September is National Suicide Prevention Month, and recent statistics show that there was a 41 percent increase in suicide between 1999 and 2016. The Means Report dives into possible reasons for the increase and a way to prevent the continued growth with Dr. Vaughn McCall a psychiatrist and the Chair of the Psychiatry Department at the Medical College of Georgia at Augusta University.
Brad Means: Dr. Vaughn McCall, a psychiatrist also with MCG his specialty is with adults. Dr. Peeples spoke to us on the kids. Dr. McCall, thanks for being here to talk about this delicate subject, but it needs the spotlight, doesn’t it?
Dr. Vaughn McCall: I think so.
Brad Means: Let’s talk about statistics that recently came out it was reported this week that 41 percent. That’s the increase, 41 percent increase in the suicide rate from 1999, to 2016. This may be unanswerable, but why has the suicide rate gone up, or at least a couple of reasons.
Dr. Vaughn McCall: Well, the especially startling has gone up while so many other causes of death have gone down. So, we made good progress as a discipline in reducing death rates for cancer and heart disease, but suicide is definitely going in the wrong direction. I think they’re a variety of reason suicide rates are increasing and I was listening very carefully to your conversation with Dr. Peeples. I think that despite being, on paper, a much more connected society through social media, and the like. That we’re actually more lonely now, than were say, 15 years ago. And being detached from society is a risk factor for suicide.
Brad Means: You know we talked a lot about bullying, in our first segment. Do you see patients who are suicidal because of bullying either currently or earlier in their lives?
Dr. Vaughn McCall: The patients as I see as an adult psychiatrist, may have been traumatized sexually, by a family member or a friend of the family. Bullying does not play as quite big a roll in the adult patient group that I see, as it might say Dr. Peeples children’s group.
Brad Means: What are the reasons that people, name couple of reasons that people have those suicidal tendencies.
Dr. Vaughn McCall: Suicide often seems to be precipitated by inability to envision yourself in the future. Meaning that you don’t see a way forward. So there can be an immediate problem, it can be loss of job it can be loss of relationship, it can be a new health concern that’s come on the horizon. In suicidal patients find hard to see any solution going forward, other than, killing themselves. And so helping with decision making and finding out why patients have a problem with decision making is at the core of addressing suicide risk.
Brad Means: But if somebody really is, in their darkest hour, how do you convince them that their life has value? Other than saying, you’re supposed to stay alive.
Dr. Vaughn McCall: You need to have the troops rally around the patient. I like to say that secrets are deadly, and when patients come and express suicidal thinking, and they don’t want their family to know, or their family involved, that’s a concern. I think it’s in the patient’s best interest if the provider can convince the patient, why don’t we engage your family, or your best friends, and have them sort of circle around the patient and provide some support. That’s I think a good security against suicide. Not perfect, of course, but it helps.
Brad Means: How long does it take with you to get with those folks, and make their suicidal tendencies disappear?
Dr. Vaughn McCall: In most cases, at best is measured in days to weeks.
Brad Means: Really?
Dr. Vaughn McCall: So, if a person that comes in suicidal today I really don’t have great expectations, that I can turn that around in a matter of minutes or hours. All that you can do is provide a safe haven, until a treatment is put in place. But there are instances where in a matter of couple of weeks suicidal ideation will dissipate, and part of it, frankly is just a passage of time I’m not sure that we have magic bullets to treat suicide but a problem that seems oh so insurmountable today,
Brad Means: Yeah.
Dr. Vaughn McCall: That I have no way forward except suicide, well, a week or two later, things may look quite different.
Brad Means: That study showed that, with the huge increase in suicides in the past many years, we also see a higher rate in rural areas. The dean of MCG himself, David Hess, sat in that chair and said, we need to get more medicine more help to rural areas. Is that the same case when it comes to addressing these high rates of suicide, get more doctors out in the country.
Dr. Vaughn McCall: I think so, you know the problem with being mentally ill in a rural Georgia, is this can be hard to find a psychiatrist.
Brad Means: Yeah.
Dr. Vaughn McCall: The other problem is, that more likely, country folk are gonna have familiarity with firearms and perhaps have a firearm in the home, and so availability, accessibility and familiarity with firearms becomes a risk factor for suicide. We know that the most common cause of suicide in rural areas is death by firearm.
Brad Means: Well, it’s funny that you said that because in urban areas being close to a gun shop was also a contributing factor for high suicide rates in the city. You don’t have to get all political if you don’t want to, but is it a gun control issue then? When it comes to, at least when it comes to the urban part of that study, make sure those folks don’t have access?
Dr. Vaughn McCall: I think it’s a matter of gun control for the individuals. I’m gonna side step the social. The society question, but I will say that part of the treatment plan in a suicidal person is obviously to ask, do you have a firearm at home? Is it secured? Do your loved ones and live-in relations, know how badly you feel? Will they help you take responsibility for this firearm so that you don’t use it in the wrong way? So, gun control is very important especially on the individual level.
Brad Means: Dr. McCall, how do you get someone to come in to see you. In other words let say you have that support system at home, and the suicidal person is listening to you, the spouse, the child said, “Okay, I hear you, I need to not be so suicidal.” How do you then get that loved one to say, alright great now let’s go to Dr. McCall’s office and put a bow on this? If they only just trust you?
Dr. Vaughn McCall: Right, that can be very hard and the first step is them even admitting at home that they are suicidal. A really concerning statistic is somewhere in the range of 20% of suicides occur in people in whom we had no idea. They weren’t having any distress at all. Presumably they were, they just weren’t letting on about it. And so, the first step is to increase our comfort level in talking about suicide at all levels of society, including in the home. Not stigmatizing it, or making judgment about it so people feel comfortable discussing very directly how they feel. But your question is, then how do you go to the next step and get them to come to treatment? Part of it is to convince them that it is something treatable, that it is something in the context of a mental illness. That it’s not a reflection of an inherent character flaw, personality, defect character problem so we have to understand suicidality in the context of something medical and something treatable.
Brad Means: What are some common warning signs, especially for the person who seems fine. There was a prominent pastor who took his life right before we recorded this broadcast, a nationally known guy, he did a lot of help with people who are suicidal. He killed himself, what are warning signs?
Dr. Vaughn McCall: One of the classic warning signs would be giving things away, inexplicably. Obviously, some easy things to detect would be overwhelming sadness, despondency talking directly about suicide. Anytime someone talks about taking their own life, my suggestion is take them at face value. Sometimes, there’s a tendency to think that people are just bluffing or not really speaking their mind, but if someone talks about killing themselves, I would just take that at face value until proven otherwise.
Brad Means: Hm.
Dr. Vaughn McCall: An area of interest of mine and my colleagues, in very recent time has been looking at changes in sleep. We know that sleep disturbance, often precedes suicidality sometimes by a matter of just a few days or a few weeks.
Brad Means: That fast.
Dr. Vaughn McCall: So, someone comes in and they say, doc, I’ve had a drastic deterioration in my sleep in the last week. That should prompt a question, the next question should be, have you been thinking about killing yourself?
Brad Means: One of the reasons that suicide was something that kids do, according to the CDC, was that it’s because they’re impulsive.
Dr. Vaughn McCall: Right.
Brad Means: And its something to do. Do you ever see that in grownups where they think, this is a good solution? They can’t see past it to realize, oh, this is permanent.
Dr. Vaughn McCall: Yes, exactly. And an area of growing interest has been the faulty decision making in people that commit suicide. There’s a part of the brain called the medial prefrontal cortex, and it is part of the brain that helps interpret urgency or emergency, do I take action? Do I not take action? Is something really critical or can I ignore it? And this part of the brain seems to be important in decision making, such as, is killing myself the answer to the present problem?
Brad Means: Right.
Dr. Vaughn McCall: We think that this part of the brain may actually go offline, in people that are who are suicidal. And therefore you’ve lost this critical decision making function. This judgment function, which leaves you at the behest of your own impulses.
Brad Means: Can you give me a pill to turn that part of my brain back on?
Dr. Vaughn McCall: Well that would be interesting, it seems that there are certain brain chemistries that impact this part of the brain and turn it off. One of them being the neurotransmitter, noradrenaline or norepinephrine.
Brad Means: Mm-hmm
Dr. Vaughn McCall: So I’m wondering if treatments which down regulate that and perhaps then leave that part of the decision making brain online, would be protected against people who are thinking about suicide.
Brad Means: Alright, and I’ll go back to the medication question again, you said there’s no magic bullet. Is there something you can give us where we pretty quickly go, man I can’t believe I ever thought of suicide I’m better now.
Dr. Vaughn McCall: Well, in a matter of a few weeks.
Brad Means: Yes.
Dr. Vaughn McCall: So, we believe that the anti-depressant medications save more lives than they take. Maybe 25 years ago there was concern that anti-depressants, I’ll use the brand name Prozac, as an example. That anti-depressants like Prozac actually made people suicidal.
Brad Means: Yeah.
Dr. Vaughn McCall: We now know that is quite the opposite, that treating depression and using anti-depressant medications save more lives than they put at risk. Interestingly, there are a couple of specific treatments that seem to make a difference, and the drug for bi-polar disorder, or manic-depressive illness Lithium seems to have very specific anti-suicide effects. It’s really quite powerful in that regard. And then, for folks that struggle with schizophrenia one of the anti-psychotic drugs called Clozapine, also has specific anti-suicide affects. So, an interesting question is, what if you do, if you’re not bi-polar, you’re not suicidal, should I use one of these two medicines? Clozapine or Lithium, would they have anti-suicide affect in me?
Brad Means: Right.
Dr. Vaughn McCall: That’s an open question, but at least it leaves a door open to a hopeful future. There’s some things that we can look at to make things better.
Brad Means: A lot of ground in a short amount of time. Dr. McCall, thank you for being here today.
Dr. Vaughn McCall: My pleasure, thank you for having me.
Brad Means: Great insight on suicide from Dr. Vaughn McCall MCG.