The End

My cousin’s fifteen-year-old son committed suicide.

Caught up in activities with school friends that got out of hand, he had made a promise to do some things that did not go the way he planned. Sick and afraid, at church with his family, he had his mother take him home. She put him to bed, then went downstairs to get him some water. A single shot rang out. He had been so afraid of disappointing his parents, getting into trouble with them, that he made a decision to take his life rather than to face what seemed like insurmountable troubles. His devastated parents, who were so proud of him and loved him unconditionally, would never have the chance to explain to him that a parent’s love is not predicated on perfection, but on a bond so strong that even death could never break it.

Halfway through the year in Aiken County, we had already had twenty-one suicides. Twenty-one people who decided for myriad reasons that life was unbearable, that there was something better, that they were too ashamed to go on, that the hurts were too harsh or the damage too deep. Some probably left notes. Some probably left clues pointing to what was about to happen. Some probably made the decision, told no one and carried out a plan that they saw as redemption. I don’t know the stories behind the decision to end each one of these lives, but I’m sure there were stories to share.

Who were they? Nineteen of them were males and two were females. Their ages ranged from sixteen to ninety-five years old. Nineteen were white, one was black, and one was Hispanic. Eleven of them had alcohol or other drugs on board at the time of death. Overwhelmingly, they killed themselves with guns. Fifteen males decided to end their lives using guns.

Do these numbers, our numbers, mirror the national ones? According to an article in the Wall Street Journal, “To Lower Suicides, Methods Matter”, by Jo Craven McGinty, 47,173 people killed themselves in 2017. This was up from 29,350 people in the year 2000, according to the American Foundation for Suicide Prevention and the Centers for Disease Control. Suicide is the tenth leading cause of death, according to the CDC. Those at greatest risk are white males, middle aged white males. People like me, and probably like a few of you reading this column, folks. In 2017, white males like me accounted for seventy per cent of all suicides. White women accounted for nineteen per cent. Men of color made up eight per cent, and women of color only two and a half per cent.

Firearms are the most common method of suicide used by men. In 2017, fifty-six per cent of males who committed suicide killed themselves with a firearm. Do our Aiken County numbers mirror the national ones? I think that is easy to see.

One thing that I found fascinating about the Wall Street Journal article was that whether someone acts on the urge to commit suicide may hinge on having access to their preferred method in a moment of crisis. Because of the percentage of suicides involving guns, wrote Ms. McGinty, the American Foundation for Suicide Prevention and the National Shooting Sports Foundation are working together to encourage the safe storage of firearms. I am not personally against guns by any means (I do not own guns at this time, but I have a younger brother who has been an avid hunter all his life), but the bleak statistics involving firearms and deaths by suicide are simply too awful to ignore. If someone is struggling and has access to an unsecured and loaded gun at the time of their most severe crisis, tragedy is simply too often the result. Blocking access to this most lethal of methods may indeed save lives.

In the world of mental health treatment, we already do a fairly good job of screening for issues including suicidality and plans to harm oneself. However, given the statistics above, we must do better. Eighty three percent of those who die by suicide have seen a health care provider in the year before their death. Aiken-Barnwell Mental Health is using the Zero Suicide initiative (www.zerosuicide.com) to address this terrible problem. This system uses evidence-based tools, systematic practices, and embedded workflows to strive for continuous quality improvement in the assessment, screening and addressing of suicidal ideation in everyone who walks through our doors. It involves systematic changes and improvement in training, identifying those at risk, engaging in a meaningful way, treating suicidal thoughts and behaviors, and making good transitions to ongoing care and follow-up once the acute crisis has passed.

What can you do?

Remember this number for the National Suicide Prevention Lifeline: 1-800-273-TALK.

Secure your guns if you own them.

Listen. Ask questions. Respond. Act.

Consider participating in the Out of Darkness Walk on November 10th at 2 PM at the H. Odell Weeks Activity Center in Aiken.

I have lost patients, family members, neighbors, and coworkers to suicide. I wager that many of you reading my column this week have had similar experiences and losses. It will take all of us working together to bring about meaningful change that leads to the end of suicide.

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