A suicide map of the US
WHEN DEMOCRATS and Republicans decided where to hold their national conventions, they probably didn't know that Massachusetts and New York have the lowest suicide rates in the nation, about 6.5 per 100,000 people per year. The national average is 10.7, and states with the biggest problem are in the 19 to 20 range.
Suicide rates in the United States generally rise as you go south and west. Earlier this year, I got interested in the exceptions to that rule, so I decided to create a map. States with lower than average suicide rates I colored blue; the rest I colored red.
And there it was: an approximation of the year 2000 presidential election map.
Thirteen states and the District of Columbia have lower than average suicide rates. All but one voted for Al Gore. Of the remaining 37 states, 29 voted for George W. Bush. The five states with the most lopsided Bush vote (Alaska, Montana, Wyoming, Utah and Idaho, with a margin of 25 percent or more) were all among the top eight for suicide.
The explanation? Many factors are involved. For example, a given region may have more members of a high-risk group, such as the elderly or Native Americans. But adjusting for age and ethnicity only nudges rates up or down a little. It can't account for a threefold variation among states.
Local and individual factors are important: personal loss, family conflict, economic travail and unemployment, the quality of the support system, and cultural or religious beliefs about death or suicide. Easy access to guns is risky for a vulnerable person.
Access to mental health services, on the other hand, reduces the risk of suicide, which is usually a result of mental illness. But stigma is an enormous obstacle to treatment. Most people with mental disorders fear a negative or patronizing response, even from health-care providers. The more severe their distress, the greater the dread of reaching out.
President Bush himself is aware of the problem. Two years ago, in a speech announcing the creation of the New Freedom Commission on Mental Health, he said, "Stigma leads to isolation and discourages people from seeking treatment they need. Political leaders, health care professionals, and all Americans must understand and send this message: Mental disability is not a scandal; it is an illness."
Yet Republicans often oppose funding for mental health services. In a 2002 study, Dr. Jean McSween of the University of Virginia found that people who identify themselves as Republican and conservative are less likely to favor government spending for mental health. Her research also showed they are more likely to fear violence from the mentally ill and want to keep their distance from people with mental disorders. It's not surprising that the Wellstone Mental Health Equitable Treatment Act has languished in the Republican-controlled Congress despite having numerous cosponsors.
The red areas on the suicide map don't necessarily reflect hardened attitudes, because when mental illness hits home, it tends to command the same sympathy and interest as other health problems, regardless of political views.
Senator Pete Domenici, Republican of New Mexico, whose daughter has schizophrenia, is the most ardent GOP supporter and author of mental health legislation. President Bush, who created the Mental Health Commission in response to an appeal from Domenici, is reported to have said he grew up thinking people with mental illness should just read the Bible and try harder. He changed his mind after a generous donor committed suicide and a friend recovered from depression as a result of treatment.
The US Air Force has recently achieved remarkable success in preventing suicide. In 1996, the leadership instituted a service-wide program to increase awareness of suicide risk factors and make resources available for treatment. High-ranking officers championed the cause, which helped reduce the stigma attached to seeking help for problems like depression. The result was a 33 percent reduction in the rate of suicide among Air Force personnel.
Conservative Republicans should be preaching to the unconverted. They could save thousands of lives by following the lead of Bush, Domenici, and the Air Force and by supporting the National Strategy for Suicide Prevention. As leaders in their home communities, they can help their constituents to understand that mental illness is a medical problem, not a moral one. The state-by-state suicide data suggest that their supporters have the most to gain.
Michael Craig Miller, MD, is editor-in-chief of the Harvard Mental Health Letter.
