Suicides are at their highest rate since WWII. Can technology help?

It may seem counterintuitive to think of technology as a means of helping someone in the throes of depression when, so often, higher levels of smartphone use are associated with feelings of loneliness, anxiety, depression, hyperactivity and isolation — mainly due to social media activity. A recent study in the Journal of Social and Clinical Psychology has even found a causal link between the use of social media and negative effects on well-being.

Luckily, there is new hope to be found in initiatives being developed to curb growing rates of suicide, especially among the younger generations. Suicide rates are at their highest since World War II, according to federal data reported by the Centers for Disease Control and Prevention (CDC), now ranking second for the leading cause of death for Americans ages 10 to 34. For ages 35 to 54, suicide comes in fourth place.

One such prevention method includes proposed national efforts to make it easier for those in crisis to seek help. A new three-digit hotline is currently being proposed to Congress by the Federal Communications Commission. If passed, the current national 10-digit hotline for those feeling suicidal would be reduced to a simpler dial code of 988, which mental health advocates are saying would make it easier for people in crisis to seek help.

Additionally, a student ID bill may also pass by 2020 called the Improving Mental Health Access for Students Act. The Crisis Text Line, which is championing the bill, offers free crisis counseling to anyone in the U.S. who sends a text to 741741. Canadians can text 686868, and those in the United Kingdom can text 85258.  They’re hoping to raise increased awareness of their services for those who need it the most — stressed out students — by requiring that crisis numbers are printed on student IDs.

“Seventy-five percent of those who text in are under the age of 25,” says Ashley Womble, head of communications at Crisis Text Line. “So a big, big chunk of them are in high school, middle school and college. We have partnerships with a number of schools who have already been putting our number on student ID cards. The student ID is now used to pay for your lunch, check out your books, get into your dorm building … so we want it to be as easy as possible for students to get help.”

Crisis Text Line has partnered with a student-led, on-campus organization called Active Minds to include the text counseling service on the backs of student IDs, along with contact information for the National Suicide Prevention Lifeline. The proposed legislation would put supportive resources into the hands of 20 million people throughout the U.S., almost all of whom fall into the most critical age category for possible death by suicide.

Texting for help

How does the service work exactly? It all starts with a text to 741741. The person who sent the message receives confirmation they’ve reached the Crisis Text Center and terms of service to agree to before entering a chat with one of their trained crisis counselors. They can then chat with the counselor about anything, even if it’s something that seems inconsequential.

“Oftentimes, we’ll start off with something quite simple, and quickly through this conversation they’ll both understand that there’s something bigger happening here. Suicide is one of those issues that we come across all day, every day,” says Womble.

“We have, based off our data, started asking every texter if they’re thinking about suicide. That can seem a little unusual, especially if the texter comes to us and says, ‘hey, I’ve got this algebra exam and I’m really worried I’m going to fail.’ But we’ve found that once we build a rapport, if we say, ‘because you mentioned that your parents don’t understand how much stress this creates for you, and you’re worried about this, I want to ask — are you thinking about suicide?’ That gives an opening for that person to say, ‘Yeah, actually, I am.’ ”

What happens next is the counselor identifies the level of risk the texter is currently in — do they already have a suicide plan in place? Do they intend on carrying out that plan in the next 24 hours? The goal of each engagement is to create a safety plan and coping tips for the texter. A strategy designed by Dr. Barbara Stanley, a safety plan might involve identifying the following, and can be practiced by anyone feeling at risk of self-harm:

1. A list of coping mechanisms for when you feel triggered, like writing down your thoughts or going for a walk.
2. Places you can go to make you feel safe, like your best friend’s house or the library.
3. People and professionals you can call when you’re in crisis, like your grandparents or your psychologist.

Besides the 120 million messages the Crisis Text Line has processed since its inception six years ago, they’ve also completed 27,100 “active rescues” and de-escalated 46,800 texters who had expressed suicidal ideation and identified a plan, means and a 24-hour timeframe to end their lives. An active rescue is the final measure taken by a crisis counselor if the texter is unable or unwilling to identify a safety plan and is already at the brink of taking their life. “They’ve basically said ‘I’m at this bridge, or I have the pills in my hand, and there’s nothing you can do,’ ” says Womble. At that point, 911 is called and a rescue mission is set into place.

A miraculous recovery — and a safety net

One such location that would certainly signal a cause for concern is the Golden Gate Bridge in San Francisco — the second most popular place to carry out a suicide attempt in the world after the Nanjing Yangtze River Bridge in China. It was estimated that, on average, one person killed themselves on the California bridge every 13 days between 2017 and 2018, bringing the death toll to more than 400. In 2000, a young man named Kevin Hines attempted suicide on the famous bridge, but he miraculously survived despite falling 220 feet at about 75 miles per hour and shattering two of his vertebrae. The end seemed near for him as he struggled to the surface amid shooting pain but was saved by a creature that was later identified by an eyewitness as a sea lion.

Hines and his wife then started the Kevin & Margaret Hines Foundation to educate others about mental health and suicide prevention. He says that if he had been engaged by anyone on the day he attempted to take his life, he wouldn’t have gone through with it. Luckily, a suicide prevention net that Hines and so many others have been lobbying for is now under construction on the Golden Gate Bridge, with a projected completion of 2021. This kind of innovative, life-saving design is starting to be implemented in places throughout the world, perhaps sparked by an increased awareness of the importance of mental health and the serious dangers of depression.

The Mapo Bridge over the Han River in South Korea, for example, is now being called the “Bridge of Life” after the Seoul city government added intuitive, interactive handrails that speak directly to passersby. The handrails use motion sensing technology and light up with short, inspirational messages that were chosen with the help of psychologists and suicide prevention specialists.

“How have you been? If you need to talk, why don’t you talk to us?” the bridge may ask, along with providing the number of a suicide prevention hotline. Emergency phone booths have been placed along the bridge for those who may not have access to a cellphone. According to the Seoul city government, the suicide rate from the bridge dropped 77 percent after the new design’s first year in 2013.

Innovative design like that of the Mapo Bridge is one step in the right direction, but long-lasting support needs to be thought of in terms of being both preventative and ongoing, advocates say.

A recent report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) shows that the percentage of Americans aged 18 to 25 suffering from mental illness has risen markedly from 18.5 percent in 2008 to 26.3 percent in 2018. Perhaps more worrying still are figures showing how many of those suffering aren’t able to afford therapy — even if they have insurance. A staggering 45.2 percent of people listed ‘Could Not Afford Cost’ as their reason for not seeking mental health treatment, and a combined 24.9 percent claimed that their health insurance either did not cover mental health services or does not pay enough for mental health services.

“Businesses that are serious about reducing health care costs — and improving the health and well-being of their employees,” states a report by the Harvard Business Review, “should take a serious look at digital therapeutics, which have the potential to provide effective, low-cost ways to prevent and treat chronic diseases and their consequences.”

These technology-based solutions primarily use consumer-grade technology, meaning patients are able to access services using their cellphone via artificial intelligence-driven smartphone apps. These smart apps are able to do incredible things such as monitor patient activity and social interaction to detect and intervene in episodes of clinical depression.

Other technologically based mental health tools include pills with embedded sensors that are able to let patients and doctors know whether medication was taken properly, and asthma inhalers that provide personalized feedback by way of connecting with networks of air-quality sensors.

The unlimited possibilities of artificial intelligence are also now starting to be used by support services like the Crisis Text Line, which uses AI to scan incoming text messages for certain keywords that determine the texter’s queue status depending on perceived urgency.

“Our algorithm is called Eva — meaning life in Hebrew,” says Womble. “It ranks our queue, so if someone says they’re on the Golden Gate Bridge and about to jump, their text is answered before, say, a person who has a calculus exam. It’s like an emergency room, but the difference between us and an emergency room is that we’re able to provide help to a person who is at high risk in 30 seconds.”

If you or someone you know is considering suicide, or even just needs to talk some things through, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

If you or someone you know would like to volunteer your time to help those considering suicide, you can apply to become a crisis counselor at the Crisis Text Line.

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