For Portland resident Stephen Canova, thoughts of suicide came unexpectedly one December night. Then 20, a sophomore in college, unhappy and disconnected from his tightknit home community, he tried to kill himself.
“I had no idea I had it in me,” Canova said. “I don’t remember a lot about that night. But I do know this — when I tried to kill myself, I didn’t want to die. I just wanted the pain to go away. I wanted out.”
Nationwide, more than 47,000 Americans died by suicide last year, according to data released this week by the Centers for Disease Control and Prevention. That’s a nearly 5 percent increase over 2016, when close to 45,000 people died. And it’s a continuation of a nearly 20-year rise in suicide rates that, along with drug overdose deaths, has been a leading factor in an ongoing decline in the average American life expectancy.
The 10th-leading cause of death among people of all ages, suicide is the second-leading cause of death among people 10 to 24, CDC numbers show.
Although youths aged 10 to 24 kill themselves at a lower rate than older people, youth suicides are climbing faster than suicides in other age groups. And the CDC says many suicide deaths could be avoided if more people knew how to recognise the signs of an imminent suicide attempt and the best ways to intervene.
In Canova’s case, 17 years ago, he said he had been separated from his family and community for the first time, and “just fell through the cracks.” After he attempted to kill himself, his roommate alerted his sister, who drove for an hour and showed up in time to get Canova to an emergency room and save his life.
Only 1 in 25 suicide attempts results in death. Research shows that most are preceded by warning signs such as extreme agitation or calm, withdrawal, and excessive drinking or drug use. Many people will talk about wanting to end their lives, say goodbye to others and give away belongings.
But if no-one notices these signals or knows what to do about them, the results can be deadly.
That’s why Oregon and a handful of other states have started initiatives aimed at training medical professionals on suicide prevention so that family doctors, emergency room practitioners and other medical professionals who care for young people can be on the lookout for those at risk of suicide and intervene.
In addition, states are requiring teachers and other school personnel to learn suicide prevention skills, as well as teach students ways of coping with stress and detecting signs of suicide risk in themselves and others.
Many states also have laws outlining what to do if a suicide is attempted on school grounds, with some states requiring schools to develop a plan for dealing with the aftermath of suicides by students, teachers and other school personnel.
This year, at least 10 states — California, Colorado, Idaho, Illinois, Iowa, Kentucky, Maine, Rhode Island, Utah and Washington state — strengthened existing school-based suicide prevention laws, in most cases providing additional funding for mental health resources.
Next year, Oregon lawmakers are expected to consider a comprehensive new schools-based suicide prevention measure, as well as increased funding for mental health services in schools.
“We’ve seen incredible momentum in states to legislate on this issue,” said Nicole Gibson, state policy director for the American Foundation for Suicide Prevention, a national suicide advocacy group with chapters in Oregon and other states.
“I think if we can promote suicide prevention in schools,” she said, “it will go a long way to support students who are at risk by making sure they get connected to mental health support and by creating a culture in schools that it’s a sign of strength to seek help.”
Canova, now 36, is helping other youths who survive the crisis of a suicide attempt to make sure they get the treatment they need to avoid trying it again.
As follow-up services co-ordinator at Portland-based nonprofit Lines for Life, which works to prevent suicide and substance abuse, Canova says his own near-death experience helps him relate to people recovering from a suicide crisis. He and his team work with a group of local hospitals to ensure that patients who are discharged after a suicide attempt receive the care they need.
Suicide can affect anyone at any time of life, but research shows that people who survive a suicide attempt are at substantially higher risk of completing a subsequent suicide than those who have never tried it.
And in the weeks and months following release from a hospital after a suicide attempt or a visit to a doctor seeking help with thoughts of suicide, individuals are at high risk of killing themselves, said Jerry Rosenbaum, psychiatrist-in-chief at Massachusetts General Hospital.
Starting this month, Oregon will require all hospitals to provide follow-up services and referrals to mental health care for patients who are released after a suicide crisis.
Canova was lucky. When he was released from the hospital back in 2001, his sister and mother took him home and he received intensive therapy for six weeks before returning to college. He said he’s still using the coping skills he learned in those counselling sessions and hasn’t had suicidal thoughts since.
“I say to my friends, ‘I’m never going to do that again.’ But we all hit incredibly vulnerable moments in our lives when we feel like we’re a burden and our pain is too much,” he said. “Who’s to say that won’t happen again to me.”
Oregon’s suicide rate is higher than the national average, and the numbers are climbing. Last year, the number of suicide deaths in Oregon jumped 7 percent, compared to a 5 percent increase nationally.
“Every day, two people die by suicide in Oregon, and nobody knows about it,” said Dwight Holton, CEO of Lines for Life. “We don’t talk about it.”
“The stress teens feel about their grades and relationships is physiologically the same as the stress we adults feel about our jobs, our mortgages and our marriages, except that teens don’t have the coping skills most of us have developed over the decades,” Holton said.
Most young people know something about suicide, either from news reports of celebrity deaths or through social media and the experiences of friends and family. A recent young adult novel and Netflix series — 13 Reasons Why — that features teen suicide has made the topic even more popular on social media and has been criticised for glamorising suicide.
It’s highly unlikely that any youth today hasn’t heard something about suicide, Holton said. Still, many parents, teachers and other adults are wary of broaching the subject because of a misplaced fear that they might plant the idea of suicide and cause a young person to act on it, he said.
As a result, most youths have a limited understanding of how to detect warning signs, how to cope with their own suicidal thoughts or how to intervene if a friend or family member is showing signs of suicide risk. And since teens are often reluctant to talk to their parents or teachers about their relationship problems and suicidal thoughts, the result can be deadly.
To make it easier for teens to talk about suicide, Lines for Life started a youth hotline that recruits high-school volunteers, puts them through more than 50 hours of training, and supervises them as they respond to mostly texts, chats and some phone calls from peers who may be grappling with depression and suicidal thoughts.
– Stateline.org/TNS
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