’s internal light is out, you share hope and support and a reminder to stay strong.

There is much work ahead to rebuild lives, homes, and communities devastated by recent natural disasters; to support communities in reducing death by suicide; and to help individuals struggling through adversity. I am living proof that a life can be rebuilt. Whatever challenge you are facing, hold on, stay strong and don’t be afraid to ask for and accept help.