While social distancing and home-isolation are the best ways to combat the COVID-19 pandemic, we also must consider the risks of these measures. We’re already seeing signs that mental health problems are rising exponentially. A recent McKinsey & Co. study found that 35% of Americans surveyed felt anxious or depressed, and many reported increases in negative behaviors, such as binge drinking and use of illicit drugs. Alarmingly, calls to suicide hotlines across the country have spiked 800%.
This is because isolation leads to loneliness and depression, which play a role in more than half of suicides. Loneliness levels had already reached an all-time high, according to a 2018 national survey by Cigna, and the Centers for Disease Control and Prevention reports that suicide rates across America rose by 33% over the past two decades, with increases across age, gender, race and ethnicity and occupations. Suicide now takes more lives in America than car accidents, more firefighters than fire and more police officers than crime.
Consider that of the more than 47,000 suicides that took place in 2017, those 65 and up — the very same population most at-risk for dying from the coronavirus — accounted for more than 8,500. Men who are 65 and older face the highest risk, while adults 85 and older are the second most likely age group to die from suicide. And the rate of elder suicide may be under-reported because the numbers do not include silent suicides, such as overdoses and self-starvation.
It’s not just older adults at risk of being harmed by isolation and loneliness. Suicide has consistently been the fourth or fifth leading cause of death for those aged 10-69 in this country in the past decade and currently is the second leading cause of death in 10-24 year-olds. We’ve made dramatic gains in preventing the other causes — heart disease, cancer and chronic lower respiratory diseases — with up to 50% reductions in mortality since the 1990s.
But we do not think of mental illness — the leading cause of suicide — as we do those illnesses. When a person goes to the doctor for a physical, the physician will check the patient’s heart and lungs and take blood to test for high cholesterol, high blood sugar, kidney function and other issues.
A discussion of suicide or mental health is rarely part of the examination. Yet, more than half of the individuals who take their own lives have seen their primary-care physician in the month before they die. This CDC finding shows that in more than half of all suicide deaths in 27 states, the individuals had no known mental health condition.
We in the medical community must ask about mental health and suicide like we monitor for blood pressure or screen for vision problems. But it is critical to go beyond the doctor’s office to identify those who may be seeking assistance and intervention in indirect ways or from non-medical professionals.
Several research institutions including ours have developed the Columbia Protocol, a simple-to-use tool with a brief series of questions to help determine whether a person is experiencing suicidal thoughts and if the thoughts include a method and intent, which significantly increases risk. As important, it asks about all types of suicidal behavior, including preparatory acts (e.g., writing a note or buying a gun). These behaviors can have the same level of risk as a past suicide attempt.
The beauty of the Protocol is that it is accessible to anyone — a teacher, parent, coworker, friend, coach, relative or anyone else. And you can ask over the phone or video chat when checking in on an isolated loved one during this crisis. Social distancing does not have to mean social isolation, because we can all still be there for each other.
We know the Protocol works: As just one example, since implementing in Tennessee by Centerstone, the largest provider of community-based behavioral health care in the United States, suicides were reduced by 65%.
We still have such a long way to go. But by changing how we speak and act — and expand the expectation of who can ask about suicide and take action — those who are most at-risk can get the help they need and deserve.
Kelly Posner Gerstenhaber is director of The Columbia Lighthouse Project, which works with systems, states, countries and communities to empower everyone to identify people who are suicidal and to help them get the support they need.