The Divide Over Involuntary Mental Health Treatment – Kirk Siegler

Involuntary commitment to a hospital for mental illness can be a lengthy and complex process. A California law makes mandatory outpatient treatment an option.

 

Kirk Siegler writes for NPR:

The attacks near the University of California, Santa Barbara, are renewing focus on programs aimed at requiring treatment for people who are mentally ill as a way to prevent mass shootings and other violence.

In California, a 2002 law allows authorities to require outpatient mental health care for people who have been refusing it. Proponents argue that this kind of intervention could prevent violent acts.

But counties within the state have been slow to adopt the legislation and mental health professionals are divided over its effects.

Do Family And Friends Know Best?

The story behind Laura’s Law begins in 2001. In rural Nevada County, near Lake Tahoe, 19-year-old Laura Wilcox was shot and killed by a 41-year-old man with a history of mental illness. He had walked into the county’s behavioral health center and opened fire.

“[Officials] were declaiming privacy issues and stuff and wouldn’t communicate with the family,” Anderson says. “He … started amassing guns and setting up booby traps around his house and he had this psychosis of he was going to be attacked any minute.”

Now Nevada County’s presiding judge, Anderson is also a vocal advocate for Laura’s Law, which was passed by the state legislature in 2002. The law allows counties to compel outpatient treatment for people whose family or friends are concerned about their mental state. It’s seen as an intermediate step before someone is forced into inpatient psychiatric care.

“The beauty of the program — the wonderment of it to me — is that roughly about 60 percent of the people that they do outreach to, where they go out to intervene after a person has been referred, voluntarily accept services at that time,” he says…

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Capitalism is My “Mental Illness”

 

Suanta writes:

Apparently, I am ‘mentally ill’.

A couple of years ago, I remember telling a friend that I had finally realized that there was nothing WRONG with me. At that time, I was waking up from the necessity of using labels with which to refer to myself and my experience. Feeling as though I was probably just like most other flailing human beings on this dying planet – I was expressing the need to be accepted as is. Well, I’ve since revisited that initial thought, and while I still don’t think that there is anything wrong with me per se, I can also state with great confidence that being ‘neuro-typical’ is definitely not my issue! And in the context of life in this society, apparently, this makes me ‘sick’. A brain chemical imbalance! Well, it’s been said that people like me ‘lack insight’ into this. So, I present to you my oppositionally defiant attempt to explain this lack.

Apparently, I am ‘mentally ill’ because I sense and feel things that other people do not. I suppose you could call it ‘delusional’ if you find the labels helpful. The fact is that I seem to possess a hyper-sensitivity and empathy in which I physically, emotionally and spiritually sense and feel negative energy from others. And it overwhelms me. Do I go out looking for this? Not a bloody chance! It’s something that just happens really – on a sensory level. Too much stimulus. Perhaps a nervous system too finely tuned? Research has suggested that different people have different levels of tolerance to pain. It does not seem to be a stretch to suggest that this could be true for the neuro-processing of external stimulus as well. When I was younger, I used to describe myself as a sponge, just involuntarily soaking up the energy of others (as a sponge will soak up liquid on the counter), left to deal with this toxicity and despair that doesn’t belong to me – or does it? We are all each other, just not at the same time… No? Don’t we all have distress and despair at different points in our lives? Maybe distress and despair is more of a phenomenon shared by ALL of us at some point… A kind of omnipotent energy floating around in the atmosphere caused by our seeming human necessity for mass destruction… But I digress… For me, being in large crowds is the worst, particularly if there is a great deal of consumption going on (or if we are surrounded by riot police). I stopped going to shopping malls a long time ago, as the overwhelm from generally unhappy consuming people – along with bright flashing lights, ‘happy’ shopping music, noise and massive waste – was too much for me, and I would become seriously agitated/panicked without understanding why. Now I know. But of course, that is also part of my ‘mental illness’ – as this sensory experience of overwhelm has no proven scientific validity! Few academics are studying this and because of that, it does not exist. It is not REAL. And of course, once again, I am lacking insight….

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Maya Angelou speaks about forgiving oneself

Maya Angelou

Maya Angelou

“I don’t know if I continue, even today, always liking myself. But what I learned to do many years ago was to forgive myself. It is very important for every human being to forgive herself or himself because if you live, you will make mistakes- it is inevitable. But once you do and you see the mistake, then you forgive yourself and say, ‘Well, if I’d known better I’d have done better,’ that’s all. So you say to people who you think you may have injured, ‘I’m sorry,’ and then you say to yourself, ‘I’m sorry.’ If we all hold on to the mistake, we can’t see our own glory in the mirror because we have the mistake between our faces and the mirror; we can’t see what we’re capable of being. You can ask forgiveness of others, but in the end the real forgiveness is in one’s own self. I think that young men and women are so caught by the way they see themselves. Now mind you. When a larger society sees them as unattractive, as threats, as too black or too white or too poor or too fat or too thin or too sexual or too asexual, that’s rough. But you can overcome that. The real difficulty is to overcome how you think about yourself. If we don’t have that we never grow, we never learn, and sure as hell we should never teach.”

– Maya Angelou, celebrated American author and poet who died yesterday at the age of 86

“A safe place to stay: the struggle to find housing for America’s mentally ill patients”

Geraldine, 64, has spent the past 20 years trying to find a safe place for her son. But a chronic shortage of ‘supportive housing’ for people with mental illness has taken its toll, and, as she tells Amanda Holpuch, ‘I know what happens. He ends up in jail’:

Estimates suggest somewhere between 70,000 and 96,000 homeless people have severe mental illness. Photograph: Chloe Cushman/The Guardian

 

At any given time, there may be a few hundred homeless people in Seattle’s Pioneer Square neighborhood, huddling under the overpasses from the persistent Washington rain. It’s a familiar place for Geraldine, who has spent the past 20 years caring for her 38-year-old son, who is mentally ill.

When her son is not in prison or in hospital, Geraldine, 64, makes daily visits to a three-block area to bring him food, drink and warm clothing. She knows the color of his sleeping bag, and seeks it out among the dozens of others in between the shopping carts and trash bags. Sometimes he rejects her help. Other times, he gives her gifts to other people on the street.

Often, her son has lost more weight, and his hair is more unkempt. His eyes look distant and strained.

These days, however, instead of going to Pioneer Square, Geraldine makes aweekly trip to a psychiatric hospital, where her son is being treated for schizophrenia.

It’s the longest Geraldine’s son has been stably housed since his initial diagnosis nearly 20 years ago, but she’s afraid he will end up back on the streets, in prison, or dead – because of the lack of safe, long-term housing available to people with severe mental illness.

“It’s all-consuming. I think about it all the time, even when I’m doing things I enjoy,” Geraldine told the Guardian. “Then I think about him and how he is living.”

Ever since her son disappeared from home as a teenager, he has ping-ponged through jails, homeless shelters, halfway houses and the streets, and Geraldine has spent that time working to find him a safe place.

She emails, calls and meets advocates, politicians and administrators on her son’s behalf. She is not comfortable providing her surname – her complaints within the system have caused her to be a recognized name, and she is afraid those complaints will affect her son’s chances to receive adequate care. She also asked that her son not be named.

Geraldine, who has two other children, believes stable housing is the only way her son can manage his schizophrenia and lead a safe, healthy life. Despite being her son’s primary caregiver, Geraldine doesn’t have the resources to provide him with the so-called “supportive housing” she believes he needs, and which, research shows, could keep him from returning to jail or the emergency room.

Gretchen Locke, at social policy thinktank Abt Associates, has researched homelessness for more than 20 years, and is a firm believer in the power of supportive housing.

“It really does facilitate stable housing, and also reduces the use of expensive crisis care, which is often where homeless people end up. If [people with mental health problems] are not stably housed, they’re more inclined to end up in the emergency room or jail or detox and those kind of expensive safety net services,” Locke said.

“Stable housing can provide a platform for addressing mental illness that may not have been addressed in the past.”

Once in supportive housing, mentally ill people rely less on other expensive services, according to a University of North Carolina Charlotte study from February this year.

Researchers found that the total hospital bill for 61 chronically homeless adults – 38 of whom had a mental illness – decreased by $1.8m over one year that they spent in supportive housing. Once in housing, residents had a 78% reduction in emergency room visits and a 79% reduction in days spent at the hospital.

Supportive housing programs don’t always pay for themselves, but because mentally ill people tend to use more expensive services, the costs of putting them in supportive housing are often offset by decreases elsewhere, said Dennis Culhane, a professor of social policy at the University of Pennsylvania and the director of research for the National Center on Homelessness among Veterans at the US Department of Veterans Affairs.

“Being homeless involves a range of dehumanizing experiences, and also greatly puts people at risk of victimization and exposure to injury – as well as being marginalized,” said Culhane. “Housing, by its nature, affords people protection: socially, physically and emotionally. So its really about transforming people’s quality of life.”

To finish reading the article, follow this link

Key takeaways

1. 20 to 25% of the single, adult homeless population has some form of severe mental illness

2. Hospitals are notoriously overwhelmed by the number of people seeking psychiatric care, in part because the number of available psychiatric beds decreased by 14% from 2005 to 2010

3. The alternative is often incarceration, a common fate for homeless people with severe mental illness. Jails house ten times as many mentally ill people as state hospitals do

Is misused neuroscience defining early years and child protection policy?

Zoe Williams writes for The Guardian:

The idea that a child’s brain is irrevocably shaped in the first three years increasingly drives government policy on adoption and early childhood intervention. But does the science stand up to scrutiny?

A much-used image purporting to show the affect of neglect on children’s brain development

Neuroscience can now explain why early conditions are so crucial,” wrote Graham Allen and Iain Duncan Smith in their 2010 collaboration,Early Intervention: Good Parents, Great Kids, Better Citizens. “The more positive stimuli a baby is given, the more brain cells and synapses it will be able to develop.”

Neuroscience is huge in early years policy. This week, in what’s been characterised as the largest shake-up of family law in a generation, the 26-week time limit for adoption proceedings has come into force, much of it justified by the now-or-never urgency of this set of beliefs, that the first three years (or sometimes first 18 months) hardwire a baby’s brain, either give it or deny it the capacity for a full life. This is the engine of what is known as the First Three Years movement, which has transfixed politicians from across the spectrum. Allen and Duncan Smith’s report opened with an illustration of the “normal child’s” large brain and the shrivelled, walnut brain of the neglected child. With conferences such asTwo Is Too Late (organised by Conservative MP Andrea Leadsom) and papers such as The 1,001 Critical Days, a set of claims are made that echo and reinforce those bold claims made by Allen: first, that we now have a set of scientific findings about the infant brain that can teach us new things about parenting. Second, that concrete events occur – from the production of synapses to the lighting up of areas of the brain on an MRI scanner – that can be interpreted in a straightforward way upon which all science is agreed. Third, with terms such as “critical periods” and “hardwiring”, the thesis is put forward that brains have a finite time window for learning certain things. Fourth, that we can distil the treatment of infants into a set of behaviours that will determine the networks in their brains, either equipping them to empathise, learn, engage and produce, or irreparably failing to equip them. The connections made are endless: babies who fail to make the right neural connections will do badly at school, lack empathy, succumb to criminality, have mental health problems, and end up in a cycle of deprivation themselves.

For instance: “Very early experiences need to be rich in touch, face-to-face contact and stimulation through conversation (or reciprocating baby babble). These stimuli encourage a more richly networked brain, particularly the regions that govern social aspects of life,” wrote Rebecca Brown and Harriet Ward in Decision Making Within a Child’s Timeframe, devised as the definitive document for use in family courts, as the calling of expert witnesses declines and this 26-week deadline is enforced. “Science is helping us to understand how love and nurture by caring adults is hardwired into the brains of children,” notes Sally Davies, Chief Medical Officer, in the foreword to The 1001 Critical Days.

The child protection changes are the most extreme end of the policy shaped by neurosciences, but it’s visible across all early-years policy; it can justify the removal of children who have been exposed to domestic violence or even children who may be hypothetically exposed, the mother having been abused before. It’s the foundation of the Family Nurse Partnership scheme, the state intervention at week 16 into a pregnancy that has been deemed “vulnerable”. It’s one of the reasons given for the CanParent pilot, free parenting classes offered as a trial in five boroughs (though likely to be abandoned after only 4% of new parents took them up). A major proponent of parenting “training” is the Sutton Trust, which recently produced its own estimate that 40% of children lack “secure attachments”.

Here’s the thing: what if it’s over-baked? What if the claims made for neuroscience are so extreme that most neuroscientists would disown them? What if the constant references to “brain scans of neglected children” actually just meant one brain scan, from one highly contested study? What if synaptic development were a bit more complicated than “the more synapses the better”, and what if MRI scans tell us much less than we think? Jan Macvarish, author of Biologising Parenting: Neuroscience Discourse, says: “There’s a wow factor to the images that the substance of the research doesn’t merit. We’re not actually seeing inside brains. We’re certainly not seeing emotions written on to the brain that we can then draw conclusions from into how parents should love their children.”

To continue reading this article, follow this link

The only ‘parity’ for mental health is that it is being cut and privatised as well

Peter Beresford writes:

Mental health services are amongst the hardest hit by cuts and privatisation. A new Charter suggests how people can build alliances and fight back. 

Image: Phil Hamer

This government has promised that mental health will at last be given ‘parity of esteem’ with physical health.

We need it. We have a psychiatric system still rooted in nineteenth century notions of medicine and ‘science’. Successive governments have failed to drag it into the twenty first century. Psychiatric policy is underpinned by a narrow medical model which service users report is damaging, unhelpful and stigmatising. It is far too reliant on drug treatments which are repeatedly shown to be of limited effectiveness, have problematic ‘side’ effects and give an undue influence and responsibility to ‘big pharma’. ­­

But what is mental health actually getting from government?

Not any new funds – mental health continues to be grossly underfunded.

The latest funding changes have imposed a 20% higher cut on payments to mental health services, than to acute hospitals. Mental health patients are being discharged into B&Bs to free up mental health beds, it was reported this week. And three quarters of local NHS Clinical Commissioning Groups have just announced cuts to already overstretched mental health funds for young people.

In recent years only forensic and compulsory ‘treatment’ have had funding increases – and even this now appears to have been reversed.

Nor does ‘parity of esteem’ seem to mean more ‘person-centred’ care.

Service users call for person-centred support, flexibility and non-medicalised services. They call for user-led out of hours, crisis and peer support provision.

But both councils and the NHS are instead cutting day care, social work, occupational therapy and other valued help. Posts remain unfilled, increasing caseloads for mental health staff.

In fact, the only way in which the Coalition is being even-handed with mental health is in its commitment to privatisation – as strong with mental health as with the rest of the NHS.

Psychiatric services are being outsourced at an accelerating rate. Capita, Virgin Care, Accenture, Reed, G4S and Serco are lining up for lucrative contracts despite a minimal track record in this difficult area. The growing presence of big private sector providers is diverting scarce NHS resources away from frontline support and into corporate profits.

The increasingly privatised services emphasise ‘throughput’ – people receiving short care help rather than long term support. Short term provision and drug interventions are prioritised over longer term talking treatments and the kind of family and social support valued by service users and carers. New managerialist techniques ignore calls from service users and instead talk of ‘care pathways’ and ‘payment by results’ (PbR).

Support is seen as only needed temporarily, until ‘normality’ is restored – ignoring the reality of many people’s situation. Mental health conditions often fluctuate, and people need ongoing help and support to maintain progress.

At the heart of new developments in mental health lies the bright, new, cosy-sounding idea of ‘recovery’. This has been welcomed by some service users. It suggests they will no longer be written off as ‘hopeless cases’, doomed to be damaged – and perhaps damaging – for the rest of their lives. Instead they are offered hope that their problems can be helpfully addressed and they can ‘get their life back’.

But increasingly service users find the officials dealing with them, under pressure from above, are using ‘recovery’ and related terms like ‘reablement’ to mean simply getting people off benefits and into employment – any kind of employment.

As the high profile Campaign to Save Mental Health Services in Norfolk and Suffolk points out, the impact of all of this is devastating.

People in crisis are waiting up to eight hours for an ambulance. Because of cuts in local beds, mental health service users are being sent all over the country, sometimes to costly private hospitals. People are not receiving their personal budgets, a flagship government policy, because of cuts in services. Patients who had remained well with outreach services are now coming back in need of help because these have been cut back.

As local MP and Care Minister Norman Lamb was launching a ‘Mental Health Crisis Care Concordat’ the campaign was highlighting that over a period of five months in 2013, there were 22 unexpected deaths among mental health service users.

It is because of this enduring crisis in mental health services, that the Social Work Action Network (SWAN) has launched its Charter for Mental Health this month at its international conference in Durham

To continue reading this article, follow this link

Borderline Personality Disorder – a feminist critique

Quinn Capes-Ivy wrote in 11/06/10 for the f-word blog:

Among my many diagnoses, I have what is known in the UK as Emotionally Unstable Personality Disorder (Of The Borderline Type), known elsewhere as Borderline Personality Disorder. BPD is described by Wikipedia as “a prolonged disturbance of personality function … characterized by depth and variability of moods.” It manifests in many ways, including rapid cycling mood swings, ‘self-destructive behaviour’, black and white thinking, disassociation and extreme fear of abandonment.

BPD is a serious mental illness and is difficult to diagnose. Unfortunately it is also well-known as being used by psychiatrists and mental health professionals as a way of labelling ‘difficult’ or ‘problem’ patients – I know at least one woman who was threatened with a diagnosis of BPD by a mental health professional because she wouldn’t do as she was told.

Three-quarters of patients diagnosed with BPD are female. I’ve spent some time since my diagnosis wondering why that is, when one would expect the split to be roughly 50/50.

My first thought is that the diagnostic criteria cover much of what is considered to be “stereotypically feminine” behaviour, but to a more extreme level. For example, one of the diagnostic criteria, “Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).” – well, women are supposed to be overly emotional people anyway, right? Another of the criteria is “Frantic efforts to avoid real or imagined abandonment.” We’ve all heard the stereotyped stories of bunny boilers, of women who get pregnant to ‘trap their man’, of women who are controlling and possessive and who are terrified of being alone. Women are supposed to be flighty, unable to control their emotions, and to have trouble navigating their interpersonal relationships.

The second thing I’ve been thinking about is that it’s possible that women get the diagnosis of BPD because some of the diagnostic criteria include things which are considered ‘normal’ for men, but ‘abnormal’ for women. For example, if a woman behaves in an ‘unfeminine’ way, say by expressing extreme anger (another of the diagnostic criteria is “Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)”), the label of BPD is slapped on her by the psychiatrist…

To read the rest of the article, and the interesting comments on it, follow this link

 If you found this article interesting, make sure you take part in The Big Mad Experience (@BigMadTweeter)’s weekly #BigMadChat on Tuesday 29th April 2014 8pmBST/3pmEDT, when we’ll be discussing the social politics of the Borderline Personality Disorder diagnosis!

Dispelling the nightmares of post-traumatic stress disorder

Daniel Freeman and Jason Freeman post for The Guardian Blog:

Treatment for post-traumatic stress disorder can take months, but an intense course may relieve symptoms in just a week

In post-traumatic stress disorder or PTSD, patients repeatedly relive the traumatic event. Photograph: Azhar Rahim/EPA

On Wednesday morning we woke to the news that a passenger ferry had sunk off the coast of South Korea, with at least four people confirmed dead and 280 unaccounted for. Meanwhile, though the search has continued for the missing Malaysia Airlines plane, relatives’ hopes of a safe landing have long since been extinguished.

Human tragedies like these are the stuff of daily news, but we rarely hear about the long-term psychological effects on survivors and the bereaved, who may experience the symptoms of post-traumatic stress disorder for years after their experience.

Although most people have heard of PTSD, few will have a clear idea of what it entails. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) defines a traumatic event as one in which a person “experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others”. PTSD is marked by four types of responses to the trauma. First, patients repeatedly relive the event, either in the form of nightmares or flashbacks. Second, they seek to avoid any reminder of the traumatic event. Third, they feel constantly on edge. Fourth, they are plagued with negative thoughts and low mood.

According to one estimate, almost 8% of people will develop PTSD during their lifetime. Clearly trauma (and PTSD) can strike anyone, but the risks of developing the condition are not equally distributed. Rates are higher in socially disadvantaged areas, for instance. Women may be twice as likely to develop PTSD as men. This is partly because women are at greater risk of the kinds of trauma that commonly produce PTSD (rape, for example). Nevertheless – and for unknown reasons – when exposed to the same type of trauma, women are more susceptible to PTSD than men.

What causes it? In one sense, the answer is obvious: a specific trauma. Yet this is only part of the story, because not everyone who is raped or badly beaten up develops PTSD. Of the contemporary psychological attempts to answer that question, the most influential is the one formulated by the clinical psychologists Anke Ehlers and David Clark at the University of Oxford.

They argue that PTSD develops when the person believes they are still seriously threatened by the trauma they have experienced. Why should someone assume they are still endangered by an event that happened months or even years previously? Ehlers and Clark identify two factors.

First is a negative interpretation of the trauma and the normal feelings that follow, for example believing that “nowhere is safe”, “I attract disaster”, or “I can’t cope with stress”. These interpretations can make the person feel in danger physically (the world seems unsafe), or psychologically (their self-confidence and sense of well-being feel irreparably damaged).

Second are problems with the memory of the trauma. Partly because of the way the person experiences the event, the memory somehow fails to acquire a properly developed context and meaning. As a result, it constantly intrudes. Ehlers and Clark liken the traumatic memory to “a cupboard in which many things have been thrown in quickly and in a disorganised fashion, so it is impossible to fully close the door and things fall out at unpredictable times”…

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Student Expelled From King’s College London University ‘For Failing To Prove She Was Depressed’

File picture | Johner Images via Getty Images

Indigo Ellis writes for The Huffington Post UK:

A former student at King’s College London has claimed she was expelled for not being able to provide sufficient evidence she was depressed after falling behind with her work.

Jane* says the university “failed and humiliated” her and spoke out to criticise the lack of support and insensitivity she suffered through a period of depression which she says eventually led to her expulsion in 2012.

The former student highlighted King’s inability to support her pastorally, and felt let down by her personal tutor and university counsellors – the support systems in place for incidents of this type.

Having being severely depressed prior to and after a serious operation, Jane failed an assignment by a single mark. Her place on her course was terminated and appeals denied after the written evidence of her illness was deemed “inappropriate”. The university claimed the letters she provided from her GP and counsellor were insufficient in explaining the failure of the assignment as they covered the wrong dates.

Jane visited a university counsellor but says they did not provide any help, simply telling her she came from a “dysfunctional family”. Her personal tutor, another supposed point of support for students pastorally, was similarly unhelpful.

The former student told The Huffington Post UK she had finally found the confidence to speak out about her experience, saying KCL failed to give her the “key ingredient to success – support”.

“In 2012, I underwent a very serious operation which left me distraught and depressed,” she said. “Unaware as to the extent of my mental illness, I fell behind with one assignment and my place on the course was terminated. It was too late to prove my mental health issues once I had been kicked to the curb; they requested evidence to ‘prove’ that I had had depression, they said that the evidence that I had provided was ‘not enough’…

To continue reading this article, follow this link

*Jane’s name has been changed to protect her anonymity.

‘Suicide Prevention Sheds a Longstanding Taboo: Talking About Attempts’ – The New York Times

Dese’Rae L. Stage, a photographer and writer living in Brooklyn, tried to kill herself in 2006. She has since created an online photo exhibit of people who have also survived suicide attempts and is among the dozens whose stories are becoming known on Internet forums and through social media.

Benedict Carey writes for The New York Times:

The relationship had become intolerably abusive, and after a stinging phone call one night, it seemed there was only one way to end the pain. Enough wine and pills should do the job — and would have, except that paramedics barged through the door, alerted by her lover.

“I very rarely tell the story in detail publicly, it’s so triggering and sensational,” said Dese’Rae L. Stage, 30, a photographer and writer living in Brooklyn who tried to kill herself in 2006. “I talk about what led up to it, how helpless I felt — and what came after.”

The nation’s oldest suicide prevention organization, the American Association of Suicidology, decided in a vote by its board last week to recognize a vast but historically invisible portion of its membership: people, like Ms. Stage, who tried to kill themselves but survived. About a million American adults a year make a failed attempt at suicide, surveys suggest, far outnumbering the 38,000 who succeed, and in the past few years, scores of them have come together on social media and in other forums to demand a bigger voice in prevention efforts.

Plans for speakers bureaus of survivors willing to tell their stories are well underway, as is research to measure the effect of such testimony on audiences. For decades, mental health organizations have featured speakers with schizophrenia, bipolar disorder and depression. But until now, suicide has been virtually taboo, because of not only shame and stigma, but also fears that talking about the act could give others ideas about how to do it.

“This is a real shift you’re seeing,” said Heidi Bryan, 56, of Neenah, Wis., who has been speaking for years about suicide attempts she made in the 1990s. “For people working in suicide prevention, they always told us not to talk about our own experience, like they were afraid to tip us over the edge or something. Honestly, we’re the ones who know what works and what doesn’t.”…

To continue reading this article, follow this link.