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Call for help

St. Mary's B.E. Colway knows the warning signs of suicide and knows which questions to ask.

"Do you have a plan? And, if so, what is your plan? Is there a means available? If they're talking about their car and they came alone, I'm not sure how safe they are," she explains. "Past history is a big factor. How many times have you attempted before? And what was your method? If they've overdosed 10 times before, I bet they've got some pills at home or know how to get some. All of those things play into it.

"You also look at family history. We've had a patient whose father suicided, whose mother suicided, and her brother suicided and her other brother died in a single car wreck a few years ago. All were between the age of 35 and 40. When this person came in, she was 33."

If any of these questions hit a chord with you and you feel that you may be a danger to yourself, please contact any of the following free resources.

CONTACT Helplines:
In Oak Ridge and Anderson County: 482-4949
In Knox, Blount, and Loudon Counties: 523-9124
In Meigs, McMinn and Monroe Counties: 745-9111

Mobile Crisis Response Unit: 539-2409

St. Mary's Assessment Center: 545-7222

If you need assistance immediately, go to your closest emergency room.

If you are grieving a suicide:

Knoxville Suicide Grievers Support Group: 671-9631 or [email protected]. The group meets the second Thursday of the month from 7-9 p.m. at the Cokesbury Center (9915 Kingston Pike), room 400.

Maryville Suicide Grievers Support Group: 984-7132, 368-5774 or sandyogle51@ wmconnect.com

More young people take their own lives than die from better publicized killers. And the numbers just keep growing.

by Adrienne Martini

Suicide is a particularly awful way to die; the mental suffering leading up to it is usually prolonged, intense, and unpalliated. There is no morphine equivalent to ease the acute pain, and death not uncommonly is violent and grisly. The suffering of the suicidal is private and inexpressible, leaving family members, friends, and colleagues to deal with an almost unfathomable kind of loss, as well as guilt. Suicide carries in its aftermath a level of confusion and devastation that is, for the most part, beyond description.
—Kay Redfield Jamison

The numbers speak more loudly than any prose a writer could dream up. In Knox County, the number of suicides has doubled in the last four years, from 37 in 1999 to 74 in 2002. In Blount, the number has tripled in the last two years, from 9 to 28. Just for comparison's sake, last year there were 22 murders in Knoxville, while 369 Knoxville teenagers attempted to kill themselves. The percentage, which is 4.4 percent of all area teens, makes the number of kids trying to snuff themselves seem paltry, but the raw number is greater than most area high schools' graduating classes.

In the U.S., 30,000 people kill themselves each year, a number that exceeds UT's enrollment. It is the third leading manner of death for teenagers and the second leading cause of death of people aged 25-34. Only unintentional injuries kill more Americans in this demographic. Twice as many people die by their own hands as from HIV, and for every two homicides there are three suicides. Cancer and heart disease run behind suicide—and make the news more frequently, what with all of the public information campaigns and rallies for more research dollars.

With these numbers, you'd think that methods of suicide prevention would be as deeply ingrained into our public consciousness as our cholesterol numbers and resting heart rates. But the stigma that surrounds taking one's own life keeps it from being a cause to rally around.

"The room gets very quiet when you talk about this particular issue," says Alice Brown of the Mental Health Association of East Tennessee. "It's like you can't even say the word because that might put the idea in someone's head. I think one of the things that we've learned through this program is that by just saying it, you're not going to cause anybody to attempt suicide. They're probably already thinking about it."

Even though we as a culture won't talk about it, suicides are still occurring—even here in Knoxville—and the numbers continue to rise.

Losing a Son

Sandra Ogle has faced a parent's worst nightmare. Three years ago, on March 8, Ogle walked into her bedroom and found the body of her son Rodney, who had shot himself in the head with a 20-gauge shotgun. He was 29 years old.

Rodney had been going through a difficult time. He and his wife were having some problems, and he'd moved back home until it all sorted out. He was also a father who was separated from his two kids. And he was also an alcoholic, struggling to stay sober.

"There is a quote that I keep going back to," Ogle says. "'Suicide is a permanent solution to temporary problems.' People who suicide really do not want to die. They just want to end the pain. I think in Rodney's case—he had always acted on the spur of the moment—if he'd have had a distraction for just a few minutes, then he would not have done it."

But there is more to Rodney than the reasons behind why he ended his life.

"The biggest thing I could say about Rod is that he was one of the most kind-hearted people you could ever meet. He was the type who would give a person his last dime if he thought they really needed it. He loved his children so much, which makes it so hard to understand why he'd do it. He was never in any trouble, never got in trouble with the law or anything like that. He was just a super great person."

Rodney, while a unique individual in his own right, does fit into some larger nationwide trends. Men are four times as likely to die from their attempt as women are. More than half of all suicides are committed with firearms. Suffocation and poisoning account for 30 percent—and recent changes in dispensing medications and limiting car exhaust emissions continue to bring that number down. Falls account for a mere 2 percent of all suicides, yet these deaths are probably the most public. Just a few weeks ago, a 36-year-old UT student leapt to his death from his 14th-floor apartment on Laurel Avenue.

What doesn't show up in these statistics is the cost to the people who are left behind. While the grieving process is similar to that brought on by other deaths, suicide packs with it an enormous helping of guilt with its grief.

"With an accident, you don't have the guilt feelings, the always wondering why and always thinking that you should have been able to do something...should have been able to see this—and it's not just one person who feels this. It's everyone in the family," Ogle says. "In my son's case, he has two little children. They're left without a dad. That's something that can never be replaced."

Talking about what happened helps Ogle work through the unique issues raised when a family member kills him- or herself. She found the Knoxville Suicide Grievers' Support Group (see "Call for help" for meeting information) and it gave her a place to start processing her grief. She has also started her own group in Maryville.

"I don't think I that I could have survived without the [Knoxville] group. It gave me a chance to talk to people who would understand what I was going through. Anyone who hasn't lost a child or gone through suicide, they think they know what you're going through, but they don't. It helps a lot to talk about it. Talking about it is something that we will always have a need to do. I have people who have lost someone 15 years ago who still have a need to talk."

If there were one thing that Ogle would like everyone to know about what happened, it is this:

"There is hope if you just reach out to someone. My son tried to, to me. I could see that after it happened, but he never talked to me in a way where I really understood the kind of help that he was needing. Just get it out and talk to someone—a psychologist, a family member," she says.

A Moving Response

On this drizzly morning, the Mobile Crisis Response Unit is quiet. Two operators—one a friendly woman in her early 30s, the other an older woman who is on the phone—staff the call center, which is housed in Peninsula Behavioral Health's Bearden building. Outside of the office is a large wooden lighthouse, a remnant of the location's former life as a seafood restaurant.

The symbolism is apt. For over a decade, Mobile Crisis has functioned as an assessment service for people in urgent need of aid and information. Five counties—Knox, Sevier, Loudon, Monroe, and Blount—are served by Mobile Crisis. The phone lines are staffed 24 hours a day, 365 days per year and are free for all who need them.

"Pretty much any kind of emotional crisis would qualify somebody," says Mark Potts, the unit's director of clinical services. "Anyone who is experiencing a crisis can call us anytime of the day, and someone will talk to them. They will talk to a trained counselor on their first call—and that person is trained specifically to do a risk assessment, a quick determination whether this is one we need to attend to absolutely immediately or if the last one we had to attend to immediately is still the priority.

"You'll hear me refer to it as 'urgent assessment' whenever I talk about what Mobile Crisis does because I think the program was misnamed," Potts says. "We get a lot of calls asking us to come—calls that should be 911 calls. Like—'come over here, he's got a gun.' What we provide is an urgent assessment."

In addition to the call center, the team, which consists of over a dozen trained staff members, makes assessments in the community. Seventy percent take place in area emergency rooms. Others can vary in location, from physicians' offices to the backs of police cars.

By late afternoon, more staff has come on board, and the phone lines light up like those at a PBS fund drive. This pattern plays itself out every day. Mornings are quiet, but it consistently picks up by 3 p.m., then tapers of by 9 p.m., according to Potts.

There are other patterns as well. While Potts won't comment on whether or not call volume increases after the Vols lose, he does mention that "there's a whole pattern of calls that are related to alcohol-type crises. Those typically are early morning calls, and we aren't even able to assess someone who is intoxicated until their blood level goes below a certain level.

"We could probably take statistics over the last 10 years and locate any event that you'd typically associate with more calls. You'd probably find some time in the last 10 years that proved it. I was talking to another Mobile Crisis Response staffer who was on duty on Father's Day. They got almost no calls in the morning, then the board lit up," he says.

Potts, who bears a striking resemblance to Dr. Phil, has been in the mental health field for 25 years and in his current position for more than a year. While perceptions about suicide and the mental illness that underlies it have changed over the years, it is still stigmatized.

"Not wanting to say 'mental illness is no big deal'—it is a serious illness—it doesn't mean that the person can't have a meaningful life. It means that there are things they have to do to take care of their particular condition. And that's all it means.

"The more we learn about the brain, a lot of things that were hopeless conditions 25 years ago are not today because of the advancement of our knowledge. The most important thing when talking about mental illness is to keep an open mind and keep your hope. It doesn't mean you're a bad person."

A Brain Attack

People who are having suicidal thoughts don't just present themselves to the mobile crisis team. Area hospitals also offer aid to those who are starting to visualize harming themselves.

"The cry for help can go anywhere," says B. E. Colway, a behavioral services program manager for St. Mary's Health System. "Any adequately trained professional will hear that and recognize that if it's beyond their level of competency to care for, what the next appropriate step would be. You never want to just let them go."

There are many redundancies built into the mental health network in Knoxville. Rather than hinder the system, this web of possible support agencies only helps those who are in need. Each provider offers a specific level of care. St. Mary's and Baptist hospitals both offer inpatient psychiatric services that are voluntary. Lakeshore provides a place for those who are violent, homicidal, and/or an active danger to themselves or others.

Emergency rooms catch quite a few potential suiciders. Thirty percent of St. Mary's psychiatric unit admissions come from the ER, with another 30-to-35 percent coming from private physicians or psychiatrists, and the rest coming through the instigation of family and friends of the patient. Caregivers build their own assessments of the patient and are free to send them to the specific program—no matter whether it is the one that hospital operates or not—that would offer the most help.

"Hospitals work closely together with this population," says David Hamilton, community resource manager at St. Mary's. "You maybe get someone who is more appropriate for the program at Baptist. We make sure we have those good relationships for the benefit of the person we're working with. We look at what the best available resource is, within the entire community. "

One step down from the ER, which is where the most acute cases are urged to go, is St. Mary's free assessment center. Appointments must be scheduled for this service and the staff generally sees people who can sense that they're slipping or are referred by their family doctor. From there, a counselor will make a recommendation for further care, which can also involve continued care on an outpatient basis with this service.

"Our program here is an intermediate program," Colway says, "for a person who is having a lot of better-off-dead feelings or even suicidal thoughts but has no intent and is willing to contract for safety. Maybe life's gotten really rough for them and they just don't know what to do. If they've got adequate support at home—the husband or wife will remove the guns, for example—then very often they may come to our program, which is a step between once-a-week therapy and inpatient treatment.

"If it's a person who cannot contract for safety, who is not willing to come on the unit, then I'm going to involve Mobile Crisis. Sometimes those people won't sit still—they'll just walk out—and I'll have to get other people involved because this person is clearly a risk to himself and others."

In Colway's opinion, the number of suicides may be under-reported, both locally and nationally. Some deaths that are chalked up to accidents may actually be suicides in disguise.

"It's one of those hidden, silent threats. In doing an assessment, I will ask if people have a plan. Some have been very clear and said 'yeah, I'll be in my car. I think about going over that bridge or into that tree.' So I don't know how many of those fit into the numbers. But I know that anyone I talk to who talks about suicide, I take them seriously. I know a lot of people say 'oh they're just saying that to get attention.' But aren't there other healthy ways to get attention," she asks.

Both Colway and Hamilton stress that suicide is a public health issue like diabetes.

"It's not anybody's fault," Colway says. "A metaphor I use is my glasses—I can't not wear my glasses and wish that I can see. But if I don't put my glasses on, I'm a danger to myself and others. So I wear my glasses. We don't blame people for having heart attacks. This is like having a brain attack and the onset may be rapid or gradual. Where the fault may lie is in not getting help."

Better and Worse

Help can be hard to come by lately, despite the fact that in the past 25 years, the attitudes toward mental illness have changed. In the late 1970s, the country was just emerging from decades of hiding anyone with a mental illness in an institution, where they were frequently pumped full of drugs and treatments like electroconvulsive therapy that had as much subtlety as a machine gun. Those who survived rarely got to mingle with the outside world. It is no wonder that a psychiatric diagnosis was stigmatized.

Great strides have been made in the intervening years both in terms of formulating effective medications and treatments as well as eradicating some of the negative perceptions of the brain conditions that can lead someone to take his or her life. But there is plenty of room for improvement.

"Each individual's brain is so intricately wired that the same treatment is not going to work identically for people. The more research dollars we can get into mental health, the more we understand," Hamilton says. "Yet with the economy the way it's been the last couple of years, you know what's going to get cut—education and health. For those who have a long-term persistent mental illness, the coverage just isn't there. It's like they're saying, 'if you just quit acting like that, everything will be all right.'"

Tennessee falls firmly in the middle when the rate of suicides is compared across the nation. Per 100,000 residents, the statewide rate stood at 12.8 in 2000, with the national rate hovering at 11.3 (which means that if 100,000 people were in a room, almost 13 would kill themselves that year). Rural counties fare much worse than the urban ones. In nearby Claiborne county, suicide is the leading cause of death for residents 25-44. In tiny DeKalb, near Cookeville, the rate of suicide deaths falls at 51.7 per 100,000.

In many ways, the innovative TennCare program promised hope for those who were unable to afford treatment for their psychiatric conditions. But that seems to have fallen by the wayside in budget-crunched Tennessee.

"Five years ago," Brown says, "there was a push for therapeutic nurseries. But now there are maybe one or two left in the state. It was a proven program—but we get in financial trouble and it was one of the first things that are cut. The same thing with TennCare. Granted it's not perfect—but that's the first thing that people attack. We know what works, but it's hard to convince the people who have the money that it's going to work in the long run."

Regardless of how help comes, suicide is a public health issue that needs to be talked about. The numbers don't lie.
 

July 24, 2003 * Vol. 13, No. 30
© 2003 Metro Pulse