Alaska is consistently among states with the highest rate of suicide in the country, and suicide touches almost every Alaskan to one degree or another. Whether we experience it directly among family members, friends, neighbors or co-workers or we know someone who has experienced such a devastating loss, the ripple effect is profound. Suicide is an enduring issue and has been a major public health problem in Alaska.
This begs the question: how do we combat this significant and profound public health problem? First, I want to express my gratitude for all the efforts Alaskans put into preventing suicide each and every day. We have made some great strides in raising awareness, including training of thousands of Alaskans across the state in suicide prevention. People are learning that it's OK to ask someone if they are thinking about suicide, it is OK to talk about suicide, suicide is not a taboo subject, and that help is available.
In addition, more people are reaching out for help. In 2017, more than 17,000 calls were received by Careline, Alaska's statewide crisis "someone to talk to" call center at (877) 266-4357 any time, day or night. The service is free, confidential and offers anonymous support. Public awareness efforts, such as the American Foundation for Suicide Prevention's Out of Darkness Walk, have also experienced high turnout in both urban and rural communities to remember the lives lost to suicide and those who carry on as survivors.
We are also seeing some movement at the national level. The National Strategy for Suicide Prevention has promoted a health care model called "Zero Suicide." The "Zero" in the title is an aspirational goal to propel and encourage health care organizations to make suicide prevention a core component of their health care system. Examples where this has shown to reduce suicide as much as 40 percent include the U.S. Air Force and the Henry Ford Center. These efforts have demonstrated that reducing suicide is entirely possible and that is something to celebrate wholeheartedly. For a closer look, check out www.zerosuicide.org.
If we wish to create a prioritized agenda, we must think and act "upstream" of suicide beyond the health care system to reach people within their communities. The title of the newly revised five-year Alaska Suicide Prevention Plan is "Recasting the Net." Since the net was "cast" in 2012, the Statewide Suicide Prevention Council has been working tirelessly to emphasize that the "web of causality" (the factors that contribute to our understanding of what causes suicide), which needs to be better understood if we expect to reduce and prevent suicide. It would be irresponsible to suggest that suicide has a single cause requiring a single solution.
We are learning more about adverse childhood experiences and how predictive early childhood trauma and abuse can be in determining increased risk of suicide as an adult. Investing in our children, families and communities early to reduce and prevent all forms of violence, abuse and neglect is investing in suicide prevention for future generations.
We are also learning more on how historical trauma and the profound effects of colonization among Alaska Native people has contributed to suicide in very distinct ways. Some argue this explains the disparity in rates of suicide, in particular among Alaska Native teen boys and young men in rural communities and increased risk of suicide attempts among girls and young women. In furthering our understanding of this question, a renewed research effort is being led by Alaska Native village elders and leaders, the University of Alaska Fairbanks, and regional and state partners creating the Alaska Native Collaborative Hub for Research and Resiliency. This five-year effort expects to show how community-level protective factors (i.e., traditional language, cultural teachings, education, subsistence activities, spirituality, economic supports, etc.) promote and support cultural health as a buffer against suicide.
I would be remiss if I didn't bring up the relationship between firearms and suicide, which represents the majority of firearm deaths in the United States. This phenomena is not unique to Alaska, but consider this: According to the World Health Organization, firearms account for 46 percent of all suicides in the Americas, whereas in other high-income countries, firearms account for only 4.5 percent of all suicides. In states such as Colorado and New Hampshire, the Gun Shop Project is an example of what community groups and coalitions can do to address this problem by working with gun shops, pawn shops, firing range owners, gun clubs and firearms safety instructors to promote suicide prevention awareness and prevent the sale and rental of firearms to people who may be at risk for suicide.
Unfortunately, we have yet to see the rates of suicide drop. This phenomena is not unique to Alaska by any means. As quoted by one of the leading pioneers in suicidology, Edwin Schneidman, "Each suicidal drama occurs in the mind of a unique individual." That was one of my first lessons conducting crisis intervention services as a freshly graduated mental health clinician, that people and the circumstances that contribute to their mental health are "unique" to their individual experience. We also know that the majority of those who experience suicidal thoughts do not want to die, but have common experiences of deep psychological and emotional pain; feel they are a burden to others; feel they don't belong; and are hopeless about the future which leads them to believe that suicide is a permanent solution to what others perceive as a temporary problem.
So what is the answer to prevent suicide? I believe, in simple terms, it is to instill hope, increase human connection and belonging — and, most importantly, to help those who are struggling to relieve the pain that accompanies suicidal thoughts and behaviors.
How to do that collectively with our family, friends, neighbors, communities and as a state is the bigger question. It requires us to think about our relationships and how we interact and talk about the larger questions and issues that surround mental health. It requires us to move out of our comfort zones, and to speak openly and honestly about difficult subjects. It requires us to break through the codes of silence that surrounds suicide that brings with it the stigma, fear and shame to what should be otherwise viewed like any other treatable and preventable health condition. It requires leadership to create a prioritized agenda for suicide prevention that will allow us to put our best efforts forward. And lastly, it should include in our words and actions as stated in the Alaska Suicide Prevention Plan, "Promoting wellness to prevent suicide in Alaska is a call to every Alaskan … In ways big and small, we can work together to prevent suicide."
James Gallanos has a master's degree in social work and served as the Suicide Prevention Coordinator for the Department of Health and Social Services, Division of Behavioral Health for the 10 years. He now serves on the Colorado National Collaborative for Suicide Prevention for the Colorado Department of Public Health and Environment.
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