Licensed mental health counselors are very well qualified and trained to work with and diagnosis those suffering from mental health issues in a variety of settings and with a diverse populations. Allowing more people to see and work with LHMC's is needed in New York State.
I urge especially the NYState Senate Higher Education Committee to act in good faith for the people of New York to pass Senate Bill S6582A.
It is criminal at this point to withhold passing this bill because of the the lobbying efforts of those who seek to retain their turfs.
Serious question. Why do we want to stop people who are suicidal from killing themselves. How can any of us know what is better for them? I get it if someone leaves a dependent behind it is a larger issue, and yes people left behind are so very hurt and sad and ... I struggle desperately 3 or so times a year and for me having someone nearby who recognizes the signs and talks to me is often enough to keep me on the ledge rather than off. That may not work sometime down the road, but we talk about it and are prepared as we can be. I understand the difference between my healthy brain being in control and my depression being in control but truthfully, I don't believe this is the only life I get. Ending it for a re-boot may not be as tragic as we seem to think.
I know people feel helpless after a high-profile suicide, but can we stop pretending that publicizing the 1800 suicide hotline is the solution? Suicide, and the severe depression that often precedes it, is a complicated illness that requires more than a stranger at the end of a phone line.
4
It appears that suicide prevention has been turned into a business, with a lot of money involved in foundations that give grants to entrepreneurs who create suicide prevention companies or businesses, registered as non-profits for tax exemption. Typically, a foundation will have a high-paid CEO, and lots of underlings who are either volunteers (unpaid labor) or very low-paid. The underlying source of funding appears to be from drug companies that manufacture and market psychiatric drugs (suicide prevention services usually arrange for callers to be sent, often by police, to a psychiatric ward where medications are started). Who would've imagined that suicide-prone people can be legitimately exploited for making money?
1
Most of what you wrote is not true. There is no huge moneyaking scheme developed around suicide.
1
Commercials for privately owned suicide lines are being shown several times every day on the cable TV shows I watch. These aren't a public service although they pretend to be. It looks like psychologists with an entrepreneurial bent are creating these companies, using grant money from the government, drug companies and other money sources. People need to understand that privately owned suicide help lines do the same thing the public service ones do - they clandestinely obtain the caller's location and send the police, who take the caller to a psychiatric facility where medication is administered. From then on, the caller becomes a mental patient, with a history of mental illness.
"Mental health workers, who have a unique perspective on America’s suicide crisis, recently opened up about what it looks like to them"
I'd rather hear the perspectives of those who have experienced suicidal thougjts. Their experiences would provide more helpful information to understand this than those of mental health professionals, many of whom are too focused on mental illness and medication and not enough on the human being in front of them.
3
Thanks to Nancy Wartik for the only clear and definitive statement addressing mental health in this country. The United States is now facing many of it's mythologies. This is not the land of the free and the home of the brave, where all beings are created equal and yes; there is no mental health care system. Perhaps if that were true the defining pathologies common to politicians would be clear to most.
4
The most insightful advice I ever received from a psychiatrist is that I always have a certain level of depression and sometimes it becomes worse but it never improves to the point that I cannot honestly say I am not depressed. Over the last 50 years I have taken many psychopharmacological cocktails that were to make me feel "better" perhaps even "happy". What I have found to work has been my acceptance of this is who I am. I also have the luxury of having insurance that pays for support group for seniors, I am retired and can be out with nature and exercising on a daily basis. Someone else in my situation who does not have insurance and is not financially stable may not be able to cope. This may sound a bit far fetched but I have often thought how many individuals on public assistance who by being on public assistance are usually depressed would benefit from an exercise program, a stress free few hours, a walk in the park. I would like to see a study done on that.
7
That last "no system" comment, by Patricia Veech, sums the problem so very well; and the earlier comment regarding so-called HMO vs "fee for service" mental health coverage provides an expansion of it. These relate not only to mental health services in the U.S. of course, but to our medical services generally. Yes, "Oh why didn't he/she just get help?".
However, the excessively controlling, paternalistic -- and essentially authoritarian -- approach to persons seeming to need mental health assistance, and even potentially suicidal persons, is not truly generous and helpful; -- i.e. ask them what they are feeling and thinking, and then call in the "authorities" to prevent them from further expression of it.
This is also simply self-serving. We should never feel responsible for another persons' essential life decisions, however sorry FOR OURSELVES we may feel about the results. We only OWN our own lives - NOT the lives of others.
1
I've spent thousands upon thousands of dollars on therapy throughout my life thus far. I'm lucky I can "afford" it. That said, I'm not rich. Last year, I lost my job and had met my $1500 deductible for the year. I searched far and wide for a mental health provider that took my insurance -- it was supposed to be $20 an appointment after my deductible was met. My old company changed their health coverage a month after I was let go and failed to tell me. The deductible increased to $3000. I had to pay $500 unexpectedly out of pocket for appointments I went to thinking they would cost $20 each. Want to know how to make a depressed person more depressed? Well, this is definitely one way.
7
As a licensed psychologist, I agree with all of the comments in this article. I would add that a suicidal person feels separated from people and society. The physical presence of another person is absolutely essential. Hospitalization, or rest homes, could provide that, but the health insurance "system" actively works against a patient being hospitalized. If a psychologist or psychiatrist recommends or "orders" hospitalization, that should be the final word, not the insurance company's far less qualified utilization review person who has never even seen, let alone, treated the patient.
7
Kate Spade and Anthony Bourdain were probably afraid of calling suicide prevention because of the career-ending publicity it could've caused. Even though a call to suicide prevention is about a mental health problem, in many cases it is the police ("emergency personnel") that respond, because suicide prevention finds the caller's location and may inform the police, which can lead to abuse and/or violence. No doubt, each of them had already undergone treatment and finally realized that a trip to a psychiatric ward wouldn't make things any better. Since there's no recognized cure for mental illness, these celebrities knew that if their personal troubles became public, it would've destroyed the iconic image that made them who they were. In most high-profile cases like these, the public usually isn't told that the deceased had a substantial history of mental health treatment.
4
workerbee:"because suicide prevention finds the caller's location and may inform the police, which can lead to abuse and/or violence". Is this true, that they track your number even if you don't want it??
Suicide hotlines and assistance are confidential endeavors.
A million prescriptions with no side effects and not one patient lost to suicide sounds like a case study in delusional practice..
16
I wondered about this. And what are other "prescribers" doing so wrong?
2
Whenever there is a notable suicide in the news, we are treated to a round of public service announcements. The compassionate voice over tells us that help is available: "just call this number." But there are rules. Rule #1 is about hope. If you don't have hope, don't make the call. If you don't have hope, you are choosing to be depressed. Rule #2 is you must take the medication. If you say it doesn't help or that it makes he problem worse, then you are non-compliant. If you're not compliant, then you are choosing to be depressed. They'll give you opioids, if you are compliant. They can't help with the depression, but they can help with addiction.
Oh, never mind.
8
Thanks, Cassidy. Sounds familiar.
Bless you for your frank and honest assessment. I could tell stories that support how little care is given to poorer people but not those more privileged with a PPO.
3
Patricia, thank you for pointing out the truth. There is no system.
7
"There is no system" But isn't this true of health care in this country? It is ridiculous that Americans can get their pajamas in a knot over immigration when adequate care for our normal population is so inadequate. We watch too much television apparently and think that it is reality.
4
In short, thanks to the GOP, the government response to the suicide crises has been, "Who cares?" And that's not hyperbole, that's a fact.
The GOP has long held that access to a mental and physical heath-care system is not a right, but a privilege. And one that only the wealthy should be able to afford. Or, as in the case of members of congress, one that everyone else should pay for, for their exclusive use.
Sick of the situation? Never vote GOP. And the problem will be solved in a few years.
9
Chicago Guy--I've got news for you: The mental "health" system has been broken for eons. You must be either very young or very naive to think that voting Democrat will change anything. The lack of affordable access to healthcare was no better in years under Democrats than it is now. I know--I experienced horrible mental health "care" during years of Democratic power.
2
Attempted suicide a year ago. I agree with Patricia Veech. There are established hospital groups and individuals who provide care. Some take my insurance, some don't. But there is care available to anyone who needs it.
I totally agree with one of the six mental health workers who shared their thoughts for this article. The one who said that there's no mental health system in America. Likewise there is no healthcare system in general in America either.
9
Can someone summarize any effective mental health care systems in other countries ? Suicide and homicide have so many different causes, complexities, diagnosis, and treatments . There is no one-size-fits-all solution. How can we improve the care for different types of patients?
2
"Can someone summarize any effective mental health care systems in other countries?" Well, since we rank 14th in the world in quality of life, which includes healthcare, we might have something to learn from 13 other countries. However, since based on what they see in movies and television, hordes of people want to come to the U.S., we're not likely to admit that we need to learn anything.
4
While most of the comments speak to the ills of our fractured mental health system, I propose that we do something differently in this section rather than just vent. Let's focus on including specific places or programs that can help those that need it. I am a psychiatrist that works at a large multi-specialty medical group in New Jersey. We accept most major insurances and provide high quality cognitive behavioral therapy and medication management services. If you are in need of help, google me.
1
"We accept most major insurances" is quite telling. My son, often too clinically depressed to hold a job, has moved to another country so he can see a psychiatrist on a regular basis for $13.
3
Rusty, which country is that? Is it $13 with private health insurance or with just the national health insurance?
Please keep in mind that many Psychiatrists do not contract with insurance companies. Many insurance companies have had Psychiatric carve outs, and it was not it our patients' interests nor ours to work through the insurance company.
There are excellent Psychiatrists throughout the country who have a fee for service practice, and will be willing to work with you if you ask.
I have been doing just that for over thirty years, and by working directly for my patients, I am able to spend a lot of time with them, answer all their questions, see new patients within a few weeks, and have us make the medical decisions. I also see about half my patients in weekly psychotherapy.
Please consult with your local medical school for referrals.
We can't prevent all suicides, but we can alleviate a tremendous amount of pain and suffering with proper treatment.
2
The same goes for psychologists - especially those with a clinical doctorate....it's an out-of-pocket experience....but as the Doctor notes - many will work with patients on a sliding fee basis.
Psychiatrists are often under extreme pressure to dispense medication and move to the next patient. I'm aware of a patient who within the first 10 minutes of his initial appointment with a psychiatrist was diagnosed with ADD and given a prescription for Adderall. The patient opted not to take the prescription - but now won't even consider trying another mental health professional because he is convinced that his next experience will be similar.
4
All psychiatrists, like all medical doctors, are not
reliable professionals. That just complicates an already complicated situation.
"There are only providers: some individual and some groups. But the idea that there is an established, organized 'system' of care is simply incorrect."
There is what can be called a system, which consists of nationwide community mental health centers, which are regulated by the Centers for Medicare and Medicaid Services. But, more importantly, there is a systematized method of treating mental patients. It's called "medication management," and nearly all psychiatrists administer exactly this same treatment because that's what medical school trains them to do. All insurance-approved treatment for serious mental problems (e.g., psychosis) consists of prescription drugs, although in some cases, electroshock is still approved.
So true. I am a LMFT and executive director of a non profit substance abuse and mental health agency. There are providers and agencies; not a system. Care coordination is lacking, not all of us are credentialed by the same insurance agencies, our services are not always similar. Fiscal restrains are challenging; for example, we only have one doctor prescribing suboxone, other agencies have more, others none. I no longer accept insurance at my private practice due to dismal reimbursements rates and undue amounts of paperwork. There are many people who can't afford co-pays or monthly prescriptions.
Hundreds if not thousands of peer reviewed studies show the most effective treatment for depression and suicide is a combination of medication and talk therapy.
Alfred Alvarez discovered that life was not a problem to be solved when convalescing in a hospital bed after an attempted suicide. Camus believed that suicide was not logically permitted: you cannot solve an equation by just eliminating one of the data. John Donne, who admitted that he had considered suicide himself, felt that he had developed "a charitable interpretation of their action, who die so.” The thing is that suicide is one of those decisions people make in the obscurity of their own hearts, leaving the rest of us dumbfounded and puzzled, and often with a feeling of guilt.
Camus confessed that he had never heard of anyone committing suicide because they thought the earth was square; on the other hand, he wrote, “many die because they judge that life is not worth living.” And many more commit an intellectual suicide of sorts by refusing to accept that the world is this and that, good and evil, sacred and profane, ugly, beautiful and sublime. They close their eyes and pretend they do not see. How else to explain our current political predicament except as philosophical suicide?
Oedipus the King did not commit suicide after he discovered his sexual past: he simply concluded that things were now OK. Guided by his daughters, he found the strength to confront the world, not to escape from it. May we enthrone in the 12,000 schools in our midst, beacons of wisdom and paragons of probity to point to the wondrous beauty and joy of being alive.
8
You so-called mental health workers are clueless. The real reason for the drastic *increase* in suicides over the past year or so is ECONOMIC; i.e. Trump, the Kochs, Mercers and their plutocracy are ruining the entire social and economic fabric of this country. The only jobs available today, especially to older workers (even those with advanced degrees) are temp jobs without benefits. Most last 6 months or fewer. Companies do not want to hire permanently because they are afraid the employees will jump ship, so they hire and fire temps freely.
How is someone supposed to support him/herself when it is impossible to estimate income for more than 6 months? You aren't eligible for employment after working a half year.
And don't get sick; permanent workers are guaranteed 10 weeks recovery, but contingents are fired if they become seriously ill. And no unemployment for the sick!
This--not some mysterious surge in so-called mental illness, is the cause of the increase in suicide. If you have no money, no home, and no means to support yourself, then it makes much more sense to euthanize yourself than prolong the torture.
Right now there is no solution to this problem. And it's only going to get worse as robots and artificial intelligence decrease the need for human workers. Scandinavia and many parts of Europe are already preparing to handle these problems.
The United States, however, would prefer to bury its head in the sand of "rugged individualism".
24
People whose status declines are more likely to commit suicide. Poor people who lose one of their 3 or 4 part time jobs are not.
Thank you for your comments. Context for the surge in feeling hopeless is very important. It is different from serious mental illnesses.
2
It’s true that the economic stress can add to someone’s depression, but you are oversimplifying suicide. If what you write is true, there should be an epidemic of suicide among the most economically disadvantaged. Kate Spade and Anthony Bourdain, by your reasoning, would be alive right now.
Time for humans to stop painting suicide as a crime, a sin, a dumb thing to do. Ancient Athenians had professionals to sooth the rigors of life by administering substances that would kill you as the stuff on the streets of America does today. Stopping the pains that folks feel is a blessing, not a curse.
5
I have two daughters with mental health problems. For the younger daughter who is still on my insurance plan, we continue to be able to meet with her psychiatrist who has been with us for years. Her going rate now is $245 an hour, but she sees my daughter for $40/hour plus anything the insurance reimbursement might provide. My plan even allowed in-patient care in 2016 when my daughter had a crisis. The other daughter is older. Our psychiatrist was unable to work with her because of that violates patient privacy. Her only choice has been practices that agree to take her insurance and frankly we've run into so much inferior almost incompetent care because of this limitation. Wrong meds. A doctor that gave her a bipolar diagnosis and never tested her blood levels. A swinging door of departing staff. No, this country has no mental health system. Its truly like the dark ages. Most people with severe mental health problems are in prison or living in homeless shelters or on the street. Shocking state of affairs!
30
One million prescriptions without side effects ...really ?
10
Tylenol has side effects. The question to be considered: are the effects short-term as the patient becomes adjusted to them? If not, the patient should seek additional contact with the psychiatrist.
1
To clarify what mental health system does exist in the United States. In the late 1980s, managed care or managed cost, replaced traditional indemnity compensation with the goal of controlling excess. It is mismanaged and providers in network often forced to leave the panels as reimbursement rates have not increased since the 1980s. However, our system is vastly superior to those of other countries, particularly where mental health in patient care is concerned. Pharmacological drugs have also vastly improved the quality of life for so many.
For those who are depressed there is also the possibility of Ketamine as a therapy, which frequently gets overlooked. Developed by the Dean of Mt. Sinai Medical School some 17 years ago, it is the quickest and most effective treatment for those who are suffering from acute suicidal tendencies. Many psychiatrists don't prescribe it because they know little about it--mostly because ketamine is a generic and there is little Big Pharma interest in it--but if you do your own research (recent cover story in Scientific American) there is much one can learn about this promising treatment.
4
I am thankful for the comment by Reeley Miklashek, M.D., Spring Green, Wis. as he seems to greatly understand the need to find a balanced state through medication (and other means). It's not all meds, but if you suffer from a Mood Disorder or some other psychiatric illnesses, you need medication. My psychiatrist is a psychopharmacologist and he is so far from getting my meds right it is ridiculous. During my first two years with me I saw him regularly and basically tried everything. I had faith it would work out. Now, my faith is gone. I don't think he is exceptional or even good at finding medications that work, yet I haven't changed. He is good spirited, knows my history well and still believes he can find the right combination. People like me are stuck. We want to have faith that something will work - a miracle drug - so, we hang on. But days slip into weeks, slip into months, slip into years. I am never far from the precipice of suicide. It slips in each day. There is a clear pattern as fatigue and depression take hold and bring me further and further down. Soon I am in a web and start disassociating. I take a couple of PRNs (they work) to stop the rumination and essentially sedate me. Is this any way to live? Usually, I conclude this is not living which is why I want to die. Near me we have a local crisis line. I've called them many times to talk things out. They don't rush to your house and drag you to the hospital, a place I have been many times.
10
When I work with a patient who does not substantively improve after a period of time, despite our best efforts, I get a second opinion. In Dallas, we are fortunate to have an excellent medical school, and outstanding clinicians are there for our patients who need extra help.
Please consider getting a second opinion, or going to the closest medical school Department of Psychiatry for a fresh pair of eyes to look at you.
5
I wish I could pass you a miracle.
You and I are living in the same world with all of its good and bad.
I want to tell you it's not so bad but the little I can understand is that your brain works differently that most of us.
I send you whatever compassion and love of one human being for another that I can.
4
The general public needs to be taught to understand that depression is an illness; it is not just 'being sad." For me, years or months of depression could be described as an 'overall depletion" of physical and mental energy, capacity for pleasure, and clear thinking. One battles it as best one can -- hopefully with the aid of precisely diagnosed medications which can sometimes feel hit or miss, and can run out of effectiveness. The social stigma prevents depressives fro both asking for help and admitting suicidal thoughts. Insurance companies and dr.s must treat this as an illness; society must understand that this is an illness often genetically passed along, Time for renewed vigor in all walks of medicine in honoring this increading outbreak.
8
For heaven's sake -- do the math. A for-profit insurance company is paid by a third party to provide health insurance to a "consumer". That "consumer" (who is not the customer) develops a chronic mental health condition and needs many costly therapeutic visits and pharmaceutical interventions which take time and carefully calibrated calculations to be effective. Isn't it a lot cheaper for the insurance company and therefore doesn't it lead to better profits for the CEO's and the shareholders if the mentally ill "consumer", who is not even the customer, kills him or herself? What incentive do for-profit insurance companies have at all to reimburse care for any chronic health condition?
10
My 28-year-old suicidal daughter got emergency services but then had to wait six weeks to get into therapy - and she had insurance - because so few therapist accepted the military health insurance. One of the professional commenters was right - there is no mental health care system in this country - and the availability of mental health care is abysmal.
13
I work with at-risk boys living with HIV.
At-risk for what.
Prison...
Homelessness. School failure. Depression, and the fragments they have become after enduring years of sexual abuse.
Then, sex work. Conflicted. Irony.
Then, addiction.
And this is Appalachia where people OD by the dozens. In terms of categories where you can compare the numbers, the boys are in a perpetual state of suicidal ideation. It does not lift of its own accord. Nor does sexualized violence aimed at them.
It all gets expressed in the art they make.
Click a button on a camera, "I can't do that. I can't make things."
They can. But giving up is harder when you've been teamed with a peer.
These boys are the throwaways. The invisible. The kids who no one can help because the boys reject just about anything that comes at them.
Everything but art.
I am the Creative Director of Real Stories Gallery Foundation. I have forty years of experience dealing with this population.
Immunity is relative. We make art.
I have every problem they have. We are not unalike.
Getting the right medications is a life-long battle with institutions. The average kid has nine different meds.
Our public health clinic greets kids with cops at the door armed with guns.
They have a list of patients' names as to who has an appointment. People with HIV do not need guns at the door they are about to walk through.
Adolescent boys will leave. Then what. Shampoo. Rinse. Repeat.
Suicide is an out from the cyclical pain.
11
America briefly had a grand beginning step into access to healthcare at an affordable price, called Obamacare. That will disappear very soon, thanks to our Republican Party who believe that all citizens should have the freedom to choose the healthcare they can afford. If you cannot afford healthcare, that's your problem and responsibility alone.
There is no healthcare in America, none. What we have is a charade that is really only about profit and nothing about healthcare. We have Health Insurance Companies, that will do everything in their power to avoid releasing monies for actual healthcare. Hospitals, Physicians, Pharmaceuticals and Medical Devices are part of the feeding frenzy to grab as much monies as possible from the till called healthcare.
That said, we do have another fairly good healthcare option, called Medicare. This is available only to senior citizens and disabled. The problem with this is that it could easily be expanded but the Republican Party hates "socialism" in the guise of Medicare, which they would love to destroy as well.
The other American anomaly is health care has become the perk of business. Many companies offered access to healthcare insurance to their employees but over the years the insurance has become more and more costly and so fewer businesses offer this perk.
America pays more than any other Nation in the world with worse outcomes, so we have no healthcare, none.
11
I work as a psychologist treating people with chronic pain, illness and stress-related disorders. I also specialize in working with older adults. I had a client who had been suffering from treatment resistant depression call me late at night requesting to come in for a second appointment that week. I agreed to see her the next morning.
I billed her insurance, United Health, for the second appointment. Payment for the second appointment was denied because I had not received prior authorization to see the patient for a second time that week. I appealed the decision and was again denied payment.
While I (and most of my colleagues) will continue to have additional sessions for patients who are suicidal, insurance companies need to hold some responsibility for this crisis.
34
Apart from what we CAN do, it's not clear to me that all suicide should be prevented. I'm NOT suggesting it be encouraged. We can see some who have been upended by some trauma and are having trouble coping. For those, getting help and getting through, or past the trauma, and the individual may well regain their their balance and go on to enjoy life again. But, for others, the path ahead is just misery. I'm not sure "mental health" should enter into this type. Some seem to think suicide should be prevented whenever possible because of how it makes THEM feel (powerless, empty, traumatized, afraid, alone, a failure) as a survivor or a family member or a therapist of a suicide. Perhaps we should focus more on assisting them. I'm a psychologist and nine years ago was diagnosed with cancer. After two surgeries and complications, I was advised to "reconcile myself with my mortality." (Ironically, the same advice a drill instructor gave me and my fellow recruits in training to go to Vietnam.) After making it through the cancer, both friends and family told me (independently) never to speak of death to them. The topic frightened them, whether it be mine or theirs. Is it possible that we vainly try to prevent it when we should be investing in understanding its attraction and utility to so many who choose it?
13
I'm a veteran who has been a mental health counselor for 10 years. I agree with my colleague that there is no mental health system in the US. I've worked in large urban setting and rural areas. Treatment depends on finding an available therapist, a therapist with the necessary tools, and the ability to pay. Treatment also hinges on transportation, child care, and sick leave from work. If the stats don't line up right, someone who needs therapy isn't going to get it.
14
I join readers requesting more reporting on suicide and its contributing sources. Significantly it is time to focus on the criminal actions taken by insurance companies, which driven by financial benefits, deny, limit or cut access to treatments of those conditions that without intervention lead to suicide. Suicide results from illness. Citizens at risk deserve treatment. I celebrate Carolyn for her ethical stance in denouncing the felonious acts committed by the insurance company for which she worked. This happens everyday. In a society where health is a product for trade, target for financial benefits and de-humanization of insurers and health professionals, financial gains are obtained at the expense of lives. As long as this model prevail we will continue to learn about preventable and treatable suicides. Insurance companies are also responsible for the gradual demise of American medicine and psychiatry in particular. It is time to focus on insurance companies for their share of responsibility in the deaths of citizens.
12
I worked in mental health for fifteen years, starting in the 80s at a community mental health center. We were fairly well funded at that time, because the state had recently "de-institutionalized" and people who had spent long parts of their lives in institutions were now living on their own and this was a very visible change to society at large. We provided a lot of support and programs and people did well. But, then something seemed to happen to our "system" over time; our state legislators seemed to forget about the mentally ill and we were slowly but surely defunded and people received less and less help. It was like mental illness somehow didn't exist like it formerly had. It didn't help that laws were passed which made it more and more difficult to detain someone involuntarily and the economics of expensive hospitalizations made it difficult for people to even be hospitalized voluntarily. I appreciate the 6 therapists who wrote about their experiences treating the suicidal and my wish is that a mental health system was truly in place again, and that there were many more qualified psychiatrists available to people needing help with medications. Right now, many of our burgeoning homeless population are mentally ill people who are not being treated.
13
I am a psychiatrist with 35 years of clinical experience. Patricia Veech, in her statement, ‘But please stop alluding to a “system” of mental health care in this country. It simply does not exist’ is no doubt asserting that this country has no deliberately designed system and she is correct. But there is a system; it usually “works” on an ad hoc basis; is arbitrary, unmanageable, indifferent, cruel more often than kind, and, for want of a better term, organized around the principle of monetary profit. Another triumph for the market. And those profiting from that triumph are so removed from the morbidity and mortality that they have no sense of the tragedy taking place. But if they could see the blood on those dollars, would anything change?
11
The emphasis in our capitalist system is capitalism and money and if you do not fit in with this or do not make lots of it you are left behind. It is also true that money will not guarantee that even if you obtain your mystical goal of 'success' that you will not come to see the pointlessness of pure striving and commit suicide. Ultimately our society talks a lot about mental and physical health spending huge amounts on these things, but has little vision of what a healthy person is or the sufferings of individuals. We spend lots of time talking about politics and that is OK for part of the answer is in the formation of a real health care system that really 'CARES'. But to do that we also need caring people who will see the need and support the answers alluded to by these six health care professionals.
1
Vox had an interesting article on the social aspects of depression. It said that the treatment we're not using is making sure people have a stable life with social contacts.
https://www.vox.com/the-big-idea/2018/2/25/16997572/causes-depression-pi...
6
I just read the article, and second the recommendation. Simple and profound.
In NYC, the neighborhoods with the lowest suicide rates are immigrant communities filled with extended families.
Most Chassidim also have low suicide rates. What happens in these communities is that distraught adults have a job to do in the extended family, if they cannot obtain a paying job. They are not alone. That depressed adult has a seat at the dinner table with mom and dad and the grandparents every night, together with a half dozen or more other relatives. Everybody sees and support each other everyday, not just at Thanksgiving and Christmas. He (or she) has a roof over his head. He or she will clean house, walk the dogs or attend to the very old and/or the very young.
There are middle class Jewish and Italian extended families in Brooklyn in which every body in the family is in the same apartment building or within walking distance of each other. Great grand parents, grand parents, parents, adult children, children and grand children -- 10, 20, even 50 or more family members are altogether in the same building or nearby. Families like that have very few suicides. Homicides, every once in a great while, yes, suicides, no.
4
I wish this article were longer, with more reports from the front lines. But, despite the difficult news, and many issues that need attention, it is good to hear what is actually going on. I want more coverage of the view from therapists and social workers, and from folks managing their illnesses. I'm one, and the recent very public deaths of celebrities sufferers have inspired me to be more open with friends and family. And, and, these are just the symptoms. We need to know how to grow up, how to manage our emotions, walk with one another, and not, as the infoentertainment/buysomethingnow complex would have us do, stimulate and avoid our way through life.
37
Perhaps we should just feel relief for them, they are finally free of the pain they carried and could not shed. All the therapy, medications, simple solutions, pep talks, and prayer could not alleviate the pain they bore.
There isn’t a solution for everything, not one that will inspire, energize, or ease all that hurts. We can never know the depths of their pain, sadness, loneliness, or hopelessness.
So maybe instead of feeling sad, angry, or judgmental, just feel the relief that the pain they suffered is now over. No more clueless “cheer up – you’ll feel better tomorrow” speeches. The pain is gone. There is either nothing and no pain, or a life after.
Maybe either is better for them than the unending pain and despair of this life.
46
I appreciate this perspective. As a licensed mental health professional, I have worked with many pervasively mentally ill clients for whom suicide is not simply "a permanent solution to a temporary problem." We use this phrase far too often and it smacks of both misunderstanding and ignorance. Many individuals suffer without relief from a combination of biopsychosocial challenges that are not met successfully, whether due to lack of adequate resources or compounded organic deficits. Of course we want to identify and treat those who are struggling, and most often we can do that effectively. But there are those for whom years of treatment has not been effective. We seem to have more understanding and sympathy for the right to choose the end when an individual is diagnosed with a terminal physiological illness. For some, mental health challenges present even worse suffering.
11
Too many suicides result from mental illnesses which go untreated, or are difficult to treat. My personal introduction to suicidal depression was sudden...and an education. The urge to kill myself was frequent: the automatic, unwanted and strong response to any passing bus, subway train or streetcar, to any balcony, high bridge, knife or pair of scissors. The urge was anything but rational. It was definitely illness, and completely terrifying.
Suicidal urges can be as much a symptom of clinical depression as pain is of a broken leg. When someone kills themself, chances are that they've been killed off by a major mental illness.
Should we really feel relief ? Perhaps a more appropriate response might be the kind of grief we feel when anybody dies of illness.
5
Mark, it sounds like you have not (yet) lost a person you loved to suicide.
3
People say on FB and elsewhere that one should not judge suicide but I disagree. It seems it would be important to make clear to those who might think of this as a solution to make it abundantly clear, in no uncertain terms, that suicide is wrong according to all social norms. It is just as wrong as homicide. I would hope the suicidal person would take a step back and remember that no one is going to accept what they might do as "okay." However sad one might be, remember that death is a certainty. It will come. In the meantime, there are thousands of ways to make oneself happy. If none of those ways are working, then you need to get medication or try something else. I just cannot abide that we should let people who are depressed think it is normal to feel so sad. Fight back. Remember that all of one's thoughts are not for digestion. Pick your thoughts and if you are terribly depressed, know that it is not normal and you should seek help medically.
5
You obviously have never suffered severe depression, unrelenting and always returning and overwhelming despite years of therapy and medication. Or what about those who don't have insurance and can't get help or those who must settle for a therapist in their insurance plan. therapy is personal, it is a relationship and it depends on the therapists knowledge, experience, intuition and the ability to know when a patient's problems or issues far exceed the therapist's knowledge and expertise. Moral judgments and pronouncements do not matter to someone who is so distressed, in despair, hopeless and alone because if you are dead who cares what other's think. Sorry, but it is comments like yours that not only miss the point, but cause greater pain and loneliness to those already in the depths of despair.
2
Thanks for the droll view of such things. You would learn if you are someday lucky enough to be in such incredible, intense pain for the long time it takes to conclude there is no other way. Until then I think that at least people could make some effort to understand.
13
Vanessa Elliott--excuse me, but you know absolutely nothing--not one single thing--about depression. Apparently, you've had the good fortune to be depression free--but don't pat yourself on the back because you drew the right health card in life--that was pure genetic chance.
If you believe depressed people can just "accept" a life of agony because death will come sooner or later--I have a bridge to sell you.
It's not a matter of finding that magical key to "happiness" btw. It has nothing to do with how successful, wealthy, well-loved you are--obviously Anthony Bourdain and Kate Spade had it all, at least materially. And they had children--no parent is going to leave a young child unless they are convinced that child is better off without them.
There are people whose illness(yes, that's what it is--not some happiness deficient moral failing) is treatment resistant--they try medication after medication and talk therapy after talk therapy, but it never works. What would you say to those people--try harder?
Your comment is cruel and unnecessary--try learning more about depression--you have a whole lot to learn--oh, and more empathy is in order. Finally, be extremely grateful you don't suffer from depression.
Oh, and please try to overcome your own moral failure--a lack of empathy.
20
What a great many people do not understand anymore, as if we ever did, is just why "suicide" is actually considered to be abhorrent/abnormal behavior. Just because alleged 'normal' "society" does not consider it to be normal, does not mean a thing all in all. It's as if the Ozzie and Harriett's of the world, where everything is just so TV land perfect, have a right, no, an obligation, to have all believe that everything can be so much like their own Ozzie and Harriet existences, where there's zero reason to think that life isn't so great as the "Nelson's" have it, and that everyone who does not have such a perfect existence must be abnormal and need mental "help". The very concept of such "thought" is aberrant in itself. Life is complicated, and not a rosy bed of pillows exists for all. Indeed. Some would even welcome a bed, let alone a pillow. Society should get off it's high horse, and understand that life can be horrible- too often continually, and such tunnel vision points of view are dangerous to those who suffer the most.
30
Regarding the retired psychiatrist statements.
I am also a psychiatrist with over 35 years of experience.
Based on his numbers he wrote about 500 prescription a week. That's 10 an hour with 10 hour days five days a week. This is not credible.
Worse; 25,000 patients treated with 1 million prescriptions and no suicides. Given the incidence of suicide in this patient population this is even less credible. ( I'm being polite using the word credible.)
Sir please don't muck up the discussion with nonsense.
63
Thank you! The grandiose idea that one person can titrate all those meds is absurd. I am acquainted with a woman whose two sons, both of whom had bipolar disorder, killed themselves in succession. The family had access to top-notch psychiatric care which none but a few families could afford. In both cases, once lithium became ineffective the line to suicide was direct. We just don't know enough about suicidal thought and the anguish that leads to it, and while I think better community health and less access to guns would be big help, there is no panacea, pharmaceutical or therapeutically. (And let's not forget those who would like to end their suffering therapeutically.)
2
I see an error in the calculation here. If the retired psychiatrist practiced radical polypharmacy, ie., much more than one med per patient, he would not need to work all those hours to fulfill the numbers.
1
Psychiatrist here. Agreed it’s not a credible comment.
4
Seeing 25,000 patients over 41 years means that the good doctor Greeley Miklashek, MD, quoted herein, had to see at least 11 new patients a week, 52 weeks a year.
Writing 1,000,000 prescriptions over 41 years means he had to write about 94 prescriptions a day, five days a week, 52 weeks a year.
What degree of individual attention could each of his patients receive? How much thoughtful titration could he possibly put into each one of his 'scripts?
If Dr. Miklashek has "never lost a patient to suicide" he should count himself lucky. Very lucky.
25
A number of comments have focused on the doctor who included some statistics in his treatment of patients. While I am not about to start analyzing his statistics to see if his breakdown is credible (and maybe it is not), I see someone who is positive about the use of medication. Perhaps he has an inflated ego and probably many of his patients never attained a stable lifestyle, but we will never know.
As a physician myself, I agree that his numbers seemed to strain credulity.
However, he is right about one thing. Most of the psychotropic medications are written by primary care doctors, who have only a few hours worth of training in the diagnosis and treatment of mental illness, and not psychiatrists who have at the minimum three years worth of training in these. The Times often leaves this piece out of its stories on misprescription of psychiatric medications and leaves it to readers to think that it's only psychiatrists who prescribe them.
5
Dr. Miklashek is known for other projects, including using NYT commentary spaces for hawking it and his book, while also taking some liberty in associating the good name of Stanford, whose web server he simply uses space on. Unfortunately, as a psychologist, my tracking of his contributions suggests much of it sounds not unlike the same sort of reasoning process that characterized another noted psychiatrist, Dr. Wilhelm Reich. It might be more appropriate, sir, to take out an ad rather than co-opt the NYT reader comment sections. I would hesitate to say something except that the numbers he suggests, plus the willingness of the NYT to allow, even invite, his input, suggests that allowing my comment here should be at least as acceptable as a contextual perspective on what we read, with NYT's implicit permission, in these comments and articles.
4
Over 1MM prescriptions for 41 years? That's >25,000 prescriptions per year, i.e., over 2,000 per month, i.e., over 100 per day! How many patients did you see in one day?
12
I am a licensed psychotherapist and agree my colleagues in this article who commented on our system of care. We don't have a comprehensive system of care, but we need one desperately and then for all Americans to be educated on how and when to use it. Right now what we have is emergency care; no quality, affordable outpatient care for people without insurance; and a tiered system of care for the rest of us: if you have Medicaid, your care is probably provided by clinicians with minimal support and large caseloads of high-need patients; if you have commercial insurance, your therapist is being grossly underpaid without your knowledge (reimbursement rates are insultingly low which is why so many therapists don't take insurance) and probably doesn't have healthcare coverage through her own employer because she works as a 'fee-for-service' provider, and your psychiatrist probably has a months-long waiting list; and if you can afford to pay for care out of pocket, you have good provider options.
Our lack of an effective mental health care system stems from stigma, ignorance, and national stinginess.
56
I completely agree with you. When I initially became sick (over six years ago), I had health insurance through my job and had a number of psychiatric hospitalizations. However, I paid for my psychiatrist out-of-pocket and that certainly wasn't cheap. I then had to switch psychiatrists (and while my former psychiatrist did both talk therapy and meds), I was now in the world of having to pay a psychiatrist for medications and a psychologist for therapy. This costs were outrageous. Unaffordable to most. Then my world collapsed even more and I lost my job. I now have Medicare, but attend a day outpatient program where most of the recipients are on Medicaid. Some of the clinicians are SWs, one is a psychologist and the rest are Mental Health Workers (a degree I had never heard of). They only see you individually every two weeks for half an hour! Unbelievable! And while they have a psychiatrist on site, I would prefer to see mine. This also exempts me from the more intensive treatment groups. Their psychiatrist, whom I met once upon intake, is elderly, sort of forgetful and I certainly did not connect with him. My point is that I am supplementing this day program with my own psychiatrist and therapist. Psychiatric care is expensive and unaffordable to most. Look at how we treat our VETS - what an epic failure there which could be remedied.
7
I love the idea of Lean on Me program offered by KH, California: To honor Mr. Bourdain, a voluntary donation at restaurants around the country can be attached to the bill to pay for the program.
This should be nationally implemented. #leanonme.
34
As a depressed and sometimes suicidal patient of a therapist and psychiatrist, the first writer's comment sums up the limits of help in America: "If anyone reaches out to you who is suicidal, don’t be afraid to call the police." Very few other countries require providers to report patients considering self harm. After being institutionalized in a mental health facility several years ago against my will and being atrociously abused by staff and almost raped by another patient, I deliberately cannot tell my therapist about my suicidal thoughts for fear she'll report me and I'll end up back in that jail of a facility. Mandatory reporting is highly unethical given the sorry state of America's mental health services. The lack of available and affordable mental health services (even with my excellent health insurance it took me months to find a qualified therapist who had any openings, and she was off-network so costs $170/session), and the lack of oversight of mental health institutions means that patients may be worse off than before if they admit suicidal thoughts to a therapist.
71
You misstate the law. If someone is believed to be at imminent risk for harming oneself, which is only a small number of people who have had suicidal thoughts, and that person refuses treatment, then it is the responsibility of any healthcare professional seeing the person to seek that care against the person's will. And remember that in most places in this country, the most time that a person can be confined before coming before a judge is 3 days and even that short stay usually requires an assessment by two physicians who agree hospitalization is indicated.
And most other industrialized countries have similar requirements for institutionalization.
If every person who expressed suicidal thoughts to a therapist had to be hospitalized, we'd need millions of psychiatric beds.
It's misinformation such as yours that frightens people away from getting the mental health care they may need.
2
I'm so glad you're still here and got help. I am sorry it's so hard. I am a child of a father who hanged himself. He was a paranoid schizophrenic dead at 39. Suicide is a gift that keeps on giving. He never got the help he needed but it was less of the psychiatric help then his own brilliant mind. I, too, have been where he was and you are. All the best thoughts. Be well.
3
I am sad to read Q's story of being involuntarily institutionalized and atrociously abused. I am even sadder knowing that this happens to many people, not just Q. Calling the police is a very dangerous thing. This is true in America and in other countries. There is an extreme lack of oversight and accountability in mental health wards all over the world. When a Mental Health Act is used to force people into these places, it can destroy their lives and constitutes a violation of basic human rights.
Please, think before you subject anyone to that. And lobby for changes to Mental Health Acts that allow people to be treated worse than criminals by people who don't have the professional skills to make proper judgements.
3
I wonder what magic doses the psychiatrist quoted had found. Most pharmacotherapy is pretty much useless, chasing after something that doesn't exist. Yet he seems to have obtained some unique knowledge, which alas he did not divulge.
This culture pathologises too much. Not everything requires a diagnosis. It's as though people have lost the ability to deal with things, including by getting support, without calling their situation by some pathological name.
ER and "psych" is the dumping ground for society's problems: drugs, drugs, drugs and also homelessness, poverty, violence.
Problems are up-coded to get reimbursed, Personality disorders become "Bipolar", people are absurdly diagnosed with "PTSD, Bipolar, ADHD" and more! The whole thing is ridiculous.
Pharma has utterly failed to produce any curative treatments for the big things in particular (schizophrenia) and instead peddles antidepressants that barely work and antipsychotics for fake 'Bipolar'. People look for the magic pill when they need support, rearranging their lives, coping skills, etc.
I wish we could introduce psychological well being as an important component of life. Just like general physical health. It's not for 'sick people' its for everyone. Some mix of exercise, talk, life changes and sometimes medications, as needed. This is life, always has been, it's never "solved', you just try to make things better as you go along.
25
If you believe that psychiatric medications are worthless because they don't cure the diseases they are used to treat then I'm sure you must feel the same way about diabetes and hypertensive and all analgesic medications for pain taken by tens of millions of people as they don't cure those diseases either.
In fact, apart from antibiotics, we have few medications that actually cure diseases rather than treat them.
3
If you ever witnessed a close family member or friend having a severe manic episode, you would not believe bipolar disorder was "fake." Careless comments such as yours only add to the stigma people with bipolar disorder face. It is a medical illness and needs to be treated as such.
4
@Steve yes, we have few medications in all of medicine that cure diseases, However, antidepressants are equal to placebo in their effectiveness, except for severe depression. Should we ignore this? Obviously I do not 'feel the same way about diabetes'. To say so to a medical doctor is absurd. Obviously, if a person (usually a kid) develops IDDM, they require insulin or they will die from diabetic ketoacidosis.
Psychiatric drugs are mostly unhelpful, do not resolve problems, do not save lives, all that hype is just that, hype, and we should stand up to it. But there's so much money involved, the entire profession has deteriorated to prescription writing without much else, that anyone stating the glaringly obvious will be shouted down.
We think it's virtuous to prevent our citizens from killing themselves, and then do NOTHING to support a life worth living. What a messed up country.
73
Very insightful article. It helps to understand the POV of the providers and professionals working in this industry. We need to tackle this issue as a society. As mentioned there is no "system" so how do we tackle this issue all together -- through volunteerism, policy change, kindness to one another, and removing the stigma of talking about our suffering. Americans are constantly told to be positive, but perhaps this is one of our wrongdoings because it stops us from talking about what is truly going on inside of our heads.
11
The extensive media coverage of the recent suicides of high-profile people, Kate Spade and Anthony Bourdain included a directive for those contemplating suicide to call the listed national crisis phone number. This NY Times article about the perspectives of mental health workers and their patients exposes the fact that consistent and quality mental health care for all is lacking in America. Calling a crisis number for a conversation with a compassionate person manning the line may offer short-term relief, but may not result in the long-term services and help that are needed by desperate people. Mental health disorders have a history of stigma and still do. As faculty in a nursing college, I teach my students that mental health disorders have physiological origins neurologically, even if some are emotionally triggered, hoping that my students view patients with mental health imbalances as compassionately as they do those with other medical disorders that are so readily "acceptable" and receive appropriate interventions.
28
Yes, Yes, Yes and Yes! YES, there is no mental health "system" in this country. YES, mental health therapists and workers "in the trenches" are underpaid, undervalued, underappreciated and unsupported by the non-existent "system." YES, we need a national program with a "door always open" policy to address this epidemic. YES, the health insurance system prioritizes its bottom line and nothing else. The major problem is that our Medical Industrial Complex is a capitalist system with no incentive whatsoever to address the vast mental health problems of our society. In fact, as a mental health clinician with 20+ years experience I've often cynically, but probably realistically, wondered if insurance companies have no incentive to prevent suicide because in the end it will save them money. I'm not alone in this observation.
50
Suicide article:
I agree we don't have a Mental Health System. Probably never will. We really don't have a real Health Ministry with the necessary authority to regulate Health like is done in other countries. Health being as necessary or more than utilities should be an even, socially just, benefit.
The psychiatrist who contributed to this section, who reports, he had found the right combinations and amounts to treat depression successfully, and for that reason never had a Suicide, is either lucky or lying. I have been a Psychiatrist for 53 years, I have been in private practice and City clinics.
Suicide has always been a core problem. Training, Clinics, Hospitals, and professional associations, and publications address it. It is inescapable. Like "treatment resistant depression" is always a topic in all fields of Mental Health , we, who live in that world, are always ready for the battle to freely enter and provide help.
8
Are there statistics on the financial status of persons who attempt or commit suicide?
It seems so many people are stressed because they can no longer afford housing, food and can't find jobs that pay a living wage. As noted in the article, medical insurance that adequately provides for mental health is also contributing factor.
18
When I had my first ever experience with extreme anxiety that caused sudden onset of suicidal thoughts, I learned that my medical health insurance plan (through a large employer) did not allow my MD to refer me to mental health practitioners she knew of, only to my HMO's referral service where I was only given three referrals at a time over the phone. When I called the phone numbers I was given for practitioners in my area (major metro area), they were so out of date that one was for a drycleaner. They were so inaccurate that I got people who treated children, but not adults, or who followed only narrow focuses of treatment or who tried to diagnose me over the phone as bipolar because I talked fast.
I agree with the comment about lack of a system for mental health.
47
As per the therapist in N.W., there is no system. The ACA was to have removed some of the stringent controls over how long, where and why of mental health treatment.
For those of Mr. Bourdain's age range and older there seems to be no coverage in Medicare, when seniors with exhaustive health conditions might consider that suicide option in lieu of impending downward spiral of health. And that alone needs to be treated.
But why is there such a wave of energy about Right To Life for the unborn and little or none to help the physically able who may find themselves in the downward spiral of whatever mental issues that lead them to suicide? Is there so little concern for retaining the lives of these people already here among us?
Where are the good answers to these questions?
41
I agree with the mental health therapist who writes that there is no mental health 'system' in the United States. I'm educated, have health insurance and live in a major city with hundreds of providers, yet most do not have appointments available after work hours and I am not permitted to miss work for weekly appointments. I take medication that keeps me afloat and I am grateful for that. But even a weekly appointment wouldn't be enough. And who can miss work for a hospitalization or risk a hospitalization record on job applications or background checks? The "Lean on Me" program is a good idea. Our friends and family alone can't stop someone, especially if they are suffering themselves. Also, I am looking for a forum to ask this question: What do we do when the word suicide itself -- the word used by hotlines, prevention organizations, mental health providers and researchers -- is a trigger? Have any mental health workers encountered this?
6
Not only is there not a "mental health system" in the U.S. there is a national shortage of psychiatrists, which is projected to worsen. It can be nearly impossible to access care for severe depression and anxiety. In my case, it's a chemical imbalance of the brain and fortunately I am helped enormously by prescribed antidepressants. I've frequently suggested medication myself, using the book 'Instant Psychopharmacology' by psychopharmacologist and professor at the University of Wisconsin, Dr. Ronald J. Diamond. I have had to argue for antidepressants after being a zombie for many months. This is not easy when one is severely depressed and cannot sleep more than 3-4 hours a night with anxiety. I recently had a cheek swab to run a genotype report indicating the most and least effective medications for me. I hope this is helpful to readers. Kudos to Dr. Greeley Miklashek of Spring Green, Wis.! His patients were most fortunate to have him.
11
I worked for a number of years as a protective services worker for children. Getting them out of their abusive homes was difficult; finding them good foster homes was hard; obtaining the resources they needed to deal with their emotional problems was nigh on impossible. Sometimes I ended up getting them connected with a big brother; sometimes I provided nothing more than carfare; my motto being when you can't provide exactly what's needed, or don't know what to do , do something.
24
There are so many barriers to people needing mental health services - the cost, the stigma, the shortage of clinicians especially in rural areas, the waiting lists if you can try to access care , the shortage of beds and finally the insurance companies who refuse to give parity.
(If it takes ,for example, 6 weeks to recover from a bone fracture you can't hurry it along by telling the patient they are only going to be allowed two weeks to recover. But that is exactly what mental health patients and told as they are not "given" enough sessions or hospital days to begin to recover.)
So often families have no where to turn to in a crisis.
As a retired licensed therapist I can tell you that trying to get help even for someone in the system is very difficult with constant road blocks.
Its time to have parity for mental health and to have services readily available. If someone is in crisis they can't wait for "approval".
If someone is seen while in crisis they can usually be stabilized and then supported as they work through their situation. Suicides are prevented every day when the patient gets the right help. Its a disgrace that so many don't.
17
Could any sensible person, reading these stories, not be in despair over the chances of receiving qualified, adequate care in this country? There were helpful tips: stay away from HMO...if you can afford it. Be very careful about picking your practitioner,especially if they are prescribing for you. I would add: do not become isolated from friends and family. Be not ashamed of asking for help. Everyone needs it at some point in their lives.
18
Very interesting insights from the perspective of health providers. This really is the "new autism", and I hope more studies are done about prescription drugs to treat depression. It's scary to think that doctors are just taking a semi-educated guess when they are prescribing this powerful drugs to our kids.
3
Here is a very simple and cost effective suggestion. Basic behavioral techniques like DBT/CBT should be taught around the country at community centers and places of worship on a regular basis, free of charge or at minimal cost like CPR/first aid. Watch how many people it helps...
13
How about in schools from pre-K to high school?
4
We need to talk about Internet use here. The anonymous people (not all trolls or bots) who feel it is OK to accuse anyone of terrible deeds, to wish they would "suicide" when they disagree with an opinion, to destroy a reputation via twitter or a blog post. The lack of civility and consideration on the Internet is in direct opposition to the "kindness" we are all in need of. I don't know if there are statistics on how many suicides result from personal attacks via the Internet/Social Media, but I think many.
6