11.05.19

Murray, Casey, Hassan Press Health Department to Work to Prevent Suicide After Public Health Emergencies

Murray, Casey, and Hassan call for Health Department to ramp up suicide prevention efforts in preparing for and responding to natural disasters and public health emergencies

 

Senators press Department on implementation of provisions in recently passed legislation focused on helping families deal with the mental health consequences of public health emergencies

 

Victims of emergencies and disasters have rates of PTSD and depression five times higher than those of the general public and are more likely to die by suicide

 

Senators: “Incorporating mental health support and suicide prevention efforts into public health emergency preparedness and response efforts can have a positive impact on both short- and longer-term suicide rates.”

 

Washington D.C.—Today, Senator Patty Murray (D-WA), ranking member of the Senate Health, Education, Labor, and Pensions Committee, along with Senators Bob Casey (D-PA) and Maggie Hassan (D-NH), released a letter pressing the Secretary of the Department of Health and Human Services, Alex Azar, on the Department’s implementation of sections of the Preparedness and All-Hazards Prevention and Advancing Innovation Act of 2019 (PAHPAI).

 

“Incorporating mental health support and suicide prevention efforts into public health emergency preparedness and response efforts can have a positive impact on both short- and longer-term suicide rates. Accordingly, we urge that the Department of Health and Human Services expeditiously implement the relevant sections of PAHPAI and prioritize suicide prevention efforts as part of the Department’s work related to public health emergency preparedness and response,” the Senators said in the letter.

 

Victims of emergencies and disasters are five times more likely to have post-traumatic stress disorder (PTSD) and depression than the general public and are more likely to die by suicide in the months and years that follow. Recent studies have found that:

 

  • In Puerto Rico, there was an average of 19 suicides per month in the 8 months before Hurricane Maria in 2017, and 25 suicides per month in the immediate 3 months post Hurricane Maria.
  • In New Orleans, there were significant increases in the prevalence of suicidal ideation and suicide plans 6 months post-hurricane Katrina compared with 2 years later. Researchers concluded that psychosocial stressors associated with the natural disaster continue or intensify as time progresses.
  • Following a significant flash flood in southern Alberta in 2013, the most costly natural disaster in Canada to date, nearly one out of three flood-related calls to the Distress Centre Calgary were of a suicidal nature.

 

Full text of the letter is below and the PDF is HERE.

 

November 5, 2019

 

The Honorable Alex Azar

Secretary

Department of Health and Human Services

1000 Independence Ave SW

Washington, DC 20201

 

Dear Secretary Azar:

 

We write to urge your focus on preventing suicides following public health emergencies or disasters.  The Preparedness and All-Hazards Prevention and Advancing Innovation Act of 2019 (PAHPAI, Public Law 116-22) recognizes the important role government can perform in helping families recover and deal with the anguish and aftermath of a public health emergency or disaster, and includes several provisions designed to promote and enhance mental health among individuals impacted by these events. Incorporating mental health support and suicide prevention efforts into public health emergency preparedness and response efforts can have a positive impact on both short- and longer-term suicide rates. Accordingly, we urge that the Department of Health and Human Services expeditiously implement the relevant sections of PAHPAI and prioritize suicide prevention efforts as part of the Department’s work related to public health emergency preparedness and response. 

 

Suicide trends in the United States are alarming, and the tragedy of suicide has deep and long-lasting impacts on families, workplaces, and communities. Suicide was the tenth leading cause of death for all ages in 2017, responsible for 47,173 deaths.[1] Suicide rates vary significantly by age; suicide is the second-leading cause of death in Americans aged 10-34, and the fourth leading cause among people aged 35 to 54.[2] In 2018, the Centers for Disease Control and Prevention (CDC) reported that suicide had risen nearly 30 percent from 1999 to 2016 and has increased in 49 of the 50 states.[3]

 

Public health emergencies create loss of life and property, financial and physical uncertainty, and psychological distress. Public health emergencies and disasters are correlated with post-traumatic stress disorder (PTSD) and depression; data demonstrate that the prevalence of PTSD among direct victims of disasters ranges from 30 percent to 40 percent compared with a prevalence of five percent to 19 percent in the general population.[4] These symptoms and impacts are especially acute for people who have experienced a financial loss or have fewer social supports, which are also risk factors for individuals who die by suicide.[5]

 

Disasters and emergencies also correlate with higher suicide rates in the months and years following their initial impact. According to a study published in the New England Journal of Medicine, suicide rates increased in the four years after floods by 13.8 percent; in the two years after hurricanes by 31.0 percent; and in the first year after earthquakes by 62.9 percent.[6]

More specifically:

 

-         In Puerto Rico, there was an average of 19 suicides per month in the 8 months before Hurricane Maria in 2017, and 25 suicides per month in the immediate 3 months post Hurricane Maria.[7]

-         In New Orleans, there were significant increases in the prevalence of suicidal ideation and suicide plans 6 months post-hurricane Katrina compared with 2 years later.[8] Researchers concluded that psychosocial stressors associated with the natural disaster continue or intensify as time progresses.

-         Following a significant flash flood in southern Alberta in 2013, the most costly natural disaster in Canada to date, nearly one out of three flood-related calls to the Distress Centre Calgary were of a suicidal nature.[9]

 

PAHPAI requires that applicants for the CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement include in their All-Hazards Public Health Emergency Preparedness and Response Plan a description of how they intend to “integrate information to account for individuals with behavioral health needs following a public health emergency.”[10] Research shows that training providers to recognize and treat depression and other risk factors can help reduce suicide rates.[11] In acute crises, where feelings of hopelessness and loss can feel overwhelming, behavioral health services are necessary and can save lives.

 

PAHPAI also reauthorizes the National Advisory Committee on Children and Disasters (NACCD), requiring the Advisory Committee’s membership include behavioral health professionals and that the Substance Abuse and Mental Health Services Administration (SAMHSA) be included among federal representatives. These requirements will ensure behavioral health experts are involved in creating and implementing best practices and plans that assist in stabilizing people with mental health needs following disasters and other public health emergencies. With the concerning trends in youth suicide rates, it is important that the NACCD include youth-focused behavioral health strategies to ensure that all people who have lived through disasters and public health emergencies have age- and culturally-appropriate behavioral health services.

 

We request a response no later than November 19, 2019, describing the efforts you are undertaking or planning related to preventing suicides following disasters and other public health emergencies, including in your implementation of the Preparedness and All-Hazards Prevention and Advancing Innovation Act of 2019. If you have any questions regarding this letter, please contact Andi Fristedt with the HELP Committee Staff at (202) 224-7675.

 

Sincerely,

 

Patty Murray                                                                       

Ranking Member

United States Senator                                      

 

Robert P. Casey, Jr.

United States Senator

 

Margaret Wood Hassan

United States Senator            

 

cc:       Dr. Robert Kadlec

            Assistant Secretary for Preparedness and Response 

            Department of Health and Human Services

           

            Dr. Robert Redfield

            Director of Centers for Disease Control

            Department of Health and Human Services

 

            Dr. Elinore McCance-Katz

            Assistant Secretary for Mental Health and Substance Abuse

            Department of Health and Human Services

 

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[1] Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2017.

[2] Centers for Disease Control and Prevention. CDC WISQARS: Leading causes of death reports, 1981–2016.

[3] CDC’s National Vital Statistics System; CDC’s Vital Signs, June 2018.

[4] Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008; 38:467-480.

[5] National Violent Death Reporting System, 2018.

[6] Krug E, Kresnow, M, Peddicord J, et. al.  Suicide after Natural Disasters. N Engl J Med 1998; 338:373-378.

[7] Preliminary Statistics of Cases of Suicide in Puerto Rico, January to November 2017[in Spanish]. http://www.salud.gov.pr/Estadisticas-Registros-y-Publicaciones/Estadisticas%20Suicidio/Noviembre%202017.pdf.

[8] Kessler RC, Galea S, Gruber MJ, et.al. Trends in mental illness and suicidality after Hurricane Katrina. Mol Psychiatry. 2008;13:374-384.

[9] Gordon,K., et al.(2011). The impact of the Red River Flood on interpersonal risk factors for suicide. The Journal of Crisis Intervention and Suicide Prevention,32(1),52-55. DOI: 10.1027/02275910/a000051.

[10] Preparedness and All-Hazard Prevention and Advancing Innovation Act of 2019 (PAHPAI).

[11] Schwartz-Lifshitz M, Zalsman G, Giner L, Oquendo M. Can we really prevent suicide?. Curr Psychiatry Rep. 2012 Dec; 14(6): 624-633.