A Tale Of Misclassification By Health Equity Jazz

Trigger Warning

September is Suicide Prevention Month. In honor of that, I want to share a personal story that has been on my heart and has shaped my thoughts and understandings of addiction, death, and suicide. This blog post discusses the topic of suicide, suicidal ideation, addiction, and depression. If you are not in a state of positive mental health, please be cautious in reading this post. If you are actively in a state of anxiety, depression, passive or active suicidal ideation, please know that there are resources available for you. You can always text the word “HOME” to the Crisis Text Line at 741741 or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Please seek help when you need it. There is no health more important than your mental health. Support is always available.

I was in middle school when my favorite male cousin was found dead in his apartment. The cause of death listed on his death certificate? A heroin drug overdose. Everyone in my family knew that he struggled with addiction, and everyone in my immediate family tried to help him. He was my father’s nephew, but grew up with my mother and was one of her best friends. (How my mother’s family grew up next to my father’s sister’s families, but they didn’t meet until she was in her twenties is another story for another day.) Needless to say both of my parents were very invested in his health and wellbeing and would have moved heaven and earth to help him.

What I Remember About Him

I remember spending time with my cousin, basking in his light, even if he was drunk or high. He was an enigmatic person who could make you laugh with his antics and then quickly become serious and wise with the insight of someone twice his age.

I remember the times he tried to go to rehab and even tried to detox in our basement because he desperately wanted to get clean, but as soon as we would drop him off at home, we were back at square one. Living in and out of jail and in and out of the projects of Southeast DC after leaving Virginia, he didn’t really stand a chance to be in a space of sobriety.

I remember sitting in the car next to him as we drove him home, wanting him to know how loved he was, by everyone, but especially me. As an only child, he was like the older brother I didn’t have. He teased me about boys, and always reminded me that no boy would ever be good enough for me. He loved on me like I was his little sister, even though he had his own siblings. Even when he reeked, I would lovingly embrace him, knowing that it could possibly be the last time.

I remember when we got the call that he was dead, and I immediately thought to myself, this wasn’t an accident. Replaying in my head, I could hear the times he told my mother that he would have to get high to go home, to deal with his common-law wife, to deal with his life. As someone with a prison record, he could never hold stable employment and with two kids, two boys, he always felt like he was less than.

At thirteen years old, I knew in my heart that my cousin’s overdose was a type of suicide that happens far too often in the Black community. However, this type of depressed and suicidal behavior is never named. It’s far too easy to blame the drugs and not the society that breaks down the psyche of Black men and women causing them to believe that they have no other alternatives than to escape.

The Misclassification of Suicide Data

As someone who has actively and passively thought of suicide, I know in my heart that the pain that causes you to seek solace in drugs is very similar to the pain that causes you to think about taking your own life. These experiences are two sides of the same coin. Spectrums of mental health illness that when left unchecked can result in death by suicide (even if it is classified differently).

Over the past decade or so, a few articles (1,2,3,4) were written on the idea of suicide misclassification. The hypothesis is that due to classifying death in four categories (homicide, accidental, suicide, and natural), unless a suicide is unquestionable it is likely to be classified as accidental. This misclassification phenomenon may be the reason for the disparate rates of suicide among Black people when compared to whites. The 2003-2005 rate of suicide for the white population was 13.5 per 100,000 in comparison to a rate of 5.3 for Black people. (5)

Let me pause to acknowledge that in any normal world, I would applaud the “positive” disparate rates of suicide in the Black community. However, as a public health professional, I know that it is unlikely that the rates are this dissimilar. Yes, there are protective factors in the Black community with the church and religion, but I don’t think these protect enough to account for a 1/3 rate of suicide. What I hypothesize is that there are a fair number of suicides misclassified as “accidental drug overdose” and in some cases even homicides. (If you have mentally given up and put yourself into a situation to be killed by another person, to me that is a form of suicide.)

Now back to the facts. A 2010 research article states, “Empirical research supports the possibility that Blacks are more misclassification-prone than Whites. For example, a 1970s New York City study of medical examiner data estimated that suicide was underenumerated by 80% for Blacks compared to 42% for Whites, and is consistent with other evidence that variation in suicide misreporting between Blacks and Whites is systematic.”

With this in mind, do we expect any change over the past 50 years? I think not. But you know what has changed? The face of opioid addiction. 21 years ago when my cousin died and I thought to myself it was a misclassified suicide, opioid addiction was a Black people problem. However, now that Becky and Ken are the face of opioid addiction, more people are coming to my way of thinking.

A February 2021 research article, looked at broadening the definition of suicide to a more inclusive term, self-injury mortality (SIM). Researchers define SIM as “suicides plus estimated “non-suicide” drug self-intoxication deaths.” Using this expanded term, the annual SIM rate is 4.3% versus 1.8% for suicide, causing further alarm to the bourgeoning mental health crisis in the country. What stands out to me most is when you look at the proportion of “non-suicide” drug self-intoxication deaths in the SIM rate, DC tops the list. And while the “Chocolate City” may be losing its hue, you better believe the people who are dying from drug use in DC are disproportionately Black, like my cousin.

Why This Matters to Me

I was thirteen when I had the wherewithal to know that my community was hurting and lost in the data. That was 21 years ago and nothing has changed. The recent death of Michael K Williams hit me hard because even without specifics, his death reminds me of my cousin’s. It reminds me that we are still struggling to name this mental health crisis in our Black community, and that due to the legacies of slavery and mistrust within the healthcare system, we may never seek the psychiatric and therapeutic care that we need, especially our Black men.

At the end of the day, as a Black woman who had a Black Daddy, who is in love with a Black man, and who will hopefully one day be mother to a Black boy — I just want all Black men to live. Happily. Freely. Lovingly. Fully. Longly.