Last year Russia passed a law giving the government powers to control and blacklist certain websites that it deemed to be harmful to children.  It went into effect in November, and the New York Times reports that authorities have begun cracking down. There appears to be a particular focus on sites containing information pertaining to suicide — both Facebook and Twitter have agreed to remove such content in the past few weeks. YouTube, however, filed an appeal in February over a takedown notice; the video in question depicted a woman using makeup and a razor blade to make it appear as if she had cut her wrists, but Google argued that the clip was intended as entertainment.

Outgoing FCC chairman Julius Genachowski has said the legislation signals "a troubling and dangerous direction" for the internet in Russia, and speaking to the Times, journalist Anton Nosik called the laws "absurd, harmful, and absolutely unnecessary" — while playing down the likelihood of a broader enforcement across the web. The government, for its part, argues that the bill was designed to protect children from harm by blocking pages on drugs, suicide, or child pornography. While there's no clear indication yet that the Putin administration has or will employ the new laws to stifle political opposition online, it's not surprising that many in Russia are feeling uneasy about the new powers afforded to the Kremlin nonetheless.

Interesting things going on in Maine.  A bill requiring suicide prevention training in public schools.  Christopher Cousins writes in the Bangor Daily News:

 
AUGUSTA, Maine — There’s virtually no way the Legislature’s Education and Cultural Affairs Committee could have given stronger support Tuesday to a bill that would require suicide prevention training in Maine’s public schools.

Not only did the committee give the measure its unanimous endorsement, but it also vowed to find a way to cover the cost of the program and called on the Department of Education to implement the law in time for the beginning of the next school year while putting the concept through a rigorous rule-making process that will bring the issue back to the committee next year.

Rep. Paul Gilbert, D-Jay, said after the vote that his bill, “An Act to Increase Suicide Awareness and Prevention in Maine Public Schools,” was the most important measure he has ever championed as a legislator.

“If I’m remembered for anything I’ve done in the Legislature, I hope it’s this bill,” said Gilbert, who sponsored the legislation at the suggestion of school guidance counselors in his district. “I can’t imagine anything bigger
than saving a kid’s life.”

Earlier this month, the committee heard hours of heart-wrenching testimony from educators and parents, many of whom told personal stories about students, sons or daughters who have been lost to suicide. Speaker after speaker said that while a bill like this one can’t stop all suicides, it might well have made a difference for some.

The bill would require the Department of Education and local schools to implement programs for all personnel to complete suicide prevention awareness training and for at least two people from every school district to undergo more extensive suicide prevention and intervention training.

It was clear from the start of Tuesday’s work session that lawmakers on the Education Committee were supportive, with some tearfully relating their own personal stories of a sibling or a neighbor who died by suicide. One of them was Sen. Brian Langley, R-Ellsworth, who lost his younger brother to suicide in addition to two students he taught during his teaching career.

“It’s just pretty rough,” said Langley. “One of the students I might have suspected. The other one, that was really tough. If we’re better aware of what those signs are, we might be able to pick up on one of them.”

Sen. Chris Johnson, D-Somerville, gave an impassioned plea to his colleagues to support the bill.

“I think it’s time that we don’t view this in light of other education issues,” he said. “This is a matter of life or death so our young people can live out their adult lives and fulfill the expectations of everyone.”

Rep. Michael McClellan, R-Raymond, suggested that if the committee is serious about the bill, its members have to find a way to provide funding so suicide prevention and awareness training doesn’t go to public schools as an unfunded mandate. According to the committee’s analyst, the training is offered for free by nonprofit groups such as the National Alliance on Mental Illness of Maine.  The only cost to local school districts would be for hiring substitute teachers while full-time teachers take the training.

“If you lined up all the trainings we ask our educators to do, I would put this one at the top,” said McClellan. “This might be an opportunity to be bold as a committee and put this into the budget and pay for it. Let’s put our money where our mouth is.”

In addition to its vow to cover any costs — which were described as “moderate statewide” in the bill’s fiscal note — the committee amended the bill so it will go through both routine and major substantive rule processes concurrently. That means if passed by the Legislature, which would require a two-thirds vote of both chambers if a mandate preamble is attached, the bill would take effect for the coming school year and require the Department of Education to come back to the Education Committee after it has drafted rules. The bill calls for a ramp-up of the training, which is to be in full effect during the 2014-15 school year.

The suicide crisis is getting more and more attention in the press.  While it's good that people are talking about it, I don't see the ACTION needed to help.

NBC News just printed a story 'The Enemy Within: Soldier suicides outpaced combat deaths in 2012' by Bill Briggs.  Please read and share.


More soldiers took their own lives than died in combat during 2012, new Department of Defense figures show. The Army's suicide rate has climbed by 9 percent since the military branch launched its suicide-prevention campaign in 2009.

Through November, 177 active-duty soldiers had committed suicide compared to 165 during all of 2011 and 156 in 2010. In all of 2012, 176 soldiers were killed in action -- all while serving in Operation Enduring Freedom, according to DOD.

Army suicides have increased by at least 54 percent since 2007 when there were 115 — a number the Washington Post then called "an all-time record." An Army spokesman said Wednesday it is uncertain if 177 marks a new annual high (with December numbers still to come), or if suicides have ever outpaced combat deaths in a single year, because the Army has not always tracked suicides.

Some Army families who recently lost members to suicide criticize the branch for failing to aggressively shake a culture in which soldiers believe they'll be deemed weak and denied promotion if they seek mental health aid. They also blame Army leaders for focusing more heavily on weeding out  emotionally troubled soldiers to artificially suppress the branch's suicide stats versus embracing and helping members who are exhibiting clear signs of trouble.

Furthermore, in September, two U.S. lawmakers pressured the Pentagon to immediately use unspent money specifically appropriated to the agency to help slow the suicides within the military. Rep. Jim McDermott, D-Wash., and Rep. Leonard Boswell, D-Iowa, also pushed for increased anti-suicide funding for the Department of Defense in 2013.

“The Pentagon hasn’t spent the money that it has for suicide prevention for this year — and that money wasn’t nearly enough money to reach all the soldiers who need help. Now we are hearing about bureaucratic technicalities at the Pentagon that are preventing them from acting. This is unconscionable,” Rep. McDermott said. “The Pentagon is funded to help soldiers and needs to do much more on the epidemic of suicides."  

But the Department of Defense contends that anti-suicide programs installed throughout the armed services soon will curb military suicides — and that such initiatives already have helped douse mental-health stigmas.

"We have seen several programs that we are optimistic are going to start making a dent in this issue," said Jackie Garrick, acting director of the DOD suicide prevention office. "We’ve asked all of the services to use the same messaging, the same talking points. So the Army, included in that, is trying to adapt and promote those same messages because we realize that this is an across-the-board problem."

The Army could not provide a suicide-prevention officer to comment, but an Army spokeswoman did forward NBC News a link to the “Army Suicide Prevention Program.”

Within that initiative, soldiers are taught to “Ask, Care, and Escort” any Army buddy who mentions considering suicide, to usher them to behavioral-health provider, chaplain, or a primary-care provider, and to “never leave your friend alone." The U.S. military also installed a prevention “lifeline:” 1-800-273-TALK.

What's more, soldiers are assured that seeking mental-health counseling will not harm their chances at gaining a security clearance. And on that website, a videoshows Sgt. Maj. Raymond F. Chandler III, the Army's top non-commissioned officer, speaking to other NCOs: “Know your soldiers. Know the resources available to them when they are in crisis ... Encourage your soldiers to seek help ... Seeking help is a sign of courage.”

The anti-suicide strategy was rolled out in April 2009 by Army Vice Chief of Staff Gen. Peter W. Chiarelli.

In July 2010, the Army released a report that sought to explain its suicide epidemic. Some Army families were irked by one of the key findings: Loosened recruitment and retention standards — due to the furious pace of repeated deployments — had allowed more than 47,000 people to remain in the Army despite histories of
substance abuse, misdemeanor crime or “serious misconduct.”

Chiarelli further frustrated many Army families who had lost members to suicide when, amid the release of that same report, he added: “I think it’s fair to say in some instances it would be a soldier that’s possibly married, couple of kids, lost his job, no health care insurance, possibly a single parent.” Those types of soldiers, he added, are “coming in the Army to start all over again, and we see this high rate of suicide.”

Two days before Charielli’s comments, 28-year-old Army soldier Brandon Barrett showed up at his parents' home in Tucson, Ariz. The family believed he was on leave following a brutal, year-long deployment in Afghanistan with the 5th Stryker Brigade during which he saw several buddies killed or wounded by bombs and did some killing himself.

During that visit, Barrett’s family thought his Army experience seemed to be helping him to mature, recalls his brother, Shane Barrett, a detective with the Tucson Police Department.

In August, Brandon Barrett left his parents’ home and drove — for unknown reasons — to Salt Lake City where he donned his combat fatigues, boots and helmet, grabbed his AR-15 rifle, went to a hotel and told an employee to call the police. As he waited for the officers, Barrett paced the hotel parking lot as if he was on patrol, a  hotel video showed. A police officer arrived. Barrett shot him in the leg. The officer returned fire and killed Barrett with a bullet to the head. His family believes Barrett intended to commit “suicide by cop,” his brother
acknowledged.

“He’d been home for nearly a month,” Shane Barrett told NBC News. “We had no contact from anybody in the Army until my brother’s incident. And then, after the fact, it was: ‘Your brother was AWOL (absent without leave).’ Really? We didn’t know that.

“If a guy goes AWOL, the Army is supposed to notify the family immediately. We never received phone calls, letters. We were blindsided. At the police department where I work, they ran all kinds of record checks on him. But they found absolutely nothing (about an AWOL report).

“My mother has always believed he was declared AWOL after the fact just so the Army could get him off the rolls and not have his suicide count against the Army,” Shane Barrett said. “To just discard him, like he never existed, is just wrong. And there’s no paper trail, no nothing to back up the AWOL claim.”

The Barrett family later learned that Brandon had confided to a chaplain within his unit, revealing that his year of combat in Afghanistan had left him depressed and anxious. And possibly mulling suicide.

“From talking to a couple of other guys in his unit, he didn’t want to come forward (to seek mental-health help) because you’d be red-flagged. It would be your exit out of the Army,” Shane Barrett said. “The guys in the Army are just flat-out afraid to come forward.”

At the Department of Defense, anti-suicide chief Garrick was asked if the Army is indeed clinging to a culture of “suck it up" and handle your own problems,” as some Army families contend.

“No, I think all of the services have done a pretty good job of trying to get a message out. The Army ... they’ve done the 'shoulder-to-shoulder,' (approach, and have said) ‘no soldier stands alone.' That’s been some of their messaging, now going back a while,” Garrick said.

“The Secretary of Defense (Leon Panetta), this past year, issued a statement talking about how our service
members are our most valuable resource and that we need to do everything we can to take care of our people. So we’re doing everything we can to prevent suicides in the military, recognizing that it’s a complex and urgent problem.”

More members of the U.S. Armed Forces died by their own hand — usually with a gun — during the first nine months of this year than had their lives ended by the enemy in Afghanistan during the same period.

That startling suicide statistic has led to a realization by National Guard units across the country that more effort needs to be spent identifying Guard members who could be suicidal, and getting them the help they need before a tragedy occurs.

During the first nine months of 2012, there were 247 suspected suicides among Army active- and reserve-duty personnel, compared to 222 military deaths among active and reserve personnel from “hostile causes” as of Sept. 28.

Members of the Massachusetts National Guard are as much at risk as their counterparts across the nation, although the number of suicides among Massachusetts Guard members since 9-11 has remained in the single digits, according to Major Gen. L. Scott Rice, adjutant general of the Massachusetts National Guard.

“That’s still more than we have had in the past,” said Major Gen. Rice, although he did not have exact figures.

“Every single one is more,” he said. “Every single one is special, making it important that we figure out why, what and where and how do we make it better for the future.”

With each suicide a tragedy, efforts are now under way to identify and treat Guard members who might be vulnerable, as well as build resiliency among Guard members before they head overseas.

In the commonwealth, those efforts will involve a partnership between the University of Massachusetts Medical School in Worcester, the National Guard and the Massachusetts Department of Veterans’ Services.

An announcement of the joint venture was made last week at the medical school by Dr. Michael Collins,
the school’s chancellor; Coleman Nee, secretary of the state Department of Veterans’ Services; Maj. Gen. Rice; and Dr. Barry Feldman, director of psychiatry programs in public safety and assistant professor of psychiatry at
the medical school.

“Working together, we will build a collaborative program that will not only help address the unique health needs of today’s members of the Massachusetts National Guard, but which also can serve as a model for addressing the needs of military members of all branches, as well as veterans, across the nation,” said Dr. Collins.

Nationally, suicides among active and non-active military personnel are increasing. In July alone, a
record 38 confirmed or suspected suicides were recorded, including 26 among active-duty soldiers and 12 among National Guard or reserve soldiers who were not on active duty.

The behavioral health faculty at the medical school will collaborate with the National Guard and the Department of Veterans’ Services to implement suicide prevention strategies specifically designed for military personnel, including training by medical school experts for National Guard personnel in suicide prevention and resiliency building.

The medical school and Veterans’ Services Department participated with the National Guard in a statewide stand down this past September that focused on suicide prevention.

According to Maj. Gen. Rice, there were numerous Guard members who volunteered to be trained to identify comrades who are at risk for suicide, as well as to find them help.

“It’s not an assigned duty,” he said.

Resiliency — helping to fortify Guard members who may go oversees — is also an important feature of the work that will go on between behavioral faculty members and the military, according to Dr. Feldman.

Resiliency training does not mean just preparing Guard members for some of the sites and scenes they may encounter, but also letting them know that the various reactions they may experience are not something they have to keep to themselves.

“They need to know that if they experience feelings that are upsetting, it is all right to talk to others about this,” said Dr. Feldman.

The partnership will also seek and educate civilian medical personnel, who are often the primary medical providers for reserve members and veterans, to prepare them to respond to the unique social, psychological and
medical needs impacting military members and combat veterans.  Medical personnel can be trained in the intricacies of military language and acronyms, as well as the confusing myriad of federal, state and military regulations that often prove an obstacle to getting services. Additional training in military culture could also be provided to civilian medical personnel.

According to Dr. Feldman, UMass Medical School has joined more than 100 medical schools around the country in mobilizing its resources “to meet the health care needs of the military and their families.”

There is a national hot line that those in the military or their families can use. The National Suicide Prevention
Lifeline number is (800) 273-8255; press 1 for the Military Crisis Line.

I've been asked my view on this issue and I'll be sharing that in the near future. 


A divisive ballot initiative that would allow terminally ill patients to end their lives with medication prescribed by physicians was narrowly defeated.

The Death with Dignity Campaign conceded this morning, as unofficial results tallied by the Associated Press showed that, with 95 percent of precincts reporting, 51 percent of voters had opposed the measure, compared with 49 percent in favor.

“For the past year, the people of Massachusetts participated in an open and honest conversation about allowing terminally ill patients the choice to end their suffering,” the campaign said in a statement released at 6:30 a.m. “The Death with Dignity Act offered the terminally ill the right to make that decision for themselves, but regrettably, we fell short. Our grassroots campaign was fueled by thousands of people from across this state, but outspent five to one by groups opposed to individual choice.

“Even in defeat, the voters of Massachusetts have delivered a call to action that will continue and grow until the terminally ill have the right to end their suffering, because today dying people needlessly endure in our Commonwealth and do not have the right to control their most personal medical decision.”

The ballot question has been the subject of a ferocious political battle.  After a Boston Globe poll in September showed voters overwhelmingly supported the measure, support steadily eroded in the face of a last-minute effort by a diverse group of opponents, including religious leaders, anti-abortion activists, and conservatives who aired their message in aggressive television advertisements and at church services. The concerted opposition campaign, which also included a major physician’s group, raised more than three times as much money as proponents.

In a statement, Rosanne Bacon Meade, chairperson of the Committee Against Assisted Suicide, said that while some votes remain to be counted, the efforts to stop the measure had been successful. She added that she hoped the result would spark discussions about how to improve medical care at the end of life.

“We believe Question 2 was defeated because the voters came to see this as a flawed approach to end of life care, lacking in the most basic safeguards,” Meade said in the statement. “A broad coalition of medical professionals, religious leaders, elected officials and, voters from across the political spectrum made clear that these flaws were too troubling for a question of such consequence.”

“Tuesday’s vote demonstrates that the people of the Commonwealth recognize that the common good was best served in defeating Question 2,” Cardinal Sean O’Malley said in a statement.

Massachusetts would have followed Oregon and Washington, which have passed similar initiatives to allow terminally ill patients to seek life-ending drugs from physicians. Donations to opposition groups, which raised nearly $2.6 million, came from far-flung Catholic dioceses, fueled in part by fear of a domino effect if the measure were to gain a foothold in Massachusetts.

Proponents of the measure raised about $700,000.

Other efforts to legalize physician-assisted suicide in New England have failed. In 2000, a ballot initiative in Maine lost by a close margin.  Legislative efforts to pass a similar bill in Vermont and New Hampshire have
been defeated in recent years.

Voters said they formed their opinions about the controversial ballot initiative after careful consideration, informed by personal experiences with family members and by concerns about the safeguards written into the law.

North End resident Paul Santoro, 42, cast a vote against the initiative.

“I’m actually in favor of assisted suicide, but not how this is written,” Santoro said, citing concerns about the proposal’s lack of required psychiatric evaluations and family notification and the lack of tracking for any leftover
pills.

Santoro, who works in sales, said he has five children and worries about young people getting access to dangerous, untracked medications.

Alex Coon, 37, voting at the Dante Club in Somerville, said he voted for assisted suicide for a very personal reason.

“My grandmother was Dutch, and she always said, ‘When I get sick, take me home to Holland, because they’ll let me die,’ ” he said.

The Massachusetts ballot measure was modeled after similar legislation passed by voters in Oregon in 1994. If it had passed, it would have allowed terminally ill patients with less than six months to live to request medications to end their lives. Patients would have had to request medication from physicians multiple times verbally and in writing, be deemed competent to make the decision, and administer the lethal dose themselves.

Critics had said the measure was sloppily written and contained insufficient protection for vulnerable patients. Objections ranged from the difficulty of assessing how much time a patient has left to the failure to require a mental health screening by a specialist. Others opposed the initiative for moral reasons, or because it was counter to the fundamental do-no-harm ethos that governs physicians.

The legislation would have required the state Department of Public Health to write rules by March 20, 2013, to require physicians to report when the drug was dispensed, file copies of prescriptions, and help facilitate the collection of other statistical information.

Statistics kept by Oregon and Washington are frequently cited by proponents as evidence that the law is not being abused and poses no large-scale societal threat. Those detailed statistics show that the fatal doses of medication are requested by a small number of patients and used by even fewer.

Oregon’s law was mired in legal challenges for several years, but since 1997 when it was enacted, 935 people have requested prescriptions, and 596 have used them to end their lives. In 2011 in Oregon, most of the 71 people who used the medication were white, well-educated, and suffering from cancer.

In Washington last year, 103 people requested the prescriptions, with 70 using them and 19 dying without taking the drugs. Of those who requested prescriptions and died, nearly half were married, three-quarters had some college education, and the overwhelming majority had cancer.

The rate of suicide in the United States rose sharply during the first few years since the start of the recession, a new analysis has found.   

In the report, which appeared Sunday on the Web site of The Lancet, a medical journal, researchers found that the rate between 2008 and 2010 increased four times faster than it did in the eight years before the recession. The rate had been increasing by an average of 0.12 deaths per 100,000 people from 1999 through 2007. In 2008, the rate began increasing by an average of 0.51 deaths per 100,000 people a year. Without the increase in the rate, the total deaths from suicide each year in the United States would have been lower by about 1,500, the study said.        

The finding was not unexpected. Suicide rates often spike during economic downturns, and recent studies of rates in Greece, Spain and Italy have found similar trends. The new study is the first to analyze the rate of change in the United States state by state, using suicide and unemployment data through 2010.        

“The magnitude of these effects is slightly larger than for those previously estimated in the United States,” the authors wrote.  That might mean that this economic downturn has been harder on mental health than previous ones, the authors concluded.        

The research team linked the suicide rate to unemployment, using numbers from the Centers for Disease Control and Prevention and from the Bureau of Labor Statistics.        

Every rise of 1 percent in unemployment was accompanied by an increase in the suicide rate of roughly 1 percent, it found. A similar correlation has been found in some European countries since the recession.        

The analysis found that the link between unemployment and suicide was about the same in all regions of the country.        

The study was conducted by Aaron Reeves of the University of Cambridge and Sanjay Basu of Stanford, and included researchers from the University of Bristol, the London School of Hygiene and Tropical Medicine, and the University of Hong Kong.       

The following article is by Dr. Lachlan Forrow.  It's a subject that I plan on focusing on over the next few weeks.  Thoughts?

Should  a doctor in Massachusetts be legally permitted to write a prescription for a
patient to use in suicide?On November 6, the people of the Commonwealth will decide.

This is an issue about which deeply thoughtful, caring, and principled people in Massachusetts have profoundly differing views.Each "side" has, among its most passionate advocates, people I greatly admire.The moral, practical, political, religious, and other issues that Question 2 raises for people are almost infinitely complex.But the choice each of us will face when we vote is as simple as it can be.

Just two choices.

YES.

NO.

I have serious misgivings about whether a ballot initiative is the best way for the people of Massachusetts to make decisions about profound, complex moral issues.My misgivings are especially great when, as I believe is
true of Question 2 next Tuesday, many people are going to have to cast their vote without having had the time, opportunity, or help they needed to develop a clear and accurate understanding of what those issues
are.

I am further distressed that too many of the ads, op-eds, and advocacy emails that I have seen -- from both sides -- seem to me to present seriously distorted, irresponsibly exaggeratedclaims that are designed to frighten you into voting one way or the other.If I didn't know better, I would be more frightened than ever about myself or a loved one ever having a so-called "terminal illness". 

Scaring people by misinforming or misleading them, even if you think you are doing that in order to help them do what is good for them, is wrong.The fact of our inevitable mortality is, for most of us, scary enough. Exploiting those fears for political purposes, however well-meaning, is wrong.It was wrong when Sarah
Palin and others promulgated lies about non-existent plans for alleged "death panels" during the national health care reform debates.  It is wrong today in Massachusetts when people exploit your fears to get you to vote the way they think you should on Question 2.

More specifically, I think it is wrong here in Massachusetts when scare tactics are used to frighten people into thinking that Question 2 is "a recipe for elder abuse", as if that is even remotely the intent of its proponents, or even remotely acceptable to them.  I also think it is wrong to promulgate fears that, if Question 2 passes, insurance companies will encourage you to commit suicide in order to save themselves money, as the "No on 2" website implies in a video titled "Barbara's story" that features a headline from Oregon:

"Health Plan covers assisted suicide but not new cancer treatment...Don't let her experience in Oregon happen here in Massachusetts."

I do not believe any health plan in Massachusetts would ever do that.  Suggesting that they would is insulting to them and their leaders.I sometimes disagree with our health plans and their leaders, but in my experience the leaders of Massachusetts health plans care deeply about trying to ensure that their subscribers receive the best patient-centered value out of every health care dollar spent. 

And even if leaders of a health plan in Massachusetts were one day as venal as some people believe they already are today, they are not that stupid.  The people of Massachusetts are vigilant, and even a single well-documented case of a health plan trying to encourage a patient to commit suicide in order to save money would lead to such a public backlash that that plan's "business success" would be devastatingly damaged, if not ruined forever.  As it would deserve to be.

Similarly, I think it is wrong when proponents of Question 2 suggest that, unless a doctor is legally permitted to write lethal prescriptions, you or a loved one may well be forced to endure a prolonged period of terrible physical suffering.Here is what the "Yes on 2" website says:

Patients dying of late stage cancer, and other terminal illnesses, can face weeks or months of extreme pain and suffering before death.

They clearly want you to believe that unless Question 2 passes, you are at high risk of being forced to experience unconscionable levels of suffering.  In truth, whether Question 2 passes or not, the only reason a patient in Massachusetts need ever face "weeks or months of extreme pain and suffering before death" is if their medical caregivers are utterly incompetent.

Scaring people does not usually help them think more clearly, or help them make decisions more responsibly.And for the overwhelming majority of people, no matter how they decide to vote, and no matter what the result on November 7, there is little or no reason to be scared about what happens with Question 2.