Four years ago this month, my 21-year-old brother died by suicide. My family does not need Suicide Awareness Month every September to remember.
In his note to us, his family, Patrick described how depressed he had become and that he saw no other way to stop feeling so desperately hopeless. There were no drugs involved, no foul play, no bad romantic break-up, no real indicators he was considering suicide until it was too late.
We believe his depression was sparked two years earlier when in December 2011 our mom– who was in good health otherwise– died suddenly following a pulmonary embolus.
Our family is now part of the suicide survivors club, membership reserved for those who have either survived an attempt or are loved ones left behind. We are not alone.
According to the American Foundation for Suicide Prevention, 44,193 Americans die by suicide each year, making suicide the 10th leading cause of death. It costs the U.S. approximately $51 billion each year. Though it does disproportionately affect some groups, suicide is nondiscriminatory in regard to age, race or ethnicity, income, education, or any other demographic you might choose.
Ask around. You’ll likely be surprised how many people you know are in the club.
We knew Patrick was struggling with the loss of our mom and we all tried to help him during those two years between our mother’s death and his. Most of us closest to him, his siblings, are healthcare providers. I am a nurse practitioner and assistant professor of Community Systems and Mental Health Nursing at Rush University in Chicago.
In my own nursing practice, I regularly work with patients who report they are depressed and feel hopeless. I’ve been trained to ask those sensitive questions: “Have you ever thought of harming yourself or others? If yes, what is your plan?”
We struggle with the presumption that if anyone had the knowledge and resources to help a loved one struggling with depression, surely it should be us– healthcare providers who knew and loved him best.
But honestly, I didn’t nor did my siblings know how to help my brother. Our own emotions were a factor as we were all struggling with grief over the loss of our mom. We tried to help him deal with his depression, but in searching for community and healthcare resources for him, and resources for us to learn how to help him, we struggled and came up short. We were also limited by logistics such as living in different cities and trying to find a local provider for him that had availability, took his student insurance and specialized in adolescent grief.
Had we known that he had reached the point where he was considering suicide we could have turned to digital resources and support such as the National Alliance for Mental Illness and the Suicide Prevention Resource Center. And at the heart of this, we didn’t know how to have “the talk” with one another or with him.
The tragic truth about suicide awareness and mental health understanding is that many just don’t talk about it or are aware of the severity or complexity of the situation until it is too late.
Mental health is burdened with stigma and discrimination; this is a fundamental reason why conversations about it don’t occur. It is not easy to have these conversations. But conversation is the first line and most powerful preventative measure when dealing with mental health issues.
In the context of suicide, experts agree that talking about feelings of depression or suicide does not make someone suicidal. Rather, initiating a conversation about suicide tells your family member that he or she doesn’t need to avoid the subject with you, hide it or feel ashamed. It communicates you care and are there to help.
Still, you can implement some important tips when you begin the conversation. Remember to be yourself and be sympathetic. Let the person know you care. Be patient and calm, and avoid judgmental comments.
Create time and space for the conversation– at least 30 minutes, and listen. Be prepared for possible negative reactions such as anger or embarrassment.
Remember that even if the conversation is negative, the fact that it is occurring is a positive.
Humor helps, though be sure to balance it with taking the person seriously. And if a face-to-face talk is too intimidating, consider starting with a text, email or even a written letter with something as simple as “there are important things on my mind and I’d like to make time to talk with you about them”.
Family interaction is a critical piece to improving mental health. But healthcare providers and law enforcement agents – not family – are often the first line responders for people with mental illness. However, at least in my own experience, mental health education for this group is often done as extra learning modules, an extra elective class, or something “tacked on” to the core curriculum. But to truly begin addressing the mental health problems in our country, we must incorporate mental health education at every opportunity and at every level for our first responders, not just as an afterthought.
Delivering mental healthcare in the community relies upon strong partnerships between healthcare providers and community organizations. I call this “leveraging a built environment.”
For instance, my work involves partnering with community organizations that provide social services to underserved populations. These community organizations recognize that preventative healthcare is a key component of social well-being, yet they themselves are not healthcare providers, and this is where the partnership comes into play.
I create partnerships to provide nursing wellness and preventative medicine in these communities. We use their built environment, whether it a counseling center, church, school or apartment complex, to bring preventative healthcare into the community. We build upon the community relationships and connections that already exist in order to reach high-risk populations.
Primary care, preventive care, counseling, and the bulk of mental health treatments do not occur in the hospital. To be most effective and to reach people before their health becomes a crisis, healthcare must be delivered in the community. It must be done in schools, in workplaces, and in neighborhoods. All of this requires funding and persistence.
But equally as important is that families and friends start talking about mental health, making it a key part of our lives.
As a survivor of my brother’s suicide and through my nursing experiences, I now know that having this conversation is the first step. My wish is that my brother Patrick would be here, standing with me starting this conversation.
Angela Moss, PhD, RN, is the Director of Faculty Practice and Assistant Professor of Community Systems & Mental Health Nursing at Rush University College of Nursing