Harford's suicide rate prompts discussion of causes, warning signs, prevention

May 15--Every seat in a conference room at University of Maryland Upper Chesapeake Medical Center in Bel Air was taken Thursday evening as 50 health care providers from Cecil and Harford counties took in reams of information on preventing suicide, a leading cause of death for Harford County residents.

"Anticipated, threatened or perceived triggers [for suicide] are just as important as actual ones," Philadelphia psychologist Matthew Wintersteen said.

Wintersteen, who is also with the Division of Child and Adolescent Psychiatry at Thomas Jefferson University and Jefferson Medical College in Philadelphia, was the keynote speaker during a workshop on suicide prevention hosted by Upper Chesapeake Health in partnership with the Harford County Department of Community Services and Harford County Health Department and Healthy Harford, a local nonprofit community health initiative.

Wintersteen said young people often feel like they should end their lives because things will never get better, or they think others would be better off if they were not around.

"Part of it is sitting with them and recognizing that there's things happening in their lives that they don't have control over, so being able to sit with them while they talk about that is actually very important," he said.

Harford County has the 10th-highest rate of suicide in the state, according to information provided by the county health department prior to the workshop. Health officials reported that 16 percent of high school students and 15 percent of middle school students have reported that they have had serious thoughts about taking their lives during the past 12 months.

Members of a panel, including Sue Lichtfuss, director of the Harford County Mobile Crisis Team; Dr. Sarah Edwards, of the Maryland Behavioral Health Integration in Pediatric Primary Care; Bel Air psychologist Shreya Hessler; and Pat Thompson, a registered nurse with the behavioral health unit of Upper Chesapeake Health, answered audience questions and talked about the array of mental health services available for people who are considering committing suicide.

Wintersteen gave a series of tips which health care providers, including primary care doctors, can use when talking to a patient who is going through a difficult time and has expressed suicidal thoughts, as well as working with a young patient's parents and prescribing the appropriate antidepressants.

He said factors that can cause a person to consider suicide are "situational life events" such as problems at school, problems with friends or conflicts with family members, as well as financial problems, losing a job, losing a loved one or experiencing a traumatic event.

Wintersteen said it is critical for primary care doctors and mental health professionals to talk with their patients in a calm, non-judgmental manner, to ask many questions about their home and school lives and to work with youths and their parents to develop strategies to deal with times when suicidal thoughts come up.

Providers must also give patients an array of community resources they can use beyond their primary care doctor.

Wintersteen said health care providers should be aware of reported symptoms such as insomnia and make sure their patients do not have access to firearms.

Wintersteen said many parents have concerns about antidepressants such as Prozac because of reports in recent years that people taking such medicines have committed suicide.

He said a recent Food and Drug Administration study of more than 4,000 users of antidepressants showed that not one young person in the study died from suicide.

Wintersteen said anyone who has been prescribed an antidepressant and has suicidal thoughts should alert his or her doctor, and such thoughts should be monitored closely.

He said it can take several weeks of using antidepressants before patients notice a change in their mood or behavior.

"The parents often see the differences and changes in behavior before the kids self-report," Wintersteen said.

Members of the Mobile Crisis Team, which is part of the Sheppard Pratt Health System, respond when called to a mental health emergency in Harford County.

Although people considering suicide are encouraged to call 911 or go to their local hospital, Lichtfuss said her team works to help patients avoid the emergency room and provide services at the site of the emergency, especially if the patient is a child or adolescent.

"If we can't avoid the emergency room, we will do everything we can to make it as smooth as possible through the emergency room," she said.

Lichtfuss noted that "if someone is out of control and immediately in danger, you really don't have a choice, but we try to help avoid that [hospital] when possible."

"We want to keep kids in the least restrictive environment," Edwards added.

She said patients typically get better faster "in a more natural setting."

Leaders in Harford County's health care community have developed work groups to improve the health of residents in three areas: tobacco use, obesity and behavioral health. Those initiatives grew out of the State Health Improvement Process, or SHIP, of 2011, a project of the Maryland Department of Health and Mental Hygiene.

The suicide rate in Harford was a key target of the SHIP, according to the health department.

A suicide prevention work group was formed, as a subcommittee of the behavioral health work group, Harford County Health Officer Susan Kelly said after the seminar.

Health department staff member Paula Nash, who is head of the suicide prevention work group, noted during the panel discussion that no inpatient facilities are available for adolescents in Harford County with mental health issues.

"It is one of those gaps here in Harford County, along with [few] child and adolescent psychiatrists, day programs for teenagers," Nash said.

Funding for the workshop came from the Maryland Community Health Resources Commission.

"We wanted to provide this training opportunity to as many providers in the county as possible," Kelly said.

Parents whose children are considering suicide can contact the Harford County Office on Mental Health at 410-803-8726, the Mobile Crisis Unit at 410-638-5248, the Maryland Crisis Hotline at 1-800-422-0009, their family physicians or 911.

Any health care providers who want more information can contact William Wiseman, of the health department, at 410-612-1771.

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