THIS NEWSBREAK CONTAINS DETAILED DISCUSSIONS OF SUICIDE. THE NATIONAL SUICIDE PREVENTION LIFELINE PROVIDES FREE, 24/7 SUPPORT AT 1-800-273-8255.
From the World Health Organization (WHO):
World Mental Health Day is observed on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health.
The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide.
You may have heard of Michelle Carter, the Massachusetts woman who, as a 17-year-old, convinced her boyfriend to take his own life. The man, 18-year-old Conrad Roy III, had talked about suicide throughout his relationship with Carter. One day, she told him to end his suffering, his indecision, and just do it. Just kill himself. So he did.
Carter was convicted of involuntary manslaughter, a verdict upheld by the Massachusetts Supreme Judicial Court. Now she is asking the U.S. Supreme Court to exonerate her by calling her actions “free speech.” The case is the subject of an HBO documentary, I Love You, Now Die: The Commonwealth v. Michelle Carter. Legal scholars are following the case closely, as it offers a unique test of First Amendment concerns. It could also make things better, or worse, for mental health advocates.
Suicide is the 10th leading cause of death in the U.S. Almost 45,000 people kill themselves each year. Another half-million are treated in emergency rooms for self-inflicted wounds. From 1999 to 2016, instances of suicide rose by 30%. According to the National Alliance on Mental Illness (NAMI), suicidal thoughts and behaviors represent a “psychiatric emergency.” Suicide has been a concern for centuries—Aristotle, Plato, and Pythagoras all condemned it—and yet, we are no closer to making peace with it than those ancients. Simply put, we don’t know how to talk about it. Sometimes, when a celebrity dies by suicide—Junior Seau in 2012, Robin Williams in 2014, Kate Spade and Anthony Bourdain in 2018—there is an uptick in talk, but it fades too soon. What we need is sustained discussion about suicide and about mental health in general.
This NewsBreak shares resources librarians can use to facilitate that discussion.
In 2010, Matthew Boylan was handling telephone reference with the New York Public Library when he received a harrowing call. It was from a police officer, who told Boylan that a 16-year-old girl was threatening to jump from the Verrazano-Narrows Bridge. Her only identification? A library card. The officer wanted Boylan to use this card to look up the girl’s name, address, and parental contact information.
Not every librarian will be in the position of helping stop a suicide like Boylan: He gave the officer the information, and the girl survived. And yet, with suicide attempts on the rise, especially for teenagers—among this age group, rates of suicidal thoughts, plans, and attempts in some cases more than doubled from 2008 to 2017, and depression increased by more than 60% for ages 14–17 from 2009 to 2017—most of us have served people who have considered killing themselves or have tried to.
As with other at-risk populations, offering useful materials can be tricky. One way is through research guides that are specific to suicide (rather than general mental health guides). The following are a few U.S. academic libraries that have them:
- University of Illinois—A comprehensive guide with articles, statistics, and catalog search terms. One link is to Suicide Awareness Voices of Education (SAVE), one of the country’s first suicide prevention organizations.
- Shippensburg University—This guide focuses on teen suicide, including resources on hazing, bullying, depression, and LGBT+ issues, and is policy-heavy. Many of the resources are restricted to library use, but some, such as ProPublica, are free.
- Pitt Community College—This guide is short on prevention but offers an excellent collection of statistical resources, many of them free, such as those from the World Health Organization (WHO), the Centers for Disease Control and Prevention, and the indispensable Suicide Prevention Resource Center.
Because suicide is an even greater scourge in the LGBT+ community—40% of transgender adults have attempted suicide, and LGBT+ young people are five times as likely to do so compared to heterosexual youth, according to the Trevor Project—a robust LGBT+ collection can be a de facto suicide-prevention resource.
According to NAMI, 46% of people who die by suicide struggled with their mental health. In my book The Accidental Law Librarian, I discuss providing law-related reference service to patrons who ask bizarre or misguided questions or who may be mentally ill. The techniques are effective in any reference transaction:
- Treat every question seriously and every patron with respect.
- Clarify the question by saying, for example, “Could you tell me more? I’m not sure I understand.”
- Focus on the question, not the patron’s appearance or demeanor, which is sometimes hard to ignore (e.g., rambling monologues, outbursts, disheveled or smelly clothing, talking to unseen companions).
- Keep your voice even, your gaze steady, and your movements undemonstrative.
- [P]atrons may want to talk. A lot. Don’t let them monopolize your time. When they get off-topic, find a way to re-orient them to the reference request.
- Don’t argue with the patron. Accept, but don’t enter, their reality.
- Maintain boundaries: no touching, no personal questions, no breaking library policy.
- Call a colleague for backup if necessary
It’s helpful to have a written policy on handling this type of patron. The New York Public Library developed such a policy after Matthew Boylan’s experience. Moreover, libraries should invest in crisis response training for public service staffers. Some libraries employ social workers or mental health professionals to step in when needed.
If specialized staffing or training isn’t possible, librarians should take time to become experts—not familiar with, but experts—in referring patrons to the right U.S. government agencies and social services organizations. Here are a few:
Suicide and the Law
As Michelle Carter found out in tragic fashion, a host of legal issues surrounds someone’s effort to end their life. Many states consider the preservation of life the highest priority, and it can be difficult to distinguish suicide assistance or support from murder. Most questions about the legality of suicide center on patients who are terminally ill or catastrophically injured—i.e., they seek physician-assisted suicide.
A series of U.S. Supreme Court decisions governs this area of law. A 1990 ruling, Cruzan v. Director, Missouri Department of Health, established that the Due Process Clause of the Constitution protects a patient’s liberty to refuse any medical treatment, including life-saving treatment. Two later cases, Washington v. Glucksberg and Vacco v. Quill, ruled that refusing life-saving medical treatment is not the same as asking a physician to end a patient’s life. Thus, the government’s interest in preserving life outweighs a patient’s liberty to choose to die. In other words, suicide is not illegal. Helping someone die by suicide, however, may be, even for a medical professional.
The upshot of the Supreme Court’s decisions is that physician-assisted suicide is a matter of state, not federal, law. Currently, eight states plus the District of Columbia have passed so-called death with dignity laws, which allow competent, terminally ill adults to work with medical professionals to hasten their imminent death:
Although Montana does not have a death with dignity statute, physician-assisted suicide is legal there due to a 2009 state Supreme Court ruling. Bills have been proposed to formalize this permission and to revoke it, but none have passed.
The Work Ahead
Many efforts have been made in recent years to destigmatize suicide and mental illness. There is still work to be done, and as the statistics indicate, the need is greater than ever for robust intervention. Librarians have been and will be on the front lines for mental health. Our weapon in this battle, as in all warfare, is information. The resources in this NewsBreak can sharpen this weapon, but only if we use them. Here’s hoping we never abandon the fight.