"Here's the thing: Either you have lost someone to despair or you're going to," said Willi Carlisle, a Fayetteville musician.
Medical professionals expected suicide rates to spike during the isolation of the covid-19 pandemic. But the number of deaths nationwide from suicide experienced only a slight rise and is now falling, according to numbers released last month by the federal Centers for Disease Control and Prevention.
The Arkansas Department of Health this month shared similar reports for the state and Northwest Arkansas.
"But even one suicide is too many," said Reba Glidewell, a psychologist and assistant chief of staff for mental health at the Veterans Health Care System of the Ozarks. "Anything beyond that is too many."
The impact of a suicide reaches from family to friends to coworkers and more, said Linda Cromer, director of crisis and forensic services for the Northwest region at Ozark Guidance, an affiliate of Arisa Health.
"It's not calculable, the loss that happens when someone ends their life," Carlisle wrote in an email Aug. 11 while traveling to a show in Phoenix.
Carlisle said he's passionate about suicide prevention because he once stood on that precipice.
"Suicide always seemed like an inevitable consideration because I had no plan for myself, and didn't like myself," he wrote in a text message. "In a time of profound humiliation and loss of family, I figured (incorrectly) that the two options were clear: bear the brunt of a public loss-of-face, be ostracized forever, be a liability to my friends and 'good-riddanced' by my chosen family, or to end my life. I tried the easier option.
"I'm still here, though. I called the suicide hotline the next day," Carlisle continued. "By the time Ben, an anonymous guy on the other end, finished talking with me for 45 minutes, I felt a lot better."
PANDEMIC EFFECT
Rebecca Brubaker, executive director of the Arkansas Crisis Center, noted recent suicide hotline callers have all types of anxiety -- the loss of a job or loss of a marriage, she said. Their family members might have covid or might have died of covid, she continued. They have a fear of covid. They have a fear of going on a ventilator.
"And they live alone and are isolated with their fear," she said.
Cromer agreed.
"There are multiple risk factors, but there is no single cause of suicide," Cromer said. "Most often it's extra stressors. And there's definitely been an increase in stressors after the pandemic started. Even getting back into the normal routine can be a stressor."
Those contemplating suicide also can be in the throes of addiction to drugs or alcohol.
"Part of addiction is despair," Carlisle said.
A February report by the centers shows suicide rates nationally declined in 2020, continuing a decline that started in 2019, said Julie Eschelbach, a health communications specialist with the centers. Unconfirmed data from 2021, however, shows an increase in the number of U.S. suicide deaths to 48,031, as compared with 45,979 deaths in 2020, Eschelbach said.
Arkansas recorded 619 suicides in 2021, compared to 583 in 2020, according to Danyelle McNeill, a spokeswoman for the Arkansas Department of Health.
HOTLINE HELP
On July 16, the federal Substance Abuse and Mental Health Services Administration changed its toll-free crisis hotline number to 988, also toll-free.
"Like 911, it's easy to remember wherever you are," Brubaker said.
The Arkansas Crisis Center saw the effects of the pandemic on mental health. The Rogers-based center staffs a hotline 24 hours a day to assess and help people contemplating suicide.
The number of calls is up 730% from 296 in February 2020, the last month before Arkansas schools and businesses closed for the pandemic, to 1,919 in February 2022, she said.
The center has recorded 13,379 calls this year through the end of June. It experienced its first post-pandemic decrease in calls in June with 1,976, down from 2,476 in May.
The crisis center was founded in 1985 to take calls from Northwest Arkansas residents at risk of suicide. The center for many years has also received calls from Arkansans who called the federal Administration's National Suicide Prevention Lifeline, the predecessor of 988.
Call specialists answer 24/7, with 15 volunteers and two staff members, Brubaker said. Working in four- to six-hour shifts, a call specialist will take about 15 calls.
Before volunteers begin manning the crisis line, they receive 40 hours of intensive training, but are not certified licensed therapists, Brubaker said.
VETERAN SUICIDES
The Veterans Administration has for years operated its own hotline. And callers to the new 988 number first will be directed "Press 1" if they are veterans, Glidewell said. Those who do will be transferred to the Veterans Administration line.
Nationally, veterans accounted for 6,261 suicides in 2019, or 13% of all adult suicides that year, according to the National Veteran Suicide Prevention Annual Report issued in September 2021 by the Veterans Administration.
The report listed 5,989 suicides among veterans in 2001, which represented 20% of suicides among all adults.
Glidewell noted 60% to 70% of those veterans are not enrolled in the Veterans Administration's mental health programs, which locally can range from acute inpatient care to targeted rehabilitation to group therapy sessions, she said.
The local veterans health system was unable to provide data on local suicides among veterans.
"Each veteran suicide is one too many," Sen. John Boozman said in a statement from his office Thursday. "Expanding opportunities for men and women who served in uniform to connect with VA services is vital to providing the resources and care they deserve."
In 2020, President Biden signed into law a Veterans Mental Health Care Improvement Act. Boozman authored a provision of the act to create a Veterans Administration grant program to support nonprofit agencies and organizations serving veterans.
SILENCE OR SHARE
Different organizations that deal with mental health issues vary on whether publicity and open discussions help or hurt.
A widespread stigma is associated with suicide, and, as a result, many people are afraid to speak about it, Glidewell said.
"It's like you were less of a person," she said.
Police departments, schools and even many media outlets handle suicides with kid gloves. The Democrat-Gazette does not report suicides unless it's the suicide of a public figure or done in a public place.
Brubaker said all deaths should be covered the same, with organizations having a consistent policy.
"Ignoring it has not worked out so well," she said. "We absolutely want to respect our patients, but we need to do our best to shine a light on suicide risks. We need to talk about prevention and strategies."
Cromer said it's important to talk about resources, spread awareness of risk factors and give people a toolkit for dealing with situations where suicide might be involved.
"If we don't talk about what's painful, we reinforce the stigma," she said.
Northwest Arkansas schools will bring in counselors from Ozark Guidance in any case of death among students, said Katie Jenkins, a counselor at Shaw Elementary School in Springdale. But school administrators consider memorials for all deaths on a case-by-case basis, Jenkins said.
"There's a fine line between glorifying a suicide and remembrance of a friend," she said.
In an effort to prevent "suicide contagion," school officials will consider how the death is likely to affect other students, according to protocols from the state Health Department. They will determine which students are most likely to be affected so they can receive services to prevent another suicide.
Suicide contagion is the exposure to suicide or suicidal behavior, according to the federal Department of Health and Human Services. Direct and indirect exposure to suicidal behavior has been shown to precede an increase in suicidal behavior in persons at risk for suicide, especially in adolescents and young adults.
In May 1990, three Sheridan students shot themselves in two days -- the first in front of his history class, according to a report at the time by the Associated Press. Another student shot himself in March of that year and three other county residents -- ages 22, 40 and 82 -- had killed themselves since Jan. 23.
Linda Oakley, a counselor at Central Junior High in Springdale, said education about suicide is needed for the city's diverse cultures. Every culture looks at mental health differently, she said.
"What I hope is that public and interpersonal knowledge grows massively in this regard, that we begin to talk about the loneliness and addiction epidemic and that we create public spaces to work to solve it," Carlisle said. "Shrouding it in mystery isn't helpful."
A sign offering assistance to veterans in crisis stands Wednesday, Aug. 10, 2022, at the entrance of the Veterans Health Care System of the Ozarks in Fayetteville. Visit nwaonline.com/220811Daily/ for today's photo gallery. (NWA Democrat-Gazette/Andy Shupe)