Beyond the Stigma: NH had nation’s 3rd highest hike in suicides from 1999 to 2016, according to CDC


New Hampshire Sunday News – June 9, 2018

A famous designer. A world-traveling chef and TV personality. A beloved Concord school principal. And a 12-year-old boy in the Upper Valley.

All recently took their own lives.

According to new data from the Centers for Disease Control and Prevention, New Hampshire had the nation’s third-highest increase in suicides from 1999 to 2016, 48.3 percent, behind North Dakota (57.6) and Vermont (48.6).

What leads someone to take his or her life is complex. Many factors can contribute to suicide, the CDC report states, including relationship problems (42 percent), a recent or pending crisis (29 percent), substance use (28), a physical health problem (22), job or financial problems (16), criminal legal problems (9) and loss of housing (4).

And 54 percent of those who died by suicide did not have a known mental health condition, the CDC reports.

The data was no surprise to Kim Fallon, chief forensic investigator at the state Office of Chief Medical Examiner. She said the number of deaths by suicide has been rising in New Hampshire, from about 182 in 2008 to 264 last year.

Suicide is also considered under-reported, she said, “because unless there’s compelling evidence that it’s a suicide, it could get deemed an accident, or the manner could be undetermined.”

The medical examiner’s office, in collaboration with the state Bureau of Behavioral Health, sends a packet of resources to the families of those who die by suicide, including information about support groups and “a CD of healing music from somebody whose son died,” Fallon said.

Families deal with stigma

There’s an additional burden of stigma for the loved ones of these individuals, she said. “Any death is heartbreaking to so many people, but in suicide deaths, the families have such a harder time dealing with it, especially when they didn’t see it coming,” she said.

Fallon has seen families wait years before contacting her office to ask for more information about their loved ones’ deaths.

Peter Evers is president and CEO of Riverbend Community Mental Health in Concord; he’s also vice president of behavioral health at Concord Hospital.

Evers said the rise in suicides here could be tied to the state’s aging population. At a certain age, he said, “Many people feel they haven’t achieved what they wanted to do. And for a lot of absent parents, this is a time you reflect back on what you should have done.”

In addition, he said, “I really do think that this is a more stressful society that we live in.”

But at the same time, Evers said, “This is a country that expects people to be rugged individualists and make it on their own. There’s a huge stigma attached to asking for help.”

Programs such as the Change Direction campaign and Mental Health First Aid are aimed at getting people to recognize signs of possible mental illness, and to take action.

 Signs of suffering

Co-chaired by Evers and former Supreme Court Chief Justice John Broderick, the Campaign to Change Direction New Hampshire identifies five signs of emotional suffering: personality change, agitation, withdrawal, poor self-care and hopelessness.

The last is called “anhedonia,” meaning a loss of hope, Evers said, “and therefore a loss of vision into the future.”

And that’s a major element in suicidal thinking, he said: “If you can’t see that your mood or how you’re feeling will change, especially with kids, in the next couple of days, that’s very worrying.”

The National Action Alliance for Suicide Prevention estimates that for every person who dies by suicide annually, there are another 278 people who have thought seriously about suicide but did not kill themselves.

Experts’ advice: Reach out

And experts say the simple act of reaching out can be a powerful prevention tool.

The Mental Health Center of Greater Manchester offers Mental Health First Aid trainings, with classes for adults, youth, veterans and teachers.

“What CPR is for the heart, Mental Health First Aid is for the mind,” explained Bill Rider, president and CEO of MHCGM. “It teaches somebody who may see somebody else in distress … how to be present and how to help that person in the moment.”

Rik Cornell, the center’s vice president of community relations, said the class teaches five strategies to help: Assessing for risk of harm; listening nonjudgmentally; giving reassurance and information; encouraging appropriate professional help; and encouraging ongoing strategies to stay well.

Resources available to help

There are 10 community mental health centers across the state, and they all have emergency resources available. In Nashua, Concord and Manchester, mobile crisis response teams also go into the communities and meet individuals experiencing a behavioral health crisis.

There’s also a national suicide prevention line that connects people with their local services, Rider said. When people are in crisis, he said, “They need to be with other people.”

“Because the intensity of these feelings, they wax and wane. And intervention with others can disrupt a feeling or an urge to hurt oneself,” he said.

Strength and resilience come from our interdependence on each other, Rider said. “When people feel like they have to do this themselves, and they wall themselves off from others, is when people are most vulnerable,” he said.

Cornell said the public is shocked when someone as successful as Kate Spade, Anthony Bourdain or Robin Williams – celebrities we think we know – takes his or her life. “We make judgments of people based on what we see,” he said. “But what we see is what they’re letting us see. It’s what’s going on inside our heads that really is who we are, and what we’re about is not necessarily what everyone sees.”

Loneliness often the issue

In many cases, the cause of death is really loneliness, Evers said. “Because social isolation leads to depression and leads to people making those poor choices,” he said.

Evers said studies have found that half of those who take their lives “do so without telling anyone, and on the first attempt.”

When someone you know appears anxious or troubled, reaching out can make a big difference, Cornell said. “What I find is that people who aren’t OK and are having a hard time, struggling, they’re looking for that conversation,” he said. “They want that conversation but they’re afraid to ask.”

Evers said we’re taught to respect others’ privacy. But he agreed it’s critical to speak up if you notice a friend, family member or co-worker is not acting like himself or herself. “Just ask the question: ‘Hey, is everything all right?'”

“And don’t just ask it once,” he said. “Keep offering.”

Nearly everyone goes through a life crisis at one time or another, Evers said. “We’re all going to lose a parent. Many of us will lose our jobs and go through difficult periods,” he said. “Very few human beings get through unscathed.”

It’s always about communication,” he said. “Being brave enough to ask. “And brave enough to tell.”