New York State has the third lowest suicide rate in the U.S.

When I was in graduate school getting my MSW in the early 70s our class was divided into groups and we had to pick a social problem area to research, study, and report on to the whole class. My group picked suicide.

In my career I worked for 18 years as a "psychiatric assignment officer" in 3 large urban hospitals doing mental health and substance abuse evaluations and dispositions. I estimate over those 18 years I did over 14,000 suicide evaluations.

Over my 56 year career I have continued to follow the suicide data and recently found the suicide rate for 2022.

The states with the lowest suicide rates are NJ with 7.7/100,000 followed by MA with 8.3, NY with 8.5, ML with 9.5, and CA with 10.4.

The states with the highest suicide rates are MT with 28.7, AL with 27.6, WY with 25.6, NM with 24.7 and ND with 22.5

It is very interesting that suicide rates vary by as much as 3 - 4 times as much in the highest rate states from the lowest rate states. It is interesting that suicide rates are much higher in red states than in blue states.

Why do you suppose the rates vary so significantly from state to state?

Open letter to mental health professional colleagues as they witness the pain of their clients.

A colleague wrote in part : “This has been an ugly week of multiple clients upset with the executive orders. The thing that continues to strike me is how der Trumpenfuhrer embodies the sum of all fears…..I spent two hours on Zoom today with crying people in the midst of the total meltdown of their lives, having lost jobs in the past several months and now worried about the ways in which the executive orders will effect them and the world. It was an ugly day.”

My reply is below:

It seems very important for therapists to support one another in what they are observing and experiencing. Vicarious trauma may be on the rise in our profession when therapists witness and describe days like the one you just had.

Psychopaths like pain. Inflicting pain is the point because it makes them feel powerful. Perhaps one of the most challenging things for therapists to observe and attempt to mitigate is cruelty and sadism.

In recent days not only is cruelty and sadism being perpetrated but it is being normalized with "pardons" that lift external constraints and restrictions and allows those so inclined to behave in further cruel and sadistic ways with impunity.

As I learned working on inpatient psych units and psych ed, what works best with these behaviors is injections of Haldol and four point restraint with a skilled team trained to exert a "show of force". These tactics are used only after de-escalation techniques have failed.

After such interventions staff always met for a brief de-debriefing so that calm could be restored and confidence in maintaining safe order was reinforced.

As therapists we need to find ways to keep each other safe so we can keep our clients safe as best we can.

Remember, cruelty is not a byproduct of what is being perpetrated, but the cruelty is the point to dominate, coerce, and subjugate. It is important for us as MH professionals to confront it head on, lean into it, and mitigate it. Some of us will be harmed in the process, but in the end justice, compassion, dignity, and peace will be achieved.

Keep the faith. Stay strong. Be courageous, Do the right thing. Focus on what matters.

Psychotherapy outcomes for suicidality based on modality type

There is an interesting article published, 07/02/25, in the Clinical Psychology and Psychotherapy Journal reporting on a meta analysis of the effectiveness of individual, group, and family therapy on suicidality.

The topic is of great interest to me because in my career of 56 years as a Psychiatric Social Worker I estimate I have done over 15,000 suicide evaluations, as many as 11 in one day when working as a Psychiatric Assignment Officer in a large urban hospital in Rochester, NY.

Based on my clinical experience and observation I already realized that a combination of modalities is the most effective treatment plan in most cases and in fact that is what the meta analysis found. When individual therapy was combined with group and/or family therapy outcomes were better.

This meta-analysis highlights that combined psychotherapy approaches, integrating individual sessions with group or family sessions, yields significantly higher effect sizes, reducing the risk of suicide attempts by 50%. These findings support the adoption of combined therapeutic strategies in clinical settings to effectively address suicidality. (https://onlinelibrary.wiley.com/doi/10.1002/cpp.70112?af=R, accessed on 07/03/25)

I am currently working with a family where the mother has been hospitalized twice in the last year for suicide attempts. I have used a combination of individual sessions with the four family members as well as combination sessions.

The therapeutic work has taken many twists and turns and what one might expect has turned out to not be accurate and what one might not expect emerged. Murray Bowen describes families where there is a schizophrenic member in which roles can change and the person labeled “schizophrenic” turns out to be one of the healthier members of the family whereas the “healthier appearing” family member starts showing signs of significant psychiatric symptoms.

Dr. Bowen’s teaching led to the appreciation of the system’s view of mental illness and contributed to an understanding of the strategic family therapy phrase, “What is the function of the symptom for the system?”

So what does suicidality in a family member indicate about the family system? Can the family system be ignored as we focus on the symptomatic member alone? If we ignore the social context of our client will we achieve as good an outcome ameliorating the suicidality of the identified patient? Now we have some research that validates practice wisdom which indicates that focusing on the individual’s suicidality alone will not get as good an outcome as taking into account the individual’s interpersonal relationships.

Lastly, and it's a whole other topic, how do we chart and bill for such work and how does compliance with a medical model and its practice hamper and constrain effective therapy?

Should psychological fitness be a standard for holding public office?

People who would be red-flagged for employment at my agency were elected to the two top positions in the American government which makes me question the mental health of the American public as well.

When people with mental illness reach high levels of public office and have concomitant power to make policy and engage in actions which affect millions of people, it would seem that psychological fitness might be a standard to use in the selection process. Police officers in major cities go through more psychological evaluation for their jobs than politicians who make policy to govern the police officers' actions.

Could a standard of psychological fitness be politicized and misused and abused? Yes, there is a huge potential there, and yet if we see psychological standards being increasingly used in other human service professions in criminal justice, ministry, counseling and mental health, education, would it be too much to ask that our political leaders also be subjected to such evaluations?

The argument that voters will decide is not reliable judge of fitness because most voters are naive when it comes to a candidates psychological fitness.

For more click here.

Longer term psychotherapy works according to a study published in JAMA

A study which appeared in the October 1, 2008 issue of the Journal of the American Medical Association which found that long term psychodynamic psychotherapy works. Here is a snippet from the article:

People with complex mental disorders or personality disorders would benefit from long-term psychodynamic psychotherapy that lasts at least a year or longer, according to new research.

Published in the Oct. 1 issue of the Journal of the American Medical Association, the German study found that compared to the more commonly used short-term therapy, long-term psychotherapy left people better off. In fact, the number of therapy sessions the patients had was directly correlated to improvements in symptoms.

"Long-term psychodynamic psychotherapy was significantly superior to shorter forms of psychotherapy applied in the control groups. This was true with regard to overall effectiveness, target problems, and personality functioning," said the study's lead author, Falk Leichsenring, a professor of psychotherapy research in the department of psychosomatic medicine and psychotherapy at the University of Giessen in Germany.

"With regard to overall effectiveness, on average, patients with complex mental disorders were better off after treatment with long-term psychodynamic psychotherapy than 96 percent of the patients in the comparison groups. Thus, this meta-analysis provides evidence that long-term psychodynamic psychotherapy is an effective treatment for complex mental disorders," said Leichsenring.

"This study provides a great value for doctors and for patients, and one would hope could have an influence on policy decisions," added Dr. Charles Goodstein, a clinical professor of psychiatry at the New York University School of Medicine and Langone Medical Center in New York City.

Symbolic threat leads to faulty generalizations out of touch with reality

Across six studies, we found that people commonly exaggerate the presence of certain groups – including ethnic and sexual minorities – simply because they are perceived as ideologically threatening. Psychologists call this feeling – that groups hold different values and worldviews from the mainstream, thereby jeopardizing the status quo – “symbolic threat.”

From an article on The Conversation on 06/09/2022 entitled "People overestimate groups they find threatening- when "sizing up others," bias creeps in.

"They're eating the cats! They're eating the dogs!" Donald Trump in presidential debate with Kamala Harris in 2024.

How crazy are your beliefs? Are you aware of them? Can you manage them realistically? Being self aware is one of the first skills of spiritual intelligence. Socrates said an unexamined life is not worth living, and the humorist said an unlived life is not worth examining.

AI psychosis can lead to suicide

The parents of a teenager who died by suicide have filed a wrongful death suit against ChatGPT owner OpenAI, saying the chatbot discussed ways he could end his life after he expressed suicidal thoughts. The lawsuit comes amid reports of people developing distorted thoughts after interacting with AI chatbots, a phenomenon dubbed “AI psychosis.” John Yang speaks with Dr. Joseph Pierre to learn more.

For more click here.