The day after beloved comedian and actor Robin Williams committed suicide, the National Suicide Prevention Hotline received more than 7,500 calls, twice as many as usual. Mental health treatment centers all round the country reported a similar jump in calls.
Suicide is one of the 10 leading causes of death in the U.S. In 2010, an American took his or her own life every 13.7 minutes. Statistics show that half the U.S. population will experience some mental difficulty during their lives, and yet there’s been a reluctance to address mental health issues in ways that actually help the people who are afflicted, according to Dr. Delaney Ruston, a Seattle-based internal medicine physician, who has advocated for more than a decade for those struggling with mental illness.
Ruston has taught in the University of Washington's Department of Medicine and worked as a primary care physician at the Pike Market Clinic and other clinics for Seattle's underserved populations. She has received numerous honors for her mental health advocacy work. This past spring, she helped lobby for a groundbreaking new state law that requires all primary health care providers to get training on suicide prevention and intervention.
To address the silence on the issue, Dr. Ruston also produced (wrote, directed and partially shot) two award-winning, full-length documentaries on this ignored aspect of human health. The first, Unlisted: A Story of Schizophrenia, recounts her father’s struggle with schizophrenia and eventual suicide. (He leapt from a pier in Los Angeles.) Hidden Pictures explores how most global health resources are devoted to physical health and illnesses. This despite the fact that, according to the World Health Organization, about 450 million people around the world live with mental illness, and almost one million of them a year commit suicide. (Most of those suicides occur in low and middle income nations where as many as 85 percent of the people with severe mental disorders receive no treatment.)
You’ve been touched personally by suicide. What was your response when you heard about Robin Williams?
"My son told me, 'That’s the first time I felt such emotion about the passing of a celebrity.' We had listened to [Robin’s] interviews, and he was very open about his struggle with mental health, alcohol and drugs. Our family loved Robin’s brilliance in improv and comedy.
"The sadness of my son was moving to me. I think about Robin’s family and all who are thinking 'if only.' And that 'if only' never goes away. I still have days when I think about my father. I think about when he went missing and I went to L.A. to try to find him. I often think if only I had stayed in L.A. and seen him when he reappeared — would that have prevented his suicide? When a family has experienced a death from suicide, focusing on if it could have been prevented is really counterproductive to the healing process."
After Williams' death people said things like “How could he do this to his family?” One celebrity called suicide “stupid” and added “there’s always someone to help.”
"I don’t think there’s a way to fully appreciate feeling a pain that’s so bad you’d rather not live — until you are there. I can’t imagine it, but it is clear in most instances that people who commit suicide are at that place and their brain has lost touch with any feeling of hope. Suicide involves a combination of that hopelessness and the feeling of being a real burden on others. Many of the underserved people I see are disconnected from family and others. My goal is to give them hope with small goals they can achieve."
How do you deal with family or friends of a suicidal person or with a person who talks about hurting themselves?
"For somebody who’s in the throes of suicidality, that’s a medical emergency. More and more, research is showing that individuals who feel connected to a group are better off emotionally and much less likely to want to harm themselves. I work with my patients to learn what they like to do, such as cartooning, and I work with a social worker and our team to find an organization where they could do that and maybe even teach that skill to others.
Did you see anything in your travels in developing countries that would help to address suicide?
"The research shows that when the modes people use to commit suicide are made less accessible, suicide rates drop. For example, the #1 way people commit suicide in India is by ingesting pesticides. So now certain areas in India are locking up pesticides and rates of suicide have indeed gone down in those areas. In the U.S., research has shown that making guns less accessible also decreases the rate of suicide."
You’re very concerned about the stigma of mental illness and the way the media portrays mentally ill people as violent or scary.
"It can be difficult for people to have natural empathy for those who are behaving in ways that are considered strange or violent. Two main scenarios come up: people with untreated severe mental illness living on the streets, and the extremely rare case of people with untreated mental illness who commit a mass shooting. The key is to have full supportive services for these people, which can prevent homelessness and the rare tragic shooting. But this takes empathy from citizens and policymakers."
What can be done to address the stigma around mental illness?
"We should be helping people talk openly and seek counseling. Let me give a personal example: Recently, a businesswoman friend with Type I bipolar illness started a group of high-functioning professionals with mental illness. They will give talks about creating more open and supportive environments around mental illness.
"The funny thing was, I didn’t know if I could be in the group. Here I have been a mental health advocate for over a decade and yet I am not open about my own anxiety. Much of my documentaries have focused on severe forms of mental illness and I felt a bit of guilt voicing my struggles when they are so much less [severe] than many of the stories I have brought to light.
"Another reason I have not been publically open is that it’s been a long road to try to understand my anxiety issues. This began in medical school. One day I was doing a clinical rotation in an ER in San Francisco and a nurse said, 'Dr. Ruston, you look pale as can be,' and I immediately had my blood count analyzed. It turns out that my red blood count was shockingly low. It became clear that the reason was my diet and running. I did not think I was fat but I was compulsively controlling my food [intake] and running. It was during medical school that I got into counseling.
"Now, as a wife and a mother, working on my anxiety is ever more critical because of the impact it can have on the people I love most. For example, at times my anxiety around money causes me to stand motionless at a counter struggling to buy even one cup of tea. I see how my daughter becomes anxious watching me and how she develops real concerns about small sums of money. So now I get support and treatment and this has really helped lessen my anxiety."
You also promote educating children about mental health issues.
"It’s such a missed opportunity that most schools across the globe do not teach about mental health. When I show my films in elementary and high schools, the level of curiosity students have about the human brain, about our behavior and about mental illness is remarkable.
"Teaching about mental health in schools, using real life personal stories can have a big impact, particularly in two areas. The first is educating students to help themselves and their family and friends. Second is that by teaching in a way that inspires compassion, students will develop empathy.
"Illinois and Alaska are the only two states that mandate that mental health issues and psychosocial education be taught [in schools]. They actually integrate material into all classes, which works to build strong and emotionally intelligent children.
"In my work as a documentary filmmaker, I think a lot about the power of story. One of the most effective ways to teach mental health topics to students is to have them meet people with lived experience. It might not be possible to get people with lived experience to come to all schools but using great short videos to do this virtually is an excellent substitute.
"While we are waiting for [mental health education] at schools, we need to start right away in our homes. I talk to my teenagers about my anxiety, what it feels like and what interventions have helped.
What are you working on now?
"My new podcast Finding Mental Health is all about exploring ways that work to improve our mental health. Every time I talk to patients about their hard times, I ask them what they did to get over that, what helped?
You seem very hopeful about efforts to address the stigma of mental illness.
"Some day we will look back and say, 'I remember when there were high suicide rates, people with severe mental illness sleeping in alleyways, kids being cared for by parents immobilized by depression, and we didn’t even teach about mental health issues in schools? Thank goodness we developed a science-based, compassion-driven curriculum using impactful stories and group learning. Thank goodness generations have now been inspired to work to ensure that all people get the support they need.'
"If I didn’t believe that, I could not do the work that I do."
Robin Lindley is a Seattle writer and attorney. He is the features editor for the History News Network and he also contributes to Crosscut, Real Change, and more. He has a special interest in human rights, health and the history of medicine.