Five Questions With: Jeffrey Hill

Jeffrey Hill has severed as the R.I. Department of Health’s violence and injury prevention coordinator since October 2016. Previously, he was the youth suicide prevention coordinator for the department for nearly six years. Prior to that he spent 10 years in higher education at colleges in Rhode Island and Pennsylvania working in student affairs.

Providence Business News reached out to Hill to ask about the national spike in suicide-related deaths, and how Rhode Island seems to be bucking the trend.

PBN: Rhode Island appears to be bucking the national trend with a steady decline in annual suicides. What is Rhode Island doing to effect this change?

From a recent high of 136 suicide deaths in 2013, Rhode Island has trended downward in terms of total suicide deaths, with 118 suicide deaths in 2016 [2017 final total still pending]. The rate of suicides per 100,000 Rhode Island residents also decreased during that time period, from 12.10 in 2013 to 11.09 in 2016.

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Unfortunately, changes in suicide deaths and rates can never be attributed to a single program or set of services, but rather reflect a broad confluence of different factors. Some of these factors include:

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  • An improving economic environment in Rhode Island, reducing financial stress on households.
  • A sustained public health campaign [carried out by the R.I. Department of Health and other stakeholders] to train individuals all over the state in evidence-based suicide prevention/mental health awareness training.
  • Public awareness campaigns conducted by nonprofit entities and others that challenge the stigma of mental illness and encourage troubled individuals to seek help.
  • Systemic changes that increase access to mental health services, such as the Suicide Prevention Initiative, a school-based emergency department diversion program that connects at-risk students to local mental health providers.
  • Educating residents on the risk of suicide and how to act proactively to mental health concerns in themselves and those around them.

PBN: Does the state’s focus on the opioid crisis and mental health services to combat that problem give it an edge in preventing suicides?

The act of suicide can be viewed as a convergence of multiple risk factors, including but not limited to: mental illness, substance abuse, social isolation, low access to mental health services and more. Therefore, any resources or programs that are focused on reducing the burden of a particular risk factor, such as abusing opioids, usually have a positive effect on rates of suicide.

The focus of state leadership on mental health issues through bodies such as the Governor’s Council on Behavioral Health and community-driven groups like the Rhode Island Suicide Prevention Coalition have led to collaboration opportunities and sharing of resources to address the issue of suicide by working together on reducing risk factors and increasing protective factors, such as strong social bonds.

PBN: What are the signs a person is contemplating suicide? What should a person do if they spot those signs?

As listed by the U.S Substance Abuse and Mental Health Services Administration, warning signs of suicide may include:

  • Talking about wanting to die or kill oneself.
  • Looking for a way to kill oneself.
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or being in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawing or feeling isolated.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

It is also good to note that these signs indicate a greater risk if they appear to be related to a painful event, loss or life change. In addition, those who have lost someone close to them to suicide have an even higher risk than the general population.

If anyone sees these warning signs in someone that is close to them, they should immediately utilize resources, such as the National Suicide Prevention Lifeline [1-800-273-8255], the Crisis Text Line [text HOME to 741741] and compile a list of local mental health providers before reaching out to the individual and starting a nonjudgmental conversation about their current state.

Questions such as “Are you OK?” or “Can you tell me what’s going on in your life?” are good starting questions for this conversation. If the person continues to show warning signs of suicidal ideation during this conversation, i.e. statements [such as] “I just wish I could go to sleep and never wake up,” the responding individual should express care and nonjudgement for the person and persuade them to go with them to get help. That could mean calling the National Suicide Prevention Lifeline together, going to a local mental health provider to set up an appointment, or even self-hospitalization of the individual if they feel they will not be safe for the immediate future.

There are evidence-based trainings that instruct the general public on how to react appropriately in these situations and get at-risk individuals to the resources they need. Trainings such as QPR [Question. Persuade. Refer.] or Mental Health First Aid are highly recommended for anyone who may encounter at-risk individuals in the course of their lives or work.

PBN: If someone has been identified as suicidal but is dissuaded from the act, how likely are they to relapse into suicidal thoughts?

This is a very specific question that would depend entirely on the individual and the number of risk factors as well as protective factors associated with their situation. For instance, someone who has very strong social connections [a protective factor] would be less likely to relapse into suicidal thoughts than someone who is very socially isolated [a risk factor].

Unfortunately, at this point in time there is no accurate way of predicting when a person will become suicidal, although recent advances in artificial intelligence and machine learning using risk and protective factors are developing more-accurate estimations of an individual’s risk level. For now, a person’s risk for suicide is best determined by a qualified mental health professional conducting a detailed evaluation of the person’s mental health status and corresponding risk/protective factors.

PBN: What more can the state do to continue to see the number of suicides dwindle?

Current funding from the U.S Substance Abuse and Mental Health Services Administration to the R.I. Department of Health allows for work targeted at preventing suicide among youth ages 10-24.

While this work has been very successful in creating sustainable system changes to prevent youth suicides, it does not directly address the portion of the Rhode Island population with the highest number of suicide deaths, which are adults, especially middle-aged men. Increasing resources around adult suicide-prevention projects or campaigns while continuing the implemented youth [suicide-prevention] efforts will yield further positive results.

Enforcing mental health care parity laws and increasing the number of mental health providers in the state, especially those who serve low-income populations, will also improve outcomes for at-risk individuals.

Finally, continuing to engage the general public on the topic of mental health and decreasing the stigma associated with seeking mental health care will increase the chances that those in need seek out help without feeling ashamed to do so.

Rob Borkowski is a PBN staff writer. Email him at