Old People Died Of Covid, Young People Are Dying By Suicide – Could Connecting Them Help?

Twice as many young people in the US died of suicide than of Covid. Three-quarters of Covid deaths struck people over 65. But suicide has become the leading cause of death for young people in over 100 countries – including India, says Dr. Vikram Patel, the Professor of Global Health at Harvard who curated a Deep Dive on Mental Health for Harvard’s Advanced Leadership Program this week. While this may hide the good news that youngsters are no longer dying of a host of other illnesses that used to carry them off early, the hard truth is that the world is now watching its youth self-destruct. The Covid crisis aggravated a pre-existing problem. The question is why? And what can be done about it? Can we harness the old to heal the young? Some are trying.

Of the 800,000 deaths by suicide in the world each year, the vast majority involve people in what we usually refer to as the prime of life – from 15 to 50. Although the prevalence of suicide is highest in the over-70s, the bulk in absolute numbers bulges in the first half of life. Mental health issues mostly appear before the age of 20, so are often lost in the maelstrom of incomprehensible adolescent behaviour. In the US, it’s the second cause of death for people between 10 and 34. Twice the number of people in America die from their own hand rather than someone else’s – suicides are double the homicide rate. This is not just a matter of America’s love of deadly guns. It is true globally. Suicide is much more common than homicide in all countries of the world – sometimes as much as ten or twenty times higher. South Korea tops the charts, whereas Greek minds seem as sunny as their climate.

The past 20 years has seen huge progress on issues surrounding and understanding mental health, says Dr. Thomas Insel, who was on the front lines as Director of the National Institute of Mental Health (NIMH) from 2002 to 2015. But mostly on awareness and on treatment. Billions have been spent studying the staggering complexity of our brains with imaging methods and novel molecular therapies. International organisations, from the World Health Organisation and the OECD to the World Economic Forum and the National Institutes of Science have prioritised mental health. But as Tom Insel compellingly writes in his book Healing: From Mental Illness to Mental Health, the results of our growing understanding are not being effectively implemented. “If current treatments are so good,” asks Insel, “why are outcomes generally so bad?” Even in high-income countries which have liberally thrown billions at the problem.

And yet. “Many of the most refractory social issues of the decade – homelessness, incarceration, poverty – could be tracked in part to our nation’s failure to care for people with mental illness.” He shared a horrifying graph of what he calls ‘trans-institutionalisation’ – the shift from people in mental institutions to jail from 1965 to 2016. Two mirror curves showing the drop in hospital beds for mental health patients and the exactly corresponding rise in incarceration, with the cross over point in the early 1980s. A tragic and incomprehensible criminalisation of illness.

The cost of mental health conditions (and related consequences) is projected to rise to $6 trillion globally by 2030, from $2.5 trillion in 2010 warns the World Economic Forum. One in every two people will suffer from mental health in their lifetimes, says the OECD, but the majority won’t find the support they need. This is unnecessary, debilitating and costly. While some may point to the looming crises that face the human race (climate change, inequality, democracy under threat or the rise of robots) as reason enough for any thinking person to be depressed, Insel and Patel insist there are solutions to our mental distress. Most people can recover from mental health challenges and live purposeful, contributory lives. But for prevention and recovery, they need three things:

• People – overcoming a crisis of connection with human relationships, which Insel describes as “support, attachment or love … a power that has not been studied sufficiently.”
• Place – a safe place to live, without which people are incapable of recovery.
• Purpose – because as Nietzsche wrote “he who has a why to live can bear with almost any how.”

Dr. Patel shared how simple and affordable practices can have a major impact. Given that many older people report suffering from loneliness and lack of purpose, and many younger people are suffering from a lack of connection and support, why not put them together? This is what Dr. Dixon Chibanda has done with a program called Freedom Bench which started in Zimbabwe training grandmothers in basic mental health interventions and then built benches near schools and daycare centres where they could sit quietly with young people in need of a friendly ear. They became skilled supporters to the young. It seems an obvious connection. One that was effective in human history over centuries but that has been lost as inter-generational families fell by the wayside and the generations siloed off into separate – but seemingly depressing – spaces.

In India, Dr. Patel built on this approach with Empower.care, a scalable, tech-enabled program to train non-specialists to provide mental health support. The program’s success has led to it being imported into the US, a rare example of South to North solutions transfers. The idea is that almost anyone can become skilled at detecting and supporting a friend, colleague or family member facing a mental health challenge. A simple app, called the mhGAP, has also been developed by the WHO to train non-specialists. Our ALI class have decided we will train in basic mental health as a group.

It’s time to recognise that there is no useful distinction between mental and physical health. They are flip sides of the same human. But we’ve spent most of our lives and our science focusing on our bodies. Now, as the human race faces some depressingly difficult civilisational challenges, it’s time to muscle up our minds.