Suicide prevention has garnered new attention in the media and at the dinner table with the recent death of actor Robin Williams. In the wake, experts say it is important to know the signs of depression, what resources are available in the community and the local trends in deaths by suicide.
For someone at risk of suicide to get help, it is important to individuals, friends and loved ones to know the signs.
According to the American Foundation for Suicide Prevention, some of these include mood swings, showing rage or talking about seeking revenge, sleeping too little or too much and talking about being a burden on others.
A person who is thinking about suicide may say so directly, “I’m going to kill myself.” More commonly, they may say something more indirect, such as “I just want the pain to end,” or “I can’t see any way out.”
Depression or bipolar (manic-depressive) disorder is often a factor in suicides. Kristin Yach, Director of Clinical Services at Pathways Community Health, said it is important to know if loved ones are suffering from depression or another mental health issue.
“Depression tends to be outwardly shown by feelings of hopelessness and often losing interest in activities that someone used to engage in. Sometime there is a preoccupation with talking about wanting to hurt one’s self, making vague suicidal references such as ‘people would be better off if I wasn’t around.’ Sometimes there is an increased use of alcohol or drugs. Isolation is a big indicator,” Yach said.
Experts say, if a loved one is exhibiting abnormal behavior, actively encourage the person to see a physician or mental health professional immediately. People considering suicide often believe they cannot be helped.
Assist them to identify a professional, schedule an appointment, and go to the appointment with them. If the person is threatening, talking about, or making specific plans for suicide, this is a crisis requiring immediate attention. Do not leave the person alone.
Remove any firearms, drugs, or sharp objects that could be used for suicide from the area. Take the person to a walk-in clinic at a psychiatric hospital or a hospital emergency room.
Preemptive measures that may help in preventing suicide include receiving effective mental health care, positive connections to family, peers, community, and social institutions such as marriage and religion that foster resilience and obtaining the skills and ability to solve problems, according to the American Foundation for Suicide.
Burrell Behavioral Health is one organization that offers behavioral health in Pettis County and operates a 24-hour crisis hotline at 800-395-2132. Pathways offers outpatient and community based counseling as well as other behavioral services and can be reached at 888-403-107.
The National Suicide Prevention Lifeline at 800-273-8255 is also an excellent resource that can provide contacts to local providers.
In addition to outpatient and community based mental health services, Pathways offers two programs available locally focused on prevention that are available for civic organizations, teachers, law enforcement or any group interested.
“We have prevention services in several counties and a couple different programs where the prevention department goes out to groups of people, it might be a private club, a church group, and teachers, whoever wants to call together a group,” Yach said.
The first is called QPR (Question, Persuade, and Refer).
“That is what you would call a ‘gatekeeper’ training program for suicide prevention,” Yach said. “It is similar to CPR, if you were walking down the street and you saw somebody choking, you know how to perform the maneuvers. QPR is an emergency response. Individuals that have gone through the training know how to question and persuade someone to get next-step help and provide the contact information.”
Mental Health First Aid is another Pathways Program that takes the training a step further and addresses addiction and other mental health factors.
“It’s for the laypersons in the community, to teach them the signs of addiction and mental illness. It’s often taught to teachers or people that come into contact with large numbers of people. It’s a little bit longer than the QPR, it’s like eight full hours of training,” Yach said.
Missouri Department of Health and Senior Services (DHSS) figures for the period 1998-2008 show there were 238 visits to the emergency room for self-inflicted injuries in Pettis County, which reported a significantly higher number of self-inflicted injuries (suicide attempts) than the statewide average in every age group.
The highest number reported was in the 20-24 year-old age group with 17.5 of 10,000 hospitalizations being reported for self-inflicted injures. The state average is 10.49 per 10,000 hospitalizations.
The second highest figure reported was in the 15-19-year-old group with 16.6 of 10,000 hospitalizations reported as due to self-inflicted injuries. This figure is also significantly higher than the state average of 9.94. The 34-64 year old group was reported as having a lower figure of 10.8 hospitalizations per 10,000, but still above the state average of 7.6.
There are several reasons why young people are at a greater risk of committing suicide. Adjusting to adulthood is very difficult, experts say, and sometimes the transition is overwhelming.
“From the late teens to the mid-20s is the period of time that people are still trying to figure out who they are, that and the fact that the brain is not fully developed,” Yach said. “Most research shows that the part of your brain that relates to impulsive behaviors, or making you stop and think about your actions, is not fully developed until the mid-20s.”
The 34-64-year-old group was reported as having a lower figure of 10.8 hospitalizations per 10,000, but still above the state average of 7.6.
Most of these visits were to Bothwell Regional Health Center, which does not provide mental health services and is often challenged in finding follow-up treatment for those patients.
“We see a lot of mental health cases in our emergency department and I believe that is because there is a lack of access in the area. We don’t provide mental health services, but we do, de facto, because of the emergency department,” said Lisa Church, Director of Marketing and Communications at BRHC.
Church said that emergency department treatment of behavioral health issues often comes down to an ability to pay, but also happens when a person is not receiving treatment, not dealing with the issue or has a substance abuse problem.
“Then it reaches an emergency and they are brought here,” Church said. “Whenever that happens, we try to find services for them by looking to the community providers. Often times they are occupying a bed in the emergency department, sometimes for up to 24 hours while we are finding a place for them to go. It is indeed a problem.”