Surviving suicide: Prevention efforts focus on support, conversation
- If you fear a friend is contemplating suicide%2C it is important to ask them directly if they are
- There were 76 suicides in Westchester County in 2012
- That same year%2C there were 23 suicides in Rockland
- Putnam County had a dozen suicides in 2012.
Every 13 minutes in America, someone takes his or her own life.
Each of those deaths – whether it means the loss of a husband, wife, son or daughter – creates a ripple of trauma and grief that doesn't end with the act itself. Each marks the beginning of a long process for those left to try to make sense of it all.
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In Westchester County in 2012, the last year for which there are official state numbers, there were 76 suicides, an average of one about every five days. In Rockland, there were 23, an average of one every 16 days. In Putnam in 2012, there were suicides at the rate of about one a month.
Nationally, suicide was the 10th leading cause of death in 2013, according to the Centers for Disease Control and Prevention.
Whatever the interval — whether it's 13 minutes or 30 days — there are lives changed behind each death.
Ask the question
For the Mental Health Association of Westchester's Dr. Barbara Bernstein, suicide prevention begins well before someone is at imminent risk of harming himself or herself.
"Prevention is about being sensitive to when things aren't going right for somebody," she said, "and having the courage and confidence to say to somebody: 'It seems to me that something's not right. What's going on? Would you talk with me?' "
As the conversation unfolds, Bernstein said, it should lead to a question that many people might think is the last one you'd ask. Bernstein said to ask it, nonetheless: "Are you contemplating suicide?"
Suicide prevention/intervention resources
"We have had a myth for a long time that talking about suicide plants the idea," she said. "Research has shown that that's not the case. By asking the question, we give people permission to talk about it."
And if they're talking about it with someone, they're not alone.
The question shouldn't come out of the blue, Bernstein said. The best way to ask about suicide is to connect it to the behavior you've noticed, to tell the person you care about them, and to say that their behavior — withdrawing from people, isolating themselves, not doing activities they used to do — is what people do when they're thinking of suicide.
Asking the question does three things, Bernstein said.
First, it breaks the stigma, the silence around suicide. "It's something that, for the longest time, we weren't allowed to talk about, but when we name it, it makes it OK to talk about," she said.
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"Next, if they're not thinking of suicide, the question makes them wonder what kind of signals they're sending out. And if they are thinking about it, the question can bring relief."
Michael Piazza Jr., of Putnam's Department of Social Services and Mental Health, agrees.
"I've heard clinicians say that when they say to the person, 'You sound like you've thought about suicide' — even though the person never said it — sometimes there's a breath of relief, like: 'I'm not hiding it, someone does know,' " he said. "It lets the air out of the balloon and lets the pressure out, and then you can start talking about it."
Bernstein is direct: "It's OK to be nosy in the service of doing good."
The tough part, she said, is starting that conversation. The next part is to help the person find professional help at a crisis line or community agency. If the problem is at a crisis, there is the National Suicide Prevention Hotline at 1-800-273-TALK (8255).
Raising awareness
Piazza said suicide prevention has been on the front burner for years across New York state.
"Every county has had this big push to show that suicide is preventable," said Piazza, whose county typically has nine to 14 suicides a year.
A suicide prevention task force has been working to raise awareness among schools and community leaders, taking on topics of particular interest here.
When county health department numbers showed that most suicides — 15 of 23 in the past two years — were by gunshot, the task force set up last month's "Means Matters" panel discussion, which centered on the use of guns in suicide.
Piazza said some of the 70 or so people who attended were gun owners fearing a government push to confiscate their weapons.
"We didn't talk about gun control, but we talked about safely handling guns, helping people know it's OK to put your gun in storage, lock it up, if you're not feeling right," he said. "That impulsive moment of suicidal thoughts can pass. Guns are lethal ways to commit, and if you make the decision to commit and you have access to a gun, it's a dangerous situation."
There are ways to separate yourself from a weapon, Piazza said, including asking your friends to help you make the decision.
"You can take the bullets out and give them to somebody, or keep your bullets in one safe and your handgun in another and have a friend change the combination and give it back to you when you're feeling better," Piazza said.
The task force's next presentation is "Trauma, PTSD & Suicide: Helping Professionals at Risk," on May 28 (6-9 p.m.) and May 29 (9 a.m.-noon) at the Training and Operations Center, 112 Old Route 6, Carmel.
Sheriff Timothy Whitcomb of Cattaraugus County will talk about post-traumatic stress and suicide among law enforcement.
The program is recommended for first responders and their managers and will include information on how family members and managers can identify, intervene and help professionals at risk. (For details, contact Elaine Haskell at 845-808-1400 or elaine.haskell@putnamcountyny.gov.)
'Tell your story'
"Suicide was never in my consciousness," Rebecca Walkley said.
Then she lost her brother to suicide.
"After one experiences a suicide, here's your new world," said Walkley, a licensed mental health counselor who runs a support group for people who have lost loved ones to suicide.
For those whose lives have been untouched by it, suicide awareness ebbs and flows. It peaks when a celebrity such as Robin Williams ends his life and it is splashed across supermarket tabloids. Then it recedes from public consciousness until the next celebrity death, or until there's a spate of suicides that the media can label a trend.
In 2010, syndicated columnist Dan Savage created the "It Gets Better" video campaign, geared toward at-risk LGBTQ youth. More than 50,000 videos have been created, aimed at convincing at-risk kids that their trials will pass, that pain will ease with time.
The stigma behind suicide is strong, said Walkley, whose office is in Cross River.
"Shame can be an unbearable emotion, and it needs three things to exist: secrecy, isolation and judgment," she said. "When we speak about things that might be shaming, we're not keeping it a secret, we're with other people who have experienced the same thing, so it's not isolating, and we can look at it compassionately and with empathy."
Walkley's work with survivors centers on viewing suicide as a trauma that should be treated by a trauma therapist.
For survivors, a group setting with those who have the shared experience can be an excellent way to heal, she said.
"You don't feel like you're crazy or different, and it gives a person a chance to tell their narrative," she said. "What you need to do is tell your story until you don't need to tell it anymore. After you don't need to tell it for yourself, it becomes healing to tell it for other people."
Sharing your story out loud in the group means hearing yourself enunciate its elements — "This happened, and I'm OK," Walkley said.
The group is for support, not therapy, but the fact that someone is listening, in a safe, non-judgmental way, is important.
"Who gets to be listened to these days?" she said with a smile.
Risk factors vs. warning signs
Barbara Bernstein of MHA Westchester said there are underlying risk factors and emerging warning signs to monitor for suicide.
Risk factors are things about a person's life that might raise the possibility of suicide:
•Exposure to suicide attempts by themselves, friends, family or even a celebrity
•A mental health condition
•Substance use
•Access to the means of taking one's life
•A history of trauma.
Warning signs are more in the moment, red flags that suggest suicide may be down a path:
•A college-bound student deciding not to finish his or her college application
•Someone who says, "It doesn't matter anymore," or, "They'd be better off without me"
•Someone gathering the means to end their life; someone losing their sense of purpose.
Sudden unexplained change, Bernstein said, is a red flag.
Peter D. Kramer