“In our [2017 Policy Studies Journal] paper, we mostly looked at overall gun control policies and access to mental health rather than specific policies,” Smith said, explaining that most states which implement gun control laws do so more with more than one, making it difficult to assess which laws have caused what specific effect. Despite this challenge, Smith and his team still found a definite pattern in terms of how gun control laws impacted suicide rates.

“What we do find in our research is that states with more gun control laws have fewer gun deaths (including those who die by suicide from guns) and for non-suicides (homicides and accidental discharge together), a combination of more access to mental health services and an overall stricter climate for gun control laws correlates with a particularly lower rate of gun deaths,” Smith said. Specifically, the team found that more access to mental health care did not correlate with lower rates of suicide by gun; stricter gun control laws, however, had that desired impact.

“This relationship is perhaps due to the fact that many mental health treatments take time to have an effect, while the effect of removing a gun (or preventing one from having it in the first place) is immediate,” Smith said, adding that more access to mental health care is still good for other reasons. “It is also very difficult under existing law to remove a gun due to mental illness, but having stricter gun control laws generally can either prevent (assault weapons ban) or delay (through background checks) when one has access to a gun.”

This, she said, was despite advances in medications, and major campaigns that reduced the stigma of seeking help for mental illness.

“We’ve had no effect on the rate of suicide; in fact it’s higher than it ever was,” said Alonzo, an associate professor at the Graduate School of Social Service and director of Fordham’s Suicide Prevention Research Program.

She attributes the rise in part to the main focus of suicide prevention research over the years, which has centered more on desperate patients in the emergency room and less on those initially seeking outpatient services. Also, in much of the mental health research, patients’ sociocultural backgrounds are not taken into account.

“What differentiates social work from other mental health professions, like psychiatry or psychology, is that we look at more than just the individual person sitting in front of us. We look at their ecosystem,” she said. “We need to know the populations if we are hoping to help.”

Alonzo said that, up until recently, psychological research groups were largely made up of white males—and then the findings were generalized to everyone. It was a great advance when women and minorities were included, but much nuance is still lost on large groups. For example, Hispanics—although minorities—have a relatively low suicide rate when considered as a single group.

Even then, she said, looking at Hispanics as one whole group can lead to misinformation.

“When we break it down by Hispanic subgroups, we find that Cuban Americans and Mexican Americans have among the lowest rate of suicide of any ethnic group, but Puerto Ricans have a higher rate of suicide by ninefold,” she said.

Assuming risk for an entire group can also have a profound effect on communities, Alonzo said. Limited resources may be diverted to areas where they are not needed.

“A lot of evidence-based practices are largely based on quantitative research, which uses large randomized control trials and less of an emphasis on understanding the population,” she said. “We’re doing a disservice . . . assuming risk for populations that don’t have as much risk, and underestimating risk for populations who are at great risk.”

For example, Alonzo recalled an ad campaign for suicide prevention that appeared on buses running through a Washington Heights neighborhood, where the majority of the population is Dominican. That campaign might have been better placed in a Puerto Rican neighborhood, had research been available, she said.

Alonzo’s own research into suicide prevention found that the point of contact at which the research was conducted didn’t necessarily tell the whole story, because the majority of people who are at risk don’t go for treatment.

“This is a hard population to treat and study,” she said. “It doesn’t matter how great your evidence-based intervention may be if the at-risk individuals are not going to treatment to receive it.”

After finding that most people who came to the ER had already attempted outpatient treatment, Alonzo focused her research on outpatient centers with substantial caseloads.

“Somehow we had missed an opportunity to get them engaged with treatment,” she said. “Once someone goes to an emergency room saying that they’re thinking about suicide, then they’re going to the hospital—which is psychologically and financially burdensome.”

There, she works with patients who are coming in for a first appointment. She implements an onboarding procedure at the moment of intake, where suicide intervention can be initiated “in a way that’s realistic for overworked intake departments with large caseloads.”

“We need to make an impact early on, so that people who go in for an intake [will]experience an immediate benefit to treatment. [This will] limit the likelihood that they will then drop out and end up in the emergency room,” she said.

Alonzo’s intake procedure combines risk assessment and “engagement-focused intervention” alongside standard intake procedures. She said the intervention doesn’t require extensive clinical training. It can be used across personnel, and can be delivered quickly.

“It’s a brief motivational interview that involves personalized feedback on a risk assessment, and then follow-up contact,” she said.

She said most of the research that’s done on suicide focuses on the high-risk behavior, but not on engagement or adherence to treatment.

“We know very little about what keeps them in treatment,” she said. “What we do know is that those who are at the highest risk aren’t going to treatment to begin with, or they drop out very quickly and are not taking advantage of the evidence-based practices that exist to help mitigate their risk.”

She said her intake assessment tool provides personalized feedback that debriefs patients on their condition in everyday language—and with an awareness of their cultural background.

“We’ve learned that at-risk individuals experienced the standard risk assessment and treatment as impersonal and routine,” she said.

“By individualizing our feedback, the feedback itself can become the start of an intervention.”

Laurie Boncimino, a college student in Michigan with a passion for social service, was 20 when she committed suicide. Joshua Anderson, just 17, never made it to his freshman year.

Their stories were among hundreds featured in a traveling suicide prevention exhibit that stopped at Fordham’s Rose Hill Campus on March 30. More than 1,100 empty backpacks—many of them bearing photos and stories donated by deceased students’ families—were scattered across Edwards Parade as a powerful illustration of the number of college students who die each year by suicide.

Mental health awareness

The daylong exhibit was a prelude to Fordham’s Mental Health Awareness Week. Beginning April 7, the week will feature events such as music therapy and a Fordham TED Talk in an effort to raise campus-wide awareness about the importance of cultivating mental health as well as seeking help for mental illness.

“There is a misconception that people are entirely responsible for their own psychological and emotional struggles. Many people wrongly believe that someone suffering from a mental illness can just snap out of it,” said Jeffrey Ng, PsyD, director of Counseling and Psychological Services.

“The goal of this awareness week is to show that we all have a role to play in optimizing our students’ wellness and mental health.”

Hand-painted signs lining Edwards Parade told sobering facts about mental illness among 18- to 24-year-olds—for instance, that suicide is the second leading cause of death among college students and that as many as 44 percent of students report having felt so depressed in the past year that it was difficult to function.

Combating stigma and silence

Send Silence Packing is an initiative by the national mental health awareness organization Active Minds, a nonprofit founded in 2003 by then-college student Alison Malmon after losing her 22-year-old brother to suicide. Since its launch in 2008, the exhibit has traveled to more than 85 cities nationwide to shed light on college student suicide and to promote healthy dialogue about mental health.

Fordham College at Rose Hill juniors Gloria Siclari and Catarina Araujo established the first Active Minds chapter at Fordham, joining more than 400 other student-led chapters across the country. The duo managed to secure Fordham as the first stop on the Send Silence Packing spring 2015 tour, which will visit colleges and universities throughout the northeast from March 30 to May 1.

“You can’t ignore this display,” said Siclari, who has lost several family members to suicide. “I think it’s amazing we’ve had this ability to touch so many students on campus today. It’s not easy to talk about these issues, but we have to.”

“In so many of these stories, families said that they didn’t see the signs,” said Rose Hill junior Vanessa Agovida as she wandered through the rows of backpacks. “It makes me wonder about the people around me who might be hurting and are hiding it really well.”

Mental Health Awareness Week kicks off this afternoon with a tabling event at the McGinley Center, which will be followed by a “stress buster” training at the CPS office.

“I want students to know and understand that they’re not alone in their struggle—that there’s help, resources, and support available,” Ng said. “There’s no shame or weakness in reaching out. It’s a sign of strength and maturity to ask for help when we need it.”

For a complete list of Awareness Week events, visit the Facebook page.

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