Stigma biggest obstacle to preventing tragedy

SANDPOINT — Suicide is a socially touchy subject: taboo. Many people dance around the topic, fearful that discussing it with someone they suspect may be considering taking their own life might give the person the final push to complete the act.

And that’s entirely the wrong approach, according to therapist Catherine Perusse, licensed clinical professional counselor for North Idaho Children’s Mental Health in Sandpoint. If you think someone you know is considering suicide, ask them, she said. Be blunt:

“Are you thinking of killing yourself?” Perusse said.

The stigma of suicide is one of the biggest boundaries to prevention, according to Perusse, and it keeps people from talking about it openly — and preventing suicide.

She advocates for an open dialogue, a full-on assault on the subject of suicide. It isn’t something to be whispered, but to be shouted out, spread out on the table and the its underlying cause dissected on a case-by-case basis.

“We were all taught long ago, because of the stigma, that you don’t mention suicide or you might give somebody the idea,” Perusse said. “Well, if you think about it, that’s really dumb.”

Perusse ought to know. Not one, but two of her children committed suicide, and she speaks with authority through that lens.

Idaho has been one of the top 10 states for suicide “as long as I can remember,” Perusse said. The Gem State has the eighth highest suicide rate in the U.S, according to the Suicide Prevention Action Network of Idaho. In 2013 there were 308 suicides.

After accidental death, suicide is the most common cause of death for 15- to 34-year-olds, and for males ages 10 to 14 in Idaho, according to SPAN Idaho.

Locally, 46 people died by suicide in Bonner County between 2009 and 2013, a rate of 22.5 per 100,000 people, according to SPAN Idaho.

Yet these are cold, stark statistics. Numbers. Behind each one of them is a story, and a series of incidents, or multiple causes that lead those 46 people to think about, and ultimately complete the act of suicide.

According to experts, each of them likely exhibited some indicator: depression, increased use of alcohol or drugs, changes in sleeping habits, mood swings. Some may have even talked about suicide, or at least about feeling trapped or hopeless.

Those signs and symptoms are what friends and family, coworkers or acquaintances should focus upon if they see or hear them.

Part of local and regional suicide statistics is related to the western ideal of independence — the “pull yourself up by your bootstraps, don’t asking for help mentality. The, “you can do it,” attitude, Perusse said. There’s a problem with that ideal, however.

“Sometimes you can’t do it,” she said.

There is no one reason for suicide. Usually, Perusse said, it’s combination of things such as a recent relationship break, or maybe someone has been bullied on Facebook and they feel they lack a support structure. Then they go to a party and start drinking, where normal, defense inhibitions melt.

“Bullying does not cause suicide,” Perusse said. “It’s not that simple.”

Anyone one thing, however — a breakup or bullying, for example — could become the trigger.

Combine the reasons with access to means — the tools people use to kill themselves — and you have a recipe for suicide.

According to a July 2014 Pew Research Center survey, 50-plus-year-old, non-Hispanic whites living in rural areas are the predominant owners of firearms in the U.S.

And the Pew survey results parallels suicide data. SPAN Idaho data shows that two-thirds of suicides are accomplished with a gun, and that between 2009 and 2013, 79 percent of Idaho suicides were accomplished by men, although nationally women are nearly as likely as men to own a gun, according to Pew.

So some reason — or reasons — to consider suicide, combined with access to means, Perusse said, “and you have a recipe for possible disaster.”

It’s important to recognize those two things: symptoms, and access to means. In both lie the path to intervention and prevention.

Someone talking about, or threatening suicide is an obvious sign that they require immediate intervention.

Other less obvious warning signs that a person is considering killing themselves include gathering access to means — collecting prescriptions, buying a weapon or ammunition — or giving away prized possessions, expressing issues with sleeping patterns, such as inability to sleep, or sleeping too much. Drastic mood changes — someone previously depressed who is suddenly very euphoric — is an indication of a decision to commit suicide.

“And it’s such a relief to decide,” Perusse said.

People who have previously attempted suicide are statistically at higher risk, Perusse said.

The acronym QPR is the mental health equivalent of CPR. It stands for question, persuade, refer, according to the Institute for Suicide Prevention. It’s “an emergency response to someone in crises,” the website states.

Like performing CPR on a heart attack victim, with QPR, “you’re not expected to fix anybody,” Perusse said. “Your goal is to keep a person alive until you can get them professional help.”

Educational programs like QPR teach people to recognize the signs and symptoms of a mental health emergency, and how to step in and administer help.

Access to means — the tools people use to kill themselves — is also important recognize. Eliminating access to them is a prevention method.

While the pain that someone is experiencing may end for them after the commit suicide, a different kind of pain is  transferred to the lives of the people they left behind. That transfer has both an emotional and economic impact.

SPAN Idaho estimates that suicides cost Idaho $36 million each year, and $343 million in total lifetime productivity costs.

Perusse lost her oldest son in 1996 when he committed suicide in Las Vegas. Her youngest son killed himself in 2003 while he was serving with the Army in Iraq.

“Obviously he was unhappy and felt a sense of hopelessness,” she said of her second son. “What things specifically I don’t know.”

Perusse said she felt destroyed and betrayed by the loss of her boys.

“It destroys families,” she said. “It changed me more than any other event in my life.”

A community needs to be able to talk about suicide the same way it talks today about subjects like sexually transmitted diseases and homosexuality, Perusse said, because “twenty years ago we didn’t talk about either one.”

“If somebody’s threatening suicide to get attention, then give them attention,” she said. “Figure out what’s going on, because there’s more going on. It means they need professional help.”

If you suspect someone of being suicidal, confront them; get them talking. Then seek professional help by calling the National Suicide Prevention Hotline at 800-273-TALK (8255).

For both free and fee-based suicide prevention training and resources, try the QPR Institute at www.qprinstitute.com, or try the Suicide Prevention Network of Idaho who has a wealth of information on the issue at www.spanidaho.org.