By Mark Levine & Melissa Bailey

Several high-profile deaths by suicide, along with a new report from the Centers for Disease Control and Prevention, have put this public health issue in the spotlight once again. In Vermont, where suicide is now the eighth leading cause of death, we are working to put systems in place that help people before a crisis. At the same time, we need to recognize the many contributing factors that lead one to self-harm or to attempt suicide. This will require a cultural shift for all of us. We must work together to remove the shame associated with mental health conditions like depression – and embrace social connection as a protection that supports people in crisis. We can save lives if we pay attention, show up and connect, ask questions, and remove lethal means from the homes of those who are at risk.

What’s the Vermont story? Since 2010, more than 100 Vermonters have died by suicide every year except 2012, and more than 1,000 were hospitalized or visited the emergency room each year as the result of a suicide attempt. Tragically, we have seen these numbers rise in our state by nearly 50 percent over the past 17 years, compared with a 30 percent increase nationwide. Over half of all suicide deaths in Vermont are caused by firearms, and most hospitalizations for self-harm are due to poisoning or cutting/piercing. Each data point represents a person in pain, and the numbers reflect only a fraction of the people who are suffering.

Who are we worried about? One thing the data shows is that certain groups of people are at higher risk for suicide in Vermont. Males are more likely than females to take their own lives regardless of age, and females are more likely to be hospitalized for self-harm with poisoning or cutting/piercing. Veterans are at much greater risk for suicide than non-veterans, as are older white men in general, and refugees/new Americans living in Vermont. The 2017 Youth Risk Behavior Survey found that Vermont teens, especially those who are lesbian, gay, bisexual or transgender (LGBT) and students of color are at higher risk than their heterosexual or white, non-Hispanic peers.

The CDC report also highlights an important fact: more than half of all people who died by suicide did not have a known mental health condition. This means we should not be complacent about a person’s risk if they exhibit warning signs, but lack a prior history of poor mental health.

Why do people attempt suicide? Suicide is rarely the result of any single factor, but research has teased out some common reasons that lead people to consider, attempt, and die by suicide. An individual’s emotional health changes over the lifespan. Some people have a mental health condition, like depression, while others do not. Personal challenges – difficult relationships, alcohol or drug use, stress due to illness, financial hardship, legal problems, divorce or job loss, social isolation – can add up to overwhelming feelings of hopelessness and despair.

Loneliness and isolation are the common threads in stories of suicide, regardless of age, gender, sexual orientation or race. And we know that positive human connections during a crisis saves lives.

What to do if you’re thinking about suicide – If you’re in crisis, remember that even the worst feelings of sadness will pass, and the desire to hurt yourself is likely temporary. Crisis data shows that the time between thinking about suicide and an attempt is relatively short, so make a connection before you act. Find somebody you can talk to, and remember that you can make a verbal or written connection.

  • Call the National Suicide Prevention Lifeline at 800-273-8255 or dial 2-1-1 to speak with a counselor in Vermont. You can also call 9-1-1 or go to the closest emergency department.
  • If you don’t want to talk, then use the Crisis Text Line  (text VT to 741741), which offers immediate counseling and support through text messaging.
  • 10 community mental health centers located around the state offer 24/7 crisis services and ongoing supports. Find the list of mental health services at mentalhealth.vermont.gov, then click on the red ‘In Crisis?’ button.

How to help a person who is having thoughts of suicide If you suspect that someone is thinking about suicide, the first thing to do is ask them. Asking shows that you care, and opens the door to connection; it doesn’t increase the likelihood that somebody will be prompted to think about or attempt suicide. Show up, listen, and help them get support from a professional mental health care provider.

Since we know that most people who survive a suicide attempt do not go on to die by suicide later, helping someone get through a crisis can save their life. Reducing access to the most highly lethal means in a person’s home is an effective strategy. Firearms are the most lethal of all suicide methods, so lock up or remove guns from the home. Do not keep lethal doses of medications in the home, and reduce or remove alcohol because it can increase the chances that a person makes an unsafe choice.

What we all can do There’s much we can do to support those who are at risk for suicide. In Vermont, we often speak about our sense of community and tradition of helping in times of crisis. CDC recommends a public health/community-oriented approach that builds on that strong foundation and combines a range of strategies: teaching coping and problem-solving skills for managing life’s challenges, and promoting positive social connections at a time when many feel isolated; training people to recognize and act when they or someone in their world is in distress; reducing the shame associated with mental health concerns; making sure that people have access to mental health care and crisis services when appropriate; and restricting access to means for self-harm.

It will take all of us – as individuals, families, communities, workplaces and schools, and with state government – to reverse the tide.

Mark Levine, MD, is Vermont’s Commissioner of Health and Melissa Bailey, MA, LCMHC, is Vermont’s Commissioner of Mental Health.