National Action Alliance for Suicide Prevention Tackles LGBT Suicide

By Kellan Baker and Josh Garcia

Kellan Baker is a health policy analyst with the LGBT Research and Communications Project at the Center for American Progress and a member of the Action Alliance for Suicide Prevention LGBT Task Force. Josh Garcia is an intern with the Project. 

Before he completed suicide at the age of 26 in 2010, Joseph Jefferson recorded his final words on Facebook: “I could not bear the burden of living as a gay man of color in a world grown cold and hateful towards those of us who live and love differently than the so-called ‘social mainstream.’”

Though LGBT suicide is frequently portrayed as a wholly youth phenomenon, Joseph was an LGBT activist who had built a life for himself as an adult after getting through what many people assume to be the only tough part of an LGBT person’s life—adolescence.

The National Action Alliance for Suicide Prevention, the public-private partnership aimed at saving the more than 34,000 lives in the United States lost every year to suicide, has taken a lead in changing public misperceptions about LGBT suicide. In particular, the Action Alliance task force that concentrates on the LGBT population has changed its name from the LGBT Youth Task Force to the LGBT Populations Task Force, acknowledging the struggles with suicide ideation, suicide attempts, and death by suicide that many LGBT people confront at different points in their lives.

The reasons that suicide is a lifelong concern for many LGBT people are complex and dynamic. These risk factors include family rejection, lack of social support, lack of access to culturally competent healthcare providers, and the stress of living with discrimination and prejudice.

Because of family or employment obligations, many LGBT adults, like most LGBT youth, do not get to choose where they live and work—often leaving them trapped in hostile environments with family members, co-workers, or neighbors who do not accept them.

Certain protective factors may mitigate these risks. Such factors include family acceptance, affirming and culturally competent mental and behavioral health services, and policies that extend legal protections and promote acceptance.

Indeed, the past several years have seen several advances across the country on behalf of fairness for LGBT people. New York state passed marriage equality for same-sex couples in 2011, and Washington state and Maryland followed suit in 2012. And, recently, the federal government has taken an active role in implementing LGBT-inclusive laws and policies.

But much remains to be done to help eliminate suicidal thoughts and behavior among LGBT individuals. In addition to increased legal protections and working to change stubborn social prejudices, there is a particularly pressing need for further research and data collection regarding mental health and suicide among the gay and transgender population.

Currently, there are no national data regarding suicidal ideation or suicide rates among the LGBT population as a whole. Nor are there sufficient data regarding the experiences of specific segments of the LGBT population, including LGBT youth and elders, transgender adults, and LGBT people of color, who may be at increased risk because of the multiple burdens of discrimination they bear.

Thus, as part of the implementation of the upcoming National Strategy for Suicide Prevention (NSSP), the Action Alliance must take the lead in pushing for nationally representative data on suicide rates among the LGBT population. These data will inform the development and implementation of evidence-based interventions that can help protect the lives of LGBT people.

Such interventions may include initiatives fostering resilience and help-seeking behaviors among LGBT people, connecting them with providers who are both familiar with mental and behavioral health issues and comfortable accepting and respecting their LGBT clients, and promoting supportive school, work, and other environments.

In addition to driving research that can guide efforts to prevent LGBT suicide, the ultimate purpose of the Action Alliance is to save lives by decreasing the rate of suicide in our country. And to do this, each one of us—whether LGBT or ally, pastor or policymaker, researcher or activist—must respond to the moral imperative to help build a world where LGBT people count and are counted, and where they can live their lives free from discrimination, harassment, and the violence of suicide. 

Protecting Life in Indian Country

As the Action Alliance carries out its important work of advancing our National Strategy for Suicide Prevention, I believe that we can make a significant difference in the lives of many. For American Indian and Alaska Native communities, this assistance is especially needed.

Bringing awareness to this issue is of utmost importance and for this reason the Indian Health Service, Bureau of Indian Affairs, Bureau of Indian Education, and Substance Abuse and Mental Health Services Administration recently hosted two Action Summits for Suicide Prevention.  The first Summit was held August 2011, in Scottsdale, Arizona and the second Summit was held October 2011 in Anchorage, Alaska.

Yvette Roubideaux, MD, MPH
Director
Indian Health Service
United States Department of Health & Human Services
National Action Alliance Executive Committee Member

The Summits brought together nationally recognized speakers, behavioral health providers, tribal leaders, health care providers, law enforcement, first responders, school personnel, and many others. In total, more than 1,000 people attended. During this time, we worked to develop and strengthen new and existing collaborations, gather information on best and promising practices, and collect information on the most up-to-date research on suicide and substance abuse prevention, intervention, and aftercare. Most importantly, the Summits provided an opportunity to share personal experiences in addressing suicide and substance abuse in Indian Country.

In order to bring about real change, numerous parties need to be involved and dedicated. The Summits focused on the importance of collaboration among tribal, federal, state, and community- and program-level leadership to promote American Indian and Alaska Native behavioral health.  This work will pave the way for new partnerships and help advance the mission of the Action Alliance.

The Action Alliance American Indian and Alaska Native Task Force has a goal. That goal is to implement suicide prevention strategies to reduce the rate of suicide in American Indian and Alaska Native communities. We are working hard to ensure that we reach our goal.

As a member of the Rosebud Sioux tribe, reducing suicide in Indian country is very important to me and I have dedicated my career to improving American Indian health care. I hope that my leadership of the American Indian and Alaska Native Task Force and membership on the Action Alliance’s Executive Committee will advance suicide prevention in our nation and I work every day to do my part in ensuring that this goal is reached.

Running to Pole 69

Eduardo Vega is the Executive Director of the Mental Health Association of San Francisco and a California Mental Health Services Oversight and Accountability Commissioner. In addition holding a seat on the Executive Committee of the National Action Alliance for Suicide Prevention, where he leads the task force on suicide attempt survivors, he is a member of the Steering Committee of the National Suicide Prevention Lifeline.

Exercise is crucial medicine for me, as it is for many. I feel certain, for instance, that training over many years in yoga, martial arts, and now running, has saved me from the worst effects of recurrent depression that were part of my life since childhood. Whenever possible on Tuesday mornings before work, I run to the center of the Golden Gate Bridge, to the landmark of light-pole 69. More people die by suicide off the Golden Gate Bridge on Tuesday than any other day. And it seems possible that at Pole 69 more people have jumped to their death than any other single place in the world.

You get accustomed to it, of course, but the beauty of the Bridge can still strike you on a given day--the dramatic rise of the red towers through shawls of fog, the infinite vista of ocean, and the powerful detachment from land and city.

As I run on it I think about the people who come here in despair, people who are feeling that death is the best way, or maybe the only way, to wrest power, dignity or simply relief from a life that seems unendurable; people in a place similar to where I once was.

When I get to Pole 69 I spend a quiet moment. Sometimes I think about the four friends I lost to suicide, or the parents, brothers, and sisters I've met whose lives were devastated by loss in the wake of such a death. I look at the water and feel the rails and try to connect with the many people who have come here seeking a resolution, however tragic, to their sense of utter desolation. Sometimes I reflect on my own suicidal moments and attempts. The seemingly endless months where I felt so far from hope, the years in which I yearned daily for an accidental decisive death. I think of the time I took actions to do the same, the fleeting feeling that I was no longer a victim, that in planning to die I finally had taken the power away my pain.

When you look out on most days from the center of the bridge you see Alcatraz island very clearly. It seems lugubrious as a metaphor, but I can’t help but think how that might affect me, if I was planning to jump.

Like it or not, we live in a society that prizes individual freedom above all, one in which punishment is meted out in terms of lives without it. One in which many people see being identified as mentally ill as worse than being a criminal, and some see it as worse than death. For some, the first time one goes through the doors of a locked psychiatric facility, that sense of self is forever altered. For people who struggle and are hospitalized repeatedly, the undermining messages, the insults to personal dignity, and the cuts at hope can be intensely magnified.

People who advocate for such things as mental health services, myself included, sometimes lose perspective on how powerfully such things as hospitalization can affect those on the receiving end. How, ironically, one’s conception of oneself may be shaken, weakened, even damaged by something designed to support it. 

As I stand on the Bridge, I know that somewhere in the world there is someone asking themselves --what is worse, to be a mental patient, or to die? 

Our biases about mental illnesses run deep--cultural prejudice, stigma, and shame are pervasive in our media, our conversations, and our dinner tables. They are alive within the system of mental healthcare, too— even though mental health providers feel professional stigma they also pass it on to clients through slights on individuals’ dignity, mistreatment or low expectations that diminish people’s hope for their lives.

That does not mean that we should not promote good mental health services and supports. Treatments and therapies make a huge difference in saving lives and in helping people grow into their own resources for recovery, self-care, and wellness. But it does mean that, if we want to reduce death by suicide, we have to combat stigma, silence, and shame associated with mental health conditions and treatment.

There is a very good reason the US Surgeon General identified stigma as the biggest barrier to progress for our country’s mental health overall. In order to really eliminate stigma as a barrier to mental health, and thereby as a contributor to death by suicide, we must change no less than society’s view of people themselves. We must embrace the reality that living with mental health problems is a challenge to many, that debilitating mental illness can affect us all, and that its experience is part of being human. To free our society from the tragedies of suicide we must make personal dignity more powerful than symptoms or disability, we must foster communities that believe in and support their people, not regardless of, but especially when they are facing personal struggles. 

I believe we can make this evolution happen-- we can challenge our history of fear and judgment and build on our resources of compassion. We can take the side of people when they are suffering, seeking to understand, rather than label, to help without depriving anyone of the strengths that come with overcoming hurdles.

The course back from the Bridge is tougher. A large part of it is up a steep hill and not too pleasant. Some mornings it can be hard to keep going, even to put one foot in front of the other.

I suffer much less and less frequently now from symptoms of mental illness. But there are still days when getting up, going to work, talking or even walking down the street can feel unendurable. There are moments I feel crushed under a paralyzing weight, when everything real retreats into bleak grey clouds.
Sometimes in those moments, the desire to die returns again, a specter of deliverance emerging like a boat out of the fog.

That boat will take me nowhere, will help no one. There’s just too much work to be done.

It is the work I so often come back to on these little journeys. If we were successful in eliminating stigma, I know people would not be jumping from this bridge twice a month. We would not be dying at Pole 69 because we would be able to prevent mental illness or to manage it successfully; we would have the resources to create enduring wellness in our mental and emotional lives, and an atmosphere of acceptance. We would be healthier because we would have the right kinds of support from our communities and families, from professionals that see people before diagnoses, from helpers who know that dignity is more important than medication, that hope is more powerful than pain.

As an attempt survivor, a loss survivor, and a mental health advocate, I am convinced that preventing death by suicide is the result of many minds, many hearts, and many hands. I’m honored and feel grateful to contribute in my way and to join with the leadership of the Action Alliance in this mission.  As we move forward, I’ll continue to add some legs and feet to the mix, to take your thoughts and good energy with me on the road to Pole 69, where we can all make a difference together.

A Hole in the Soul that Never Heals

It’s as if it were yesterday.

I was a college freshman studying in my room when my very best friend Pam walked in. She was ashen. I asked her what was wrong. In a near-catatonic state she told me her beloved brother John, a high school sophomore, had killed himself. In that instant Pam’s world collapsed. She immediately blamed herself for being away at school when he needed her. I watched the family blame themselves and go through all the stages of grieving – yet they never fully healed.

Even now, decades later, Pam and her entire family are still suffering from that tragic choice

Judy Cushing
President and CEO
Oregon Partnership
National Action Alliance Executive Committee Member

I had never been touched by anything like it. I decided that I wanted to do something that would help prevent other families from going through that level of devastation. It became a very personal mission.

Years later Oregon Partnership, the non-profit organization I direct, was able to add a fully certified Suicide Prevention Lifeline. Last year we received over 19,000 suicide calls to our Lifeline.

I can’t express how satisfying it is to be in our crisis line center and to overhear one of our team members help move a caller from a position of life-threatening crisis to one of safety. It’s literally life-changing. Not only are lives saved on the LifeLine, but compounded waves of tragedy and years of grief have been averted. 

Thousands of families didn’t have to go through what Pam’s did because of our skilled staff and volunteers.  The best news is that there are Lifelines all across the country quietly preventing people from taking their lives.

Suicide is the ultimate “elephant in the room” that our society doesn’t want to acknowledge or talk about.   I am so proud to be part of an initiative like the Action Alliance that is focusing on changing the way society thinks about mental illness and suicide.  I’m confident that some day we will discuss suicide and mental health issues as openly as we would discuss cancer. When suicide is moved out of the shadows of secrecy and shame – the twin enablers - we cast a bright light on it and, in so doing, foster prevention.

Suicide prevention needs to become a national priority. It must receive the level of attention and action of any other pandemic that kills people every day. The formation of the Action Alliance is a huge step in that direction. It’s an honor to serve with so many accomplished decision makers who are ready to influence national suicide policy. I’m also deeply touched by how many of my fellow committee members have been impacted by the devastation of suicide.

My personal area of emphasis on the Action Alliance is the Lifeline network across the country and Military and Veterans and their families.   An average of 18 veterans a day die by suicide in America.    We must come together to provide a safety net for them across all sectors of society.

We must take action to prevent suicide. For Pam, for John, and for all of our families.

It is hope...that keeps me working

I am an advocate for suicide awareness and prevention.   My husband, Bill Popp, and I have worked for many years to help educate the general public about the signs of an impending suicide, plus ensure that support is offered to survivors of suicide.

Teri E. Popp

President of the Minnesota Military Family Tribute

 Limited Partner in the Minnesota Timberwolves

National Action Alliance Executive Committee Member

Eighteen years ago, I was diagnosed with a major depressive episode.  Interestingly, I did not have a trigger for this episode.  In some ways, that made my diagnosis easier.  However, I can say, without a doubt, that I would not have been diagnosed, at least not at that time, without the strong support of my husband and family.  In fact, I might not have made it to a diagnosis at all. 

When I was diagnosed, depression was not spoken about.  It was classified as a mental illness, and mental illnesses were not discussed.  In addition, I grew up in a military family, being the child of a career Air Force officer.  As a result, you didn’t, generally, speak about failings.  And depression and mental illness were certainly seen as failings. 

But I have a husband who is remarkable.  And he got me the aid I needed. He did not view my depression as a failing, but instead, viewed it as a treatable disease, like diabetes.  Because of his support and enlightened thoughts about depression, I now speak openly and honestly about my depression and the possible ramifications.  We understand that deadly consequences can occur with untreated depression.  We also understand the genetics involved within families.  We hope to help other families, as well as our own, in correctly identifying depression and having it treated to avoid the long-term pain and suffering that can ensue from a lack of diagnosis.

We have learned that peer-to-peer counseling and open dialogue and communication are some of the more effective methods of working to curb suicide rates.  My husband and I are lucky to have Suicide Awareness Voices of Education (SAVE) nearby, and we are strong proponents of SAVE’s work.  We would like to see that great work continued and expanded from a regional to a national level.

Recently, I was privileged to attend the SAVE Fashion Show to help raise funds for suicide prevention on the regional level.  One of the women there came up and thanked me for my involvement and support.  She asked me if I was being helped in collecting my auction items.  I said, “Yes, the young lady behind the counter is helping me.”  The woman responded:  “That is my daughter, Angel.  And she truly is my angel.  I had two teenage sons who committed suicide and, through the work of [suicide prevention agencies], I see hope for my angel.”  It is hope, such as this mother’s, that keeps me working to see that suicide prevention is addressed on a national level.

In closing, I would like to say that one of the most intriguing aspects of the National Action Alliance for Suicide Prevention is that it is a private, as well as public, initiative.  The NAASP offers a golden opportunity for the private sector to work directly with government agencies.  This is not a problem that can be solved by the government or by individuals alone—we all must work together, in partnership, to eradicate suicide.  I am honored to be a small part of this monumental endeavor. 

Self Built Lonely Walls

The first I heard of suicide was a story about my great uncle told by my parents when I was a child. He was a Navy Seabee, loved by many, and then gone. He took his life. I wondered why? Another story told to me, a threat of suicide during my college days…my friend talking her roommate down from exiting via the window of a high-rise dorm building, lots of screaming, tears, then hugs, and then off to the college pub to party…it will be ok? Then as a high school substitute teacher hearing rumors among students about life-threatening behaviors, they were just high. Everything was fine? Attitudes and behavior merging to silence often so lonely, and so quiet, suicide not to be spoken of, yet almost deafening noise created by loss, pain, and anguish.

Brian Dyak
President and CEO
Entertainment Industries Council, Inc.
National Action Alliance Executive Committee Member

Finally out of college ready to tackle the world, I was young, married, and energetic. Opportunity abounded, she a trained crisis intervention teen counselor and me an activist organizing and creating youth crisis services for runaway youth. I heard stories of dysfunctional families, physically abusive family circumstances, alcohol abuse and drug addiction, rape, incest, violence, and suicide. My path became clearer to help make the community aware that compassion was necessary and services such as hot lines and crises centers were essential. The challenge: to somehow stop the cycle of discontent and to work to make things better by finding like-minded people who cared and promote services that can assist.

Then, what seemed to me out of nowhere, I came home to find that my wife compromised her life and her service to others by ending her life. The same friend who talked her roommate out of jumping. I took solace in a note that spoke of love and life and her trials to be a part of this world. She spoke of her own “self built lonely walls” and vindicated those who loved her clearing the blame, guilt, suspicion, and doubt. She put forth a challenge to discover how strong one must be to go on. A challenge she chose not to accept for herself. I went forward with great confusion. What could I have done?

Unfortunately it did not stop. My friend and college roommate, a talented musician, decided he “had enough” following in the footsteps of one of his good friends who permanently left his children and family to fend for themselves. I wrote his parents to lend what support I could, explaining all the good that their son had bestowed on so many and his high standard of friendship. Other suicides surfaced in my life among close family, friends and acquaintances, the most recent a friend who just lost his son a few months ago. How can anyone really understand that split-second of decision to actually leave life behind?

Suicide, creating wounds and then scars for life, challenges the power of optimism that the world can be a better place. Yet, like a huge human experiment of life, I have been fortunate finding compassion and support from loved ones early on, learning the importance of sending out love, unconditional love, and finding like-minded people. The havoc suicide does to relationships may be countered by love and time. Working together towards understanding and openness is essential…hiding only contributes to the loneliness and the confusion, a consideration I made when I said yes to writing this blog. I also deeply considered the contributions that the media could make to suicide prevention.

The National Action Alliance for Suicide Prevention is an amalgamation for me of what has been, what is, and what can be. It is an honor to participate as a member of its Executive Committee. The Action Alliance is a gift that permits many people with varied life experiences and vast expertise to work together on behalf of others and unselfishly themselves. The notion that shaping public policy, service to others, raising awareness, and educating about real-life circumstances of suicide is a power that states,” I am not alone, we are not alone”. Feeling the support of others, communicating the caring for the purpose and mission, and, most importantly, showing love of life and optimism creates opportunity that together we can truly make a difference. I believe we can set a course that can break down “self built lonely walls” and let life be the gift it is intended to be. The Action Alliance is a vehicle for that belief to come true and I am grateful to be able to play a small part.

David Covington

In 1995, the very day I completed my masters in Community Agency Counseling, I returned home feeling like a “master clinician” only to immediately receive an imminently suicidal caller. My first thought was how I could possibly go through a 60-hour CACREP accredited program without a shred of preparedness! My balloon of confidence popped, and I spent the next 10 hours in a more important final exam.

David W. Covington, L.P.C., M.B.A.
Vice-President, Adult & Youth Services
Maricopa County Regional Behavioral Health Authority
Magellan Health Services
National Action Alliance Executive Committee Member

Fourteen years later, as Chief of Adult Services for Magellan of Arizona, our CEO Richard Clarke charged me with leading an initiative to end suicide for those enrolled in our care. We found thousands in our network’s workforce feeling similarly unprepared, as I had been years earlier. I have found the metaphor of the Golden Gate Bridge and the story of Kevin Hines extremely powerful in understanding our challenge and our opportunity.

Eighteen-year-old Kevin Hines was receiving usual and customary behavioral healthcare but was despondent over the challenges of his bipolar disorder. In September of 2000, he kissed his father goodbye and caught a municipal bus to the bridge where he hurled himself over the rail, a tragic scene that has been played out some 1,500 times over the last 80 years.

The railing is embarrassingly low at four feet. The rationale has been that people like Kevin would simply go somewhere else or do something different if the rail were higher. “You cannot stop someone from killing themselves if they really want to do it,” or so the saying goes.

In Phoenix, we have used the bridge to tell the story of the opportunity Community Behavioral Health has to challenge suicide directly and raise our own rail to stop these deaths.

Forbes magazine last October in “The Forgotten Patients” chastised the mental health industry for ignoring the 35,000 people who die by suicide each year. The Suicide Prevention Resource Center’s published report on progress since the 2001 National Strategy found little focus on improved training.

The core belief currently strongly ingrained among many healthcare professionals is that there are two distinct kinds of people who have very little to no overlap in terms of their experience – “Group A” are those who kill themselves, and “Group B” are those who talk about it. This is what we were taught.

Kevin did not just talk. He took an action that is lethal 98% of the time. He recounts vividly the last five seconds prior to jumping. One second he was so distraught he would do anything to end his pain, and the very next, there was no more grip on the bridge’s firm steel. Instantly, he realized he had made the worst mistake of his life and would do anything to undo what he had just done.

In 1975, Dr. David Rosen interviewed 7 of 10 known survivors with similar stories. Three years later, Dr. Richard Seiden interviewed 515 people who were taken off the bridge by law enforcement. The average length of time since their experience was 25 years. Yet, only 6% had gone on to kill themselves somewhere else and later on.

The same year that Kevin took the bus to the bridge, Don Berwick challenged the Henry Ford Health System (HFHS) in Detroit to improve its depression care. HFHS adopted what has become known as the “Perfect Depression Care” initiative. They raised their rail, and in 2010, they reported their tenth quarter without a suicide death.

In 2009, our Phoenix behavioral health collaborative determined to end the practice of suicide care as a specialty referral. We raised our rail and trained 2,000 in the core of the workforce in a two-day suicide prevention training. It has changed our culture and provided a level of skill, confidence, training, and support to effectively engage those at risk.

Kevin and others like him have taught me that suicide is always preventable and future deaths are avoidable. We have two powerful allies in suicide intervention, namely the mind and body of each person who struggles with intense emotional pain. They do not cooperate and continuously find ways to fight back.

Recently, 25-year-old Lashanda Armstrong drove a minivan off a dock and into the Hudson River. The only survivor was her 10-year-old son, who climbed out the window and swam to safety. Initially, his mom told him if she was going to die, he was going to die with her. But, as she plunged into the water, she desperately tried to put the car in reverse and repeated, “I made a mistake.”

We do not have to feel helpless or hopeless. We can make a difference. Mike Hogan is the Commissioner of Mental Health for New York State and my co-lead for the National Action Alliance Task Force on Clinical Care and Intervention. I believe we can do that best by dedicating ourselves to frank and open discussion of a higher rail and real solutions.

Question: Months after Kevin’s story was released in Eric Steel’s documentary, the bridge authority voted 15 to 1 to install a physical deterrent underneath the full span. What is the equivalent of the programmatic safety net we need in healthcare to render suicide a “never event?”