“To rescue the fallen is good, but ’tis best to prevent other people from falling.”

—The Fence Or The Ambulance by Joseph Malins, 1895

5280 September 2015
More From The Issue

Bright colors danced before Josi Stewart, a blurry kaleidoscope floating in the distance. She blinked her chocolate brown eyes and implored them to focus. Slowly, her vision sharpened. Hazy blobs became rectangles. Ambiguous hues turned to familiar blues and pinks and yellows.

Her brain was still sludgy from the medication doctors injected to revive her. Josi couldn’t remember how she ended up in this hospital bed, with an IV piercing her arm and a machine breathing for her. She recalled feeling overwhelmed by the responsibilities of her two new jobs. She assumed she would slip up and be fired soon enough. That was the scenario doctors once outlined for her: She’d never be steadily employed, so she should settle for simply trying to keep up with her meds.

Over the previous few weeks, hopelessness dominated her thoughts and flushed every constructive feeling from her mind. Shame paralyzed her; it prevented her from asking anyone for help. She was exhausted from trying to compress her emotions into something manageable, and she chastised herself as she lay in the darkness: What’s wrong with you? She couldn’t think of anything good about her life. Her blackest thoughts took over and fostered an emotional anguish that hollowed her out until she couldn’t imagine living with the pain for one more minute. She decided to swallow every pill she could find. In that moment, like several times before, she just wanted it to end.

When you have a brain that’s functioning as it should, it’s nearly impossible to empathize with those whose minds are not. People aren’t generally aware of the tangles of neurons inside their heads; the brain has no pain receptors. People like Josi, though, know an unsettled mind—one besieged by feelings of worthlessness—can rebel without warning and trap itself in a desperate labyrinth, far from reality.

Society has long stigmatized the issue with the phrase “committed suicide,” which implies a crime or a religious sin. This taboo silences and isolates people dealing with suicide ideation (the term used to convey thoughts about or a preoccupation with suicide); it breeds shame so deep it collapses their abilities to seek or accept help. What most don’t understand is that nine out of 10 people who survive a suicide attempt won’t go on to die by their own hands. On this January day in 2008, Josi was in the majority. She was alive.

Her co-workers and family took shifts so Josi would see a familiar face when—if—she awoke. Two of them were sitting with her as her vision cleared and the colorful shapes sharpened. For a split second, Josi thought she had died and was having an out-of-body experience. Gradually she began to comprehend what she was seeing: Dozens of cards—from colleagues and friends, some store-bought, others made lovingly by hand—were taped on the wall across from her hospital bed, hopeful notes crafted over the past three days while she lay unconscious. She settled her gaze. Right there was proof of the impact she’d had on others. For the first time in her 29 years, Josi finally realized that her life might actually mean something.

Josi’s experience is not unique. More than 800,000 people worldwide, including about 40,000 Americans, die by suicide each year. Suicide is the 10th leading cause of death in the United States—roughly twice as many people take their own lives annually as die by homicide—and it affects all age groups, sexes, and races (though death by suicide in the United States is most prevalent among working-age, non-Hispanic white men). Males die of suicide about four times more often than females. Women, however, are three times more likely to make attempts than men.

In Colorado, suicide is the second leading cause of death for people ages 10 through 44, and its highest mortality numbers are among 45- to 54-year-olds. In 2014, 1,058 people died by suicide in the state, the most since at least 1940, eclipsing the previous high in 2012. Elevated suicide rates are particularly prevalent in the mountain states—so much so that researchers have dubbed our region “the suicide belt.”

(Click here for data on the 10 Leading Causes of Death by Age Group in the U.S.)

The Centennial State currently ranks seventh nationally for suicide deaths and regularly appears in the top 10. It could be the large swaths of rural land that encompass 77 percent of Colorado’s geography, where access to health care and mental health services can be limited. It could be the culture of rugged individualism and self-reliance, high rates of gun ownership, or the large population of transplants, who sometimes lack strong personal ties nearby. It certainly has something to do with the general dearth of funding for prevention efforts. Colorado’s swelling veteran population is also a contributing factor, as veterans die by suicide 50 percent more often than civilians in similar demographics. It might even be the mountainous geography: Researchers are exploring whether high elevations exacerbate the effects of mood disorders.

Two days after she woke up, Josi moved to the psychiatric unit at Presbyterian/St. Luke’s Medical Center, where she spent the next few weeks recovering. She still can’t remember many details because her hospital stays blur together. The now 37-year-old has paced hallway after hallway in such facilities fairly regularly since her first mental illness diagnosis at age 14.

The world has long burdened Josi’s barely five-foot-tall frame. She lived briefly in an orphanage in her native Peru after her birth mother threw her from a moving vehicle. A single Caucasian woman in Colorado adopted her when she was two years old. Josi was bullied in school and sexually assaulted at least three times. This past May, she was diagnosed with fibromyalgia, a chronic condition whose painful physical symptoms, Josi says, don’t compare to what she’s long endured internally. Over the years, she’s been diagnosed with everything from bipolar disorder to Asperger’s syndrome to PTSD to obsessive-compulsive disorder. (All but bipolar are part of her current diagnosis, which also includes anxiety and schizoaffective disorder.) In the few weeks leading up to her most recent attempt, in 2008, Josi became more and more despondent, lost in a tangled web the light could no longer reach. Her mind slowly and deliberately discarded every option and homed in on what she mistakenly believed was her only solution.

If you or someone you know is experiencing a crisis, call 1-844-493-TALK (8255) or visit coloradocrisisservices.com. Scroll down for more resources in Colorado.

According to the National Alliance on Mental Illness, one in four U.S. adults experiences mental illness, and one in 17 lives with a serious mental health condition such as bipolar disorder or major depression. When it comes to people who die by suicide, up to 90 percent have a diagnosable mental illness. But not everyone with a mental health issue experiences suicide ideation, even though such thoughts are surprisingly common throughout society. In 2013, the Suicide Prevention Resource Center reported that 9.3 million adults in the United States had serious thoughts of suicide in the past year. Of those, 1.3 million made an attempt and approximately three percent of them died.

Yet suicide remains among the country’s least publicized health issues. News reports and press releases about the nine-month-old Colorado Crisis System—part of Governor John Hickenlooper’s $20 million mental health agenda—sidestep the word almost entirely. “You should be as comfortable talking about your mental health with your co-workers, with your family, as if you have a cold,” the governor told me this past June. “And yet the truth is, we’re a long way from there.”

The key to preventing suicides is connecting with people before despair and isolation turn passing thoughts into unwavering resolve. That’s why advocates are encouraging attempt survivors and those who have experienced suicide ideation to share their stories of recovery. Narratives like Josi’s, they say, may be the most crucial piece to saving lives because they spread messages of resilience and hope and the idea that feeling suicidal isn’t a permanent state. “It’s not an unusual story,” says Sally Spencer-Thomas, a clinical psychologist and founder and CEO of Denver’s Carson J Spencer Foundation. “It’s just that few people are telling it.”

Sally Spencer-Thomas works in suicide prevention in memory of her brother, Carson.

Sleep sometimes eludes me. The world is still, except for the incessant hum of the air conditioning, and I lie there staring into the darkness until the wee hours, willing myself to tire. When I was a child, I’d occasionally give up and sneak out of bed to find my dad. Sometimes he’d be lying in bed, my mom fast asleep beside him, watching John Wayne Westerns, and I’d nestle in between my parents. Other nights, I’d find him in his garage workshop and help with whatever electronic device he was tinkering with. He’d catch me up—on the plot of the film or how a speaker’s wiring worked—and after a while, he’d tell me it was time for bed. My busy mind, now satiated and calmed, would finally be ready to turn off. I’d snuggle under my pink comforter, stuffed animals piled around me, and fall right asleep.

Samuel Singer was exciting to be around. An entrepreneur and engineer, he ultimately had eight patents to his name. He spoke four languages. He was born in Russia and immigrated to Israel and then Canada, where I was born. He taught me to swim and to ski and to ride a bike. He helped me with my multiplication tables and introduced me to Doctor Who. He built a treehouse next to the swing set in our backyard and a go-kart my brothers and I would zip around in near our childhood home in Pennsylvania. He loved to dance to the Gipsy Kings and read science fiction and eat and laugh. My small fingers would get lost in his as he twirled me around the dance floor. Those solid, strong hands wrapped ponytails that stayed perfectly in place during my band recitals. They were the same hands that tenderly picked me up and carried me to the car after I broke my leg playing on our tree swing.

He loved to take photos, hundreds of them, and captured every family trip and moment, big or small. He was behind the camera on December 15, 2000, documenting my eighth-grade semiformal dance. I beamed in the purple dress and dangly earrings I’d picked out with my mom. My older brothers no longer lived at home; one was in college, and the other had already started his career. I slept at a friend’s house that Friday night and was home for a short time the next morning before my dad headed out the door. When I reminded him about our plans to shop for holiday gifts that weekend, he shrugged me off. I didn’t think much of it, but my mom would later note that it seemed like an unusual response. I don’t remember if he hugged or kissed me goodbye. But sometime later that day, my handsome, brilliant, gregarious father picked up one of his guns and never came home.

There’s no single reason people die by suicide. Depression and previous attempts are among the most common risk factors, and feelings of hopelessness and exposure to trauma are also widely cited. But it’s almost always a combination of factors. “It’s important for society to see suicide as a major, lethal outcome of a difficult, often tragic personal situation or mental health condition,” says Eduardo Vega, a suicide attempt survivor based in San Francisco who leads several prominent suicide prevention organizations.

Scientific understanding of suicidal behavior and prevention is a young field, but in his illuminating 2005 book Why People Die by Suicide, clinical psychologist Thomas Joiner, who lost his father to suicide, argues that in addition to myriad recognized risk factors (including mental illness, substance abuse, and age), there are typically three concurrent circumstances that contribute to death by suicide: a perception of burdensomeness, feeling disconnected from others, and an acquired ability for self-injury. “People are not born with the developed capacity to seriously injure themselves,” he writes, but they can cultivate it via painful events throughout their lives.

Taken alone, these aren’t unusual states of being; in adventurous Colorado, the thirst for perilous escapades is perceived to be commonplace. As journalist Tony Dokoupil wrote, “Joiner’s conditions of suicide are the conditions of everyday life.” An overlapping of all three, though, is rare. When they merge like circles in a Venn diagram, it intensifies a falsehood in the suicidal mind that the person’s death is worth more than his life.

Timothy Bishop can relate to that self-deception. He received a diagnosis of bipolar 1 disorder with psychotic features at age 19; he’s experienced two major episodes of mania and countless more minor instances, as well as at least two serious bouts of depression. He speaks eloquently and thoughtfully about his illness and its effects, a combination of the wisdom that comes with time—he’s now 50 years old—and the professional skills he’s learned. Timothy is a peer support specialist at Rocky Mountain Crisis Partners (RMCP), which runs the new 24/7 statewide crisis hotline, and a certified professional coach specializing in mental health.

Timothy says he’s contemplated suicide hundreds of times. He once sat on his bed as a 16-year-old, debating whether to grab a shotgun from the hall closet. Another time, he walked out to the barn at his home in Elizabeth to see how much rope there was. He made one serious attempt, the summer before his diagnosis, while on a manic upswing; his friends forced him to throw up the pills he’d swallowed. Sometimes, his suicide ideation appears in fleeting notions—a desire to escape the psychological torture his illness has wrought—but at other times it develops into an obsession lasting weeks or months.

As Timothy tries to describe those despondent moments, he repeatedly lifts his right foot and places it back on the floor, as if he’s trying to ground his thoughts. His blue eyes gaze through his black-framed glasses, and he takes a deep breath. “If you’ve lost somebody close to you, that’s sadness and that’s grief,” he says slowly. “Depression is that sadness where the bottom falls out. Where, if you can see a color, it is the blackest of the black. You can’t see out of it. There’s a hopelessness that this is never going to end. It feels like you’re dead—you’re dead and you want to be more dead.”

It’s been said that “only” is the most dangerous word in a suicidal person’s vocabulary. Again and again, Josi and Timothy became trapped in the tunnel vision that often accompanies suicide ideation. Asking if someone is suicidal can break that intense focus; the frankness creates a connection, opens communication, and can provide a sense of liberating respite. Once the mind finds clarity beyond the haze, it’s able to comprehend that there are other ways to fight the anguish. “In the mind’s eye of that person, suicide is perfectly sensible,” says David Jobes, a clinical psychologist and professor of psychology at Catholic University in Washington, D.C. “But it’s the most extreme response to usually relatively treatable issues.”

Jobes believes research like his may lead to more effective treatments. Currently, only a handful of replicated therapies have proven to reduce suicide ideation and behaviors. Among them are Jobes’ contribution, Collaborative Assessment and Management of Suicidality; cognitive therapy; and the most promising suicide prevention treatment to date, dialectical behavior therapy. Sadly, most of these methods still aren’t widely practiced. Traditional interventions such as involuntary hospitalization, quick-fix medications, or forcing patients to sign contracts saying they won’t take their own lives are often knee-jerk and can be needlessly coercive. (Hospitalization can be beneficial, but experts say it shouldn’t be the only option.)

Suicide prevention advocates want to shift their efforts upstream, pre-crisis, but a dam is blocking their path: The majority of American mental health professionals lack adequate suicide prevention training. It’s typically not part of medical school curriculum; most physicians and clinicians learn about it on the job. “We have clinicians who are inadequately trained and patients who are suffering with treatable issues,” Jobes says. “It’s an emperor-has-no-clothes situation.”

Susan Marine is a retired sociologist and a board member for the Suicide Prevention Coalition of Colorado. She lost her children, Kevin and Alice, to suicide in the early 2000s; both were young adults living with bipolar disorder. She says her one regret is that she wasn’t educated enough on depression and other risk factors for suicide. In 2013, she surveyed 479 Colorado mental health professionals about their suicide prevention training. Forty percent said they received 10 or fewer hours of suicide education, even though 43 percent indicated that they deal with the issue on a weekly basis and 72 percent said clinical training would be helpful.

The only medical profession with formally mandated suicide prevention training is psychiatry. Dr. Michael Allen—a researcher at the University of Colorado Depression Center and member of the Colorado Psychiatric Society’s legislative committee—says more than 90 percent of American psychiatrists receive suicide risk assessment training (compared to 50 percent of psychologists and fewer than 25 percent of social workers). This supervised learning amounts to a mean of just 3.6 hours of formal seminars and lectures during their residencies. In 2012, Washington state passed the Matt Adler Suicide Assessment, Treatment and Management Act, the first of its kind, which dictates that certain mental health providers, including social workers, psychologists, and occupational therapists, must receive six hours of training every six years as part of their continuing education requirements. In 2014, the law was expanded to include a one-time six-hour training requirement for physicians and nurses.

Colorado state Senator Linda Newell, with help from Marine and other advocates, attempted to craft a similar bill in 2013, but it never made it to the Statehouse floor. A number of groups, including the Colorado Psychiatric Society and Colorado Psychological Association, expressed concerns about the state’s structural readiness for such a law, and they evinced a general resistance to outsiders—that is, politicians—setting requirements. These groups argue that not every type of medical practitioner needs the same type of instruction. (Until this past spring, psychologists in Colorado didn’t even have a general requirement for continuing professional development.) To date, the result has been little or no required suicide prevention training at all.

This means those at risk often aren’t being identified even when they seek help. Allen supports focused training but understands the lack of support for Colorado’s bill. “We at least want a workforce to be able to ask questions and identify suicide risk,” he says. “[The proposed legislation] was just kind of premature because the continuing education framework wasn’t there.”

The problem extends to primary care providers (PCPs). According to the American Foundation for Suicide Prevention, 45 percent of people who die by suicide have seen a PCP within the previous month. Asking about depression or suicide risk often isn’t part of a routine medical visit, and even if PCPs do inquire and get an affirmative answer, lack of training means they may not have many—or any—vetted referral options. (Screening tools have been developed and accepted for use in PCP settings.) Paul Quinnett, president and CEO of suicide prevention training provider QPR Institute, has been involved in public mental health for more than 30 years and says, “Sometimes a failure to ask is interpreted as permission to proceed.”

(Read 5280‘s special report about Colorado’s mental health crisis)

In Colorado, longtime grassroots efforts finally helped create a statewide Office of Suicide Prevention (OSP) in 2000. The 24/7 National Suicide Prevention Lifeline launched in 2005 and is overseen locally by the Pueblo Suicide Prevention Center and RMCP. When Governor Hickenlooper took office in 2011, he named suicide one of the state’s “10 winnable battles.” In 2012, federal officials updated the National Strategy for Suicide Prevention (suicide prevention was first declared a national priority in 1998). And in 2014, Colorado legislators created the Suicide Prevention Commission, a 26-member advisory group charged with leading prevention and intervention efforts here. Improving training absent a legislative directive is just one of the group’s myriad objectives. These efforts can’t evolve quickly enough: The number of suicide deaths in Colorado rose higher than ever last year.

The Office of Suicide Prevention’s Jarrod Hindman fights against a small budget and suicide’s stigma every day.

Although the statewide crisis system has experienced some implementation hiccups since it launched in December 2014, there already has been a noticeable uptick in the number of people seeking help. “We know Colorado hasn’t been at the top of anything when it comes to behavioral health funding,” says Cheri Skelding, a licensed clinical social worker and clinical director for RMCP’s 24/7 statewide crisis hotline and 14-hour-a-day peer support line. “This is the starting point for Colorado’s commitment toward behavioral health in the future.”

Now that the big-picture crisis system is in place—beyond the crisis and support line, it includes walk-in clinics, crisis stabilization units, mobile crisis services, and respite and residential centers—Colorado activists want to create a comprehensive continuum of care. Currently, “suicide prevention is really suicide intervention,” says Jarrod Hindman, violence and suicide prevention section manager at OSP. In other words, while the crisis system is important, we still aren’t doing enough to stop people from reaching the precipice of suicide—or to help them after an attempt.

For example, even though the period after discharge is particularly dangerous for suicidal people, Colorado hasn’t established standards for what information hospitals must give patients or their families following an attempt. In 2012, our Legislature passed HB 1140, which required OSP to provide materials about suicide warning signs, post-attempt treatment, and community resources to hospitals. But a follow-up assessment found that only 51 percent of hospitals that responded reported using the materials.

A new pilot project at four hospitals (two metro, two rural) takes a different approach by having a clinician from RMCP speak with patients or parents by phone before the patients are released and then follow up several times over the next few weeks. Hindman hopes this more focused effort, which requires identifying a point person at each venue, will help bring more hospitals on board. Broadening awareness and identification of those at risk as early as possible is key because even those closest to a suicidal person may not recognize or believe there’s a problem.

Memories of my dad were everywhere. His laugh and his booming voice still echoed through the quiet that had overwhelmed our house—interrupted often by recollections of the doorbell’s chime, the cop standing there, and my mother crying.

I needed to get out. Some close friends gathered at a neighbor’s house a few days later. I tried to be normal and joke and eat the holiday cookies my friend’s mom baked every December. Their lightheartedness seemed purposeful, as if they were determined to cheer me up. When someone asked me what I wanted for Hanukkah, I desperately wanted to maintain the levity and forget my horrible new reality, but the words tumbled out: “I just want my dad back.”

I couldn’t cry the night he died, even when I tried thinking of something sad to generate tears. I realize now I was in shock, but at the time I was appalled at myself, even as I recognized that I was probably just trying to protect my mother from seeing her own pain reflected back.

As a suddenly fatherless 13-year-old, I was furious—at my dad, at my mom, at the world. How could he have left me? He couldn’t have been thinking of me, I decided, or he wouldn’t have done it. I felt guilty. Did he call out for help and I missed the signs? I had no idea how to face a world in which I’d barely heard the word “suicide” uttered before.

For every suicide death, researchers believe an average of 115 people—family, friends, co-workers—are impacted. Those who have experienced the suicide of a close relative are up to six times more likely to attempt suicide themselves. Two of my father’s siblings, my aunt and uncle, also died by suicide. (None of them were ever formally diagnosed with mental illnesses, but family anecdotes reveal some instances of depressive and manic behaviors.)

I don’t want that to be the legacy my family—my father—leaves my brothers and me. I want his creativity, his drive, his charisma, and his kindness to be what we carry with us. For people bereaved by suicide loss, those gifts often are overshadowed internally by anger, guilt, confusion, and a sense of abandonment.

For a long time after his death, I was lost. I slowly resumed my routines (school, volleyball, movies with friends), but something was still missing. That void resulted in arguments with my mother—two people stuck together in a house that should have been more full. It made me more of a risk-taker at times; when I got older, I’d drink more than I should, or I’d carelessly cliff-jump off a 50-foot precipice. The danger didn’t concern me—not because I was a daredevil, but because I thought, What does it matter?

I never felt I lacked a male role model. I have two inspiring older brothers to whom I’ve always turned for life and career advice—or more often, a laugh. My mom has continued to parent the way she and my dad did before, by always supporting me and by giving me the freedom to find my own way. I know I’m not alone. And yet, we each carry our grief in our own ways. It’s something we can’t share.

My father’s absence has also made me strong, confident, and independent. But his death did leave me with what one attempt survivor calls a psychological “limp.” I am, in a way, broken. Unexpected early morning or late-night phone calls still cause a tightening feeling in my chest. I have occasional nightmares in which someone I love is in an accident. I’ve given mental eulogies to people who are still alive. I rarely make it through a father-daughter wedding dance without breaking down. Without him, I’m more stubborn, more hotheaded, more sure that my way is the right way. Because I need to know that if I have to, I can do it all on my own.

But now I realize something else: In researching this story and meeting people who’ve been through similar situations, I can finally, as a 28-year-old, empathize with how my dad must have felt, even if I’ll never fully comprehend his state of mind.

My heart will always bear a scar, but today the sadness I feel is much more for him. I’m pained that my dad’s worldview must have seemed so bleak and that his heart bore such a burden. How awful it must have been to carry that every day. I wish he had known that he could have lost everything—his business, his money, the rest of his hair—and we would have never stopped loving him. He taught me to be strong and face adversity with courage. We would have carried the burdens he couldn’t. I wish he had given us the chance. I wish I had realized how much he needed us.

My father has already missed so many important moments—my college graduation, my first byline, my brother’s wedding—and he’ll be absent for whatever lies ahead. The yearning for his presence never subsides. Grief is a constant companion. You grow around it, the way a tree matures around a foreign object, but you never forget it’s there. It arises at predictable times—anniversaries or birthdays—but also in the most mundane and unexpected moments, like when you see “Dad” pop up on your friend’s iPhone screen.

It’s difficult to keep my father’s memory alive. My friends, colleagues, and boyfriend never met him. They don’t know the person he was in his soul, so there’s a part of me they won’t ever fully understand. I’ll never know who I would be today if my father was still here, but I hope I’ve grown into someone he would recognize and respect. I can’t remember his laugh anymore, or his voice. I forget what it was like to have a conversation with him. I feel guilty that I didn’t hold on tighter to those memories, that I let growing up fill in the holes.

I hope I never forget how safe I felt when he hugged me. And how much he loved me and how proud he always was of even my smallest accomplishments. I think I remember his smile, which amplified the creases around his eyes. But maybe that’s because of a picture sitting on my bookshelf, a framed, sepia-tone photo of him captured by my oldest brother, Seth. I look at it every day.

Suicide attempts are a complex mix of impulsivity and planning. Those who attempt typically have underlying risk factors and, like Josi, have been fighting a losing battle against overwhelming feelings of hopelessness—usually while dealing with a mental illness—for an extended period of time. The decision to act, though, often occurs in hours or minutes.

Firearms are the most common means of suicide fatalities, partly because they’re so lethal—about 85 percent of attempts with firearms result in death—and in much of the country, so accessible. “You’re not more likely to become suicidal if you’re a gun owner, but if you become suicidal, you’re more likely to use a gun in your attempt and therefore to die,” says Catherine Barber of the Harvard Injury Control Research Center.

Gun ownership will always be a contentious issue in Colorado, where 76 percent of all firearm deaths between 2005 and 2012 were suicides. (See graph at right.) “We need to demand a harder conversation politically about how long we are going to put our heads in the sand and not talk about the access to firearms,” says Senator Newell, who has sponsored two pieces of suicide prevention legislation in the past three years.

Barber and many others are pushing to change social norms around firearm safety—what she calls the “designated driver approach.” Whether it’s locking guns in a safe or storing ammunition separately, means restriction (the reduction of access to lethal methods) saves lives. In Colorado, a gun owner can legally transfer a firearm, even to an unregistered person, for up to 72 hours—longer if it’s being given to a family member or if it’s “necessary to protect themselves from imminent death or injury.” Research shows that just interrupting the acute crisis often creates enough time for the person to find help, or at least to take a moment to manage his thoughts. For instance, installing suicide barriers on bridges deters people from jumping at those spots; suicides dropped from 24 in six years to one in five years after the city erected a barrier at D.C.’s Duke Ellington Bridge. In 2014, officials in California approved a $76 million project to install steel-cable nets 20 feet below the Golden Gate Bridge, where more than 1,600 people have leapt to their deaths.

This past year in Colorado, OSP and other prevention groups ran a means restriction education training pilot program at Children’s Hospital Colorado. It involved a mental health service provider meeting with parents or guardians of suicidal children to discuss how to make their homes safer. The program was successful enough that Children’s has officially adopted the protocol.

OSP is also reaching out to gun owners with a project in five Western Slope counties that mimics a successful one in New Hampshire. The premise is simple: Find a gun enthusiast in each community to approach gun shops as a peer and educate them about warning signs they or their customers might encounter. OSP intends to expand and improve both programs over the next year, and Senator Newell and OSP’s Hindman have hinted that some federal organizations, including the National Action Alliance for Suicide Prevention, are considering Colorado as a pilot site for federal-state collaborations.

This would mean federal money could start flowing into the state, easing one of the biggest impediments to suicide prevention: funding. “The burden of suicide in Colorado is disproportionate to the available resources,” reads OSP’s annual prevention report for 2013-2014. OSP’s yearly budget of approximately $465,000 confines Hindman’s efforts to small projects around the state. The money issue is bleak even when you zoom out. The National Institutes of Health’s suicide-related funding has dropped by $10 million since 2011.

Perhaps the only benefit of this small till is that it breeds creative thinking. The negative, beyond the obvious, is that inadequate funding gives weight to pervasive stigma surrounding the issue and supports the idea—at a governmental level—that suicide can’t be prevented. Until convictions change, money won’t follow. “One of the greatest misperceptions about suicide—and that drives funding—is that when someone dies by suicide, it’s their fault,” says Michelle Cornette, executive director of the American Association of Suicidology, who compares the sympathetic reaction someone with cancer receives to the you-made-your-bed response to a suicide. “There’s a tendency with a suicidal individual to say, ‘Well, that’s their choice.’ We know that to be not true. It’s not a choice.”

Millions of people have stories similar to mine, and until recently, they’re the ones who largely carried the suicide prevention flag. We’re all confronted with the question that haunts those left behind, what Sally Spencer-Thomas’ mentor calls “the canyon of why.”

Spencer-Thomas lost her younger brother, Carson, to suicide in 2004. A successful entrepreneur with a young family, he was living with bipolar and substance abuse disorders. Two weeks before his 35th birthday, Carson took his own life. Spencer-Thomas is unsure exactly what changed that summer and fall, but a downward spiral of loss may have launched Carson into his deepest depression, a pit of self-loathing he never managed to escape. It flipped his view of himself from a confident, charming man into someone who could barely get out of bed.

Anxiety, sorrow, and fear consumed Spencer-Thomas after her brother’s death. The assistance of family, colleagues, her faith community, and a survivor support group helped her move through the initial year of acute pain. They lifted her up again eight years later when she battled her own severe depression. Now, seated behind the desk at the foundation that bears her brother’s name, a photo behind her of the two of them dancing at her wedding, Spencer-Thomas says she’s become certain of one thing. “I’m pretty sure that he would have figured it out,” she says. “I believe he could have made it through if he knew on the other side he could have gotten his life back. I feel like that’s the part he had lost hope on.”

As with other types of unexpected loss, those bereaved by suicide face tsunamis of grief as they sort through not only the anguish of lives cut short, but also the trauma of what is usually a violent death, the isolation of community stigma, questions of blame, and many other unanswerable thoughts. When the survivor’s world is upended, how does he or she move forward?

Clinical grief support can be difficult to find, but volunteer organizations such as HEARTBEAT can ease some of that bewilderment. LaRita Archibald founded the support group in Colorado Springs in 1980 for those bereaved by suicide; there are now chapters in 15 states and three countries. Her son Roger died by suicide in 1978 at age 24. “Stigma was just thick,” she says of that time, her eyes bright and her hair now white. In the late 1970s, there were few organizations in the country addressing grief, so she started her own. “Everybody who goes through this is knocked to their knees,” she says. “But we can take things that happen and make meaning from them. It takes a lot of courage to face society when someone in your family has crossed a taboo boundary.”

Today there is an international movement loudly clamoring for a paradigm shift called Zero Suicide. Though most people realize we’ll never truly get to zero—suicide has been part of the human narrative for millennia—the phrase signifies a foundational belief that the suicide deaths of individuals who access health care and behavioral health systems are preventable. It’s about keeping people from falling through the most basic cracks, and it’s a bold, outspoken stance on a topic that’s been feared for far too long. “The big message is that a million people attempt suicide every year in the United States, and most of them go on to recover their lives and find meaning and purpose in life,” Eduardo Vega says. “We are not the ‘other.’ We are not strangers or aliens. And we have messages of hope that can help others if we can be heard. Suicide is preventable. The real tragedy is that in most cases, if most people had better supports—the right kinds of supports—they wouldn’t get to that point of
finally pulling the trigger.”

Josi thinks her last suicide attempt was her sixth; it’s difficult to recall the exact number. It’s been seven years since that wall of get-well cards inspired her to focus on living, inspiration drawn from friends and colleagues who made sure to tell her how much they loved and appreciated her—even though her doctors weren’t sure she’d ever wake up. “In the past, I felt like no one would care if I died,” she says, her fingers constantly fidgeting. “For the first time, I had people who said they’d miss me.” Josi now works as a peer support specialist at RMCP, where she uses her own experiences to help others overcome challenges. She’s also the drop-in coordinator at CHARG Resource Center, a Capitol Hill nonprofit that aids adults with mental illnesses.

Josi knows her mental health will be a constant struggle. She still has serious bouts of depression. January, in particular, has always been difficult; she doesn’t know why. She’ll probably have to go to the hospital again—she calls it a “pit stop”—to reset. Remaining so diligent can be exhausting. But it’s critical. “For me, recovery is a day-by-day, hour-by-hour, and sometimes minute-by-minute choice that I have to make,” she says. The need to continually revive her most basic will to live is a sentiment Josi shares with other attempt survivors.

On good days Josi pauses, urging her brain to remember every ounce of the positive feelings she’s experiencing, burning them into her memory so she can draw on that reservoir whenever bleakness seeps in. She educates herself on her illnesses. She attends therapy regularly. She keeps a gratitude journal, jotting down three or four positive things that happen every week. “Those good things don’t come to you when you’re depressed,” she says. “When I’m depressed, it’s like I’m walking through this world but I’m not really a person, not really alive.” It also helps to be able to look up at that collage of cards from the hospital: They’re framed on a wall in her apartment.

In my bedroom at my mom’s house, there is a handwritten message from my father on a ruled pink sticky note. The paper has faded with time, but his words, and their meaning, are unchanged. The note is taped to a Popsicle-stick bridge we crafted together for a junior high class. It’s dated December 6, 1999, and reads: “Always do things right, and always have confidence in your work—makes life fun! I love you more than anything in the world!”

The last sentence became the foundation of a drawing my brother David made me for my 14th birthday, seven months to the day after my dad died. Sketched in pencil, the words are accompanied by hand-drawn portraits of my father and me. The precious gift hangs by my bed at home. When I visit, it’s usually the last thing I look at before I turn out the lights.

On the night my dad died, I fell asleep at some point on his side of my parents’ bed, my head resting on the pillow that still held an indentation from the last time he lay there. I’m not sure when I closed my eyes or for how long I slept.

There’s a flicker in time, a split second between sleep and consciousness, when your brain hasn’t fully rebooted and you float in an ethereal space as the light of morning hovers in a hazy golden kaleidoscope before your closed eyelids. In that moment I seemed to exist in some sort of in-between, a place of calm and peace where yesterday’s reality had not yet resurfaced. The comforter swathed me in its warmth. As the sun streamed through the blinds onto my face, I slowly blinked awake into the unmistakable glow of the new day.

Postscript: We are saddened to inform our readers that Josi died on Tuesday, October 6, 2015. Our deepest condolences are with Josi’s family, friends, and colleagues. Her family is raising money to pay for her medical bills and funeral; if you wish to contribute. You can also read senior associate editor Daliah Singer’s tribute to Josi. 

RESOURCES

General
Colorado Crisis Services: 1-844-493-TALK(8255)
National Suicide Prevention Lifeline: 1-800-273-TALK(8255)
American Foundation for Suicide Prevention, Colorado Chapter
University of Colorado Depression Center
Suicide Prevention Coalition of Colorado
Man Therapy
HelpPRO Suicide Prevention Therapist Finder
Mental Illness Research, Education and Clinical Centers (for veterans)

For Rural Colorado Communities
Mind Springs Health
Western Colorado Suicide Prevention Foundation
Reaching Everyone Preventing Suicide (REPS)

For Youth
Second Wind Fund
Voz Y Corazon
Sources of Strength
The Trevor Project

For Those Bereaved by Suicide
HEARTBEAT

This article was originally published in 5280 September 2015.
Daliah Singer
Daliah Singer
Daliah Singer is an award-winning writer and editor based in Denver. You can find more of her work at daliahsinger.com.