Preventing suicide preceded by mass murder

As the country struggles to process the horrific massacre in Newtown, Conn., those of us who treat patients with mental illness must keep several facts in mind.

We know that 20,000 out of 100,000 people in the United States have a mental illness and that much of this is depression. In addition, an estimated 1 million adults in the United States reported making a suicide attempt in the past year.

Finally, it turns out that overall, for the last 30 years, the suicide rates run around 11/100,000 people across all age ranges and 20/100,000 for young adults. This makes suicide the third-leading cause of death among young people. Yet, suicide is actually a rare event. Furthermore, the likelihood of a person committing a single homicide before committing suicide is even rarer.

As an expert in violence prevention who has been investigating these phenomena for 45 years, I view such incidents as "suicides preceded by mass murder" (mass murder defined as three or more people being killed). The problem is there is no solid evidence for this theory. Also, these kinds of suicides are even rarer and even more difficult to study with the goal of preventing these tragedies.

Of course, if people get their understanding about public health and the frequency of certain events from the media, they believe such events are not rare, but rather are quite common. These difficulties make it tricky for public psychiatrists to inform public policy and public opinion to do things that prevent these horrible events from occurring and repeating.

When an individual commits suicide and the media give that suicide a great deal of coverage, shortly afterward, there are what are called "copycat" or "contagion" suicides – this was David Phillips’s seminal work back in the 1970s. The proof is so strong that the American Foundation for Suicide Prevention, the American Association of Suicidology, and the Annenberg Public Policy Center have provided "Reporting on Suicide: Recommendations for the Media." These guidelines suggest that the media not give a great deal of attention to the phenomenon of suicide, and it begins with the assertion that "Suicide contagion is real."

Those of us who work with these patients know that when the media provide details about these suicides, they provide depressed, hurt individuals who express their pain through anger and violence with a blueprint for what to do with their suicidal ideation. We know that a huge dynamic in the thinking of suicidal people is often: "I’ll fix you; I’ll kill myself." Unfortunately, some people take this a step further and think: "I’ll show you; not only will I kill myself, but I will kill a bunch of other people first." Fortunately, as I said earlier, this is an extremely rare event – despite the perception perpetuated by the mainstream media that this is common.

In light of these facts, I have several recommendations:

• First, I realize that the media cannot ignore these horrific events, but it could report on them differently to minimize what I suspect is contagion.

• Second, we can increase the protective factors that generally prevent more suicides from occurring.

Here are four steps we can take to stop these events:

1. We can increase the social fabric surrounding mentally ill people, which entails not being afraid of them and not stigmatizing them.

2. We can ensure that all youth are strongly connected to people so they will be able to feel good about their relationships and about themselves. Such support systems help ease some of the pain caused by depression.

3. We can teach all of our children social and emotional skills such as "affect regulation" so that "hurt people will not hurt people."

4. We can monitor our young adults (that is, anyone under 26), because research shows that brain development is a gradual process. The limbic system (the flight, fight, or freeze system of the brain) is the first to develop. The frontal lobes, where thinking, judgment, and wisdom occur, are not fully developed until age 26 – in other words, young adults tend to be all gasoline and no brakes or steering wheel. Thus, it is up to families, schools, friends, and neighbors to supply the brakes and steering wheels for young adults in a loving manner – not a punitive one – so they are influenced by formal and informal social controls that prevent risky behaviors.

• Lastly, the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action, if followed, could prevent "suicides preceded by mass murder."

Dr. Bell is professor of public health and director of the Institute for Juvenile Research in the department of psychiatry at the University of Illinois at Chicago. He has written extensively on the issue of suicide and homicide, and was appointed to serve on the Institute of Medicine’s Board of Neuroscience and Behavioral Health study on pathophysiology and prevention of adolescent and adult suicide in 2000 that produced the seminal IOM report "Reducing Suicide" in 2002. Dr. Bell also worked with former U.S. Surgeon General David Satcher on "Youth Violence: A Report of the Surgeon General" in 2001.

As the country struggles to process the horrific massacre in Newtown, Conn., those of us who treat patients with mental illness must keep several facts in mind.

We know that 20,000 out of 100,000 people in the United States have a mental illness and that much of this is depression. In addition, an estimated 1 million adults in the United States reported making a suicide attempt in the past year.

Finally, it turns out that overall, for the last 30 years, the suicide rates run around 11/100,000 people across all age ranges and 20/100,000 for young adults. This makes suicide the third-leading cause of death among young people. Yet, suicide is actually a rare event. Furthermore, the likelihood of a person committing a single homicide before committing suicide is even rarer.

As an expert in violence prevention who has been investigating these phenomena for 45 years, I view such incidents as "suicides preceded by mass murder" (mass murder defined as three or more people being killed). The problem is there is no solid evidence for this theory. Also, these kinds of suicides are even rarer and even more difficult to study with the goal of preventing these tragedies.

Of course, if people get their understanding about public health and the frequency of certain events from the media, they believe such events are not rare, but rather are quite common. These difficulties make it tricky for public psychiatrists to inform public policy and public opinion to do things that prevent these horrible events from occurring and repeating.

When an individual commits suicide and the media give that suicide a great deal of coverage, shortly afterward, there are what are called "copycat" or "contagion" suicides – this was David Phillips’s seminal work back in the 1970s. The proof is so strong that the American Foundation for Suicide Prevention, the American Association of Suicidology, and the Annenberg Public Policy Center have provided "Reporting on Suicide: Recommendations for the Media." These guidelines suggest that the media not give a great deal of attention to the phenomenon of suicide, and it begins with the assertion that "Suicide contagion is real."

Those of us who work with these patients know that when the media provide details about these suicides, they provide depressed, hurt individuals who express their pain through anger and violence with a blueprint for what to do with their suicidal ideation. We know that a huge dynamic in the thinking of suicidal people is often: "I’ll fix you; I’ll kill myself." Unfortunately, some people take this a step further and think: "I’ll show you; not only will I kill myself, but I will kill a bunch of other people first." Fortunately, as I said earlier, this is an extremely rare event – despite the perception perpetuated by the mainstream media that this is common.

In light of these facts, I have several recommendations:

• First, I realize that the media cannot ignore these horrific events, but it could report on them differently to minimize what I suspect is contagion.

• Second, we can increase the protective factors that generally prevent more suicides from occurring.

Here are four steps we can take to stop these events:

1. We can increase the social fabric surrounding mentally ill people, which entails not being afraid of them and not stigmatizing them.

2. We can ensure that all youth are strongly connected to people so they will be able to feel good about their relationships and about themselves. Such support systems help ease some of the pain caused by depression.

3. We can teach all of our children social and emotional skills such as "affect regulation" so that "hurt people will not hurt people."

4. We can monitor our young adults (that is, anyone under 26), because research shows that brain development is a gradual process. The limbic system (the flight, fight, or freeze system of the brain) is the first to develop. The frontal lobes, where thinking, judgment, and wisdom occur, are not fully developed until age 26 – in other words, young adults tend to be all gasoline and no brakes or steering wheel. Thus, it is up to families, schools, friends, and neighbors to supply the brakes and steering wheels for young adults in a loving manner – not a punitive one – so they are influenced by formal and informal social controls that prevent risky behaviors.

• Lastly, the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action, if followed, could prevent "suicides preceded by mass murder."

Dr. Bell is professor of public health and director of the Institute for Juvenile Research in the department of psychiatry at the University of Illinois at Chicago. He has written extensively on the issue of suicide and homicide, and was appointed to serve on the Institute of Medicine’s Board of Neuroscience and Behavioral Health study on pathophysiology and prevention of adolescent and adult suicide in 2000 that produced the seminal IOM report "Reducing Suicide" in 2002. Dr. Bell also worked with former U.S. Surgeon General David Satcher on "Youth Violence: A Report of the Surgeon General" in 2001.

As the country struggles to process the horrific massacre in Newtown, Conn., those of us who treat patients with mental illness must keep several facts in mind.

We know that 20,000 out of 100,000 people in the United States have a mental illness and that much of this is depression. In addition, an estimated 1 million adults in the United States reported making a suicide attempt in the past year.

Finally, it turns out that overall, for the last 30 years, the suicide rates run around 11/100,000 people across all age ranges and 20/100,000 for young adults. This makes suicide the third-leading cause of death among young people. Yet, suicide is actually a rare event. Furthermore, the likelihood of a person committing a single homicide before committing suicide is even rarer.

As an expert in violence prevention who has been investigating these phenomena for 45 years, I view such incidents as "suicides preceded by mass murder" (mass murder defined as three or more people being killed). The problem is there is no solid evidence for this theory. Also, these kinds of suicides are even rarer and even more difficult to study with the goal of preventing these tragedies.

Of course, if people get their understanding about public health and the frequency of certain events from the media, they believe such events are not rare, but rather are quite common. These difficulties make it tricky for public psychiatrists to inform public policy and public opinion to do things that prevent these horrible events from occurring and repeating.

When an individual commits suicide and the media give that suicide a great deal of coverage, shortly afterward, there are what are called "copycat" or "contagion" suicides – this was David Phillips’s seminal work back in the 1970s. The proof is so strong that the American Foundation for Suicide Prevention, the American Association of Suicidology, and the Annenberg Public Policy Center have provided "Reporting on Suicide: Recommendations for the Media." These guidelines suggest that the media not give a great deal of attention to the phenomenon of suicide, and it begins with the assertion that "Suicide contagion is real."

Those of us who work with these patients know that when the media provide details about these suicides, they provide depressed, hurt individuals who express their pain through anger and violence with a blueprint for what to do with their suicidal ideation. We know that a huge dynamic in the thinking of suicidal people is often: "I’ll fix you; I’ll kill myself." Unfortunately, some people take this a step further and think: "I’ll show you; not only will I kill myself, but I will kill a bunch of other people first." Fortunately, as I said earlier, this is an extremely rare event – despite the perception perpetuated by the mainstream media that this is common.

In light of these facts, I have several recommendations:

• First, I realize that the media cannot ignore these horrific events, but it could report on them differently to minimize what I suspect is contagion.

• Second, we can increase the protective factors that generally prevent more suicides from occurring.

Here are four steps we can take to stop these events:

1. We can increase the social fabric surrounding mentally ill people, which entails not being afraid of them and not stigmatizing them.

2. We can ensure that all youth are strongly connected to people so they will be able to feel good about their relationships and about themselves. Such support systems help ease some of the pain caused by depression.

3. We can teach all of our children social and emotional skills such as "affect regulation" so that "hurt people will not hurt people."

4. We can monitor our young adults (that is, anyone under 26), because research shows that brain development is a gradual process. The limbic system (the flight, fight, or freeze system of the brain) is the first to develop. The frontal lobes, where thinking, judgment, and wisdom occur, are not fully developed until age 26 – in other words, young adults tend to be all gasoline and no brakes or steering wheel. Thus, it is up to families, schools, friends, and neighbors to supply the brakes and steering wheels for young adults in a loving manner – not a punitive one – so they are influenced by formal and informal social controls that prevent risky behaviors.

• Lastly, the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action, if followed, could prevent "suicides preceded by mass murder."

Dr. Bell is professor of public health and director of the Institute for Juvenile Research in the department of psychiatry at the University of Illinois at Chicago. He has written extensively on the issue of suicide and homicide, and was appointed to serve on the Institute of Medicine’s Board of Neuroscience and Behavioral Health study on pathophysiology and prevention of adolescent and adult suicide in 2000 that produced the seminal IOM report "Reducing Suicide" in 2002. Dr. Bell also worked with former U.S. Surgeon General David Satcher on "Youth Violence: A Report of the Surgeon General" in 2001.