Ruth Andruiser Outline + Draft

Summary

Ruth Andrusier
CRT

OUTLINE

Topic: Suicide Screening & Prevention

Intro: (hook, intro to topic, thesis statement) Suicide rates at every age have been rising steadily since the beginning of the 21st century. Economic uncertainty, gun violence, and ignored mental health issues have been the biggest risk factors for suicide in recent years. In 2014, Barbara Mantel published a report on teen suicide. Her report found several inadequacies in suicide screening and prevention programs geared toward teenagers. These include: the cost of universal screening, limited resources, and reluctance to share information, and lack of research on treatment. The purpose of this paper is to analyze how efforts to increase the efficacy of suicide screening and prevention have changed since Mantel’s report. By discussing new research into screening, policies for suicide prevention, and new avenues for treatment, I will show that continued investment into suicide screening and prevention programs is the best course of action in reducing suicide rates.

Premise 1: New research shows that a methodical screening approach and designed response system can successfully increase the ability to recognize suicide risk.

Supporting Evidence:

AI and Big Data
“experts in artificial intelligence and machine analytics are raising hopes that computerized tools that sift through massive amounts of health data could help identify potentially suicidal patients.” (Lyons, 11)

“The Department of Veterans Affairs is using a computer algorithm that sifts through voluminous health data to detect common warning signs and flag veterans who are at risk of suicide.” (Lyons, 18)

“Those participating in the program were admitted to mental health inpatient units less often, showed up more often for doctor appointments and visited the VA more frequently than other vets.” (Lyons, 18)

“A 2014 study found that 83 percent of those who killed themselves had visited a doctor's office within the previous year, but about half of them did not have a mental health diagnosis.” (Lyons, 19)

C-SSRS:

“It has been translated into over 110 languages and has been adopted, mandated, or recommended by many international regulatory agencies and institutions.” (Pumariega, et al., 32)

“Recent findings from hospital settings using the C SSRS demonstrated lower rate of false positives and lower rate of false negatives” and “follow up assessments with the C SSRS detected three times the number of suicide attempts when compared to chart review.” (Pumariega, et al., 33)

“The C SSRS Screener makes systematic hospital based suicide screening feasible, addressing barriers identified by Posner et al., and other authors concerning time burden for administration (2–3 min on average).” (Pumariega, et al. 37)

Premise 2: In recent years, in the interest of suicide prevention, there has been an academic pursuit towards identifying risk factors for suicide alongside a political one seeking to address common drivers of suicide.

Supporting Evidence:

RISK FACTORS
GUN CONTROL:
“The theory that depriving suicidal people of firearms will make it less likely that they will die by suicide is incorrect” said David Kopel, the research director of the Independent Institute. Lyons cites him, “Several other methods of suicide — namely hanging, carbon monoxide exhaust or drowning — are nearly as likely as firearms to result in death.” (Lyons, 13)

SOCIAL MEDIA
“researchers concluded that screen use had a “tiny” effect on teens' mental health when compared with a range of other potential correlating factors,” and “found that screen time had [an insignificant] effect on mood.” (Lyons, 15)

BULLYING/CYBERBULLYING
“Children who are bullied in person or online are more than twice as likely as other children to consider killing themselves.” (Ladika, 3)

“There is evidence that state anti-bullying laws have helped reduce in-person bullying and cyberbullying, but experts note that states often do not budget money to implement those laws, such as training for teachers.” (Ladika, 8)

Anti-bullying and bystander programs have seen mixed results due to inconsistencies in demographics among tested groups. However, one program, KiVa has shown promise as “the program improved the mental health of the most severely bullied sixth-graders, decreasing their depression and improving their self-esteem.” (Ladika, 10)

“State laws that require school districts to enact strong anti-bullying policies were linked to an 8 to 12 percent drop in bullying”, but “many state anti-bullying laws ask school districts and schools ‘to take on additional tasks — such as providing training on bullying for teachers and other school personnel — without allocating additional funds for these tasks.’” (Ladika, 13, citing a study in the Journal of Population Economics)

Premise 3: Research into drug therapies has been advancing, and experimental drug treatments have proved hopeful for managing depression and other medical issues that increase suicide risk, but they are still held back by lack of government assistance and funding.

Supporting Evidence:

“Funding for suicide research through the National Institutes of Health rose from $46 million in fiscal 2015 to $96 million in fiscal 2018. It was budgeted at about $117 million in fiscal 2019, but some suicide experts say that is not enough.” (Lyons, 7)

“New research suggests that certain psychological therapies that focus on changing patients' thinking patterns and behavior — such as the Collaborative Assessment and Management of Suicidality (CAMS) or dialectical behavior therapy (DBT) — can treat patients with suicidal thoughts or behaviors.” (Lyons, 10)

“A researcher found that the CAMS protocol helped some patients [and] three clinical trials are studying whether the approach reduces suicide attempts.” (Lyons, 38)

“By getting a better estimate of those affected, there will be a day when health care and mental health care are better-funded systems that can truly help people.” (Lyons, 38, citing Julie Cerel, a suicideologist at the University of Kentucky)

“Jobes, of Catholic University, urges training more medical providers in suicide prevention, and starting a public education campaign to inform patients about available treatments,” as well as “a national mental health service corps.” (Lyons, 51)

Premise 4?: Despite efforts to improve suicide screening and develop new prevention programs, one hurdle that persists in reducing suicide rates is that people—especially teenagers—are reluctant to speak to counselors or doctors regarding difficulties they may be facing. (POSSIBLE TOPIC OF DISCUSSION)

Conclusion:
Since Mantel’s report in 2014, numerous strides have been made in the way we approach suicide screening and prevention. Continuing research into screening protocols and cutting-edge drug therapies has been somewhat able to decrease suicide risk. However, what it has absolutely shown is how important suicide screening is and how we should focus more on it if we hope to reduce suicide rates. Societal issues like economic downturns or the slew of stories about mass shootings don’t appear to be slowing down at all, which takes a significant mental and emotional toll—especially on children and adolescents—increasing their risk for mental health problems and, potentially, suicide.
 
DRAFT

Suicide rates at every age have been rising steadily since the beginning of the 21st century. Economic uncertainty, gun violence, and ignored mental health issues have been the biggest risk factors for suicide in recent years. In 2014, Barbara Mantel published a report on teen suicide. Her report found several inadequacies in suicide screening and prevention programs geared toward teenagers. These include: the cost of universal screening, limited resources, and reluctance to share information, and lack of research on treatment. The purpose of this paper is to analyze how efforts to increase the efficacy of suicide screening and prevention have changed since Mantel’s report. By discussing new research into screening, policies for suicide prevention, and new avenues for treatment, I will show that continued investment into suicide screening and prevention programs is the best course of action in reducing suicide rates.
New research suggests that a methodical screening approach and designed response system can successfully increase the ability to recognize suicide risk. Within the last decade and a half, the most promising results have been attributed to the use of artificial intelligence (AI) and the Columbia Suicide Severity Rating Scale (C-SSRS). In a report titled Suicide Crisis, Christina Lyons discusses the utility of AI and big data in early detection of at-risk persons, saying “Experts in artificial intelligence and machine analytics are raising hopes that computerized tools that sift through massive amounts of health data could help identify potentially suicidal patients.” (Lyons, 11) Of course, this is not a perfect system that would be able to predict every possible person at risk of suicide, but it has had promising results. For example, “The Department of Veterans Affairs is using a computer algorithm that sifts through voluminous health data to detect common warning signs and flag veterans who are at risk of suicide,” these veterans were then “admitted to mental health inpatient units less often, showed up more often for doctor appointments and visited the VA more frequently than other vets.” (Lyons, 18) This is still a small sample size, however, and detractors of these methods often cite the low accuracy of the predictive models as a reason to move away from them. But they do have a use. Even if it is in a niche setting, any positive result is a step in the right direction as it draws attention to the possibilities of AI in this context, and it provides a research base for future exploration.
The same is true of the C-SSRS and its contributions in the identification of at-risk persons. This tool is used to screen for suicide ideation and behavior and has shown encouraging results as well as wide-scale adoption. The C-SSRS “has been translated into over 110 languages and has been adopted, mandated, or recommended by many international regulatory agencies and institutions.” (Pumariega, et al., 32) This is due to its ability in identifying metrics that other screening tools haven’t considered before to greater accuracy. For example, “Recent findings from hospital settings using the C-SSRS demonstrated lower rate of false positives and lower rate of false negatives” and “follow-up assessments with the C SSRS detected three times the number of suicide attempts when compared to chart review.” (Pumariega, et al., 33) Additionally, “The C SSRS Screener makes systematic hospital-based suicide screening feasible, addressing barriers identified by Posner et al., and other authors concerning time burden for administration (2–3 min on average).” (Pumariega, et al. 37) This is significant as a persistent issue with universal screening in the past has been the time it takes to screen individual patients and recommend treatment. Furthermore, the tool provides standardized training and response protocols which address another issue with universal screening, mainly the variability in different screening programs. Overall, despite limited success with AI and the C-SSRS progress has still been made and increased investment of both money and focus will lead to a refinement of screening processes for the identification of persons at risk of suicide. Beyond screening, another avenue to reducing suicide rates is more rigorous prevention programs.
In recent years, in the interest of suicide prevention, there has been an academic pursuit towards identifying risk factors for suicide alongside a political one seeking to address common drivers of suicide. The three most identified drivers are gun control and accessibility of guns, the prevalence of social media in superseding human interaction, and bullying. A lot of of discourse relating to suicide prevention has been in the realm of gun control in the sense that people who think of committing suicide can do so by using firearms which are only loosely regulated. However, studies have shown that the availability of guns doesn’t necessarily lead to increased suicide rates. “The theory that depriving suicidal people of firearms will make it less likely that they will die by suicide is incorrect” said David Kopel, the research director of the Independent Institute. Lyons cites him, “Several other methods of suicide — namely hanging, carbon monoxide exhaust or drowning — are nearly as likely as firearms to result in death.” (Lyons, 13) As such, a focus on gun control laws, though definitely something admirable and worthy of pursuit, would do little to curb suicide rates in the country. Another possibility often studied is the presence of social media, especially in children and adolescents. Once again, research has been put forth suggesting increased screen time contributed negatively to mental health either through the content depicted or due to the isolating factors of social media. Although it has in certain cases, been responsible for suicide, there is little data to suggest it has a universal effect on suicide rates. In fact, “researchers concluded that screen use had a “tiny” effect on teens' mental health when compared with a range of other potential correlating factors” and “found that screen time had [an insignificant] effect on mood.” (Lyons, 15) Therefore, efforts to reduce use of social media amongst kids and teenagers is also not the most efficient way to prevent suicide.
Bullying and cyberbullying is yet another common reason cited for suicidal ideation and behavior. Here, the research has been mostly unilateral with studies confirming the effect of bullying on suicide rates. In a report titled Bullying and Cyberbullying, Susan Ladika analyzes the effects of bullying and the means of addressing them. Based on the data, she states outright, “Children who are bullied in person or online are more than twice as likely as other children to consider killing themselves.” (Ladika, 3) This puts a very explicit perspective on the bullying problem and shows why it is something that needs to be considered with more urgency than gun control or social media. Furthermore, the reason why this is an attractive avenue to pursue as far as suicide prevention is that “There is evidence that state anti-bullying laws have helped reduce in-person bullying and cyberbullying, but experts note that states often do not budget money to implement those laws, such as training for teachers.” (Ladika, 8) This supports the idea that regulating bullying is the issue to focus on when addressing prevention. It also highlights the main reason as to why it has not been implemented in full, mainly the lack of investment. Ladika supports this sentiment with the following, “State laws that require school districts to enact strong anti-bullying policies were linked to an 8 to 12 percent drop in bullying”, but “many state anti-bullying laws ask school districts and schools ‘to take on additional tasks — such as providing training on bullying for teachers and other school personnel — without allocating additional funds for these tasks.’” (Ladika, 13, citing a study in the Journal of Population Economics) Once again, as was the case with suicide screening, the bottleneck that hinders proper handling of suicide is the lack of resources. The research is there, the willingness to stop the problem is there, the only thing lacking is the funds. With sufficient investment it is very possible to make significant strides in reducing suicide rates.
Research into drug therapies has been advancing, and experimental drug treatments have proved hopeful for managing depression and other medical issues that increase suicide risk, but they are still held back by lack of government assistance and funding. In the context of treatment is where we see the biggest casualty of insufficient government investment. Research into new therapies and studies is ongoing and the results are promising but are for the most part theoretical. Without the money, many of the proposed developments will never see daylight. “New research suggests that certain psychological therapies that focus on changing patients' thinking patterns and behavior — such as the Collaborative Assessment and Management of Suicidality (CAMS) or dialectical behavior therapy (DBT) — can treat patients with suicidal thoughts or behaviors.” (Lyons, 10) These are just two of the dozens of studies and therapies that have shown results in treating mental health issues that contribute to suicidal thoughts. In addition, “A researcher found that the CAMS protocol helped some patients [and] three clinical trials are studying whether the approach reduces suicide attempts.” (Lyons, 38) In most cases, the funding for these trials come from private groups which is good but also limited in scope as these private studies rarely have as much access as a properly government funded exploration would. In fact, the most cited reason for slow progress in research is the lack of investment. “Funding for suicide research through the National Institutes of Health rose from $46 million in fiscal 2015 to $96 million in fiscal 2018. It was budgeted at about $117 million in fiscal 2019, but some suicide experts say that is not enough.” (Lyons, 7) Also, “By getting a better estimate of those affected, there will be a day when health care and mental health care are better-funded systems that can truly help people.” (Lyons, 38, citing Julie Cerel, a suicideologist at the University of Kentucky) And finally, “[David] Jobes, of Catholic University, urges training more medical providers in suicide prevention, and starting a public education campaign to inform patients about available treatments,” as well as “a national mental health service corps.” (Lyons, 51) After all, how do we expect to see any results if things can barely get off the ground? The main reason detractors of expanded research into these treatments cite is the notion that suicide is relatively rare with only about a dozen cases per 100,000 people annually. It is indeed an uncommon occurrence but one that warrants study regardless as the drivers of suicide are issues inherent in society such as human relationships, geopolitics, and the economy, problems that have only been exacerbated over the last several decades. The big problem isn’t the fact that people commit suicide but the fact that these rates have consistently grown and the issues that contribute to them show no signs of slowing down. Though it may seem like throwing money away on a relatively small complication, shouldn’t we get ahead of the problem rather than waiting for it to grow into something significant?
Since Mantel’s report in 2014, numerous strides have been made in the way we approach suicide screening and prevention. Continuing research into screening protocols and cutting-edge drug therapies has been somewhat able to decrease suicide risk. However, what it has absolutely shown is how important suicide screening is and how we should focus more on it if we hope to reduce suicide rates. Societal issues like economic downturns or the slew of stories about mass shootings don’t appear to be slowing down at all, which takes a significant mental and emotional toll—especially on children and adolescents—increasing their risk for mental health problems and, potentially, suicide.