Roughly 1,000 Washingtonians kill themselves every year, contributing to a suicide rate that is 15 percent above the national average. But if the state Senate passes and the governor signs a bill that passed the House 94-3 earlier this month, Washington will lead the nation in its efforts to prevent suicide. Granted, the bar has been set pretty low.
The bill now before the Senate would require suicide prevention training for doctors, nurses, naturopaths, chiropractors and other primary healthcare providers. (This training would take up six of the continuing education hours already required.) No other state has passed similar legislation. Two years ago, Washington became the first state to require suicide prevention training for counselors, social workers and other mental health professionals. A couple of other states have already followed suit.
Why is this happening here? "I was approached by [University of Washington assistant professor of social work] Jennifer Stuber," explains state Rep. Tina Orwall, the prime sponsor of both suicide prevention training bills. "Her husband had just completed suicide." (In suicide prevention circles, one doesn't speak of "committing" suicide. One "commits" a crime, which is what suicide has traditionally been considered. One does not "commit" a public health problem, which is how they want suicide to be seen now.)
Stuber's husband had seen professionals, says Orwall, but "the people he had sought help from really hadn't been trained." After her husband's death a few years ago, Stuber approached Orwall. Last year, Stuber co-founded the UW-based suicide prevention group Forefront, which has organized a lobbying day Tuesday in Olympia.
Before introducing any legislation, Orwall says, she and Stuber "really built a coalition." Two years ago, they introduced and passed the “Matt Adler Suicide, Assessment, Treatment and Management Act of 2012″— named in honor of Stuber's late husband — which required training for mental health professionals. But some professional groups, including doctors and nurses, didn't want the law applied to them at the time, and they were left out. "This year, we're taking the big step, which is around providers," Orwall says.
Although the bill sailed through the House with only three "no" votes, in the Senate, it faces "a fair amount" of pushback. She explains that professional associations still don't want anyone telling them what to do. And some conservative legislators don't like government telling anyone what to do. In House testimony, opponents also raised concerns about the costs.
Some people have wondered if knowing the questions to ask potentially suicidal patients would increase a practitioner's liability for patients who killed themselves, says Lauren Davis of Forefront. Ironically, Davis says, "the reality is you're liable now if you don't ask."
The Washington State Psychiatric Association opposes the legislation. In an open letter, the association's president, Daniel Crawford, argues that given the number of people who kill themselves every year and the trauma their deaths cause survivors, "the option of inaction is unconscionable," but that "evidence for effective ways to prevent suicide remains frustratingly limited." Crawford quotes a nine-year-old Journal of the American Medical Association(JAMA) article which concluded that physician "education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates," but "[o]ther interventions need more evidence of efficacy."
As Crawford acknowledges, the statistics are pretty staggering. "Some 38,000 people killed themselves in the United States in 2010," the magazine Nature recently observed, citing a February report by the National Action Alliance for Suicide Prevention. "That’s more than were killed in traffic accidents (34,000) or by prostate cancer (29,000), and more than twice the number murdered (16,000)." Nature also reported, "Since 2008, the suicide rate among soldiers has exceeded that of the general population, and in the past few years the army has lost more soldiers to suicide than to combat."
Rates have risen in the civilian workforce, too. Paul Quinnett, a psychologist who runs a Spokane-based suicide prevention training institute and has been a clinical assistant professor in the UW Medical School's department of psychiatry and behavioral science, observes that rates have gone up among people of prime working age, between 25 and 55 since the start of the recession. He says that every 1 percent rise in unemployment is matched by a 1 percent rise in suicides.
Like what you just read? Support high quality local journalism. Become a member of Crosscut today!