According to the Vermont Department of Mental Health, the suicide rate in Vermont has increased over the past 10 years. Dr. Eliot Nelson, general pediatrician at the University of Vermont Children’s Hospital, and a professor at the Larner College of Medicine at the University of Vermont, tells us what some risk factors of suicide may be, the role that gun safety plays, and how to get help or help others.
Listen to the interview at the link below or read the transcript that follows.
UVM Medical Center: According to the Vermont Department of Mental Health, the suicide rate in Vermont has increased over the past 10 years. In 2014, there were more than 17 suicides per 100,000 Vermonters. The New York Times reported that the national average that year was 13 suicides per 100,000 people. Here to speak with us today is Dr. Eliot Nelson. He’s a general pediatrician at the University of Vermont Children’s Hospital, and a professor at the Larner College of Medicine at the University of Vermont. He is also a member of the Vermont Suicide Prevention Coalition out of the Center for Health and Learning in Brattleboro, and works with the Vermont Child Health Improvement Program.
Welcome to the program, Dr. Nelson.
Eliot Nelson: Thank you.
UVM Medical Center: To get started digging into this topic, can you tell us a little bit more about how we can tell if someone is at risk for suicide? What are some of the signs?
Eliot Nelson: The signs for suicide and the risk factors for suicide have been discussed a lot in lay press. I think it’s important to recognize what some of those risk signs are. We can talk about that. Some of the classic ones, for example, are whether somebody is acting depressed. What do we mean by that? We mean if they’re acting withdrawn, if they’re unusually fatigued, if new emotions are being expressed in any direction, meaning sometimes people are obviously sad, but sometimes people are just extra irritable or grumpy. In young people, who I take care of, unusual anger, bitterness, is often a sign of depression. In fact, sometimes more often than overt sadness. Things like not having energy, expressing feelings of worthlessness or hopelessness … All those things are signs of suicide risk.
I also think it’s important to keep in mind that with young people in particular, feeling depressed and sometimes feeling so depressed that we feel like might not be worth living is common in being human beings in our world these days. It means that almost everybody is potentially, at some point, going to be at risk of being suicidal. I don’t think people should assume that they’ll always be able to pick out somebody who’s at risk of suicide from all the other people who aren’t at risk of suicide.
UVM Medical Center: How then, if that is true … and I understand that of course we won’t always be happy all of the time. I think what you say is true about, in our society today, and with the social media, it’s kind of a little bit difficult in terms of expectations around emotions and feelings of happiness. For parents or others listening … and you mentioned some of these warning signs. When should somebody be concerned, then? If we do have a spectrum of feelings, when does concern come into it and when is it appropriate to reach out to somebody who you might fear is feeling this way?
Eliot Nelson: I think the important thing is to be alert to changes and to be open to talking with people if you notice that there are changes in their demeanor, or affect, or their behavior, and asking them simply, “Are you okay?” Asking that question by itself is a sign that you’re paying attention to them, that you care. Then if you find out that there really is something going on, you’re in a better position to keep being able to help.
I think that all of the risk factors we talk about, they’re so non-specific that it’s very hard sometimes to sort out when somebody who is sad is actually very sad or when they’re just having a bad moment. The other part with kids that’s so important is that young people change rapidly. They go from being very sad and down one day to being much happier the next day. You really have to keep aware that feelings can change in both directions and therefore the risk of something being serious could change in both directions, too. I don’t want that to sound scary to people. I want it to be realistic so people don’t just assume that it’s easy to spot a suicidal individual or know when something’s going to happen. We all have to be watching out and being sure to show that we care and that we’re willing to listen.
UVM Medical Center: It sounds like conversation is really the key to that. If you do end up opening a conversation with somebody and they do express some of these more serious feelings that might point to suicidal ideation or suicide risk, how then do you continue that conversation? I would imagine that that’s tricky. What do you do? What do you talk to somebody about?
Eliot Nelson: I think that the first thing to say and to keep in mind yourself is this really isn’t such a rare thing. When we’re talking about young people in Vermont, we know that from the youth risk behavior surveys, probably about 25% of people are periodically so sad that they might be close to having suicidal feelings. And in fact, about 10 to 12% of youth by high school have had serious enough depression that they’ve had suicidal feelings to the point where they’ve thought about making a plan. It’s not rare.
When somebody in fact opens up or we get somebody to open up, the first thing that we should do is let them know we’re going to listen and that we want to be sure they know that we’re going to help them. We always have to tell our young people that if one of their friends opens up to them, which is often going to happen … Many youth will tell us that if they were ever so sad that they thought they might be suicidal, that the first person they would tell would be their best friend. We hope that the best friend will have been taught and will have accepted the idea that if they’re this person’s best friend, they’re going to get help and that means reaching out to an adult, and not just keeping a secret or keeping it to themselves. That’s what being a best friend is really about.
UVM Medical Center: Our guest today is Dr. Eliot Nelson. He’s a general pediatrician at the University of Vermont Children’s Hospital and a professor at the Larner College of Medicine at the University of Vermont.
I want to shift the conversation a little bit to guns and gun safety. In Vermont, there was a report that 420 people died from gunshot wounds between 2011 and the end of 2016, and 89% of those, or 373, were suicides which is above the national average which is 60%. What role do you see that guns play in suicide in Vermont? And I guess beyond that, what are some ideas around gun safety that we might be able to share with listeners?
Eliot Nelson: We feel that it’s important for us to ask about whether guns are present in people’s homes. We feel, more importantly, that because the potential risk of a suicidal act is so unpredictable from time to time in people, especially in young people, we think it’s best to make sure that guns are stored in a secure, safe way, locked up and unloaded as a matter of routine so that they won’t be easily accessed if someone has a short-term but serious crisis in his or her life. That’s our hope.
I think along those lines, it’s also important for Vermonters to realize something that they might not, that most of the time, people might think of only handguns as being risky for suicide. In fact, in rural states like Vermont, a large percentage of guns that are used for firearm suicide are long guns, rifles and shotguns. We even found, when we looked at this carefully in research over a 25, 26-year period, even for young people, more than half of the firearms that were used in firearm suicide were rifles or shotguns, not handguns. People shouldn’t assume that a hunting rifle is not something to be worried about. It’s potentially a weapon that can be used.
I think it’s hopeful to know that we’ve seen at least some decrease in firearm suicide in Vermont in the last decade or so. I have to speculate here, but I think it’s likely in part to be that more people are aware of the value of storing their guns in a safe way. It’s not something which is at all a source of political controversy for most people. Safe storage of firearms is something that’s recommended by sport-shooting foundations, by the National Rifle Association, when there are children or youth in the home. Safe storage means locked up, not accessible, unloaded. We think that that’s an important aspect of a safe environment given that sometimes depression and suicide in our loved ones is not something that we will necessarily have a lot of warning to deal with.
UVM Medical Center: Do you see a lot of cases of more impulsive suicide then? What is the difference?
Eliot Nelson: It’s a great question. I think the evidence is strong that, especially for younger people, the actual suicidal act is very often not long-term in its making. It may have been a degree of depression or sadness for a while, or unhappiness, but in young people in particular, a short-term crisis … maybe something to do with trouble at school, trouble with a relationship, a boyfriend or girlfriend, or a crisis or conflict within the family … may produce intense unhappiness and in fact lead to a suicidal act on very short notice. In young people, impulsivity is a very important aspect of suicidal behavior and that’s one of the things that makes easy access to a firearm so dangerous.
UVM Medical Center: Wow. Lots of good information. We’ll wrap it up now. I’m sure we could talk a lot about this. I’m wondering, from your perspective for our listeners, where is the first place people can get help if they’re feeling suicidal? Where should they turn to?
Eliot Nelson: Throughout the state of Vermont, there are excellent crisis services available in every county. The crisis numbers are easily available in the phone book or simply by calling the universal helpline number in Vermont, 211. You will get helped 24/7 at any time. You will potentially be connected to the National Suicide Health Hotline. Within your own county, for example in Chittenden County, the Howard Mental Health Center, the County Mental Health Center, has First Call for Children, Youth, and Families, 488-7777. That kind of number is always available. People should not be hesitant to call that number when they’re worried. Never be hesitant to call it. The people who work in these centers are very skilled and very helpful, and they will go to great lengths to make sure that your loved ones are protected, or you yourself.
UVM Medical Center: All right. Well, thank you, Dr. Nelson for joining us today. Our guest today has been Dr. Eliot Nelson, a general pediatrician at the University of Vermont Children’s Hospital and a professor at the Larner College of Medicine at the University of Vermont. If you are suicidal or know someone at risk, please call the National Suicide Prevention Lifeline at 1-800-273-8255. You can also text the Crisis Text Line at 741741.