Lawyers are at special risk for suicide

Tracy Franklin Squires

Assistant Criminal District Attorney in Bexar County

Albert was a detail-oriented perfectionist.1 He always had been, and that’s why he was so successful in law school. When I first met him—I’m going to be honest—he struck me as overly anxious. He was a law student interning at the District Attorney’s Office during his last semester. He planned to stay on through the bar exam and await the results, hoping to land a job as a prosecutor once he passed the bar. He asked more questions than anyone I’d ever heard, and he did not seem terribly satisfied with the answers—he remained anxious. He was a friendly guy, though, and he was married and had a toddler.
    Al had started drinking quite a bit in law school to control the stress. It was easy to get into that habit because the law school hosted happy hours every Friday in the courtyard with six kegs of beer. That was just a warm-up for the 1Ls, who went out to the bars afterward. By his third year of law school, Al and most of his class had graduated to drinking at home alone every night.
    Al passed the bar and was hired on at the DA’s office. A few years in, he was a very successful trial attorney. He had actually never lost a trial and was on a 7-of-7 winning streak. But Al had a very tough caseload (he worked on child pornography cases) and viewed those images day in and day out for four years. Such a caseload left him with uncontrollable feelings of helplessness, rage, and guilt. Al began to see himself as the only person who could help these children, yet he felt guilty about the numbness he had eventually developed toward the images. He had to prioritize the cases somehow, and he loathed himself for seeing some victims’ horrific circumstances as “not that bad.” His perfectionism gave him an over-developed sense of control, so when cases didn’t go as planned (e.g., he didn’t get the sentence he wanted), he blamed himself and considered himself a failure.
    Al stopped hanging out with colleagues outside of work, was having at least six drinks a night, and stayed up late playing video games. He was willing to sacrifice sleep and healthy habits to meet the unrealistic expectation of never losing a case, but it came at a great cost. He was also taking medication for anxiety and depression and had become addicted to Xanax, but we didn’t find that out until later.
    At one point, Albert was preparing for a big jury trial, and as it was looming, he suffered from feelings of inadequacy, fatigue, and muscle tension; he had difficulty concentrating and sleeping; and he was plagued with worry and a sense of impending danger. Then his wife had a miscarriage, which he took very hard.
    The big trial was set for a Monday morning, but Al was not at the office early that day to prepare, as he would’ve normally been, nor was he in court when trial was ready to start. Our office got the call around 10:00 a.m. from Al’s mother-in-law that he had died by suicide the day before. He was only 27 years old.
    The next day, the DA’s office provided counselors for two one-hour group sessions. In these sessions, we could express our emotions over losing Al and ask questions about mental health and suicide. It was a great resource provided to the other staff and attorneys in a time of great need. We learned that the warning signs we saw in Albert were real and that we might have been able to help him (if he would have accepted it).
    The purpose of this article is to educate prosecutor office staff—especially attorneys, who have a higher risk of suicide than non-lawyers—on the risk factors and warning signs of mental illness, as well as what professional help is available to those with alcohol or substance-abuse problems. I first became involved in mental health and suicide prevention awareness in 2009, when my family lost my brother, Donald William Elster III, to suicide. He was not a lawyer, but I am, and I use the information I now have about these topics to educate other attorneys so that they can look for warning signs and risk factors in their colleagues, family, friends, and clients. I have been on the Board of the Texas Lawyers Assistance Program (TLAP) since 2016. I also represent TLAP on the Board of the Texas Suicide Prevention Council (TSPC). TSPC is the result of a collaborative effort throughout the state of Texas of community-based organizations, state and local agencies, academic institutions, and many others who work together to reduce suicides in Texas.
    Read on to find out how to help someone in need, even if that someone is you.

What the numbers say
Statistics show that suicide is the 10th leading cause of death, and that each year, 44,965 Americans die by suicide. White men accounted for seven of 10 suicides in 2016. The rate of suicide is highest in middle age and for white men in particular. Also, firearms accounted for 51 percent of all suicides in 2016.2
    New, attorney-specific research released by the American Bar Association Commission on Lawyer Assistance Programs and the Hazelden Betty Ford Foundation3 found that the most common mental health conditions reported were anxiety (61.1 percent), followed by depression (45.7 percent), social anxiety (16.1 percent), attention deficit hyperactivity disorder (8.0 percent), and bipolar disorder (2.4 percent). Also, 11.5 percent of participants reported suicidal thoughts at some point during their career, 2.9 percent reported self-injurious behaviors, and 0.7 percent reported at least one prior suicide attempt. Another alarming statistic from the study is that 20.6 percent of attorney participants scored at a level consistent with problematic drinking (defined as hazardous, harmful, or otherwise consistent with alcohol-use disorders). This is a much higher rate than other professions. The study finds “the significantly higher prevalence of problematic alcohol use among attorneys to be compelling and suggestive of the need for tailored, profession-informed services,” including a need for “specialized treatment services and profession-specific guidelines for recovery management.”4
    In addition to these statistics, lawyers are three times more likely than any other professional to suffer from depression,5 they are at least twice as likely as the average person to die by suicide,6 and the third-leading cause of death among attorneys is suicide, after only cancer and heart disease.7 Disturbingly, there is a six-fold increase in suicide rates for those who suffer from alcohol- and substance-use disorders.8

There is help
Please know that there is help for people who need it. Currently, approximately half of all assistance provided by the Texas Lawyers Assistance Program (TLAP) is directed toward attorneys suffering from anxiety, depression, or burnout. TLAP’s staff consists of experienced attorneys who can be trusted: Their confidentiality is established under Chapter 467 of the Texas Health and Safety Code. The statutes ensure all communications by any person with the program (including staff, volunteers, and committee members) and all records received or maintained by the program are strictly protected from disclosure. TLAP does not report lawyers for discipline. Furthermore, Texas Health & Safety Code §467.005(b) states that “a person who is required by law to report an impaired professional to a licensing or disciplinary authority satisfies that requirement if the person reports the professional to an approved peer assistance program.” Any person who “in good faith reports information or takes action in connection with a peer assistance program is immune from civil liability for reporting the information or taking action.”9
    Once an attorney contacts TLAP, resources are provided directly to that person, and it ranges from:
•    direct peer support (from TLAP staff attorneys or trained peer-support attorneys who have overcome a particular problem and have signed a confidentiality agreement);
•    self-help information;
•    information about attorney-only support groups, such as Lawyers Concerned for Lawyers (LCL), which provides weekly meetings for alcohol, drugs, depression, etc.;
•    monthly wellness groups with professional speakers on various wellness topics in lecture format;
•    referrals to lawyer-friendly and experienced therapists, medical professionals, and treatment centers; and
•    assistance with financial resources to get help, such as the Sheeran-Crowley Memorial Trust, which is available for attorneys in financial need to defray the costs of mental health or substance abuse care.
    If you are the person who needs help, please ask for it. Visit one of the resources listed below to get information and find a treatment provider. If you believe a coworker to be suicidal, ask the person directly if he is planning to kill himself. Research shows that asking someone if he is suicidal does not put the idea in that person’s head—it is either already there or it is not.10 Asking simply shows the person that you noticed his pain and opens the door to sharing that pain with another. When you ask, seek a private area to talk, and be open, gentle, validating, concerned, and willing to listen. If you discover the person is indeed suicidal, contact the resources listed below, or drive the person to the nearest emergency room. Always take all threats of suicide and self-harm seriously.11

Additional resources
National Suicide Prevention Hotline
800/273-TALK (8255)
suicidepreventionlifeline.org
A national phone line network of local crisis centers, free, 100-percent confidential, available 24 hours a day, seven days a week, with support, prevention, and crisis resources.

Crisis Text Line
Text “CONNECT” to 741741
www.crisistextline.org/textline
A national, free, 24-7 text phone line connected to live, trained volunteer counselors who help people in crisis.

The Trevor Project
Trevor Lifeline: 866/488-7386
TrevorText: Text “Trevor” to 202/304-1200 (M–F, 3-10 p.m. EST)
www.thetrevorproject.org/get-help-now
The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth. The Lifeline is a 24-7, national crisis intervention and suicide prevention phone line.

Texas Lawyers Assistance Program (TLAP)
800/343-TLAP (8255)    
www.tlaphelps.org
A free, 100-percent confidential phone line for law students, lawyers, judges, legal employers, young lawyers, and aging lawyers with support for wellness, stress, anxiety, depression, bipolar disorder, suicide prevention, substance abuse, and cognitive decline with support and referrals, peer assistance, CLE and education, mandated monitoring, and volunteer opportunities.

Substance Abuse and Mental Health Services Association (SAMHSA)
www.samhsa.gov
SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. Help and treatment locations can be found on the website.

Lawyers With Depression
www.lawyerswithdepression.com
This website was created by Dan Lukasik (a personal injury attorney in Buffalo, New York) and is dedicated to helping lawyers overcome depression.

American Foundation for Suicide Prevention (AFSP)
afsp.org
AFSP raises awareness, funds scientific research, and provides resources and aid to those affected by suicide

Endnotes

1  “Albert” is based on two prosecutors I know, but identifying information has been changed.

2  Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2016, www.cdc.gov/injury/ wisqars/fatal.html.

3  See Patrick Krill, Ryan Johnson, and Linda Albert, The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, Journal of Addiction Medicine, Feb. 2016, Vol. 10, Issue 1, Pp. 50, http://journals.lww.com/journaladdictionmedicine/Fulltext/2016/0200/The_Prevalance_of_Substance_Use_and_Other_Mental.8.asp.

4  Id.

5  See Ted David, Can Lawyers Learn to be Happy?, 57 No. 4 Prac. Law 29 (2011).

6  A 1992 OSHA report found that male lawyers in the U.S. are two times more likely to die by suicide than men in the general population. See www.lawpeopleblog.com/2008/09/the-depression-demon-coming out-of-the-legal-closet/.

7  See C. Stuart Mauney, The Lawyers’ Epedemic: Depression, Suicide, and Substance Abuse; www.scbar.org/Portals/0/ Outline%20for%20Laywers’%20Epidemic.pdf.

8  Center for Substance Abuse Treatment, Substance Abuse and Suicide Prevention: Evidence and Implications—A White Paper, DHHS Pub. No. SMA-08-4352, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2008, https://store.samhsa.gov/shin/content/SMA08-4352/SMA08-4352.pdf.

9  Tex. Health & Safety Code §467.008(a).

10  See T. Dazzi, R. Gribble, S. Wessely and N.T, Fear (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44 pp. 3361-3363 Received from https://mhfa.com.au/sites/default/ files/Asking%20about%20suicide%20does%20no%20harm%20Dazzi%20et%20al%202014.pdf.

11  Ask About Suicide to Save a Life. ASK Video Training, Lessons and PowerPoint available at www.texassuicideprevention.org/ training/video-training-lessons-guides/.

SIDEBARS

Warning signs of suicide

•    increased substance abuse (including starting to smoke)
•    dramatic mood changes (high and low)
•    withdrawal from friends, family, or society
•    anxiety or agitation
•    anger, rage, or revenge-seeking behaviors
•    recklessness and risky activities
•    feelings of hopelessness, purposelessness, worthlessness, or
    powerlessness
•    shame, guilt, self-hatred, or inadequacy
•    feeling trapped
•    inability to sleep or sleeping all the time
•    deterioration of hygiene
•    repeatedly asking for extensions for assignments or work
•    sudden constant illness
•    disinterest in former activities, hobbies, and relationships
•     flat affect, disorganized speech, lack of eye contact
•    sleeping in court
•    suddenly skipping appearances, hearings, or trials
•    declining performance and interest in work
•    rapid weight gain or loss
•     threatening to or talking about hurting or killing oneself
•    attempting to gain access to lethal means (guns or pills)1

Endnote

1  See https://www.sprc.org/about-suicide/warning-signs and https://www.sprc.org/about-suicide/risk-protective-factors, see also http://www.texassuicideprevention.org/how-you-can-help/how-to-help-know-the-signs/ and https://afsp.org/about-suicide/risk-factors-and-warning-signs/ and http://www.suicidology.org/resources/warning-signs and Ask About Suicide to Save a Life. ASK Video Training, Lessons and PowerPoint available at http://www.texassuicideprevention.org/training/video-training-lessons-guides/.

Risk factors for suicide1

•    mental illness diagnosis
•    substance abuse (drugs and/or alcohol)
•    trauma, abuse, or bullying
•    LGBTQA
•    major physical illness
•    advanced age
•    obesity
•    gifted and talented
•    family history of suicide
•    previous suicide attempt
•    impulsiveness and aggression
•    access to lethal means (guns or medications)
•    isolation and lack of social support
•    stigma to seeking help (men, living in rural community, in the
    military, in law enforcement, in a counselling profession)
•    barriers to health and mental health care
•    ability to inflict or tolerate pain
•    cultural or religious beliefs that normalize suicide
•    loss (of job, relationship, health, reputation, or freedom)
•    exposure to clusters of suicide (defined as “a group of suicides
    or suicide attempts or both that occur closer together in time
    and space than would normally be expected in a given
    community”)2

Endnotes

1  According to the Centers for Disease Control, www.cdc.gov.

2  https://www.cdc.gov/mmwr/preview/mmwrhtml/00001755.htm.