Talking About Suicide Is the First Step in Preventing It

Out of the Darkness

In 2020, suicide took 45,979 lives in the U.S. — one death every 11 minutes, and twice the number of homicides.

Many factors enter into someone’s decision to end their life, which can often seem like the best decision to make the pain go away; these factors include, but are not limited to, mental and physical health conditions; stress from harassment, divorce, financial crisis, or other life transitions; loss, abuse, neglect, and/or trauma; or family history of suicide.

Even though suicide rates actually dropped 5% from 2019 to 2020, the isolation during the pandemic caused more mental-health issues; in fact, one in five adults dealt with a mental-health issue in 2020. And isolation is the number-one symptom of suicidal ideation, according to behavioral-health professionals who spoke with HCN.

“The isolation may have been comforting to people. They don’t have to leave the house. Then that may have been comforting, not having to face different outside factors,” explained Elizabeth Therian, program director for Behavioral Health Network (BHN). “But on the flip side, the pandemic also increased a lot of the risk factors, such as domestic-violence situations, and increased anxiety for a lot of people, like this big fear of the unknown virus that there wasn’t much known about.”

Cristina Rivera, director of Outpatient Services at MiraVista Behavioral Health Center, agreed and added that increased substance use was another factor during the pandemic because of the lack of support for many people. Other common symptoms include, but are not limited to:

• Talking about wanting to die, great guilt or shame, or being a burden to others;

• Feeling empty, hopeless, trapped, extremely sad or anxious, or unbearable emotional or physical pain;

• Changed behavior, such as making a plan or researching ways to die, taking dangerous risks (including driving fast or recklessly), displaying extreme mood swings, or eating or sleeping more or less; and

• Saying goodbye or giving away important things.

One symptom that can be overlooked is anger and agitation, a state often not associated with depression.

“Most people don’t really express depression or being sad in a typical way, like isolating or not talking to anybody or withdrawing themselves,” said René Piñero, vice president of Behavioral Health and Clinical Operations at the Mental Health Assoc. (MHA). “But a lot of times, if you see somebody who is more irritated or gets angry more easily than usual, then those are typically signs that somebody might be going through something and they just haven’t talked about it with somebody.”

Mental health and suicidal ideation often causes a person to feel some sort of guilt or shame, and they repress the feelings, causing them to isolate from friends and family even more.

A lot of times, if you see somebody who is more irritated or gets angry more easily than usual, then those are typically signs that somebody might be going through something and they just haven’t talked about it with somebody.”

René Piñero

The stigma is especially high among men and the elderly. Males make up 49% of the population, but nearly 80% of suicides, and people over age 85 have the highest rates of suicide among all age categories (20.86 per 100,000 individuals).

Mental health for older generations has been seen as taboo and a topic that shouldn’t be discussed; it is often looked down upon negatively. And displaying emotions of sadness or asking for help is often seen as a weakness amongst men.

But in order to combat the mental-health epidemic that was worsened by the pandemic, a more positive light needs to be shined on the importance of getting help and treatment when necessary. And that starts with a conversation.

It’s OK to Ask for Help

The first step to destigmatizing suicide and suicidal ideation is to talk about it.

“Often you’ll hear people say, ‘I have asthma,’ or ‘I have diabetes.’ And it’s not anything that people would think twice about sharing,” Rivera said. “But someone struggling with severe depression or anxiety or maybe bipolar schizophrenia, those are things that are a little bit more difficult to speak about. The more people normalize and talk about their diagnosis, the more welcoming as a community we will become.”

One positive from the pandemic was the rise of telehealth communication, allowing people to talk to a licensed therapist or behavioral-health specialist over video-chat platforms. It allowed them to connect from the comfort of their homes, making it easier to talk about what they’re going through.

Another option is the Behavioral Health Help Line created this year through the state Department of Mental Health and operated by the Massachusetts Behavioral Health Partnership. Meanwhile, Community Behavioral Health Centers offer immediate care for mental-health and substance-use needs, both in crisis situations and more routine settings. Crisis services are available around the clock for anyone in Massachusetts experiencing a potential mental-health emergency and are entirely insurance-blind, meaning anyone can access services, regardless of insurance coverage.

If therapy, medications, and traditional services aren’t working, people have the chance to participate in outpatient and inpatient treatment programs.

Outpatient programs are structured, non-residential, psychological day programs that address mental-health disorders and substance-use disorders that do not require detoxification through a combination of group-based psychotherapy, individual psychotherapy, family counseling, educational groups, and strategies for encouraging motivation and engagement in treatment.

MHA, BHN, and MiraVista all offer outpatient treatment programs; BHN and MiraVista specialize in adolescent mental-health programs as well.

“It is very important from a young age to speak about feelings and how we cope with them. Giving people different tools to be able to cope with those feelings is important,” Rivera explained. “There is such a need in this area, and that’s one of the reasons why we wanted to open that unit.”

Inpatient treatment programs are the most intensive level of treatment for individuals suffering from mental health and addictive disorders. It offers 24-hour care in a safe and secure facility, making it best for patients with severe mental-health or substance-abuse issues who require constant monitoring. The highly structured inpatient environment emphasizes understanding the signs of psychiatric illness, rapid stabilization, developing strategies to avoid rehospitalization, and discharge planning. Patients in inpatient care programs can work on rebuilding life skills without exposure to negative influences that fuel the urge to continue destructive behaviors.

MiraVista offers inpatient treatment to youth (ages 13-18) and adults who need the extra care. Dr. Negar Beheshti, chief medical officer for MiraVista and TaraVista behavioral health centers, told HCN that patients stay five to seven days, on average, at its inpatient facilities in Holyoke and Devens.

“Usually, when people get to a point where they need inpatient psychiatric care, they are at a point where they are not going to be safe in the community, meaning that they have extensive or significant unsafe thoughts of self-harm or harm to others, or they’re so compromised by their psychiatric symptoms that they’re really unable to function out in the community, and do need that level of care in an inpatient unit,” she added.

Usually, when people get to a point where they need inpatient psychiatric care, they are at a point where they are not going to be safe in the community, meaning that they have extensive or significant unsafe thoughts of self-harm or harm to others.”

Dr. Negar Beheshti

Behavioral-health practitioners and nurses are able to provide education around diagnosis, symptoms, coping strategies, and medication while a patient is under MiraVista’s care. Patients are also given one-on-one check-ins with therapists and psychiatrists to discuss their feelings, medications, and concerns.

Beheshti said this setting is also an opportunity for patients to share their experiences with others in the program, and they can learn from one another about different strategies that may or may not work.

Reap What You Sow

Gould Farm in Monterey, in the Southern Berkshires, is a twist on inpatient treatment programs, but on a more long-term scale.

Founded in 1913, Gould Farm became the first residential therapeutic community in the nation dedicated to helping adults with mental health and related challenges move toward recovery and independence through community living, meaningful work, and clinical care.

In a community of about 90 people, ‘guests,’ as residents are called, stay from nine to 12 months to help them get re-accustomed to life.

“People, prior to coming here, kind of lose relationships with themselves and others. And this is a way to step back into that and return to relationships with other people and with themselves,” explained Tamara McKernan, Admissions director and clinician on the farm. “There’s a level of trust here, where people stepping out of the hospital have kind of had everything taken away, and need to step back into feeling trusted and able to do things.”

During their stay, guests have a structured schedule; they do many of the same things they would in any inpatient program, like check-ins with therapists and clinicians, group work, and activities that ground them, but they also have jobs on the farm: working in the dairy barn or making cheese; tending the gardens, forestry, and grounds; working in the kitchen; and more.

Gould Farm reflects a more holistic approach to mental-health issues, in which people develop purpose and learn transferable skills to become more independent.

McKernan told HCN that guests are often referred to Gould Farm if outpatient and/or inpatient treatments, therapy, and medications aren’t working anymore. The sense of community and responsibility helps guests take the next step of gaining control of their life.

In order to destigmatize mental health on the farm, everyone works closely together — even the faculty and staff helping to run the farm. Their families grow up around the guests to make the experience seem more normal.

Words Matter

When it comes to mental illnesses or suicidal ideation, part of breaking the stigma is being aware of the words we use.

“Oftentimes, we’ll hear people say, ‘I’m bipolar.’ But it’s not who you are,” Therian said, noting that ‘I am a person that has bipolar disorder’ is more accurate. “It’s similar to the way we wouldn’t say, ‘I’m high blood pressure.’ It flips that a little bit when you look at it that way.”

Piñero agreed, adding that the work “crazy” is often used when talking about mental-health services, especially inpatient and outpatient treatments.

“It’s about letting people know that there’s no such thing. It’s just people dealing with stressors or dealing with medical conditions that are based on mental health or behavioral health. And that what we’re here to do, to provide assistance, provide help,” he said. “All of us, at some point or another, could be dealing with some type of issue, and all of us could benefit from these types of services. So it’s just making it something that’s more normal and general to everybody.”

One of the best ways to help a loved one in crisis is asking them if they’re all right. The professionals who spoke with HCN expressed that people may feel they will offend someone, or they’re scared of the answer, or feel like it might give someone the idea of suicide, but it just opens the conversation for that person to be vulnerable and honest. If a friend or loved one shows a worrisome change in behavior, one shouldn’t hesitate to ask and get help for that person if they’re willing to accept it.

McKernan added that helping someone look for moments of joy and using grounding techniques can also help them through the moment.

Mental-health healing is not linear, he and others stressed, and some days will be more difficult than others. Being educated on the warning signs and symptoms of suicide and suicidal ideation can help save the life of a loved one.

At the same time, no one who has lost someone to suicide should feel it’s their fault — even though avoiding guilt is easier said than done.

The bottom line is, untreated mental illness can lead to suicide, and speaking up is the first step to getting help. “The brain is like any other organ,” Beheshti said, “and we really need to honor it and respect it like any other organ.”

If you or someone you know is having suicidal thoughts or ideations, call or text 988 or visit 988lifeline.org for more information.