Read this Issue. Your or Your Colleague’s Life May Depend on It.

From the 5/14/2021 newsletter

Director’s Corner

Read this Issue. Your or Your Colleague’s Life May Depend on It. 

Adina Kalet, MD MPH

This week, we focus on suicide and its prevention. Dr. Kalet urges you to read what is likely our most compelling issue ever of the Transformational Times, curated by Dr. Jeffery Fritz and the Kern Student Leadership group. You will learn a few things, be moved, and be better prepared to save a life …

The MCW-Milwaukee medical school graduating class of 2021 has suffered the loss of two of its cohort to suicide. This has been devastating for the families and close friends of these individuals. Their grief, profound and deeply personal it must be, and has been, treated with tenderness and respect for desired privacy. 

As new physicians, this class joins a profession where suicide is all too common. An estimated 300 US physicians take their own lives each year and the rates may be rising. It is likely that each of us have been, or will be, touched by suicide amongst our colleagues and friends. 

For many people who are contemplating suicide, prevention is possible. As colleagues, it requires each of us to be proactive, skillful, and brave in facing our own acculturated barriers to reaching out to others in times of despair. On a personal level, we must all learn to identify and skillfully intervene with friends and colleagues at risk, and vow to accompany those family members and friends who are left to deal with the grief and guilt that suicide leaves in its wake. It is good news that more than 90% of people who survive an attempted suicide never go on to die by suicide. Intervention and treatment save lives.

We also know that, in some cases, there is little that we can do. Some people are committed to ending their lives without intervention and offer no detectable warning or cry for help. With these deaths, we must care for the survivors, enact the self-compassion to digest and deal with our own thoughts and feelings, and develop meaningful ways to acknowledge the loss.  

What we know about suicide

Suicide is among the most common causes of death in those under 55 years of age. The rate of suicide has increased from 17 to 22 per 100,000 over the past twenty years, rising particularly among white and Native American men. Other Americans with higher-than-average rates of suicide are military veterans, people who live in rural areas, and workers in mining and construction. Lesbian, gay, bisexual, or transgendered young people have higher rates of suicidal ideation and behavior compared to their straight peers. There is a rising concern for adolescents who have been socially isolated during COVID-19. Those with mental health diagnoses, such as major depression and bipolar disorder, and those who struggle with alcohol or other substance abuse disorders are at increased risk. Because of their access to lethal weapons, people who live in homes with firearms are at higher risk. About 60% of firearms deaths each year in the US are suicides.

Systemic approaches to preventing suicide include cultural and institutional efforts that eliminate professional burnout and enhance wellbeing. This requires, as Dr. Cipriano points out in this issue, viewing suicide through a public health lens. Meaningful prevention of suicide on a population basis will require comprehensive approaches that strengthen financial safety nets and coping skills, promote connectedness, and enhance access to excellent mental health care. 

What to do when the person in front of you is suffering

Preventing suicide while in the presence of an individual who concerns you requires your active intervention. Learn to ask about suicidality. Be willing to remain present and keep the individual safe. Help the person stay connected to others and follow up. In this issue, our students describe their efforts to disseminate these basic principles. 

The experience of relatives and friends 

I find hearing that someone has killed themselves is always disorienting and unfathomable. While not ubiquitous, it is common for families to close ranks and feel both stigmatized and ashamed for a time. Traditionally, many cultures and religions have created a stigma around suicide although, as a result of work to raise awareness around these issues, most groups have faced down their stigmatizing actions. As one of this week’s authors, Toni Gray, points out, things have changed for the better through research, public awareness campaigns, and the compassion of mental health caregiving.  The key is to try, follow the lead of those who are grieving, and remember that they will be dealing with the loss for their lifetimes. 

Suicide in medical settings gets uncomfortably close

Suicide has touched my personal social circle a few times over the last years, including a teenager and more than one adult with loving families and seemingly rich lives. 

When I was just starting out in medical practice, it was a commonly held (and incorrect) belief that asking someone, especially someone who was desperately fragile emotionally, if they were considering killing themselves might “plant the idea in their head.” This approach likely cost lives. Now we know better. Many people who attempt suicide have seen a physician, usually not a mental health expert, in the weeks prior to the attempt. Physicians and healthcare workers in every specialty must understand their obligation to recognize and intervene.

In medical settings, I have noticed that suicides tend to happen in waves. A few years ago, a medical student, well known and loved by his peers and teachers and who had no known personal or academic troubles, jumped from the roof of a building in New York City. Soon thereafter, two other young physicians in our community died by suicide. Four senior physicians at a hospital where I have worked took their own lives over the course of a year; this was attributed to workloads of over 100 hours a week. 

MCW has been similarly touched. These are profound shocks for any educational institution and, despite having policies, protocols, confidential counselling, and employee assistance offices, deaths still occur. Each suicide is devastating. With each occurrence, we look for answers. We redouble our commitment to reach out if we are concerned about colleagues, friends or patients. We educate ourselves. We plan to simply ask, “Are you thinking about killing yourself?” and then commit to sitting and listening.  Each loss leaves the community diminished.

We hear the voices of people who have struggled

Like our anonymous student essayist, survivors of profound depression and grief often become so focused on their own suffocating isolation that they can see no other option. Shakespeare reminds us that, "Everyone can master a grief but he that has it." It falls to those of us nearby to accompany the person suffering, offering safety, connection, and help. As the student tells us, “As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction.” We might be the one to save a life.

We are deeply grateful to those who contributed pieces in this issue. Students, staff, and faculty members who have struggled personally or vicariously through close relatives and friends, share their stories. We hear from Brett Linzer, a physician who, having experienced the loss of a number of colleagues and friends to suicide, as he faces his own burnout with the help of his loved ones. Although reluctant at first, he seeks the coaching that strengthens him with skills and support, enhances the joy he experiences in his work, and compels him to use his experience to work toward systems change for all of us. We get to know Kerri Corcoran, Student Behavioral Health and Resource Navigator in the MCW office of Student Services, who is committed to providing direct support for our students. MCW-Central Wisconsin students write about their work at self-organizing, with great creativity, to do suicide prevention work. 

This is a difficult, ongoing, and devastating problem that disproportionately touches us as physicians. We desperately want to do this right and welcome your experiences and efforts. 

I urge you to read this issue. You never know when it will be your turn to save someone’s life. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.