Suicide in America

In 1995, the national death statistics showed suicide as the ninth-leading cause of death in the America; 1.3 percent of all deaths in America were reported as suicide.  The death statistics for heart disease was 32%, and 23% from cancer of all deaths for that year.

Suicide rates are typically the number of deaths per 100,000 persons, the number of people in the population and its age distribution.  American suicide rates vary from state to state. The Western states have the highest rates. The lowest rate is for the District of Columbia.

In America suicide rates vary dramatically by age, gender, and racial group. White males commit suicide at a rate higher than black males and white and black females.   The rates for black males have been rising, especially those ages 15 to 25.  In the age group with the highest rate of suicide is with older white males. This is also true in other countries.

In America, the most common method of suicide is the use of guns, which is reported for 60% of all suicide methods. Of all deaths with guns, about 80% are committed by white men.

Findings from psychological autopsy studies, where the person’s state of mind prior to the suicide is determined through interviews and medical history, indicate that about 90% of persons who completed suicides in all age groups had a diagnosable mental or substance abuse disorder.  Having a mental or substance abuse disorder does not mean that someone is at high risk for suicide; the majority of people with these disorders do not die from suicide.  Substance abuse and behavior problems such as conduct disorder are more common among adolescent suicides, while depression without substance abuse is the most common pattern among older adults.

To study risk for suicide among persons with mental or substance abuse disorders a follow-up on people who have been hospitalized for such a disorder. The high-risk group is identified and risk factors are recorded prior to the person’s death.  However, not all persons with mental or substance abuse disorders are hospitalized, not all hospitals keep the same records, and different studies use different methods.

The results when it comes to estimating the particular rates of suicide for people with certain mental or substance abuse disorders or determining what risk factors, in addition to the disorder, played a role in the suicide were not exact.   Most researchers agree that persons with schizophrenia have a much higher risk of suicide than the general population; the estimates have ranged from 2% to 15%.   In some studies, younger males with schizophrenia appear seem to be most at risk, while other studies find that women with schizophrenia commit suicide as frequently as men.

Persons with depression, some studies have found psychotic symptoms to increase risk for suicide, while others have not found any evidence for this risk.  In addition to the mental or substance abuse disorders, there are other factors that have been researched to find if they increase the risk for suicide. These include having a second mental or substance abuse disorder;  history of sexual abuse; hostile temperament; history of previous suicide attempt; hopelessness; inability to carry out activities of daily living; stressful life events such as the loss of a close relationship and change in doctors.

Suicide is believed to be preventable, compared to other causes of death suicide it is a rare occurrence and in contrast to the occurrence of mental and substance abuse disorders.   Trying to predict suicide using as all known risk factors, researchers are still unable to predict who will and who will not commit suicide. There are circumstances where talking about suicide is very appropriate and helpful. If an individual who has survived a family member’s suicide needs to talk about suicide and receive support then it is beneficial; however sometimes the thought or act can be brought about by planting the seed in a person’s mind.  Doctors need to assess persons in distress for their suicide potential in order to take steps to minimize the suicide risk.  But there is always the chance for the person to become a higher risk by talking about disturbing emotions at an inappropriate time.

The best prevention of suicide would appear to be improving treatments for mental and substance abuse disorders and being more vigilant in screening for suicide risk among persons with these disorders.

Much more research is needed to test prevention programs to improve attempts to avert a suicide act.  Diagnosing a person that is at risk as quickly as possible; while avoiding implanting the idea by triggering emotions or situations that can be disturbing for the person.   Proven programs and practices that prevent suicide should be implemented by the healthcare professional.

Unfortunately suicide occurs too many times.  High risk persons should be evaluated frequently for the chance of them committing suicide.  During the past few decades much has been done to prevent suicide but the  danger still exists for some persons. 

Co-ocurring Disorders and their Effect on the Mental Health System

The consequences are harsh. Persons with a co-occurring disorder have a greater tendency for violence, medication noncompliance, and failure to respond to treatment than a person with just substance abuse or a mental illness. These problems also affect families, friends and co-workers.
Having a mental illness and a substance abuse disorder together frequently leads to overall poorer functioning and a greater chance of relapse. The person is in and out of hospitals and treatment programs without lasting success. People with dual diagnoses also tend to have tardive dyskinesia and physical illnesses more often than those with a single disorder, and they experience more episodes of psychosis.
People with mental illnesses often are more susceptible to co-occurring disorders as a consequence of their mental illness they may find themselves living in neighborhoods where drug use exists.  Some people find themselves more easily accepted by groups whose activity is based on drug use. Some may believe that a drug addiction is more acceptable than one based on mental illness.  People with co-occurring disorders are also much more likely to be homeless or in jail.
The on and off treatment alone currently given to non-violent persons with dual diagnosis is costly.  Violent or criminal persons, no matter how are dangerous and also costly. Society has to pay for jailed or hospitalized persons.   Those with co-occurring disorders are at high risk to contract AIDS, a disease that can affect society at large. Costs rise even higher when these persons, as those with co-occurring disorders have been shown to do; constantly renter healthcare and criminal justice systems again and again. Without the establishment of more integrated treatment programs, the cycle will continue. 
The constant noncompliance with treatment is a factor in the disability rates of the government system.  Homeless shelters are full of persons who refuse treatment and the homeless rate is increasing daily.  With substance abusers develop mental disorders because of the continuous substance abuse the impact on the heath system becomes a revolving door of treatment, relapse and then again seeking treatment.  Without adhering to a treatment plan and maintaining a consistent medicine regime for their problem the health care team sees a same patients repeatedly with no improvement of symptoms or worsening of symptoms.  The drugs have to be increased in order to be beneficial and the cost increases greatly.  A lot of patients go off of medication because of the high cost of medication and the absence of insurance to cover it and the cycle goes on with the burden of cost to society.
Changes in the system need to be made to help the number of people with mental illnesses and are trying to maintain their mental health with treatment and are finding it difficult to manage to comply with treatment because of the monetary cost.  Until the person can accept their problems and conform to the mental health treatment plan there will be more abuse of the system and less help available for patients seeking help.