Experts on Camera

Dr. Emmy Betz: 988 and suicide prevention

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July marks the one-year anniversary of the 988 Suicide & Crisis Lifeline’s national launch, and there are currently more than 200 call centers around the country responding to 988 calls for help.

On Thursday, July 13, 2023, SciLine interviewed: Dr. Emmy Betz, a professor of emergency medicine at the University of Colorado, where she directs the Firearm Injury Prevention Initiative. She discussed topics including: statistics about suicide in the United States; who should call 988 and when; her research on firearm safety, suicide by firearm (more common than firearm homicide), and prevention strategies for firearm suicides; and what journalists should know about covering suicide without contributing to suicide contagion.

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EMMY BETZ: My name is Emmy Betz. I’m an emergency physician and a professor of emergency medicine at the University of Colorado School of Medicine. I work in the ER treating mostly adults, and often with suicide risk. And I also do a lot of research in suicide prevention, mostly in the space of firearm suicide prevention.


Interview with SciLine

Can you share some statistics about suicide in the United States?


EMMY BETZ: So, we know that suicide continues to be a leading cause of death in the United States. In fact, it’s the 12th leading cause of death among all ages. We unfortunately had been seeing suicide rates rise from about 2000, up until around the COVID era. There was a small dip in rates during those COVID years, which was great, but unfortunately we’ve now seen rates increase again. So, in 2021, there were 48,000 suicide deaths in the United States, which is about one for every 11 minutes.

What do we know about recent rates of youth suicide?


EMMY BETZ: We’re also very concerned about youth suicide. People like to think that children would never do that. No parent wants to think that their kid would ever be hurting that much. But we know, unfortunately, that suicide rates among youth in particular have increased. We’ve seen between 2011 and 2021—so over a decade—suicide rates for youth rose 60%. Particularly concerning are increases in suicide rates among young individuals of color, where there have traditionally been lower suicide rates. So, we’re very concerned about what might be happening in youth populations to be driving these rates.

Who should call 988, and when?


EMMY BETZ: So, 988 is the suicide and crisis lifeline. And so I want to really emphasize, it’s not just for suicide. It’s for anyone who’s experiencing substance abuse, mental health crisis, emotional distress, or suicidal thoughts. You can call for yourself. You can call for someone in your family or a friend. It’s available 24/7, and it’s free and confidential.

What are warning signs that a person is thinking about suicide? What should people do if they observe these signs in someone they know?


EMMY BETZ: So, it can vary. Sometimes, it can look like what we think of classically as depression. So, somebody who might seem very sad, seems withdrawn, not doing the things that they previously have been wanting to do. Certainly anything like talking a lot about death, mentioning suicide, mentioning not wanting to be around anymore, those are all certainly very concerning. Some people though, with suicide risk or depression actually can present with with anger, for example, or seeming sort of ramped up or different. I would say, the main things to look out for is if someone seems that they’ve lost hope or that they aren’t looking towards the future anymore. That’s something to be concerned about. And perhaps the most important thing to know is it’s OK to ask someone. If you’re ever worried that someone might be having thoughts of suicide, it’s fine to ask them directly. You’re not going to prompt suicidal thoughts by asking that question.

How has the first year of the 988 hotline gone?


EMMY BETZ: So, there hasn’t been an official report in terms of sort of numbers or overall like official statistics of how it’s been going. I think what we do know is that certainly people are continuing to call 988 and connect with crisis services in their states or elsewhere, which is really important. One thing that I think is concerning is there was a survey done by Pew in April of this year in 2023, and unfortunately, only 13% of respondents said they knew both about 988 and what it was for. So, I think we still have a ways to go in terms of raising awareness among people about what the hotline is, when you should call, and then what happens when you do call.

What can you tell us about your research on prevention strategies for firearm suicides?


EMMY BETZ: So, here at the University of Colorado, I lead the firearm injury prevention initiative, which is a new program funded through the medical school that hopes to reduce all sorts of firearm injuries and deaths, including suicide. Where I live in Colorado, 73% of our gun deaths are by suicide. So, it’s a it’s a critical problem in our state. And the important thing is that these deaths are preventable. Suicide typically occurs in the context of some kind of crisis, whether it’s related to a job, a recent breakup with a romantic partner, and so forth. So, it’s all about getting people through that high-risk period, to get the treatment that they might need or the resources they need. Unfortunately, we know that when a firearm is present, and if a person uses a firearm in a suicide attempt, about 90% of the time they die. So, my work and the work of our initiative really focuses on how can we reduce firearm access when someone is in that high risk period. And really importantly, it’s not about confiscation. It’s not about legislation. It’s about engaging with communities, educating communities, educating health care providers about what we can do to reduce firearm access. So, specifically, encouraging people to take steps to lock up guns differently, perhaps when someone’s at risk, changing the locks or changing the password so that the at-risk person can’t access the gun. We’re also really excited about the work we’re doing in out-of-home firearm storage. So, when someone has suicide risk, or even just if someone’s going on a long trip, or for many other reasons, it can be a good idea to move firearms out of the home temporarily. So, we’ve been leading work, working with ranges and retailers and other locations that offer voluntary and temporary firearm storage as a solution for people, again, to just make the home safer while someone’s getting better.

Is there broad consensus on prevention strategies for firearm suicides?


EMMY BETZ: What I’m really excited about in the suicide prevention field is the amount of discussion and conversation and collaboration that’s happening in the space of firearm suicide prevention. I think we’re used to gun violence feeling like this topic we can’t even touch. And yet in suicide prevention, we all agree no one wants deaths to occur. And there are things we can do, like voluntary and temporary changes in firearm storage, that don’t conflict with views on Second Amendment rights, for example. And so I’m thrilled to see firearm rights organizations working with large organizations like the VA, the Department of Defense, medical organizations, as we find a path forward together, I think it’s really showing that at the end of the day, we all want our family and friends to be safe—and that there are things that we can be doing to develop education and messaging and programs that hopefully will get the word out—in particular to communities with firearms in the home—about what they can do to reduce the risk of suicide.

What is suicide contagion, and what should journalists know about covering suicide without contributing to it?


EMMY BETZ: Suicide contagion is the phenomenon whereby hearing about one suicide—in particular the methods—leads to additional individuals attempting or dying by suicide using the same methods. It’s really important that journalists talk about suicide, and that we raise awareness, and we get these messages out. But there are guidelines about how to reduce contagion. There are guidelines from the American Foundation for Suicide Prevention and other large organizations that really spell out best practices for journalists. Some examples include: always including a helpline in any story that you might be doing, and also avoiding too many details about how a suicide was completed or sensationalizing it in any way.

How are reporters doing covering suicide?

[Posted July 13, 2023 | Download video]