Suicide Prevention: When a ‘Crisis of Hope’ Signals a Call for Help

Kerry McCray Holland
By Kerry McCray Holland March 15, 2014 15:15

Call for Help: Click here for a local, state and national Depression and Suicide Prevention Resources 

Your father is newly diagnosed with cancer. Your neighbor lost her longtime husband. Your friend cares 24/7 for his wife, who suffers from Alzheimer’s.

You may think these things are just part of getting older. But Central Sierra and Northern California health professionals say they could lead to a bigger problem: suicide.

But isn’t suicide more common in younger generations? Teen-aged girls upset over breakups or middle-aged men despondent after losing their jobs?

The answer is no: Nationwide, baby boomers and elderly Americans are at higher risk and foothill seniors higher still. In Tuolumne, Calaveras and Amador counties, suicide rates are on average two to three times higher than the statewide figure.

Both here and nationwide, older men take their own lives at a rate often twice that of teens and young adults.

Why men? They are more likely than women to use guns, a far more lethal method of committing suicide.

“We don’t want to think about people 50, 60- plus killing themselves,” says Patrick Arbore of the Institute on Aging, a San Francisco-based nonprofit providing services to the elderly, caregivers and adults with disabilities.

Arbore started the Center for Elderly Suicide Prevention and Grief Related Services, a program now under the umbrella of the Institute of Aging, to help address the problem.

“There’s a lot of denial,” he says. “We don’t want to think it’s my husband, my father, my grandpa.”

Rural reality

It seems almost unnatural to think about suicide in our mountain communities, where many people come to enjoy their retirement years. But rural areas throughout the world, including the foothill counties, have historically had high suicide rates.

Consider California: According to 2003-2010 Centers for Disease Control and Prevention statistics, tiny Alpine County had the state’s lowest population (fewer than 1,200) and its highest suicide rate (43.6 per 100,000). And sprawling Los Angeles County had its highest population (nearly 10 million) and lowest suicide rate (7.3 per 100,000).

Small populations like Alpine’s can yield fluctuating, inconsistent data. But of California’s 58 counties, the 23 highest suicide rates are all in sparsely populated mountain and agricultural counties.

In 2009, the latest year for which statistics were published online by the state Mental Health Department, California’s suicide rate was 9.7 per 100,000 people.

By comparison, the suicide rate for Tuolumne County was nearly three times higher – 29.1 per 100,000. Amador County reported a rate of 22.6 and Calaveras, 17.0. In all, 89 suicides were reported in the tri-county area from 2007-2009. Of those, 72 were men. More than half of those who took their own lives were 55 or older.

Public health officials have long speculated on reasons why the rate is higher in rural areas. Does access to mental health care make a difference? Ethnicity? Economic status?

Dr. Todd Stolp, Tuolumne County’s health officer, examined the issue in 2009. He came up with a 13-page study suggesting four factors contribute to high suicide rates here: drug and alcohol abuse (people on drugs and alcohol can be impulsive); violence (as measured by reported child abuse and homicide); ethnicity (Native Americans and whites are statistically more likely to attempt suicide); and ready availability of guns.

Access to guns has long been linked to increased suicide rates. People who live in areas of high gun ownership are more likely to die by suicide, according to a 2007 study by the Harvard School of Public Health.

Other studies have concluded that a gun in the home increases suicide risk dramatically – by two to 10 times.

Myriad factors

Still, there are other factors.

“Men could be widowed, living alone, have access to guns,” says Brock Kolby, interim director for Behavioral Health in Calaveras County. “Alcohol use is often there.”

So are life changes, like losing a spouse, caring for a loved one, or experiencing an identity crisis after retirement.

“If you live long enough, you are going to experience some crisis of hope,” says Bob White, director of Tuolumne County’s YES Partnership, a group active in suicide prevention for all ages. “It’s how you move through that crisis that matters.”

This points to the importance of mental health resources, often scarce in rural communities. In 2007, after concern about suicide grew statewide, local officials established a task force focused on prevention. Several programs – including three types of suicide-prevention training – came out of the effort.

The YES Partnership now contracts, through the Tuolumne County Behavioral Health Department, to provide these services. Its workers also speak with gun shop owners and employees about suicide, as well as to physicians and their office staffs.

Some suicides, says Martha Golay, youth and family programs coordinator for the YES Partnership, come after medical appointments. It could be that a patient receives a bleak diagnosis; it could be that a patient with suicidal thoughts makes an appointment looking for help. Another possibility is what doctors call somatization – when a patient feels physical pain in connection with psychological pain.

Other regional prevention efforts include senior peer counseling, telephone help lines and 24-hour local crisis lines in each county.

These efforts may be helping, but the problem is so complex that it’s hard for health officials to say. In small populations, yearly statistics can swing wildly due to the small sample size compared to the state’s steady rate in a 38-million population.

Tuolumne County, population 54,000, reports a rate of 18 suicides per 100,000 population in 2012 and 6 per 100,000 in 2013. While this decline is good news, Stolp says, it’s difficult to know whether it is a trend or an anomaly.

The county reported nine suicides in 2010, 14 in 2011, 10 in 2012, and three in 2013. Of the four-year total of 36, 29 were men; four were 65 or older. Stolp says it’s “too early to assess” whether interventions may have played a role in the falling numbers, and that “much longer periods of data collection are required to accurately reflect rates in small populations.”

Amador County, with a population of 37,000, had 15 suicides in 2010, and nine such deaths each year from 2011-2013; 39 of the 42 who died were men, and about half were 55 or older, the sheriff’s office reports.

Calaveras County, population 44,700, has had a rate of about 18 suicides per 100,000 people in recent years. The county reported seven suicides in 2010, 14 in 2011 and 16 in 2012; about half were 65 or older. Figures for 2013 were not available.

Recognizing depression

Suicide prevention resources can help, says the Institute on Aging’s Arbore, but only if seniors use them.

He says older people – particularly men – may not seek help, especially in rural areas. Arbore, 65, raised on a Pennsylvania dairy farm, tells of the attitude he experienced growing up.

“From the time you were little the message was, ‘You take care of yourself,’ ” he says. “But as you get older, you need people, you need to ask for help.”

Yet research shows that older people tend to shy away from therapists or counselors. Fewer than three percent of adults 65 and older have visited a mental health professional, according to a study published in the American Journal of Psychiatry.

They might mention symptoms of depression to a friend or neighbor. But often those friends dismiss things like being anxious or sleeping too much as typical signs of aging.

“We confuse depression with getting old,” Arbore says. “Depression is not a product of being older – it’s a medical illness.”

Risk factors

Other risk factors include alcohol and drug abuse, impulsivity or aggression, and mental illnesses, including bipolar and anxiety disorders. These risks may be heightened by the death of a loved one, a financial loss, and prolonged unemployment or relationship conflicts, according to the American Foundation for Suicide Prevention (AFSP).

Warning signs of suicide include acting anxious or agitated, sleeping too little or too much, talking about having no purpose, talking about being a burden, and often even mentioning suicide.

In suicide-prevention lingo, that kind of talk is called an invitation. It means the person wants to talk about suicide, says Bob White of the YES Partnership.

“There are usually invitations, and either we miss them or we ignore them,” he says. “They might say, ‘I’m sad I lost my spouse, I’m depressed, I’m not getting out.’ ”

Don’t be afraid to ask the person if he or she is contemplating suicide, says Calaveras County’s Kolby. Contrary to popular belief, bringing up the topic won’t make the person more suicidal.

“Sometimes they’re relieved if people ask them about suicide, or ask them if something’s wrong,” Kolby says.  “They often give signs, but people don’t put it together.”

At least half and as many as 75 percent of those who attempt suicide gives some early indication, either directly or indirectly, the AFSP says.

While people often go to lengths to hide suicidal thoughts, Stolp says, “Seeing through those efforts to conceal such thinking or revealing such plans … can lead to steps that successfully prevent suicide.”

How to help

If you suspect a person is contemplating suicide, the foundation recommends these steps:

  • Tell the person that you are concerned and why.
  • Do not leave the person alone, and remove any firearms, drugs or alcohol.
  • Take the person to an emergency room; if that’s not possible, call 911 or the National Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Helping an older person anticipate life changes is another way to prevent suicide, Arbore says. A son or daughter might ask what his or her parent will do when a spouse dies or how he or she will finance long-term care.

“Say, ‘As difficult as this may be, we need to talk,’ ” Arbore says.

It’s particularly important to ask men, he adds, because their suicide attempts, frequently with a gun, more often lead to death. Have the conversation with anyone you think might be going through a crisis.

“Connect with people,” Arbore says. “Be kind, conversational, not confrontational. The worst thing is to ignore.”

Time is of the essence, as research indicates suicide is often an act of impulse. A 2001 University of Houston study of 153 people who survived a suicide attempt found that 70 percent decided to kill themselves less than an hour before the attempt.

For people who survive such an attempt, however, there is hope. Stolp notes that 90 percent do not subsequently die by suicide.

 Copyright © 2014 Friends and Neighbors Magazine

Kerry McCray Holland
By Kerry McCray Holland March 15, 2014 15:15
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