Suicide rates have exploded in the Fox Valley. A new report offers new insights and policy recommendations.
Sixty-six percent.
That's how much the suicide rate increased in the Fox Valley between 2010 and 2018, especially for middle-aged men; people in professional industries like farming, construction and law enforcement; veterans; and members of the LGBTQ community.
But why have Outagamie, Winnebago and Calumet counties lost so many more to suicide in less than a decade?
To answer this question, Northeast Wisconsin (NEW) Mental Health Connection created a suicide prevention initiative called Project Zero in January 2020. Its mission is two-fold: prevent adult suicides across the Fox Valley and beyond, and address systemic issues that generate these conditions in the first place.
Three years following its launch, community stakeholders are closer to understanding the reasons behind this bleak increase. The report, "Mental Health & Suicide Prevention Recommendations," which published in May, highlighted health equity gaps across three counties — Winnebago, Outagamie and Calumet — and brought forth recommendations that place the obligation of change on the system rather than the individual. The Institutional Review Board at the Medical College of Wisconsin approved the survey and its associated analyses.
"We want to target organizations, communities and public policy with these recommendations," said Sarah Bassing-Sutton, a suicide prevention coordinator with NEW Mental Health Connection. "That is where the big improvement in people's mental health is going to occur when we start addressing some of these systemic issues."
Financial strain creates a ripple effect in health outcomes
Financial strain dominates poor health outcomes in early adulthood, with bill-paying hardships hitting people harder than either food hardships or health resource hardships. Of these three hardships, an inability to pay bills has the most debilitating effect on someone's depression and suicidal thoughts, according to the survey.
But it goes much deeper than that.
Bassing-Sutton described a cascading effect when a household can't make ends meet: It throws off sleep, which further elevates anxiety, depression, suicidal thoughts and the risk of suicide attempts, and the likelihood of experiencing chronic pain. These results illustrate a vicious cycle, where financial stress and social isolation interfere with sleep, and lack of sleep interferes with job performance and a sense of belonging.
A significant percentage of tri-county households make less than $50,000 annually: 43.5% in Winnebago, 38.7% in Outagamie and 32.8% in Calumet.
Nearly half of people with annual household incomes of $50,000 or less report having a higher prevalence of depression and anxiety, at 44% and 64% respectively. Of the people of color surveyed, 70% report household incomes of less than $50,000, and LGBTQ+ people surveyed were close behind at 67%. By comparison, 43% of white people surveyed made less than $50,000 in household incomes; 29% of non-LGBTQ people surveyed made less than $50,000.
Unsurprisingly, the same groups who tend to make less than $50,000 annually are the likeliest people to not get a good night's sleep.
Moreover, a living wage for a single adult with no dependents in Wisconsin is considered $16.40, according to data from MIT, while the minimum wage is less than half the living wage, at $7.25.
"That's a pretty huge discrepancy," Bassing-Sutton said. "And that's going to take some really big changes on a policy level to resolve."
Marginalized communities are twice as likely to experience social isolation
Social isolation, according to the U.S. Centers for Disease Control and Prevention, exacerbates most physical and mental health conditions, which can lead to the risk of premature death. It's one reason people of color and LGBTQ people living in the Fox Valley experience much higher rates of suicide attempts and self-harm: They are more than twice as likely to be socially isolated than non-LGBTQ white people.
LGBTQ people especially suffer from a lack of social belonging in the Fox Valley, both within their families and in the greater community. LGBTQ people and people of color in the tri-county regularly endure various levels of discrimination, whether in the form of quiet comments, audible slurs or overt acts of violence, all of which worsens anxiety, depression and chronic pain as it also increases the risk of suicide.
People of color surveyed reported being more than three times likelier to attempt suicide than white people surveyed, while LGBTQ people surveyed said they were a whopping 11 times likelier to report one or more attempts at suicide in a single year than non-LGBTQ people.
Additionally, three times as many LGBTQ people surveyed said they engaged in non-suicidal self-harm than non-LGBTQ people.
"Marginalization has its roots in bias, stereotypes, and ignorance," the survey reads. "In order for social connection to be experienced by all, it will require a shift in mental models and open mindedness to achieve deeper understanding and unconditional positive regard for all human beings."
Lengthy waitlists mean people are less likely to seek mental health care
Across the nation, waitlists to see a mental health specialist have exploded, one of the many fallouts of the pandemic. On the professional end, this has led to higher patient-to-therapist ratios, burnout and turnover. The unfortunate upshot to this is that patients are experiencing longer waitlists to see a specialist, if they know where to go at all.
Major health care clinics in the Fox Valley reported patients waiting anywhere from two to eight months to see a mental health professional, with some 1,500 people languishing in the queue. One local walk-in mental health care facility has seen a 220% increase in use over the last two years, according to the report.
This is not a unique situation, Bassing-Sutton said, but these conditions have larger implications.
More than 30% of respondents said they would seek mental health treatment if only they knew where to go. And 75% of those surveyed said they weren't sure whether the Fox Valley had adequate resources for mental health.
Faith in the Fox Valley's mental health care sector has plummeted.
That's because waitlists and a lack of resource knowledge, in addition to stigma, medical bills and historic distrust of the health care system, have discouraged people from seeking out professional mental health care. All told, 58% of respondents said they would not seek mental health from a medical provider while 70% said they would rather look to family and friends for support.
"Folks don't really have a choice but to rely on family and friends for those supports," Bassing-Sutton said. "Going to a health care provider for a mental health issue then triggers insurance and then triggers a code and then triggers a billing. Some folks really would prefer to try to handle it another way."
To better capture everyone in the community, future surveys must be reframed
The Connection has acknowledged limitations to its premiere survey. Multiple conversations with Multicultural Coalition and Diverse & Resilient underscored the reality that The Connection and the Medical College of Wisconsin based survey questions on clinical definitions from the Diagnostic Statistical Manual or DSM — and don't adequately capture non-white or LGBTQ experiences.
Data collection often fails marginalized communities because it relies on a white-centric, non-LGBTQ lens, Bassing-Sutton said, which the report acknowledged.
It isn't out of the ordinary, Bassing-Sutton explained, for many people of color and LGBTQ people to experience the world through elevated levels of stress, depression and suicidal ideation — their baseline for tolerating stress may look completely different.
"(Struggling) is not out of the norm. It is the norm. So, how do we ask a question that really helps to identify what anxiety symptoms look like for community members who maybe are already living in a heightened state of alertness?"
Bassing-Sutton said the organizations aren't sure what the next survey will look like, but they're working on revisiting each survey question for version 2.0 to better serve the community.
Next steps: Listening sessions for legislators
Concrete, accurate data in future surveys that reflect everyone in the community, Bassing-Sutton said, is an important step in The Connection's ultimate goal of bringing these concerns to Wisconsin legislation, community leaders and organizations.
The next step is to arrange a legislative listening session that addresses increasing the minimum wage, expediting the time it takes to process licensures to practice mental health care and supporting existing social emotional learning policies, among other critical policies.
Organizations can add employee wellness that includes family support, fitness opportunities and limits on overtime and mandatory on-call shifts. Mental health organizations can offer services outside normal business hours, as data from the 988 Wisconsin Lifeline reveal that 51% of calls happen between the hours of 5 p.m. and 8 a.m.
"If we focus these recommendations on those who are most impacted, it's going to help everybody," Bassing-Sutton said.
MORE: Green Bay School Board could vote on school closures plan Monday. Critics demand board votes no.
MORE: As mental health needs surge in rural areas, bipartisan bill would expand services
Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.
This article originally appeared on Green Bay Press-Gazette: Suicide rates have exploded in the Fox Valley. A new report explores why.
