Policy Advocacy for Mental Health Disorders: A Case of Suicide as a Major Social Problem

Introduction and Overview

Identification of the Social Problem/Policy

Suicide is one major social problem related to various mental health disorders, including depression and post-traumatic stress disorders. Moreover, substance use disorders also increase the risks of suicide in various populations. Suicide is a major issue; the experiences range from individuals, families, communities, and society. Suicide rates in the United States are high and a major health problem in the global community. According to Brådvik (2018), suicide contributes to 1.4% of deaths worldwide. In 2015 over 44000 Americans died by suicide through different methods, including using a firearm and hanging/suffocation (Department of Health and Human Services, 2017). The rate of people who die from suicide has increased annually over the last decade, 28 percent, from 2000 to 2015(HHS, 2017). Incidences reported in the emergency department over suicidal ideation have also increased annually over the last decades, 12 percent from 2000 to 2015 (HHS, 2017). In 2019 suicide was the tenth leading cause of death in the United States. From 1998 through 2018, suicide rates increased by 35%, with more than 48000 deaths in 2018 alone. Caspani (2020) explains increased suicide risks among the LGBTQ community. Particularly 40 percent of the young LGBTQ individuals in the United States have considered suicide, with suicide attempts increasing significantly over the years.

Suicide relates to psychiatric diseases, mainly psychosis, substance use disorders, and depression. Similarly, organic mental disorders, trauma-related disorders, anxiety, and personality disorders also contribute to the risks of suicide. The risk of suicide for individuals with mental disorders ranges from 5-8% for schizophrenia and depression (Waidzunas, 2012). However, suicide is not aligned with the psychiatrist’s illness but with the experiences of hopelessness, which causes suicidal ideation, and the act of suicidal feelings. Brådvik (2018) explains suicidal feelings and suicidal actions as multifactorial, with socioeconomic conditions causing major implications. Social forces like lack of adequate healthcare facilities or lack of information on various healthcare systems are risk factors for suicide. The risk factors for suicide vary in the community. Adverse childhood experiences(ACE) relates to negative health outcome in adulthood, including depression and suicidal death. Therefore the main focus in addressing this social problem is prevention efforts which are aligned to the

Community Agency that Addresses the Problem

With a need to examine an extensive view of the suicide problem, the Trevor Project provides information on crisis intervention and suicide prevention for LGBTQ youth ages 13-24 and implements various interventions to reduce risks. Primarily the agency advocates for policies and laws to reduce suicide among vulnerable groups, particularly young LGBTQ people. Recent findings show suicide is the second leading cause of death for all persons aged 10-24 years. The Center for Disease Control and Prevention (CDC) is the main government agency in preventing suicide risks in the United States. The agency commits to leveraging interventions that reduce risk factors’ impact and leverage forces that promote resilience (CDC, 2022). The national center for injury prevention and Control (NCIPC) provides information, resources, and statistics on suicide, suicide risk, and suicide prevention. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) also actively supports suicide prevention efforts. The agency has supported various interventions to assess the effectiveness of various prevention programs in different issues relating to behavioral health, including suicide.

Understanding of the Issue

My primary understanding of suicide is that it is a major social challenge that can be accurately estimated. Indeed while suicidal deaths are a clear indicator of the social problem, the main challenge is suicidal thoughts. A recent analysis by the CDC shows more people attempt or think of suicide than the attributed suicide deaths (CDC, 2022). For instance, while 48000 people died of suicide in 2018 in the United States, 10.7 million Americans seriously thought about suicide (CDC, 2022). At this level, interventions are aligned with the risk factors for suicidal behaviors, including social problems such as poverty and unemployment, which increase stress in the community.

The second level of suicide as a social problem is making a suicide plan. Indeed, while the number of people who think of suicide is significantly high, only a major proportion will make efforts for suicide. Of the 10.7 million Americans who seriously thought of suicide in 2018, only 3.3 million made a suicide plan. Suicide attempts signify a lack of resilience to overcome stressful situations. According to Sher (2019), resilience explains the capacity and dynamic process for adapting to overcome stress and adversity and maintain normal psychological and physical functioning amidst stressful events. Individuals and communities with high resilience positively explore the various dynamics of stressful events and make plans to deliver positive outcomes.

The third level of the social problem explains suicide attempts. Of the 3.3 million who planned suicide in 2018, a significant 1.4 million attempted suicide (CDC, 2022). Suicide attempts are a major social problem since it explains environmental factors which promote suicide actions among various individuals. In the psychiatrist’s treatment of patients with suicide attempts building resilience against stress-related disorders is important to reduce death risks. In 2019, 39% of LGBTQ youth attempted suicide, and the risks increased during the COVID-19 pandemic.

Finally, suicide is aligned with the reported suicide incidences of death. Building resilience is a protective factor against suicide since Americans in contemporary society live in a highly stressful environment. For the LGBTQ, high suicide incidences are attributed to a lack of opportunity to access mental healthcare services. For individuals experiencing various health challenges, including mental health disorders and substance use disorders, isolation increases the risks of a suicide death.

Although some people can view suicide as an individual problem, it is a social problem. Similarly, suicide is a medical problem because it represents the prevalence of risk factors for mental health disorders within the community (Sher, 2019). For instance, suicide among gay teen and other marginalized groups have increased over time as the impacts of these social dimensions increase (Waidzunas, 2012). Particularly suicide indicates the prevalence of mental health issues among vulnerable groups and barriers to accessing mental health services. For instance, I understand suicide among men as influenced by the prevalence of social stigma, which promotes Stoicism over commitment to seek help. Immigrants have a higher risk of suicide than the native population due to the lack of social connectedness and social capital necessary to survive various life challenges. The immigrant’s language barriers and the separation from their families cause anxiety, hopelessness, and depression. Loss of social networks and loss of status are significant triggers for suicide for individuals with or without major mental health disorders.

Justification of its Impact on the Population

Suicide causes lasting harmful effects on individuals, families, and communities. This demands focused and coordinated efforts to reduce the risk of suicide. Suicide has both social and economic effects. According to CDC (2022), suicide has an immense economic effect on society, causing America $ 70 billion annually through lifetime medical and work-loss costs. The impact of suicide is more significant for vulnerable groups, hence the demand for personalized interventions to deliver a positive outcome. For instance, LGBTQ youth are very likely to attempt suicide than their peers.

Solution (s) Advocacy

Proposed Solution and Reasons (Suicide Prevention among Vulnerable Youth)

The proposed solution is the comprehensive prevention of suicide among LGBTQ youth in Rural America. This policy proposal is aligned with the need to address the specific risks of suicide thoughts, suicide plans, suicide attempts, and suicide deaths among adolescents and young people from vulnerable groups. The definition of the vulnerable population in this policy is ethnic, gender, sex, age, and social class population with limited access to healthcare services. Since all the LGBTQ members of the rural community are not the same, factors that increase the vulnerability to suicide increase in some groups and vary in others. Living in a tight-knit community is important to increase the sense of connectedness but increases the suicide risks among marginalized groups. Particularly LGBTQ youth and racial minorities have unique risk factors which need a clearly defined policy program.

However, the policy does not cover the middle-aged and elderly groups assumed to have significantly greater resilience to stressful life events. In this proposal, Trevor’s project capitalizes on the dimensions of care related to intersectionality. Primarily suicide prevention strategies range from enhanced competencies of medical healthcare practitioners to enhance diagnosis and treatment and reduced access to the means of suicide (Zalsman et al., 2017). The overall objective is to reduce suicide attempts and incidences within the population. Within the vulnerable groups, there are limited resources; hence it is necessary to optimize utilization to increase effectiveness and efficiency.

Suicide prevention is very important since the country is becoming sicker. Depression and other critical mental health diseases are inevitable, so building resilience is more important. Trevor’s project review of empirical evidence shows suicide prevention should be transformed to integrate measures of injury prevention and mental health perspectives. The proposed public health perspective must explore the diversity of the population and respond to current and emerging needs.

Expected Changes for the Population Impacted by the Issue

The suicide prevention strategy for the American youth is expected to reduce morbidity and mortality rates. Reported suicide incidences and attempted suicide within the target populations’ communities should be reduced. According to Caine (2013), forging an agenda for suicide prevention in America is aligned with reducing the increasing rates of suicide in the community. Indeed while the focus group is young people in rural areas, the intervention strategies focus on changing the behavior of the suicidal persons, their families, and healthcare providers. This is aligned to various suicide risk factors for suicide among the LGBTQ youth living in rural areas for different racial, age, gender, and social class characteristics.

• The suicide prevention strategy will create a sense of connectedness through activities that decrease social isolation.
• The interventions will also increase access to mental and behavioral health services by increasing affordability, leveraging means to access the services, and utilizing different technology tools.
• A suicide prevention strategy will reduce the impact of unemployment and persistent poverty on the emotional well-being of the population.
• The decline in the influence of various social and cultural factors reduces healthcare services utilization among individuals with mental and substance use disorders. Mental illness stigma is a significant factor that prevents help-seeking efforts and increases the threats of suicide.

Impact of the Change on the Social Work Practice

According to the National Association of Social Work Practice, the fundamental principle of the social work practice is to use different social work practices, techniques, and practices to (i) improve population access to tangible services, (ii) provision of counseling services to individuals, families, and group and to (iii) help institutions tooffer and improve social and health services, (iv) and participation in the legislative process. Reducing the mortality and morbidity rates is important in the social work practice to enhance improved well-being in the community.

Unlike healthcare practice, social work practices emphasize the improvement of the overall well-being of the individual. Instead of treating individuals who attempt suicide to build resilience, the prevention program emphasizes resolving various factors that influence suicide (Caine, 2013). Since prevention strategies included will emphasize coordination and collaboration among various stakeholders, the change will improve efforts to resolve various social issues. Specifically, the prevention program to reduce mortality and morbidity (suicide attempts and suicide deaths) will improve access to healthcare services, especially for victims of mental health disorders and substance use disorders.

Implementing the policy program and reducing suicide rates will leverage the capacity of various institutions in the community. Particularly there are different institutions in the community, including hospitals, community health centers, non-governmental organizations, and community groups with efforts to prevent suicide rates. However, very few individuals understand evidence-based measures to build resilience and reduce the risks of suicide deaths in the community. First, all stakeholders will clearly understand the issue of race and ethnicity and how various social factors affect healthcare utilization. The NASW commits to leveraging social justice and ending racism, thus emphasizing efforts to reduce discrimination and prejudice directed at the LGBTQ and immigrants, which damage the economic, emotional, and social well-being of the local community and the American Society.

How Recommendations corresponds with Social Work Values, Policy Positions, and Ethics

Prevention of suicide among LGBTQ youth is consistent with social work values, policy positions, and ethics, which emphasize the well-being of marginalized groups in the community. The LGBTQ faces discrimination from families, peers, the community, and healthcare systems. The primary role of social work is to ensure the population is not discriminated against in the suicide prevention strategy. To ensure that LGBTQ access quality healthcare services without discrimination, diversity and inclusion are important factors in the policy programs. Staff and volunteer leadership in the program will emphasize diversity by sex orientation, gender, age, race, and ethnicity to ensure active involvement and address unique concerns. The National Committee on Gay, Lesbian, Bisexual, and Transgender Issues is among the key stakeholders in the policy programs and will provide a wide range of insights on leveraging the well-being of the population. Particularly while different institutions hold different views regarding the LGBTQ, this policy emphasizes their importance in every community with significant contributions to society every day.

Advocacy Map for the Planned Advocacy Efforts

Community Partners, Reasons for Selection, and Efforts for Negotiation

The organization partners with corporate partners, institutions, and groups to enhance coordination in suicide prevention strategies across the country. Corporate partners are selected to provide different resources required to implement policy strategies. For instance, a key strategy in the policy is to leverage the use of technology for healthcare services in rural areas. Innovation technology and communication tools are key solutions necessary to implement the policy goals. Similarly, the organization also partners with product partners to advocate for products and services which are aligned with the unique needs and values of the population to improve efficacy and reduce suicidal thoughts.

Institutional and individual funders are also selected to provide the financial and human resources necessary to implement policy programs. Volunteers with knowledge of the socioeconomic factors which influence suicidal thoughts, attempts, and deaths are key partners in providing mental health support. Within the local communities, leaders, including group leaders and schools, are key partners in implementing education efforts. Educating the community and families on the needs of vulnerable youth will reduce suicide attempts and incidences. Negotiation with community partners will include collaboration to leverage the missions and visions of both organizations in improving the well-being of the community. For corporate partners, communication of the opportunities and challenges of the policy programs is important to influence the review of their strategic priorities.

Advocacy targets, Reasons for Selection, and Approaches for Persuasion

The primary advocacy targets for suicide prevention strategy include the federal, state, and local government policymakers, government and private agencies involved in suicide interventions, and professional organizations involved in mental healthcare services. First, the policymakers are selected for legislation to address various concerns, including the socioeconomic factors which influence suicidal thoughts, attempts, and deaths. For instance, policy efforts to control the use of firearms are important to reduce suicide incidences among the youth (Timsina et al., 2020). The accessibility of firearms is a major factor that influences suicide among the youth. Government and private agencies, including the Department of Health and Human Services, CDC, and SAMHSA, have a key role in the advocacy and implementation of the policy programs. These institutions have the up to date information on the extent of the healthcare challenges and the necessary measures needed to improve the health outcome of the population. Comprehensive public health intervention (s) are important to achieve positive health outcomes and reduce suicide risks for the target population. For instance, the CDC has the political goodwill and knowledge on the mental health trajectory of specific healthcare populations for communication of unique healthcare needs.

Policy Strategies or Tactics to Implement to Bring About the Change

Different policy strategies are recommended to reduce suicide risks in the population. The first strategy is to reduce stigma in communities. Primarily the stigma against mental health disorders is high among LGBTQ living in rural areas where people live in a tight-knit community. Opening up on stressful events is difficult for LGBTQ youth due to personal interactions with mental health providers and life coaches. To minimize the spread of news about the mental health conditions of various individuals, counseling, and education interventions are important to address the rural cultural norms which leverage stigma. For instance, individualism and Stoicism are critical rural cultural values that impact help-seeking and thus increase the risks of suicide.

The second strategy is to increase access to behavioral and mental health services designed to meet the unique needs of the population. The LGBTQ youth in rural areas faces economic and social challenges in accessing healthcare services. Some interventions include leveraging access to telehealth services, integration of mental healthcare and primary care services, and improved health insurance coverage. Public programs to provide health insurance improve access to healthcare services through improved affordability. The use of video, telephone, and web-based technologies to provide care at a distance is effective for emergency mental health services to treat a range of mental health conditions (CDC, 2018). While LGBTQ youth with suicidal thoughts seeks primary care services, they are less likely to seek mental healthcare, and hence it is effective to integrate primary care with mental health.

Another suicide prevention strategy necessary for the target population is a collaboration with different community groups and institutions to increase social connectedness and reduce the risk of suicide. Peer norm programs in the local community through different organizations to encourage help-seeking and improve connectedness is important for behavioral and social change (CDC, 2018). Promoting the unavailability of lethal methods of suicide, including firearms, requires active collaboration between various community stakeholders.

Timeline for the Advocacy Project

The timeline for the advocacy project is 12 months. During this period, various activities are completed to enhance the implementation of the policy programs. The activities include a review of risk factors for the social problems and evidence-based strategies, negotiation with potential community partners, review of current solutions or situations, persuasion of the advocacy partners, and review of recommendations and implementation of the proposed strategies.

Evaluation of the Advocacy Efforts

Process measures, including coordination and collaboration with the community partners, are key in the evaluation of the advocacy efforts. Community partners’ design of common policy goals and objectives is important for coordinated advocacy for change. For advocacy, partners buy into the description of the issue, and the solution from different perspectives is necessary. Conflicts of interest between different groups must be minimal for successful advocacy and resolving of social problems. Another key measure of the advocacy efforts is the alignment of the goals and objectives with unique requirements in the overall social work practice.

Monitor Policy/ Problem once the Advocacy Efforts are Over

Legislation, including development, implementation, and review, are key indicators to monitor policy/problem following the advocacy efforts. Policymakers’ buy-in and integration of policy recommendations in the national agenda is an important milestone in promoting change. For the successful completion of the project and implementation of the policy programs, consistency with the mission and vision of various government bodies and agencies is significant.

Conclusion

The policy advocacy for mental health disorders(suicide prevention among rural American youth) has enhanced the development of three core course competencies. First, the policy integrates the NASW ethical codes, including social justice for all, in the efforts to reduce discrimination against marginalized groups. Second the policy advocates for the rights of marginalized populations in the community, including the poor, youth, and those living in rural areas. The recommendations made in the policy proposal advance social justice by improving the well-being of the target population. Finally, the policy advocacy process involves efforts to identify current policy on suicide prevention and recommends a solution to improve outcomes. Differences in access to healthcare services are a major factor that increases suicide rates among the target population. I have learned some important lessons from my knowledge, skills, competencies, values, and interests from completing the advocacy paper. Particularly I am committed to addressing social problems from the perspective of marginalized groups. Every individual has basic human rights, which must be leveraged in the policy process and interventions at the local, state, and national levels.

References

Brådvik, L. (2018). Suicide risk and mental disorders. International Journal of Environmental Research and Public Health, 15(9), 2028. https://doi.org/10.3390/ijerph15092028

Caine, E. D. (2013). Forging an agenda for suicide prevention in the United States. American Journal of Public Health, 103(5), 822–829. https://doi.org/10.2105/ajph.2012.301078

Caspani, M. (2020, July 15). A survey finds 40% of U.S. LGBTQ youth considered suicide in past year. U.S. https://www.reuters.com/article/us-usa-lgbt-youth-idUSKCN24G1S7

CDC. (2018, October 19). Suicide policy brief | CSELS | OPHSS | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/ruralhealth/suicide/policybrief.html

CDC. (2022, July 19). Suicide prevention | Health topics | Polaris | ADP for policy and strategy. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/healthtopics/suicide/index.html

Department of Health and Human Services. (2017). National Strategy for Suicide Prevention Implementation Assessment Report (863-890). SAMHSA. https://store.samhsa.gov/sites/default/files/d7/priv/sma17-5051.pdf

National Association of Social Workers. (n.d.). Practice; Ethnicity & Race. https://www.socialworkers.org/Practice

Sher, L. (2019). Resilience as a focus of suicide research and prevention. Acta Psychiatrica Scandinavica, 140(2), 169–180. https://doi.org/10.1111/acps.13059

Timsina, L. R., Qiao, N., Mongalo, A. C., Vetor, A. N., Carroll, A. E., & Bell, T. M. (2020). National instant criminal background check and youth gun carrying. Pediatrics, 145(1). https://doi.org/10.1542/peds.2019-1071

Waidzunas, T. (2012). Young, gay, and suicidal: Dynamic nominalism and the process of defining a social problem with statistics. Science, Technology, & Human Values, 37(2), 199-225. https://doi.org/10.1177/0162243911402363

Zalsman, G., Hawton, K., Wasserman, D., Van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., Purebl, G., Kahn, J. P., Sáiz, P. A., Lipsicas, C. B., Bobes, J., Cozman, D., Hegerl, U., & Zohar, J. (2017). Suicide prevention strategies revisited: a 10-year systematic review. The Lancet Psychiatry, 3(7), 646-659. https://doi.org/10.1016/s2215-0366(16)30030-x