suicide prevention

What Employers Need to Know About Suicide Prevention

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  What should organizations do to help prevent suicide among its employees — and to help support suicide survivors after the death of a coworker? Research suggest first leaders and managers must recognize the workplace predictors of suicide. Then, create a respectful…more

Between 1999 and 2018, the rate of suicide deaths in the United States increased by 35%. Each year, approximately 47,000 Americans die by suicide, which equates to approximately 130 deaths each day. The majority of suicide deaths occur among working age individuals, and statistics show that the number of suicides enacted at work have reached record highs.

As the world continues to battle an ongoing pandemic, more individuals are at risk for experiencing decreased mental health as well as increased suicidal thoughts and behaviors. Now, more than ever, it is critical for organizations to evaluate the role they play in preventing suicide deaths, as well as strategize about ways to aid those considering suicide and effectively support suicide survivors after the death of a coworker.

Workplace Predictors of Suicide

Suicide is a complex phenomenon that is influenced by several intersecting life factors, including individual attributes, environmental conditions, and access to lethal means. As a result, identifying employees at risk for dying by suicide is a complicated process. Our research has shown that one important piece of the puzzle involves employees’ work experiences, including characteristics of the job itself (e.g., meaningfulness, autonomy, variety) and social interactions with coworkers. Take, for example, the suicide deaths or attempts of 13 employees at the Chinese manufacturing company Foxconn in response to extreme working conditions, or the suicide deaths of 35 employees at the French-based telecommunication company Orange as a result of managerial bullying. These situations underscore the very real and adverse effects that the workplace can have on employees’ psyches and behaviors, which can ultimately result in suicide.

We conducted a review of more than 500 studies related to work and suicide to uncover the work-related factors that predict employees’ suicidal thoughts and behaviors. At the core of the review, we identified social and psychological pain to be the central causes of suicide-related behavior. According to the interpersonal theory of suicide, social pain occurs because individuals are unable to establish meaningful connections with others or perceive themselves to be a burden to others. On the other hand, the psychache theory of suicide focuses on psychological pain that is akin to mental suffering or extreme anguish. Individuals who experience either type of pain may enact suicide to end their suffering, especially when they perceive their situations as unchanging or hopeless.

Workplaces are inherently social institutions. While they can provide a sense of community, they can also engender feelings of both social pain and psychological pain. Our review of the literature uncovered a multitude of factors that predict suicide-related thoughts and behaviors among employees, including interpersonal relations, work-family conflict, unstable employment, unemployment, burnout, fatigue, job demands (e.g., workload, stressors, scheduling), job characteristics (e.g., meaningfulness, autonomy, variety), and the physical work environment (e.g., ergonomic and safety features).

As apparent from this varied list, the predictors of suicide are not limited to a single industry or occupation; any job can engender suicidal ideation. Indeed, suicide develops from experiences of social and/or psychological pain, which can develop from detrimental aspects of any workplace. For this reason, all organizations must be cognizant of their influences on employees’ mental well-being, as well as actions they can take to reduce suicides. Additionally, organizations must be prepared to respond to an employee’s suicide death — actions known as postvention strategies.

Organizational Prevention Strategies

In light of the relationship between workplace factors and suicide, organizations have an obligation to prevent suicide-related deaths. The Suicide Prevention Resource Center (SPRC) is federally funded and uses research to create infrastructures to prevent suicide deaths. The SPRC recommends that organizations can use three primary strategies to proactively address suicide: 1) create a respectful, inclusive work environment, 2) identify employees who may be at risk, and 3) create a plan to respond to take action.

Create a respectful work environment and foster social inclusion.

Social connectedness is essential for fulfilling employees’ belongingness needs and helping them to feel part of the work community. While important for all employees, fostering social connectedness will become increasingly important as more employees engage in telework or work in isolation, both due to the current Covid-19 pandemic and changing technological innovations. Thus, inclusion should be a key component of a workplace suicide prevention program.

Organizations can foster a sense of connectedness by establishing mentoring programs and encouraging team-based work projects that allow employees to share ideas and collaborate to reach goals. Providing opportunities for employees to informally engage with another can also build social bonds and has been shown to predict job satisfaction and affective well-being. In providing such opportunities, it is important for organizations to create workplace social norms that favor respectful communication and behaviors.  Research has demonstrated that incivility and bullying are on the rise within workplaces. Such deviant behaviors not only degrade social bonds but also isolate employees at work, therefore making possibly at-risk employees more susceptible to experiencing suicide-related thoughts and behaviors.

Identify employees who may be at risk.

Managers and HR professionals are important gatekeepers for recognizing individuals who are at risk of suicide and aiding those who need help. In addition to workplace specific factors, prior research has identified the following as risk factors of suicide: 1) health conditions such as mental illness, alcohol and substance abuse disorders, as well as major physical illnesses; 2) negative life events including unemployment, job loss, and loss of key relationships; 3) a personal history related to suicide such as a family history of suicide deaths, previous suicide attempts, and a history of trauma or abuse; and 4) access to lethal means, which includes accessibility to means to enact suicide such as a firearm and other weapons or lethal medications.

Tackling these risk factors may be extremely challenging for leaders, however. Directly asking employees about certain topics may be protected under the Americans with Disabilities Act, such as asking employees to disclose mental illnesses. It is important to refer to continuously managed resources, such as those provided by the Society for Human Resource Management and the Job Accommodation Network, to determine whether it is legal to ask specific questions.

Despite this challenge, it’s important for managers to understand these factors so that they can provide employees with adequate social support and access to resources — even when an employee has not explicitly indicated suicidal intentions. For instance, when organizations undergo restructuring or have to make layoffs, these changes in employment status could contribute to suicidal ideation or behaviors among the affected employees. Thus, an important component of any organizational change or severance package would be access to mental health resources and health care.

Additionally, while a manager is restricted in the types of questions they can ask employees, employees may voluntarily disclose information that would indicate their potential risk for suicide. As an example, a person might reveal that they own a gun. While this information on its own isn’t alarming, it would be important knowledge to have if that employee were to experience a serious negative work event such as being written-up or passed over for a promotion. In this instance, if a manager felt concerned about the employee’s safety, they could take actions to contact the appropriate individuals (e.g., the police or a mental health professional).

Keep in mind that, although the factors discussed above are risk factors to suicide, not all employees who meet these criteria will be affected by suicidal thoughts or behaviors. For instance, having a mental illness does make one more vulnerable to dying by suicide, but not all individuals with a mental illness die by suicide. Rather, knowing this information can be vitally important in certain contexts or in the presence of other concerning behaviors.

Because of this, it’s also essential for employers to pay attention to employees’ language and behaviors that might indicate someone is experiencing distress, such as withdrawing oneself, acting anxiously, or experiencing extreme mood swings, or talking about being a burden to others, feeling hopeless, or having no reason to live. For example, if an employee has recently undergone a divorce and has been very withdrawn at work for several weeks, managerial intervention would be valuable. Intervention could include checking in on the employee and referring the employee to available mental health resources (e.g., employee assistance programs, local psychological service providers, support groups).

There may also be times when a manager perceives an employee to be at risk, but the employee is not – even in these instances, no harm is done by reaching out and offering extra support. In other words, managers should not be fearful about getting it “wrong.” Equally important, it is necessary to develop a climate within which employees feel comfortable reaching out to others rather than relying on others to notice their risk factors or behaviors to receive help. Practitioners can refer to previous HBR articles that provide guidance on how to create these inclusive and supportive climates.

Create a plan to take action.

Recognizing that an employee is in need is not enough on its own. Managers and HR professionals need to be prepared to help individuals get help. This preparation includes training managers about mental health concerns, creating strategies for having difficult conversations, and developing an action plan that can be enacted should a crisis arise. To act swiftly and appropriately in these situations, organizations should prepare a decision-making flowchart that outlines who and in what order to contact should an immediate risk arise (an example of what such a flowchart might look like is on page 17 of this report). Managers should also compile a list of available resources and make these publicly available to employees, including contact information for EAPs, local mental health providers, and community resources such as support groups or treatment programs.

Managers should perform routine check-ins with employees (especially those at risk) to gauge their well-being and to listen to any concerns without passing judgment. These conversations provide opportunities for managers to inform employees of available resources as well as to remind the employee that they are supported and cared about in the workplace. Although managers are often important gatekeepers who can monitor changes in employees’ behaviors, their primary role is to provide employees with information and resources for help-seeking — the managers themselves are not expected to counsel or solve the employees’ struggles. Maintaining this boundary is important for protecting the well-being of the manager as well.

Finally, organizations should invest in suicide and mental health training that builds employees’ and managers’ efficacy for having difficult workplace conversations and reduce the stigma associated with suicide. By making mental health a priority in organizations, individuals may feel more comfortable reaching out for help if a need arises. Most importantly, managers, and HR professionals should err on the side of caution and intervene anytime they believe someone is at risk for suicide – a quick response is critical, as once a suicide occurs the window for prevention is permanently closed.

Organizational Postvention Strategies

Unfortunately, organizations may not be able to prevent all suicide deaths, and they need a plan for postvention — psychological first aid, crisis intervention, and support offered after a suicide death.

First and foremost, recovery from a suicide death is a process that should be handled with intention and sensitivity. In the immediate aftermath of suicide, managers’ responses fall into the acute stage that requires protecting the privacy of the deceased, communicating quickly and clearly to quell rumors or misinformation, and offering practical assistance to family members. The short-term response involves identifying affected employees and providing them support through EAPs and other resources. Importantly, not all employees will be impacted the same way and grief can manifest differently. In this time frame, it is necessary to be flexible and patient as employees come to terms with the loss, and to allow time and space for employees to grieve (which likely necessitates changes in expectations for productivity).

Finally, in the long-term response, managers should be mindful of important milestones or anniversaries that may be difficult for suicide survivors — and to honor those who have died by suicide in a respectful manner. This process involves continued investment in suicide prevention programs and policies to minimize the likelihood of future suicide deaths.

While many companies are embracing the importance of well-being, few have focused specifically on the role of suicide. To be effective, policies and practices must specifically target suicide, as conventional well-being programs (e.g., mindfulness, yoga) will likely fail to identify employees who are at the greatest risk. Most importantly, organizations can support employees in crisis by investing in suicide prevention programs. If even just one person is helped, the investment will pay dividends many times over.If you or someone you know is having thoughts of suicide, please use the resources below to seek help.

Suicide Prevention: Gun Laws, Depression Meds, And Other Methods Vary In Success

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Suicide is a tricky public health issue, with experts and policymakers attempting to address both the roots of the problem and the crucial moments of crisis when people try to act on their suicidal feelings. Yet it’s still the second leading cause of death among those 25 to 34, and the third among those ages 15 to 24. Worldwide, there are more than 800,000 suicides every year. It’s still nearly impossible to identify those at risk for suicide before they begin exhibiting suicidal thoughts or behaviors in the first place. But a new international review has taken a look at all the methods available to reduce suicides and determined that some really do work while others show little effectiveness.

Researchers from the European College of Neuropsychopharmacology and the Expert Platform on Mental Health, Focus on Depression examined almost 1,800 studies on suicide published over ten years. The authors’ results were printed in Lancet Psychiatry.

One important finding was that restricting a person’s access to ways of committing suicide has a significant impact. Erecting barriers at popular suicide spots like high bridges and restricting the number of pills in packets are two measures that have proven effective. Places that have stricter gun licensing laws also have lower suicide rates. The report notes that if impulsive attempts at suicide could be blocked, many lives could be saved.

Addressing depression, which is an important risk factor for suicidal behavior, also proved to be effective in certain populations. Medicines like lithium and clozapine have reduced suicides among those over 75, but in children and adolescents the drugs may actually increase suicidal thoughts. Untreated depression, however, is also a risk, so the problem is highly personal and consequently complicated.

bridge

Additional methods that showed some positive effects included placing professionals trained to recognize at-risk behavior in schools, but this was only useful if integrated with other suicide prevention measures. The study also noted that following up with those who have previously attempted suicide is strongly recommended.

“We found that there is no single way of preventing suicide,” Zohar said in a press release. “However, implementation of the evidence-supported methods described in this study, including public and physician education and awareness together with appropriate legislation, has the potential to change public health strategies in suicide prevention plans. With these measures, we can significantly reduce the number of deaths due to suicide.”

The president of the European College of Neuropsychopharmacology, psychiatry professor Guy Goodwin, said the college was proud to have supported such a definitive review.

“As is still not sufficiently known, suicide is always among the commonest causes of death in young people,” he said. “Policies to reduce it need to be evidence-based and this review highlights where evidence does and does not exist currently.”

Military Suicides, Deployment Unrelated.

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No increased suicide risk seen in troops sent to war zones..

Military suicides may be more likely after members leave the service than during active duty deployment, particularly if their time in uniform is brief, a U.S. study finds.

“It was certainly intuitive as the wars went on and suicides went up for people to assume that deployment was the reason, but our data show that that is too simplistic; when you look at the total population, deployment is not associated with suicide,” said lead author Mark Reger, of Joint Base Lewis-McChord in Tacoma, Washington.

While the U.S. military has traditionally experienced lower suicide rates than the civilian population, suicides among active duty service members have surged in the past decade, almost doubling in the Army and the Marines Corps, Reger said.

To understand the link between deployment and suicide, Reger and colleagues analyzed military records for more than 3.9 million service members in active or reserve duty in support of the conflicts in Iraq and Afghanistan at any point from October 7, 2001 to December 31, 2007.

A total of 31,962 deaths occurred, including 5,041 suicides, by December 31, 2009, according to the April 1 online report in JAMA Psychiatry.

Suicide rates were similar regardless of deployment status. There were 1,162 suicides among those who deployed and 3,879 among those who didn’t, representing suicide rates per 100,000 person-years of 18.86 and 17.78, respectively.

Leaving the military significantly increased suicide risk, however, with a suicide rate of 26.06 after separating from service compared with 15.12 for those who remained in uniform. Those who left sooner had a greater risk, with a rate of 48.04 among those who spent less than a year in the military.

Service members with a dishonorable discharge were about twice as likely to commit suicide as those who had an honorable separation.

“This is the first time such a huge, comprehensive study has found an increased suicide risk among those who have separated from service, particularly if they served for less than four years or had an other than honorable discharge,” said Rajeev Ramchand, a researcher in military mental health and suicide prevention at Rand Corporation who wasn’t involved in the study.

It’s possible that pre-deployment examinations may screen out people who have mental health problems, making those who deploy several times a healthier, more resilient group, said Dr. Alan Peterson, a psychologist at the University of Texas Health Science Center in San Antonio who specializes in combat-related post traumatic stress disorder (PTSD).

“Those who really struggle with a deployment don’t go the second time,” said Peterson, a retired military psychologist who wasn’t involved in the study. “Early separation from the military is often a marker for something else.”

For those contemplating suicide, access to firearms can exacerbate the problem, Peterson said. “It’s a risk factor that sometimes gets overlooked, but we’ve seen when they don’t have access to weapons they are less likely to kill themselves.”

http://www.medpagetoday.com/newad_native.php

Some service members who leave the military early may have had risk factors for suicide such as mood disorders or substance abuse problems that contributed to their separation, particularly if they had a dishonorable discharge, said Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention.

“Some of the dishonorable discharges may be related to having a mental health disorder and being unable to keep that behavior in check and breaking the rules, and some of the early separations may be people in distress who appropriately opted out of service,” said Moutier, who wasn’t involved in the study.

It isn’t realistic to expect former service members to instantly reintegrate into their former civilian lives, but they may be experiencing serious mental health problems if they’re not eating or sleeping or if they’re extremely agitated or irritable, Moutier said.

“The lack of an association between deployment and suicide risk isn’t surprising,” she said. “At a very high level, these findings highlight the need for us to pay closer attention to what happens when people leave the military.”

SOURCE: http://bit.ly/1BMzKsh

JAMA Psychiatry 2015.

Limiting access to pesticides can prevent suicides.

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Limiting access to pesticides and firearms, among the most common methods of suicide globally, can help reduce the number of people taking their own lives, according to a latest WHO report.

Farmers spray pesticides to their farm. Limiting access to pesticides and firearms, among the most common methods of suicide globally, can help reduce the number of people taking their own lives, according to a latest WHO report. File photo

More than 800,000 people die by suicide every year, according to WHO’s first global report on suicide prevention, which found that pesticide poisoning, hanging and firearms are among the most common methods of suicide globally.

Evidence from Australia, Canada, Japan, New Zealand, the U.S. and a number of European countries shows that limiting access to these means can help prevent people dying by suicide.

“There is no single explanation of why people die by suicide. However, many suicides happen impulsively and, in such circumstances, easy access to a means of suicide — such as pesticides or firearms — can make the difference as to whether a person lives or dies,” the report said.

Another key to reducing deaths by suicide, WHO said, is a commitment by national governments to the establishment and implementation of a coordinated plan of action.

Currently, only 28 countries are known to have national suicide prevention strategies.

Suicide occurs all over the world and can take place at almost any age. Globally, suicide rates are highest in people aged 70 years and over.

In some countries, however, the highest rates are found among the young. Notably, suicide is the second leading cause of death in 15-29 year-olds globally.

Some 75 per cent of suicides occur in low- and middle-income countries (LMICs).

“One of the key methods of suicide in LMICs, particularly in countries with a high proportion of rural residents engaged in small-scale agriculture, is pesticide self-poisoning. A systematic review of world data for 1990-2007 estimated that around 30 per cent (plausible range 27-37 per cent) of global suicides are due to pesticide self-poisoning, most of which occur in LMICs,” said WHO.

Other effective measures include responsible reporting of suicide in the media, such as avoiding language that sensationalises suicide and avoiding explicit description of methods used, and early identification and management of mental and substance use disorders in communities and by health workers in particular, the report said.

Follow-up care by health workers through regular contact, including by phone or home visits, for people who have attempted suicide, together with provision of community support, are essential, because people who have already attempted suicide are at the greatest risk of trying again.