Dr. Samantha Morel April 14th, 2020
There is little doubt in my mind that mental health, perhaps even suicide more specifically, will be the next “great wave” of concern amidst the COVID-19 pandemic. My colleagues in the mental health profession have seen it coming. We’ve been talking about it, preparing for it, bracing for it. I want to start by providing some perspective here… but stay with me. I promise to share information about what YOU can do to help including identify signs, how to reach out, what to do if someone is really struggling.
What History has shown Us
While I may not have been practicing during the recent Great Recession that occurred from 2007-2009, research on this time has proven that the impact of this recession on mental health was significant. A longitudinal study [1] (one that follows the same people and over an extended period of time) published in 2019 found that individuals who experienced even one negative recession impact had higher odds clinically significant symptoms of depression, generalized anxiety, panic, and problems with drug use. Furthermore, these trends could still be seen three years after the recession ended. While those with fewer resources and socioeconomic advantages (such as education, financial stability, previous mental health) had the most significant health declines, these findings were true even taking these factors into account. This highlights, in essence, that nobody was spared in the hit to mental health.
Fast forward to today, and pretty quickly here we are likely to see unemployment rates meet those seen during the Great Depression in the 1930s. This is important when we consider the well-known reality that economic cycles and unemployment have a clear and well-defined impact on suicide rates[2]. Some studies have suggested that for every 1% increase in unemployment, we may see as much as a 1% increase in the number of deaths by suicide in our society[3]. This percentage is significant, and while we should not have been ignoring it in the past, we simply cannot ignore it now.
What are the Signs and What to do About Them
So, let’s talk about some ways to notice struggles in those around you and how to get them some support. Perhaps one of the best things we can do if we think someone is struggling is to reach out and let them know you are there. What they may need is an offer for some lighthearted fun and connection. Sometimes asking, “Hey, want to play a video game together or have a virtual coffee date?” may be just the ticket! Small moments of connection are invaluable right now.
Are you afraid someone you care about is suicidal? Or, how do I know if they might be? As a therapist, one of the most common misconceptions that I hear around suicide is “Won’t talking about suicide put the idea into someone’s head?”. I don’t want to clutter this message with research and studies, but the answer is a simple and emphatic “NO!”
What we know is:
1) asking directly about suicide intent lowers anxiety,
2) opens the relationship up for communication,
3) reduces risk of impulsive actions.
The reality is that the situational cues we normally look out for related to suicide are there– people are losing jobs, socially isolated, fearing financial security, and uncertain about their future. So what about other signs? Are you noticing someone close to you pull back from social support, even if it’s virtual? Are you seeing clear reductions in energy or motivation to get small things done (think grooming, eating, etc.)? Is there a significant increase in substance use? Are they saying things such as “I can’t do this anymore” or “It doesn’t really matter anyways” ?
Noticing and checking in with someone in a caring, compassionate manner about how they are feeling is so darn important. Statements like, “I can tell that you are really upset and unsure about the future. I’m concerned. Are you thinking about suicide?” can be helpful. While how you ask is less important than just asking, try and avoid questions like “You’re not thinking about killing yourself, are you?” The latter question basically prompts the person to respond with “no” while the former creates a space for conversation and connection.
If someone does open up about their struggle, whatever it may be, please listen. Listening may seem small, but truthfully it is one of the most important things we can do for one another. It communicates, “You are not alone!” Once they talk and you listen, you can ask about how you can support them in getting connected with professional help. Can you sit on the phone while they send out emails seeking an appointment? Can you call a therapist for them to ask questions about availability or fees? I’m not sure how well therapists are communicating to those not already in treatment, but we are available to help! And many of us are offering tele-health sessions to meet the needs of our communities. You can also provide them information for the National Suicide Hotlines (which I’ve included below) that are available to anyone 24/7.
What if I’m Struggling?
You might find yourself asking, “But, what if I’m the one struggling?”. Let me be the first to assure you, you are not alone. There are people out there who want to support you. Can you reach out to them? Do you want some lighthearted connection? Who can you go to for some fun and distraction? Do you want to share how you’re feeling? Who feels safe for you to reach out to? “I’ve been having a hard time and really need a friend right now” is one way to start that. The therapists, the hotlines, the emergency support — they are all there for you too. Please reach out.
Final Thoughts
We can get through COVID-19, and we will get through COVID-19. The question is — are we going to do it together, supporting each other and reaching out to those who need it most?
Stay Well,
– Dr. Morel
National Suicide Hotlines (Available 24/7):
Crisis Text Line: Text “START” to 741-741
Please read *If you or someone you know is in immediate danger, please call a local emergency telephone number or go immediately to the nearest emergency room.
References
[1] Miriam K. Forbes, Robert F. Krueger. The Great Recession and Mental Health in the United States. Clinical Psychological Science, 2019; 216770261985933 DOI: 10.1177/2167702619859337
[2] Schapiro, Morton and Dennis Ahlburg, “Suicide: The Ultimate Cost of Unemployment,” J. of Post Keynsian Economics: Winter 1982-83,Vol. 5, No.2.
[3] Luo, F., Florence, C. S., Quispe-Agnoli, M., Ouyang, L., & Crosby, A. E. (2011). Impact of business cycles on US suicide rates, 1928-2007. American journal of public health, 101(6), 1139–1146. https://doi.org/10.2105/AJPH.2010.300010
