(This paper was originally written for Dr. Jeffrey Kash’s Senior Seminar in Political Science, submitted on December 10th, 2019.)
Introduction
Political actors debate solutions to public problems, preferring to implement more feasible solutions rather than risk spending political capital on a program where the potential results are uncertain. With regard to suicide, several solutions present themselves. This paper analyzes 3 potential solutions to the problem of suicide—first, a brief overview of the problem will be given, and then each solution will be discussed, paying special attention to the solutions’ technical and political feasibility. Finally, the paper will conclude with the identification of the most feasible solution of the three presented.
Overview
In the last two decades, the suicide rate in the United States has increased among both men and women across almost all age groups (Curtin et al.). The Centers for Disease Control (CDC) have determined that suicide is a major public health issue, given its prevalence and the severity of its human and social cost (ASAP – Suicide Prevention). Several interest groups are involved with the addressing of the suicide problem, such as the National Alliance for Mental Health (NAMI) and the American Foundation for Suicide Prevention (AFSP). The National Institute of Mental Health (NIMH), a component of the National Institutes of Health (NIH), dedicates much of its research to suicide prevention: the NIMH’s Division of Services and Intervention Research, under which suicide prevention research falls, had a budget of over $153 million for the 2019 fiscal year and is slated to have a budget of about $138 million in the 2020 fiscal year (FY 2020 Budget).
Gun Control as a Solution for Suicide
One potential solution to the suicide problem is enacting gun control legislation, specifically gun buyback programs that would reduce the overall gun ownership rate. In 2017, a majority of suicides occurred by firearm (CDC Fatal Injury Report), and more than 82% of suicide attempts by firearm are lethal (Spicer and Miller 1888). Researchers have also found that higher rates of gun ownership are a good predictor of overall suicide rate at the state level (Siegel and Rothman). Means-reduction measures have proven to be effective at decreasing the suicide rate (Means Reduction Saves Lives), so it follows that reducing the ownership rate of firearms would in turn reduce the overall suicide rate (perhaps by a substantial measure, considering the large portion of suicides committed by firearm).
Other nations have successfully implemented legislation that restricted and reduced gun ownership in the past, leading to decreases in the gun death rate overall as well as the suicide rate. In 1997, the Australian government implemented major gun control legislation, including banning certain kinds of weapons and enforcing a mandatory buyback program for the now-illegal firearms. This eliminated about 20% of all Australian firearms, or 650,000 guns (Leigh and Neill 509–10). In 1995, before this gun control legislation was introduced, there were 2.2 firearm suicides per 100,000 people in Australia. In 2006, 9 years after the legislation went into effect, there were 0.8 firearm suicides per 100,000 people, a decrease of 65% (518). In 2018, the Small Arms Survey estimated there to be over 393 million civilian-held firearms in the United States (Karp 4). To reduce the number of civilian-held firearms by one-fifth, as was done in Australia, the United States would have to eliminate about 78.5 million guns—121 times as many. For reference, the total population of the United States (about 327 million) is only about 13 times the size of Australia’s total population (about 25 million) (United Nations). As such, the technical feasibility of such a buyback program is much lower in the United States than it was in Australia.
Gun control action in the United States faces serious challenges to its political feasibility. Comparison with other countries indicates that the United States has the some of the laxest gun control legislation among developed nations (Lopez). The National Rifle Association (NRA) is a prominent advocate of gun rights and opponent of gun control in the U.S. The NRA spent nearly $10 million in lobbying across 2017 and 2018 (Allison). 19% of U.S. gun owners said they were members of the NRA in 2017, and these members have more extreme anti-gun control views than gun owners at large or adults as a whole (Parker). The influence of these political undercurrents can be seen in Wyoming, a state with a high (and increasing) suicide rate where gun culture is strong. Suicide prevention professionals in Wyoming have found that national rhetoric around gun control has negatively impacted their ability to separate suicidal people from the means to kill themselves (Barry-Jester). The last time the federal government passed gun-control legislation was in 1994, when assault weapons were banned for ten years (Gray). Additionally, the Second Amendment’s protection of the right to bear arms opens up any gun control measure to potential federal litigation. As such, there is very little political feasibility for gun control measures aimed at reducing suicide to be implemented.
Increasing Treatment Access as a Solution to Suicide
Research shows that most suicides are linked to some kind of mental illness (Brådvik). Increased access to treatment for those mental illnesses would likely help drive down the suicide rate. Research has found that there is an inverse correlation between the prevalence of SSRIs, a common type of antidepressant, among a population and its suicide rate—i.e., access to SSRIs can help drive down suicide rates (Ludwig et al.). Cognitive behavioral therapy, a type of talk therapy, has also been proven to reduce the risk of suicide in patients with mental illness (Schwartz-Lifshitz et al. 630). Given this information, increasing the availability of SSRIs and therapy could help drive down the suicide rate.
One technical obstacle to increasing treatment access is the shortage of doctors in rural areas: in a 2019 poll, 26% of rural Americans said that there was a time in the last few years when they needed heath care but did not get it (Siegler). Given that rural counties in most regions of the country have higher suicide rates than urban ones (Curtin et al.), this disparity is particularly relevant. Professional organizations like the American Association of Family Physicians (AAFP) have taken steps to address the crisis by funding fellowships for doctors to take employment in rural areas (New AAFP Initiative Addresses Rural Health Care Crisis). The federal government could grant tax credits or student loan forgiveness to doctors willing to work in rural or other medically underserved areas in order to help alleviate the suicide crisis. To more specifically address suicide, funding could be restricted to, or increased for, doctors who specialize in the treatment of mental illnesses.
Politically, health funding for rural areas has aspects attractive to politicians on both sides of the aisle. Rural people make up an increasingly large portion of the Republican Party’s base (Parker et al.), so any legislation that directs resources to those constituencies would be a political win for the GOP. Democrats tend to favor increasing access to health care, and “ensuring universal health care” was one of the party’s planks in their 2016 platform (2016 Democratic Party Platform 31). However, in the current fiscal climate, creating a new program that would require a substantial budget to be effective would require justification from the party to both constituents and party members who are concerned about the growing federal budget deficit.
Addressing Toxic Masculinity as a Solution to Suicide
Researchers have defined the term “toxic masculinity” as referring to a host of negative behaviors and beliefs prevalent among men due to their social conditioning (Salam). While the boundaries of what can and cannot be considered toxic aspects of the male gender role remain unclear, there is obviously a gender disparity in suicides. The ratio of male to female suicides was 3.6 to 1 as of 2016 (Hedegaard et al.). An aspect of toxic masculinity commonly identified by researchers is the need to suppress or mask emotion (Salam): this could dissuade men from seeking treatment for their suicidal thoughts and prevent others in their lives from seeing that they have a problem. Anna Maria Barry-Jester identified the “cowboy mentality” of self-reliance as a facilitator of high suicide rates in her case study of suicide among men in Wyoming. Ad campaigns targeted at programs with a largely male audience could help make men aware of the signs of depression and suicide and work to erode social norms against men seeking psychiatric help. For comparison, the popularity of erectile dysfunction drugs illustrates the impact that a concerted ad campaign can have on making men more willing to talk to their doctors about awkward or touchy subjects (Viagra sales totaled about $1.6 billion in 2012 (Mukherjee)). While depression and suicide are certainly darker topics than erectile dysfunction, both issues carry social stigma tied in with popular conceptions of masculinity.
The Ad Council is a non-governmental organization that works with the federal government (and other groups) to produce public service ad campaigns. This is a common avenue for public service ad campaigns to get onto the air, and in all likelihood any ad campaign related to suicide would go through them. Data would have to be collected on the programs where the target audience of men most at risk for suicide could be reached. Nielsen collects data on the demographics of program viewers for television and listeners for radio, so this data could be employed to target men at risk for suicide most effectively. The CDC is the primary federal institution tasked with achieving public health goals through practice, so it is likely that they would be the ones footing the bill for the ad buy. This project could become costly, as sustained messaging would be necessary to erode the strong social barriers for men seeking psychiatric help.
Political obstacles to an ad campaign of the sort just described could include public backlash against a perceived attack on social norms. If the ad is considered too aggressive in the way it challenges traditional masculinity in order to get men in need to seek treatment for mental illness, there could be a reverse effect of entrenching the very attitudes the ad seeks to eradicate. Ad buys could also be considered an insufficient measure to take against suicide, given the severity of the problem. It is possible that activist groups such as AFSP and NAMI would push for more drastic action.
Identification of the Most Feasible Solution
Given the historic difficulty of passing gun-control measures in the United States, the sheer scale at which any significant gun buyback program would have to operate, and the potential for extended litigation challenging the program on second amendment grounds, the gun control avenue for suicide reduction is likely to be the least feasible. Next, while increasing rural health access has attractive aspects for both parties, the costs of incentives for doctors to take employment in rural areas would likely induce some sticker shock to politicians, and Congress could easily get mired in the small details of any program of the sort.
Thus, while it is the least drastic solution of the three offered, creating an ad campaign targeted at men who have a socially-induced higher risk of suicide is the most feasible solution. Congress would likely not have to appropriate funds expressly for these ads—the CDC purchases ads from the Ad Council periodically as part of its operating budget (FY 2019 Operating Plan).
Conclusion
Suicide is a prevalent and increasingly dire problem in the United States. When considering the three possible solutions of gun buybacks, increased rural health access, and ad campaigns targeting at-risk men, the last of the three is both the least drastic and the most feasible. In fact, it is the most feasible precisely because it is the least drastic.
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Dillon McCormick 