The Uninsured and Suicide

I haven't heard this anywhere in the health care discussion, although talking to other uninsured people, it seems suicide is often a bona fide option to some if they become seriously ill. I know if I was given the option of expensive treatment, going bankrupt and leaving my family living on the street in a box, suicide would cross my mind. After googling "uninsured suicide," I found an article from 2007 that noted in states with the highest number of uninsured, the suicide rates are also higher. It didn't make a direct connection between the two, but it seems it would be a worthwhile study to make. From the 11/27/2007 USA Today:

Report links higher rates of uninsured and suicide

By Marilyn Elias, USA TODAY
The higher the percentage of residents in a state who say they can't afford health care, the greater the prevalence of serious depression and the higher the suicide rate in that state, suggests a report released to USA TODAY.
The state-by-state analysis also links fewer suicides to more adults receiving mental health treatment, greater availability of psychologists and psychiatrists, and "parity" laws requiring equal insurance coverage for physical and mental illness.


NUMBERS:Depression and suicide rates state by state
The report doesn't prove that lack of care causes depression or suicide, says senior author Tami Mark of Thomson Healthcare. "But it suggests we should be monitoring mental health care and comparing outcomes," she says.

Mark used federal data on mental health and state databases to develop a "depression index," ranking states and the District of Columbia on seriousness and prevalence of depression, as well as suicide rates.

When both depression and suicide rates are considered, states that ranked the best are Maryland, New Jersey, Illinois and Hawaii. Among the worst off: Utah, West Virginia, Idaho and Nevada. Suicide rates in states ranked lowest were two to four times higher than those with the most favorable records.

Major depression strikes 17% of Americans, and about 30,000 a year commit suicide, government figures show.

States with more affluent residents tend to have better mental health ratings, but the tie between barriers to treatment and increases in depression can't be accounted for by different average incomes in the states, says David Shern of Mental Health America, an advocacy and education group that commissioned the survey. It was funded by pharmaceutical company Wyeth, which had no influence on the design or outcome, Shern says.

The results underscore the importance of health insurance as a presidential campaign issue and of a mental health parity bill before Congress, he says. "There are consequences of no mental health treatment; it can cost lives."

But the report may be oversimplified "because there are so many differences between states, it's hard to capture them all," says health policy researcher Ronald Kessler of Harvard Medical School. For example, many rural, Western states have high suicide rates. "Isolation raises the risk of suicide, and so does more households having guns, which is the case in these Western states," says Paula Clayton, medical director of the American Foundation for Suicide Prevention.

Also, the analysis compares states by expenditures for mental health services, but some spend heavily on administration, and others offer better programs with less money, says Lee Carty of the Bazelon Center for Mental Health Law.

The report hasn't been carefully scrutinized and published yet, cautions John Holahan, director of the Health Policy Center at the Urban Institute, "but it's pretty interesting and important because it suggests that having insurance and improving access to care has an impact on mental health and suicide."

doctors can contribute to the discussion if only they would.

Do they ever do follow-ups on patients who are presented with options in a serious illness or injury and then are not heard from again? How many people who are not insured decline treatment and inform the doctor of this.

Recently had a friend who had cancer. When she had the treatment that made her too ill to work, the church where she worked "laid her off" and she lost insurance coverage. The rest of her short life was consumed with treatments, disposing of her wordly goods so she could qualify for Medicaid and begging state workers for the treatments and medical devices she needed to have any kind of life.

From what I have seen, suicide at the get-go is a viable option.

Rarely. Follow-up is (currently) indicated only when substance abuse or previous suicide attempts are present. Expanding the scope of follow-up is a legitimate public health concern, and fortunately is part of the Healthy People 2010 initiative, objective 26-22:

http://www.healthypeople.gov/document/html/objectives/26-22.htm
"(Developmental) Increase the proportion of persons who are referred for followup care for alcohol problems, drug problems, or suicide attempts after diagnosis or treatment for one of these conditions in a hospital emergency department. Potential data source: National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS."

for the link.

There are so many black holes of information.
Here - Doctors offices take calls from the uninsured seeking help. But the receptionist says "I am sorry but you will have to call a doctor who accepts uninsured patients" knowing full well there are not any.
The office I go to has a sheet with the hours of the free clinic where the uninsured can see a nurse on Tuesdays from 5 - 8.

Who are the doctors telling about this? Why aren't more of them speaking out now.

add it to the list.

It is taxing, mentally and emotionally, to always have in the back of your mind that one bad misfortune could ruin every aspect of one's life.

We recently upgraded something on the computer and all of a sudden I'm having a hard time cutting and pasting links.

:D

who aren't supporting the public option for easier access, they'll stare blankly - because people don't want to believe that shoddy care of the poor or uninsured could result in them thinking it's better to not be here. :cry: