With her usual blend of empathy and hope, Loni Parrott greeted the circle of familiar faces along with a newcomer.
Here, on the first and third Thursdays of the month, some come, still in shock, to weep and never return. Others sit silently arms crossed. Some often come to share their story or tell of the latest friend or family member who said what they said or never called to check on them. Some are angry. Most have questions that can never be satisfied.
“We are sorry, so sorry, you are here for the reason you have to be here,” Parrott began the grief support meeting in Iowa City in May. “We had to come the same way, so we know exactly what that’s like.”
“My suicide was March 7, 2002,” she began.
Each person in the circle shared. A sister who lost two brothers within two years to suicide. A mother who recently buried her middle-aged daughter. A man who found his friend in the 90s and then lost another one and then a step-brother three years ago.
Some had warning. Parrott’s co-facilitator, Lori Panther, knew her husband wanted to die. He talked about it, they found a noose hidden in the basement months ahead of time and he was treated at multiple psychiatric hospitals for his anxiety he had hidden away so well for years.
Others, like Parrott, had no suspicion. Her husband, a prominent dentist in Iowa City, was found dead in his car at his dental practice. With a 15-year-old son at home and an 18-year-old son in his first year of college, Parrott became a single mom trying to cope with her own grief and guilt, comfort her sons who at times blamed her, while now having to financially support her family.
“It left never-to-be-answered questions,” she said. “It seemed like he took all the pain he was feeling and handed it to us. He didn’t even say goodbye.”
UNLOCKING THE MYSTERY
Americans spend billions of dollars a year trying to cheat death. They buy devices that track their movement, heart rate and sleep patterns. They take vitamins. They pay for the latest diet fad. They shop organic, meditate and do yoga.
That is why those who defy the human will to live, often shock the conscious, and those who act can be either vilified or romanticized. But why a person takes their life is still largely a riddle.
While research offers clues to what circumstances or conditions that may be contributing factors,, one of the leading researchers in the country on suicide wrote in 2016 that despite decades of research, scientists, clinicians and counselors are just beginning to unlock the mysteries of suicide.
“There are many well-intentioned prevention programs out there, but we have very little data on which ones work and which ones don’t,” wrote Harvard Psychology Professor Matthew Nock in a 2016 Washington Post editorial.
Suicide screenings and tests are fallible and recent research has shown they are often no better at predicting who will take their life then flipping a coin.
And in spite of public health campaigns, 24-hour hotlines, school talks, training for community members, suicide rates in America rose from 1999 to 2016 and 25 states, including Iowa, saw rates increase by more than 30 percent, according to a new report from the Center for Disease Control and Prevention.
While suicide has often been tied to mental illness, the CDC found in its latest research that less than 50 percent of those who took their life were diagnosed with a known mental health condition.
Those without a diagnosis suffered more from relationship problems and other life stressors, such as criminal or legal matters, eviction or loss of home or an impending crisis, the report said.
Experts caution suicides at the hands of those with a mental illness is likely higher since many people go undiagnosed. Even so, experts say the latest research shows that suicide prevention strategies should cast a wider net and strategize more broadly about life stressors and societal problems.
“The issue is so much bigger than mental health,” said Sarah Brummett, director of Colorado’s Office of Suicide Prevention, which is planning a comprehensive suicide prevention approach in partnership with the CDC and several national organizations. “Prevention efforts focused solely on mental health treatment (while important and necessary) are only the tip of the iceberg.”
In Iowa, someone dies every 20 hours from suicide and it is the second leading cause of death for people between the ages of 15 and 34.
Still, middle-aged, white men make up the largest portion of people who kill themselves, state public health records show.
And the most frequently cited circumstance in all age groups was a depressed mood, a state analysis of the seven most populous counties found.
While Iowa’s suicide rate rose 36 percent since 1999, the state currently provides little direction to counties or funding on suicide prevention strategies, said Ryan Nesbit, co-chair of Iowa’s chapter of the American Foundation for Suicide Prevention, who lives in Ankeny.
“It’s very fragmented. Everyone is doing their own thing,” he said. “We’re not getting much government help and there is no direction from the state.”
Iowa’s Public Health Department budgets $50,000 on suicide prevention — the equivalent of .09 percent of the $53.5 million funds the state allocated this year.
Pat McGovern, the suicide prevention coordinator for the state’s Public Health Department, said after a three-year federal grant ran out in the end of 2016, the state couldn’t sustain most of the initiatives they had started.
Currently, the state uses the funding for the Your Life Iowa website, where people can go to find information, a number to call or chat online with a representative from the crisis center in Cedar Rapids about suicidal ideation, as well as alcohol, gambling or drug addictions, McGovern said.
In the Legislature, lawmakers point to several new laws that passed to show how they are being proactive to prevent suicide.
A new law will require teachers to receive one-hour mandatory training to recognize suicidal signs among their students.
The Legislature also created a statewide 24-hour crisis hotline and passed more mandatory requirements for the state’s 14 mental health regions to create crisis services for people who are often suicidal or have made threats to harm themselves. But the regions will be required to fund those new services, unless new funding sources are identified.
Rep. Lisa Heddens, D-Ames, who runs NAMI Central Iowa, admits that state departments are siloed with the Department of Human Services focused specifically on mental health while the Public Health Department is tasked more closely with suicide prevention strategies, yet she sees little collaboration on key issues that overlap.
While crisis services are an important piece, they are just one of many suicide prevention strategies the CDC and national organizations say should be a strategy in every state.
But where the state has been absent, Nesbit said a handful of communities have begun to show initiative.
In Iowa City, a string of tragedies a decade ago forced key community leaders together and led to systemic changes in how the community responds to people in crisis.
In 2008, an indicted and disgraced former Iowa City bank vice president beat his family to death and took his own life in a car crash, then the devastating flood that ripped across the state in 2008 caused many families to be in crisis, followed by two high-profile suicides on the University of Iowa’s campus by two professors.
At the time, Keri Neblett, a Johnson County Crisis Center community outreach coordinator, helped orchestrate a town hall meeting that led to a suicide prevention coalition.
With one-time funding from the state’s public health department, the coalition began an Out of the Darkness walk and fundraiser for families who survived suicide, created a suicide packet to give to the medical examiner’s office for grieving families and a pamphlet warning gun owners of the signs of suicide and what to do to stay safe, said Neblett, who is the chairperson.
With limited funding, the coalition is focused this year on expanding training opportunities for the public to learn how to help their neighbors, friends or customers who may be suicidal.
While the coalition hasn’t gone as far as Neblett would have hoped, she is excited about the growing collaboration in the community that has many public health benefits.
For example, key stakeholders formed another group after the coalition that brought in crisis intervention training for police that has expanded across the state and created the idea of a safe place for people to go when they are in crisis, diverting from jail and the hospital — an idea the state has now adopted.
Johnson County is also on the front end using technology to intervene. While the state’s mental health regions have focused on expanding the 24-hour crisis phone lines, the Crisis Center has found more and more people, especially young people, want to chat online with a person about their suicidal thoughts, said the center’s spokesperson Sara Sedlacek.
Last year, the center found of the 13,000 chats on their site, 80 percent were suicide related and 85 percent of the people chatting said if the center wasn’t there, they wouldn’t have reached out to anybody, Sedlacek said.
People seem to be drawn to the option to stay anonymous and talk about their pain or concerns with someone who is willing to listen and who isn’t a therapist or a doctor, said Beau Pinkham, director of the center’s crisis intervention services. The center trains its own volunteers using best practices from across the country and is planning to expand their training this summer across the state to keep up with demand.
Yet the Crisis Center is only one of two places in the state that Sedlacek is aware of with the technology to do what they do and there are many communities who aren’t aware the option exists in the state.
Organizing intervention strategies on a smaller scale is also occurring in a few rural communities, such as Knoxville, a town of 7,313 located 40 miles southeast of Des Moines.
Community members are beginning to ask more poignant questions about how to help people who don’t typically receive any services and how to advocate for changes on a statewide level, said Jean Holthaus, a local counselor, who helped spearhead their coalition. The coalition is also strategically including the faith-based community, a key player to build trust and expand its reach.
“In our churches, our sport teams, we have to pay attention to our networks, said Ryan Nesbit, who is helping several communities organize. “People are slipping through the cracks.”
Still, in a state with 99 counties, there are less than a dozen organized groups or coalitions on suicide prevention that meet regularly, he said.
For more than a century, sociologists have warned of how the breakdown of community ties and social connections was contributing to public health risks.
People who feel more connected in society and feel like they belong are less likely to take their own life, Emile Durkheim, a French sociologist often referred to as the father of sociology, first proposed in the late 1800s.
In recent history, Harvard Political Scientist Robert Putnam has warned of how Americans had become more disconnected then ever, abandoning civic clubs and churches and voter turnout and community meeting attendance was down threatening the fabric of society.
“We’re 35 percent less likely to visit our neighbours or have dinner with our families than we were 30 years ago. We watch sport alone instead of with our friends,” wrote Putnam in his 2000 book “Bowling Alone.”
Helping communities to build connectedness and a sense of belonging could be one of the missing factors in suicide prevention strategies, believes Behavioral Scientist Deborah Stone at the CDC. Connectedness is one of the seven key factors Stone cites in her recent guide she created for states and local governments to adopt.
“It’s really a crucial element to this broader approach,” Stone said in an interview.
Critics caution against putting too much weight on social connections, especially where communities have little social or economic power — meaning the problems could be more likely rooted in deep class issues rather than social bonds.
But Stone’s work also highlights that communities need to think about creating economic support as well, such as more affordable housing, loan modification programs and examining rental eviction policies. She is hoping a tangible blueprint can exemplified in another state — Colorado.
The Colorado Office of Suicide Prevention goal is to help support more nurturing communities and prevent people from getting to the place of a crisis in the first place, while reducing suicides overall by 20 percent.
The sobering truth is that no state has been able to cite specific prevention strategies to show a decrease in suicide, said Sarah Brummett, Colorado’s suicide prevention director.
“The standard in suicide prevention (is) know the warning signs and how to get people help, but if that’s all we’re doing, we’re never going to get to the place where we impact suicide,” Brummett said. “What are the roots and social drivers of suicide?”
One of the six Colorado counties chosen as an incubator to test the policies created in collaboration with the local communities is Mesa County where the population is about 150,000 and the suicide rate is more than double the national average.
Over the years, Mesa County created safety programs and offered suicide awareness training, but never saw any measurable results, said Jeff Kuhr, the county’s health director.
Recently, community members went back to the basics and asked what was driving the health risks in their community, which included suicide and also poverty, child abuse and crime rates that always brought the same groups together after an incident or a high-profile death.
With the help of a hired community organizer, they were able to identify, through public meetings and a county-wide survey, one area most people thought was a contributor — lack of community connections.
To start, the group chose one neighborhood — a square-mile surrounding an elementary school — where poverty and crime rates were high, where there was a large Hispanic and elderly population.
Then police, school and hospital officials, mental and public health providers, along with the business community, identified how to bring more resources to their neighborhood, build trust among residents with law enforcement, bring needed health services, sign up more elderly residents for meals on wheels and get more parents involved in the school, he said. With a community grant of $150,000, Kuhr said they hope to eventually expand into new neighborhoods.
“I don’t want new programs. We need to do what we do better,” Kuhr said. “It’s about agencies working together to understand how they complement each other and it’s about empowering the community and building that connectedness.”
After Loni Parrott’s husband killed himself, she had a difficult time leaving her house.
“Everyone is looking at you, talking about it because of the way he died. I didn’t even want to go to the grocery store at first because of the way people were looking at me and saying, ‘Oh how are you doing?’” she said. “I just wanted to disappear.”
Often the grief of losing a loved one is compounded by the shame and guilt family members often feel when grieving a suicide, she said, and society often reinforces those feelings.
Both Parrott and Lori Panther struggle with how people now view their husbands and even their own families. But Panther tries to battle the stigma she often sees by letting people know about the misconceptions of suicide.
Panther saw the way her husband suffered and tried to get help for his anxiety but eventually she believes he thought his family would be better off without him burdening them. She wishes he and others like him could know that is never the case.
“I always thought suicide was such a selfish thing,” Panther said. “But unless you know and walked in someone else’s shoes…” her voice trailed.
Parrott knows her husband’s family struggled with a long history of suicide and mental illness. His grandfather killed himself when his mother was still a child and as an adult his mother died from a drug and alcohol overdose. For years, Parrott’s husband was the stabilizing force in his family.
“I see it as shattering families,” Parrott said.
But she also struggled with her anger. Anger at the psychiatrist who released her husband when he went to the emergency room, a few days before he died. But she is also still angry with her husband 16 years later because of how his death impacted her sons.
“The man I knew would have never left his sons like that,” she said.
She struggles with the right approach to suicide prevention, one that is compassionate and works to correct the shame of suicide but also recognizes the harm that is left behind. That is why she hopes to one day publish a book that describes what her family and those closest to her husband went through.
For the right words, she often turns to her oldest son Cody’s journal entries, where he describes his own battle with anxiety and depression after his father’s death, trying to make sense of what happened.
“Dad’s act held such enormous power;” he wrote in 2005, three years after his father’s death. “It was like he held us up, all of us, in his palm, and then he pulled it forever away.”
Contact Joy Lukachick Smith at firstname.lastname@example.org or 423-596-7766.