From the September Issue issue of National Underwriter Life & Health Magazine • Subscribe!

Ending it all: Can life insurers help stop suicide?

What can the life insurance industry do to help prevent suicide? More than you might think.

Photos by Jeff Clark Photography Photos by Jeff Clark Photography

One night about a year ago, I was hanging out on Facebook when I got a frantic instant message from a good friend of mine, Jake. (Not his real name.) A long-time female friend of his, Lisa (not her real name, either), was on the phone with him and she was threatening to commit suicide. Alarmed, Jake pinged me and asked what he should do. He knew that in January of 2009, I lost my brother Tom to suicide, and that I had spent an entire year in grief counseling to better cope with the loss. Jake and I spoke often about it, so I was Jake’s go-to when Lisa was in crisis.

Once I determined that Lisa had not yet actually hurt herself, I had to get Jake to calm down to the point where he could accept my instructions. He did so pretty quickly; Jake’s a smart guy with a good head on his shoulders. I told him to keep Lisa on the phone and to continue talking to her while I got on my phone and called the National Suicide Lifeline at 1 (800) 273-8255. As soon as I had an operator on the line, I identified myself and informed her I was not in crisis. I was calling on behalf of a friend who had a problem, and I made sure to explain that I really did have a friend with a problem; I was not merely using that old saw of talking about myself through an imaginary straw man.

I explained to the Lifeline operator, whose name I forget (but let’s call her Brenda) what Lisa was telling Jake and asked for advice on what to tell Jake to tell Lisa. The whole thing was a weird social media and mobile telephone daisy chain in which Lisa, in crisis, was getting help from the Lifeline through two different intermediaries without even knowing it. Together, we determined what signs of imminent suicide Lisa was exhibiting. She was basically ideating her own death and expressing feelings of hopelessness, and we got her to verbally commit to not hurt herself that evening and to agree to get some counseling.

Meanwhile, I helped Jake track down Lisa’s actual location. He knew she once lived in the same city he did, but as with so many friendships in the Facebook era, their relationship had largely become a virtual one, and Jake did not know Lisa’s current ground address. That’s the downside of life on the Internet; the typical points of contact you take for granted with people are not always there. The upside of the Internet is that it is populated by about a billion amateur detectives, and so Jake’s own friends who also knew Lisa soon were on the case, and within minutes were able to provide him with her location. Jake contacted the local emergency services, who stopped by to make sure Lisa was alright. Lisa was angry and embarrassed that other people knew she had been in crisis, but Jake’s take on it, as well as mine, was that this was somebody’s life at stake. Mental health is nothing to be embarrassed about, but I would rather embarrass somebody than let them slip through the cracks. You can always apologize for needlessly calling 911 on a friend in need. It sure beats spending the rest of your life wondering what more you could have done.

Eventually, Jake let me go; he was staying on the line with Lisa, but he was confident things had calmed down, and things would be under control. Indeed, they were. Lisa agreed to go into counseling, and she has not been in crisis since. As for me, Brenda at the Lifeline said I probably saved Lisa’s life. I don’t know about that. Jake did all the heavy lifting, not me. What I do know is that when I lost my brother, there had been warning signs a-plenty that he was heading toward suicide, signs that only became clear to me after the fact, when it was too late. I just don’t want to be too late ever again.

 

By the numbers

Up-to-date suicide figures can be tricky to come by since they are often compiled differently by different local county, state and national agencies, and more importantly, national results are, like insurance industry figures, at least a full year behind, if not more. Perhaps some of the most reliable numbers come from the John L. McIntosh, Ph.D, a leading suicidologist, whose statistics are published by the American Association of Suicidology (AAS). According to McIntosh, 36,909 Americans took their own lives in 2009. Of them, 29,089 were men; just 7,820 were women - underscoring the longstanding fact that men are at least three times more likely to commit suicide then women.

Now, nearly 37,000 people seems like a lot and a little at the same time. Compared to the nearly 600,000 people who died in the U.S. in 2009 from heart disease, suicide is not exactly a huge toll. But compared to the 15,241 homicides and non-negligent manslaughters that same year, suicide becomes quite a large problem indeed. Even larger still when considering that suicidologists estimate that for every successful suicide attempt (i.e., one resulting in death), there are some 25 unsuccessful ones; in 2009, there were an estimated 922,725 attempts. What’s more, the average suicide event is estimated to impact six people. The AAS projects that the total U.S. suicide toll of 787,681 from 1985 through 2009 has resulted in some 4.73 million suicide survivors (those who lose one to suicide, not those who try to commit suicide and fail). Put another way, one out of every 65 Americans is estimated to be a suicide survivor.

The 2009 figures are interesting because they are the first ones that reflect a concern among suicidologists that the severe financial strain the Great Recession put on many people may have contributed to an increase in suicide itself. Joblessness, especially prolonged joblessness, is a common contributing factor to suicide. And even though the AAS notes that there is no clear correlation to periods of economic recession and rising suicide rates, it did mention in a press release issued during the early days of the current economic crisis, entitled “The Economy and Suicide,” it noted that that suicide rates did peak in 1933, one year after the U.S. hit its highest rate of unemployment during the Great Depression, at 25%.

See also: Do economic conditions create suicide hotspots?

“There is a clear and direct relationship between rates of unemployment and suicide...At the individual level, unemployed individuals have between two and four times the suicide rate of those employed,” the AAS writes. It adds that “economic strain and personal financial crises” are common precipitating events to deaths by suicide, especially in those whose coping mechanisms are compromised by mental disorders, drug or alcohol use, psychiatric symptoms or other risk factors.

Not long after the Great Recession got under way, several deaths among high-profile business figures underscored the correlation between suicide risk and financial stress. Two days before Christmas 2008, French aristocrat and investor money manager Rene-Thierry Magon de la Villehuchet struggled with deep feelings of guilt and responsibility after losing his entire savings as well as more than $1 billion of his clients’ money to the $50 billion Ponzi scheme perpetrated by fraudster Bernard Madoff. After writing to his brother Bertrand that he had to accept responsibility for the losses, de la Villehuchet locked himself in his Manhattan office, swallowed a dose of sleeping pills and slashed his wrist with a box cutter. He was found by police the following morning.

Barely two weeks later, 52-year-old Steven L. Good, CEO of Sheldon Good & Co., one of the nation’s largest real estate auction firms, was found dead in his Jaguar from what authorities believed to be a self-inflicted gunshot wound. A month earlier, Good had described in an industry outlook news release that the rapidly deteriorating market conditions had become “very challenging.”

A third prominent business suicide that same month was 74-year-old German billionaire Adolph Merkle. In 2008, Merkle was worth some $9.2 billion through a business empire based on generic pharmaceuticals manufacturing, pharma wholesaling and cement making. But he lost hundreds of millions of dollars on bad investments in Volkswagen stock, and as the Great Recession got underway, credit shortages threatened to break up his business empire. Distraught, he stepped in front of a train.

But it isn’t just tycoons who are suffering. College grads with huge loans and no job prospects are increasingly at risk, as are those in the middle and lower classes who have lost their job and have been unable to replace it. Compare the cities with the highest suicide rates in the country with those that have suffered the worst economically in recent years as identified by Brookings’ 2010 report, “The Great Recession and Poverty in Metropolitan America,” and a short list of potentially economy-driven suicide hot spots emerges.

The data does not match perfectly, as the latest nationwide survey of suicide statistics by city comes from the Big Cities Health Inventory, last published by the National Association of County and City Health Officials in 2007. It only tracks data to 2004, well before the economic crisis hit. But even then, some cities clearly stand out as having suicide rates well above the national average of 12.0 per 100,000 people, and in some cases, having shown substantial increases in those rates since 1990:

• Las Vegas, NV (34.5; +20.7%)

• Colorado Springs, CO (26.1; +40.9%)

• Tucson, AZ (25.0; +21.2%)

• Sacramento, CA (22.7; -10.6)

• Albuquerque, NM (21.0; -0.1%)

• Miami, FL (17.1; -21.3%)

• Denver, CO (16.2; -35.5%)

• Jacksonville, FL (15.6; -6.3%)

• Pittsburgh, PA (15.2; +3.1%)

• Wichita, KS (15.2; +1.7%)

• Portland, OR (15.1; -12.9%)

• Tulsa, OK (14.5; +50.1%)

Again, there are imperfections here. Mesa, AZ has a suicide rate of 19.6, which has grown 31.2% since 1990, but it was excluded from this comparison because it was not included in the Brookings poverty study. Likewise, Las Vegas, NV, though ravaged by the economic downturn, has long had unusually high suicide rates; for starters, many of its people are transplants from elsewhere who may not have a close support structure to lean on in times of emotional or psychological distress.

The correlation holds up under anecdotal evidence as well. A call to the American Foundation for Suicide Prevention revealed that suicide prevention hotline calls have risen by some 50% since the beginning of the Great Recession. Likewise, county mental health officials serving Las Vegas, Colorado Springs and Portland all admitted that they had either seen upticks in suicide activity since the end of 2008, or suggested that it was possible, given the increase across the board for people’s financial stress. But the affect of the recession is not just limited to a few cities. A cold call to the Monmouth County Department of Human Services for Monmouth County, NJ revealed that even there, there was a noticeable increase in suicides since the end of 2008. “We had one precisely because of financial reasons,” said a representative before stopping short, unwilling to offer any further information.

A survey of the recession’s impact in Europe is simpler, but just as compelling. According to the Lancet’s article, “Effects of the 2008 recession on health: a first look at European data,” suicide rates in European Union countries had steadily declined before the 2008, but afterwards instantly reversed, rising as much as 7 % in some EU states. Generally speaking, any rise in unemployment greater than 3 % was also met with a corresponding rise in rate of suicide.

Aside from the clear mental health implications this level of suicide activity presents, there are also life insurance implications, especially among those who commit suicide because of a sudden reversal of financial fortunes. Those who are insured are most likely to receive a full payout on their policies, since typical life insurance policy wording includes a two-year contestability period during which self-inflicted mortality or mortality caused by factors knowingly hidden or obfuscated would give the carrier cause to contest payment. For many cases of middle-class financial suicide since 2008, the life insurance was already in place well before the financial turmoil that contributed to acts of suicide. What this means is that contrary to the commonly held notion that suicide always voids a life insurance policy, a good portion of the 30,000 or so suicides occurring each year in this country are also triggering a life payout.

Given the many billions of dollars the life industry otherwise pays out on all life claims, the costs incurred by suicide very well may not be of a magnitude that merits some kind of claims management in terms of reaching out to policyholders with suicide awareness materials or by making available access to counseling services if they are needed.

That is unfortunate, because the life industry is in a unique position to raise suicide awareness dramatically if it so chose.

USAA Steps Up

Calls to suicide prevention organizations in every city on the above mentioned “hot list” revealed that none of them had ever received any formal support from life insurance companies. The Insurance Industry Charitable Foundation, a group that coordinates the philanthropic efforts of life/health and property/casualty insurers confirmed that they neither supported suicide prevention efforts, nor were they aware of any member companies that did.

Calls to the American Council of Life Insurers likewise turned up nothing either on its own or among its members. Calls to a dozen other major life insurers also turned up nothing, which seems like a lost opportunity, since National Suicide Prevention Week (which this year runs from 9/7 to 9/15) dovetails with Life Insurance Awareness Month.

It would seem that not a single life insurer has in place any kind of suicide outreach program or even lends their support to raising suicide awareness. Except for one: USAA. USAA is an unusual company in that its focus is on its military members, and in many ways, as Joe Annotti, president of the American Fraternals Alliance notes, USAA behaves like the world’s largest for-profit fraternal society. It is the kind of life insurer that actually steps up how much life insurance it sells to soldiers as they are going off to war, because it knows the troops will probably need it.

USAA is the sole sponsor of the USAA Educational Foundation, a separate, but allied, organization that provides a wide variety of educational materials to USAA members and the general public. Each year, they keep in print more than 70 different booklets on topics ranging from cybersecurity to distracted driving to living a greener life, to financial planning. In 2010, as it was becoming clear that the U.S. military was suffering a suicide crisis of its own, USAA decided to print a booklet on suicide awareness.

To understand the depth of the suicide problem in the military right now, know that U.S. service members are committing suicide at an average rate of more than one a day, outpacing battlefield deaths. The situation is so bad that the Army recently approved a $3 million research grant to develop a nasal spray that would deliver a dose of thyrotropin-releasing hormone that will reduce suicidal urges. Previously, such hormones could only be administered by spinal tap, but the Army hopes that a simple nasal spray could be issued and that it could help prevent additional deaths.

Steve Finley, executive director of the The USAA Educational Foundation, says the military has been unable to pinpoint why it has such a large problem. Financial hardship definitely plays a role, he says, and soldiers are hardly immune from that. (Which is one reason why the Foundation also offers a 50-minute financial briefing to ROTC cadets and active duty called Basic Financial Management, which teaches basic financial responsibility, to stave off money problems before they start.) Relationship problems are also a contributing factor, especially for those stationed far from home.

The USAA Educational Foundation’s booklet, Suicide Prevention, describes common suicide risk factors, behaviors that tend to precede suicide, how to help someone in crisis, important steps for servicemembers and veterans, and what to expect when grieving a suicide loss. The piece is updated once a year, and is currently undergoing its 2012 update. It is also available to the public online.

Since October 2010, 118,000 copies of Suicide Prevention have been distributed through police departments, fire departments, veterans support groups and other groups allied with The USAA Educational Foundation. Finley has received numerous thanks from groups disseminating the literature, and reports that so far, it has been very well received. Finley does not have an exact cost for development, but says that it was not much, considering how many other print products the Foundation develops. “It’s just a piece of what we do,” he says.

An Epic Loss

Few people in the insurance world understand the impact of suicide better than Michael McRaith, director of the Federal Insurance Office. In 1996, McRaith lost his partner, Eric, to suicide. Eric lost his job that Spring for being gay. “Looking back, he had probably symptoms preceding his firing that were bipolar. And when he lost his job, those events cascaded into more frequent and more volatile episodes that I couldn’t, at that point in my life, comprehend or understand,” McRaith explains.

That July, McRaith left for Colorado to run a race there. He originally meant to bring Eric along, but at that time, decided they needed some time apart. When McRaith came home, he had a phone call with Eric. It wasn’t an argument, but it was a conversation in which Eric was saying things to McRaith that McRaith had difficulty comprehending. “Unfortunately, I was the last person to speak with him, “McRaith recalls. “He was found a day and a half later.” Eric had hanged himself in his apartment.

As a survivor of suicide, McRaith first spent a year recovering himself. People often underestimate just how much work it takes to cope with the rawness of suicide. It is the kind of suffering for which time does not heal all wounds. The pain does not subside or recede; one learns to live with it and build around it.

Afterwards, McRaith joined the Chicago chapter of the American Foundation for Suicide Prevention and became an outspoken advocate for suicide awareness and prevention, eventually joining the AFSP’s Chicago board of directors. He helped organize the first National Survivors of Suicide Awareness Day in Chicago, an annual AFSP event held the Saturday before Thanksgiving to connect members of the suicide survivor community by satellite to show that one does not need to recover from suicide alone. “There is always this fear that we’re the only ones who can ever understand or suffer through this trauma,” McRaith says. “The value of awareness day is to show there is a community of people who have experiences similar epic, tragic loss, and who are working every day to recover from that loss.”

 

In 2001, he participated in the AFSP’s first Out of the Darkness suicide awareness walk in Washington, D.C., which was hosted by the AFSP. Today, Out of the Darkness walks are held in cities across the country, and have become a major national suicide awareness effort. As for McRaith, he remains active with the AFSP and engaged with the Chicago chapter.

 

A problem with raising awareness about suicide in particular and mental health in general, is that people simply to not wish to talk about it. Although mental health and suicide are limited to no demographic, stigmas about them persist. “Our first challenge as a country is removing the stigma that is often stuck on someone who identifies himself or herself as having a mental health issue,” McRaith says, noting that public policy conversations about mental health parity in coverage and access to mental health services are critically important. “We need as a community to acknowledge this and talk about it without creating a culture of shame.”

The next step, he says, is simply making more people aware of the scope of the problem and for people to listen to their friends, family and colleagues more closely so they might attune themselves to the signals that someone might be in need of professional help. That is where suicide education comes in. The AFSP has chapters across the country, and every community has some kind of volunteer opportunity for people who are interested in mental health issues or suicide prevention.

“Every employer should consider awareness programs, sensitivity and education for their employees to help them better understand what their colleagues might be experiencing,” McRaith says. “There are a variety of organizations that would benefit from the constructive participation of all aspects of our country’s biz comm. That’s not limited to financial services. Being open to the subject of mental health and supporting organizations that are directly involved in providing mental health services or suicide prevention programs provides businesses across the country with an opportunity to get involved in their local communities.”

For individuals or organizations interested in getting involved, but have concerns about being attached to such a sensitive topic, McRaith dismisses any possible downsides as fiction. “Every family, every community is affected by suicide to one degree or another, and in acknowledging it and supporting education, awareness efforts and suicide survivor programs, we are providing support for people in their most vulnerable moments. That is an indelible imprint an organization or a business leave on a community’s well-being.”

To underscore McRaith’s point, the city of San Francisco recently honored Bernard Mayes, the founder of San Francisco Suicide Prevention, which Mayes founded 50 years ago on his own, without any training. He simply placed cardboard ads on city buses with a hotline for desperate people to call, and he went home to wait by his phone. All he did was listen to what people had to say. Today, the SFSP handles 200 calls a day at (415) 781-0500, with 10 paid staff and 100 volunteers. The service has been repeated in 500 cities across the country, in every state. As for San Francisco, its suicide rate has dropped by 50% since Mayes first started taking phone calls. It doesn’t take much to make a big impact; the SFSP has proven that. Large national organizations like the American Foundation for Suicide Prevention and businesses such as USAA have led from the front against a problem that can never be truly eradicated. And as laudable as their efforts are, what is needed most is something else. The real difference may very well be made by the local efforts, the grass roots movements, the individuals. When it comes to saving a life from suicide, sometimes all it takes is just a single person and a willingness to get involved.

Need help? In the U.S., call 1-800-273-8255, the National Suicide Prevention Lifeline. 

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