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For YSPH student, creating suicide prevention guide both an academic and personal project

October 18, 2023
by Fran Fried

Sophie Edelstein, MPH ’24 (Social and Behavioral Sciences), had the opportunity to help her community in several ways this past summer. She chose to work on ways to prevent suicides in New Haven.

The lifelong Elm City resident was one of 12 YSPH Health Equity fellows, a program funded by the Yale School of Public Health’s Office of Public Health Practice (OPHP), the Community Alliance for Research and Engagement (CARE) at YSPH, and Southern Connecticut State University. Of all the host sites for the program, Edelstein got to work with her first choice: in the City of New Haven’s Office of Community Mental Health Initiatives.

After analyzing the city’s data on suicide deaths, suicide attempts, and self-harm instances over the past five years and identifying trends, Edelstein – along with Department of Community Resilience Executive Director Carlos Sosa-Lombardo, and Lorena Mitchell, Office of Community Mental Health Initiatives coordinator – created a publicly available City of New Haven Suicide Prevention Guide. (The city also has a suicide prevention web page.)

They compiled the guide after meeting with members of community organizations such as BHCare, the Alliance for Prevention and Wellness, Alternatives to Suicide, and Keep the Promise Coalition. Hard copies of the brochure will be distributed by the city to community partners, libraries, and the school district’s office of social and emotional learning. Edelstein said the hard copies will also be available at Yale’s Harvey Cushing/John Hay Whitney Medical Library.

My fellowship with [the Office of Community Health Initiatives] was incredibly rewarding. Despite the difficult subject matter, working with community stakeholders reminded me of the power that the city government has to improve access to care and mitigate the social determinants of health that are closely linked with suicide risk.

Sophie Edelstein, MPH '24

The 20-page guide is divided into two parts: local data on suicides by which the office is taking action; and information and resources so people can recognize the signs of someone struggling with possible self-harm, and resources where people can seek help and guidance.

But Edelstein’s mission is not finished. She is working with Mitchell, her former preceptor, on an academic publication about the role that local governments play in suicide prevention and mental health efforts.

They are also working with Dr. Marco Ramos, MD, assistant professor in the history of medicine and Department of Psychiatry at the Yale School of Medicine, on developing a presentation for his students that details some of the current community mental health programs in New Haven. (Ramos is the secondary advisor on Edelstein’s YSPH thesis; her primary advisor is Laura Bothwell, assistant professor of clinical public health and of epidemiology of microbial diseases.)

“My fellowship with [the Office of Community Health Initiatives] was incredibly rewarding,” Edelstein said. “Despite the difficult subject matter, working with community stakeholders reminded me of the power that the city government has to improve access to care and mitigate the social determinants of health that are closely linked with suicide risk.”

Mitchell said it has been “an immense pleasure” to work with Edelstein, that she was “very grateful” to partner with her and cited her thoughtfulness and thoroughness.

“She approached suicide prevention work with sensitivity, self-awareness, and the sense of urgency that this topic demands,” Mitchell said. “Sophie is a very inspiring person, and with her inquisitiveness, ambition, intellect, and kindness, I know she has made a huge difference and will continue to do so in her community.”

Edelstein graduated from Yale College in May 2023 with two bachelor of arts degrees (in the history of science, medicine, and public health, and in molecular, cellular, and developmental biology), and won the Harvey B. Applebaum Award for her essay on geriatric health care and U.S. policy. Her interest in suicide prevention, she said, is both academic and personal.

As a senior, she chronicled the rise and fall of social psychiatry in 20th-century America. Her work delved heavily into public health policies surrounding mental health, and it became apparent to her that while the rate of suicide death for veterans is 57% higher than for non-veterans, non-veterans were what she called “suffering in the dark.”

“Populations of various other identities also deserve attention and support,” she said. “Thus, I became especially interested in how community organizations and institutional partners increase (or inhibit) access to mental health care.”

Her interest in community-institutional relationships led to her developing a thesis with a local angle – her case study, and her thesis subject, is the founding of the Connecticut Mental Health Center in New Haven in 1966. She is using this as “an opportunity to deconstruct how we imagine ethical and constructive community-institutional relationships that promote, rather than racially inhibit, access to mental health care.”

In addition to her academic thesis, Edelstein also has a personal connection when it comes to suicide prevention. “A number of individuals close to me have attempted suicide, and in those moments, I simply wished I could have done more,” she said. As a result, she has since been certified in Question, Persuade, Refer (QPR) prevention training, as well as Mental Health First Aid (MHFA). But, she said, the work doesn’t stop there.

“Surely, reframing state and national policies and increasing access to care are important aspects of addressing high suicide rates,” she said. “However, prioritizing person-centered approaches is also important, especially at the local level.”

Crisis management systems also need to do a better job of providing social support and addressing the social circumstances that may lead someone to consider suicide, Edelstein said. “Therefore, it becomes paramount that we promote harm-reduction approaches that prioritize consent and voluntary participation,” she said.

Edelstein’s analysis revealed that New Haven’s suicide prevention efforts appear to be working, as the city has defied national trends when it comes to suicide rates. While national suicide death rates increased from 2020-2022, New Haven’s dropped from 13 in 2020 to 9 in 2022. Edelstein attributes the decrease to the city’s launch of numerous suicide-prevention programs, including Elm City COMPASS (in collaboration with the Consultation Center at Yale and Continuum of Care) and the Community Healing Support Team (collaborating with the Clifford Beers Clinic).

More needs to be done, though, Edelstein said. Community partners would appreciate more planning and training opportunities. There is a need for more suicide intervention resources and support groups that prioritize consent and voluntary participation; and there needs to be stronger promotion and better community access to suicide prevention and safety measures such as gun locks and drug take-back programs.

Edelstein plans to continue working in mental health promotion after graduation. She hopes to pursue an MD/PhD in the history of medicine, drawing from the skills she honed at YSPH.

“Both my education at YSPH thus far and my fellowship experience have emphasized the multifaceted approach that we employ in addressing public health problems, one that includes understanding and critically analyzing history to effectively support those who have been marginalized,” she said.

If you or someone you know is considering suicide, help is available. In Connecticut, call 211 to reach trained counselors who are available 24/7 to provide support and an open ear. This service is free and confidential. Call 988 anywhere within the United States to reach the National Suicide Prevention Hotline.

Submitted by Fran Fried on October 13, 2023