ANALYSIS

Why isn’t suicide prevention part of Maine’s public safety debate?

Robert Long, Erin Rhoda, Andrew Catalina, Eric Zelz | BDN
The second leading cause of death for Maine's young people and the 10th leading cause of death among Maine people of all ages, suicide claims an average of about 160 people, about 129 males and 31 females, each year. The Maine Suicide Prevention Program hotline number is 1-888-568-1112. SOURCE: Maine Suicide Prevention Program, U.S. Centers for Disease Control and Prevention.
Posted Feb. 01, 2013, at 4:52 p.m.
Last modified Feb. 01, 2013, at 9:14 p.m.
Joel Cartwright committed suicide in 2008 at the age of 24. His father, Steve Cartwright, of Waldoboro, urges Maine to enforce laws that prevent people in crisis from acquiring firearms.
Steve Cartwright
Joel Cartwright committed suicide in 2008 at the age of 24. His father, Steve Cartwright, of Waldoboro, urges Maine to enforce laws that prevent people in crisis from acquiring firearms.
Joel Cartwright committed suicide in 2008 at the age of 24. His father, Steve Cartwright, of Waldoboro, urges Maine to enforce laws that prevent people in crisis from acquiring firearms.
Steve Cartwright
Joel Cartwright committed suicide in 2008 at the age of 24. His father, Steve Cartwright, of Waldoboro, urges Maine to enforce laws that prevent people in crisis from acquiring firearms.

AUGUSTA, Maine — Maine legislators submitted dozens of bills related to gun violence this session. But of the more than 1,600 pieces of proposed legislation, only one, LR 82, directly addresses suicide. LR 82 would require suicide risk assessment and prevention training for certain licensed mental health professionals.

Statistics illustrate why suicide should factor more prominently in discussions of safety, mental health and access to firearms in Maine.

Suicide is the 10th leading cause of death in Maine and the most common type of violent death. For every homicide in Maine, approximately seven suicides occur, according to the Maine Center for Disease Control and Prevention. Between 2005 and 2009, a total of 902 people in Maine died from suicide, an average of 181 per year. The number of deaths by suicide in Maine rose to 186 in 2010 and 204 in 2011, an average of almost four per week.

This is all happening while Maine has one of the nation’s most respected suicide prevention networks. The Maine Suicide Prevention Program, launched in 1998 with a focus on preventing youth suicide, combines resources from state agencies and private providers, notably the National Alliance for Mental Illness Maine, to offer training, outreach and crisis intervention. More than 6,000 people in Maine, most affiliated with schools, have been trained on how to assess suicide risks and intervene when individuals exhibit potentially suicidal behaviors.

Those efforts correspond with a 7 percent decrease from 2001-05 to 2006-10 in the suicide rate for Maine residents between 10 and 19 years old. That good news is offset by a dramatic increase, especially since the recession of 2008, in suicides among “working-age” people, mostly men, according to Greg A. Marley, senior manager of education and support for NAMI Maine.

From 2001-05 to 2006-10, suicide rates for men between 50 and 54 years old jumped by 65 percent, according to the Maine Suicide Prevention Plan, 2012-17. The rate for men between 40 and 49 also increased by almost 40 percent. Between 2005 and 2009, Maine recorded 641 suicides for people between 25 and 64, compared to 92 among Mainers younger than 24.

In 2009, the Maine Suicide Prevention Program broadened its focus from young people to a “lifespan” approach designed to improve services to adults. Suicide prevention advocates have reached out to veterans groups and employers — notably L.L. Bean, Marley said — to offer training and resources designed to help at-risk adults.

A November 2012 analysis by The Lancet, a medical research journal, links increases in suicide rates among working-age people in the United States and Europe to rising unemployment rates. Adult suicide rates correspond most directly with demographic groups hit hardest by poor economic conditions.

“It’s true across the country but even more so in Maine,” said Marley, citing national statistics that place white adult males just below Native Americans between 20 and 35 years old as the demographic with the highest suicide risk factor.

Gender factors heavily in people’s means of suicide. Males account for four out of five Maine deaths by suicide. While firearms cause 53 percent of all Maine suicides, 85 percent of male suicide fatalities in Maine result from the use of guns, according to the Maine Center of Disease Control and Prevention.

Gun rights advocates bristle when limiting access to firearms is suggested as a suicide prevention strategy. But Waldoboro resident Steve Cartwright, whose son, Joel, 24, fatally shot himself in 2008, offers a survivor’s perspective.

“Guns make it so much easier,” he said. “I think our son might still be with us if he wasn’t able to [buy a gun]. One hour later he was dead. As someone who has suffered catastrophic loss, I would like to see Maine take some serious steps to regulate the sale of firearms.”

Cartwright’s son had survived a previous suicide attempt with pills and had been committed involuntarily to a hospital, which would have made him ineligible to buy a gun under federal law if Maine reported that information to the U.S. government agency that maintains data for firearms purchase background checks. Enforcing laws that prevent people in crisis from acquiring firearms should be viewed as a reasonable public safety measure, “not a burden or infringing on our rights,” Cartwright said.

The Maine Suicide Prevention Program website, which provides information for parents, young people, survivors and professionals, notes that suicide attempts are five times more likely to be fatal if a firearm is present. Comparing removal of lethal weapons with taking car keys away from an intoxicated person, the website offers suggestions on how to prevent a potentially suicidal person from gaining access to firearms.

Cartwright also decried the national “dearth of services,” stigmatization and double standard for people with mental illness. An overemphasis on cost-containment and lack of resources for mental health care placed his son in jeopardy, he said.

“Where are the life-saving interventions related to mental injury?” Cartwright asked. “If someone had a blood clot or a failing heart, the hospital would never put him out on the street. That’s essentially what they did with my son. He had as serious an illness as that. He was a danger to himself, and they knew it.”

Providing risk assessment training to primary care physicians, clinicians, substance abuse counselor and other professionals likely to encounter people at risk of suicide, an initiative that Marley said the Maine Suicide Prevention Program started two years ago and hopes to expand, is “a terrific idea,” Cartwright said.

“I think doctors need to get involved and find out where a patient is emotionally,” he said. “It gets back to being more preventative, rather than treating the extreme.”

Cartwright, his wife and daughter talk openly about Joel’s suicide to help break stigmas that surround mental illness and suicidal behavior. “In Maine, we have to open our eyes to mental illness and bring it out in the open,” he said.

That corresponds with the 2012-17 suicide prevention plan’s argument that “as long as suicide is seen as a private tragedy, associated with individual and familial shame and failure, it is difficult for suffering people and their families to seek help.”

The Maine Suicide Prevention Program is not in line for cuts proposed by the LePage administration to balance this year’s state budget, according to Katharyn Zwicker, a comprehensive health planner who recently took over as director of the Maine Suicide Prevention Program. However, a $500,000 annual federal grant that helped fund the program from 2009 to 2011 expired last year. Given the uncertainty of federal budget deliberations, Zwicker is exploring other funding sources.

The program is budgeted to receive $180,000 in state dollars this year, according to Maine Department of Health and Human Services spokesman John Martins. That’s down from $200,000 for the previous fiscal year and $271,736 from fiscal year 2011. Prior to that, DHHS budgeted $160,000 in 2010, $173,815 in 2009 and $158,859 in 2008.

“Suicide is something that crosses age lines, class lines and education lines. It’s vitally important that suicide prevention stay on the radar, particularly in times of shrinking budgets and layoffs,” Marley said. “We’re living in a stressful time. It’s important to maintain an adequate safety net of training, education and support services for someone who is struggling.”

The Maine Suicide Prevention Program offers a 24-hour hotline at 1-888-568-1112.

Robert Long is a political analyst for the BDN.

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