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Understanding — and Preventing — Suicide

Students in UCLA Luskin’s undergraduate program came together Jan. 9 to gain a better understanding of suicide and practice ways to identify risk and offer a lifeline. Sandra Rodriguez of Didi Hirsch Mental Health Services’ Suicide Prevention Center led the training session, part of the undergraduate program’s community impact requirement. Among Americans between ages 15 and 24, suicide is the second-leading cause of death, after car accidents, Rodriguez said. Despite the stigma that surrounds mental illness, many people contemplating suicide are relieved when asked to share their feelings, she added. Empathy is key when approaching someone exhibiting warning signs. “As helpers, we need to be able to sit in that dark place with them, to not judge those emotions, to not try to offer quick fixes,” she said. “Unless we really get in touch with why they want to die in the first place, we’re not going to get to the point where we’re turning them to the side of life.” Understanding suicide is valuable for those seeking careers in public health policy, research or outreach. For the students at the training session, it was also personal. Many said they knew someone who had committed suicide or made an attempt, and some shared their struggles with trying to provide real help to those in need. Rodriguez offered practical advice and stressed that people offering support should protect themselves by setting clear boundaries. She also shared several suicide prevention resources, including the National Suicide Prevention Lifeline, Teens Helping Teens, Know the Signs and the My3 app.

Mark S. KaplanUCLA Luskin

Social Work Journal Tackles Firearm Violence in Special Issue Professor Mark Kaplan of UCLA Luskin sees latest issue of Health & Social Work as a call to action for social workers and the profession to address a national epidemic

By Stan Paul

A new special edition of a social work journal focuses on gun violence in part because of guidance provided by Mark Kaplan, professor of social welfare at UCLA Luskin.

Kaplan was part of an editorial team of social work scholars from throughout the United States who bring together research on various aspects of firearm violence in the November edition of Health & Social Work, which is published by the National Association of Social Workers (NASW) Press and Oxford University Press.

He said that the special edition was meant to spark serious discussion and serve as “a call to action to people to begin thinking of this as a major challenge in professional circles.”

Kaplan, who uses population data to understand suicide risk factors among veterans, seniors and other vulnerable populations, joined colleagues in contributing articles to the publication. Kaplan’s contributions were co-authored with UCLA Luskin Social Welfare Ph.D. students Amelia Cromwell Mueller-Williams and Carol Leung, along with Ziming Xuan, an associate professor at Boston University’s School of Health.

According to an editor’s note about the special issue, “The field of social work has an obligation to address significant issues affecting clients and communities, including the outstanding issues of gun violence in the United States.”

Firearm violence in the United States is considered a public health crisis, and statistics cited in connection to the special issue paint a sobering picture.

Almost 40,000 people — about 60 percent from suicide — die annually. A large proportion of those dying are young people, the editors noted in their call for papers. Not all populations are affected equally — African American men make up the majority of firearm homicides.

The special issue also looks at the stress faced by people who survive shootings, pointing out that many live with chronic effects from their injuries. Gun violence affects immediate victims plus their families and communities.

Kaplan serves on the Board of Scientific Counselors for the National Center for Injury Prevention and Control, a branch of the Centers for Disease Control and Prevention. And he is a scientific advisor to the American Foundation for Suicide Prevention.

“Given the alarming rates of gun deaths in this country, the time seems right for social workers to address this issue in a more comprehensive way,” said co-editor Mickey Sperlich, an assistant professor at the University at Buffalo’s School of Social Work. The volume’s other co-editors are Patricia Logan-Greene, also an associate professor at the University of Buffalo, and Karen Slovak, who serves on the faculty of the School of Social Work at Capella University in Minneapolis.

Although recent mass shootings across the country have heightened public awareness and concern, policy action and research remain obstructed at the federal and state levels by strong opposition from national anti-gun-regulation groups, according to the editors. They note that some professional organizations have responded to this crisis by issuing comprehensive policy statements and practice guidelines for frontline workers, but little guidance exists for social work practice.

Contributors to the special edition delve into the relationship of firearm violence to race, gender and geography, as well as a less-publicized aspect — suicide.

Articles focus on the impact of firearm safety legislation on homicide rates and data that show differences in effectiveness for black and white populations. Another article looks at how fear of crime and racial bias influence gun ownership, especially for white people. A literature review of gun violence published in social work journals since the 1990s identifies the strengths and weaknesses of existing scholarship. Another literature review of community-based gun violence interventions suggests the value of systems-based approaches.

An article by Kaplan and his co-authors looks at the effects of firearm control policies on suicide rates for men, a “hidden epidemic” that accounts for the majority of deaths — not only of suicides but all gun-related deaths nationwide.

“One of the things we tried to do with the hidden epidemic paper was to even dig deeper and show that suicides involving firearms are even more hidden than other forms of gun violence, which often get most of the attention,” Kaplan said. “Most gun deaths in the country are suicides.”

At one level, the more guns in a community and the more guns in a state, the greater the age-adjusted firearm suicide rate, according to the article. “There are policy levers that we identified,” Kaplan explained. “So this is an epidemic that may be amenable to policies that would restrict people’s access, population-level access, to guns.”

In a “Viewpoint” article, Kaplan writes that “evidence suggests firearm-means restriction and firearm-suicide prevention represent gaps in social work education and practice, offering opportunities for universities and continuing education programs.” By increasing knowledge in this area, social workers can effectively engage their communities and advocate for stricter firearms laws. When enacted statewide, such laws lead to decreased numbers of firearm suicides.

A “Practice Forum” in the volume describes how social workers who were already engaged in a community-violence-prevention initiative responded to local outrage over the shooting of Alton Sterling, a 37-year-old black man and father of five who was shot and killed by Baton Rouge police in 2016.

“Social workers have an important role to play in supporting communities to heal and promoting community health in the aftermath of gun violence and trauma,” the authors conclude.

“Hopefully, it’s the start of a conversation that people will have about resorting to means that are more policy-oriented approaches,” Kaplan said. But he cautioned, “This is not a problem that will be resolved or addressed adequately on a one-by-one individual level. This is a much larger problem that needs to be addressed in a more upstream, universal way.”

For more information on the special edition of Health and Social Work and to access the articles, visit Oxford University Press (Oxford Academic) or NASW Press.

Kaplan on Infrastructure for Suicide Prevention

In a Santa Monica Daily Press article, professor of social welfare Mark Kaplan discussed strategies for suicide prevention. Since September 2018, five people have taken or attempted to take their own lives in parking structures in downtown Santa Monica. Experts have found that barriers, cameras and signage can serve as prevention measures in parking structures. “It’s often an impulsive act, and there’s research showing that people think twice if there’s a barrier,” Kaplan explained. “That doesn’t mean people won’t go elsewhere or take their own lives some other way, but you can at least erect barriers that reduce the possibility of this happening again.” Those struggling with suicidal thoughts can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) or chat online.


MSW Team Hits the Streets to Support Suicide Awareness

A team of faculty, students and friends of UCLA Luskin Social Welfare took to the streets over the weekend to raise funds for the Didi Hirsch Suicide Prevention Center. The team joined the Alive & Running 5K, which took runners and walkers on a course near LAX on a cool Sunday morning. Social Welfare field faculty member Laura Alongi Brinderson, who specializes in mental health issues among children, adolescents and their families, organized the team. The race marked Suicide Prevention Awareness Month, established as a time to share resources and start conversations about the taboo topic. In addition to providing services to people across the nation who have thought about, attempted or lost someone to suicide, the Didi Hirsch Center trains more than 20,000 people each year — including LAPD SWAT teams, the FBI, firefighters and other emergency responders — how to recognize and respond to warning signs.


 

Astor on Risk of Suicide Among California’s Youth

A Southern California News Group article about a survey asking California students whether they have thought about killing themselves cited Social Welfare Professor Ron Avi Astor, an expert on school safety. Of the students surveyed, nearly one in five had considered suicide within the last 12 months, the news group’s analysis found. The rate at individual school sites ranged from 4% to nearly 70%, according to Astor, who has conducted an extensive study of the data. “What happens in the classroom and on the playground matters,” he said. “How students are treated between themselves and by teachers, it matters.” Each school district in the state decides whether to administer the survey to ninth- and 11th-graders and students in non-traditional high schools. Districts that obtain the information and act on it report a reduction in suicide ideation rates, the newspaper reported. Astor also commented in a second Southern California News Group article about three California bills aimed at preventing teen suicide, and discussed the issue in a televised interview with CBS Los Angeles.

 

Preventing Suicide Among Veterans and Other Vulnerable Groups

Experts on suicide, particularly among veterans, led a wide-ranging conversation about risk factors and effective interventions at an event hosted by UCLA Luskin Social Welfare. Professor Mark S. Kaplan shared insights from his extensive research of at-risk populations with the gathering of students and social workers. “What many vulnerable young veterans returning from places like Afghanistan and Iraq needed more than anything else was not a psychiatrist but a social worker, somebody who could help them with that transition into civilian life, somebody who could help them with their family and their community,” he said. “It was really a challenge of reintegration that mattered most; it wasn’t a psychiatric problem.” The Nov. 6, 2018, panel included Susan Pindack, a social worker with the Veterans Affairs Greater Los Angeles Healthcare System; Sam Coleman, a lecturer at Cal State Long Beach and coordinator of the Veterans for Peace PTSD Working Group; and Carolyn Levitan, director of the crisis line at Didi Hirsch Mental Health Services’ Suicide Prevention Center. The panel’s broad experience led to an expansive discussion that touched on Civil War fighters who took their own lives, firearm use among female soldiers, the role of pain management in preventing suicide and the impact of the Netflix series “13 Reasons Why.” Students from the Mental Health Caucus at UCLA, one of several event co-sponsors, led a question-and-answer session after the panel presentations. — Mary Braswell

View a Flickr album from the event here.


 

 

Kaplan to Advise CDC on Prevention of Violence and Injuries

The U.S. Department of Health and Human Services has named UCLA Luskin Professor of Social Welfare Mark S. Kaplan to a board of experts on the prevention of violence and injuries. Kaplan will serve a four-year term on the Board of Scientific Counselors for the National Center for Injury Prevention and Control, a branch of the Centers for Disease Control and Prevention. The CDC reports that 214,000 people die from injury every year in the United States, and millions who survive an injury face lifelong mental, physical and financial problems. The board will advise the federal agencies on a variety of research areas to help set priorities and improve public health. “This is an incredible career achievement,” Social Welfare chair Laura Abrams said of the appointment. Kaplan’s research has focused on understanding suicide risk factors among veterans, seniors and other vulnerable populations. The CDC reports that suicide is one of just three leading causes of death that are on the rise. Members of the Board of Scientific Counselors represent several disciplines and include epidemiologists, statisticians, trauma surgeons, behavioral scientists, health economists, political scientists and criminologists.

Kaplan Discusses CDC Report About Suicide Rates Rising Across U.S. 

New CDC figures documenting the growing rate of suicide may not reflect the full scope of the problem, said Mark S. Kaplan, professor of social welfare at UCLA Luskin. Many suicides are actually classified as ”accidental deaths,” Kaplan, a noted suicide prevention researcher, told WebMD. “Some are classified as unintentional self-injury when, in fact, if you take a closer look, they look more like suicide,” he said. “The true incidence of suicide is unknown.” Kaplan said the Great Recession from 2007 to 2009 contributed to what he terms ”deaths of despair” by suicide. Some people, he said, never recovered economically.


 

The Connection Between Poverty, Inequality and Firearm Violence UCLA Luskin’s Mark Kaplan explains how circumstances in U.S. urban centers go hand in hand with gun violence

By Stan Paul

A fatal gunshot wound. This is a slide that Mark Kaplan, professor of Social Welfare at the UCLA Luskin School of Public Affairs, shows early in his presentation on gun violence.

As he recites annual gun death statistics in the United States, the vivid and unsettling scene serves as a backdrop.

“This might have been a suicide, this might have been a homicide; we’re not exactly sure. All I can tell you is that it was a fatal gunshot wound,” said Kaplan who spoke on “Poverty, Inequality and Firearm Violence,” Jan. 26, 2017 at the Luskin School as part of the Public Child Welfare Seminar series.

“The reason for putting this up is because quite often the discussion about guns is sanitized.” Kaplan explained, “We often treat the issue of gun violence as an abstraction but when you talk to people who are working in emergency departments, when you talk to coroners and medical centers, this is what people tell you. This is the net effect of guns.”

Across the nation, that net effect amounts to more than 33,000 similar scenes recorded each year on average, and more than 36,000 for 2015, Kaplan reported as the latest available data. What stands out for Kaplan is that two-thirds are suicides, his area of research. Kaplan, who holds adjunct appointments in psychiatry at the Oregon Health & Science University and in epidemiology and community medicine at the University of Ottawa, focuses on using population-wide data to understand suicide risk factors and firearm violence among vulnerable populations.

“So, the problem of gun violence in this country is primarily a suicide problem, less so a homicide problem,” said Kaplan to the audience, which included future social workers who are students in the master of social welfare (MSW) program. While recognizing the spike in gun deaths in cities such as Chicago – more than 50 in January in that city alone — Kaplan said that over the past 10-15 years there has been an overall national decline in the rate of gun deaths.

Kaplan said gun ownership in the U.S. is at more than 300 million and growing, and the death rate is only part of the story. He pointed out that for all of the recorded deaths by guns, there were more than 81,000 people – more than 200 per day – injured nationwide by guns in 2014.

“There are a lot of individuals who are shot, who survive, who wind up in emergency departments, are hospitalized and often disabled for life.”

A relationship exists between the high rate of guns and gun ownership and the number of homicides, suicides and injuries. Kaplan said that work is needed “on the ground” in America’s cities, such as limiting access to guns that would “go a long way to reducing some of the fatalities that we’re experiencing both in the homicide and suicide.”

He pointed to the work of one of his doctoral students that showed almost 90 percent of suicides involved guns in some parts of the country. California is an exception, according to Kaplan, who credited the state’s stringent gun control measures.

“California is an outlier. There aren’t many states like us,” he noted, suggesting that California could serve as a role model for the rest of the country. Unfortunately, two-thirds of states fall into the quadrant with both high rates of gun violence and lax restrictions on gun ownership, he said. “We are a gun-toting, gun-culture nation, and that’s going to make things a little bit challenging.”

The U.S. stands out among industrialized nations, Kaplan said. Gun homicides in the U.S. are 25 times higher than the average of other high-income countries. Factors such as poverty and inequality are contributing factors, he said.

“You all hear about poverty, but inequality is another measure of economic well-being. And there is a strong correlation between homicide per million and income inequality,” said Kaplan, pointing out that countries that are most equal have the lowest rates of gun-related homicides.

In terms of race and ethnicity, Kaplan said that 77 percent of white gun deaths in the U.S. are suicides, while less than 1 in 5 (19 percent) is a homicide. The figures are nearly opposite for African Americans, for which only 14 percent are suicides.

African American males in the 20-29 age group have the highest risk (89 per 100,000) in terms of the firearm homicide rate, a figure that is comparable with Honduras (90.4 murders per 100,000 people).

“In many ways we look like what some developing or Third World countries are experiencing,” Kaplan said.

Citing recent scholarship published by the Brookings Institution, he said that people who witness gun violence are also at increased risk for a variety mental health issues that can manifest as post traumatic stress disorder (PTSD), depression, poor academic performance, substance abuse, risky sexual behavior, delinquency and violent behavior – a “constellation of interconnected pathologies.”

Cities such as Los Angeles and New York have been stereotyped as “dangerous big cities,” Kaplan said, but both have benefitted from gun control measures. “Look how well we do in Los Angeles. New York is another place where the homicide rate has declined quite dramatically in the past 10-15, maybe 20, years.”

In contrast, Philadelphia today still has a high homicide rate, he said. And Texas, which has some of the least restrictive gun law on the books (with both Dallas and Houston appearing close to the bottom), has among the highest rates of gun deaths in the United States.

UCLA Luskin’s Mark Kaplan talks about a spike in gun violence in Chicago, a topic that has been much discussed by President Donald Trump and others. Photo by Stan Paul

Kaplan, who was born in Chicago, spoke about that city’s spike in murders in the past few years – nearly 300 shootings this January. One of Kaplan’s slides showed a recent tweet by President Trump about gun homicides in Chicago.

“We don’t know what [Trump] is going to do, but he is reacting to something legitimate” that is not occurring randomly, Kaplan said in reference to the accuracy of the numbers.

“You can approach this problem as a criminal justice problem … or approach it as a public health or social welfare or social justice problem, and that’s was missing in the discussion,” Kaplan said. Social inequality and income inequality are to some extent fueling the gun violence epidemic in Chicago, he noted.

Over the long term, however, little has really changed in Chicago, which has concentrated areas of poverty and racial segregation. Some areas are 90 percent African American. “Neighborhoods still look the same way as they did 10, 15, 20, maybe even 30, years ago. Chicago is a very divided city socio-economically,” Kaplan said.

The addition of guns increases violence. “The more guns, the more lethal the assault. When guns are absent, people are more likely to survive an assault,” said Kaplan. “If we could just tamp down the levels of gun ownership, that might – might – be the first step in trying to reduce the rate of gun violence.”

Compared to other leading causes of death in the U.S., the national investment in trying to understand and prevent gun deaths “pales by comparison” to what is spent on other causes of death and other major health problems, he said. A prohibition in the United States related to research on firearms doesn’t help.

“There is so much we need to know,” Kaplan said. “That’s what depresses me and keep me up at night.”