Tipping Point: Advocating for Social Justice as a Suicide Prevention Movement
By Sally Spencer-Thomas, Psy.D., is the Executive Director of the Carson J Spencer Foundation and the Survivor Division Chair of the American Association of Suicidology.
A Paradigm Shift
A social movement is emerging, and it’s gaining momentum. When I speak at conferences and on campuses from coast to coast, I find that audiences first tilt their heads with intrigue and then nod with enthusiasm as I explain what it means to position suicide prevention as a social justice issue.
We can easily understand that suicide is a mental health issue. When authorities report that an estimated 90% of people who die by suicide suffer from some diagnosable mental illness or substance abuse condition, we can clearly see the link between the two. However, if we only view suicide through the mental health lens, we will be very limited in our ability to create systematic change. When we look at suicide prevention through this lens, the change agents are the mental health service providers, who work with individuals who are suffering; one on one, one at a time. Systemic change and proactive prevention is not possible.
For instance, if we only focus on the mental health conditions of our Lesbian, Gay, Bisexual and Transgender and American Indian/Alaska Native youth, we will miss the underlying social inequities that drive their inner states of turmoil. In fact, a sole focus on the mental illnesses among these populations could actually increase marginalization and scapegoating.
In order to take a more “upstream” approach to this, we need to think more broadly and conceptualize suicide prevention as a public health issue. When we view suicide through this lens, we appreciate how many systems are involved in creating change– schools, workplaces, healthcare systems, justice, faith communities and more. With this framework, everyone can play a role in suicide prevention. Through the public health lens we also see that change begins through an emphasis on bolstering protective factors like social connections and resilience as much as it does on medication and treatment.
But, I would argue, even this perspective falls short. Because if you haven’t been touched by suicide directly, you are usually unaware of its widespread and devastating impact and therefore, less inclined to allocate your energy toward targeting this particular health issue over others. Who takes care of “public health issues”? I am pretty sure it’s someone in the government, thinks the average citizen. What we need is a social justice approach to suicide prevention. In this framework, the change agents are everyday people, standing up for injustice.
We can take notes from the breast cancer movement. This movement has modeled for us how to create a tipping point of change by bringing the strength of community solidarity to engage a wider circle. Breast cancer survivors are bolstered by others who cheer their courage and stand with them through their struggle. Those who have lost their battle to breast cancer are remembered with honor. Many who have not been touched by the impact of breast cancer are moved by the energy of the large walks and moving testimonies of healing and recovery and want to know how they can help. Once cancer was stigmatized and misunderstood; now symbols supporting the fight against breast cancer can be seen everywhere.
The suicide prevention movement has many parallels as the community walks, candle-lighting ceremonies and town hall meetings grow. In essence, it’s the politics of witness: when we take a private event like suicidal thoughts and say, 3,000 people are willing to come out and do something about this, all of a sudden, a suicidal person doesn’t feel quite so alone any more.
What is a Social Movement?
Sociologists have defined social change as the transformation of culture and social institutions over time and suggest that social movements are organized activities that encourage or discourage such social change. Social movements often evolve in four stages: 1) an initial emergence triggered by a shared belief that something is not alright, 2) a coalescence, which may happen at the grassroots level in pockets of communities as local leaders work to recruit new members, develop strategy, and attract the attention of the media, 3) a bureaucratization happens when the movement obtains a higher-level organization and becomes an established and coordinated entity, and finally 4) decline.
The suicide prevention movement has evolved through stages one and two and is moving to stage three. Disparate efforts have responded to local needs, whether for people at risk for suicide or people bereaved by suicide, to the significant efforts in the last decade to improve national strategy and coordination. Grassroots leaders have gained coordination and resources, and now organization and prioritization is happening at the national level.
So what are the aspects of injustice we need to fight against? For one, we have a grave imbalance in the way we treat mental health conditions and the way we treat other physical disorders. Because of this imbalance, people with mental health conditions often have a terrible time accessing adequate care. There are too few mental health treatment options and most of them are too costly for the average person.
As my colleague Dr. Doug Johnson once said to me, “We have a psycho-social injustice problem. We have Americanized mental illness– by looking for quick fixes and ignoring the emotional impact of marginalization.” To elaborate on his first point, Dr. Johnson referred to the trend in our country to reach for medication as a first line of defense against mental illness rather than to focus on broader health and wellness behaviors and the influence of the environment. For his second point, he explained that those who have a mental illness experience one level of distress, but for those who live with discrimination and judgment that come with a diagnostic label, the distress increases considerably.
Furthermore, we have developed dysfunctional narratives in our country about mental health conditions that get reinforced in careless media reports and lead to further isolation and hopelessness. People are genuinely afraid to reach out to get the help they need to survive. If that is not a social justice issue, I do not know what is.
For all social movements, changes occur at all levels. On the individual level, internal changes such as attitudes, beliefs, aspirations, and motivations translate into external behavioral change. Within groups, we begin to see changes in language and communication patterns and social pressure to accept or reject collective perspectives. As the movement matures, changes in institutions manifest through developments in their structure and function as evidenced by new policies and protocols. Finally, societal shifts occur when universal systems like education, religion and public policy start leveraging broad, significant and steadfast change.
Malcom Gladwell called it a “tipping point”: it only takes a few people with a special set of skills to get the ball moving and accelerating. Change advocates create the infectious emotional contagion that is needed for sweeping change.
What is a Suicide Prevention Advocate?
The World Health Organization defines mental health advocacy as follows:
The concept of mental health advocacy has been developed to promote the human rights of persons with mental disorders and to reduce stigma and discrimination. It consists of various actions aimed at changing the major structural and attitudinal barriers to achieving positive mental health outcomes in populations.
On a personal level advocacy allows those who have suffered to publicly state, “this is who I am, this is how the dreams of mine and others like me have been systematically destroyed, and this is how I see that change is possible.” For survivors of loss and survivors of attempts and their loved ones, advocacy builds resiliency in the soul. Often each step forward is met with backlash and cynicism, and as advocates persevere they find meaning and strength in their convictions.
What can suicide prevention advocates do to further the social movement of suicide prevention?
1) Give voice to those who have been silenced
2) Mobilize bystanders and connect constituencies
3) Show solidarity in public displays of unity
4) Stand up for injustice by speaking out
5) Champion policy changes to support mental health
6) Engage a wider circle of influential leaders
7) Testify at public hearings or host a town hall meeting
8) Collaborate with the media and share stories of hope and recovery
Most importantly, never give up. As one ecological psychologist once said, “Before the water turns to ice, it looks just the same as before. Then a few crystals form, and suddenly the whole system undergoes cataclysmic change.”