For the last ten years, I’ve worked as a doctor in an emergency department. And people often ask me, “What’s the most unbelievable thing you’ve ever seen?” We do see some very weird things, but my job is not nearly as dramatic as it might seem on TV, and those strange cases are actually pretty rare.
What has been surprising to me, though, is that every single time I work in the emergency department, I talk with people struggling with depression, and with thoughts of killing themselves. And it really feels like to me we don’t talk about suicide enough, probably because of the stigma that’s still attached to mental health issues.
So, I started doing research and public health advocacy related to suicide prevention, and that has led me here today. It has also led to some very odd dinner table conversations with my family, and I still have to remind myself that suicide prevention is not a typical topic of conversation at cocktail parties. But I actually think maybe it should be, because I think we’ve got to start talking about this.
And so, today I’m really hoping to give you all some ideas about how you can help save lives, because we have a lot of work to do. Suicide now causes twice as many deaths every year as car crashes do. And suicide death rates appear to be going up at the same time that death rates from car crashes are going down. In Colorado, a healthy and happy state, we actually have one of the highest suicide rates in the country. Now, we don’t hesitate to tell our kids to never drink and drive, or to ask a car dealer about safety features.
Yet, we might hesitate to ask a troubled friend if he’s had thoughts of suicide. But the research tells us that asking that question will not cause suicide. When I talk with patients who are suicidal, I tell them that I’m there to listen, and to help, and that I’m really glad they came into my emergency department, but I also ask them a question, an important question, that I think we all need to be asking anyone at risk of suicide: “Do you have access to a gun?” And to explain to you why I think we need to be asking this, I’d like to share with you a few facts about suicide.
The first is that most suicides are impulsive. In a study of people who survived a near fatal attempt, over two-thirds said that it was less than one hour from the time that they decided to kill themselves to the time they took action. And a quarter said it was less than five minutes. Certainly, there’s often a period of depression or mental anguish leading up to that point, but the final decision is often an impulsive one, and it often occurs during a time-limited crisis, like a breakup of a relationship.
The second fact is that being suicidal is not a terminal illness. We know from research that, of all people who survive a suicide attempt, only one in ten later go on to die by suicide. The other nine don’t. And we know that most people who are considering suicide are unsure and ambivalent, and that those who survive an attempt are ultimately happy to be saved.
The third fact is that guns are, by far, the most lethal method of suicide. For every ten people who attempt suicide using a gun, nine will die. That’s a much higher death rate than any other method of suicide, and it’s a much higher death rate than many of the diseases that we fear most. And because of that, having a gun in the home actually increases the risk of death by suicide. And guns are now responsible for over half the suicides in this country.
And the fourth fact is that we know from research that temporarily limiting access to lethal methods of suicide, like guns or bridges to jump off of, can help save lives. If a suicidal person doesn’t have access to a particular method, that person is not automatically going to switch to a different method. So, we need to talk about this because there are actually some really simple things that we can do to help protect people at risk of suicide. It’s just like, if a friend has had too much to drink, we hold on to his car keys until he’s sober and safe to drive again.
In the same way, if someone is troubled and considering suicide, we can work with him to store his gun with a friend or a family member, or somehow lock up the gun in the home in a way that he doesn’t have access to it. Now, I know that talking about guns might feel like entering a minefield, given the current political debates over gun control. But the thing is this is not political. This is about helping protect the people we love, the people we care about, when they’re in times of crisis. And I think probably most of you, like me, at some point have been worried that a friend, or a coworker, your teenage daughter, your elderly father, your stressed-out husband, someone near to you was at risk of suicide, or you maybe have been considering it yourself.
And you may have been unsure how to help the person, or how to ask for help, and you may have worried about finding the right words, but the thing is that you might be able to help save a life just by asking questions. And the wording of those questions doesn’t matter nearly as much as showing that you care.