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How can Pa. lower suicides? Ideas range from mental health funding to state park signs

Patriot-News - 11/7/2023

Early in the morning of Sept. 4, about an hour after sunrise, fishermen at Codorus State Park spotted what they feared was a lifeless body in a raft on Lake Marburg. They were right. The man in the raft had died of a self-inflicted gunshot wound, according to the York County corner.

The incident was not the first at the park. A month prior, an elderly woman died the hospital days after jumping off a bridge. In 2020, a woman was found dead on a trail from a self-inflicted gunshot wound and in 2017 a man in a wheelchair drowned after intentionally rolling himself into the water.

Since 2010, 164 suicides have occurred in state parks, according to the Pennsylvania Department of Conservation and Natural Resources. This number peaked at 20 deaths in state parks in 2017, and has tapered off in recent years, roughly matching the broader trend in Pennsylvania and the U.S.

After years of steady increases, suicide rates in Pennsylvania and the nation declined in 2019 and 2020, according to data from the Centers for Disease Control and Prevention. But the most recent numbers for 2021 show those rates ticking back up, close to their 2018 peak.

The trends have generated a number of proposed solutions from state legislators – everything from greater mental health funding, to a phone surcharge supporting the state suicide hotline, and even a proposal to have the DCNR erect signs at state parks with that hotline info.

“Unfortunately I’ve had a front-row seat to a lot of suicides,” said Rep. K.C. Tomlinson, R-Bucks County, one of the signage bill’s sponsors and a third-generation director at her family’s funeral home. “If they would’ve just waited or saw a hotline number or talked to someone, maybe they would’ve made different decision.

Tomlinson and the bill’s co-sponsor, Rep. Kristin Marcell, R-Buck County, said the bill was born in part out of a high-profile suicide of a young woman in Tyler State Park, which runs through their districts.

“I realize that the state parks and forests are a narrow area, but I also believe, if this legislation results in someone choosing not to end their life, it’s a step worth taking,” Marcell said.

The rate at which Pennsylvanians take their own lives doesn’t have a singular clear cause or answer, according to experts. Starting around 2008, the commonwealth’s suicide rate rose faster than the national average, peaking at 15.7 deaths per 100,000 people in 2018, according to the CDC.

Pennsylvania’s rate then fell faster than the national average in 2019 and 2020, but rose again in 2021, coming in at 13.9 deaths per 100,000 people compared to a national average of 14.1.

“It’ll take some time to know whether things stabilize or keep getting worse,” said Dan Mallinson, a professor of public affairs at Penn State Harrisburg. But, Mallinson noted, “the underlying explanatory factors haven’t really changed.”

Mallinson headed up a study commissioned by the Center for Rural Pennsylvania looking at suicide trends, particularly in the rural part of the state where suicide rates are markedly higher, a phenomenon mirrored though the United States.

Using data current through 2018, the report found that suicide rates had “increased substantially” in Pennsylvania in the prior two decades, and that suicide rates in predominantly rural counties had accelerated faster, sitting 25% higher on average than their urban counterparts.

Crucially, Mallinson’s study also identified a number of factors that correlate strongly with higher suicide rates, and which vary significantly between counties. These include, for instance, education and marriage rates - for both of which higher levels correlate to lower suicide rates – as well as handgun sales per person, where higher sales have a strong correlation with more suicides.

Even after adjusting for such factors, however, rural counties still showed higher rates of suicide - indicating other causative factors are likely also at play in the state’s suicide trends.

“A huge issue is access to care,” said Samantha Bruno, director of the American Foundation for Suicide Prevention’s eastern Pennsylvania chapter.

“If they need help and they can’t find a therapist, they can’t find doctor or they get on a waiting list for six months, that doesn’t help them,” Bruno said of those at risk for suicide.

Although it is too early to tell if the results will be replicated in Pennsylvania’s data, the AFSP’s notes on the 2021 federal suicide statistics found that disproportionate increases were seen in young people – despite suicide rates being generally higher among older age brackets.

Black, Hispanic, and Native American populations were particularly affected, all of which experience greater barriers to mental healthcare access.

That healthcare landscape has not appreciably improved. The American Psychological Association reported that, in 2022, 60% of member therapists were full booked and not taking new patients as the industry continues to struggle to meet increased demand.

Further, Pennsylvania contains vast rural areas where healthcare access is decreasing, with several recent closures of hospital systems in the state’s more remote counties. These areas are also less likely to have the broadband internet access needed for tele-health therapy, Mallinson noted – although the federal government’s massive broadband subsidy initiative may change that in the coming years.

Another complicating factor in understanding suicide trends is the frequency of suicide attempts compared to suicide completions – something which is hard to gauge.

During a meeting with local police on incidents in Tyler State Park, Marcell said it was also revealed to her that officers were responding to a significant number of threatened or attempted suicides as well. Tyler State Park has seen five suicides since 2007, but in addition has seen at least one call for a suicidal person every year since 2009, according to police data shared with Marcell.

AFSP survey data estimates roughly 1.7 million suicide attempts in 2021, a ratio of about 35 attempts per actual death.

As Mallinson’s report noted, rural Pennsylvania counties’ higher suicide rates track closely with higher handgun sales. Without a definitive way to track suicide attempts relative to actual suicides, the possibility exists that suicidal behavior in rural areas may not be as outsized as it appears, but rather that those rural residents have easier access to a more effective method: firearms.

“A firearm is the most lethal means,” Bruno said. “You are more likely to survive a suicide attempt from other means than you are a firearm.”

The fact that gun sales skyrocketed during the COVID-19 pandemic makes it more unusual that the drop in the suicide rate continued into 2020, despite a flood of firearms onto the market. Surveys overwhelmingly showed growing mental health struggles during the pandemic as well, particularly among students.

The impact of these factors may not be fully seen in the data for 2021, and it’s possible the pandemic included mitigating factors as well. For one, the federal government increased the social safety net during the pandemic, with an expanded child tax credit, larger food benefits, drastically higher unemployment payments, and more.

“There’s probably a case to be made that economic support and social support during the pandemic was very concerted in a way that we don’t normally see,” Mallinson said.

The idea that these supports reduced suicides borne of socio-economic desperation “could be part of the story, but it’s really hard to test that,” Mallinson said, but the 2020 statistic “makes a convincing argument that social support investment has an impact on people.”

State lawmakers have floated policies that would impact nearly every variable. The House passed a bill this summer dedicating $100 million in federal stimulus funds to mental health grants, and this year’s budget includes another $50 million in hospital and health system assistance.

The House also approved a “red flag law” measure that would allow judges to temporarily confiscate the firearms of person adjudicated to be threat to themselves or others, a measure that in other states has corresponded to suicide reductions.

The legislature has also floated a phone surcharge to serve as a permanent funding for Pennsylvania’s 988 line, which was implemented as part of a federal requirement in 2020.

But the simplest and most universal measure, lawmakers say, may be to simply put up signs at the places where Pennsylvanians are more likely to take their own lives, giving them a number to call and reminding them that they aren’t alone.

“I’m not sure there’s a one size that fits all [solution], that’s why I think the hotline is important,” Tomlinson said. “I think this is something that everybody can understand and get behind.”

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