Social Workers Can Reinforce Clients' Coping Skills During Recession Setbacks

Drawing: depressed manSeveral major news stories have shed light on a disturbing trend: Suicide rates in some regions have spiked and the economic recession is being cited as a factor.

While national statistics on suicide lag by three to four years, news sources have conducted their own investigations about the topic. The Wall Street Journal, The New York Times, MSNBC and Business Week have published stories in the past year highlighting local data and calls for more support for the newly unemployed or those facing financial devastation.

The Wall Street Journal surveyed 33 of the nation's most populous states and found 19 have suicide data for 2008. In all, those 19 states reported 15,335 suicides in 2008, up about 2.3 percent from the previous year. Thirteen states, accounting for 30 percent of the U.S. population, also reported more suicides in 2008 than the previous year, the story noted.

Suicides by county: Taking a look at statistics on a county level, a recent investigative report by MSNBC noted spikes in suicides in certain areas of the Midwest. One example was Elkhart County in Indiana, where it was noted that before 2009 even came to a close, 22 suicides had been recorded. That figure outpaced the annual average of 16 self-inflicted deaths. John White, Elkhart County medical examiner, was quoted as saying more than a quarter of the cases were attributed to distress caused by job loss or financial failure.

"We have a real problem," White told MSNBC. "They left notes specifically stating that the reason they did this was because of the economy."

The state of Michigan has been devastated by the economic downturn. It became the first state in 25 years to suffer an unemployment rate exceeding 15 percent, according to the U.S. Department of Labor. In June, the state's unemployment rate rose to 15.2 percent, the highest of any state since March 1984. Michigan has been battered by the near collapse of the auto industry and was among the first states to suffer through the housing crisis before it became a national trend.

MSNBC examined Michigan's Macomb County, which has around 830,000 residents. From 1979 to 2006, the county saw an average of 81 suicides each year. The figure jumped to 104 in 2008 and to an alarming 178 in the first seven months of 2009. The county sheriff's department said it responds nearly daily to calls about suicide attempts.

Kent County in Michigan has a population of about 605,000 and reports an average of about 47 suicides each year. In 2006, there were 66 suicides and in the first seven months of 2009, there were already 41 self-inflicted deaths.

Multiple reasons: Social workers and health professionals interviewed for this story agree that suicide is a complex area of study. However, one theory is consistent with experts: It is rare that a single cause leads people to want to kill themselves.

Social worker Frank Campbell labels himself a forensic suicidologist. "When it comes to suicide, there is never one factor," he said. "If a person lost his job, that is one variable."

If depression or other negative events are brewing in a person's life at the same time, it can lead to a deep feeling of despair, said Campbell, past president of the American Association of Suicidology and executive director of the Crisis Center Foundation based in Baton Rouge, La.

When a person suffers a job loss, it's important to pay extra attention to him or her, Campbell explained. One reason is people tend to closely associate their identities with their careers. This loss of character definition is not uncommon for those who retire and suddenly find themselves depressed and unable to cope with the new situation, Campbell said.

"That's why a job loss is considered a crisis," he said.

"What we do know is that suicides do go up in difficult, economic depressions," Campbell said. Stories about suicide rates increasing in relation to the ongoing recession can show correlation of data.

"It points us in a direction, but we can't prove it," Campbell added. "However, it is hard not to be swayed by the reports."

There is a positive way to look at how the recession affects suicide rates as well. Even though millions of people have become unemployed in the past few years, the majority are coping with the situation and are not suicidal, Campbell said.

It is vital that social workers and other health professionals be extra alert to those who may be at risk of suicidal thoughts, Campbell said. If a client is facing a job loss or foreclosure, encourage him or her to talk about the situation. "We need to reach out more during hard economic times," Campbell said.

Social workers can help reinforce their client's coping skills as well. Campbell said he likes to think of these abilities in relation to four legs on a stool. The legs represent the person having a supportive community or family, daily activities, physical well-being and a passion for interests.

It's important that a person understand that "a crisis gets resolved one way or another," Campbell said.

Another social worker who specializes in the study of suicide prevention is Stacey Freedenthal, associate professor at the Graduate School of Social Work at the University of Denver. She said when a person loses a job, it's not unusual for depression to follow.

"Hopelessness is the most important risk factor," she noted.

Sudden unemployment can create a cascade effect that can lead to suicidal thoughts for a person.

"You may have mounting debt and the risk of foreclosure," Freedenthal said. "This can snowball into many more problems."

A way to help people is to remind them that the situation is only temporary, Freedenthal pointed out, adding: "Hope is an antidote to suicidal thoughts. Help them identify the distortions in their thinking and challenge those distortions."

Feeling ashamed of the situation can be common as well.

"It's important to help people de-stigmatize the emotional reactions so they realize they are not alone with it," Freedenthal said. She added that social workers can help people connect with resources such as churches and support groups that have emergency funding.

The American Association of Suicidology has acknowledged an increase in media attention about the relationship between the economy and suicide. The association reports that suicides reached a peak rate of 17.4 suicides per 100,000 residents in 1933 during the Great Depression. The crest that year occurred one year after the U.S. unemployment rate reached 25 percent. At the individual level, studies show unemployed individuals have between two and four times the suicide rate of those employed, the AAS states.

National support: There have been other examples of a rise in suicidal thoughts throughout the nation while the recession lingers.

The National Suicide Prevention Lifeline (1-800-273-TALK), coordinated by the Substance Abuse and Mental Health Services Administration, reported a sharp rise in calls recently, from 39,000 in January 2009 to 57,000 in July of the same year.

It is estimated that 30 percent of those calls relate to economic problems, said Richard McKeon, lead public health adviser for suicide prevention at SAMHSA. He coordinates the multi-agency effort that makes up the National Strategy for Suicide Prevention.

Fortunately, suicide is not a common response when a person loses a job. "However," McKeon said, "it is a risk factor for some people when (a job loss) is combined with other factors. Losing a job can lead to depression."

SAMHSA has addressed the issue directly, providing a guide called "Getting Through Tough Economic Times" on its Web site. It explains that unemployment, foreclosure, loss of investments and other financial stress can be devastating to a person's emotional and physical well-being.

It also lists warning signs and ways to manage stress and find help.

"Unemployment and other kinds of financial distress do not 'cause' suicide directly, but they can be factors that interact dynamically within individuals and affect their risk for suicide," the guide explains. "These factors can cause strong feelings such as humiliation and despair, which can precipitate suicidal thoughts or actions among those who may already be vulnerable to having these feelings because of life experiences or underlying mental or emotional conditions that place them at greater risk of suicide."

Started in 2005, the national lifeline works to link callers to the closest facility among its network of 142 different crisis centers across America and provides an always-on-call resource for those in need.

McKeon said local crisis centers are telling him they are also experiencing an increase in calls about suicide. In response, SAMHSA successfully convinced lawmakers recently to grant the program an additional $1 million in emergency aid. Up to $50,000 will be provided to each of up to 20 different crisis centers, McKeon said.

Suicide experts Campbell and Freedenthal both praised SAMHSA for insisting on more funding for its suicide prevention resources at a time when government cutbacks are putting a strain on local agencies.

"This is a trend I hope will continue," Campbell said. "The phone is a place people feel free to speak their minds. Social workers are often volunteers who support these crisis centers."

The National Suicide Prevention Lifeline is meeting its goals by helping to distribute around 50,000 calls per month in 2009. The program also gets feedback that leads to ongoing improvements, McKeon said. There have been a number of innovations, standards and guidelines for risk assessment and response.

The recession is expected to linger through 2010 and McKeon noted that social workers play a key role in the ongoing effort to improve the way the nation helps those in distress.

"We encourage them to give the National Suicide Prevention Lifeline number or local crisis center numbers to their clients," he said.