Suicide Prevention Takes a Community Effort—Especially During the Pandemic

It's no secret that the COVID-19 pandemic has amplified stress levels in the U.S. Here in California, pandemic challenges such as physical distancing, lost wages, and concern about our families' health have been compounded by social unrest and ongoing wildfires.

Extreme stress, especially from multiple stressors, can increase the risk of suicide. Eyes and ears throughout the community are needed to prevent suicide deaths.

Palo Alto University is on the front lines of helping to mitigate these risks. We collaborate with and help support the County of Santa Clara Suicide Prevention Program, which offers a 24/7 crisis hotline and text service. Since the development of the program in 2010, suicide rates have remained relatively stable in Santa Clara County, while U.S. rates increased 35% from 1999-2018.

It’s still early to know the full impact of COVID-19 on mental health and suicide. However, in March, the County Crisis Text Line service received more than four times its average volume of conversations, from 40 a month to more than 170. Rates stayed high through spring, landing at 68 conversations in May.  
Nationally, nearly 11% of respondents to a June survey by the Centers for Disease Control and Prevention reported having seriously considered suicide in the previous 30 days. However, a recent Harris Poll survey shows that half of respondents are more open to talking about mental health since COVID-19 emerged. And 81% say it’s important to make suicide prevention a national priority.

In light of this pressing need—and since September was National Suicide Prevention Awareness Month—let's take a moment to refresh ourselves on the terms and risks associated with suicide and how we can all do our part to support one another.

If you or someone you know needs help, contact the Santa Clara County Crisis Text Line by texting RENEW to 741741. The word HELLO can be used nationally and BAY for the Bay Area.

Terminology Related to Suicide Risk

To have constructive conversations and fully support others, it helps to understand common terms related to suicide:

• Suicidal ideation: Thoughts about killing oneself, thinking positively about death, or thinking about actions that could lead to death. A person's thoughts or words may be active (“I am thinking about killing myself’) or passive (“I wonder what would be different if I were not here”).
• Suicide attempt: Non-fatal, self-directed acts intended to end one’s life. These actions do not end in the individual's death.
• Die-by-suicide: Self-directed act that results in someone ending their own life. This term is less stigmatizing and more preferred than “commit suicide,” which implies committing a crime or sin.

Some people communicate their suicidality through nonverbal, nonobvious, or generally misunderstood warning signs. Others show subtle or overt signs that can signal others to intervene and connect the person with mental health support.

Signs that a Person May be at Risk

Be aware of suicide warning signs when communicating with family, friends and neighbors. Social distancing, though necessary during the pandemic, has the potential to trigger some of these signs, which we've noted with asterisks.

Thoughts< >Thinking life is not worth living or that others are better off without them.Thinking about hurting themselves or ending their life.“I just want out.”“I’m a burden to others.”Difficulty coping with changes in health*Newly developed chronic pain*Self-harm, such as cutting themselvesAshamed, abandoned or betrayed* Hopeless, desperate, without purpose or trapped* Misunderstood or inadequate* Sudden mood changes* Unbearable emotional pain*

Behaviors Giving away favorite possessions Taking risks that endanger one's life Putting one's affairs in order Increased alcohol or drug use* Withdrawing or spending more time alone* Not attending to personal health or hygiene* Situational Trouble adjusting to a new culture, environment or set of rules Conflict or rejection involving family, friends or community* Exposure to trauma, such as abuse or bullying* Financial stress* Chronic or terminal illness* Death or suicide of a loved one* Discrimination* Failure to meet expectations*

Suicide Risks Among Demographic Groups

Suicide risks may be affected by underpinnings associated with one's race, ethnicity, age, sexual orientation, gender, or other identities. White and non-Hispanic American Indian and Alaska Native populations make up the largest groups of death by suicide in the U.S. However, the Centers for Disease Control and Prevention notes that certain groups may be under-counted. Some cultures or populations may be more reluctant to discuss mental health needs or seek help. And “help” means different things to each person, depending on their background and traditions. Helpers may represent a wide range of community members, including:

• Crisis hotline respondents
• Doctors or nurses
• Emergency service providers
• Family, friends or trusted adults
• Mental health professionals
• Spiritual helpers

This means the onus is on all of us to be mindful of the needs of others in our community. At Palo Alto University, we help to address community mental health needs through centers focused on specific factors for suicide risk:

• Multicultural Suicide Research Center, which looks at cultural variations in suicide, researching and testing how to help diverse populations.
• Risk and Resilience Research Lab, which develops and implements programs for people who have experienced traumatic events, including suicide.
• The Gronowski Center, a community clinic for psychological services for people in Santa Clara and San Mateo counties.

Read about Yan Leykin's research into suicide, including an internet-based safety plan. My colleagues and I, along with PAU students and trainees, are also part of a training and data evaluation team for the County of Santa Clara’s Suicide Prevention Program. We serve as mental health consultants and help to evaluate data to inform programs and services that support at-risk populations, particularly taking cultural considerations into account. Our faculty, staff and trainees work to identify mental health risk factors and provide the community with the tools, resources and outlets to potentially mitigate suicide risks in the California Bay Area.

Taking Care of Each Other

Stressors can be cumulative, as we're seeing right now in California amidst the wildfires, pandemic and social justice movements. In light of all that is going on in the world around us, we can all take simple actions to support one another:

• Check in on loved ones more often
• Look out for suicide warning signs, and encourage people to seek help
• Host friend and family video chats
• Practice mindfulness and meditation
• Exercise or enjoy hobbies together (virtually or outdoors)
• Use healthy coping mechanisms, such as talking with a therapist

Increased connections can help encourage people who are at risk for suicide to seek support. Managing suicidal risks is a long-term challenge. One of the best things we can do is to offer support, even when someone may seem to be feeling better.

No two people will react the same in the same situation. It’s on all of us to be the eyes and ears of our community. Let’s use COVID-19 as the reason to unite with our community and help one another.

If you or someone you know needs help, contact the Santa Clara County Crisis Text Line by texting RENEW to 741741. The word HELLO can be used nationally and BAY for the Bay Area.

Join Palo Alto University in providing community and mental health services. Students, trainees, faculty and volunteers help us continue to serve Santa Clara County. Request information today.