Coinciding with National Suicide Prevention Week, the National Council for Community Behavioral Healthcare (NCCBH) held a Webinar on Wednesday titled Suicide Primer: Signs, Symptoms and Risk Factors featuring Survivor Stories.
“Suicide is a serious public health problem,” said David Covington, a NCCBH board director and co-lead for the National Action Alliance on Suicide Prevention’s Clinical Care & Intervention Task Force. “Each year, more than 36,000 Americans die as a result of suicide, nearly 100 a day.”
Covington, who also serves as vice president of Adult & Youth Services for Magellan Health Services, said that suicide is now the tenth leading cause of death in the United States.
“For every person who dies, more than 30 others make an attempt,” he said. “We now know that more than eight million adults each year report having had serious suicidal thoughts.” Covington said that while certain groups may be likelier to make attempts, he believes that suicide “does not discriminate” when it comes to at-risk individuals.
While major media attention has been given to specific at-risk populations recently, such as veterans and LGBT youth, he said that the population most likely to attempt suicide, those with mental illnesses, are often ignored, even though individuals with serious depression, bipolar disorders and anorexia are six to 12 times likelier to attempt taking their own lives than the general population.
Covington said that the topic of suicide ideation still carries a strong social stigma, and introduced several presenters whose lives were forever altered by suicide and suicide attempts. “The importance of these stories,” he said, “cannot be underestimated.”
Retired Major General Mark Graham said that he felt as if he had “one of those Walt Disney families, where everything was just great.” He said that his sons died fighting two different kinds of battles, as he lost one son, Kevin, to suicide, while his other son, Jeff, was killed by an improvised explosive device (IED) while on active duty in Iraq.
“We didn’t know the warning signs, we didn’t know enough about it,” Graham said. Although his son died in 2003, he said the memory still “feels like yesterday.”
Graham said that his son Kevin had stopped taking anti-depressants, because he didn’t want his advanced ROTC officers to know he was on medication. Graham said that his son felt ashamed of his illness, and recalls conversations his wife had with their child.
“‘Mom, did you know depression is an illness and not just a sad feeling?’” he recalled Kevin saying.
“As a dad,“ Graham said, “I didn’t know you could die from being too sad.”
Graham later found out that depression ran on both sides of the family, but said no one was aware because it was never openly discussed.
“No one in the family talks about depression,” he said. “We have to continue the conversation, we have to get the word out. The stigma is horrendous.”
Shortly before Jeff was deployed to Iraq, Graham said his son had a discussion with a fellow soldier, who was experiencing suicidal thoughts. He said his son helped him out by telling him “don’t do like my brother, don’t die. Stay alive, we need you.”
Graham said that he felt an onus to help out others experiencing depression. “We know depression is diagnosable and treatable,” he concluded. “We can never get our son back, but we can help someone else.”
Kevin Hines, a suicide prevention advocate and author of the upcoming biography “Cracked…Not Broken, The Kevin Hines Story” said that he was “here on this planet, but of the grace of God.”
Hines is one of only 33 known survivors that have attempted suicide by leaping from San Francisco’s Golden Gate Bridge. He said that his extreme depression was rooted in his childhood, specifically noting his parents, who had alcohol problems and were both diagnosed with manic depression. He said his biological parents would often leave him and his brother unattended while they searched the streets for drugs.
Hines said that he spent several years in San Francisco’s foster care system, which he said “back then, was in shambles.” He said he bounced from home to home, until being adopted by a family that gave him a “second chance at life.”
“I grew up in this kind of fairy tale life, living with this beautiful family, my family,” he said. “But at the age of 17-and-a-half, I developed the brain disease bipolar disorder type 1 with psychotic features.”
In his late teens, Hines said he began experiencing paranoid episodes, with hallucinatory visions, which he called “terribly violent and horrifying.” He said he began hearing voices in his head, which told him that he was a burden to his family and friends.
The “most backbreaking symptoms” of bipolar disorder, he said, were the manic highs, which routinely led to him “crashing into depths of depression.” He began experiencing suicidal thoughts in September 2000.
“The pain that is accompanied on you by mental illness is so very real, and so epically painful,” he said. Hines said the emotional pain was far more powerful than any physical pain he had experienced, describing the suffering as “mind bending and bone crushing.”
At 19, he began exploring web sites that gave “tips” on carrying out suicide attempts, which gave him the idea to end his life by jumping off the Golden Gate Bridge.
“It was a four foot rail,” he said. “It was so easy.”
Hines said that, prior to his jump, he walked around the bridge for almost an hour, weighing whether or not he should make the attempt. “All I wanted to do was live, but I believed I had to die,” he said. “My brain wouldn’t allow me to care.”
Hines said that he hit the waters of San Francisco Bay at 75 miles per hour. Although Hines survived the 220-feet drop, he spent extensive time in recovery, including undergoing a procedure to insert metal plates into his vertebrae.
“From that point on, I realized that I am not to sit around idly by in my house, eating potato chips, just watching the television or playing video games,” he said. Ever since, he’s campaigned to have barricades and safety nets installed at the iconic landmark, to prevent others from ending their own lives.
“We’re all here for hope, and it exists for everyone,” he said.
Cheryl Sharp, a special advisor for the NCCBH’s Trauma-Informed Services, said that her depression began in her childhood, stating that she grew up in an environment where the illness had to be shrouded in secrecy.
“It was very clear that we were not to discuss anything that was happening in the home outside the home,” she said. Her first suicide attempt occurred when she was just 13 years old.
“I often felt as if I was walking between two worlds, one where I desperately wanted to live but didn’t know how,” she said. “The other was a world where I desperately wanted to cease to exist in order to not feel the emotional pain I lived with every day.”
Sharp said she felt the need to “mask” her depression. “I always put on a happy face,” she said, “but the underlying difficulties were not addressed.”
Suicide, she believes, never happens in a vacuum. “By the time I was 24,” Sharp said, “I had tried nine different times.”
She said that suicide is rarely a conscious individual choice, stating that when certain connections - both social and biological - are disrupted, many suicidal individuals hit a “snapping point” where desires drift from ideation to physical planning.
“We have chemicals in the body that are bonding chemicals,” she said. “We are hard-wired with a desire to be connected to others, and a desire to survive.”
Sharp said that keeping her depression a secret made her feel different from her peers, that she was too difficult and too much of a burden for the people she cared about.
She advised individuals not to tell potentially suicidal friends or family members that they have “so much to live for.” When individuals are suicidal, Sharp said, they often cannot see beyond where there are at that particular moment in their lives. Instead, she suggests that loved ones let the individual know how much they care about them, and make efforts to understand their predicaments and ask them what would be helpful to them.
Sharp considered peer support systems and wellness tools such as Wellness Recovery Action Planning (WRAP) vital to combating suicidal behavior, additionally stating that she would like to see the de-stigmatization of strong emotions connected to depression and the promotion of safe alternatives to medication and hospitalization.
Bryan Gibb, NCCBH’s Director of Public Education, is the lead trainer of Mental Health First Aid, a NCCBH program that has state government partnerships in both Maryland and Missouri.
“It’s a lot like first-aid,” he said. “It’s designed to teach people how to recognize some of the signs and symptoms of mental illness, to assist someone that’s starting to feel unwell.”
The program has trained more than 70,000 individuals, and has more than 2,000 instructors nationwide, to assess for suicidal risks and encourage self-help through support strategies.
Gibb said that while certain demographics are at increased risk for suicidal behavior, such as the chronically ill or individuals with few social support systems, the two key factors in risk assessment are uncovering whether the individual has made previous attempts or has already made plans to end his or her own life.
“Suicidologists really encourage us to be aware when someone’s mood changes dramatically,” he said. “Maybe they were morose for a while and all of a sudden they seem to be lighter, they seem to be feeling better.” In some cases, these fluctuating dispositions aren’t an indication of well-being, he said, but potentially a sign that the individual has made plans to attempt suicide, and no longer feels conflicted about his or her feelings.
Gibb said that individuals need to ask very direct questions about whether or not their loved ones are considering suicide, and encourages friends and family to provide safety contact numbers - like the National Suicide Prevention Lifeline (1-800-273-TALK) - for distressed individuals at all times.
“If someone is actively suicidal, there’s not a lot of time to tell them, ‘you really should consider going to see someone,’” Gibb concluded. “It’s a time to go with that person to the emergency room, to go with that person to see a clinician or to stay with that person on the phone [and] to call for help.”
Photo from the National Council for Community Behavioral Healthcare.