PREVENTING SUICIDE

This month’s column is the third of three columns focused on suicide risk among our colleagues, our families, and our friends. The February article discussed Experiencing Suicide; the March article, discussed Comprehending Suicide; and this article discusses Preventing Suicide.

Many of us, if not most of us, know someone who has died by suicide. Suicide is the 12th leading cause of death in the United States,1 and recent research has shown that lawyers with high stress are 22 times more likely to contemplate suicide than those with low stress.2 As you’ve seen from last month’s column, the data is alarming. So, how can we prevent it?

Critical to suicide prevention is creating a culture where everyone is smart about mental health.3 There are number of factors that can reduce a person’s risk for suicide, including mental health care, connecting with family, friends, and community, and having effective problem-solving skills.4

One of the biggest challenges in preventing suicide is ensuring that individuals address their mental health in the same way they would for their physical health. One way to encourage individuals to take their mental health seriously is to treat mental health like any other aspect of their health. If you have high cholesterol, you probably have spoken with your primary care provider about ways in which you can lower it. But since high cholesterol has no symptoms, how would you even know that your levels are high? Bloodwork. Your primary care provider orders bloodwork when you have your annual appointment. Now, let’s consider this: over the past three months, you’ve been uncharacteristically irritable, have an increased heart rate, and are feeling fatigued and restless. On top of that, work is demanding, and your stress level is at an all-time high. You may not realize it — you’re a lawyer, this is par for the course, right? But all of these are signs that your mental health is suffering. So, what should you do? The same thing you’d do if you had an issue with your physical health: go see a doctor. A trained mental health provider can help determine the best route of care to treat mental health conditions, just like a medical provider does to help combat high cholesterol. There is no “one size fits all” approach with mental health treatment; the most important thing is to find treatment that works best for the individual.

In addition to addressing your own mental health conditions, if you think someone is thinking about suicide, assume you are the only person who will reach out, and have an honest conversation with them.5 Listen to what they say — but don’t debate the value of life or minimize their problems or give advice — and if they are thinking of suicide, work with them to keep them safely away from any lethal means and stay with them while you call or text 988 for the Suicide & Crisis Lifeline.

Lawyers are prone to mental health issues and have been found to be twice as likely as the general population to experience suicidal ideation, with perceived stress being the number one predictor of suicidality.6 Compared to lawyers with low stress, those with high stress were a remarkable 22 times more likely to experience suicidal thoughts, and lawyers with intermediate levels of stress were 5.5 times more likely.7 But to date, most efforts to reduce stress within the legal profession tend to target the individual (e.g., providing personal stress management tools and self-care resources) rather than the more “structural and systemic precipitators of stress” (e.g., unrealistic time pressures, unclear expectations, workload control, lack of feedback), which most lawyers have found were “highly ineffective.”8

While it’s true that self-care interventions improve mental health, the legal profession needs to find a systemic way to create a more mentally healthy workplace. The workplace can provide an important structure and help foster relationships and a sense of connectedness, offering people a place of purpose and a sense of identity, all of which helps give people a meaning for living.

Research suggests that reducing the incidence and impact of perceived stress among lawyers is a great place to start.9 This requires us — together, as a profession — to reshape the attitudes, norms, and cultures relating to our work. That idea may sound impossible, but even the smallest changes can have a big impact. For example, many lawyers are reluctant to disclose or seek help for a mental health condition, fearing that doing so will negatively impact their career. But if we destigmatize mental health conditions and encourage lawyers to seek mental health treatment, we’ll create a culture of empowerment, rather than a culture of fear. Think about it: you wouldn’t tell a colleague to just “get over it” if they told you they had heart disease, so why do we do that when it comes to anxiety or depression? We need to reshape the way we think and talk about mental health.

Lawyers are notorious for being overcommitted to their work because the profession rewards overcommitment, even though it plays a detrimental role in lawyer mental health and often leads to burnout. Lawyers with high levels of work overcommitment are 2 times more likely to contemplate suicide, while those with intermediate levels of overcommitment were 1.5 times likely to report suicidal thoughts.10 Social

If you are in crisis, please reach out to:

988 SUICIDE & CRISIS LIFELINE

Dial 988

(Press 1 for Veterans, Press 2 for Spanish)

TEXT 988 (English only)

CRISIS TEXT LINE

Text Talk to 741-741 isolation or loneliness is common among lawyers, often related to the demanding, high-stress, and competitive nature of the legal profession. Lonely lawyers are nearly three times more likely to have suicidal thoughts, and those who are highly over-committed to work more than twice as likely.11

We need to be transparent about the notable downsides of being too committed to work and encourage lawyers to set and maintain appropriate boundaries. We need to prioritize collaboration and regular social interactions among lawyers, which in turn will create a sense of relatedness and belonging at work. This kind of transparency has been shown to correlate with overall improved wellbeing, not to mention an increase of productivity.12

Ultimately, we need to go back to the basics — ask colleagues how they are doing; ask about their families, hobbies, and interests; send a note of recognition to a colleague’s family after being in expedited litigation for several weeks; take time to explicitly recognize someone’s work on a brief; treat one another like your most important client.

As I wrote this, I learned of a lawyer who took his life in a neighboring state. We cannot continue to stand idly by and do nothing. The time to act is now. We owe it to each other.

Notes:

1. Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2020.

2. Krill, P.; Anker, J. (2023). Stressed, Lonely, and Overcommitted: Predictors of Lawyer Suicide Risk. Minneapolis, MN., downloaded from https://calawyers. org/california-lawyers-association/lawyers-high-stress-contemplate-suicide/.

3. American Foundation for Suicide Prevention, Talk Saves Lives Presentation

4. Id.

5. Id

6. Krill, P.; Anker, J. (2023). Stressed, Lonely, and Overcommitted: Predictors of Lawyer Suicide Risk. Minneapolis, MN., downloaded from https://calawyers. org/california-lawyers-association/lawyers-high-stress-contemplate-suicide/. 7.

Victoria Sweeney is a Deputy Attorney General at the Delaware Department of Justice. An advocate for mental health awareness, Victoria began volunteering with The American Foundation for Suicide Prevention (AFSP) in 2014, and serves as Board Member for the Delaware Chapter. She can be reached at victoria.sweeney@delaware.gov.