By Michael Lott-Manier

Suicide is a serious and growing public health issue in Colorado. In 2012, suicide was the leading injury-related cause of death in the state and the second-leading cause of death among people ages 10 to 35. At least 1,053 Coloradans lost their lives to suicide last year. In comparison, 457 people were killed in motor vehicle crashes, and 205 were killed in homicides. Since records have been kept, Colorado has never been outside of the top 10 among states in suicide deaths.

September 8-14 is Suicide Prevention Week in Colorado. Let us take this opportunity to examine how we can reduce the high rate of suicide in our state.

Untreated mental health and substance use disorders are the primary risk factors for suicide. Colorado is in the bottom tier of states in funding for mental health and substance use disorder treatment, and consistently receives poor grades in mental health outcomes. Increased access to affordable health care is indispensable to improving this state of affairs. However, even if Colorado had adequate mental health services for our at-risk population, that would not guarantee a substantial decrease in the number of attempted and completed suicides. Many people choose not to access mental health services because of the stigma associated with mental illness. This social adversity affects everyone who experiences mental health and substance use disorders, but it plays a particularly malign role in suicide.

Literally a mark of disgrace setting someone apart from others, stigma involves social disapproval of a person or class of people, exclusion, stereotyping, prejudice and discrimination. Self-stigmatization occurs when the fear of these consequences causes shame, secrecy and isolation. The stigma of mental illness has a particularly dark history. Organizations like Mental Health America of Colorado (MHAC), now in its 60^th year, were formed in response to countless years of repression and violence against individuals with mental illness.

One legacy of this stigma is the battle to prevent suicides. The urge to do self-harm and commit suicide can affect any of us. When one of us is at risk, he or she often won’t reach out for help because of the potential repercussions. We might fear being labeled by friends and family as dangerous, disabled and weak. For good reason, we have feared being disqualified from employment, social groups and even insurance coverage because of a record of seeking professional help. All of these reasons also tend to discourage the friends and family of someone who is at risk of suicide from reaching out and intervening.

For decades the stigma-busting advocacy of organizations like MHAC has changed attitudes toward mental health and suicide. The innovative suicide screening and prevention campaign ManTherapy.org targets Colorado’s most at-risk group (males, ages 25 to 54) with humor and pop culture references, disarming its audience and avoiding traditional stigma triggers. This tool has spread beyond our state borders and is spurring other creative approaches. Such new thinking is promising both in terms of educating the public and helping people who are in or nearing a crisis.

Increased awareness among at-risk groups, however, doesn’t adequately address the barrier stigma poses. Efforts to reduce stigma through education have proven somewhat effective, but research shows that knowledge alone is not enough. When individuals with mental health conditions are engaged and able to access services, they still encounter structural stigma that can actually increase the risk of suicide. Even highly educated and trained doctors and counselors can perpetuate the stigma of mental health and substance use disorders, to say nothing of health care bureaucracies. In other words, even when people are getting the help that’s available to them, they can still feel as if the only option left is to take their own life.

Fighting stigma in order to prevent suicide requires changing how we perceive mental health, and how we treat ourselves and each other. Individuals with depression and bipolar disorder who have attempted suicide often report that they felt as if they were solely responsible for the state in which they found themselves. That is self-stigmatization, directly tied to social attitudes toward mental illness. Despite what we know about mental health conditions — that they are diagnosable and treatable, involving complex interactions between our bodies, behavior and environment — many people still view them simply as character flaws and personal weaknesses. Everyone from family members to physicians contribute to this stigma when they insist that someone experiencing a mental health problem “snap out of it,” or when they accuse someone of using a diagnosis as an excuse or a cry for attention.

We each can play an important role in fighting stigma and preventing suicide. The first step is to accept that mental health is a part of all our lives, and experiencing a mental health or substance use disorder is a normal part of being human. We should never be ashamed or afraid to ask for help, or fear talking with others about mental health. By serving as nonjudgmental resources for people in our lives who may be at risk, and reassuring them that recovery is possible and there is always hope, we can prevent suicides from happening.

If you or someone you know are experiencing a crisis, please call Metro Crisis Services at 888-885-1222.

For other suicide prevention resources in Colorado visit the Suicide Prevention Coalition of Colorado.

Michael Lott-Manier is the public policy and advocacy coordinator at Mental Health America of Colorado.