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(cross-posted from Beyond Vermont State Hospital blog, here)

*Updated* (with the usual edits)

When it comes to the delivery of community mental health and developmental disability services across the state, there are ten (10) catchment areas and each of these are served by one of the ten (10) designated regional community mental health centers (CMHC’s).

Back in early September of this year, Art Woolf blogged a post to Vermont Tiger on the Department of Depressing Vermont Statistics, which regarded the state’s suicide rate (here):

In its annual compendium on Vital Statistics, the Centers for Disease Control reports that Vermont’s age-adjusted suicide rate was 13.8 per 100,000 population.  That translates into 89 suicides in 2007 and gave Vermont a number of dubious distinctions.

• The 16th highest suicide rate among the 50 states and well above the U.S. average of 11.3.  Most of the states with higher suicide rates are in the West.
• Only two states east of the Mississippi River, Kentucky and West Virginia, had higher rates than Vermont.
• Within New England, Connecticut, Rhode Island, and Massachusetts had rates well below Vermont and below the U.S. average while Maine’s rate was just under Vermont’s and New Hampshire’s rate was just below the U.S. average.

[…]

Read the entire blog post, here

As saddening as those statistics and facts might prove to be, even more disturbing are the recent regional and statewide data on resident suicides that has come to light of late. Apparently, however, this data has not been widely enough known or shared and, other than when individual suicides happen, also not widely known and reported on by the press or media as of yet either.

If there was any good news to be gleaned from the Vermont Resident Suicide Statistics provided by the Vermont Mental Health Performance Indicator Project (PIP) recently, which compared certain data over the last two twelve month periods (i.e., September 2009 through August 2010 and September 2010 through August 2011), four (4) of these ten (10) catchment areas experienced a decrease in suicides within the last twelve (12) month period reported in the statistics from what they were within the previous year.

That was the good news.

The bad news reported in these same statistics was how there has been an increase in suicides experienced within the six (6) other catchment areas.

Furthermore, based upon the data received thus far, although the number of overall suicides for the given time periods appear to indicate an increase of thirteen (13) additional suicides statewide between the two, when one wades through the different catchment areas of the state served by the different CMHC’s and, while as mentioned above there has been a decrease in four (4) of those catchment areas that then brings down the overall number as far as actual increases goes, some of the six (6) other catchment areas have seen noticeable increases or even a spike over last year’s number (the below areas and numbers are only those indicating increases in suicides over the previous twelve month period): i.e.,

Catchment area: 2009/2010 versus (vs) 2010/2011 = Increase

NCSS (Northwestern Counseling and Support Services): 7 vs 11 = 4

HC (Howard Center): 13 vs 18 = 5

HCRS (Health Care and Rehabilitation Services of Southeastern Vermont): 14 vs 22 = 8

RMHS (Rutland Mental Health Services): 5 vs 10 = 5

USC (United Counseling Service of Bennington County): 8 vs 9 = 1

WCMH (Washington County Mental Health): 9 vs 13 = 4

Total Increase (in the above six catchment areas alone, not counting the catchment areas that experienced actual decreases): Twenty-seven (27) suicides.

Thus the decreases elsewhere end up painting a picture that is somewhat misleading when these numbers are not looked at in terms of increases in each of the given local catchment areas that had experienced such as well as then added up as a whole in terms of overall increases over the numbers from the previous time period.

Therefore this is not merely a statistical increase of thirteen (13) suicides statewide, as would be the case when taking into account the decreases experienced elsewhere, but is actually an increase of twenty-seven (27) suicides above and beyond what transpired within those particular catchment areas as indicated during the previous time period.

It should also be understood how these numbers also do not take into account any suicides that might have occurred since the end of August of this year, which would also mean the increases in suicides indicated by the data occurred during a period of time mostly prior to Tropical Storm Irene and the closure of the Vermont State Hospital (VSH), save for a few days afterwards. That said, there is also deep concern over what has transpired since then, from September 1st of this year, as well.

In addition, the data also included statistics indicating how many of the suicides within each time period were by persons connected with the local CMHC within a given catchment area and both time periods illustrate how the majority of the reported suicides were committed by persons who had not been connected to CMHC services at the time.

However, due to its very limited scope in an attempt to answer the questions posed at the time, the statistical data does not provide information concerning whether or not any of these persons had attempted to connect with CMHC or other services and, if they had, if they were on waiting lists or were turned away for one reason or another. It would be important to have such data collected and analysed.

There is also a need to ascertain other general information and data concerning the persons and what might have led to their suicide that could indicate possible patterns and potential correlations to be assessed and learned from as well, which could help inform the state as well as community service providers about what needs to be done differently and better or otherwise be put in place.

That said, the state and its various community partners need not wait until all such information and statistical data is available in order to begin doing something meaningful to address these serious matters of concern in the time being either.

Beyond the above, the state and its various local community partners can also assess whether there is something beneficial to learn from the local catchment areas that have seen decreases as well.

They are as follows:

Catchment area: 2009/2010 versus (vs) 2010/2011 = Decrease

CSAS (Counseling Service of Addison County): 7 vs 2 = 5

LCC (Lamoille Community Connections): 5 vs 4 = 1

NKHS (Northeast Kingdom Human Services): 10 vs 7 = 3

CMC (Clara Martin Center): 8 vs 4 = 4

Unknown (no catchment area listed or known): 1 vs 0 = 1

Total Decrease (in the above four catchment areas — and one unknown — alone, not counting the catchment areas that experienced actual increases): Fourteen (14) less suicides between the two given time periods.

As the state moves forward in dealing with these matters and determines its priorities as well as funding choices for how to proceed, it would be crucial that it not make the mistake of robbing Peter to pay Paul however.

For example, by pouring additional resources to the six (6) catchment areas experiencing the increases in suicides of late and either not also equally supporting the other four (4) catchment areas as is also needed or providing less support to them in an effort to pay for additional services where they are sorely needed elsewhere.

The fact is we need to continue to support the other four catchment areas in their work or otherwise the consequences could make matters worse.

It should also be noted how none of this is to suggest the state did not have a problem with suicides prior to this either, because it of course still did (view statistical data for 1985 through 2006, here), however as the more recent data referred to earlier within this post appears to suggest (here), the problem appears to be getting even worse.

There will be those among the state’s political leaders and other policy makers who will not want to admit it, however it will not be a surprise if the successive cuts over the last several years — including those made during the former Challenges for Change process — to the CMHC’s as well as many other community service providers helping those most in need across the state have resulted in such a dire fraying of the social safety net as to make it harder and harder to meet the needs being experienced at the community level.

Such unmet basic human needs and the toll they take on persons, families and communities eventually show up in higher rates of usage of various types of emergency services, hospital emergency rooms, prison, other forms of costly and dehumanizing forms of institutionalization including VSH-type settings as well as also resulting in unemployment, homelessness as well as, when it seems like there is no hope and one has run out of viable options one would freely avail themselves of, suicide.

With all the above seemingly focused up to now on access or the lack of access to formal or traditional medical model mental health and related services, it should also be pointed out how it would be important to provide such services in a very different and also voluntary manner versus what has been the case up to this point in time with the mental health system having a heavy reliance or dependence on forced or coercive treatment and its negative focus as well as usually bad or poor outcomes.

This could be done in a variety of ways, including creating a more robust community services system that is much more proactive, holistic, recovery-based, trauma informed, person-centered as well as driven and, thereby, addressing basic human needs (including in areas of housing) far more upstream versus usually waiting for the worse to occur and when it is more costly to do so.

In doing this however, there should be a serious increase in funding various alternative services and supports, including those that are peer-run and operated.

If the state takes opportunity the current crisis affords to create and provide services and supports people actually need and want to use, then people would be more inclined to seek as well as access such and less inclined to avoid a system many now dread will take over their lives and make them career mental patients.

If, rather than continuing to focus the bulk of funding on forced or coercive treatment most people would rather not have foisted upon them if given an actual choice, the state instead shifted its focus and energy as well as greater funding toward voluntary services and supports needed, people who often seek out services would not be turned away or put on waiting lists due to a lack of adequate funding.

Although it appears the state is now headed in this direction, not only are there those who are pushing back against such needed change out of fear and possibly other motives as well, the increase in suicides being seen points out an obvious need how crucial such changes are needed and also how certain things need to be put in place sooner rather than later.

All this could be done if these matters remain a top priority, which it now seems to be the case and also if the political will to bring such about is exercised, not just while these matters have our attention for the moment, but also when they once again become too easily forgotten or otherwise taken for-granted and have fallen off the table.

*Note*: Made several, mostly minor, edits for the purposes of clarification and readability; last updated on Monday, November 28, 2011 at 9:45 AM (EST).