Suicide a growing concern

• By Megan Bachman
• Published: June 21, 2018

• No Comments

This article is first in a four-part series on suicide and mental illness in the village.

It’s called the ripple effect. When someone takes their own life, the act impacts entire families and communities, spreading out as water from a stone tossed in a pond. Every suicide directly affects 147 people, and six people experience a major disruption to their lives, according to a 2015 study.

It comes as no surprise, then, that many in Yellow Springs may be reeling from a spate of recent suicides here, in addition to several high-profile suicides nationally. The Greene County Coroner confirmed this week that three residents of Yellow Springs and the surrounding area have died by suicide since Dec. 31, 2017. Those studying local suicide cases suggest a fourth likely suicide, but the coroner is still investigating.

But as the effects of a suicide can ripple through a community, so can stories of recovery and hope. And as the number of local people affected by a suicide has increased, so has the response of local and regional groups intent on preventing more suicides in the village and helping survivors heal. 

One upcoming opportunity is a training in QPR — Question, Persuade and Refer — where participants learn evidence-based strategies to redirect someone who may be considering suicide to instead seek help.

The training offers the chance to practice asking some version of the question, “Are you thinking of killing yourself?” The question may be difficult to ask, but it could save someone’s life, according to Angela Dugger, a co-organizer.

“A key piece is getting comfortable saying the word ‘suicide,’ getting comfortable asking someone whether they are going to harm themselves,” said Dugger, also the director of the National Alliance for Mental Illness of Clark, Greene and Madison counties, or NAMI CGM.

“Ultimately it’s not about how we ask the question, it’s about opening up the dialogue about suicide and saving a life,” Dugger said.

The QPR Gatekeeper Training is Monday, June 18, from 7 to 8:30 p.m. at the First Presbyterian Church, 314 Xenia Ave., in Yellow Springs. It is free to attend, but attendees should RSVP at the Event Brite website (see the link at the end of the article).

Those attending the training will also learn suicide warning signs and where to refer a person who is struggling. Another  goal of QPR is to reduce the stigma associated with suicide and learn how to offer hope, according to QPR trainer Adriane Miller.

“We start off talking about hope and we end talking about hope because if someone is suicidal, they are hopeless,” said Miller, also the assistant director of treatment, prevention and support at the Mental Health and Recovery Board of Clark, Greene and Madison counties.

As villagers deal with the complex emotions that arise when a loved one takes his or her own life, several people addressing suicide who were interviewed this week encouraged continued dialogue on the issue. They addressed several misconceptions around suicide that hinder efforts to address it, and they identified ways that people can find support for themselves and others when someone is dealing with mental illness, or a just having a hard time. Ultimately, it’s about helping each other through pain, according to Dugger. 

“Suicide is not about death, even though that is the end result. Suicide is about pain,” Dugger said. “A person living in pain sometimes can’t see the other side. They can’t see that hope exists. It’s our job as community members to not only remind that person that there is hope, but maybe hold their hand for a little while.”

Suicide in the village

In order to understand, and prevent, suicide in the village, several individuals and groups have been analyzing the recent local suicides. One such group is the Greene  County Suicide Prevention Coalition, a collection of mental health professionals, county agency representatives and community volunteers who meet monthly. 

Although the task is a challenging one because the reasons for a suicide are often unclear, several facts are known. Those who died by suicide in the Yellow Springs area in the last six months ranged in age from 24 to 66 years old, and included both men and women. According to those familiar with the situations of the deceased, potential triggers varied from the recent loss of a relationship to a health crisis.

While the series of suicides here may be a statistical aberration, the Greene County Suicide Prevention Coalition is treating it as a public health crisis. Suicides are on the rise nationally, statewide and in Greene County, but they are increasing especially quickly in Yellow Springs and Fairborn, according to Bob Stolz, president of the coalition.

“Lately it seems like Fairborn and Yellow Springs are the hotbeds for this activity,” Stolz said. “It is no surprise that at our last meeting, the representative from the coroner’s office said we have to do more.”

 Stolz was hesitant to offer specific reasons for the increase, but others weighed in on the possible reasons Yellow Springs might be experiencing a surge, and thus how the community can begin to address it.

To Miller, who also lives in Yellow Springs, it is clear that the village has experienced plenty of recent pain, pointing specifically to the 2013 fatal police shooting of a villager with known mental health issues during a late-night standoff, among other losses. There may be similarities in how villagers deal with pain as well, she said.

“I think in a community like ours, full of empathetic individuals, people carry that pain around even if it didn’t impact them directly,” Miller said. “Then when your own life becomes stressful, it compounds it.”

At the same time, Miller believes the village isn’t immune to outside cultural influences, for instance, that one should cultivate a positive social image over an authentic expression of one’s emotions.

“We all have the Facebook persona and that’s what we want to put out there, so when you are feeling sad, you hide it,” Miller said.

Kathryn Hitchcock, director of outreach and development for NAMI CGM, agreed that Yellow Springs may be affected by broader trends. A significant one is that towards declining participation in civic groups and clubs and lower church attendance, which means a severing of social ties.

“We don’t belong to social groups the way we used to,” Hitchcock said. “We’ve lost social contact and Facebook and Instagram don’t do the same thing.”

Those interviewed this week pointed out a host of additional reasons that suicide may be rising nationally, and locally, including the increased availability of firearms; a weak economy; the rise in substance abuse, particularly alcohol and opiates; the bullying environment of social media; the effects of trauma and PTSD, especially on veterans; and the opioid epidemic’s impact on first responders. 

Unpacking suicide facts

Of course, Yellow Springs isn’t alone. Suicides are on the rise across  America, according to a report released just last week from the Centers for Disease Control. The report revealed that the rate of suicide grew 25 percent in the U.S. between 1999 and 2016, and rose even more sharply in Ohio, which experienced a 36 percent surge over that time period.

Nationally, 45,000 people die annually of suicide, making it the 10th leading cause of death and the second among those 15 to 24 years old, according to the CDC. Those most at risk of suicide are men; LGBTQ youth, who are four times more likely to attempt suicide; and people who are transgender, 41 percent of whom have attempted suicide, the Suicide Awareness Voices of Education found.

In 2016, Greene County had a lower suicide rate (at 12.75 per 100,000 people) than the state (14.11) and country (13.42). But suicides in the county are becoming more common. Last year, the 25 suicides in Greene county increased the county rate to 15.17, up from its five-year average of 12.36. In 2012, by comparison, there were 14 suicides countywide. Counting four suicides in Yellow Springs, the rate would be 108.7 here, seven times the county average.

Nationally, men are four times more likely to die than women by suicide. There is a similar ratio in Greene County. Of the 112 suicides in Greene County over the last five years, 91 were male, 63 were among those aged 25 to 66, and 61 were completed with a gun, which are all on par with national figures. In addition, 104 were white.

“White, middle-aged men are still the highest category in Greene County,” said Miller of the Mental Health and Recovery Board.

One reason men have a higher suicide rate is that they are more apt to use firearms, which are more likely to be lethal than other methods. But there are other reasons, Miller said, including the cultural messages that “boys don’t cry” and that men should “be strong” by not discussing their feelings when facing adversity.

“In Yellow Springs I don’t feel gender roles are as pronounced, but they are still there,” Miller said. Another reason could be that men, who often feel like it’s their role to provide for their family, take the loss of employment particularly hard, she  said.

Hitchcock added that men might be less likely to reach out for help when they need it.

“Most men don’t ask for help, even men we think are emotionally expressive,” Hitchcock said. 

However dismaying these suicide statistics may be, the problem might be even worse, according to several people interviewed. Miller believes that suicide statistics are lower than the reality because a coroner may be reluctant to designate a death a suicide for a variety of reasons. For example, the decision is difficult if not impossible to reverse and the designation may affect the payment of a life insurance policy or come with other legal repercussions, according to Miller.

In addition, there are times when a death that is ruled to be natural causes is actually a suicide, but there is not enough evidence for the coroner to be sure. 

“Death by suicide statistics are very, very low because single car crashes, drug overdoses, or someone who has attempted suicide and dies later from the complications are not labeled suicide,” Miller explained.

There is also the issue of stigma that a family has to deal with when the death of a loved one is determined to be a suicide. 

“I think it’s for the protection of the family sometimes,” Miller said. “People don’t want that on the death certificate.”

Fighting stigma through dialogue

The stigma associated with suicide may be one reason why those struggling with suicidal thoughts resist seeking help, and it’s also a factor that complicates the grieving process of suicide survivors, according to several interviewed.

Contrary to what some think, suicide is not a selfish act, asserts Hitchcock. Angela Dugger, of NAMI, said that mental illness and addiction are the only illnesses where  those with the illness are blamed for their behaviors. To Miller, while the suicidal person is often blamed for their death, the root is a mental disorder.

“I don’t think people always understand this is a brain disorder — it’s not a choice,” Miller said. “People don’t choose to be sad, to be addicted, to be depressed.”

Mental illness, which affects one in five people according to NAMI, carries a stigma that can and must be, fought, according to Hitchcock. It can be as simple as reaching out to a friend or family members and asking this question, “Are you okay?” she said. 

Contrary to a popular myth, asking someone if they might harm themselves won’t cause them to do so, Hitchcock affirmed. But it makes them feel less alone, and could open the door to them seeking help.

“It shows I care. It says I’m interested in you,” Hitchcock said.

In the vast majority of suicides the person will have said or shared something that indicated he or she might take their life, according to Miller. While it may only be evident in hindsight, the opportunity often exists to intervene.

In the film “Ripple Effect” screened recently at the Little Art Theatre, suicide survivor Kevin Hines relayed his experience with depression and suicidal thoughts, saying that he wished someone had reached out to him earlier.

Hines, who jumped from the Golden Gate Bridge at age 19 and survived the fall, yearned for someone to ask him how he was, even up to the final moments before he jumped. Instead, he felt he was a burden on others and felt he had “no choice in that moment,” he said in the film. Immediately after jumping he regretted it, as did numerous other suicide survivors he interviewed in the intervening years.

Those who are suicidal may not see options, but if they can get through the moment where they feel they can’t go on, they could be helped, Hitchcock believes. 

In the QPR model, that help takes the form of asking a pointed question (Q), persuading the person not to take their life (P) and referring them to professional resources (R). According to the event flyer, “like CPR, QPR is a simple process that anyone can be trained to use to help save the life of a person in crisis.”

In cases of suicide, the person may have had a long battle with mental illness, or they might be struggling with a difficult life event. Suicide is completed in 90 percent of cases by someone with an existing mental illness or substance abuse problem, according to the Suicide Awareness Voices of Education. In those without such a history, the top contributing factors are a relationship problem, a crisis in the past or upcoming two weeks, a physical health problem, or the loss of a job or a financial problem, according to the Centers for Disease Control.

Another potential trigger for suicide is losing someone to suicide, Miller said. In fact, those who know someone who died by suicide are more likely to die by suicide themselves.

“If you are upset about someone dying of suicide and it’s not leaving you, you need to ask for help,” Hitchcock said.

Unfortunately for those who have lost a loved one to suicide, the feelings of loss and sadness are often compounded by guilt, confusion, anger, trauma and the effects of stigma, which may keep them from reaching out for support, according to a 2012 study, “Suicide bereavement and complicated grief.”

To Dugger, suicide is still a taboo topic that few are comfortable talking about. However, breaking the silence is essential to reaching those who need help processing their emotions, she said. Dugger isn’t afraid to broach the topic in public, recently sparking a conversation about teen suicide while picking up lip gloss at Kohl’s.

“I’m not shying away from conversations,” Dugger said. “Ninety percent of the time it opens up a window that it’s a safe place to have conversations around mental illness. People know they won’t be judged in response.”

Miller also urges communication. The upcoming QPR training is one place to begin.

“We need to communicate. We need to figure out how to heal as a community.  Right now we’re hurting, and we’re so divided.”

To RSVP for the June 18 QPR training, visit https://www.eventbrite.com/e/qpr-training-tickets-46116062384.

Upcoming articles in the series will cover the warning signs of suicide, strategies for survivors of suicide, new efforts by the Yellow Springs Police Department to support those with mental illness, and resources in the village, county and beyond for those with a mental health issue or who want to get involved in preventing suicide.

News intern Morgan Beard contributed to this article. 

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