tag:theconversation.com,2011:/ca/topics/suicide-475/articlesSuicide – The Conversation2024-03-26T17:02:22Ztag:theconversation.com,2011:article/2258272024-03-26T17:02:22Z2024-03-26T17:02:22ZFor people with mental illness, drugs and alcohol can be a key survival strategy. I’ve learned they shouldn’t have to ‘get clean’ to get treatment<figure><img src="https://images.theconversation.com/files/582279/original/file-20240315-20-k4w6kp.jpg?ixlib=rb-1.1.0&rect=43%2C60%2C5708%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-on-bottles-blurred-person-drinking-1200866920">Ground Picture/Shutterstock</a></span></figcaption></figure><p>A decade ago, while working in a women’s prison, I met a young woman whose story would leave an indelible mark on me. She had endured severe abuse at the hands of men, and I was initially concerned that, as a male social worker, my presence might rekindle her trauma. Yet, through careful and considered engagement, we were able to forge a relationship of trust.</p>
<p>Jenny* confided in me that heroin had become her refuge – the only respite that quieted the relentless storm of her thoughts. But her dependency had brought dire consequences: the removal of her children and her subsequent imprisonment for possession with intent to supply. Even so, Jenny told me that before she was imprisoned: “Heroin was the only thing that helped me to cope.”</p>
<p>While inside, she experienced regular flashbacks and profound anxiety. Her treatment regime included antipsychotic medication Seroquel and heroin replacement Subutex – but Jenny didn’t use them conventionally. “The only way they help is if I grind them together and snort them,” she explained. This method provided her a fleeting, euphoric respite from her psychological torment.</p>
<hr>
<p><em>Across the world, we’re seeing unprecedented levels of mental illness at all ages, from children to the very old – with huge costs to families, communities and economies. <a href="https://theconversation.com/uk/topics/tackling-the-mental-health-crisis-147216?utm_source=TCUK&utm_medium=ArticleTop&utm_campaign=MentalHealthSeries">In this series</a>, we investigate what’s causing this crisis, and report on the latest research to improve people’s mental health at all stages of life.</em></p>
<hr>
<p>It wasn’t Jenny’s drug revelation that struck me most profoundly, but the reaction of some of my prison colleagues. Her unconventional use of the medication was labelled substance abuse, leading to her being ostracised by the prison’s mental health service, which refused to work with her until she “sorted out” her drug issues.</p>
<p>Even though I had known Jenny for a year, it was only when she was about to be released from prison that I really understood how serious her situation was. I was shocked to see her breaking the prison’s rules on purpose because she didn’t want to leave. She started smoking in places she shouldn’t, damaged her own cell and areas everyone used, attacked another prisoner, which was not like her at all, and started using spice and hooch.</p>
<p>Jenny preferred staying in jail over facing life outside, but she was let out all the same. A week after her release, I received news that she had died from a heroin overdose.</p>
<h2>My search for answers</h2>
<blockquote>
<p>Mental health problems are experienced by the majority of drug and alcohol users in community substance use treatment. Death by suicide is also common, with a history of alcohol or drug use being recorded in 54% of all suicides in people experiencing mental health problems. (<a href="https://assets.publishing.service.gov.uk/media/5a75b781ed915d6faf2b5276/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf">Public Health England guide</a>, 2017.)</p>
</blockquote>
<p>Jenny’s tragic story left me with many questions – what were the underlying causes of mental illness? What spurred the spiral into addiction? Why did individuals turn to substance use? – that, even after six years as a mental health social worker working in prisons and psychiatric hospitals, I had neither the knowledge nor experience to answer. Talking to colleagues did not resolve them, so I sought answers by returning to academia alongside my day job.</p>
<p>A postgraduate diploma helped me better understand the theories of mental health from neuroscientific, psychiatric and pharmacological perspectives. But above all, I realised that many of the people I was now encountering in my new role, working in a crisis home treatment team (a community-based team set up to support people experiencing severe mental health issues), would never get better. Rather, they would just keep coming back with a new crisis.</p>
<p>And for a large majority of them (around four in five), substances ranging from highly addictive narcotics to potent, mind-altering chemicals would be a key part of their daily lives in addition to, or as an alternative for, their prescribed psychiatric medication.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
<hr>
<p>Roger was one of many people I met who relied on <a href="https://theconversation.com/what-is-spice-and-why-is-the-drug-so-dangerous-60600">Spice</a>, a synthetic cannabinoid designed to mimic the effects of naturally occurring <a href="https://www.ncbi.nlm.nih.gov/books/NBK563174/#:%7E:text=Delta%2D9%2Dtetrahydrocannabinol%20(also,the%20class%20of%20cannabinoid%20medications.),%20the%20psychoactive%20ingredient%20in%20marijuana.%20Regular%20Spice%20users%20face%20severe%20health%20risks,%20in%20particular%20to%20their%20cognitive%20function,%20and%20an%20increased%20risk%20of%20%5Bpsychotic%20outcomes%5D(https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20341">THC</a>. (In addition to consumption by smoking, there are increasing reports of synthetic cannabinoids being used in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398321/">e-cigarettes or vapes</a>.)</p>
<p>Nonetheless, Roger told me Spice was the “only thing that would help sort my head out”. And, after listening to a lecture from me about the dangers of these substances, he responded:</p>
<blockquote>
<p>I know how much to take – I know when I’ve taken too much or not enough. I use it in doses now. Why would I stop if it’s the only thing that works?</p>
</blockquote>
<p>It was clear that Roger knew much more about the effects of Spice than I did. Interactions like this ignited a desire in me for deeper knowledge – not from books or universities, but directly from people with co-existing mental health and addiction problems.</p>
<p>Perhaps surprisingly, in the UK we don’t know how many people are living in this combined state. Estimates have tended to focus only on people with severe mental health problems and problematic substance use. For example, a <a href="https://www.drugsandalcohol.ie/17764/">2002 Department of Health guide</a> suggested that 8-15% of its patients had a dual diagnosis – while acknowledging that it is difficult to assess exact levels of substance use, both in the general population and among those with mental health problems.</p>
<p>A decade earlier, US research had identified that for <a href="https://psycnet.apa.org/record/2005-09774-007">people with schizophrenia</a>, substance use (non-prescribed drugs) was a significant problem relative to the general population. More recently, a 2023 global review of evidence identified that the prevalence of co-existing mental health and substance use among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955022/">children and adolescents treated for psychiatric conditions</a> ranged between 18.3% and 54%.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Painting of Thomas De Quincey" src="https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=644&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=644&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=644&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=810&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=810&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=810&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Thomas De Quincey, author of Lessons From an English Opium Eater.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Thomas_de_Quincey_by_Sir_John_Watson-Gordon.jpg">National Portrait Gallery via Wikimedia</a></span>
</figcaption>
</figure>
<p>But what I found particularly interesting was an analysis of the writings of Thomas De Quincey from more than 200 years ago. In his 2009 article <a href="https://www.tandfonline.com/doi/abs/10.3109/10826089009056230">Lessons From an English Opium Eater: Thomas De Quincey Reconsidered</a>, leading clinical academic, John Strang, highlighted that issues raised by De Quincey in 1821 remain causes for concern some two centuries later.</p>
<p>De Quincey was arguably the first person to document his own use of substances, in particular opium. His writing shows that he self-medicated to manage pain, including “excruciating rheumatic pains of the head and face”:</p>
<blockquote>
<p>It was not for the purpose of creating pleasure, but of mitigating pain in the severest degree, that I first began to use opium as an article of daily diet … In an hour, oh Heavens! What an upheaving, from its lowest depths, of the inner spirit! </p>
</blockquote>
<p>De Quincey’s use of non-prescribed drugs mirrors that of John, Jenny, Roger and so many other people I have met as a social worker. Clearly, we’ve known about the close relationship between mental illness and substance abuse for hundreds of years, yet are still wrestling with how best to respond.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/guide-to-the-classics-confessions-of-an-english-opium-eater-by-thomas-de-quincey-a-dense-strange-journey-through-addiction-190435">Guide to the classics: Confessions of an English Opium Eater by Thomas De Quincey – a dense, strange journey through addiction</a>
</strong>
</em>
</p>
<hr>
<p>Official guidance almost always advocates for a <a href="https://www.nhsconfed.org/system/files/2022-12/NHS%20Confederation%20parliamentary%20briefing%20-%20No%20wrong%20door%20-%20a%20ten-year%20vision%20for%20mental%20health%20learning%20disability%20and%20autism%20services.pdf">“no wrong door” policy</a>, meaning that those with dual addiction and mental health issues will get help whichever service encounters them first. But from what people with lived experience were telling me, this was not the case.</p>
<p>I sent freedom of information requests to 54 mental health trusts across England, to try to discern any patterns of variation in the way their patients were being measured and treated. Some 90% of the trusts responded, of which a majority (58%) recognised the dual occurrence of mental illness and substance use. However, the estimated prevalence of this dual diagnosis varied widely – from only nine to around 1,200 patients per trust.</p>
<p>What I found most alarming was that less than 30% of the mental health trusts said they have a specialised service for addiction which accepts referrals for dual diagnosis patients. In other words, throughout England, a lot of these patients are not being appropriately supported.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Out-of-focus man holding a syringe in the foreground" src="https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-addict-young-man-syringe-action-599693732">271 Eak Moto/Shutterstock</a></span>
</figcaption>
</figure>
<h2>‘When I say I use heroin, people change’</h2>
<blockquote>
<p>I started using when I was around 18. Things weren’t good in my life at the time, and I got in with a crowd who offered me heroin. It was the most amazing experience; all my worries disappeared better than the antidepressants I had been taking. But the more I used, the more I needed it. Now I use it in stages, just before I go to work and at night.</p>
</blockquote>
<p>Carl had been using heroin for more than ten years when I interviewed him. When I asked if he wanted to stop, he shrugged and said no, explaining:</p>
<blockquote>
<p>I’ve tried so many times – I’ve been on methadone but that was worse, especially coming off it. I know how much to take, and no one knows I use gear – so, no. But, as soon as you tell a professional you take heroin, their whole attitude changes. I’ve seen it many times. I dress quite well and I have a job, but as soon as I say I use heroin, they change. It’s almost as if they don’t see the same person any more.</p>
</blockquote>
<p>Talking to Carl underlined that many users know far more than me about the substances they take and why they take them. Yet as soon as a professional (typically a nurse, social worker or doctor) hears they are taking an illegal substance, or are misusing a legal substance such as alcohol, they are stigmatised and often ostracised from service provision.</p>
<p>Suzanne was homeless and also using heroin, but for different reasons to Carl. I asked why she started using it:</p>
<blockquote>
<p>I’ve had a shit life – it numbs all of that. Now being homeless, it helps me to sleep and keeps me warm, but I only use it in the winter because I need to sleep.</p>
</blockquote>
<p>In summer, Suzanne explained, she would switch to taking “phet” – amphetamines. I asked her why:</p>
<blockquote>
<p>You need to be awake – there are lots of dickheads around. I’ve been beaten and raped in the summer when I was asleep, so you need to be awake more.</p>
</blockquote>
<p>Hearing the stories of people fighting their personal battles with mental health and substance use issues was at once haunting and cathartic for me. It was deeply moving to hear them, time and again, struggling with the most difficult aspect of their condition: the simple decision to ask for help. And sadly, far too often, when they did summon the courage, their requests would go unheard, unheeded, or they would be engulfed by a sprawling system that seemed unable to help.</p>
<p>Dave had been using alcohol for many years and had asked for support on several occasions – only to be passed from service to service:</p>
<blockquote>
<p>I was made redundant and, at 50, was finding it hard to get another job. I wasn’t drinking all of the time then. But as I started to get into more debt and the bailiffs were knocking on the door, I needed a drink to get me through it. It was not until I was charged with drunk driving that I knew I had a problem.</p>
</blockquote>
<p>Dave said he wasn’t shy about asking for help – at least, for a while. But he found himself caught in a downward spiral that led to more drinking, more suffering, and less support:</p>
<blockquote>
<p>So many times I’d stop drinking, but I couldn’t deal with the voices in my head. I’d ask for support, but the waiting lists were so long. The medication the doctor gave me did nothing, so I’d start drinking again, and because I’d start to drink again, mental health services wouldn’t touch me. All they kept saying was: ‘You should stop drinking first.’</p>
</blockquote>
<h2>The biggest barrier to getting support</h2>
<p>To expand my understanding, I also sought the perspectives of a dozen people working on the frontline of mental healthcare – from professionals in NHS mental health and substance use teams, to people working for charitable support groups. Their insights revealed a <a href="https://www.miragenews.com/northern-england-life-ups-death-risk-from-1195801/">frayed and fragmented network of services</a>, with the holes and inefficiencies obvious and crying out for attention and repair. As one nurse explained:</p>
<blockquote>
<p>The stress of trying to get services to help is unbelievable. You’ve got pressure from the person’s family because they are afraid they’ll end up dead. You’ve got pressure from managers to discharge the person. All I’d get is criticism which far outweighed encouragement or support. The stress made me so anxious that I almost gave it all up – and even considered suicide myself.</p>
</blockquote>
<p>Over 80% of the professionals I spoke to called for an integration of mental health and substance use teams, in part because of the huge cuts nationwide in funding to substance use services. One social worker in a substance use service explained the current situation:</p>
<blockquote>
<p>If you get someone with an alcohol addiction, it becomes quite apparent that they use drink as a way of coping with their mental health. But, because of massive waiting lists within mental health services or because they are told they need to stop drinking before [they can be treated], mental health support can’t be offered. So, the person just keeps drinking and eventually disengages from our services as there is no hope for them. We shouldn’t expect someone to stop using a substance that they perceive is helping without offering an alternative treatment.</p>
</blockquote>
<p>For all the professionals I interviewed, the most significant barrier to getting support for someone’s mental health issues was that they used substances and would not receive any treatment until they addressed this. As one mental health nurse told me:</p>
<blockquote>
<p>I had one chap who was using cocaine, mainly due to social anxiety. Initially, he’d use it when socialising with friends. But because it gave him confidence and he could talk to people, he started to use it all the time and got himself in debt. I wanted to address the root cause, the social anxiety, so I referred him to our Improving Access to Psychological Therapy service. But I was told he needed to be abstinent from cocaine for three months before they’d accept him. He eventually disengaged, and I haven’t seen him since.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The word HELP spelled out in white powder" src="https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/word-help-spelled-out-by-cocaine-2289738709">Runawayphill/Shutterstock</a></span>
</figcaption>
</figure>
<h2>A seismic shift is needed</h2>
<p>In the shadows of our society, hidden behind the walls of our prisons and in the dark corners of our streets, the experiences of Jenny and countless others bear witness to the profound failings of our healthcare system to address co-existing mental health and substance use issues. For those caught in the merciless cycle of addiction and illness, these systemic inefficiencies and administrative blockades do much to intensify their torment.</p>
<p>Their often brutally honest accounts (and the insights of those who try to support them) draw a portrait of a split and underfunded service, collapsing under the weight of its contradictions. The loud calls for integrated mental health and substance addiction treatment become muffled amid the bureaucratic din of funding cuts, lengthy waiting lists and policy neglect.</p>
<p>The evidence overwhelmingly confirms the need for a model of care that is <a href="https://theconversation.com/how-to-solve-our-mental-health-crisis-214776">holistic and integrated</a> – one that shifts the narrative from stigma and isolation to awareness and support.</p>
<p>The economic case for reshaping investment in our mental health and substance misuse services is powerful. The annual cost of mental health problems to the UK economy is a staggering £117.9 billion – equivalent to <a href="https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2022/09/B1482_research-demand-signalling-national-mental-health-programme_september-2022.pdf">5% of its annual GDP</a> – with substance misuse adding a <a href="https://www.gov.uk/government/publications/review-of-drugs-phase-two-report/review-of-drugs-part-two-prevention-treatment-and-recovery#:%7E:text=There's%20a%20strong%20'invest%20to,was%20spent%20on%20drug%20treatment.">further £20 billion</a>.</p>
<p>However, these figures tell only part of the tale. While we know that <a href="https://assets.publishing.service.gov.uk/media/5a75b781ed915d6faf2b5276/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf">70% of people in treatment for drug misuse and 86%</a> of people in treatment for alcohol misuse have a mental health diagnosis, the full financial impact of people with these co-occurring disorders is probably far greater.</p>
<p>This also includes people who often plough through a <a href="https://www.emerald.com/insight/content/doi/10.1108/ADD-11-2017-0021/full/html">punitive and bewildering series of services</a> as they navigate their intersecting problems, encountering barriers at every turn that fail to address their <a href="https://assets.publishing.service.gov.uk/media/5a75b781ed915d6faf2b5276/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf">acute health</a> and social care needs. As their distress is amplified, the costs to <a href="https://www.emerald.com/insight/content/doi/10.1108/17570971111197175/full/html">wider society</a> escalate too – as one social worker explained to me:</p>
<blockquote>
<p>I am currently supporting a woman who is struggling with alcohol dependency, a condition that began after she endured significant domestic abuse. The cycle is devastating: her trauma cannot be effectively addressed because of her dependency on alcohol, and she cannot abandon alcohol because it’s the only solace she finds from her emotional torment. Despite several attempts at rehabilitation, none of the programmes have sufficiently tackled the mental health aspects of her trauma. Now, with cirrhosis of the liver, her health is in critical decline. It’s a heart-wrenching situation – a stark reminder of the desperate need for integrated treatment approaches that address both substance dependency and the underlying psychological trauma.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Out-of-focus woman with a glass of alcohol on the table in front of her" src="https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alcohol-addiction-portrait-lonely-desperate-drunk-137241875">Kamira/Shutterstock</a></span>
</figcaption>
</figure>
<h2>‘I might as well be dead’</h2>
<p>In the quiet confines of a West Midlands mental health crisis centre, I’m preparing to meet someone whose story I know only from the clinical notes on my screen. The phrase “is alcohol dependent” is highlighted in bold. Behind those words is another person whose life is unravelling in the silence of a battle fought alone.</p>
<p>John walks into the room, a man living in the grip of two relentless forces – addiction and mental illness. “It was just to stop the noises,” he says of the whisky he uses as medication for his inner turmoil. His hands are trembling. This is the moment of truth – his story is no longer trapped within the clinical pages of a case file. </p>
<p>“I’ve lost everything,” he tells me. “I might as well be dead.” </p>
<p>Then John explains why he’s given up hope:</p>
<blockquote>
<p>I’ve asked for help so many times, but all I get told is that I need to stop drinking before my mental health can be treated. However, alcohol is the only thing that works for me. I’ve gone through detox, but then I had to wait months for counselling. I just can’t cope that long without any support – antidepressants don’t do anything for me. What’s the point?</p>
</blockquote>
<p>Over the past 15 years, I have met countless “Johns”, both during my day job as a mental health social worker and, latterly, in my academic research. This has led me to conclude that the health and social care system in which I work falls catastrophically short. </p>
<p>This is no mere professional critique. It is an impassioned plea for society to rediscover its collective heart; to explore the human stories that lie hidden in statistics such as that, between 2009 and 2019, <a href="https://documents.manchester.ac.uk/display.aspx?DocID=60521">53% of UK suicides</a> were among people with comorbid diagnoses of mental health and substance use.</p>
<p>Instead of viewing people through the limiting lens of labels, we should endeavour to see their humanity. Engaging in conversation, extending empathy and showing compassion are powerful actions. A kind word, an understanding nod or a gesture of support can affirm their dignity and spark a connection that resonates with their innate human spirit. Or as John, whose journey I’ve had the privilege to witness, puts it:</p>
<blockquote>
<p>It’s not about the help offered but the meaning behind it. Knowing you’re seen as a person, not just a problem to be solved – that’s what sticks with you.</p>
</blockquote>
<p><em>*All names in this article have been changed to protect the anonymity of the interviewees.</em></p>
<p><em>If you or anyone you know require expert advice about the issues raised in this article, the NHS provides this <a href="https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/">list of local helplines and support organisations</a>.</em></p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
<ul>
<li><p><em><a href="https://theconversation.com/insomnia-how-chronic-sleep-problems-can-lead-to-a-spiralling-decline-in-mental-health-224131?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insomnia: how chronic sleep problems can lead to a spiralling decline in mental health
</a></em></p></li>
<li><p><em><a href="https://theconversation.com/existential-crisis-how-long-covid-patients-helped-us-understand-what-its-like-to-lose-your-sense-of-identity-and-purpose-in-life-211223?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Existential crisis: how long COVID patients helped us understand what it’s like to lose your sense of identity and purpose in life
</a></em></p></li>
<li><p><em><a href="https://theconversation.com/ocd-is-so-much-more-than-handwashing-or-tidying-as-a-historian-with-the-disorder-heres-what-ive-learned-219281?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">OCD is so much more than handwashing or tidying. As a historian with the disorder, here’s what I’ve learned
</a></em></p></li>
<li><p><em><a href="https://theconversation.com/how-music-heals-us-even-when-its-sad-by-a-neuroscientist-leading-a-new-study-of-musical-therapy-214924?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">How music heals us, even when it’s sad – by a neuroscientist leading a new study of musical therapy
</a></em></p></li>
</ul>
<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/225827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Bratt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This is the moment of truth. John’s story is no longer trapped in the clinical pages of a case file. ‘I’ve lost everything,’ he says. ‘I might as well be dead.’Simon Bratt, Mental Health Social Worker and PhD Candidate, Staffordshire UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2247082024-03-13T16:20:55Z2024-03-13T16:20:55ZFinland managed to halve its suicide rate – here’s how it happened<figure><img src="https://images.theconversation.com/files/580125/original/file-20240306-24-fgv5q1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5442%2C3601&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-mature-couple-life-vests-canoeing-1952066041">Aleksandra Suzi/Shutterstock</a></span></figcaption></figure><p>The end of the 20th century was a particularly grim period for Finland. Suicide rates were among the <a href="https://www.washingtonpost.com/archive/politics/1994/02/21/finnish-men-defy-experts-maintain-lead-in-suicides/9bb6bdba-51e3-4c82-a4ab-8b827443edf4/">highest in the world</a>, peaking in 1990 with over 30 deaths per 100,000 citizens, compared with a European average of ten per 100,000. </p>
<p>Finland responded aggressively, implementing a comprehensive national strategy, and ultimately cutting this rate by more than half, to about <a href="https://www.who.int/data/gho/data/indicators/indicator-details/GHO/age-standardized-suicide-rates-(per-100-000-population)">13 deaths per 100,000</a>. </p>
<p>Each suicide is unique, with many precipitating factors and personal characteristics, adverse occurrences and failures to get help. These things add up and finally cluster in a lethal way. </p>
<p>That is why there is no single remedy when it comes to suicide prevention. There are, however, several factors that may have contributed to the decline in the Finnish suicide rate. </p>
<p>The <a href="https://www.julkari.fi/handle/10024/77888">main strategy</a> undertaken by the Finnish government included educating health and other care workers to conduct a comprehensive, nationwide research project that collected data on all suicides that occurred during a one-year period. </p>
<p>§The research project itself was a huge intervention, spanning Finland’s 400-plus municipalities, which provided direct feedback on suicide rates and specific preventive actions, simultaneously raising awareness of suicide risks. </p>
<p>The media learned to report on suicides in a neutral way – without glorifying or romanticising language. Policies were implemented to limit access to firearms and poisons. And the arrival of a <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825">new generation</a> of antidepressants, with fewer side-effects, in the 90s may also have contributed to bringing down the rate. </p>
<figure class="align-center ">
<img alt="A blister pack of antidepressants" src="https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580127/original/file-20240306-18-21a9k5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The newer generation of antidepressants, such as Prozac, had fewer side-effects.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/green-white-10-packet-pills-depression-666180598">callumrc/Shutterstock</a></span>
</figcaption>
</figure>
<p>Counterintuitively, the fast rise of mobile phones in the 90s may have given a big helping hand, too. While we now look at mobile devices and social media as a source of decreasing physical social contacts, they probably helped people keep in touch with others in this large, sparsely populated country. (Loneliness and a lack of sense of belonging are <a href="https://doi.org/10.1192%2Fj.eurpsy.2022.2320">known risk factors</a> in suicide.)</p>
<p>But to what extent was Finland unique in experiencing a decline in suicide rates? </p>
<h2>How other countries fared</h2>
<p>Over roughly this same period, suicide rates have fallen <a href="https://www.nature.com/articles/srep20256">across Europe</a>. We can never be certain why this is the case, but a good guess might be that there is now better awareness of suicide and <a href="https://www.apa.org/news/press/releases/2019/05/mental-health-survey">greater willingness</a> to talk about mental health. As in Finland, suicide is also reported in a <a href="https://www.who.int/publications/i/item/9789240076846">more neutral way</a> in the media. </p>
<p>And, as mentioned above, the new generation of so-called SSRI antidepressant drugs may have played a large role in the fall in suicides, along with more effective mental health treatments, such as <a href="https://doi.org/10.1177/0145445507304728">cognitive behavioural therapy</a>. </p>
<p>Unfortunately, the outlook is not universally bright, as death by suicide is increasing in some parts of the world. For example, suicide rates in the US have <a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-051920-123206">increased by 35%</a> in the first decades of the 21st century, now amounting to about 14 deaths per 100,000. </p>
<p>Why are some countries seemingly thriving in the modern era and others seemingly seeped in despair? This probably points to inequality in wellbeing distribution that leaves some groups vulnerable and unprotected. </p>
<p>In the US, the risk groups seem to include under-educated, marginalised younger people, many of whom are victims of the opioid epidemic. We know that suicide risk is higher among poorer people, and Finland, with its more extensive Nordic welfare state, may be better equipped when it comes to the difficult task of suicide reduction.</p>
<p>The story continues in Finland, where the current <a href="https://stm.fi/en/mental-health-policy-guidelines">mental health strategy</a> includes a suicide-prevention programme with similar focuses to the previous agenda, with an added emphasis on improving crisis services. And they’re conducting a nationwide suicide study on <a href="https://ulosepatoivosta.fi/en/">young people’s suicides</a>. The synthesis of these findings, coupled with continuing endeavours, has the potential to further decrease the rate.</p>
<hr>
<p><em>If you’re struggling with suicidal thoughts, the following services can provide you with support:</em></p>
<p><em>In the UK and Ireland – call Samaritans UK at 116 123.</em></p>
<p><em>In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.</em></p>
<p><em>In Australia – call Lifeline Australia at 13 11 14.</em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/224708/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marieke Liem receives funding from the Dutch Research Council. </span></em></p><p class="fine-print"><em><span>Leah Prencipe and Sami Pirkola do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Putting Finland’s precipitous drop in suicides in context.Leah Prencipe, Postdoctoral Research Fellow, Public Health, Leiden UniversityMarieke Liem, Professor of Violence and Interventions, Leiden UniversitySami Pirkola, Professor of Social Psychiatry, Tampere UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2247112024-03-04T20:47:47Z2024-03-04T20:47:47ZSelf-immolation and other ‘spectacular’ protests: How impactful are they?<p>On Feb. 25, United States Air Force member Aaron Bushnell <a href="https://www.cbc.ca/news/world/us-airman-self-immolation-israel-embassy-1.7126137">set himself on fire outside the Israeli embassy in Washington, D.C.</a>. The 25-year-old, who was in uniform, live-streamed what he called his “extreme act of protest against the genocide of the Palestinian people.” </p>
<p>His startling and fatal act quickly went viral on social media <a href="https://www.dailymail.co.uk/news/article-13127485/Air-Force-engineer-Aaron-Bushnell-set-fire-outside-Israeli-embassy-pro-Palestine-protest-belonged-Christian-cult-SUPPORTS-airstrikes.html">while the public</a>, and his <a href="https://www.bbc.com/news/world-us-canada-68455401">friends and family have struggled to make sense</a> of Bushnell’s painful sacrifice. How can we begin to make sense of such an extreme act? And, will his actions have any impact on public opinion?</p>
<p>While undeniably remarkable, Bushnell’s actions begin to make a little more sense when seen in broader context. Self-immolation, the act of setting oneself on fire, can be seen as an extreme form of a modern repertoire of protest that is both common and familiar, not just in the U.S. but in many parts of the globe.</p>
<p>For example, in <a href="https://www-sup.stanford.edu/books/title/?id=35102">my research with frontline women workers in Pakistan</a>, I found self-immolation was part of a broader set of attention-grabbing tools women used in an effort to attract both attention and allies for what they saw as an otherwise lost cause. I call this broad set of publicity seeking efforts “spectacular agency,” a set of stunning dramas people stage to publicize abuse, critique injustice, censure abusers and protect the vulnerable. </p>
<h2>Spectacular agency</h2>
<p>Spectacular agency, including extreme forms like self-immolation, is not new. Many people from the 1960s generation will be familiar with the <a href="https://rarehistoricalphotos.com/the-burning-monk-1963/">photograph of Thich Quang Duc, the Buddhist monk</a> who self-immolated to protest the South Vietnamese government’s persecution of Buddhists. His unthinkable gesture <a href="https://doi.org/10.1093/acprof:oso/9780195176056.003.0013">brought international attention to the plight of Buddhists</a> in South Vietnam.</p>
<p>Now, since the advent of <a href="https://www.npr.org/2024/02/27/1233985097/self-immolation-political-protesters-history-aaron-bushnell">globalized broadcast media,</a> such actions can quickly gain attention across the globe. Indeed, with the wider availability of social media and the possibility of going viral, such protests have become more common than you would think. </p>
<p>Not all spectacular actions include the extreme act of self-immolation, but many examples exist within its realm. They have included the use of hashtags like <a href="https://canadianwomen.org/the-facts/the-metoo-movement-in-canada/">#metoo,</a> the circulation of leaked <a href="https://nationalpost.com/news/canada/you-dont-belong-here-canadian-teacher-lambastes-muslim-student-for-eschewing-pride">videos</a>, the practice of <a href="https://www.cbc.ca/news/canada/hamilton/mcmaster-divestment-project-hunger-strike-ends-1.6793248">hunger strikes</a>, the use of <a href="https://www.thestar.com/news/gta/pro-palestinian-protesters-return-to-union-station-for-rush-hour-sit-in/article_21490aa0-93ee-11ee-bb99-032a49e54b60.html">inflammatory posters</a>, the burning of effigies (for example when U.S. protestors <a href="https://www.zinnedproject.org/news/tdih/draft-card-protest/">burnt their draft cards</a> in 1965) and also attempted <a href="https://tribune.com.pk/story/366731/lhws-protest-pushed-to-limits-man-sets-himself-on-fire">self-immolation</a>. </p>
<p>And as I found in Pakistan, this also includes the organization of <a href="https://archive.pakistantoday.com.pk/2019/03/21/lady-health-workers-protest/">dharnas</a> (sit-ins). Sit-ins have also been recently used as a protest technique to call for a ceasefire in Gaza <a href="https://www.thestar.com/news/gta/pro-palestinian-protesters-return-to-union-station-for-rush-hour-sit-in/article_21490aa0-93ee-11ee-bb99-032a49e54b60.html">at Toronto’s Union Station</a> and in Washington, D.C. in October.</p>
<p>While such acts may generate attention, this kind of agency is often costly, requiring the protesters involved to make considerable personal investments of time, money, comfort, privacy, dignity and even life. </p>
<p>Yet, despite the costs, the outcomes of spectacular agency are frequently uncertain. </p>
<p>This is because spectacular agency requires recruiting others, such as audiences, who need to buy into a message, an idea or a point of view. But no matter how carefully they stage their dramatic contention, protesters have limited control over the way their vivid efforts will be read and interpreted by others.</p>
<h2>How audiences interpret protests</h2>
<p>When the public sees spectacular acts, they may focus on the symbols protesters use, such as military uniforms, that may be both symbolically loaded and multivocal. People invest a lot of meaning into military uniforms and they may read their use in many different ways depending on their different points of view. While symbols like uniforms can be arresting, their use may not always produce the interpretation the protester desired. Instead, the use of a loaded symbol may be taken by spectators as sacrilegious, and their use, therefore, <a href="https://www.washingtonpost.com/opinions/2024/02/29/aaron-bushnell-suicide-protest/">can lead audiences to question the protester’s sanity</a>.</p>
<p>The meanings audiences draw from spectacular performance, moreover, often interact with broader currents of inequality in society. An actor’s race, gender or age can be important factors that determine whether they have the authority, in an audience’s eyes, to use a particular symbol or to spectacularly tell a story that is important to them. </p>
<p>Women engaging in spectacular agency to draw attention to sexual assault, <a href="https://www.cbc.ca/news/trending/columbia-student-brings-rape-protest-mattress-to-graduation-1.3079582">like the Columbia student who carried a mattress</a> around campus to draw attention to sexual abuse, may find audiences either blame the victim or <a href="https://www.nationalreview.com/2017/08/columbia-university-mattress-girl-emmas-sulkowicz-paul-nungesser-lawsuit-rape-accusation-exonerated/">refuse to believe her account</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/HRaw1A7REzs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Emma Sulkowicz, walks across the stage at Columbia College, 2015, with her mattress as audience members cheered and clapped. Two years later, the accused was cleared of any wrongdoing in a settled lawsuit.</span></figcaption>
</figure>
<h2>Selflessly fighting for a better future</h2>
<p>In Pakistan, women frontline workers’ spectacular actions also brought mixed results. When I say frontline workers, I mean people who provide face-to-face service to citizens. One airline attendant <a href="https://www.edition.pk/news/1006210/pia-air-hostess-sabira-rizvi-talks-age-and-being-internet-famous">took to social media in an effort to protest against the ageism and sexism of some passengers</a> and found supportive and allies <a href="https://twitter.com/ammarawrites/status/882899735690039296?lang=en">among other social media users</a>. </p>
<p>But other women workers were not so fortunate.</p>
<p><a href="https://www.aljazeera.com/features/2018/4/10/the-plight-of-pakistans-lady-health-workers">Pakistani Lady Health Workers</a>, who travelled from city to city across Pakistan engaging in long running spectacular efforts to grab attention for their poor working conditions, succeeded in getting the Pakistani Supreme Court’s attention and intervention. </p>
<p>However, the women then had to confront a slowly moving bureaucratic administration that found ways to delay or limit the women’s gains. Some of these women said the reforms they had worked so hard for would not benefit them directly. They were on the verge of retirement and were told by their bosses that their hard-won gains in wages and pensions would not apply to them.</p>
<p>Yet, most of these women said they did not regret having made the effort. </p>
<p>Speaking about her own inability to reap the rewards of spectacular agency, Nuzhat, a frontline health worker said:</p>
<blockquote>
<p>“It doesn’t matter. The next generation will get it. One person grows a tree so that the next generation can sit in its shade…What is important is that you plant it.”</p>
</blockquote>
<p>Spectacular agency is costly, requiring the surrender of money, time, comfort and also, at times privacy and dignity. Therefore, people who engage in it, often see it as an altruistic sacrifice made in the name of others. </p>
<p>Rehana, a health worker said: </p>
<blockquote>
<p>“I don’t feel sad that I derived little benefit from that effort…I feel that you should do whatever you can do. Whatever we can do for the next generation, we do it. You can’t control the outcome, but you can say: ‘O Allah, I have fulfilled my obligations. I spared no effort to create a better world for the next people who will take my place. Now it’s up to them and you.’</p>
</blockquote><img src="https://counter.theconversation.com/content/224711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fauzia Husain does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Aaron Bushnell’s self-immolation is an example of ‘spectacular agency,’ a form of attention-grabbing but costly protest. And, it is uncertain how the public will perceive such protests.Fauzia Husain, Assistant Professor, Department of Sociology, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238632024-02-22T01:22:51Z2024-02-22T01:22:51ZVoluntary assisted dying is different to suicide. But federal laws conflate them and restrict access to telehealth<figure><img src="https://images.theconversation.com/files/576955/original/file-20240221-30-6rt3ul.jpg?ixlib=rb-1.1.0&rect=125%2C224%2C2869%2C1773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-elderly-widow-sitting-on-her-191917208">Daxiao Productions/Shutterstock</a></span></figcaption></figure><p>Voluntary assisted dying is now lawful in every Australian state and will soon begin in the <a href="https://www.justice.act.gov.au/justice-programs-and-initiatives/voluntary-assisted-dying-laws-in-the-act">Australian Capital Territory</a>.</p>
<p>However, it’s illegal to discuss it via <a href="https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Telehealth-Updates-April%202023">telehealth</a>. That means people who live in rural and remote areas, or those who can’t physically go to see a doctor, may not be able to access the scheme.</p>
<p>A federal private members bill, introduced to parliament last week, aims to change this. So what’s proposed and why is it needed?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1757948089271214377"}"></div></p>
<h2>What’s wrong with the current laws?</h2>
<p>Voluntary assisted dying doesn’t meet the definition of suicide under state laws. </p>
<p>But the Commonwealth Criminal Code <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/FlagPost/2023/August/Voluntary_Assisted_Dying_and_Telehealth#:%7E:text=Sections%20474.29A%20and%20474.29,material%20that%20counsels%20or%20incites">prohibits</a> the discussion or dissemination of suicide-related material electronically. </p>
<p>This opens doctors to the risk of criminal prosecution if they discuss voluntary assisted dying via telehealth.</p>
<p>Successive Commonwealth attorneys-general have failed to address the conflict between federal and state laws, despite persistent calls from state attorneys-general for necessary <a href="https://www.abc.net.au/news/2024-02-12/voluntary-assisted-dying-telehealth-ban-law-push/103456102">clarity</a>. </p>
<p>This eventually led to voluntary assistant dying doctor <a href="https://www.abc.net.au/news/2022-08-03/voluntary-assisted-dying-communication-laws-face-gp-legal-fight/101292042">Nicholas Carr</a> calling on the Federal Court of Australia to resolve this conflict. Carr sought a declaration to exclude voluntary assisted dying from the definition of suicide under the Criminal Code. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/voluntary-assisted-dying-will-begin-in-wa-this-week-but-one-commonwealth-law-could-get-in-the-way-161982">Voluntary assisted dying will begin in WA this week. But one Commonwealth law could get in the way</a>
</strong>
</em>
</p>
<hr>
<p>In November, the court <a href="https://search2.fedcourt.gov.au/s/search.html?collection=judgments&sort=date&meta_v_phrase_orsand=judgments%2FJudgments%2F&meta_2=carr+&meta_A=&meta_z=&meta_3=&meta_n_phrase_orsand=&query_sand=&query_or=&query_not=&query_phrase=&query_prox=&meta_d=23+november+2023&meta_d1=&meta_d2=&meta_7=&meta_4=&meta_B=">declared</a> voluntary assisted dying <em>was</em> considered suicide for the purpose of the Criminal Code. This meant doctors across Australia were prohibited from using telehealth services for voluntary assisted dying consultations. </p>
<p>Last week, independent federal MP Kate Chaney <a href="https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22legislation%2Fbillhome%2Fr7146%22;querytype=;rec=0">introduced a private members bill</a> to create an exemption for voluntary assisted dying by excluding it as suicide for the purpose of the Criminal Code. Here’s why it’s needed. </p>
<h2>Not all patients can physically see a doctor</h2>
<p>Defining voluntary assisted dying as suicide in the Criminal Code disproportionately impacts people living in regional and remote areas. People in the country <a href="https://www.ama.com.au/ama-rounds/8-december-2023/articles/ama-urges-attorney-general-amend-laws-relevant-vad-and">rely on</a> the use of “carriage services”, such as phone and video consultations, to avoid travelling long distances to consult their doctor. </p>
<p>Other people with terminal illnesses, whether in regional or urban areas, may be suffering intolerably and unable to physically attend appointments with doctors. </p>
<p>The prohibition against telehealth goes against the <a href="https://www.legislation.vic.gov.au/as-made/acts/voluntary-assisted-dying-act-2017">principles</a> of voluntary assisted dying, which are to minimise suffering, maximise quality of life and promote autonomy.</p>
<figure class="align-center ">
<img alt="Old hands hold young hands" src="https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576959/original/file-20240221-28-e3qk81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some people aren’t able to attend doctors’ appointments in person.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-that-care-nursing-home-2094784921">Jeffrey M Levine/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Doctors don’t want to be involved in ‘suicide’</h2>
<p>Equating voluntary assisted dying with suicide has a direct impact on doctors, who <a href="https://eprints.qut.edu.au/213858/1/99568951.pdf">fear</a> criminal prosecution due to the prohibition against using telehealth.</p>
<p>Some doctors may decide not to help patients who choose voluntary assisted dying, leaving patients in a state of limbo. </p>
<p>The number of doctors actively participating in voluntary assisted dying is already <a href="https://www.safercare.vic.gov.au/sites/default/files/2023-08/VADRB%20Annual%20Report%202022-23.pdf">low</a>. The majority of doctors are located in metropolitan areas or major regional centres, leaving some locations with very few doctors participating in voluntary assisted dying. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/voluntary-assisted-dying-is-legal-in-victoria-but-you-may-not-be-able-to-access-it-208282">Voluntary assisted dying is legal in Victoria, but you may not be able to access it</a>
</strong>
</em>
</p>
<hr>
<h2>It misclassifies deaths</h2>
<p>In state law, people dying under voluntary assisted dying have the cause of their death registered as “the disease, illness or medical condition that was the grounds for a person to access voluntary assisted dying”, while the <a>manner of dying</a> is recorded as voluntary assisted dying. </p>
<p>In contrast, only coroners in each state and territory can make a finding of suicide as a cause of death. </p>
<p>In 2017, voluntary assisted dying was defined in the <a href="http://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/vic/consol_act/ca2008120/s4.html">Coroners Act 2008 (Vic)</a> as not a reportable death, and thus not suicide. </p>
<p>The language of suicide is inappropriate for explaining how people make a decision to die with dignity under the lawful practice of voluntary assisted dying. </p>
<p>There is ongoing taboo and stigma attached to suicide. People who opt for and are lawfully eligible to access voluntary assisted dying should not be tainted with the taboo that currently surrounds suicide.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1719587677257728045"}"></div></p>
<h2>So what is the solution?</h2>
<p>The only way to remedy this problem is for the federal government to create an exemption in the Criminal Code to allow telehealth appointments to discuss voluntary assisted dying. </p>
<p>Chaney’s private member’s bill is yet to be debated in federal parliament. </p>
<p>If it’s unsuccessful, the Commonwealth attorney-general should pass regulations to exempt voluntary assisted dying as suicide. </p>
<p>A cooperative approach to resolve this conflict of laws is necessary to ensure doctors don’t risk prosecution for assisting eligible people to access voluntary assisted dying, regional and remote patients have access to voluntary assisted dying, families don’t suffer consequences for the erroneous classification of voluntary assisted dying as suicide, and people accessing voluntary assisted dying are not shrouded with the taboo of suicide when accessing a lawful practice to die with dignity.</p>
<p>Failure to change this will cause unnecessary suffering for patients and doctors alike.</p><img src="https://counter.theconversation.com/content/223863/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michaela Estelle Okninski is affiliated with Australasian Association of Bioethics and Health Law.</span></em></p><p class="fine-print"><em><span>Marc Trabsky's research for this article received funding from an Australian Research Council Discovery Early Career Researcher Award (DE220100064).</span></em></p><p class="fine-print"><em><span>Neera Bhatia receives funding from UKRI Arts and Humanities Research Council for an unrelated project. </span></em></p>It’s illegal to discuss voluntary assisted dying via telehealth, which means people who live in rural areas and those who can’t physically go to see a doctor may not be able to access the scheme.Michaela Estelle Okninski, Lecturer of Law, University of AdelaideMarc Trabsky, Associate professor, La Trobe UniversityNeera Bhatia, Associate Professor in Law, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2223092024-02-20T16:52:14Z2024-02-20T16:52:14ZSuicide risk is higher in certain phases of the menstrual cycle – here’s what we know about this link<figure><img src="https://images.theconversation.com/files/576484/original/file-20240219-26-u4dbob.jpg?ixlib=rb-1.1.0&rect=32%2C0%2C3566%2C2375&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The study found women had a higher risk of suicide when hormones are fluctuating</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ny-usa-2-may2022young-fitness-woman-2157077103">Krotnakro/ Shutterstock</a></span></figcaption></figure><p>Women are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539867/">twice as likely</a> to attempt suicide than men. This difference <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576496/">appears at puberty</a>, suggesting the menstrual cycle may play a key role. </p>
<p>Although this link has been known for a long time, it remains a disappointingly under-researched area. But a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10082663/">2023 study</a> provided new insight into this link – finding that women may be more likely to die by suicide during certain phases of their menstrual cycle. </p>
<p>The researchers conducted their analysis by pooling data from five studies on suicide and the menstrual cycle. They were then able to identify the menstrual cycle phase of 425 women who died by suicide, ranging in age from 11 to 50.</p>
<p>They found that suicide was most common in the secretory phase of the cycle (accounting for approximately 45% of deaths), followed by the proliferative phase (29% of deaths). The least common phase for death by suicide was the menstrual phase (approximately 18% of deaths). </p>
<p>Researchers aren’t entirely sure why suicide risk is higher during certain phases of the menstrual cycle. While it’s likely due to the complex interplay of many factors, some evidence suggests hormone fluctuations and how sensitive a person is to these changes may be related.</p>
<h2>Hormone sensitivity</h2>
<p>The menstrual cycle is divided into three phases. Each corresponds to different levels of circulating hormones, in particular estradiol and progesterone. </p>
<p>In the menstrual phase (when a woman typically has her period), these hormones are consistently low and stable. This is followed by the proliferative phase (also known as the follicular phase), where estradiol peaks. Finally, in the secretory phase (also known as the luteal phase), estradiol falls sharply while progesterone rises. </p>
<p>This recent study suggests that women have a higher risk of suicide when hormones are fluctuating. Collectively, these phases accounted for almost 80% of deaths. </p>
<p>One possible explanation for this link could be that some women are more sensitive to changing hormone levels throughout their cycle. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844188/">One review found</a> that while some women have no response to these hormone changes, others experience changes in their mood and mental health that ranged from mild to severe. </p>
<p>For some, these changes negatively affected their daily lives, sleep and relationships, all of which have a cumulative effect on mental health when experienced every month.</p>
<figure class="align-center ">
<img alt="A person draws the hormonal changes throughout the menstrual cycle on a sheet of paper." src="https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some women may be more sensitive to the hormone changes that take place throughout the menstrual cycle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-view-hand-drawn-female-menstrual-2052064121">Linaimages/ Shutterstock</a></span>
</figcaption>
</figure>
<p>This link may also be explained by some mental health conditions which are known to worsen during certain phases of the menstrual cycle. </p>
<p><a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/">Premenstrual dysphoric disorder</a>, for example, is a severe mood disorder that affects one in 20 women. It causes debilitating psychological symptoms in the week or two before one’s period (the secretory phase), such as overwhelming anxiety or anger.</p>
<p>For women diagnosed with PMDD, 72% will have suicidal thoughts, half will self-harm and one in three will <a href="https://link.springer.com/article/10.1186/s12888-022-03851-0">attempt suicide</a>. Tragically, some women with PMDD do not survive.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/premenstrual-dysphoric-disorder-the-frightening-psychological-condition-suffered-by-dixie-damelio-193235">Premenstrual dysphoric disorder: the frightening psychological condition suffered by Dixie D'Amelio</a>
</strong>
</em>
</p>
<hr>
<p>The menstrual cycle has also been shown to have a negative affect on pre-existing psychiatric disorders, including bipolar disorder, depression and anxiety. This is known as <a href="https://iapmd.org/pmdd-v-pme">premenstrual exacerbation</a> (PME).</p>
<p>Some of these disorders come with increased suicide risk. PME may worsen symptoms during the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502143/">secretory and proliferative phases</a>.</p>
<p>The menstrual cycle has also been linked with perimenopausal depression. During perimenopause (the transitional period before menopause), the menstrual cycle begins to change, becoming less predictable until it eventually stops. </p>
<p>This is a high-risk phase for women’s mental health. In the <a href="https://www.statista.com/statistics/1114127/female-suicide-rate-in-the-us-by-age-group/#:%7E:text=The%20suicide%20rate%20among%20females,elderly%20women%2075%20and%20over.">UK</a> and <a href="https://www.statista.com/statistics/1114127/female-suicide-rate-in-the-us-by-age-group/#:%7E:text=The%20suicide%20rate%20among%20females,elderly%20women%2075%20and%20over.">US</a>, death by suicide in women is highest in those of perimenopausal age suggesting a link with hormones. </p>
<h2>Social and cultural factors</h2>
<p>The menstrual cycle is of course not the only factor involved when it comes to suicide risk. Other <a href="https://www1.racgp.org.au/ajgp/2023/july/placing-womens-mental-health-in-context">social and cultural issues</a> play an important role. </p>
<p>Socioeconomic factors appear to be linked to suicide risk, with 77% of <a href="https://www.who.int/teams/mental-health-and-substance-use/data-research/suicide-data">global suicides</a> occurring in low- and middle-income countries. And in some such countries, suicide accounts for approximately 70% of violent deaths among women. In Nepal, for example, suicide is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656007/">single leading cause of death</a> in reproductive age women.</p>
<p>Women are also more likely than men to experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632781">sexual violence and intimate partner violence</a> – and to experience these types of trauma at a younger age. Childhood sexual abuse is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240465/#:%7E:text=Several%20studies%20have%20indicated%20that,depression%20and%20anxiety%20in%20adulthood.&text=It%20has%20also%20been%20suggested,between%20childhood%20trauma%20and%20suicide.">strongest predictors</a> of suicidality in women. </p>
<p>This form of gender-based violence is a key reason more women than men are diagnosed with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632782/">post-traumatic stress disorder</a> (PTSD). </p>
<p>Women are also <a href="https://iris.who.int/bitstream/handle/10665/66539/WHO_MSD_MDP_00.1.pdf">more likely</a> to live in poverty, leave education early, have lower-paid jobs and a higher burden of caring responsibilities. These cumulatively impact women’s mental health and may contribute to suicide risk.</p>
<p>There is also the complex <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051505/">intersection of race and ethnicity</a>, with research showing black women have the highest risk of trauma and mental health disorders compared to any other group. Research from the US shows black women have the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0287141">highest risk</a> of suicide among women.</p>
<h2>Need for support</h2>
<p>While the 2023 study highlighted the link between the menstrual cycle and suicide, there are some limitations to its design. </p>
<p>The review only included data from five studies, the majority of which were conducted in India. As such, more research will be needed to understand whether the picture is similar in other parts of the world, and to fully understand all the factors contributing to greater suicide risk during certain phases of the menstrual cycle.</p>
<p>But it isn’t the first study to uncover a link between menstrual cycle and increased suicide risk, showing the clear need for greater support in order to prevent harm. </p>
<p>While the past few years have seen more being done to <a href="https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england">address women’s health issues</a>, many questions still have not been fully answered. These include why women are more likely to die by suicide during certain phases of their menstrual cycle, what other social and cultural factors put women at greater risk of suicide and how can health professionals better assess those who may be most at risk.</p>
<hr>
<p><em>If you’re struggling with suicidal thoughts, the following services can provide you with support:</em></p>
<p><em>In the UK and Ireland – call Samaritans UK at 116 123.</em></p>
<p><em>In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.</em></p>
<p><em>In Australia – call Lifeline Australia at 13 11 14.</em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/222309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynsay Matthews receives funding from the Royal Society of Edinburgh. </span></em></p>The study found women were at the greatest risk of suicide during the secretory and proliferative phases of their menstrual cycle.Lynsay Matthews, Lecturer in Public Health, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2196132024-02-18T22:46:53Z2024-02-18T22:46:53ZNZ is bound by international mental health agreements – statistics for Māori show we’re failing to uphold them<p>Aotearoa New Zealand ranks among the highest in youth suicide rates among <a href="https://www.oecd.org/els/family/CO_4_4_Teenage-Suicide.pdf">OECD countries</a> – and it is Māori youth at the <a href="https://theconversation.com/maori-suicide-rates-remain-too-high-involving-whanau-more-in-coronial-inquiries-should-be-a-priority-217254">forefront of this national crisis</a>. </p>
<p><a href="https://www.tewhatuora.govt.nz/our-health-system/data-and-statistics/suicide-web-tool">Recent statistics</a> show the number of suspected self-inflicted deaths for Māori males is nearly double the rate for non-Māori males. The rate for Māori females is around 1.8 times higher than the rate for non-Māori females. </p>
<p>The alarming discrepancy is most notable in the 15-24 age group, where the rate for Māori is about 2.6 times higher than for non-Māori.</p>
<p>Despite these concerning figures, there is no express right to health in New Zealand law, creating a gap in accountability. And by failing to ensure the health and wellbeing of young Māori, Aotearoa New Zealand is falling short of its international obligations.</p>
<h2>Progress and retreat</h2>
<p>Over the past five years, the government has taken some steps to tackle the country’s mental health crisis. But the priorities of the new government could threaten this already limited progress.</p>
<p>In 2019, NZ$2 billion was <a href="https://www.beehive.govt.nz/release/taking-mental-health-seriously">injected into the mental health system</a> by the then Labour government. And the <a href="https://www.mhwc.govt.nz/">Mental Health Commission</a> was established in 2021 with the aim of contributing to better and equitable mental health and wellbeing outcomes for all people. </p>
<p>Te Aka Whai Ora, the Māori Health Authority, was established under the <a href="https://www.legislation.govt.nz/act/public/2022/0030/latest/LMS575405.html">Pae Ora (Healthy Futures) Act 2022</a>. But while the new coalition government has announced the country’s first ever <a href="https://www.beehive.govt.nz/minister/biography/matt-doocey">minister for mental health</a>, it has also announced plans to <a href="https://www.rnz.co.nz/news/political/507330/reti-confirms-transfer-of-decision-making-to-regions-is-among-health-priorities">scrap the authority</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/have-you-been-feeling-your-spirit-was-sad-culture-is-key-when-assessing-indigenous-australians-mental-health-119463">'Have you been feeling your spirit was sad?' Culture is key when assessing Indigenous Australians' mental health</a>
</strong>
</em>
</p>
<hr>
<p>The <a href="https://www.platform.org.nz/assets/WorkDetail/Cross-Party-Report-Under-One-Umbrella-MHAC-Web-Accessible-FINALv.pdf">Under One Umbrella</a> report, published by the cross-party <a href="https://www.mhwc.govt.nz/news-and-resources/priority-on-youth-mental-health-strikes-a-chord/">Mental Health and Addiction Wellbeing Group</a>, presents a comprehensive, integrated approach to mental health, alcohol and addiction for young people. Significantly, it advocates for a holistic “all-of-government” approach. </p>
<p>Submissions from a <a href="https://www.health.govt.nz/our-work/mental-health-and-addiction/mental-health-legislation/repealing-and-replacing-mental-health-act">recent review</a> of the Mental Health Act show strong support for the new legislation to uphold rights in alignment with international conventions, with more focus on tangata whaiora (someone seeking health) and whānau (extended family). </p>
<p>Although these initiatives and pending legislative reform represent a step in the right direction, the statistics related to <a href="https://www.unicef.org.nz/media-releases/poor-mental-health-in-children-and-young-people-cannot-be-ignored-unicef">youth mental health</a> are still cause for concern. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1749650746629325045"}"></div></p>
<h2>International responsibilities to ensure health</h2>
<p>One strategy to address the national mental health crisis for Māori youth would be to embed the human right to health in local policy and law. This would also bring Aotearoa New Zealand’s legislation into line with its international obligations. </p>
<p>In 1946, the <a href="https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1">World Health Organization</a> adopted a broad definition of health:</p>
<blockquote>
<p>Health is a state of complete physical, mental, cultural and social wellbeing and not merely the absence of disease or infirmity. </p>
</blockquote>
<p>Over the course of the next two decades, health was conceived as a human right (in the <a href="https://www.un.org/en/about-us/universal-declaration-of-human-rights">Universal Declaration of Human Rights</a> and later in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights">International Covenant on Economic Social and Cultural Rights</a>). </p>
<p>The <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-convention-elimination-all-forms-racial">International Convention on the Elimination of Racial Discrimination</a> also obliged countries to eliminate race discrimination in public health and medical care. </p>
<p>For children, the right to health is further recognised in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">Convention on the Rights of the Child 1989</a>. And, specifically for Indigenous communities, in the <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">United Nations Declaration on the Rights of Indigenous Peoples 2007</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/equity-in-health-care-improves-peoples-health-114910">Equity in health care improves people's health</a>
</strong>
</em>
</p>
<hr>
<p>It is well established within <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">international law</a> that the right to health for Indigenous children and youth is linked to their distinct cultural, social and customary practices. </p>
<p>And various UN groups have <a href="https://www.ohchr.org/en/resources/educators/human-rights-education-training/e-general-comment-no-14-right-highest-attainable-standard-health-article-12-2000">repeatedly</a> <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G16/177/09/PDF/G1617709.pdf?OpenElement">emphasised</a> that Indigenous people have the right to receive culturally appropriate healthcare services that respect their traditional practices and medicines. </p>
<p>These groups have also urged countries to provide Indigenous communities with the necessary resources to design, deliver and control their own healthcare services. </p>
<h2>The need for a legal framework</h2>
<p><a href="https://www.justice.govt.nz/justice-sector-policy/constitutional-issues-and-human-rights/human-rights/international-human-rights/">Aotearoa New Zealand is bound</a> by these international agreements, and the rights and obligations that flow from them. Yet the right to health <a href="https://tikatangata.org.nz/human-rights-in-aotearoa/right-to-health">does not appear in our laws</a>, which leaves a void in accountability and enforcement. </p>
<p>This hinders the implementation of effective health policies for tamariki and rangatahi Māori (children and young people), particularly as it limits the legal avenues available for recourse when the system fails. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-despair-not-depression-thats-responsible-for-indigenous-suicide-108497">It's despair, not depression, that's responsible for Indigenous suicide</a>
</strong>
</em>
</p>
<hr>
<p>The disparities in mental health outcomes point to an immediate national challenge facing Aotearoa New Zealand, which is to formulate an effective mental healthcare framework. </p>
<p>The most appropriate starting point is to include the right to health in national policy and legislation. This would align New Zealand’s national policies and laws with international norms. </p>
<p>It would also mandate the government to take active steps to ensure that the highest attainable standards of mental health and wellbeing for tamariki and rangtahi Māori are met.</p><img src="https://counter.theconversation.com/content/219613/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no express right to health in New Zealand law. But international agreements protecting Indigenous rights to health and wellbeing set the standard New Zealand should follow.Claire Breen, Professor of Law, University of WaikatoRobert Joseph, Associate Professor of Law, University of WaikatoThilini Karunaratne, PhD candidate/ Lawyer, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2038672024-02-13T16:08:45Z2024-02-13T16:08:45ZEarly modern Britain was terrified of women trying to swallow pins<figure><img src="https://images.theconversation.com/files/575354/original/file-20240213-18-qi3hy7.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Illustration of the devil pricking a woman with a pin and another of a girl vomiting pins from a history of witches.</span> <span class="attribution"><a class="source" href="https://wellcomecollection.org/works/abkab8tq/items">Wellcome Collection</a></span></figcaption></figure><p><em>This article includes mention of suicide and self-harm</em></p>
<p>If someone swallows a pin today, it’s likely to be interpreted as an <a href="https://www.theguardian.com/lifeandstyle/2012/jul/13/experience-inhaled-pin-into-lung">unfortunate accident</a> or perhaps, as depicted in the 2019 film <a href="https://mubi.com/films/swallow">Swallow</a>, an example of the <a href="https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/other-eating-feeding-problems/pica/#:%7E:text=What%20is%20pica%3F,paint%2C%20chalk%2C%20or%20ice.">eating disorder pica</a>, which involves the consumption of non-food items. Though pin-swallowing is still sometimes identified in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952645/">individual medical cases as having suicidal intent</a>, this is often not the automatic conclusion.</p>
<p>But in early modern British society, where pins were ubiquitous, there were widespread fears about them being consumed. Though it seems that pins did little harm, the fear of the damage they might cause resulted in their association with and use by women who attempted suicide – and with demonic posession.</p>
<p>The metaphor of the “<a href="https://quod.lib.umich.edu/e/eebo/A48814.0001.001?rgn=main;view=fulltext">crooked pin in the pudding</a>” is suggestive of this worry that pins might end up in places they shouldn’t and be ingested by people. In one incident in 1718, <a href="https://books.google.co.uk/books?id=gtQ0AAAAMAAJ&pg=RA1-PR93#v=onepage&q&f=false">a pin was found in an egg</a> being eaten by one Mr McGill, the minister of Kinross, near Perth, Scotland, which he narrowly avoided consuming.</p>
<figure class="align-right ">
<img alt="An illustration of a girl being pricked by the devil with a pin." src="https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=504&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=504&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=504&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=633&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=633&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575357/original/file-20240213-24-sal6wx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=633&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many women who ingested pins said that the devil drove them to it.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/abkab8tq/items?canvas=177">Wellcome</a></span>
</figcaption>
</figure>
<p>This fear of swallowing pins was likely influenced by their widespread nature in early modern society. Pins were used to <a href="https://thebookandpapergathering.org/2018/05/31/the-use-of-pins-in-early-modern-england-1450-1700/">hold together clothing, style hair, organise documents and, of course, for sewing</a>. </p>
<p>The ready availability of pins meant that they were also a potential danger to those who wished to do themselves harm. A young woman named <a href="http://iapsop.com/ssoc/1882__grainge___daemonologia.pdf">Helen Fairfax</a> was tempted to end her life using a pin at her family home in Yorkshire in 1621.</p>
<p>As Helen explained it, the devil approached her and offered her various means of suicide, including to “take a pin out of her clothes and put it into her mouth”. Helen rebuked the devil, and was ultimately able to resist these temptations.</p>
<p>Owing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277877/">medical intervention</a>, swallowed pins rarely severely harm people in the modern day. Similarly, there are no records of 17th-century people who died as a result of swallowing a pin. But this act was believed to be intensely dangerous by them.</p>
<p>Early modern people believed that the devil was constantly looking for ways to tempt them towards sin. Pins crop up regularly in stories of demonic temptation and possession like that of Helen Fairfax, likely because, particularly for women, they were always at hand.</p>
<p><a href="https://quod.lib.umich.edu/e/eebo/A28315.0001.001?rgn=main;view=fulltext">A case reported by physician Joseph Blagrave</a> (1610-1682) speaks to the concerns people had. He described his treatment of a girl in Basingstoke in southern England, who was <a href="https://theconversation.com/dealing-with-devil-has-long-been-a-part-of-medicine-107310">believed to be demonically possessed</a>. Among her symptoms were repeated attempts to put pins in her mouth. </p>
<p>This behaviour alarmed her parents who feared “she should choke herself with it”. The girl tried to swallow the items so often that they had “a box near full” of confiscated pins.</p>
<h2>Hysterical women</h2>
<p>In the later 18th century, ideas surrounding pin-swallowing began to change. It was <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61589-X/fulltext">increasingly associated with “hysteria”</a>, an historical illness involving anxiety and excess emotion which was commonly associated with women, and the asylum.</p>
<p>By the 19th century, self-injurious behaviours such as swallowing or inserting pins into the body gained an increasingly moral dimension. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143867/">As the history of medicine academic Sarah Chaney explains</a>, doctors saw these kinds of acts as an indication of self-obsession and of the inability of the individual to contribute towards society.</p>
<p>In his 1857 work, A Collection of Remarkable Cases in Surgery, the American surgeon Paul F. Eve (1806-1877) detailed a vast number of medical accounts. Among these was an “<a href="https://wellcomecollection.org/works/w2zyddwx/items?canvas=215">extraordinary case of pin-swallowing</a>”, which, in Eve’s words, involved a girl in Vienna with “an aberration of intellect” who “attempted to destroy her life by swallowing a great quantity of pins”. </p>
<figure class="align-left ">
<img alt="An illustration of a girl vomiting pins" src="https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575355/original/file-20240213-26-zlpp3s.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An illustration of a girl vomiting pins from a history of witches from The history of witches and wizards: giving a true account of all their tryals in England, Scotland, Swedeland, France, and New England; with their confession and condemnation.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/abkab8tq/items?canvas=5">Wellcome Collection</a></span>
</figcaption>
</figure>
<p>Eve comes across as dismissive of the girl and her experience, an attitude also expressed in his account of <a href="https://wellcomecollection.org/works/w2zyddwx/items?canvas=218">another pin-swallowing case</a>, of which he chose to “omit some of the tedious narrative”.</p>
<p>Although 17th-century people had been alarmed by pin-swallowing, their reactions do not suggest the explicit condemnation or shaming of the people that 19th-century medical works, such as Eve’s, do. This is despite the fact that the act of suicide was both a <a href="https://www.bbc.co.uk/news/magazine-14374296">crime</a> and a sin in this period. </p>
<p>In part, 17th-century responses may be influenced by the claims of many pin-swallowers of being demonically possessed, which <a href="https://notevenpast.org/brian-levack-possession-and-exorcism/">might serve to exonerate them of blame for their behaviour</a>. Though early modern people were expected to resist the devil’s temptation, they were not necessarily held responsible for experiencing it. </p>
<p>It also seems that family members and friends were more concerned about the wellbeing of their loved ones than the potential criminal dimension of their actions.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Samaritans on 116 123</em></p>
<hr>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>Looking for something good? Cut through the noise with a carefully curated selection of the latest releases, live events and exhibitions, straight to your inbox every fortnight, on Fridays. <a href="https://theconversation.com/uk/newsletters/something-good-156">Sign up here</a>.</em></p>
<hr><img src="https://counter.theconversation.com/content/203867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Imogen Knox receives funding from the M4C/AHRC</span></em></p>Pins were ubiquitous and swallowing them became associated with demonic posession and female “hysteria”.Imogen Knox, PhD Candidate in History, University of WarwickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2166032024-02-01T13:30:51Z2024-02-01T13:30:51ZSuicide has reached epidemic proportions in the US − yet medical students still don’t receive adequate training to treat suicidal patients<figure><img src="https://images.theconversation.com/files/562904/original/file-20231201-17-ssns1k.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5982%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Every year, more than 12 million Americans have suicidal thoughts.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tired-and-downcast-man-holding-head-with-hands-royalty-free-image/1472116942?phrase=suicide&searchscope=image%2Cfilm&adppopup=true">Djavan Rodriguez/Moment via Getty Images</a></span></figcaption></figure><p>Suicide in the U.S. is <a href="https://www.mentalhealthfirstaid.org/">a societal epidemic</a> and a <a href="https://www.kff.org/mental-health/issue-brief/a-look-at-the-latest-suicide-data-and-change-over-the-last-decade/">staggering public health crisis</a> that demands attention from medical experts.</p>
<p>In 2021, <a href="https://www.cdc.gov/suicide/suicide-data-statistics.html">someone in the U.S. died by suicide every 11 minutes</a>, according to the Centers for Disease Control and Prevention. That rate equates to nearly 50,000 Americans every year. Another 1.7 million people in the U.S. attempted suicide in 2021, and over 12 million more had suicidal thoughts. </p>
<p>And the numbers appear to be getting worse: Preliminary numbers for 2022 show a <a href="https://www.nytimes.com/2023/08/11/well/mind/suicide-deaths-2022-cdc.html">2.6% increase in suicide deaths from 2021</a>. </p>
<p>Suicide particularly affects younger people – it remains one of the top three causes of death for those between ages 10-34. High school students identifying as lesbian, gay, bisexual, transgender, queer and questioning, or LGBTQ+, attempt suicide <a href="https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/">four times more often than heterosexual students</a>. </p>
<p>These statistics make it clear that far more attention needs to be given to how to talk about suicide, both with loved ones and in medical and other professional settings. </p>
<p>As <a href="https://medicine.fiu.edu/about/faculty-and-staff/profiles/office-of-medical-education/rbonnin.html">a team of experts</a> <a href="https://medicine.fiu.edu/about/faculty-and-staff/profiles/psychiatry-and-behavioral-health/gralnikl.html">who educate medical students</a> <a href="https://medicine.fiu.edu/about/faculty-and-staff/profiles/psychiatry-and-behavioral-health/ndesmara.html">on how to identify</a> and treat suicidal patients, we are well aware that most medical schools <a href="https://doi.org/10.1097/ACM.0000000000004008">do not yet adequately address the topic of suicide</a>. </p>
<p>In turn, many of their students, once they become physicians, are not adequately equipped to identify, assess and refer suicidal patients. Yet, these health care providers are expected to <a href="https://doi.org/10.3389/fmed.2022.892205">play a key role</a> in the battle to prevent suicide. But as the numbers make clear, this approach is not enough.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/DQGrkMYVWng?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The signs of someone considering suicide include giving away possessions and abusing drugs or alcohol.</span></figcaption>
</figure>
<h2>Destigmatizing suicide</h2>
<p>Suicide has a long history of stigma, made worse by how it’s <a href="https://theactionalliance.org/messaging/entertainment-messaging/national-recommendations">portrayed in the media</a>. Often, when someone dies by suicide, the media uses euphemistic phrases such as “no foul play suspected,” rather than clear and accurate language describing the death as a suicide. This type of coded language implies the subject of suicide should not be addressed directly and <a href="https://link.springer.com/chapter/10.1007/978-3-030-26840-4_1">leaves questions about what actually happened</a>. </p>
<p>When a person takes their own life, the phrase <a href="https://www.dailymail.co.uk/news/article-12856353/Emily-Matson-Pennsylvania-suicide-train.html">“committed suicide” is often used</a>, as if it were a sin or a crime. This is partly because, historically, most religions have considered suicide to be sinful and as a result it is <a href="https://doi.org/10.1111/1467-9566.12224">treated as taboo</a>. Although laws against suicide have been <a href="https://ethics.journalism.wisc.edu/2023/03/10/a-guide-to-responsible-reporting-on-suicide/">repealed in the United States and many other places</a>, attempted suicide is still <a href="https://www.law.cornell.edu/wex/suicide">considered a crime in some states</a>. </p>
<p>The verb “commit” in the context of suicide can <a href="https://twitter.com/APStylebook/status/1160941325073731584">suggest a criminal act</a>. In contrast, using language such as “died from suicide” or “took her own life” is less stigmatizing and more neutral, which is why these phrases are <a href="https://www.hse.ie/eng/services/list/4/mental-health-services/nosp/resources/language-and-suicide/">recommended by advocates of mental health</a> as best practices. Consistent with this approach, many media organizations have developed specific guidelines for reporting about suicide. For example, the Associated Press Stylebook recommends <a href="https://www.apstylebook.com/ap_stylebook/suicide">avoiding use of the phrase “committed suicide</a>.” </p>
<p>Similarly – largely because of the societal and historical stigma surrounding suicide, which medical education is not immune to – medical schools do not equip up-and-coming doctors with the language and skills needed to recognize it and properly address it with their patients.</p>
<h2>Shortage of mental health care</h2>
<p>The first point of contact for patients seeking treatment for mental health conditions is usually their primary care physician. About 44% of those who died by suicide worldwide between 2000 and 2017 had visited their primary care provider <a href="https://doi.org/10.1177/1403494817746274">within one month of their death</a>. </p>
<p>This could be due to a combination of factors, including the continued stigma of mental health, <a href="https://theconversation.com/as-the-mental-health-crisis-in-children-and-teens-worsens-the-dire-shortage-of-mental-health-providers-is-preventing-young-people-from-getting-the-help-they-need-207476">limited access to mental health professionals</a> and ease of access to and comfort with their primary care practitioner as a first step. Research shows that gaps between general medical services and specialty mental health options are preventing adults and kids from <a href="https://doi.org/10.1016/j.apnu.2019.08.001">getting the mental health care</a> they need.</p>
<p>In addition, the vast majority of patients with depression are treated by their primary care physicians rather than psychiatrists. </p>
<p>The shortage of available psychiatrists means that primary care physicians provide treatment and prescribe mental health care by default, especially for children, adolescents and geriatric patients. In fact, primary care providers – in other words, practitioners who are not psychiatrists – prescribe more than half of all psychiatric medication. And a 2023 study found that approximately one-third of patients received <a href="https://doi.org/10.1007/s10488-023-01290-x">mental health care from their primary care provider</a>. </p>
<p>Finally, many psychiatrists in private practice do not accept insurance, including Medicare and Medicaid, leading to <a href="https://doi.org/10.1001%2Fjamapsychiatry.2013.2862">reduced availability of psychiatric care</a>. </p>
<p>Thousands of additional lives might be saved if primary care physicians and other practitioners who are not psychiatrists were better trained to ask the vitally important questions about suicide. In addition, better recognition of the warning signs of suicide, readily available psychiatric care and the elimination of stigma of mental illness would facilitate better quality of care. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/SYnhoaiQ4k0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Psychiatry and behavioral health professors Rodolfo Bonnin and Nathaly Shoua-Desmarais talk about the urgent need for suicide education for all doctors, not just psychiatrists.</span></figcaption>
</figure>
<h2>Training the next generation of doctors</h2>
<p>Why do so many Americans take their lives shortly after seeing a primary care provider? </p>
<p>It may be because many doctors are <a href="https://doi.org/10.1027/0227-5910/a000555">unprepared or uncomfortable discussing suicide</a> or don’t pick up on the signs of <a href="https://pubmed.ncbi.nlm.nih.gov/33351435/">suicidal ideation</a>. It’s also possible that the doctors simply don’t have the necessary time to spend with the patients, even when intervention is needed. </p>
<p><a href="https://medicine.fiu.edu/about/departments/psychiatry-and-behavioral-health/">At Florida International University</a>, we train all medical students, beginning in the first year, on how to discuss suicide with patients. This helps to normalize the topic as just another part of their medical training, which, in turn, destigmatizes it. </p>
<p>We then emphasize the need for comfort and familiarity with the topic, as well as the many myths surrounding it. For example, there’s a false belief that asking a patient about suicide will increase the likelihood they will act upon the suicide. <a href="https://doi.org/10.1080/13811118.2020.1793857">Research indicates otherwise</a>. </p>
<p>Finally, students are told that doctors must create a safe environment for their patients to be open about discussing sensitive topics. In short, doctors must ask questions about suicide in a way that’s not pejorative or dismissive. They must not apologize to the patient or shy away from the subject.</p>
<p>Statements like “I’m sorry to have to bring this up” or “I’m sorry if this question seems too personal” can be an indication of discomfort or uneasiness. Instead, doctors should ask direct and specific questions like “Have you had any thoughts about ending your life” or “Are you having any thoughts of suicide?” </p>
<p>After a risk assessment is completed, then a patient would be hospitalized if they are at risk – there is no mandate for doctors to report on or act on depression.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AecNqFk8glo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Suicidal ideation is an emergency.</span></figcaption>
</figure>
<h2>The need for universal suicide screening</h2>
<p>Although universal suicide screening has yet to be made the best practice nationally, there are multiple reasons why a standard screening process would be beneficial. Training in suicide assessment and prevention can be made mandatory for medical license renewal, which would include universal screening practices. </p>
<p>For example, <a href="https://www.pewtrusts.org/en/research-and-analysis/articles/2023/04/19/health-care-providers-laud-universal-screenings-to-help-reduce-suicide-risk">adopting best practices</a> could include offering suicide screening during routine health care visits to identify people at risk who might not otherwise be identified. </p>
<p>Another example: More than half of 15,000 children and adolescents who were seen in a pediatric hospital emergency room for nonpsychiatric reasons between March 18, 2013, and Dec. 31, 2018, were also <a href="https://doi.org/10.1176/appi.ps.202100625">experiencing suicidal ideation and behaviors</a>. These examples emphasize the critical need to train doctors in suicide assessment and prevention. Currently there are fewer than 10 states that <a href="https://www.datocms-assets.com/12810/1577013724-afsphealthprofessionaltrainingissuebrief6-7-19.pdf">require any training on suicide assessment and prevention</a> for doctors to renew their medical license.</p>
<p>In addition, doctors can use empathy, compassion and a nonjudgmental approach, rather than making the patient feel like they are being cross-examined by a lawyer. Interacting empathically leaves the patient feeling more understood and comfortable disclosing sensitive information. </p>
<p>There is a growing movement <a href="https://doi.org/10.1097/ACM.0000000000004008">toward addressing mental health issues</a> in medical schools. Our program prioritizes training a new crop of physicians who will be prepared and motivated <a href="https://doi.org/10.1007/s40596-021-01485-0">to discuss suicide with their patients</a>. </p>
<p><em>If you or someone you know is considering suicide, please <a href="https://988lifeline.org/">call or text 9-8-8 for confidential, free support</a>.</em></p><img src="https://counter.theconversation.com/content/216603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Close to half of those who die by suicide saw a primary care doctor within a month of their death.Rodolfo Bonnin, Assistant Dean for Institutional Knowledge Management and Associate Professor of Psychiatry and Behavioral Health, Florida International UniversityLeonard M. Gralnik, Chief of Education and Associate Professor of Psychiatry and Behavioral Health, Florida International UniversityNathaly Shoua-Desmarais, Assistant Dean for Student Success and Well-Being and Associate Professor of Psychiatry and Behavioral Health, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180792024-01-31T13:35:29Z2024-01-31T13:35:29ZEating disorders are the most lethal mental health conditions – reconnecting with internal body sensations can help reduce self-harm<figure><img src="https://images.theconversation.com/files/572227/original/file-20240130-29-zz41uv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increased disconnect from your body can make it easier to harm yourself, whether by disordered eating or suicide.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/high-angle-view-of-worried-woman-sitting-on-bed-royalty-free-image/1252672806">Maskot/Maskot via Getty Images</a></span></figcaption></figure><p>Did you know that anorexia is the <a href="https://doi.org/10.1002/wps.20904">most lethal mental health condition</a>? One person dies from an eating disorder <a href="https://uncexchanges.org/2020/09/07/every-52-minutes-new-report-released-on-the-social-and-economic-costs-of-eating-disorders-in-the-united-states/">every hour</a> in the U.S. Many of these deaths are not from health consequences related to starvation, but from suicide.</p>
<p>Up to <a href="https://doi.org/10.1001/jamanetworkopen.2019.12925">1 in 5 women and 1 in 7 men</a> in the U.S. will develop an eating disorder by age 40, and <a href="https://doi.org/10.1080/10640266.2023.2196492">1 in 2 people</a> with an eating disorder will think about ending their life. About 1 in 4 people with <a href="https://www.nimh.nih.gov/health/topics/eating-disorders">anorexia nervosa or bulimia nervosa</a> will attempt to kill themselves, and those with anorexia have a risk of death by suicide <a href="https://doi.org/10.1111/j.1600-0447.2010.01641.x">31 times higher</a> than peers without the disorder.</p>
<p>In fact, nonsuicidal self-injury, suicidal ideation, suicide attempts and suicide deaths are <a href="https://doi.org/10.1080/10640266.2023.2196492">all more prevalent</a> among those with any type of eating disorder compared to those without an eating disorder. </p>
<p>Why might that be?</p>
<p>I am a <a href="https://scholar.google.com/citations?user=YZdGYOIAAAAJ&hl=en">clinical psychologist</a> who studies eating disorders and self-harm, and I have spent the past 15 years researching this question. We still don’t have the answer. But new work on perception of the internal state of the body points to some promising possibilities for treatment. And what we’re learning could help anyone improve their relationship with their body.</p>
<h2>Eating disorders and interoception</h2>
<p>To understand why people with eating disorders are at risk of dying by suicide, I first want to ask you to do a little thought exercise. </p>
<p>I’d like you to really think about your body: Think about your hair, face, arms, stomach, chest and legs. What words and feelings come to mind? Are there any things you wish you could change? Feel free to close your eyes and try this out.</p>
<p>I’m guessing as you did this thought exercise, you probably weren’t thinking, “Every part of my body is amazing. Five stars, wouldn’t change a thing!” In fact, many people tend to have pretty <a href="https://theconversation.com/body-image-issues-are-rising-in-men-research-suggests-techniques-to-improve-it-219451">negative and</a> <a href="https://doi.org/10.1002/erv.2201">highly critical thoughts</a> about their bodies.</p>
<p>Here’s another question for you: What do you do with things you don’t like? For instance, what do you do when you encounter someone you dislike, a food you can’t stand or an overwhelming list of chores? Do you care for or accept them? Probably not. Most people tend to avoid, despise or criticize the things they don’t like. This allows them to separate and disconnect themselves from these loathed things.</p>
<p>But when you think negatively about and try to avoid your body, you end up <a href="https://doi.org/10.1016/j.neubiorev.2017.03.017">disconnecting from it</a> and losing the ability to understand what’s going on inside your body. You start to see it not as your body but as an object.</p>
<p>That ability to recognize, interpret and respond to internal signals in your body actually has a name: <a href="https://theconversation.com/interoception-the-sixth-sense-we-use-to-read-hidden-signals-from-our-body-podcast-220863">interoception</a>, also known as the sixth sense. It refers to your ability to recognize, interpret and respond to a variety of bodily sensations, such as emotions, hunger and fullness, temperature and pain. </p>
<p>Interoception can be divided into various components, and <a href="https://doi.org/10.1111/j.1469-8986.1981.tb02486.x">interoceptive accuracy</a>, or how accurately you notice various internal sensations, can be <a href="https://doi.org/10.1016/j.biopsycho.2014.11.004">measured in various ways</a>. These include psychophysiological measures like a heartbeat perception test, which compares a person’s perceived number of heartbeats without taking their pulse to their actual number of heartbeats over a period of time. People with greater discrepancies between their perceived and actual heartbeat counts are thought to be worse at sensing cardiac sensations and thus have worse interoception.</p>
<h2>Interoception and health</h2>
<p><a href="https://www.redslab.org/">My research</a> over the past decade has found that the worse your interoception is, the more disconnected you are from your body and the less aware you are of what’s going on inside it. And the more disconnected you are from your body, the easier it becomes to harm yourself, whether that be through an eating disorder or suicidal behaviors. </p>
<p>Interoception is crucial to understanding and caring for your body. For instance, you need to be able to perceive hunger and fullness in order to properly nourish yourself. If you were unable to perceive pain, you might end up hurting yourself. And you need to be able to understand the emotions you’re feeling in order to respond adaptively to different situations. </p>
<p>Research suggests that interoception is integrally related to mental and physical health, and impaired interoception is considered a <a href="https://doi.org/10.1016/j.bpsc.2017.12.004">risk factor</a> for <a href="https://doi.org/10.1146/annurev-clinpsy-050718-095617">various mental disorders</a>. For example, if you are unable to sense when you’re hungry or full, that could lead to restrictive or binge eating. Conversely, if you are hyperaware of your internal sensations, such as your heart rate and breathing, that could lead to panic disorder symptoms.</p>
<iframe title="Embed Player" width="100%" height="188px" src="https://embed.acast.com/60087127b9687759d637bade/659fc88c9ed21d00167eb672" scrolling="no" frameborder="0" style="border:none;overflow:hidden;"></iframe>
<p>As you lose connection with your body, it becomes easier to harm your body as an object you’ve grown to loathe. Research from my team has found that people who have <a href="https://doi.org/10.1037/abn0000074">attempted suicide</a> have worse interoception than people who haven’t, and people who have <a href="https://doi.org/10.1080/10640266.2018.1418243">attempted suicide multiple times</a> have worse interoception than those who have only attempted suicide once. People with <a href="https://doi.org/10.1111/sltb.12603">more recent</a> <a href="https://doi.org/10.1016/j.psychres.2021.114210">and lethal</a> suicide attempts have worse interoception than those with more distant or less lethal attempts.</p>
<p><a href="https://doi.org/10.1111/sltb.12603">Impairment in interocepton</a> is more strongly associated with suicidal ideation and suicide attempts than other risk factors like hopelessness, gender and post-traumatic stress.</p>
<h2>Reconnecting with the body</h2>
<p>But many people weren’t always this disconnected from their bodies.</p>
<p>I have two young kids who are learning what their bodies can do and are finding their bodies more and more amazing. My 7-year-old son and his friends are delighted when they do gymnastics, standing on one foot or walking across a balance beam. And my daughter, almost 3 now, loves her round tummy: She proudly sticks it out and plays it like a drum. <a href="https://doi.org/10.1016%2Fj.bodyim.2012.09.001">Young kids haven’t yet learned</a> to talk to their bodies in the harsh way many teens and adults do. They haven’t begun to disconnect from their inner senses.</p>
<p>To reduce self-harm, I encourage you to try to regain a sense of connection and care for not only your body but also the bodies of those you love. This isn’t easy, but researchers are studying multiple ways to improve interoception. </p>
<p>For instance, my team has developed a training program to improve interoception called <a href="https://doi.org/10.1111/sltb.12994">Reconnecting to Internal Sensations and Experiences</a>, or RISE. First, we educate participants about interoception and the importance of cultivating awareness of internal sensations for improved mental and physical health. </p>
<p>Then we teach them to bring attention to their muscles through <a href="https://www.healthline.com/health/progressive-muscle-relaxation">progressive muscle relaxation</a> techniques and to <a href="https://theconversation.com/do-you-eat-with-your-eyes-your-gut-or-your-brain-a-neuroscientist-explains-how-to-listen-to-your-hunger-during-the-holidays-217990">hunger and fullness cues</a> through mindful and intuitive eating.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person lying on back with eyes closed" src="https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Relaxing the body can help bring attention to sensation from the muscles.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/power-nap-is-just-what-i-need-royalty-free-image/1187591660">Delmaine Donson/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>After that, we introduce participants to the concept of <a href="https://theconversation.com/8-ways-to-manage-body-image-anxiety-after-lockdown-162224">body functionality</a> by asking them to think of what their bodies can do rather than evaluating their bodies on appearance. For instance, rather than thinking, “I’m getting fat” or “I’m too old” or “I’m too slow,” they can think, “My legs helped get me out of bed today” or “My arms allow me to hug those I love” or “This scar demonstrates my body’s ability to heal.” This is important because body image is <a href="https://doi.org/10.1016/j.bodyim.2019.10.004">linked to multiple aspects</a> of interoceptive awareness.</p>
<p>Finally, we teach participants about recognizing their emotions and changing their behaviors. <a href="https://doi.org/10.1111/j.1467-6494.2011.00717.x">Emotional awareness</a> is a core component of interoception, so we ask participants to think about where they feel those emotions in their body, how they can distinguish between certain emotions, and how they can more effectively respond to stress. </p>
<p><a href="https://www.sapiens.org/culture/kichwa-body-positivity/">Consumer culture</a> doesn’t tend to promote listening to your body, so relearning how to do this may take time and dedicated practice. But I believe the rewards can be literally lifesaving.</p><img src="https://counter.theconversation.com/content/218079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>April Smith receives funding from the Department of Defense and the National Institute of Health. </span></em></p>Many people with eating disorders die from suicide. Improving perception of internal body states, or interoception, can help everyone better care for their own bodies.April Smith, Associate Professor of Psychological Sciences, Auburn UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2192132024-01-24T17:21:11Z2024-01-24T17:21:11ZVan Gogh’s final months were his most productive<p>Though he had spent the previous year at an asylum in Saint-Rémy-de-Provence in the south of France, <a href="https://www.vangoghmuseum.nl/en/art-and-stories/vincents-life-1853-1890">Vincent van Gogh</a> arrived in the village of Auvers-sur-Oise, just north of Paris, in an optimistic mood. It was here, in 1890, that he would spend the last few months of his life which, despite the depression that would soon return, were his most productive.</p>
<p>The move offered him the prospect of a fresh start, close to his brother Theo, and under the watchful eye of Paul Gachet, a homeopathic doctor with an interest in art and mental wellbeing. Over the course of the next two months, Van Gogh produced no fewer than 74 paintings and more than 50 drawings, which are catalogued chronologically by Nienke Bakker, Emmanuel Coquery, Louis van Tilborgh and Teio Meedendorf in their book, <a href="https://thamesandhudson.com/van-gogh-in-auvers-sur-oise-his-final-months-9780500026731">Van Gogh in Auvers-sur-Oise: His Final Months</a>. </p>
<p>As Van Tilborgh observes in the opening essay, Van Gogh’s final works have “a special, almost existential significance” for us. The paintings most closely identified with his final days include the profoundly melancholic <a href="https://artsandculture.google.com/asset/wheatfield-with-crows/dwFdD5AMQfpSew?hl=en-GB">Wheatfield with Crows</a> (Van Gogh Museum, Amsterdam), whose central path leads us through the golden wheat towards an intensely brooding sky. It was here, in the fields above Auvers, that Van Gogh would shoot himself at the age of 37 in July 1890.</p>
<p>As Meedendorf recounts, Van Gogh was initially enchanted by this “distinctive and picturesque” village nestling in the heart of the countryside. Accessible from Paris by train, it remained surprisingly unspoiled, with thatched whitewashed cottages and a distinctive medieval church.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ubTJI_UphPk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>At home in nature</h2>
<p>Unlike previous inhabitants of Auvers, such as the landscape artist and precursor of impressionism, <a href="https://www.nationalgallery.org.uk/artists/charles-francois-daubigny">Charles-François Daubigny</a>, Van Gogh ignored the nearby river Oise. He preferred to record the village, its quaint old buildings merging organically with the landscape and the surrounding vineyards. He also chose surprisingly modern motifs such as the town hall bedecked with flags and bunting on Bastille Day. </p>
<p>Another important subject, explored by Nienke Bakker, was a series of floral still lifes, painted between late May and mid-June 1890. Van Gogh had painted irises and roses as if “in a frenzy” towards the end of his stay at Saint-Rémy and was optimistic that his pictures would find a buyer, despite the fact that they had failed to do so in the past.</p>
<p>He had a preference for wild cornflowers, daisies, poppies, buttercups and thistles, but also painted Chinese asters, carnations and marigolds, blossoming chestnuts and acacia, rendered in rhythmic patterns that dominated the picture space.</p>
<p>Flowers and ears of wheat appear also in his portraits, most memorably in the two of Dr Gachet, leaning on his elbow in a <a href="https://www.theartnewspaper.com/2019/11/15/where-is-the-portrait-of-dr-gachet-the-mysterious-disappearance-of-van-goghs-most-expensive-painting">classic melancholic pose</a> and clutching a sprig of foxglove, which he used in his homeopathic remedies.</p>
<p>Gachet was an important early supporter, not only of Van Gogh, but of the impressionist artists <a href="https://www.camille-pissarro.org/biography.html">Camille Pissarro</a>, who lived at nearby Pontoise, and <a href="https://www.paul-cezanne.org/biography.html">Paul Cézanne</a>, who painted Gachet’s distinctive white house at Auvers.</p>
<h2>The final days</h2>
<p>The book includes a useful map of Auvers-sur-Oise which identifies many of the sites at which Van Gogh set up his easel. One of these is <a href="https://www.theguardian.com/artanddesign/2020/jul/28/location-van-gogh-final-painting-tree-roots-postcard">Tree Roots</a>(Van Gogh Museum, Amsterdam), recently identified as the final work produced by the artist.</p>
<p>It is one of a series of 13 works that were distinctive for their double-square format. As Emmanuel Coquery explains, the format derived from Daubigny, who is referenced in the third canvas in the series, <a href="https://www.vangoghmuseum.nl/en/collection/s0104v1962">Daubigny’s Garden</a> (Rudolf Staechelin Collection).</p>
<p>Daubigny is still celebrated today in the village. His house and studio, decorated by his friend Camille Corot, and also his children, have been preserved for posterity. So, too, has the room at the Auberge Ravoux, in which Van Gogh died on 29 July 1890. </p>
<p>Fittingly, the last two essays in this brilliantly researched and colourfully illustrated book focus on Van Gogh’s final days. Following a visit to Theo in early July, the artist was beset by an extended period of depression, brought on by feelings that he was becoming a burden to his brother.</p>
<p>In his letters he wrote: “My life … is attacked at the very root, my step also is faltering.” He described his latest landscapes as expressions of “sadness, extreme loneliness”. Eventually he shot himself in the chest with a revolver and died in Theo’s arms nearly two days later.</p>
<p>His body was laid to rest in a spacious, sunny plot in the graveyard, close to the wheatfields he loved so much. In 1914, Theo’s remains were transferred to the same ivy-covered grave, remarkable for its simplicity.</p>
<p>As the final essay by Bregje Gerritse and Sara Tas shows, even before his death, Van Gogh was beginning to be appreciated by critics such as Gustave Kahn and Albert Aurier.</p>
<p>He made his only recorded sale when the Belgian artist Anna Boch purchased <a href="https://www.theartnewspaper.com/2022/02/04/how-did-the-only-painting-sold-by-van-gogh-in-his-lifetime-end-up-in-russia">The Red Vineyard</a> (Pushkin State Museum of Fine Arts, Moscow) for 400 francs. Before long he would posthumously achieve the fame and commercial success he had so longed for.</p>
<hr>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>Looking for something good? Cut through the noise with a carefully curated selection of the latest releases, live events and exhibitions, straight to your inbox every fortnight, on Fridays. <a href="https://theconversation.com/uk/newsletters/something-good-156">Sign up here</a>.</em></p>
<hr><img src="https://counter.theconversation.com/content/219213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frances Fowle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite his mental anguish, Van Gogh produced some of his greatest paintings in the last few months of his life.Frances Fowle, Personal Chair of Nineteenth-Century Art, History of Art, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213762024-01-23T16:34:21Z2024-01-23T16:34:21ZPeople with OCD are more likely to die earlier, of any cause<figure><img src="https://images.theconversation.com/files/570860/original/file-20240123-21-eh39uf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7578%2C4263&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/obsessive-compulsive-disorder-arranging-paperclips-row-2025295895">Microgen/Shutterstock</a></span></figcaption></figure><p>People with <a href="https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/">obsessive-compulsive disorder</a>, or OCD for short, are 82% more likely to die earlier – from natural or unnatural causes – than people without the condition, a <a href="https://www.bmj.com/content/384/bmj-2023-077564.full">new study</a> reveals.</p>
<p>Previous studies have found <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2484488">excess deaths</a> in people with OCD, but the specific causes of death had been poorly researched – maybe with the exception of suicide. Notably, people with OCD have <a href="https://www.nature.com/articles/mp2016115">similar suicide rates</a> to people with other mental health disorders.</p>
<p>OCD affects about <a href="https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder">2% of the population</a>. People with the condition have distressing intrusive and repetitive thoughts (such as a fear of being contaminated or becoming aggressive towards others) and feel compelled to perform time-consuming rituals to reduce the discomfort caused by the thoughts, such as cleaning, repeating or checking. </p>
<p>The disorder significantly impairs daily life, affecting relationships, social activities and the general ability to function. </p>
<p>My colleagues and I at the Karolinska Institutet in Sweden <a href="https://www.bmj.com/content/384/bmj-2023-077564.full">aimed to understand</a> the specific natural and unnatural causes of death contributing to the reported elevated mortality rates in OCD. We used Swedish population registers, which include administrative and healthcare data from the whole population, to compare a group of 61,378 people who had received a diagnosis of OCD with 613,780 people without OCD. </p>
<p>We followed both groups for more than four decades (from 1973 to 2020) and found that people with OCD died at an earlier average (mean) age than those without OCD (69 v 78 years). </p>
<p>The risk of death during the study period was 82% higher in the group with OCD, compared to the group without OCD. The increased risk of death was attributable to both natural (31% increased risk) and unnatural causes (230% increased risk).</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1MJVG8kWBbc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">OCD explained.</span></figcaption>
</figure>
<h2>Specific causes</h2>
<p>For the first time, we were able to identify specific causes of death due to natural causes. People with OCD had increased risks due to lung diseases (73%), mental and behavioural disorders (58%), diseases of the urinary and reproductive organs (55%), endocrine, nutritional and metabolic diseases (47%), diseases of the blood vessels (33%), nervous system (21%) and digestive system (20%). </p>
<p>Intriguingly, the risk of death due to cancer was 13% lower in those with OCD. The reason this risk goes in the opposite direction is not known. </p>
<p>Among the unnatural causes of death, suicide was the main contributor to the increased mortality. Those with OCD, compared to those without, had a nearly fivefold increased risk of dying by suicide. Also, people with OCD had a 92% increased risk of dying due to accidents, including traffic accidents or falls. </p>
<p>The results held even after we took mental health disorders other than OCD – for example, anxiety, depression and substance use disorders – into account. </p>
<p>Also, when we compared the OCD group with their siblings without OCD, the results remained largely unchanged. This confirms that our results cannot only be attributed to any accompanying mental health disorders or genetic or environmental factors shared between families, but that are likely to be related to OCD itself. </p>
<h2>Mostly preventable</h2>
<p>Although these are not positive findings for people with OCD, it’s important to note that the proportion of people dying of each cause was relatively small, even if compared with the group without OCD it translated to a higher risk. </p>
<p>For example, during the study period, 2.5% of people with OCD died due to circulatory system diseases (such as heart attacks and strokes), which is a low percentage. Nonetheless, this percentage is higher than the 1.8% of deaths by this cause in the group without OCD. </p>
<p>Even so, it is not acceptable that people with OCD have to face these extra risks. I hope that these results spur healthcare professionals into action and contribute to people with OCD receiving better care. </p>
<p>Importantly, most of the causes of death that showed an increased risk are related to non-communicable diseases (for example, cardiovascular diseases, diabetes, chronic lung diseases, mental disorders, neurological disorders) and to external causes (for example, suicide, accidents), which can be classified as preventable. </p>
<p>People with OCD need to be aware of these risks. This may motivate behavioural changes – such as getting more exercise and having a healthy diet – that can play a role in preventing ill health and early death.</p><img src="https://counter.theconversation.com/content/221376/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:lorena.fernandez.de.la.cruz@ki.se">lorena.fernandez.de.la.cruz@ki.se</a> has received funding from the Swedish Research Council for Health, Working Life and Welfare (FORTE), Region Stockholm (ALF funding), the Swedish Society of Medicine (Svenska Läkaresällskapets), and Karolinska Institutet. She also receives royalties for contributing articles to UpToDate and Wolters Kluwer Health and for editorial work from Elsevier, outside the submitted work.</span></em></p>People with OCD have a 31% increased risk of death from natural causes and a 230% increased risk of death from unnatural causes compared to those without the disorder.Lorena Fernández de la Cruz, Clinical Researcher, Psychiatric Epidemiology, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169802023-12-21T21:37:49Z2023-12-21T21:37:49ZThe Douglas-Bell Canada Brain Bank: a goldmine for research on brain diseases<figure><img src="https://images.theconversation.com/files/557356/original/file-20231005-26-rmh9lm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4000%2C1508&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The experimental methods available today allow us to break the brain down into its elementary components in order to understand its functions and dysfunctions.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Human beings have always been fascinated by the brain. </p>
<p>Although scientific knowledge about this 1.3 kg of fragile substance embedded in our cranium has long been incomplete, dazzling technical breakthroughs made in recent years are now ushering in a Golden Age of molecular neuroscience. </p>
<p>These breakthroughs have been made possible partly thanks to brain banks, which preserve human brains in the best possible conditions for scientific research. Here in Montréal, we have one of the world’s largest such banks, the Douglas-Bell Canada Brain Bank (DBCBB), <a href="https://douglasbrainbank.ca">founded in 1980 at the Douglas Hospital</a>. </p>
<p>The DBCBB, which receives several brains each month, has collected over 3,600 specimens to date. Every year, its team processes dozens of tissue requests from scientists in Québec, Canada and abroad, preparing some 2,000 samples for research. </p>
<p>Over the past 40 years, these efforts have led to a considerable number of discoveries about different neurological and psychiatric diseases. </p>
<p>As a full professor in the department of psychiatry at McGill University, researcher at the Douglas Research Centre and director of the DBCBB since 2007, I work in close collaboration with <a href="https://www.mcgill.ca/psychiatry/gustavo-turecki">Dr. Gustavo Turecki</a>, co-director of the DBCBB and responsible for the component devoted to psychiatric illnesses and suicide.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&rect=14%2C2%2C1535%2C1231&q=45&auto=format&w=1000&fit=clip"><img alt="cerebral hemisphere" src="https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&rect=14%2C2%2C1535%2C1231&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=596&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=596&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=596&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Douglas-Bell Canada Brain Bank, which receives several brains each month, has collected over 3,600 specimens to date.</span>
<span class="attribution"><span class="source">(Naguib Mechawar)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>A brief history of research on the human brain</h2>
<p>Scientists only began to identify the microscopic elements that make up the human brain in the second half of the 19th century. </p>
<p>That was when brains were preserved for the first time in formalin, a solution that preserves biological tissue so that it can be handled more easily and stored over a longer term.</p>
<p>At the same time, precision instruments and protocols were being developed that made it possible to examine the microscopic characteristics of nervous tissue.</p>
<p>Until the middle of the 20th century, researchers were mainly satisfied with preserving the brains of patients, taken during autopsies, so they could use them to identify possible macroscopic or microscopic changes linked to either neurological or psychiatric symptoms.</p>
<p>This is in fact what the German neurologist Alois Alzheimer did when he analyzed the brain of one of his patients suffering from dementia. In 1906, he described, for the first time, the microscopic lesions which characterize the disease that now bears his name.</p>
<p>Until the end of the 1970s, numerous collections of brain specimens preserved in formalin were built in hospital environments, a bit like the cabinets of curiosities of olden days.</p>
<p>Towards the end of the 20th century, new experimental approaches were developed allowing the high-resolution analysis of cells and molecules within biological tissues.</p>
<p>It then became necessary to collect and preserve human brains, obtained with the consent of the individual or his or her family, in conditions compatible with modern scientific techniques.</p>
<p>Researchers began freezing one of the cerebral hemispheres in order to measure its various molecular components. The other hemisphere was preserved in formalin to be used for macroscopic and microscopic anatomical studies.</p>
<p>This was the context in which the Douglas-Bell Canada Brain Bank was created.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The DBCBB premises" src="https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Montréal is home to one of the world’s largest brain banks, the Douglas-Bell Canada Brain Bank, which was founded in 1980 at the Douglas Hospital.</span>
<span class="attribution"><span class="source">(Naguib Mechawar)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>New experimental approaches are yielding results</h2>
<p>Leading researchers from many universities around the world now use DBCBB samples to advance their research. This, of course, includes a number of teams in Québec.</p>
<p>For example, with his team from the Douglas Research Centre, which is affiliated with McGill University, <a href="https://douglas.research.mcgill.ca/judes-poirier/">Judes Poirier</a> discovered that the APOE4 gene is a <a href="https://doi.org/10.1016/0140-6736(93)91705-Q">risk factor for Alzheimer’s disease</a>. More recently, the team of <a href="https://crhmr.ciusss-estmtl.gouv.qc.ca/en/researcher/gilbert-bernier">Gilbert Bernier</a>, professor in the department of neuroscience at Université de Montréal, discovered that the lesions characteristic of this disease are associated with <a href="https://doi.org/10.1038/s41598-018-37444-3">abnormal expression of the BMI1 gene</a>.</p>
<p>With regard to psychiatric illnesses, and more specifically depression, major progress has been made recently by the <a href="https://douglas.research.mcgill.ca/mcgill-group-suicide-studies-mgss/">McGill Group for Suicide Studies</a>. </p>
<p>Using cutting-edge methods to isolate and analyze human brain cells, Turecki’s team has succeeded in precisely identifying the cell types whose function is affected in men <a href="https://doi.org/10.1038/s41593-020-0621-y">who have suffered from major depression</a>, and then discovering that the cell types involved in this illness differ <a href="https://doi.org/10.1038/s41467-023-38530-5">between men and women</a>. </p>
<p>These experimental approaches generate huge data sets that can be examined in subsequent studies. This is the case, for example, of work carried out in my laboratory, which identified signs of persistent changes in neuroplasticity within the prefrontal cortex of people with a history of <a href="https://doi.org/10.1038/s41380-021-01372-y">child abuse</a>. In fact, the studies mentioned above enabled us to discover at least one of the cell types involved in this phenomenon. </p>
<p>In short, the experimental methods we have today allow us to break the brain down into its elementary components in order to understand its functions and dysfunctions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cerebral hemispheres preserved in formalin" src="https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Leading researchers from many universities around the world benefit from Douglas-Bell Canada Brain Bank samples to advance their research.</span>
<span class="attribution"><span class="source">(Naguib Mechawar)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>Identify, prevent, screen and treat</h2>
<p>Thanks to the hard work and dedication of the entire DBCBB team, as well as the unfailing support of all its partners, patrons (often anonymous) and funding bodies — particularly the FRQS research fund and Québec’s suicide research network, the <a href="https://reseausuicide.qc.ca">Réseau québécois sur le suicide, les troubles de l'humeur et les troubles associés</a> — this invaluable resource has not only managed to survive, but to grow and become one of the largest brain banks in the world. </p>
<p>There is every reason to believe that, in the years to come, the DBCBB will play an important role in the increasingly precise identification of the biological causes of brain diseases, and, as a result, will contribute to the identification of new targets for better approaches to prevention, screening and treatment.</p><img src="https://counter.theconversation.com/content/216980/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naguib Mechawar has received funding from CIHR, NSERC, HBHL (CFREF) and FQRS (NEURON ERA-NET and RQSHA).</span></em></p>Montréal is home to one of the world’s largest brain banks, the Douglas-Bell Canada Brain Bank, where discoveries about different neurological and psychiatric diseases are made.Naguib Mechawar, Neurobiologiste, Institut Douglas; Professeur titulaire, Département de psychiatrie, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180222023-12-18T04:17:23Z2023-12-18T04:17:23ZHave we been trying to prevent suicides wrongly all this time?<figure><img src="https://images.theconversation.com/files/564114/original/file-20231207-24-kcxs7w.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-man-treated-by-psychologist-psychiatrist-2188371701">witsarut sakorn/Shutterstock</a></span></figcaption></figure><p>Traditional approaches to preventing suicide have focused on “who is at risk?” The aim is to identify an individual and to help them get support.</p>
<p>But that approach doesn’t seem to be working. Australia’s suicide rates have remained stubbornly high. There was an increase in the rate of suicides from <a href="https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in-australia/suicide-deaths-over-time">2012 to 2022</a>.</p>
<p>We often do not know who is most vulnerable to suicide, and if we do, we struggle to efficiently target resources to them when they need it most. So we need a fresh approach.</p>
<p>Maybe we’ve been asking the wrong question all this time. Rather than asking “who is at risk?” we should also ask “<em>when</em> is a person at risk?” </p>
<p>We know depression <a href="https://theconversation.com/suicide-prevention-takes-more-than-treating-depression-13781">increases</a> suicide risk, but on a given day most depressed people will not consider suicide. We need to know <em>when</em> a person’s risk has risen to help them access support immediately.</p>
<p>Our preliminary research conducted in a Perth psychiatric hospital, and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fabn0000880">published recently</a>, suggests this might be worth pursuing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/focusing-on-people-at-high-risk-of-suicide-has-failed-as-a-suicide-prevention-strategy-104002">Focusing on people at 'high risk' of suicide has failed as a suicide prevention strategy</a>
</strong>
</em>
</p>
<hr>
<h2>What we did</h2>
<p>We conducted a “proof of concept” study involving inpatients at the psychiatric hospital Perth Clinic. Patients were invited to complete questionnaires on iPads in each room. Over more than a decade, more than 20,000 patients participated in the study, resulting in about 350,000 completed questionnaires.</p>
<p>We then examined questionnaire data from 110 inpatients who attempted suicide in the hospital over an average 25-day period. These patients were typically female (78%) and had a diagnosis of major depression or an anxiety disorder. They were 14 to 77 years old.</p>
<p>Of note, nurses had rated roughly half as having “no” to “low risk” of suicide, based on interviews with patients.</p>
<p>We then looked for patterns in the data to see if we could see who and <em>when</em> someone was at increased short-term risk of attempting suicide.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-do-suicide-watch-at-home-202845">How do I do 'suicide watch' at home?</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>We found that on the day of a suicide attempt, a person’s perception they were a <a href="https://psycnet.apa.org/record/2017-47896-001">burden</a> to friends and family increased greatly.</p>
<p>The day before a suicide attempt, patients reported an increased loss of hope in their lives. They perceived they could not change things that mattered to them.</p>
<p>We used this data to develop an algorithm to monitor spikes in these and other key risk factors that may signal increased short-term risk of suicide attempts.</p>
<p>This algorithm, now live in the hospital, alerts staff to at-risk patients to facilitate targeted and immediate interventions when the risk of attempted suicide is at its highest.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">How to ask someone you're worried about if they're thinking of suicide</a>
</strong>
</em>
</p>
<hr>
<h2>How can we apply these findings?</h2>
<p>Key signals we identified as indicators of short-term risk of suicide – perceptions of burden or hopelessness – are often <a href="https://psycnet.apa.org/record/2009-01414-000">not matched by reality</a>. </p>
<p>While people may think they are a burden, their friends and family members disagree. Far from being burdened, those friends and family are the ones who struggle to know how and when to give the assistance they desperately want to provide. Likewise, a <a href="https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2850.2003.00573.x">perception of hopelessness</a> is often transient and doesn’t always reflect reality.</p>
<p>So clinical staff can work with patients to help them re-evaluate these misguided beliefs, and to collaboratively develop coping strategies.</p>
<p>For instance, a core belief of “I am a burden” is replaced by “I wouldn’t think a loved one was a burden if they were suffering.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse comforting patient, one hand on shoulder, one on hand on knee" src="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Clinical staff work with patients to help them re-evaluate their perceptions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-nurse-comforting-senior-man-on-738116425">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-makes-a-good-psychologist-or-psychiatrist-and-how-do-you-find-one-you-like-120981">What makes a good psychologist or psychiatrist and how do you find one you like?</a>
</strong>
</em>
</p>
<hr>
<h2>Where to now?</h2>
<p>The aim now is to trial our approach in a larger number of psychiatric patients, across multiple sites across Australia, to see if this gives staff enough time to intervene and prevent imminent suicides.</p>
<p>We’re also hoping to test our methods in the community. This includes predicting the risk of suicide among school students, and remotely monitoring people at risk of suicide who present to primary care, such as their GP. </p>
<p>For instance, we are working with GPs to extend Perth Clinic’s daily monitoring system to track the symptoms of GP patients between appointments. Through this approach the GPs can monitor the effectiveness of medications or identify periods of heightened risk that can be addressed at future appointments.</p>
<p>Our approach is just one aspect of suicide prevention. We also need to address the complex web of societal, socioeconomic and other factors that contribute to the type of distress we see in people contemplating suicide.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.</em></p><img src="https://counter.theconversation.com/content/218022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Page is a research consultant to Perth Clinic where the research was conducted. The research has been supported by the Australian Research Council's Linkage Scheme where Perth Clinic was the industry partner.</span></em></p><p class="fine-print"><em><span>Michael Kyron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rather than asking ‘who is at risk?’ of suicide we should also ask ‘when is a person at risk?’ Our preliminary research shows this has promise.Michael Kyron, Research Fellow, School of Psychological Science, The University of Western AustraliaAndrew Page, Pro Vice-Chancellor (Research), The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172542023-11-22T18:15:33Z2023-11-22T18:15:33ZMāori suicide rates remain too high – involving whānau more in coronial inquiries should be a priority<p>Rates of suicide in Aotearoa have remained stubbornly high, despite government efforts to address the issue through the <a href="https://www.health.govt.nz/our-work/mental-health-and-addiction/suicide-prevention-new-zealand/suicide-prevention-strategy-and-action-plan">suicide prevention strategy and action plan</a> and other measures. </p>
<p>Aotearoa has one of the <a href="https://mentalhealth.org.nz/suicide-prevention/suicide-statistics">highest youth suicide rates</a> in the OECD, and suicide rates are particularly high for young Māori. So the <a href="https://tewhatuora.shinyapps.io/suicide-web-tool/">latest report</a> from the Office of the Chief Coroner on the annual rates of suicide makes for sobering reading. </p>
<p>While the report shows there has been a slight decrease in the overall number of suspected suicides, the difference in rates between Māori and non-Māori remains a significant concern. </p>
<p>Overall, the suicide rates for Māori are almost twice as high as for non-Māori. For rangatahi Māori (young Māori aged 15 to 24) the suicide rates are almost three times the rates of non-Māori. </p>
<p>These stark differences are an indication of the serious <a href="https://www.tandfonline.com/doi/full/10.1080/07294360.2023.2246404">health and social disparities</a> that continue to exist for Māori.</p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/1177083X.2023.2270007">new research</a> looks at the extent to which coronial investigations met the needs of Māori bereaved by suicide. Through interviews with coroners and an examination of more than 100 full coronial files, we identified gaps in the processes as well as areas where vital improvements can and should be made.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1714902363574501826"}"></div></p>
<h2>Investigating a person’s life and death</h2>
<p>Under the <a href="https://www.legislation.govt.nz/act/public/2006/0038/latest/whole.html">Coroners Act</a>, coroners are charged with determining the causes and contributing factors in sudden unexpected deaths. </p>
<p>In the case of a suspected suicide, a coroner needs to determine, beyond all reasonable doubt, that a person deliberately intended to end their life. </p>
<p>Invariably, coroners rely heavily on documents provided by third parties such as police officers, mental health professionals and witnesses. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nz-mental-health-inquiry-calls-for-fundamental-change-108824">NZ mental health inquiry calls for fundamental change</a>
</strong>
</em>
</p>
<hr>
<p>In about 10% of suicide cases, coroners conduct full courtroom inquests. These provide opportunities for people who knew the deceased to provide evidence about the person who died and their living, work and social circumstances. </p>
<p>Importantly, inquests can generate a form of closure by providing answers to whānau after someone dies suddenly. This process is helped by questioning witnesses and others involved.</p>
<h2>Disconnect between whānau and coroner</h2>
<p>Our research found most whānau who have lost someone by suicide are eager to engage with coronial services – but they don’t always get this opportunity. </p>
<p>Rather, most suspected suicides are determined by an investigation that is referred to as “on papers” or “in chambers”. This streamlined process means coroners usually never meet bereaved whānau and, as a consequence, depend entirely on documentation from third parties when making their determinations. </p>
<p>When coroners communicate with bereaved whānau, it is usually through a coronial case manager who acts as a conduit between the two parties. Since coroners hardly ever meet with whānau in person, they rely heavily on case managers collecting the information needed to make a decision. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/auckland-is-the-worlds-most-liveable-city-many-maori-might-disagree-162503">Auckland is the world's 'most liveable city'? Many Māori might disagree</a>
</strong>
</em>
</p>
<hr>
<p>On occasion, a coroner will ask a police officer to meet with the bereaved whānau to obtain relevant information. But for some whānau, this can be traumatising, especially for those who have had negative interactions with police in the past.</p>
<p>There is also a great deal of variation in how much information is gathered by coroners to make their determination.</p>
<p>Some of the files we examined were large and contained copious amounts of information about the person who had died. Others were very slim and contained only minimal information about the deceased person. </p>
<p>Regardless of size, all files contained letters addressed to whānau which notified whānau that an inquiry had begun. These letters outlined their rights as bereaved next of kin. Whānau could, for example, request that a courtroom inquest be held. But this request needed to be made quickly. </p>
<p>Bereaved whānau were often presented with this information at times of high stress and trauma. And much of the information was couched in formal legal terms, compounding the challenges of dealing with the sudden death of their loved one.</p>
<h2>Whānau need wraparound support</h2>
<p>Our research made it clear there is an opportunity to provide better wraparound support for families going through the coronial process. This includes informing whānau of their rights in lay terms so they are able to understand what is happening.</p>
<p>Whānau should also be given the chance to add to the data collected by the coronial process, be able to describe the situation of the deceased at the time, and question those who had provided services to their whānau member, especially in the time leading up to the death. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-taking-the-government-to-court-to-challenge-new-zealands-outdated-mental-health-act-heres-why-191166">We're taking the government to court to challenge New Zealand’s outdated Mental Health Act – here's why</a>
</strong>
</em>
</p>
<hr>
<p>For whānau, being listened to and participating in the inquiry is a critical aspect of therapeutic jurisprudence which in turn will provide better data. </p>
<p>And for government agencies and the wider community, a deeper understanding of the circumstances surrounding suicides would be valuable in developing effective suicide prevention policies. </p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 0800 543 354 (New Zealand) or 13 11 14 (Australia).</em></p>
<hr><img src="https://counter.theconversation.com/content/217254/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clive Aspin receives funding from the Health Research Council of New Zealand. </span></em></p><p class="fine-print"><em><span>Gabrielle Jenkin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Allowing whānau to be more engaged in the coronial investigation into a suicide would help provide answers for family – and help mental health services improve preventative measures.Clive Aspin, Associate Professor of Health, Te Herenga Waka — Victoria University of WellingtonGabrielle Jenkin, Director Suicide and Mental Health Research Group University of Otago Wellington, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2111072023-10-05T03:16:20Z2023-10-05T03:16:20ZSuicide rates increased after extreme drought in the Murray-Darling Basin – we have to do better as climate change intensifies<p>The <a href="https://www.nature.com/articles/s41558-018-0102-4">impact on mental health of weather extremes</a> such as drought is a growing concern due to climate change.</p>
<p>Rural communities feel the impact of drought much more than urban residents. Our <a href="https://www.worldscientific.com/doi/full/10.1142/S2010007823500240">new research</a> looks at the link between drought and suicide rates in one of Australia’s biggest farming areas, the Murray-Darling Basin. </p>
<p>Drawing on monthly data from 2006 to 2016, our findings were alarming. We found, for instance, that one more month of extreme drought in the previous 12 months was strongly associated with a 32% increase in monthly suicide rates. </p>
<p>Climate change is <a href="https://www.ipcc.ch/report/ar6/wg1/">predicted</a> to bring more heat and <a href="https://publications.csiro.au/publications/publication/PIcsiro:EP201750">longer, more extreme droughts</a>. More effective approaches will be needed to prevent suicides in affected regions. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1541420049952415744"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drought-increases-rural-suicide-and-climate-change-will-make-drought-worse-185392">Drought increases rural suicide, and climate change will make drought worse</a>
</strong>
</em>
</p>
<hr>
<h2>Drought hits rural areas hardest</h2>
<p>Droughts induce <a href="https://www.pnas.org/doi/full/10.1073/pnas.1801528115">post-traumatic stress disorder, anxiety and depression</a>. Hotter temperatures can also <a href="https://www.bcm.edu/news/excessive-heat-and-its-impact-on-mental-health#:%7E:text=Heat%20alters%20those%20behaviors%20because,levels%20of%20stress%20and%20fatigue.">reduce levels of the brain chemical serotonin</a>. This has negative effects on the <a href="https://link.springer.com/article/10.1007/s11356-019-05252-5">central nervous system and moods</a>. </p>
<p>In Australia, suicide is a <a href="https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release#key-statistics">leading cause of death</a> – especially for people aged 18-44. And the suicide rate in remote areas is <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MentalHealthServices/Report">almost double that of major cities</a>. This is because drought can:</p>
<ul>
<li><a href="https://www.jstor.org/stable/24721393">reduce agricultural production</a><br></li>
<li><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-8489.12218">increase financial hardship</a></li>
<li><a href="https://journals.sagepub.com/doi/10.1080/10398560701701288">degrade the environment</a> </li>
<li><a href="https://www.nature.com/articles/s41558-018-0102-4">reduce employment</a>. </li>
</ul>
<p><a href="https://www.nature.com/articles/s41558-018-0222-x">Research overseas</a> found suicide rates rise with higher average temperatures. In Australia, a study found some evidence linking <a href="https://www.pnas.org/doi/full/10.1073/pnas.1112965109">drought and suicide</a> in New South Wales. However, a <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1440-1584.2011.01244.x?saml_referrer">Victorian study</a> found no significant association.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bushfires-drought-covid-why-rural-australians-mental-health-is-taking-a-battering-148724">Bushfires, drought, COVID: why rural Australians' mental health is taking a battering</a>
</strong>
</em>
</p>
<hr>
<h2>What happened in the basin?</h2>
<p><a href="https://www.worldscientific.com/doi/full/10.1142/S2010007823500240">Our study</a> looked at the Murray-Darling Basin. The region went through one of the worst droughts on record, the Millennium Drought, over the past couple of decades. </p>
<p>We analysed local area monthly data from 2006-16. We wanted to see whether worsening drought and heat were linked to higher monthly suicide rates, by examining differing types of droughts (moderate to extreme). </p>
<p>The map below shows the average suicide rate for 2006-2016 in local areas across the basin. Male suicide rates were over three times female rates.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541610/original/file-20230808-19-kenxlv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Average suicide rate per 100,000 by local area in the Murray Darling Basin.</span>
<span class="attribution"><a class="source" href="https://www.worldscientific.com/doi/full/10.1142/S2010007823500240">Source: Xu et al (2023) using data from National Cause of Death Unit Record File from Australian Coordinating Registry (2006-2016) and ABS Population Census, 2006, 2011, 2016</a></span>
</figcaption>
</figure>
<p>We sought to control for as many local area characteristics as possible. Our modelling included unemployment, income, education, proportion of farmers, proportion of Indigenous people, health professionals, green space and various climate and drought variables. We modelled suicide rates for different age and gender sub-groups. </p>
<p>Key findings include:</p>
<ul>
<li>one more month of extreme drought in the previous 12 months was strongly associated with the total suicide rate increasing by 32%</li>
<li>one more month of moderate drought in the previous 12 months was very weakly associated with a 2% increase in the suicide rate</li>
<li>a 1°C increase in average monthly maximum temperature in the previous 12 months was associated with up to an 8% increase in the suicide rate </li>
<li>in males and younger age groups, suicide rates are more strongly associated with extreme drought and higher temperatures</li>
<li>a higher proportion of farmers in a local area was associated with an increased suicide rate </li>
<li>a higher proportion of First Nations people in a local area was also associated with higher suicide rates</li>
<li>more green space was significantly associated with moderating impacts of both extreme drought and temperature on suicide rates</li>
<li>an increase in average annual household income moderated the relationship between higher temperature and suicide.</li>
</ul>
<p>Our results suggest the association between moderate drought and suicide rates is significant but the effect was small. As the drought becomes extreme, suicide rates increase significantly. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-findings-show-a-direct-causal-relationship-between-unemployment-and-suicide-209486">New findings show a direct causal relationship between unemployment and suicide</a>
</strong>
</em>
</p>
<hr>
<h2>What can we do better to prevent suicides?</h2>
<p>Given drought’s impact on farm production and finances, mental health will clearly get worse in rural areas if the impacts of climate change are not better managed. </p>
<p>Mental health interventions to prevent suicide in <a href="https://www.mdpi.com/1660-4601/19/13/7855">rural areas</a> are different from what’s needed in urban areas. Areas in the basin with higher percentages of farmers and First Nations people were hot spots. These areas may need special intervention. </p>
<p>Many have emphasised the need for a <a href="https://www.blackdoginstitute.org.au/wp-content/uploads/2021/05/The-National-Suicide-Prevention-Trials-Insights-and-Impact_Jan-2021-V3.pdf">systems approach to suicide prevention</a>. Actions need to be multifaceted and co-ordinated as well as possible. One intervention or approach is not enough. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1399143601125433346"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hairdressers-in-rural-australia-end-up-being-counsellors-too-70275">Hairdressers in rural Australia end up being counsellors too</a>
</strong>
</em>
</p>
<hr>
<p>Interventions in the bush range from telehealth and medical services to <a href="https://www.health.gov.au/our-work/aboriginal-and-torres-strait-islander-mental-health-program">primary health networks services</a>, <a href="https://mensshed.org/">men’s sheds</a> and drought counselling. </p>
<p>The relationship between <a href="https://www.mja.com.au/journal/2018/209/4/drought-related-stress-among-farmers-findings-australian-rural-mental-health">drought and financial hardship</a> seems to be key in farming areas. This points to the need for other forms of income on the farm, including from native vegetation and carbon credits. Work can also be done to promote drought preparedness, increase appropriate regional economic, social development and environmental policies and – where necessary – help people leave farming. </p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/211107/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Ann Wheeler has received funding from the Australian Research Council; GRDC; Wine Australia; MDBA; CRC Food Waste; CSIRO; Goyder Institute; SA Department of Environment and Water; ACCC; NT Department of Environment, Parks and Water Security; NSW Health; Commonwealth Department of Agriculture and Water; Meat and Livestock Australia; ACIAR; RIRDC; UNECE; NCCARF; National Water Commission; and the Government of Netherlands.</span></em></p><p class="fine-print"><em><span>Alec Zuo receives funding from the Australian Research Council, GRDC, ACCC, NSW Health, Department of Agriculture, Fisheries and Forestry, ACIAR, NCCARF, and the National Water Commission.</span></em></p><p class="fine-print"><em><span>Ying Xu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Suicide rates jumped in the Murray Darling Basin following extreme drought and hotter temperatures, a new study shows. The findings highlight the need for action to manage climate change impacts.Sarah Ann Wheeler, Professor in Water Economics, University of AdelaideAlec Zuo, Associate Professor, School of Economics and Public Policy, University of AdelaideYing Xu, Research Fellow, School of Economics and Public Policy, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118022023-09-26T14:03:09Z2023-09-26T14:03:09ZTyson Fury’s Netflix series highlights the mental health challenges faced by Gypsy, Roma and Traveller communities<p>The Netflix documentary series, <a href="https://www.netflix.com/gb/title/81615144">At Home With The Furys</a>, provides a fascinating look at the day to day life of Tyson Fury, family man and heavyweight boxing world champion. </p>
<p>A particular source of pride for Tyson is his heritage as a member of the Traveller community, his boxing moniker being “The Gypsy King”. Yet despite the glitz and glamour that comes with being a millionaire celebrity, Fury has had his internal, as well as external, battles to fight. These include a long history of anxiety and depression, bipolar disorder, substance abuse and suicidal thoughts. </p>
<p>Mental health issues within Gypsy, Roma and Traveller (GRT) communities have long been described as being at <a href="https://www.lenus.ie/handle/10147/111897">crisis point</a> due to a combination of complex factors that are not fully understood because of a <a href="https://www.cambridge.org/core/journals/irish-journal-of-psychological-medicine/article/rapid-review-of-irishtraveller-mental-health-and-suicide-a-psychosocial-and-anthropological-%20perspective/D15DCA7BC128965514E1476C065756E9">lack of research</a>. Indeed, GRT communities are among the most socially and economically <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/educationandchildcare/bulletins/gypsiesandtravellerslivedexperienceseducationandemploymentenglandandwales/2022">disadvantaged</a> groups in the UK and Republic of Ireland. </p>
<p>It is a situation which impacts housing, education, employment, and crucially, mental health and access to healthcare. But we don’t know enough about what the causes are or how to stop them from happening.</p>
<p>My team and I conducted <a href="https://www.researchgate.net/publication/355046420_Mental_Health_Support_Needs_Within_Gypsy_Roma_and_Traveller_Communities_A_Qualitative_Study_PDF_Proof">a study</a> on the mental health support needs of people from GRT communities. We interviewed nine people from across the UK about their mental health and their experiences with getting support: four women, four men and one non-binary individual. </p>
<p>Three main themes emerged from our interviews:</p>
<p><strong>1. Longing for acceptance</strong></p>
<p>This related to a feeling of being ostracised from wider society. One participant said: “We face a lot of racism and discrimination in our daily lives which affects our mental health. And also that even with medical professionals, there is internal racism and discrimination.” </p>
<p><strong>2. Increased vulnerability</strong></p>
<p>This theme related to the impact of economic deprivation, lack of educational prospects and future goals, as well as adverse life experiences. </p>
<p>Focusing on education, one person told us: “There’s a lot of people who think ‘it’s too late you know, my dad never went to school, his dad never went to school, I went for a bit and then I got bullied and then I didn’t go. So what am I going to do?’ There’s lots of people that feel proper stuck.” </p>
<p>The combination of economic deprivation and lack of educational prospects makes members of GRT communities more vulnerable to mental ill health. </p>
<p><strong>3. Barriers to seeking help</strong></p>
<p>The barriers to seeking help for poor mental health highlighted by our interviews were perhaps the most telling sign of a crisis in this community. We identified issues in terms of awareness of mental health support services, especially the challenges of knowing what support is available while travelling. </p>
<p>The unsuitability of services was another issue. One participant described the difficulties of even accessing emergency help: “An ambulance won’t actually come to the [Traveller] site until they have a police escort, and you are suicidal, and they treat you as if you’re a criminal and you might actually attack them.”</p>
<p>Stigmas surrounding mental health issues also cropped up. “My mother and my brother are very, very uncomfortable with me discussing my issues and they basically, they don’t acknowledge it and they don’t want to talk about it,” one person told us. </p>
<p>Participants described their lack of trust in support services too. One person said: “It’s a real driven, fear-based thing why a lot of the time we don’t access those things. It’s like a discrimination thing that’s gone down and a fear of like actual services coming and taking your kids. If you reach out with your mental health, that mental health issue may be used as a reason for taking away your children or involving social services.” </p>
<p>All of these factors negatively impacted the mental health of members of the GRT communities and prevented engagement with relevant support services. </p>
<p>Our research illustrates the importance of providing services to Gypsy, Roma and Traveller people with the cultural understanding, knowledge and resources to support them. A starting point for such an initiative would be an in-depth investigation of the psychological, social, environmental and institutional factors that make this community vulnerable and disadvantaged in their mental health care. </p>
<p>Building trust within these communities is also vital to improving their engagement with services. Dedicated outreach teams, alongside easier access to mainstream services, may be an effective method for achieving this. </p>
<p>The courage shown by Tyson Fury in discussing his mental health battles sets an example for other Gypsy, Roma and Traveller people to show that it is not a sign of weakness to experience mental ill health, and that support is beneficial and available for anyone in need.</p><img src="https://counter.theconversation.com/content/211802/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Tyson wishes to thank Rebecca Thompson for her invaluable contribution to this research, particularly in terms of interviewing members of the GRT community. He would also like to thank Bridie Stone for her assistance in writing the journal article.</span></em></p>Tyson Fury has a history of mental ill health, something which is reflected in his series, At Home With The Furys on Netflix.Philip Tyson, Associate Professor of Psychology, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134122023-09-20T13:20:17Z2023-09-20T13:20:17ZSuicide in Ghana: society expects men to be providers – new study explores this pressure<p>Suicide is a complex behaviour that is widely regarded as a significant public health issue across the globe. It is influenced by psychiatric, psychological, biological, social, cultural, economic and existential factors. In most countries, the rate of male suicides is between <a href="https://journals.sagepub.com/doi/pdf/10.1177/0706743718766052">3 and 7.5 times</a> higher than that of females even though suicide ideation (thoughts) and attempts are <a href="https://www.who.int/publications/i/item/9789241564779">more frequent</a> for females. </p>
<p>The World Health Organization <a href="https://www.worldlifeexpectancy.com/ghana-suicide">reported</a> in 2020 that approximately 1,993 suicides occurred in Ghana annually. A report in Ghana on suicide attempt trends over four years also <a href="https://www.ug.edu.gh/news/prof-akotia-advocates-change-attitudes-towards-suicide">revealed</a> that 707 suicide attempts occurred in 2018, 880 in 2019, 777 in 2020 and 417 as of June 2021. </p>
<p>Studies continue to reveal a disproportionately high number of males in both suicide and attempted suicide in Ghana. Suicidal behaviour in Ghana is a predominantly <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953610007471?via%3Dihub">male problem</a> – which is one reason it’s of interest to me as a <a href="https://www.researchgate.net/profile/Johnny-Andoh-Arthur">psychologist who studies</a> men’s mental health. </p>
<p>I undertook a <a href="https://www.tandfonline.com/doi/full/10.1080/17482631.2023.2225935">study</a> that focused on the way loss of job and income influenced relationships with close family members prior to suicide. This is not to suggest that loss of income or job is the only cause of men’s suicide in Ghana. Other <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953610007471?via%3Dihub">studies</a> have highlighted chronic illness, substance use, interpersonal conflict and loss, marital challenges, economic difficulties, perceived shame, and mental illness as other contributing factors. </p>
<p>My study used a qualitative research approach, interviewing 21 close relatives and friends of nine men who had all suffered some economic challenges in ways that affected their relationships with family members. All nine had died by suicide. </p>
<p>Even though these men lived in social settings that valued mutual support and reciprocal obligations, some of them suffered abandonment during their economic difficulties. Even those who could depend on spouses in their situation appeared to find that dependency emasculating.</p>
<h2>Men and suicide</h2>
<p>The term <a href="https://pubmed.ncbi.nlm.nih.gov/9560163/">gender paradox</a> in relation to suicide describes the observation where females have higher rates of suicidal thoughts and behaviour than males, yet mortality from suicide is typically lower for females compared to males.</p>
<p>Biologically, it is suggested that <a href="https://my.clevelandclinic.org/health/articles/24101-testosterone">testosterone</a>, which is linked to impulsivity and aggression, is about ten times higher in males than in females. Thus the likelihood for males to engage in risky behaviours including aggression towards themselves is linked to high testosterone levels. </p>
<p>The high male suicide rate is also connected to gender stereotypes and <a href="https://www.psychiatrist.com/jcp/depression/suicide/suicide-men/">role socialisation</a>. Society expects certain things of men. </p>
<p>The patriarchal nature of most societies in Africa makes being economically independent a key social expectation of being a man. Men are expected to be employed, with a regular income, and to start a family. </p>
<h2>Family support in Ghana</h2>
<p>My study highlighted Ghana’s extended family system. This system encourages support and care for one another, belonging and seeking help in times of adversity. The study found that the deceased men had perceived being a burden, loss of respect, social abandonment and anxiety when faced with crises like job losses and financial difficulties. The relative of one of the deceased stated:</p>
<blockquote>
<p>I even got angry the day this incident (suicide) happened. People even said we have been starving him, etc, etc. For Christ sake, he was 27 years. Must I keep on taking care of him? </p>
</blockquote>
<p>A friend of another deceased person said:</p>
<blockquote>
<p>His relatives visited him a lot when he was doing well in business but they stopped visiting when his problems started. </p>
</blockquote>
<p>Thus a dysfunctional, transactional social system existed around them. The implicit rule appeared to be that the victims were as valuable as their ability to provide for others and be economically independent.</p>
<p>The finding aligns with an earlier <a href="https://link.springer.com/chapter/10.1007/978-3-030-47852-0_10">study</a> in Ghana that shows that the motivation for male suicides is not that men seek to reject their social responsibilities. Instead, </p>
<blockquote>
<p>it is an intense sense of personal responsibility towards meeting prescribed social norms and roles associated with gender. </p>
</blockquote>
<p>My study also found that even though it was possible for some of the men to depend on their wealthier wives during economic difficulty, doing so created distress. Depending on their wives and seeing them assume hitherto <a href="https://theconversation.com/women-occupy-very-few-academic-jobs-in-ghana-culture-and-societys-expectations-are-to-blame-200307">“male” roles</a> were seen as emasculating. </p>
<p>A spouse illustrated:</p>
<blockquote>
<p>He felt that due to the problems he was going through, there were some responsibilities I was not supposed to do as a wife that I was doing and all of those thing got him worried. </p>
</blockquote>
<p>Where they were intent to live as <a href="https://theconversation.com/death-and-mourning-in-ghana-how-gender-shapes-the-rituals-of-the-akan-people-212398">benevolent patriachs</a> in line with internalised masculine codes, their economic predicament constrained the men’s social roles and created distress. </p>
<p>As another spouse explained:</p>
<blockquote>
<p>Things were not going so well with his job, it got to the extent that he could not help people the way he wanted to, and he was worried. </p>
</blockquote>
<h2>Men as providers</h2>
<p>The findings of this study highlight the patriachal system that defines men partly in terms of their capacity to provide materially for others. Men who strictly adhere to such <a href="https://theconversation.com/how-parenting-in-ghana-shapes-sexist-stereotypes-51823">male norms</a> may struggle to adjust when they have to depend on others, including their spouses. The extended family system should support such men emotionally and materially, but some family members chose to abandon them. </p>
<p>Public education is vital to change unhealthy gender norms that affect men in social and economic adversity. It will enable men to learn effective ways of coping and alternative <a href="https://theconversation.com/young-fathers-in-ghana-are-expanding-the-meaning-of-manhood-153807">ways of being men</a>. Education will also help change societal notions of who a man is and foster more support in times of adversity.</p><img src="https://counter.theconversation.com/content/213412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Johnny Andoh-Arthur does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Suicide in Ghana is regarded as taboo for most families.Johnny Andoh-Arthur, Senior Lecturer, Psychology, University of GhanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2097712023-08-17T12:35:12Z2023-08-17T12:35:12ZPotentially faulty data spotted in surveys of drug use and other behaviors among LGBQ youth<figure><img src="https://images.theconversation.com/files/541296/original/file-20230804-26-63jilc.jpg?ixlib=rb-1.1.0&rect=202%2C166%2C7737%2C5130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new study found that youth were providing extreme or untruthful responses to CDC surveys on LGBQ student health. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-hands-of-a-student-taking-a-test-royalty-free-image/1305362771?phrase=students+taking+a+survey&adppopup=true">FG Trade/E+ via Getty Images</a></span></figcaption></figure><p>Federal data on LGBQ student health <a href="https://doi.org/10.1111/cdev.13957">contain a significant amount of potentially exaggerated or untruthful responses</a>, raising questions about how they might skew people’s understanding of risky behavior among teens. These inaccuracies affect some responses more than others. That’s according to an analysis my colleagues and I did of high school surveys administered by the Centers for Disease Control and Prevention, better known as the CDC.</p>
<p>Without accounting for this invalid data, the CDC results suggest that for every heterosexual boy who uses steroids, three LGBQ boys use steroids. After accounting for the invalid data, neither group is shown to use steroids more. In contrast, disparities for being bullied or considering suicide were not affected by potentially invalid data.</p>
<p>Over 12,800 high school students during the 2018-2019 school year reported whether they identified as LGBQ – that is, lesbian, gay, bisexual or questioning – or heterosexual on the national <a href="https://www.cdc.gov/healthyyouth/data/yrbs/data.htm">Youth Risk Behavior Survey</a>. They also responded to items related to their health and well-being. </p>
<p>We first estimated what the risk disparities between LGBQ and heterosexual youth were before accounting for potentially invalid data. We then used a machine-learning algorithm to detect response patterns that suggested when youth were providing extreme or untruthful responses.</p>
<p>For example, we treated their responses with suspicion if they reported eating carrots four or more times every day and said they were impossibly tall. That means we gave less weight to their responses when we re-estimated all of the disparities. We then saw how the disparities changed after the potentially invalid responses were taken into account.</p>
<p>After accounting for invalid data, disparities in drug use – including steroids – injected drugs, cocaine, ecstasy and pain medication without a prescription were not as pronounced. LGBQ boys appeared to use injected drugs four times as often as heterosexual boys. But after accounting for the likely invalid data, neither group was more likely to use injected drugs. </p>
<p>Yet, while some outcomes were susceptible to invalid data, others were not. For example, LGBQ boys and girls were about twice as likely to be bullied at school and two to three times as likely to consider suicide. This shows that not all outcomes are equally affected by invalid data. </p>
<h2>Why it matters</h2>
<p>The Youth Risk Behavior Survey provides vital information on the health and behaviors of high school students. It informs research regarding <a href="https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm">teen sexual behaviors, drug use and suicide risk</a>.</p>
<p><a href="https://doi.org/10.1111/cdev.13957">Our study</a> and others using different methods to account for invalid data <a href="https://doi.org/10.3102/0013189X11422112">consistently</a> <a href="https://doi.org/10.2105/AJPH.2018.304407">find</a> <a href="https://doi.org/10.1177/2332858419888892">that</a> LGBQ students are at a much higher risk for being bullied and for suicide, consistent with <a href="https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm">CDC reports</a> on these outcomes. </p>
<p>It is critical to address the <a href="https://www.aclu.org/legislative-attacks-on-lgbtq-rights">ongoing stigmatization that LGBTQ+ people face</a> to reduce these mental health disparities. Yet, when researchers don’t check for invalid data, they might conclude that other differences are larger and more deserving of attention and resources than they are.</p>
<p>Policymakers and researchers must ensure that large-scale data collection efforts have safeguards for data quality.</p>
<p>We asked the CDC for a comment on our study’s findings. In response, they directed our attention to an <a href="https://www.cdc.gov/healthyyouth/data/yrbs/faq.htm">FAQ page</a> that discussed validity and reliability in a general sense. The CDC’s response did not specifically address the issue of how invalid data can have a disproportionate effect on minorities, which is a significant concern raised by our research.</p>
<h2>What other research is being done</h2>
<p>Other studies have found that invalid data can disproportionately influence <a href="https://doi.org/10.1111/cdev.13957">low-incidence outcomes like heroin use</a> and <a href="https://doi.org/10.1037/abn0000479">minority populations</a>, including <a href="https://doi.org/10.1300/J145v06n02_02">adoptees</a>, <a href="https://doi.org/10.1177/152822X06289161">disabled</a> <a href="https://doi.org/10.3102/0013189X14534297">individuals</a>, <a href="https://doi.org/10.1037/a0024824">racial or ethnic minorities</a>, <a href="https://doi.org/10.1177/152822X06289161">immigrants</a> and <a href="https://doi.org/10.3102/0013189X14534297">transgender individuals</a>.</p>
<p>Moreover, the issue of invalid data is not confined to youth surveys. Studies examining <a href="https://doi.org/10.1371/journal.pone.0287837">public health behaviors</a> during the COVID-19 pandemic and surveys on <a href="https://doi.org/10.1177/1948550617698203">sexual orientation among adults</a> have also encountered invalid responses, raising further questions about their accuracy.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p><img src="https://counter.theconversation.com/content/209771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Cimpian receives funding from the U.S. Department of Education Institute of Education Sciences and the National Science Foundation.</span></em></p>Potential inaccuracies in CDC high school surveys may have created an exaggerated perception that LGBQ youth engage in risky behaviors, new research shows.Joseph Cimpian, Professor of Economics and Education Policy, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2100302023-08-14T12:22:31Z2023-08-14T12:22:31ZDiscrimination took a heavy toll on Asian American students during the pandemic<figure><img src="https://images.theconversation.com/files/541293/original/file-20230804-15-4umspr.jpg?ixlib=rb-1.1.0&rect=60%2C112%2C5691%2C3716&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One study has found that only 20% of Asian college students diagnosed with a mental health disorder receive treatment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-people-seriously-sketching-royalty-free-image/1015155046?phrase=asian+college+students&adppopup=true">Ishii Koji/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Experiencing discrimination <a href="https://doi.org/10.1016/j.jadohealth.2023.04.016">significantly harmed the well-being of Asian and Asian American college students</a> in the U.S. during the first wave of the COVID-19 pandemic. </p>
<p>That’s the key finding of our study, which compared over 6,000 survey responses from Asian and Asian American students who took the <a href="https://www.acha.org/ncha">National College Health Assessment</a> – an annual survey of student health behaviors – in the fall of 2019 and the fall of 2020. Our study focused only on Asians and Asian Americans. Others have found that both <a href="https://doi.org/10.2105/AJPH.2021.306594">Asian and Native American ethnic groups</a> experienced the highest rates of COVID-19-related discrimination.</p>
<p>We found that Asian and Asian American students experienced high levels of stressors during the COVID-19 pandemic. By fall 2020, 9% had a loved one who had died from COVID-19, 7% reported experiencing discriminatory behavior because of the pandemic, and 61% had pandemic-related financial stress. Compared with 2019, Asian students in 2020 reported significantly more insomnia and psychological distress. </p>
<p>We then determined what factors most accounted for students’ poor mental health. We also tested whether the impact of these factors changed with the stressors of the pandemic. </p>
<p>In 2019, <a href="https://doi.org/10.1016/j.jadohealth.2023.04.016">11 factors were significant predictors of suicidality</a> – that is, thoughts of suicide and attempts – in Asian students. Some of these factors are variables mental health professionals know to screen for: diagnosed depression, loneliness, and higher alcohol and drug use. But we found other significant predictors of suicidality – food insecurity, hours of screen time and experiencing discrimination – that are not often assessed in health settings. We also found variables that protected mental health. These included sleeping well, exercising and spending time with loved ones. </p>
<p>In 2020, only three factors were significant predictors of suicide – depression, loneliness and discrimination. The impact that experiencing discrimination had on suicidality also almost doubled, and there were no longer any significant protective factors. </p>
<h2>Why it matters</h2>
<p>We wanted to understand the experiences of Asian and Asian American students for two reasons. First, Asian college students are the racial group with the greatest unmet mental health need. Only <a href="https://doi.org/10.1016/j.jadohealth.2018.04.014">20% of Asian college students diagnosed with a mental health disorder receive treatment</a>, compared with 40% of students overall. </p>
<p>Second, in 2020 there was a <a href="https://doi.org/10.1177/08862605221107056">sharp increase</a> in anti-Asian hate incidents. For example, the nonprofit Stop AAPI Hate, which tracks incidents of hate and discrimination against Asian Americans, saw a jump in reported incidents from about 3,800 annually before the pandemic <a href="https://stopaapihate.org/wp-content/uploads/2021/05/Stop-AAPI-Hate-Report-National-210506.pdf">to over 6,600</a> after the first year of the pandemic. </p>
<p>These incidents came at a time when <a href="https://www.businessinsider.com/anti-defamation-league-study-donald-trump-anti-asian-hate-speech-2021-3">former President Trump</a> was associating COVID-19 with Asians by calling it “the China virus” or “kung flu.” </p>
<p>From 2016 to 2020, suicide was the <a href="https://www.newportinstitute.com/resources/mental-health/asian-american-mental-health/#:%7E:text=Statistics%20from%20the%20CDC%20show,Asian%20Americans%20aged%2020%E2%80%9324.">leading cause of death</a> among Asian adolescents. To reduce deaths from suicide, researchers must first understand what individual factors increase or decrease its likelihood. </p>
<p>Our research shows that experiencing loneliness and discrimination significantly harmed Asian students’ mental health. This finding is true in typical years, such as 2019, but especially in times of acute social turmoil. </p>
<p>These findings provide insight on how universities and health care providers can better support students’ mental health by addressing the psychological impact of experiencing racism. </p>
<h2>What’s next</h2>
<p>Now that researchers better understand what predicts psychological distress in Asian American students, the next steps are to apply this information. Future research is needed to understand better how therapy that supports <a href="https://doi.org/10.1037/amp0000442">healing from racial discrimination</a> could support students’ mental health. </p>
<p>Research should also evaluate how treatments aimed at improving sleep quality could support Asian students’ <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651630/">mental health</a>. These interventions could improve mental health especially in times of social turmoil.</p><img src="https://counter.theconversation.com/content/210030/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roxanne Prichard receives funding from the National Science Foundation and Howard Hughes Medical Institute.</span></em></p>An increase in anti-Asian hate incidents during the pandemic contributed to a rise in depression among Asian and Asian American college students, a study found.Roxanne Prichard, Professor of Psychology, University of St. ThomasLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2107802023-08-03T20:16:34Z2023-08-03T20:16:34ZWhy a Toronto high school principal’s death is wrongly linked to anti-racist training<figure><img src="https://images.theconversation.com/files/540866/original/file-20230802-24657-nrwsv2.jpg?ixlib=rb-1.1.0&rect=378%2C1260%2C5592%2C2404&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A social media narrative that anti-racism and equity work is to blame for a high school principal's death could mean challenges ahead for equity workers. </span> <span class="attribution"><span class="source">(Christina Wocintech/Unsplash)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-a-toronto-high-school-principals-death-is-wrongly-linked-to-anti-racist-training" width="100%" height="400"></iframe>
<p>Last month, a former Toronto school principal, <a href="https://www.thestar.com/news/gta/former-principal-who-sued-tdsb-over-alleged-bullying-during-anti-racism-training-dies-by-suicide/article_4b9f98a9-7394-5517-909b-c69eb581aec9.html">Richard Bilkszto, died by suicide</a>. Although the <a href="https://www.medicalnewstoday.com/articles/why-do-people-commit-suicide">reasons for suicide are complex</a>, his family and lawyer released a statement linking his death to an anti-racism workshop he had attended. </p>
<p>Those ardently opposed to “woke politics” are now using Bilkszto’s tragic death to decry anti-racism and equity work. The Ontario Ministry of Education, led by Stephen Lecce, <a href="https://www.cbc.ca/news/canada/toronto/lecce-tdsb-principal-death-staff-review-1.6917432">has called the allegations “serious and disturbing” and plans to conduct a review of how anti-racism and equity work is done at school boards</a>. </p>
<p>The workshop Bilkszto attended was led by Kike Ojo-Thompson, CEO of the KOJO Institute. <a href="https://kojoinstitute.com/statement-from-kojo-institute-ceo-july-27-2023/">Ojo-Thompson</a> has called the death of Bilkszto a tragedy. Ojo-Thompson was unaware that earlier this year, Bilkszto had filed a lawsuit against the school board concerning the anti-racism workshop she led about white supremacy.</p>
<p>As someone who has worked in the fields of equity, education and anti-racism, I understand both the importance and the burden of naming “racism” and “white supremacy” within institutions. It is crucial to support those who risk their reputations and livelihoods to do this naming.</p>
<p>I see the current media storm as a precedent-setting moment on the risks associated with institutional equity work. I believe it will also test Canadians’ commitment to doing the work needed to address racism. </p>
<p>The minister’s response as well as those by right-wing news media have helped to fuel a narrative that anti-racism and equity work is to blame. </p>
<h2>Anti-racism training denigrated by news media</h2>
<p>The <a href="https://www.dailymail.co.uk/news/article-12356503/Toronto-schools-launches-probe-suicide-principal-Richard-Bilkszto-killed-bullied-harassed-following-dust-KOJO-Institute-anti-racism-trainer-Kike-Ojo-Thompson.html"><em>Daily Mail</em></a> described the investigation into Bilkszto’s death as one that will look into “whether the obsession with woke policies may have contributed” to his death.</p>
<p>The <a href="https://nationalpost.com/opinion/richard-bilkszto-cherished-merit-and-equality-canada-should-too"><em>National Post</em></a> wrote: “It’s no coincidence that Bilkszto came out humiliated” since “the DEI industry is designed to sell guilt and shame and perpetuate a culture of victimhood.” </p>
<p>The <a href="https://torontosun.com/opinion/columnists/lilley-ontario-orders-review-of-school-training-after-principal-dies"><em>Toronto Sun</em></a> has suggested there is need to look at “the general issue of diversity, equity and inclusion training” concluding “reform may be sorely needed.”</p>
<h2>Equity work disrupts ‘safe spaces’</h2>
<p><a href="https://canadacouncil.ca/glossary/equity">Equity</a> training aims to address practices that sustain institutional inequities. It begins with the acknowledgement of both historical and contemporary inequities and the premise that such work is needed to bring about equity.</p>
<p>Even at its mildest, equity work involves taking some people outside of their comfort zone. But equity work at its most meaningful involves getting people to recognize that their comfort zone has depended on other people’s silence and marginalization.</p>
<figure class="align-center ">
<img alt="A woman stands at a board pointing at sticky notes, a group of people sit in front of her." src="https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540867/original/file-20230802-17-yvpt1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Equity training takes people outside of their comfort zones.</span>
<span class="attribution"><span class="source">(Jason Goodman/Unsplash)</span></span>
</figcaption>
</figure>
<p>Yet equity work is often conducted within the context of a market-based relationship, where client priorities dictate the boundaries of change and disruptiveness. These boundaries are frequently constructed around language choices — with terms like “diversity” and “inclusion” being permissible while, <a href="http://www.yorku.ca/lfoster/documents/Canadian_Experience_Rule_RDRJournal_FINAL.pdf">“racism” is deemed too polarizing</a>. </p>
<p>When wading into discussions about equity and racism, the practice of establishing guidelines has been a central strategy for mitigating the associated risks. This practice has often been described as building a “safe space.” But <a href="https://static1.squarespace.com/static/5b6af3b236099ba883a28b1e/t/5dcc5b2ae2b90a3c5af08fc5/1573673770842/From+Safe+Spaces+to+Brave+Spaces_2013.pdf">long-time social justice educators, Brian Arao and Kristi Clemens,</a> argue “that authentic learning about social justice often requires the very qualities of risk, difficulty and controversy that are defined as incompatible with safety.” This is especially the case when these conversations are taking place within the very institutions that are being asked to confront their own racist and inequitable practices. </p>
<p>Safety also gets conflated with comfort when people expect these conversations not to be upsetting or difficult, or expect not to be held accountable for their comments. This is an impossible standard to set for conversations that challenge institutional norms and social inequities. </p>
<p><a href="https://www.theglobeandmail.com/opinion/article-the-two-pandemics-of-anti-black-racism-and-covid-19-are-tied-together/">McGill University political scientists Tari Ajadi and Debra Thompson</a> describe this type of racism as “simultaneously individualistic and systemic.” Discussing racist systems requires reference to tangible individual instances of racism to illustrate how racism is reproduced. </p>
<p>Sometimes this is met with tears and sometimes this is met with defensiveness. For example, in a training I once conducted, a white woman cried when she realized that she had been using language to describe Black children which I explained reiterates racialized stereotypes that harm and dehumanize Black people. </p>
<p>Even when we try to make intentional language choices, such as “address the comment, not the speaker,” the illustration of racism will feel personal for those whose behaviour is implicated. </p>
<p>In her column for the <em>Toronto Star</em>, journalist <a href="https://www.thestar.com/opinion/star-columnists/a-toronto-principal-s-suicide-was-wrongly-linked-to-anti-racism-training-here-s-what/article_52f30ce3-e754-5947-a754-91746b8af7ce.html">Shree Paradkar</a>, carefully delineated between the ideas of “upholding white supremacy” and “calling someone a white supremacist” in her review of Ojo-Thompson’s words in the session recordings. But this delineation fails to satisfy <a href="https://twitter.com/jonkay/status/1684758380055814144">those avowedly anti-woke commentators</a> for whom the language of racism and white supremacy is always considered unspeakable.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-be-a-mindful-anti-racist-147551">How to be a mindful anti-racist</a>
</strong>
</em>
</p>
<hr>
<h2>The unspeakability of racism</h2>
<p>Following the <a href="https://www.npr.org/2020/08/16/902179773/summer-of-racial-reckoning-the-match-lit#:%7E:text=Summer%20of%20Racial%20Reckoning%20explores,civil%20rights%20icons%20see%20it.">2020 “summer of racial reckoning</a>,” almost every sector in Canada was compelled to initiate equity work. Many developed <a href="https://www.expresspros.com/CA/Newsroom/Canada-Employed/Fewer-Than-Half-of-Canadian-Companies-Have-Diversity-Equity-and-Inclusion-Policy.aspx?&referrer=http://www.expresspros.com/CanadaEmployed/">Equity, Diversity & Inclusion (EDI) policies</a>, and several demonstrated a willingness to have <a href="https://www.canada.ca/en/department-national-defence/services/systemic-racism-discrimination/anti-racism-toolkit/courageous-conversations-guide.html">difficult conversations on racism</a>. </p>
<p>Since then, the perceived urgency of this equity work has been steadily waning, yet the resistance to this work has remained forceful. </p>
<p>Equity studies scholar <a href="https://www.cambridge.org/core/journals/canadian-journal-of-law-and-society-la-revue-canadienne-droit-et-societe/article/abs/unspeakability-of-racism-mapping-laws-complicity-in-manitobas-racialized-spaces/22CDD014685783D6A9CD87144E265D4D">Sheila Dawn Gill</a> offered the term “unspeakability of racism” to describe the barriers to naming racism within Canadian spaces. She used the example of the silencing of the late Cree politician, Oscar Lathlin, for using the term “racist.” This silencing was again applied to current NDP Leader Jagmeet Singh’s use of “<a href="https://www.cbc.ca/news/canada/manitoba/pov-racism-white-fragility-1.5619647">unparliamentary language</a>.” </p>
<p>Broad acceptance of the reality of systemic racism is meaningless if it cannot be applied towards understanding how racism is enacted both individually and institutionally through comments, actions and specific circumstances. Institutional commitments to anti-racism are meaningless if they do not extend support and care to those doing this work.</p>
<p>Two decades ago, Canadian political scientist <a href="https://www.academia.edu/5741567/Smith_Race_Matters_and_Race_Manners_">Malinda Smith</a> described how the “race manners” of Canada continue to support the suppression of the naming of racism and obscure the way that race continues to matter throughout Canadian institutions. </p>
<p>The vilification of Ojo-Thompson for talking about white supremacy demonstrates the enduring hold of Canada’s race manners, even in the wake of our collective racial reckoning. </p>
<p><em>If you are experiencing suicidal thoughts, you need to know you’re not alone. If your life or someone else’s is in danger, call 911 for emergency services. Or, call <a href="https://talksuicide.ca/">Talk Suicide Canada</a> at 1-833-456-4566.</em></p><img src="https://counter.theconversation.com/content/210780/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Bernhardt has previously received payment for equity and anti-racism training from government, non-profit, and private institutions. She has never worked with, or received payment from, the KOJO Institute. She has also received an Ontario Grant Scholarship and the Abella Scholarship for Studies in Equity.</span></em></p>The media storm that is building on equity work after the death of a Toronto school principal will test Canadians’ commitment to doing the work needed to be done to address racism.Nicole Bernhardt, Assistant Professor, Political Science, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103562023-07-28T12:19:42Z2023-07-28T12:19:42ZAs suicides rise in the US, the 988 hotline offers hope – but most Americans aren’t aware of it<figure><img src="https://images.theconversation.com/files/539383/original/file-20230725-21-y5cy7z.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4814%2C3639&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can call 988 for yourself, or for a friend or family member.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-using-phone-royalty-free-image/160077976?phrase=sad+young+person+on+phone&adppopup=true">Flashpop/Stone via Getty Images</a></span></figcaption></figure><p><em>July 2023 marks the one-year anniversary of the national launch of the <a href="https://988lifeline.org/">988 Suicide & Crisis Lifeline</a>. Currently, more than 200 call centers throughout the U.S. are responding to 988 calls. But few people know it exists. SciLine interviewed <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/12708">Dr. Emmy Betz</a>, a professor of emergency medicine at the University of Colorado, who discussed the critical need to raise awareness about 988, the increasing numbers of suicide deaths in the U.S. and the signs that someone is thinking about suicide.</em> </p>
<figure>
<iframe src="https://player.vimeo.com/video/846727921" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Emmy Betz discusses 988 and suicide prevention.</span></figcaption>
</figure>
<p><em>Below are some highlights from the discussion. Answers have been edited for brevity and clarity.</em></p>
<p><strong>Can you share some statistics about suicide in the U.S.?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide continues to be a <a href="https://www.cdc.gov/suicide/facts/index.html">leading cause of death</a> in the United States. In fact, it’s the 12th-leading cause of death among all ages. We had been seeing suicide rates rise from about 2000, up until around the COVID era. There was <a href="https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211105/20211105.htm">a small dip in rates</a> during those COVID years, which was great, but unfortunately we’ve now seen rates increase again. In 2021, there were 48,000 suicide deaths in the U.S., which is about one every 11 minutes.</p>
<p><strong>What about youth suicide?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide rates among youth in particular <a href="https://www.usnews.com/news/health-news/articles/2023-06-15/cdc-study-shows-rise-in-violent-death-rates-among-u-s-youth">have increased</a>. Between 2011 and 2021, suicide rates for youth rose 60%. Particularly concerning are increases in suicide rates among young individuals of color, where there have traditionally been lower suicide rates. </p>
<p><strong>Who should call 988, and when?</strong></p>
<p><strong>Emmy Betz:</strong> 988 is the suicide and crisis lifeline. I want to really emphasize, <a href="https://www.webmd.com/mental-health/features/988-suicide-prevention-overview">it’s not just for suicide</a>. It’s for anyone who’s experiencing substance abuse, mental health crisis, emotional distress or suicidal thoughts. You can call for yourself. You can call for someone in your family or a friend. It’s available 24/7, and it’s free and confidential.</p>
<p><strong>How has the first year of the 988 hotline gone?</strong></p>
<p><strong>Emmy Betz:</strong> In the first year, 988 answered <a href="https://www.samhsa.gov/sites/default/files/988-one-year-anniversary-issue-brief.pdf">nearly 5 million calls, chats or texts</a>. That’s great news. But one thing that I think is concerning: There was a Pew Charitable Trusts <a href="https://www.pewtrusts.org/en/research-and-analysis/articles/2023/05/23/most-us-adults-remain-unaware-of-988-suicide-and-crisis-lifeline">survey published in April 2023</a>. Only 13% of respondents said they knew both about 988 and what it was for. So I think we still have a ways to go in terms of raising awareness among people about what the hotline is, when you should call and then <a href="https://988helpline.org/what-to-expect/">what happens when you do call</a>.</p>
<p><strong>What are warning signs that a person is thinking about suicide?</strong></p>
<p><strong>Emmy Betz:</strong> It can vary. Sometimes, it can look like what we think of classically as depression – somebody who might seem sad, seems withdrawn and not doing the things that they previously have been wanting to do. </p>
<p>Certainly anything like talking a lot about death, mentioning suicide, mentioning not wanting to be around anymore – those are all very concerning. Some people, though, can seem angry or sort of ramped up or different. </p>
<p>The main thing to look out for is if someone says that they’ve lost hope or that they <a href="https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide">aren’t looking towards the future anymore</a>. </p>
<p>And perhaps the most important thing to know – it’s OK to ask. If you’re ever worried that someone might be having thoughts of suicide, <a href="https://suicideprevention.nv.gov/Youth/Myths/">it’s fine to ask them directly</a>. You’re not going to prompt suicidal thoughts by asking that question. </p>
<p><strong>What are some prevention strategies for firearm suicides?</strong></p>
<p><strong>Emmy Betz:</strong> Here at the University of Colorado, I lead the <a href="https://medschool.cuanschutz.edu/emergency-medicine/major-programs/firearm-injury-prevention-initiative">firearm injury prevention initiative</a>, which is a new program funded through the medical school that hopes to reduce all sorts of firearm injuries and deaths, including suicide. </p>
<p>Where I live in Colorado, 73% of our gun deaths are by suicide. It’s a <a href="https://coloradosun.com/2023/04/06/colorado-gun-violence-explained-charts/">critical problem in our state</a>. And these deaths are preventable.</p>
<p>Suicide typically occurs in the context of some kind of crisis, whether it’s related to a job, or a recent breakup with a romantic partner, or something else. Prevention is all about getting people through that high-risk period, to get the treatment or resources they need. </p>
<p>We know that if a person uses a firearm in a suicide attempt, about 90% of the time they die. So my work and the work of our initiative really focuses on how can we reduce firearm access when someone is in that high-risk period. </p>
<p>And importantly, it’s not about confiscation. It’s not about legislation. It’s about engaging with communities, educating communities and educating health care providers about what we can do to reduce firearm access – specifically, encouraging people to take steps to lock up guns differently, such as changing the locks or changing the password so the at-risk person can’t access the gun. </p>
<p>When someone has suicide risk, it can be a good idea to <a href="https://doi.org/10.1186/s40621-022-00389-3">move firearms out of the home temporarily</a>. We’ve been working with gun ranges, retailers and other locations that offer voluntary and temporary firearm storage as a solution for people – to make the home safer while someone’s getting better.</p>
<p>There are things we can do that don’t conflict with views on Second Amendment rights. I’m thrilled to see <a href="https://www.nssf.org/safety/suicide-prevention/nssf-afsp-partnership/">firearm rights organizations working with large organizations</a> like the Veterans Administration, the Department of Defense and medical organizations.</p>
<p><strong>What is suicide contagion, and what should journalists know about covering suicide without contributing to it?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide contagion is the phenomenon whereby hearing about one suicide – in particular, the methods – leads to additional individuals <a href="https://time.com/5572394/suicide-contagion-study/">attempting or dying by suicide</a> using the same methods. </p>
<p>It’s really important that journalists talk about suicide, and that we raise awareness, and we get these messages out. But there are guidelines about how to reduce contagion. There are guidelines from the American Foundation for Suicide Prevention and other large organizations that <a href="https://afsp.org/safereporting/#:%7E:">really spell out best practices for journalists</a>. </p>
<p><em>Watch the <a href="https://www.sciline.org/mental-health/suicide-prevention/">full interview</a> to hear more about the 988 hotline and suicide prevention.</em> </p>
<p><em><a href="https://www.sciline.org/">SciLine</a> is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.</em></p>
<p><em>This article was corrected to fix the attribution for the April 2023 survey.</em></p><img src="https://counter.theconversation.com/content/210356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emmy Betz receives research grant funding from the National Institutes of Health and the Department of Defense. </span></em></p>The 988 Suicide & Crisis Lifeline is for anyone experiencing suicidal thoughts, emotional distress, substance abuse issues or mental health problems.Emmy Betz, Professor of Emergency Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2094862023-07-12T20:04:34Z2023-07-12T20:04:34ZNew findings show a direct causal relationship between unemployment and suicide<figure><img src="https://images.theconversation.com/files/536714/original/file-20230711-27-7uc6gy.jpg?ixlib=rb-1.1.0&rect=0%2C240%2C5184%2C3205&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Studies using traditional statistical methods have long indicated a link between unemployment and suicide. But until now it has been unclear if this relationship is causal. That is, even though the suicide rate is higher among the unemployed, can we definitely say unemployment directly leads to suicide?</p>
<p>We now can. Using advanced analytic techniques borrowed from ecology <a href="https://www.science.org/doi/10.1126/sciadv.adg3758">we have found</a> clear evidence of a causal relationship.</p>
<p>Based on Australian Bureau of Statistics data on <a href="https://www.abs.gov.au/statistics/detailed-methodology-information/concepts-sources-methods/labour-statistics-concepts-sources-and-methods/2021/concepts-and-sources/underutilised-labour">underutilised labour</a> and suicide rates, we estimate that unemployment and underemployment in the 13 years from 2004 to 2016 directly resulted in more than 3,000 Australians dying by suicide – an average of 230 a year.</p>
<p>These findings have profound political, economic, social and legal implications, particularly in light of government and central bank policies that “require” unemployment. </p>
<h2>How we detected causality</h2>
<p>To test for causal effects of unemployment and underemployment on suicide, we applied a technique known as convergent cross mapping.</p>
<p>This method has been developed over the past decade to detect causality in complex ecosystems. Among other things, it has been used to study and show causal relationships between cosmic rays and global temperature, and humidity and influenza outbreaks. The period of our study (2004 to 2016) was bound by the quality of available data. </p>
<hr>
<p><iframe id="immZc" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/immZc/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<h2>Challenging economic orthodoxies</h2>
<p>A clear relationship between unemployment and suicide challenges governments and institutions to take greater responsibility for the impact of policies and actions. It challenges the ethics of ideas that require some level of unemployment for economic efficiency.</p>
<p>For example, last month the Reserve Bank of Australia’s deputy governor, Michele Bullock, said the unemployment rate <a href="https://www.rba.gov.au/speeches/2023/sp-dg-2023-06-20-q-and-a-transcript.html">would have to rise</a> to curb inflation. The central bank expects the unemployment rate to rise <a href="https://www.rba.gov.au/speeches/2023/sp-dg-2023-06-20.html">to 4.5% by the end of 2024</a>. The current rate <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia/may-2023">is 3.6%</a>, with a further 6.3% of workers underemployed. </p>
<p>As Bullock noted, “full employment” to most people means that anyone who wants a job can find one. But most economists believe there is a need for a certain level of unemployment to prevent inflation.</p>
<p>This level is known as the Non-Accelerating Inflation Rate of Unemployment (NAIRU). It’s a theoretical concept, so there’s no way to be sure what the level should be, but before the pandemic the consensus was <a href="https://theconversation.com/vital-signs-australias-5-jobless-rate-is-not-full-employment-pushing-up-interest-rates-would-be-wrong-105523">that it was about 5%</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-unemployment-steady-at-3-5-inflation-fears-shouldnt-stop-australia-embracing-a-full-employment-target-203415">With unemployment steady at 3.5%, inflation fears shouldn't stop Australia embracing a full employment target</a>
</strong>
</em>
</p>
<hr>
<h2>Impetus for far-reaching reform</h2>
<p>These findings of the human cost of joblessness bolsters the case for policies to achieve full employment as well as reduce the negative consequences of unemployment, through providing a liveable income and strengthening mental health systems. </p>
<p>Why should the unemployed face deprivation, stigmatisation and despair when unemployment is a consequence of deliberate policy decisions?</p>
<p>We hope our findings will spur discussions about expanding unemployment benefits and labour market reforms to achieve greater job security. We also hope to provoke a deeper conversation about the design of the economy and how it values people, beyond simply making money. </p>
<p>Building on the ideas of University of Queensland economist John Quiggin, the Mental Wealth initiative is proposing a <a href="https://insidestory.org.au/participation-income/">social participation wage</a>. Set at the rate of a liveable wage, it would recognise the social value of unpaid volunteer work, civic participation, environmental restoration, artistic and creative activity, and activities that strengthen the social fabric of nations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/meet-the-liveable-income-guarantee-a-budget-ready-proposal-that-would-prevent-unemployment-benefits-falling-off-a-cliff-146990">Meet the Liveable Income Guarantee: a budget-ready proposal that would prevent unemployment benefits falling off a cliff</a>
</strong>
</em>
</p>
<hr>
<p>Legally there are implications concerning duty of care and the obligation of governments and institutions to safeguard the wellbeing of the population. These findings should contribute to discussions about legal frameworks relating to employment, work health and safety, discrimination and human rights.</p>
<p>A direct causal relationship between unemployment and suicide demands a re-evaluation of policies, a prioritisation of full employment, adequate social safety nets to prevent poverty, mental-health system reform, and greater urgency in shifting to a wellbeing economy.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, you can call these support services, 24 hours, 7 days:</em></p>
<ul>
<li><p><em>Lifeline: 13 11 14</em></p></li>
<li><p><em>Suicide Call Back Service: 1300 659 467</em> </p></li>
<li><p><em>Kids Helpline: 1800 551 800 (for people aged 5 to 25)</em></p></li>
<li><p><em>MensLine Australia: 1300 789 978</em></p></li>
<li><p><em>StandBy - Support After Suicide: 1300 727 24</em></p></li>
</ul><img src="https://counter.theconversation.com/content/209486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jo-An Occhipinti is Managing Director of Computer Simulation & Advanced Research Technologies, an international alliance of centres of excellence in systems modelling to inform health and social policy. She also receives philanthropic funding from BHP Foundation for implementation of the 'Right care, first time, where you live' program working to strengthen youth mental health systems.</span></em></p><p class="fine-print"><em><span>Adam Skinner is supported by philanthropic funding from The Grace Fellowship, and from other donor(s) that are families affected by mental illness who wish to remain anonymous. </span></em></p><p class="fine-print"><em><span>Professor Ian Hickie is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University
of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to
headspace. He is the Chief Scientific Advisor to, and a 3.2% equity shareholder in, InnoWell Pty Ltd.
InnoWell was formed by the University of Sydney (45% equity) and PwC (Australia; 45% equity) to
deliver the $30 M Australian Government-funded Project Synergy (2017-20; a three-year program for
the transformation of mental health services) and to lead transformation of mental health services
internationally through the use of innovative technologies.</span></em></p><p class="fine-print"><em><span>Yun Ju Christine Song receives funding from BHP Foundation for the implementation of the 'Right care, first time, where you live' program working to strengthen youth mental health systems.</span></em></p>We estimate that unemployment and underemployment in the 13 years between 2004 and 2016 directly resulted in more than 3,000 Australian deaths by suicide.Jo-An Occhipinti, Assoc. Professor and Head of Systems Modelling, Simulation & Data Science, Brain and Mind Centre, University of SydneyAdam Skinner, Research Fellow, University of SydneyIan Hickie, Co-Director, Health and Policy, University of SydneyYun Ju Christine Song, Research Manager, Youth Mental Health & Technology and Mental Wealth Initiative Lead, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2089292023-07-03T20:07:43Z2023-07-03T20:07:43ZAustralian researchers confirm world’s first case of dementia linked to repetitive brain trauma in a female athlete<p>Researchers at the <a href="https://www.brainbank.org.au/">Australian Sports Brain Bank</a> have today reported the world’s first diagnosis of chronic traumatic encephalopathy (CTE) in a <a href="https://rdcu.be/dfQiz">female athlete</a>. </p>
<p>With the consent of her family, the diagnosis was made on the brain of Heather Anderson, a 28-year-old AFLW athlete <a href="https://www.abc.net.au/news/2022-11-14/adelaide-aflw-premiership-player-heather-anderson-dies-aged-28/101653188">who died</a> last November. Heather’s family donated her brain to the Australian Sports Brain Bank hoping to better understand why she died. </p>
<p>The findings, which Professor Alan Pearce co-authored with the Australian Sports Brain Bank, raise questions about how a lifetime of contact sport may have contributed to her death. They come as Australia’s <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Headtraumainsport">Senate inquiry</a> works on its report into concussions and repeated head trauma in contact sport, due in August.</p>
<p>Given how hard women have fought to participate in football codes and contact sports in recent years, this diagnosis has major implications for women’s sport in Australia. It also highlights the significant lack of research about women athletes in sport science and medicine.</p>
<h2>What is chronic traumatic encephalopathy?</h2>
<p><a href="https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921">CTE</a> is a devastating form of dementia which causes a decline in brain functioning and increased risk of mental illness. It is increasingly associated with athletes who play contact sports, such as football, boxing and martial arts. </p>
<p>It is incurable and can only be <a href="https://www.brainbank.org.au/cte-diagnosis/">diagnosed post-mortem</a>. Recently, a number of high-profile former Australian footballers were found to have been suffering from CTE when they died, including former AFL stars <a href="https://www.abc.net.au/news/2023-04-26/danny-frawley-family-urges-afl-to-act-on-cte-concussion/102269648">Danny Frawley</a> and <a href="https://www.abc.net.au/news/2022-08-25/brain-disease-killed-shane-tuck-not-mental-health-says-sister/101362740">Shane Tuck</a>, and former NRL player and coach <a href="https://www.abc.net.au/news/2022-10-22/qld-paul-green-brain-scans-reveal-brain-disease-cte-diagnosis/101566032">Paul Green</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1592079585201381377"}"></div></p>
<p>Concussions in contact sports have long been associated with long-term neurodegeneration in <a href="https://www.frontiersin.org/articles/10.3389/fspor.2021.676463/full">Australia</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987576/">internationally</a>. While the public and researchers are rightly concerned about serious concussions, a study published last month in <a href="https://urldefense.com/v3/__https:/www.nature.com/articles/s41467-023-39183-0__;!!PDiH4ENfjr2_Jw!FvAmUDcX-ESwwl8nG_BNNkRyB2J4TBq1oXkBTE1bBcdRGEQTl4u7qmgGsLguHpGNlFpWkz-SjKg3HGwdNYxIfEWW9U6ifytx%24">Nature Communications</a> confirmed that repetitive brain trauma over time – even seemingly mild head knocks or whiplash – is the strongest predictor for an athlete developing CTE. Athletes with long careers in contact sport are at particular risk, especially if they play from an early age.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/repeated-head-injury-may-cause-degenerative-brain-disease-for-people-who-play-sport-juniors-and-amateurs-included-196042">Repeated head injury may cause degenerative brain disease for people who play sport – juniors and amateurs included</a>
</strong>
</em>
</p>
<hr>
<h2>A sporting life</h2>
<p>Heather Anderson began playing rugby league at age five before transferring to Australian rules football in her early teens. She played representative football in the Australian Capital Territory and Northern Territory before being drafted into the inaugural season of the AFLW in 2017.</p>
<p>Anderson played a single season with the <a href="https://crowshistory.afc.com.au/aflw-players/heather-anderson#:%7E:text=Biography&text=An%20army%20medic%2C%20Heather%20Anderson,year%20and%20starred%20for%20Waratah.">Adelaide Crows</a>, during which she won a premiership and suffered a career-ending shoulder injury. She then returned to her role as a medic with the Australian Army, a physical career which also carries a <a href="https://www.defence.gov.au/adf-members-families/health-well-being/programs-initiatives/military-health-outcomes-program">heightened risk of brain injury</a>. </p>
<p>Anderson’s family donated her brain in the hope of knowing whether a lifetime of exposure to repetitive head trauma contributed to her death.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1670959654342459394"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/suicide-risk-is-high-for-military-and-emergency-workers-but-support-for-their-families-and-peers-is-missing-193451">Suicide risk is high for military and emergency workers – but support for their families and peers is missing</a>
</strong>
</em>
</p>
<hr>
<h2>Was this diagnosis expected?</h2>
<p>Concussion researcher Anne McKee predicted earlier this year it was a <a href="https://www.1news.co.nz/2023/02/20/its-coming-experts-worried-about-female-athlete-brain-injuries/">matter of time</a> before CTE was found in the brain of a woman athlete. </p>
<p>The Australian Sports Brain Bank team believe Anderson is a “<a href="https://www.ncbi.nlm.nih.gov/books/NBK564388/">sentinel case</a>” we can learn from. She is the first female athlete diagnosed with CTE, but she will not be the last.</p>
<p>Although Australian women have historically been excluded from the sports most associated with repeated head injuries, this is changing. In 2022, there were almost one million women and girls playing some form of <a href="https://www.clearinghouseforsport.gov.au/kb/women-in-sport">contact sport</a> in Australia. As women’s participation in contact sport continues to grow, so too does their risk of repetitive brain trauma.</p>
<h2>Are women more prone to CTE than men?</h2>
<p>There is emerging evidence that women are at significantly higher risk of mild traumatic brain injury (concussion) and may suffer more severe symptoms. </p>
<p>Concussion alone does not cause CTE, but an athlete’s number of concussions is a reliable indicator of their cumulative exposure to brain trauma, which is the biggest predictor of CTE. </p>
<p>While knowledge on the topic is still developing, researchers <a href="https://www.nature.com/articles/d41586-021-02089-2">propose a mix of physiological and social explanations</a> for women’s increased concussion risk. These include </p>
<blockquote>
<p>[…] differences in the microstructure of the brain to the influence of hormones, coaching regimes, players’ level of experience and the management of injuries.</p>
</blockquote>
<p>More research is needed to understand sporting brain injuries specifically in women and girls. Given their growth in participation and the enhanced risks they face in sport, it is concerning that women and girls are <a href="https://bjsm.bmj.com/content/56/17/981">underrepresented</a> in concussion research. </p>
<p>This is representative of a <a href="https://journals-humankinetics-com.ap1.proxy.openathens.net/view/journals/wspaj/29/2/article-p146.xml">broader trend</a> in sport and exercise science research to exclude women from studies because their bodies are perceived as <a href="https://link.springer.com/article/10.1007/s40279-021-01435-8">more complex</a> than men’s and thus more difficult to accommodate in testing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-study-much-of-what-were-told-about-gym-exercises-and-resistance-training-is-from-studies-of-males-by-men-205753">New study: much of what we're told about gym exercises and resistance training is from studies of males, by men</a>
</strong>
</em>
</p>
<hr>
<h2>A disease that does not discriminate</h2>
<p>This world-first report of CTE in a female athlete is proof the disease does not discriminate and lends urgency to calls for <a href="https://theconversation.com/sports-concussions-affect-men-and-women-differently-female-athletes-need-more-attention-in-brain-research-160097">greater representation</a> of women in brain injury studies. </p>
<p>Efforts to reduce concussion in women’s sport must first address resource inequalities between men’s and women’s sport. This includes giving women access to quality training and coaching support, as well as <a href="https://theconversation.com/new-study-much-of-what-were-told-about-gym-exercises-and-resistance-training-is-from-studies-of-males-by-men-205753">greater attention</a> from sport science and medical research. </p>
<p>The health of <a href="https://www.tandfonline.com/doi/full/10.1080/14443058.2019.1575262">women athletes and women’s sport</a> will only progress if researchers, policymakers and sport governance bodies ensure the attention and resources required to address concussion and brain disease are not focused solely on men.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14. The National Dementia Helpline number is 1800 100 500.</em></p><img src="https://counter.theconversation.com/content/208929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alan Pearce is currently unfunded. Alan is a non-executive unpaid director for the Concussion Legacy Foundation. He has previously received funding from Erasmus+ strategic partnerships program (2019-1-IE01-KA202-051555), Sports Health Check Charity (Australia), Australian Football League, Impact Technologies Inc., and Samsung Corporation, and is remunerated for expert advice to medico-legal practices.</span></em></p><p class="fine-print"><em><span>Rebecca Olive receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Stephen Townsend does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Chronic traumatic encephalopathy is a devastating form of dementia, which causes a decline in brain functioning and increased risk of mental illness.Stephen Townsend, Lecturer, School of Human Movement and Nutrition Sciences, The University of QueenslandAlan Pearce, Professor, College of Science, Health, Engineering, La Trobe UniversityRebecca Olive, Vice Chancellor's Senior Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2076812023-06-15T12:33:23Z2023-06-15T12:33:23ZHow the Unabomber’s unique linguistic fingerprints led to his capture<figure><img src="https://images.theconversation.com/files/532034/original/file-20230614-19-yvo44e.jpg?ixlib=rb-1.1.0&rect=20%2C6%2C2230%2C1518&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ted Kaczynski was arrested after the longest and most expensive investigation in the FBI's history.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/convicted-unabomber-theodore-kaczynski-is-escorted-by-us-news-photo/106884098?adppopup=true">Rich Pedroncelli/AFP via Getty Images</a></span></figcaption></figure><p>Can the language someone uses be as unique as their fingerprints?</p>
<p>As I describe in my forthcoming book, “<a href="https://rowman.com/ISBN/9781633888982/Linguistic-Fingerprints-How-Language-Creates-and-Reveals-Identity">Linguistic Fingerprints: How Language Creates and Reveals Identity</a>,” that was true in the case of Theodore Kaczynski.</p>
<p>Kaczynski, who was known as the <a href="https://finance.yahoo.com/news/origin-ted-kaczynskis-infamous-nickname-145500991.html">Unabomber</a>, died in a North Carolina prison on June 10, 2023, <a href="https://apnews.com/article/ted-kaczynski-unabomber-1197f597364b36e56bdbcaca9837bdc4">reportedly by suicide</a>.</p>
<p>Kaczynski had been a <a href="https://www.nytimes.com/1996/04/05/us/suspect-s-trail-suspect-memories-his-brilliance-shyness-but-little-else.html">math prodigy and a professor</a> at the University of California, Berkeley, before he withdrew from society and declared war on the modern world. </p>
<p>From a <a href="https://helenair.com/news/state-and-regional/crime-and-courts/photos-a-look-inside-the-unabombers-montana-cabin/collection_41103cf1-dc68-5950-babc-17861f0b8858.html">remote cabin in Montana</a>, he sent a number of explosive devices through the mail. In other cases, he planted them. Between 1978 and 1995, 16 of his bombs <a href="https://www.washingtonpost.com/obituaries/2023/06/10/ted-kaczynski-dead-unabomber/">killed three people</a> and seriously injured nearly two dozen more.</p>
<p>Kaczynski’s crimes triggered the longest and <a href="https://en.as.com/latest_news/ted-kaczynski-the-unabomber-has-died-what-are-some-of-the-most-expensive-fbi-investigations-n/">most expensive</a> criminal investigation in U.S. history. Law enforcement had little to go on other than a few letters that the terrorist had sent to the media, as well as fragments of notes that had survived his device’s detonations.</p>
<h2>Spellings and word choices offer clues</h2>
<p>In 1995, there was a breakthrough. That’s when the Unabomber offered to pause his attacks if a newspaper published his manifesto about the evils of modern society. Controversially, <a href="https://www.nytimes.com/1995/09/20/us/publication-of-unabomber-s-tract-draws-mixed-response.html">The Washington Post did so</a>. The FBI supported the paper’s decision, hoping that someone would recognize the terrorist based on the writing style of the <a href="https://www.washingtonpost.com/wp-srv/national/longterm/unabomber/manifesto.text.htm">35,000-word essay</a>.</p>
<figure class="align-center ">
<img alt="Copies of two newspapers." src="https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532004/original/file-20230614-22-d0iwj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Washington Post published the Unabomber’s 35,000-word manifesto on Sept. 19, 1995.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/view-of-the-front-pages-of-the-new-york-times-and-the-news-photo/106884096?adppopup=true">Luke Frazza/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>FBI forensic linguist <a href="https://www.jamesrfitzgerald.com">James Fitzgerald</a> and sociolinguist <a href="http://www.rogershuy.com">Roger Shuy</a> were able to uncover several clues about the terrorist’s identity based on the manifesto and his other writings.</p>
<p>For example, the Unabomber used strange misspellings for some words, such as “wilfully” for “willfully,” and “clew” for “clue.” Shuy recognized these as <a href="http://www.rogershuy.com/pdf/Linguistic_Profiling.pdf">spelling reforms</a> that had been championed by <a href="https://www.chicagotribune.com/ct-per-flash-simplespelling-0229-20120129-story.html">The Chicago Tribune</a> during the 1940s and 1950s, although they were never widely adopted.</p>
<p>Their use by the bomber suggested he might have spent his formative years in or near Chicago.</p>
<p>Fitzgerald noted the use of terms like “broad,” “chick” and “negro” in the manifesto was consistent with the vocabulary a middle-aged person from that era.</p>
<p>The Unabomber also referred to “<a href="https://books.google.com/books?id=1ib-AgAAQBAJ&pg=PA203&dq=20.+Roger+W.+Shuy,+The+Language+of+Murder+Cases:+Intentionality,+Predisposition,+and+Voluntariness+(Oxford:+Oxford+University+Press,+2014).&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwivhfXiqMH_AhVojYkEHbsSBVoQ6AF6BAgJEAI#v=snippet&q=raising%20children&f=false">rearing children</a>” as opposed to “raising children.” The former term is characteristic of the northern U.S. dialect and would be consistent with someone who grew up in or near the Windy City.</p>
<p>The manifesto also contains such fairly esoteric terms as “<a href="https://www.merriam-webster.com/dictionary/anomic">anomic</a>” and “<a href="https://www.merriam-webster.com/dictionary/chimerical">chimerical</a>,” suggesting that its author was highly educated.</p>
<h2>A brother’s suspicions</h2>
<p>But the move to publish the manifesto ended up being the decisive factor.</p>
<p>It was read in Schenectady, New York, by <a href="https://www.nytimes.com/1996/04/05/us/suspect-s-trail-family-brother-who-tipped-off-authorities-leads-quiet-simple.html">Linda Patrik</a>, who showed it to her husband, David Kaczynski. She asked if he thought it sounded like something his brother Ted could have written.</p>
<p>David was initially skeptical. Then he noticed that the essay contained unusual expressions, like “cool-headed logicians,” that he remembered his estranged sibling making use of. He <a href="https://www.nytimes.com/1996/04/09/IHT-a-nagging-feeling-by-family-member-pointed-to-unabomber-suspect.html">approached the FBI</a> with his suspicions, and it was noted that David’s brother had been born in Chicago in 1942.</p>
<p>A search of Kaczynski’s cabin turned up explosive devices, as well as the <a href="https://www.nytimes.com/1996/04/13/us/bomber-manifesto-amid-items-found-law-officials-say.html">original copy</a> of the manifesto. Kaczynski <a href="https://www.nytimes.com/1998/01/23/us/unabomber-case-overview-kaczynski-avoids-death-sentence-with-guilty-plea.html">pleaded guilty</a> in 1998 and was incarcerated until his death at age 81.</p>
<h2>Fingerprinting authors</h2>
<p>The Unabomber investigation has been justifiably hailed as a triumph of forensic linguistics. But sleuths of prose and punctuation have had other notable victories. </p>
<p>Even something as seemingly trivial as unusual punctuation can provide clues to a suspect’s identity – which is what happened in 2018, when a forensic linguist was able to pin a murder on a British man <a href="https://www.dailymail.co.uk/news/article-6028507/Forensic-linguist-reveals-murderer-snared-sending-texts-commas.htm">because of his unusual use of commas and spacing</a> when sending text messages.</p>
<p>Similar techniques have been used by language experts to identify authors. In 1996, “<a href="https://www.penguinrandomhouse.com/books/4166/primary-colors-by-anonymous/">Primary Colors</a>,” a novel based on Bill Clinton’s presidential campaign, was published by “anonymous.” English professor Donald Foster was able to finger Newsweek columnist Joe Klein as the author of the work, <a href="https://www.baltimoresun.com/news/bs-xpm-1996-02-16-1996047127-story.html">noting similarities</a> between the text of “Primary Colors” and Klein’s other published work, which included the use of unusual adverbs (“goofily”), states described as modes (“crisis mode”) and drawn-out interjections (“naww”).</p>
<p>And in 2013, “The Cuckoo’s Calling,” a novel authored with the pen name <a href="https://robert-galbraith.com/stories/the-cuckoos-calling/">Robert Galbraith</a>, was exposed as having been written by <a href="https://theconversation.com/the-name-game-jk-rowling-and-a-history-of-pseudonyms-16150">J.K. Rowling</a>. <a href="https://languagelog.ldc.upenn.edu/nll/?p=5315">Patrick Juola</a>, a computer scientist, and <a href="https://www.bbc.com/news/entertainment-arts-23313074">Peter Millican</a>, a philosopher, independently identified the author of the Harry Potter series as the crime novel’s true author. Both men used computer programs to analyze such factors as the distribution of word lengths and common word usage in books written by several suspected authors. They then compared the results to “The Cuckoo’s Calling” and identified Rowling as the closest match.</p>
<h2>An infallible method?</h2>
<p>These techniques seem almost magical when they work. But <a href="https://www.newyorker.com/magazine/2012/07/23/words-on-trial">they’re not foolproof</a>.</p>
<p>In 2018, The New York Times <a href="https://www.nytimes.com/2018/09/05/opinion/trump-white-house-anonymous-resistance.html">published an op-ed</a> written by an anonymous “resister” inside the Trump administration. However, the editorial was too short for linguistic analysis.</p>
<p>Even after the resister published a full-length book, titled “<a href="https://www.nytimes.com/2019/11/07/books/review/a-warning-anonymous-book-review-trump.html">A Warning</a>,” it wasn’t possible to identify the author. He eventually outed himself as <a href="https://www.nytimes.com/2020/10/28/us/politics/miles-taylor-anonymous-trump.html">Miles Taylor</a>. He had served as the chief of staff in the Department of Homeland Security. But because he had never published anything else, there was no text to which “A Warning” could be compared.</p>
<figure class="align-center ">
<img alt="Man in suit jacket poses with folded arms." src="https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532021/original/file-20230614-31-4yi2ir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The public learned of Miles Taylor’s identity only after he revealed himself as the author of ‘A Warning.’</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/miles-taylor-who-has-recently-revealed-himself-as-the-news-photo/1229883086?adppopup=true">Bill O'Leary/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>And scholars are still debating the identity of <a href="https://elenaferrante.com">Elena Ferrante</a>, the pseudonym used by a bestselling Italian novelist. Ferrante has published a dozen books, including “My Brilliant Friend,” <a href="https://lithub.com/have-italian-scholars-figured-out-the-identity-of-elena-ferrante/">but the author’s true identity remains controversial</a>. </p>
<p>Either way, technological advances have made it increasingly difficult for people who leave a paper trail to hide their identities – and the old adage to “not put anything in writing” is as true as it’s ever been.</p><img src="https://counter.theconversation.com/content/207681/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger J. Kreuz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Similar techniques used to identify criminals have been employed to unmask anonymous authors. But they aren’t foolproof.Roger J. Kreuz, Associate Dean and Professor of Psychology, University of MemphisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2004192023-05-28T11:32:23Z2023-05-28T11:32:23ZDeaths of despair: How income inequality puts Canadian youth at risk<figure><img src="https://images.theconversation.com/files/528639/original/file-20230526-19-j4xo.jpg?ixlib=rb-1.1.0&rect=253%2C176%2C4709%2C3096&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Income inequality is the gap between the highest and lowest earners in a given area. It can contribute to people's risk of poor health, and specifically mental health.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Income inequality has been linked to poor physical and mental health in past research, but more recent evidence suggests the issue of income inequality may be much more severe than previously expected. </p>
<p>While completing my PhD in epidemiology at the University of Alberta, I <a href="http://dx.doi.org/10.1136/jech-2022-219630">published a study</a> highlighting an association between experiencing income inequality in youth and deaths of despair among young Canadians.</p>
<p>Deaths of despair are deaths attributable to suicide, drug overdose and alcohol-related liver disease. These deaths are on the rise in Canada, and finding points of intervention is key to reducing the burden of this crisis.</p>
<p>In collaboration with my doctoral supervisor, <a href="https://www.emergeresearchlab.com">Roman Pabayo</a>, I led a study on a representative sample of Canadian youth and followed them up over a 13-year period to calculate average hazard for deaths of despair. The study sample included 1.5 million Canadians between the ages of 0 and 19 from 2006 to 2018. </p>
<h2>Income inequality and health</h2>
<figure class="align-center ">
<img alt="Tiny human figures standing on coins: a few people on a tall stack, and a lot of people on much smaller stacks" src="https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&rect=75%2C0%2C5513%2C3728&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Areas where income inequality is higher are less likely to have the type of social programs that are key to improving the health of communities.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Income inequality is the gap between the highest and lowest earners in a given area. It can contribute to people’s risk of poor health, and specifically mental health, in a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088996/">few key ways</a>. </p>
<p>First, in areas with higher income inequality, people are less likely to relate to their neighbours, regardless of whether they earn more or less income than they do. This can lead to social comparisons, which are detrimental for mental health and self esteem. </p>
<p>Secondly, this lack of connection with those around you — also called “social cohesion” — can cause mistrust and ill feelings about others. This in turn can lead people to become withdrawn or isolate themselves. Lack of social cohesion and isolation are both risk factors for poor mental health and substance use. </p>
<p>Finally, areas where income inequality is higher are less likely to have the type of social programs that are key to improving the health of communities. For example, divesting in mental health services and supports can lead to worsened mental health, and removal or lack of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/">harm reduction services</a> and <a href="https://doi.org/10.1177%2F070674371405901005">mental health services</a> can put people at a higher risk of deaths of despair. </p>
<h2>Income inequality and deaths of despair</h2>
<p>Deaths of despair are on the rise in Canada. Specifically, drug overdose death events have increased so rapidly that the <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants">drug poisoning crisis</a> has been referred to as an epidemic. This is a major concern, as these deaths have strong <a href="https://doi.org/10.24095%2Fhpcdp.38.6.02">impacts on the well-being of communities, families and friends</a>; but also because this crisis doesn’t appear to be ending anytime soon. </p>
<p>The impact the crisis is having on young Canadians is especially important, considering that unfamiliarity with substances, lower tolerance and risk-taking behaviours may leave them at an increased <a href="https://doi.org/10.1089%2Fcap.2019.0013">risk for drug overdose</a>. Further, suicide is a <a href="https://vizhub.healthdata.org/gbd-compare/">leading cause of death</a> among young people in Canada, indicating a critical need to intervene.</p>
<p>The results of this <a href="http://dx.doi.org/10.1136/jech-2022-219630">new study</a> also showed that higher levels of income inequality in youth are associated with an increased hazard of death from any cause, deaths of despair and drug overdose in young Canadians. </p>
<h2>Urgent need for services</h2>
<p>My colleagues and I are continuing this work by investigating income inequality and deaths of despair in other populations by using other indicators of social equity. We are also investigating more harms we suspect are associated with income inequality, such as hospitalizations owing to despair. </p>
<p>This line of work shows the urgent need for increased access to health services such as counselling and harm reduction, particularly in areas of higher income inequality, to reduce the risk of deaths of despair in these spaces. </p>
<p>The study results should be communicated to policymakers, who inform discussions on reducing income inequality and harms due to drug overdose, suicide and alcohol-related liver disease. Programs to mitigate this problem may include cash transfer programs, increases to minimum wage, or <a href="https://theconversation.com/a-guaranteed-basic-income-could-end-poverty-so-why-isnt-it-happening-182638">universal basic income programs</a> to reduce the gap between the highest and lowest earners.</p><img src="https://counter.theconversation.com/content/200419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Benny receives funding from the Women and Children's Health Research Institute (WCHRI).</span></em></p>Higher levels of income inequality in youth are associated with increased ‘deaths of despair’ in young Canadians.Claire Benny, PhD Candidate, Epidemiology, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.