October 31, 2022
Despite Medical Progress, Suicide Remains Difficult to Treat
Even as medical care has progressed, one leading cause of death remains tragically high suicide. Despite persistent research over the past decades, suicide rates have only increased , and self-harm remains stigmatized for families and among caregivers.
In some ways, suicide is among the last of the medical taboos, and that makes sense: doctors don’t like to talk about ailments they can do little about. Even at the best hospitals in the world, psychiatrists fail to predict whether a depressed patient will take their own life after leaving the hospital. Studies show that they have just over a 50 percent probability of making an accurate assessment. Ineffective prognosis and treatments make medical professionals reluctant to take on these difficult cases, leaving patients and families even more isolated. A 2019 study found that willingness to treat was significantly lower and the likelihood of referring out was significantly higher among therapists for suicidal patients.”
To make matters worse, medications intended to alleviate depression and other mental health conditions can take weeks to take effect, leaving some patients especially vulnerable as they await the onset of effect.
Overcoming Stigma and Developing Proactive Treatment
We can and must do better. Suicide is a national emergency. Every 11 minutes in the United States, someone takes their own life, according to the Centers for Disease Control, and suicide rates increased 30 percent between 2010 and 2018. In 2020, suicide was the second leading cause of death for Americans aged 10 to 14 and 25 to 34. Rates of suicidal thinking are even higher. The CDC estimates that in 2020, 12.2 million adults seriously considered suicide and 1.2 million actually tried to take their own life.
Given the pervasiveness of suicidal ideation in the United States, mental health providers must adjust how we treat and think about suicide. In order to help these patients, we have to dismantle the stigma around talking about suicide. This starts with consistent screening for depression during routine physical exams. Removing stigmas starts with the clinician. If clinicians initiate the conversation, patients may feel more comfortable discussing topics they may have otherwise been too nervous to bring up.
In addition to clinicians, our medical system must broadly establish consistent screening for depression just as it’s done for blood pressure, high cholesterol, as well as much more intensive diagnostics like endoscopies and colonoscopies. Depression should be among the first things physicians and nurses ask about during physical exams - and yet often, it's the last. In fact, a panel of medical experts recently recommended anxiety screening for all adults under 65.
Fifty years ago, the diagnosis of cancer was similarly stigmatized, for the same reason that clinicians were not well-equipped to manage these conditions. The advent of new treatments, better outcomes, and advocacy efforts by medical professionals and patients alike changed perceptions about cancer completely. We can similarly change how we as a society think about suicide through a concerted effort to develop better treatments, improve outcomes, and increase awareness and acceptance.
In particular, telehealth offers a much-needed resource to address the current situation by providing access for patients who haven’t been able to seek mental health care in the past, were excluded in underserved communities, or didn’t feel comfortable seeking care.
New Approaches Offer Promise
As a first step in improving clinical care and outcomes, we need better measures of treatment for suicidal patients, something that is sorely lacking today. Better data, consistent measurement, and more widespread benchmarks would be a helpful first step. Then, we need to develop interventions that can decrease suicidal thinking.
Some developments are promising. New research indicates that even brief regular contacts with patients experiencing severe depression through post-cards, text messages, emails, phone calls or other communication can decrease suicidal ideation.
This approach helped inspire a new paper that I co-authored with colleagues at Harvard on Bibliotherapy. After suicidal patients read brief, first-person narratives about coping with suicidal ideation written by other people who overcame suicidal thinking, the readers themselves experienced lower rates of suicidal thinking.
How Cerebral is Making A Difference
At Cerebral, we understand just how prevalent suicide is and how difficult it is to treat. And we are committed to taking on the toughest cases and making a real difference for suicidal patients and their families and utilize a comprehensive treatment plan.
Our organizational structure includes a comprehensive Clinical Safety department that includes crisis specialists, psychiatrists, and data scientists. With this crisis response capability in place, our goal is to make sure no one is neglected by the mental health care system and everyone receives consistent, measurable and high-touch interaction.
Cerebral’s data-driven approach is instrumental in improving clinical safety. Each day, Cerebral receives 5,000 to 10,000 patient messages via a chat system available on our website or mobile app. We are using machine-learning to analyze these messages, and we can correctly detect messages with suicidal content with 97% accuracy, and reach out to these patients within minutes.
This system can also serve as a way to connect with patients regularly and keep them close touch with their care team, as each patient message is reviewed and addressed by our patient support team.
As the new research indicates, there are reasons to believe we can make progress in combating the scourge of suicide. As a psychiatrist and CEO of Cerebral, I have seen the devastating impact suicide has on individuals and their families firsthand.
During medical training, medical students typically wore short white coats while more senior doctors were clad in longer ones, symbolizing that they had already completed the process of learning. At Massachusetts General Hospital, where I trained, all doctors wore short coats to emphasize that real learning never ends. We always practice medicine; we do not perfect medicine. That is the mentality which I bring to Cerebral. In order to improve care for our most vulnerable patients, we need to remain humble, data-driven, and committed to becoming life-long students of medicine. Too much is at stake for us not to try.
Dr. David Mou
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