How communities are working to prevent suicide
At this summer’s Mental Health America Annual Conference, I met Brian Michel. He supervises Mental Health America of Wisconsin's suicide prevention efforts across the state. I was really excited to talk to him, because of my efforts with Hope for Invisible Wounds and wanted to learn more about what it really takes to get after a public health crisis like suicide. I interviewed him about this work and learned so much more!
Read more below to learn about his efforts in Wisconsin and what it really takes to prevent suicide on a large scale:
Tell me about yourself: I was born in Milwaukee, Wis., an only child raised by working-class parents. My father is a carpenter and recovering alcoholic with over 12 years sobriety, and my mother has provided guidance counseling to thousands of middle-school children over the past 25 years.
While I experienced my share of trauma as a child, peppered with turbulent bouts of anger from both my father and myself, the dedication my parents displayed to improving the lives of others was inescapable. I had no ambitions to strike it rich or own three houses (as nice as that sounds).
Instead, I wanted to make an impact by finding ways to improve how our world works and help people who couldn’t help themselves.
My career took an unexpected turn into the world of mental health. After graduating law school and practicing first as a prosecutor in the urban center of Wisconsin, I transitioned to provide free legal services to individuals living with mental health challenges.
In that role, I became active and engaged with policy and advocacy, ran my own judicial campaign and eventually found my current home at Mental Health America of Wisconsin.
As recently as a few years ago, I had no clue how the complex issues of mental wellness and access to care affect our community. Even my own mental health issues went largely unaddressed until my mid 30s, despite recognizing that my actions and thoughts were too often irrational and impulsive. I was intimidated by the thought of seeking help, ignorant of how it would affect my career, and reluctant to take medication.
With the support of my caring partner, a family survivor of suicide who lives with her own mental health issues, those fears dissolved. While I still have room for improvement, she is as proud of my progress as I am of hers.
What is your role with Mental Health America of Wisconsin? I serve as the Director of Prevention Services, which means I have oversight over our suicide prevention efforts and am responsible for developing a program for crisis diversion and peer support for Wisconsin veterans. One main focus of mine is to support the revision and implementation of Wisconsin’s state suicide prevention plan through partnerships with local coalitions, public health departments, and state agencies.
We say our organization is “small but mighty.” Our reputation for being strong advocates, educating the community, and developing cross-sector relationships over the past 80 years has allowed our small staff to accomplish amazing achievements, including efforts which contributed to significant reduction in youth suicide rates, developing strong coalitions to address suicide care in their local region, and supporting the improvement of healthcare quality in organizations across Wisconsin.
After several years of working in the trenches in a broken system, I am lucky to now be in a role to improve those systems and enhance care for countless individuals.
What does a state-wide suicide prevention plan look like? The Wisconsin Suicide Prevention Strategy (WSPS) is based on the National Strategy for Suicide Prevention, which recognizes that everyone has a role to play to prevent suicide, not simply behavioral health providers.
The WSPS takes the themes from the National Strategy and identified four goals to reduce suicide each with their own objectives and recommended activities. For example, one main goal is to “Increase and Enhance Protective Factors,” and an objective under this goal is to “Increase Social Connections.” Evidence and research shows that reducing feelings of loneliness reduces suicidal ideation. The WSPS then describes a number of opportunities for partners and stakeholders to take to meet that objective, such as utilizing peers with lived experience of suicidal thoughts to support discussions and facilitating groups in a judgment-free zone.
It is not necessarily a roadmap for success, but it helps coordinate efforts so all of our coalitions and partners are paddling in the same direction. As new information and data comes in, the WSPS is revised to encourage successful efforts or identify where barriers to achieving our goals exist.
The WSPS can be viewed in its current form here: https://www.preventsuicidewi.org/wisconsin-suicide-prevention-strategy
What is something interesting that you’re doing in Wisconsin that you haven’t seen done in other states that is having an impact?
One focus has been improving the quality of care in healthcare settings for individuals at risk for suicide by training on the Zero Suicide model of care. The philosophy of Zero Suicide is that suicide is preventable among people engaged with healthcare providers.
The Zero Suicide framework asks, “If ‘Zero’ isn’t the right number to aim for, what is?” This training requires the organization go all-in, engaging executive leadership, direct service providers and supervisors to evaluate the procedures within their organization and their own competence and comfort talking about suicide prevention with the people they serve. Successful organizations will improve care and reduce suicide by formalizing screening procedures, identifying training needs and creating a just environment where management and staff can collaboratively solve problems rather than cast blame and pass the buck.
MHA has trained at least 50 organizations throughout Wisconsin in Zero Suicide in the last 5 years, and that number will continue to grow. Information on our efforts in Zero Suicide, as well as recordings of topic presentations, are available here: https://www.preventsuicidewi.org/zero-suicide.
Wisconsin is also a leader in providing peer support services to individuals living with mental health and/or substance use challenges. The state funds four residential facilities, called Peer-Run Respites, to provide 24/7 peer support for those who are near the breaking point dealing with life’s stress and need to take a pause to let themselves heal. MHA is currently establishing the R&R House, the nation’s first Peer-Run Respite which will exclusively serve veterans and focus on providing peer support informed by the unique experience and perspective that comes from serving in the Armed Forces.
The purpose of these respites is to avoid the need for more intensive and restrictive services, like inpatient hospitalization or involvement with law enforcement. Past guests at other respites have not only enhanced their own wellness, but some have even formed their own groups and been inspired to share their recovery in a way which helps others. The creation of personal connections like these serves to prevent the feelings of loneliness and of being a burden which too often lead to suicidal thoughts and attempts.
What is the biggest challenge at moving the needle in suicide prevention? One of the biggest challenges I see since taking this role is simply accessing reliable data about suicide deaths. So much depends on what law enforcement puts in their report, what the medical examiner determines, and how the information moves from one agency of government to another, that the data is often several years old when it can even be reviewed, assuming the proper information is collected at all.
Veteran suicides are underreported; LGBT suicides are underreported; opioid deaths are incorrectly labeled as “accidental” rather than suicide. These gaps and missing data make it very difficult to not only move the needle, but to know if you are even looking at the right gauge. States across the country have different methods for investigating and processing suicide deaths. Improving the data collection and sharing of this information with partners is crucial to identify the populations most at risk to craft solutions which address those concerns.
The other main challenge is changing how the topic of suicide is addressed, not only in healthcare, but also in public discourse. The words we use affect how we think, and we need to move away from suicide being a “taboo” topic and speak of it as a public health concern just like cancer or heart disease. No one would say that a person “committed lung cancer,” even if they smoked two packs every day for 70 years. Likewise, we should not say that someone “committed” suicide. People “commit” felonies and misdemeanors. Saying “commit” implies not only that the act is bad, but that the person is bad. Further, it assumes that the person was destined to take their own life that the decision was irreversible as soon as they made up their mind. In reality, that “decision” is often made on an impulse, when the feelings of loneliness and of being a burden rise so high that the psychological stress and pain becomes unbearable.
As long as suicidal ideation continues to be stigmatized, less and less people struggling with that pain will reach out. Sometimes, that might be all they need. Most suicide attempts are made within 20 minutes of someone deciding to take their life, so improving the chance that someone will seek help in those crucial moments can save a life. Our Prevent Suicide Wisconsin coalition has had great success promoting appropriate prevention messaging, and you can read more about improving dialogue around suicide prevention here: https://www.preventsuicidewi.org/prevention-messaging
Why do you personally think rates keep increasing? Two main reasons I believe rates are increasing around the nation, including in Wisconsin, are due to lack of investment in education and youth mental health, and lack of connection and hope among middle-aged men.
When I was in grade school, I recall daily classes in art, music, and other outlets which allowed young children who may lack the skills to express their emotions with words to channel their feelings and create. At the same time, I grew up in a time when I did not live in fear that over a weeknight, some ruthless classmate could have an embarrassing image or story of me go viral across the internet, tarnishing my reputation and encouraging bullying on a global scale.
Now, budgets for creative arts in schools are getting slashed, and counseling services have been replaced by law enforcement on school property turning minor behavior issues into criminal matters, while support from peer mentors and professional counselors has been eliminated. As a result, mental health issues become more severe, ostracized children become disconnected young adults, and ultimately, we see suicide as the second-leading cause of death among 15-34 year-olds.
Additionally, the highest number of suicides in Wisconsin is among middle aged men. This demographic is often unlikely to engage with traditional mental health services. This is even more prevalent among populations of color, since providers often lack appropriate cultural knowledge which may result in ineffective treatment and negative outcomes.
This is apparent from the high rate of suicide among Native and Indigenous populations. It is difficult to develop a connection with your mental health provider when they do not understand the history of your family and culture, assuming they can even speak your language. Recommendations on how to support culturally competent approaches to suicide care can be found here: https://www.sprc.org/keys-success/culturally-competent.
Wisconsin is also largely a rural state, and declining profits from poor weather conditions and market forces send many family farms to the brink of bankruptcy, increasing the feeling of being a burden and leaving too many farmers to think they are worth more dead than alive. Outside of the farming context, men in general have a difficult time forming new friendships and making the social connections which serve as a protective factor against suicidal thoughts. In their late-middle years, many men may be internally tormented by their feelings of inadequacy and that they lack any real prospect for comfort in a world where their retirement account can simply disappear overnight.
Rather than engage in healthy coping mechanisms or forging positive social connections, many turn to alcohol or substances to reduce that stress, compounding the feelings of being a burden. By increasing the positive social connections of this population and providing a sense of purpose, suicide rates among middle-aged men should decline, and those who are struggling will improve their skills to manage the stress which goes along with life. You can learn more about recommendations for prevention among this population here: http://www.sprc.org/sites/default/files/resource-program/SPRC_MiMYReportFinal_0.pdf
If you could have any federal legislation regarding mental health, what would it be? The most effective solution on a federal scale would be universal access to healthcare services, which includes mental health, substance use, dental services, and any other practices which improve wellness.
While the Affordable Care Act increased the number of people who could access insurance, it did little to curb the greed of private insurance companies, who remain free to charge high deductibles, co-pays, and prescription costs which can amount to nearly one third of a person’s paycheck.
I watched my own family suffer through the slog of going back and forth on state-sponsored insurance, which stifles the American Dream by tying healthcare so closely to employment that individuals who want to create and work for themselves are left to either operate below the poverty line or risk diving into the unaffordable pool of Marketplace options, with minimal care benefits and poor access to mental health services.
Additionally, the lack of professionals who actually provide mental health services is directly related to the amount that public and private insurance plans reimburse for such services. This makes it too expensive for many organizations to even employ mental health professionals and imposes hurdles to billing and accessing care for the clients they serve. The result is a long waiting list to see providers, the need to travel long distance to see the nearest professional, and high rates of turnover due to compassion fatigue.
If we collectively decided to invest more in providing healthcare to every person, care would improve and suicide rates would most likely decline. We need to look at healthcare, including mental health care, as a preventative measure, rather than something people access only in an emergency. With a focus on wellness and supporting a life worth living, we could shift the conversation and make quality care available to all.
Mental Health Resources If you or someone you know is struggling with mental health issues, don’t suffer in silence! There are free and affordable resources to help you get through these times. Here are just few options for you below:
National Suicide Prevention Lifeline (1-800-273-8255): Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential, toll-free call goes to the nearest crisis center in the Lifeline national network.
Some federal agencies offer resources for identifying practitioners and assistance in finding low cost health services. These include:
Health Resources and Services Administration works to improve access to health care. The website has information on finding affordable healthcare, including health centers that offer care on a sliding fee scale.
Centers for Medicare & Medicaid Services has information on its website about benefits and eligibility for its programs and how to enroll.
Mental Health and Addiction Insurance Help from the U.S. Department of Health and Human Services offers resources to help answer questions about insurance coverage for mental health care.
Service members and Veterans have unique needs. https://www.mentalhealth.gov/get-help/veterans provides for their specific needs.
National Alliance for Mental Illness (NAMI) offers peer-to-peer support groups in most locations. This in-person group experience provides the opportunity for mutual support and positive impact. You can experience compassion and reinforcement from people who relate to your experiences.