The numbers are staggering.
Every eight hours a Hoosier dies from suicide, according to the American Foundation for Suicide Prevention. In fact, more than twice as many people die by suicide in Indiana annually than by homicide.
Suicide is also the second leading cause of death in the state among people ages 15-34; the fourth leading cause for ages 35-54; and the eighth leading cause for ages 55-64.
In Howard County, there is an average of 10 deaths per year by suicide; four per year in Miami County; and six per year in Tipton County, according to local officials.
Since the suicides of high-profile personalities like designer Kate Spade and author/chef/TV personality Anthony Bourdain, people are questioning why. Why did these very successful, beloved people commit such an act?
What drives people to such despair that they would take their own lives?
As humans, it is very natural for us to want to know why, explained Vanessa Enos, a therapist at Community Regional Health Behavioral Health in Kokomo.
"It's really common for people left behind by a suicide death to want to find a rational reason or excuse," she said. "Humans tend to be very logical and suicide is an illogical thing for people who don't have a mental illness.
"It doesn't make any sense. We try to make sense of it, so if there's a recent event, that is a great target for our frustration, anger, sadness and our grief — but the vast majority of the time, it is compounded by a person's mental health, substance abuse, home life and family history."
Mental health
In 2015, Indiana was ranked 45th in the country in a “State of Mental Health in America” study by Mental Health America, down from 19th in 2011.
One of the main mental health issues that leads to suicide is depression.
“Have you ever been in an all-consuming fog? Maybe you have a car 5 or 15 feet in front of you and you just can’t see it? It might as well not even be there due to your inability to see it or sense it. That’s what major depression is like,” said Brandi Christiansen, executive director of Mental Health American of North Central Indiana.
“When you’re struggling with depression, the chemicals in your brain, serotonin and dopamine, are depleted. You’re going to isolate yourself, which means you’re not going to be active, you’re not going to be getting sunlight, you’re isolating yourself socially — so there’s no lifeline to pull you out of that,” Christiansen said. “It’s sort of a self-propelling phenomenon. The big word that comes up with people who are experiencing suicidal thoughts is this ‘hopelessness’ and the inability to see beyond it.”
That sense of complete hopelessness often drives suicidal thoughts.
"It's not just being sad, it's much deeper and more profound than that," said Enos. "When a person gets to a point of thinking about dying, suicide or hurting themselves in some way, in general, they are at a point where their suffering, their hopelessness and their pain has become intolerable for them."
According to the 2011-2015 Suicide in Indiana Report, death by suicide accounted for 44,193 lives lost in the United States in 2015, which equates to 121.1 suicides per day, a 15 percent increase since 2010.
However, many suicides or suicide attempts are unreported or misreported as accidents, causing the magnitude of the problem to be far greater than current statistics indicate, the report continued.
“Of the 10 leading causes of death in Indiana, suicide is the only one that is rising,” said Kelsey Steuer, Indiana Area director of the American Foundation of Suicide Prevention. “Cancer, diabetes and heart disease have all been decreasing over the years and suicide is rising — and it’s the only one that is preventable.”
The most vulnerable
As of 2016, Indiana ranks 10th in youth suicide rates and first in suicide ideation, that is, the number of young people who report thinking about suicide and developing a plan to do so, according to the state report. The ideation rate was last reported at 19 percent — nearly double the national average.
Nearly 30 percent of high school students in Indiana reported feeling sad or hopeless almost every day for two weeks or more, resulting in changes in behavior during the past 12 months, according to data from Kids Count, an annual assessment of child well-being in the U.S. by the Annie E. Casey Foundation.
Almost 10 percent of high school-aged Hoosiers reported they attempted suicide in the previous 12 months.
There are several factors that play a role in a young person’s mental health, one of them being the development of the brain.
“Their prefrontal cortex hasn’t been developed yet — that’s your impulse control and the part of the brain that puts on the brakes and makes rational decisions,” Christiansen said, noting a person’s brain isn’t fully developed until they reach their mid-20s.
Another factor that affects mental health has been the popularity of social media — something that has only grown to be problematic within the last decade. Facebook, Twitter, Instagram and other social media have allowed people to remain connected, but can also contribute to someone’s negative self-esteem, Christiansen continued.
“Social media is creating cognitive dissonance,” she said. “It’s always been an issue for human beings to compare their insides with other people’s outsides, but never before have we been bombarded with these photos and representations of everyone’s life, regardless of whether that’s an accurate depiction of what their life is like.”
Who's at risk?
According to the Suicide in Indiana Report released in 2017, males accounted for nearly 80 percent of all suicides, and of those, 93.4 percent were white males. White males aged 45–54 years had the highest rate of suicide, followed by white males 65 years of age or older, the report continued.
A portion of those statistics could be attributed to the alarming rate of veterans dying by suicide.
According to the U.S. Department of Veterans Affairs, 136 Hoosier veterans and 7,388 veterans across the country took their own lives in 2014.
As a veteran herself, Christiansen knows what some of these men and women are going through. She meets with other veterans every week at Jackson Street Commons in Kokomo during a group program called Vet-to-Vet, which is open to all veterans, not just ones who live at the housing facility. A lot of them do have mental health problems, varying from the post-traumatic stress disorder to depression to substance abuse, she said.
Yet, Mental Health America and other organizations are more concerned about the veterans who are not coming to group programs like Vet-to-Vet.
“Obviously the vets that we really worry about are the ones that we can’t even reach — the ones that come home from the war, they don’t have faith in the institutions that sent them to war, they are not involved with the VA and they are sitting in either their parent’s basement or their own place, in the dark, isolating themselves and abusing substances,” Christiansen said.
“They are the ones that we are desperately trying to reach because they are the most vulnerable. We haven’t figured out how to do that yet, but we have a ton of people in our community that love the vets and appreciate their service and sacrifice.”
Those left behind
Steuer was just 11 years old when her father killed himself.
She remembers attempting to shield her younger brother, who was 9 at the time, from the pain of such grief.
“I thought that by being silent, I was being strong,” she said. “We talked about my dad, but we didn’t talk about how he died. I went my whole childhood and through my senior year of college until I met another suicide loss survivor.”
It was 13 years after her father passed away that Steuer even heard the words “suicide” and “prevention” in the same sentence. She was sitting in a Starbucks when she overheard the then-Indiana area director of the American Foundation for Suicide Prevention talking.
“It was one of those moments in my life where my life changed forever,” Steuer said.
She then started volunteering for the organization before becoming the area director for the state.
Today, the American Foundation of Suicide Prevention is the nation’s largest nonprofit dedicated to saving lives by creating a culture with increased mental health literacy. In order to achieve that mission statement, the foundation funds scientific research, educates the public and advocates for public policies regarding mental health and suicide prevention.
The American Foundation of Suicide Prevention is also a major supporter of those left behind after someone they love dies by suicide. Just one of several ways it helps loss survivors is by pairing them with people who have shared similar experiences within the Survivor Outreach Program.
“We have trained volunteers who are loss survivors that we pair with people who might be where it just happened or not happened recently,” Steuer said. “We help connect them to resources and we are just an ear to listen.”
As a volunteer in the Survivor Outreach Program, Steuer said she learned how important it was to talk with people who share those similar, tragic experiences of losing someone to suicide.
“We talk about how I’ve navigated through that grief — I don’t think it ever goes away, but you can learn how to carry it differently, especially when you meet other people like you,” she said.
“I think it’s important for us to connect with people like us, because mental illness can take our loved ones from us even before they take their own lives — it withdraws them, it isolates them and makes them feel that they are a burden. To be a caregiver for someone with a mental illness — it’s hard.”
Christiansen also has lost someone close to her. She recently learned one of her fellow Navy shipmates, a police officer, had died by suicide.
“I had no idea,” she said. “I wasn’t constantly in communication with him, but it did strike me hard because this is one of our most vulnerable populations to suicide, veterans and police officers, because of PTSD.”
She continued to say one of the most heartbreaking elements of the loss is the fact the family has chosen to stay silent. Suicide is not something that should follow the old rule of “out of sight, out of mind” anymore and talking about suicide is the only way to break through that stigma of shame, she said.
“There’s nothing we can do about the past, so every time we reside in the ‘should’ve, could’ve, would’ve,’ we are just repeating that brain pattern and solidifying that guilt,” Christiansen said. “What I decided with the loss of my shipmate and my friend, I am just digging in all the harder for it to honor his life because he is just an amazing person and I refuse to pretend like it didn’t happen.”
Some solutions
Mental Health America of North Central Indiana is focusing on education and early intervention, Christiansen said.
“We know a few things. We know that we don’t have enough mental health providers in Indiana or in the nation,” she said. “We know that mental health disorders are presenting themselves as early as 8 years old, with a median age of 11 years old, and we know that the earlier you can intervene in those situations, the higher chance of a full recovery.”
At Kokomo’s First Friday on July 6, Mental Health America will be hosting a pre-K and parental interaction session at the Kokomo-Howard County Public Library that will teach emotional intelligence with a licensed therapist.
In addition to teaching parents, Christiansen said the nonprofit also is working to teach “Mental Health First Aid.” Last month, Mental Health America trained 29 community leaders how to assist someone experiencing a mental health crisis.
“Our goal is that we want everyone to be literate on mental health so we can take down those walls, barriers and stigma so people can just stand in the light and get the same help that they would get if they were diabetic or a had cardiological problem," Christiansen said.
That's where behavioral health therapists like Enos come in. Some people need medication to help handle the weight of depression and others don't, Enos said.
"There's not a quick fix — with depression and anxiety there are chemical chemical changes happening in your body," she said.
Those suffering from a mental illness might be recommended to an individual, group or family therapy. In some cases, inpatient services are needed to stabilize the person and keep them alive, Enos continued.
After witnessing the destruction of a suicide loss firsthand, Steuer also knows what needs to be done to keep the statistics from rising.
“We need more education, training, community outreach and just the ability to have an honest, real conversation with one another and be OK with the answers that we get,” Steuer said. “I like to say that even the softest of voices can be courageous. You don’t have to have a mic or a sign in your hand to make a difference, there are other ways to help save lives.”
Part of that solution lies within people having uncomfortable conversations with their loved ones who might be struggling with depression, Steuer continued. It is not easy to ask someone, “Are you having thoughts about killing yourself?”
Many people are hesitant to ask that difficult question because they think it might put the idea into someone’s head, Christiansen said.
“You have to ask the question without dread, do it straight up and be prepared to listen,” she said. “Be a friend and be the one to ask the question.”
Because one question may just save a life.
“I would much rather have an awkward conversation than go to another funeral,” Steuer said.