Suicide Prevention: A Focus on The Professional Mirror

Here we are again.
Another year – to plaster the world with the same messages that we believe will save lives ended too soon.
Survivors of suicidal loss have passionately done their best-they have shared. Many have turned “saver of souls.”

Increasingly many more well-known people with lived experiences have utilized social media to share their mental health journeys.

A new phenomenon has emerged of scientific studies mainly about medications and other chemicals (including nontraditional) being put in the same space that the lay world “passes through” (social media). The jury is out on how it will help the lay person.

There is the new “mental health 911’- the 988 mental health crises /suicide help line.(USA)

We hear that some funding has increased for Mental health.

And yes, there is still the ever-explosive discussions of how to limit the lethality means.

**But today I focus on what the discussions have largely been silent on- because only a select few of us trained with taxpayer money are privileged to have the knowledge – mental health professionals specifically psychiatrists but also any professionals licensed to treat.

We all would agree that prevention of severe consequences of any medical condition depends on:

• Awareness of preventative measures that may avoid the condition altogether: as humans with genetic influences, this may not always be feasible. Knowing our family history is not a life sentence, it gives us a “leg up.”
• Awareness of early signs in us or others that indicate need for attention.
• Correctly identifying the problem which determines the appropriate treatments.

We get this in one of the common medical conditions. -strokes –

• Even with doing everything right-diet, exercise etc., a family history of one of the common causes, Hypertension, could still put us at risk.
• Awareness- a chance to monitor blood pressure and present early when abnormal.
• Treatments start with accurate identification of other factors in addition to the blood pressure readings.
• Prevention of stroke depends on partnership with treating clinicians to educate and manage including medications ,often necessary.

Mental health has no physical gadgets, blood work or Xray/scans to make diagnoses. Like migraine headaches, it is the skilled gathering of information that leads the clinician to make the correct diagnoses.

And herein lies the problem of Mental health: it is here that I implore us all to look into the mirror.

We spend many years in training in our specialty to hone our skills of gathering relevant information- NOT just what is presented by patients but others that we have been trained to review. This takes the standard about 45 to 60 mins. or more “Diagnostic interview” (code 90792)
It includes.

• Hearing the person’s presenting problems.
• Engaging with them to expand on the problems to ensure you do not assume their terms but understand.
• Exploring for unusual changes in other areas that have not been spontaneously discussed -ALL four emotional areas- Joy, Sadness, Anger, Worries **Not just the present” snapshot” but the life span “videotape.”
• Family history or descriptions (“dad can go from ok to mean in a second”, “mom sometimes in her room for weeks”, suicide in the family)
• Medical history-
• Substance use history: we must be ware of jumping to conclusion “aha that is the cause- that Alcohol, marijuana cocaine!” It may be the only thing that is holding them till appropriate help comes.

Nowhere in mental health conditions is this collection of information as important as in the presentation of “Depression”, one of the highest risk factors to suicide.

Why?
A current bout or “Episode” of Depression is not necessarily the same as the illness or “Disease of Depression” (sounds confusing? Yes, we have.
confusing terms)

Consider this – A current bout/episode of cough and fever does not tell us what the underlying illness to be treated is. Assuming that each all bouts as one particular illness can spell disaster for the patient. Not all “coughing diseases” are treated the same.

Similarly, a current Episode of “Depression” must be explored to determine the type of “Depression disease”.
The only way to do so is to determine EVER experiencing other emotional changes!!

So you can see what don’t ask don’t tell past history can do: Make wrong diagnoses and go down wrong treatment path.
It happens too many times in real life!
And it is not a far reach to say it can and has contributed to complexity of illness and suicidal acts

-Of the four(4) emotions -only two are distressing -Sadness and Worries and so are the most spontaneously presented

It is the duty of us, clinicians-all of us, to explore for changes in the other emotions- It can take time, but the standard 45 -60 mins allows time generally.

So, what’s the problem?

The art of engagement has been modified for generations of clinicians to beat the reimbursement lowering practices of Managed care which swept the medical field about three decades ago. While specialties that have laboratory testing may get away with it, in mental health, shortening patient time to only focusing on the here and now (“snapshot”) has played a role in Misdiagnoses of “Depression” and consequently treatment of the wrong Depression Disease.
It has almost become the culture!

Treating the wrong type of Depression may worsen underlying illness and contribute to suicide.

Call to action:

Everyone: Whether asked or not, describe your lifelong pattern of changes in emotions including what has been expressed by those who know you
All of us clinicians- Let us look in the mirror and get back to what we were trained to do- get a “videotape” and NOT a “snapshot”.

Fixing this little discussed “leak” in the system could contribute to stymying the current of avoidable loss of life by suicide.

Let’s give it a try – every life is worth saving