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After years on the rise, early data indicates suicides declined during COVID-19 pandemic

Detroit Free Press - 8/5/2021

While COVID-19 upended and ended the lives of thousands of Michiganders, taking a profound emotional toll, the challenges of 2020 did not seem to bring about a rise in suicides, which early data indicates dropped last year after rising significantly over the previous decade.

According to provisional data from the state health department, Michigan recorded 1,284 deaths by suicide in 2020, down nearly 200 from the 1,471 recorded in 2019 and more than 250 from the 1,547 deaths in 2018.

Nationally, suicides dropped from 47,511 in 2019 to 44,834 in 2020, a decline of 5.6%, preliminary data from the Centers for Disease Control and Prevention shows. In Michigan, suicides have been on the rise for years, increasing annually with few exceptions over the past decade.

The decline indicated by preliminary data comes despite Michiganders and Americans reporting they felt more anxious and depressed — and GOP state lawmakers promising pandemic regulations would lead to skyrocketing suicide rates.

The data came as a surprise to the state's suicide prevention coordinator.

"I think everybody's assumption ... was that there would be a dramatic increase," said Patricia Smith, who leads the state health department's prevention efforts.

To be sure, drug overdose deaths were up by an estimated 16% in Michigan. Many overdose deaths have already been reviewed by state health officials, who have included any overdoses by suicide in the provisional data.

Final suicide numbers are expected to increase after officials finish their records review. But experts don't anticipate a substantial increase to the final tally.

For now, last year's 1,284 suicides in Michigan is lower than the previous seven years.

The pandemic coincided with an expansion of suicide prevention efforts in the state that could prove crucial even as the rollback of COVID-19 restrictions and an uptake in vaccinations has facilitated a return to pre-pandemic routines for many.

Suicide prevention advocates warn of a possible future spike. They point to the economic fallout from the expiration of temporary social safety net programs — such as the eviction moratorium and expanded unemployment benefits — along with possible long-term stress, anxiety and isolation tied to the experience of living through the pandemic as possible causes.

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Without waiting for any suicide data from the state, Republican lawmakers claimed there was a surge in these deaths in Michigan stemming from public health measures enacted to slow the spread of the coronavirus. One GOP lawmaker repeated the assertion even after data indicated he was wrong.

About a month after Gov. Gretchen Whitmer issued a "stay at home" order, state Rep. Beau LaFave, R-Iron Mountain, warned that if such orders continued, Michigan would see an increase in suicides.

By the fall, Republican lawmakers claimed LaFave's prediction had panned out. State Rep. Matt Hall, R-Emmett Township, claimed that "prolonged isolation" gave way to an increase in suicides. In a February response to Whitmer's extension of bar and restaurant restrictions, LaFave was joined by state Reps. Greg Markkanen, R-Hancock, and John Damoose, R-Harbor Springs, in asserting that Whitmer was responsible for "an unconscionable spike" in suicide deaths.

State Rep. Jack O'Malley, R-Lake Ann, cited suicides in a recent speech justifying why lawmakers should strip the governor of emergency powers she had used to combat the pandemic.

"We had one person ruling under the guise of public safety, but yet suicide rates soared, children missed crucial time in the classroom, small businesses went belly up and were forced to police their own communities with vague executive orders," he said.

In response to Free Press questions, Damoose, LaFave and Markkanen didn't dispute the provisional suicide data, but said that the communities they represent faced a different reality. Local papers reported suicides and opioid overdoses "more than ever before in our professional careers," LaFave and Markkanen said.

Damoose said that the statewide provisional data stood in stark contrast "to what we've been hearing from mental health professionals on the front lines in the Upper Peninsula and northern Michigan."

O'Malley said that he based his statement on conversations he had with coroners, EMTs and mental health officials, who told him suicides had increased based on their observations. He declined to say whether he believes the state data is inaccurate.

The decade preceding the pandemic saw a significant surge in suicides in the state. Between 2009 and 2019, the suicide rate among Michigan residents increased 28%, according to a report from the Michigan Suicide Prevention Commission. The report also found that suicide rates in Michigan are generally higher in more rural areas.

But in 2020 in Michigan, data shows both urban and rural counties saw a decline, although not every medical examiner's office has shared information on the number of suicides that occurred in their counties.

In the tri-county area, Wayne County saw 246 suicides in 2019 and 238 in 2020 while Oakland saw 154 in 2019 and 150 in 2020. Data for Macomb County was not available.

Meanwhile less densely populated Clare and Mecosta counties recorded similar declines. Clare County saw nine suicides in 2019 and three in 2020, and Mecosta County saw six in 2019 and two in 2020.

But the story wasn't the same everywhere.

Lake County, for instance, saw eight suicide deaths in 2020, up from three in 2019 and two in 2018. Josh Snyder, chief clinical officer at West Michigan Community Mental Health, said it's hard to know what explains the increase.

"I guess my initial thought would be it'd be hard to believe that COVID and the impact of COVID wouldn't be a part of that," he said.

He added that it would be premature to assess the impact of restrictions on suicides, but noted they could have played a role.

"Some of the restrictions that have happened, whatever you believe about them, right or wrong, they have an impact on health indicators across the board," he said.

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Understanding why someone died by suicide requires undertaking a psychological and social autopsy that entails talking to a victim's family, friends and partner, said Steven Stack, a Wayne State University professor whose research focuses on suicide. Without that kind of deep investigation, it's difficult to know whether the pandemic played a role in the death, Stack said.

Mental health struggles frequently accompany economic downturns.

And social distancing during the 1918 Spanish Flu epidemic in the U.S. was associated with an increase in suicide deaths, according to Stack's research.

Looking at school closures, business closures and quarantines in 1918, he found an increase in suicide rates correlated with every additional 10 days of social distancing in the large American cities he analyzed.

But Stack said that daily life during the COVID-19 pandemic differs from the 1918 flu in significant ways. Social isolation has been buffered by technology that has allowed people to stay in close contact. And a more expansive social safety net in present times could also explain why the uptick in suicide deaths that accompanied social distancing in prior pandemics didn't occur in the U.S. this time.

Those who work in suicide prevention point also to humans' ability to cope during times of collective stress as a possible explanation.

When there's a global event like COVID-19 that impacts everyone, "everybody has a reason to be depressed and anxious," said Melissa Bowman, who coordinates suicide prevention programs at Common Ground in Oakland County. "So a lot of people aren't feeling as isolated and alone and helpless in their suicidal thoughts."

And a lot more people were reaching out for help, an indication of the increased demand for support as well as increased contact between those in crisis and mental health providers. Bowman said that Common Ground's crisis line handled about 4,000 more calls to its crisis line in 2020 compared with 2019. She said her organization observed an increase in the number of calls from people with suicidal thoughts, but a decrease in actively suicidal individuals requiring intervention.

Advances in suicide prevention and the widespread adoption of telehealth and virtual support groups could also offer an explanation for why the pandemic wasn't accompanied by a surge in suicides.

While the onset of the pandemic initially hampered the ability to deliver mental health services typically offered face-to-face, many providers transitioned quickly to providing telehealth services, said Brian Ahmedani, the director for the Center for Health Policy & Health Services Research at Henry Ford Hospital who sits on the Michigan's suicide prevention commission. Those telehealth appointments saw lower no-show rates, said Ahmedani, who hopes to see the availability of telehealth mental health services continue indefinitely.

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Experts warn that the mental health impact of a generational health crisis may linger.

"We'll be watching over the next one, two, three years, to see if we see that kind of time lag with suicide death that may be related to the pandemic," said Smith, the state's suicide prevention coordinator.

The same month Michigan reported its first coronavirus cases and deaths, the state's first-ever suicide prevention commission began crafting a statewide suicide prevention strategy. In a March 2021 report, the commission called for long-term investments in prevention and community involvement that includes health care workers, teachers, employers and others.

Among the more than 30 recommendations to support the commission's goal toward achieving zero suicides in Michigan, the group calls for increasing suicide prevention awareness among firearm advocacy groups, veterans organizations and other groups as well as requiring suicide prevention training as part of the licensing process for health care professionals and ensuring transitional care for those with suicidal thoughts or behaviors discharged from health care settings.

The pandemic inspired those working on suicide prevention to build new relationships, said Barbara Hawkins-Palmer, executive director of Healthy Kent, a community health initiative within the Kent County Health Department. "That was not happening until virtual meetings. I mean, I never connected with anyone statewide," she said.

Limited resources have plagued mental health services for years, Ahmedani said, and prevention advocates across the state hope that their collective efforts can change that. Approaching suicide as a treatable public health threat, like COVID-19, offers an example of what large investments can accomplish, he said.

"I mean, this is a challenging time, but it's amazing that you could come up with a vaccine in a year."

Suicide prevention advocates have assumed that it would take decades for their work to garner the same kind of credibility as those working to address other areas of public health such as cancer research, said Leo Nouhan, a health care attorney who sits on the board of directors for Kevin's Song, a metro Detroit organization devoted to increasing public awareness about suicide prevention.

"I think we're getting there a little quicker than that," he said during a March meeting for With One Voice, an effort to bring prevention advocates across the state together.

Clara Hendrickson fact-checks Michigan issues and politics as a corps member with Report for America, an initiative of The GroundTruth Project. Make a tax-deductible contribution to support her work at bit.ly/freepRFA. Contact her at chendrickson@freepress.com or 313-296-5743. Follow her on Twitter @clarajanehen.

Contact Dave Boucher: dboucher@freepress.com or 313-938-4591. Follow him on Twitter @Dave_Boucher1.

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National Suicide Prevention Hotline: 800-273-TALK (8255)

Detroit Wayne Integrated Health Network. Provides a full slate of mental health services. The helpline is answered 24 hours a day: 800-241-4949. Also: dwihn.org.

Common Ground is the largest provider of mental health crisis services in Oakland County. The crisis hotline is answered 24 hours a day: 800-231-1127. Also: commongroundhelps.org.

Care of Southeastern Michigan. This Macomb County-based nonprofit provides a number of programs, including counseling and addiction treatment. Go to careofsem.com or call 586-541-2273.

Community Care Services. Located Downriver, this agency provides mental health treatments, including substance abuse. Go to comcareserv.org or call 313-389-7500.

Oakland Family Services. Headquartered in Pontiac, it provides counseling and other mental health services for children and adults. Go to oaklandfamilyservices.org or call 248-858-7766.

For a list of crisis services across the state, compiled by the Michigan Department of Health and Human Services, go to michigan.gov/mdhhs.

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