Lora Thomas vividly remembers the day: a snowy February afternoon in 2012. She was Douglas County’s coroner then and she was standing in the kitchen of a home in Parker, talking with a father who had lost his son to suicide just hours before.
A year earlier, he told her, his son was an all-star athlete, taking advanced placement classes and in a serious relationship. But when he started smoking marijuana, his grades slipped, the father said, he got kicked off the football team, his girlfriend broke up with him.
Thomas, coroner from 2011-15, tried to visit every family who lost a young child by suicide during her tenure on the job. She wanted to reassure them she would treat each case with tremendous care.
“It can happen to anyone at anytime,” Thomas, now a Douglas County commissioner, said. “You don’t have to be poor. You don’t have to be in a bad family situation. You don’t have to be unemployed. There is no cookie-cutter description of someone who ends their life by suicide. It can happen to anyone.”
Tears well in the eyes of Jill Romann, Douglas County’s coroner today, as she recalls a case 30 years ago in Minneapolis when she was working as a lead death investigator. As she opened the home’s door, a mother on the far end of the room collapsed, pleading with Romann not to tell her that her daughter had killed herself.
“She was on her hands and knees,” Romann said, “crawling and begging in anguish.”
‘A community response’
As Thomas and Romann attest, the effects of suicide tear through communities across the country, leaving behind loved ones with wounds that never fully heal.
On average, 123 suicides happen per day in the United States, according to the American Foundation for Suicide Prevention. It is the third-leading cause of death for persons ages 10 to 24 and the 10th-leading cause for adults, claiming the lives of nearly 45,000 people each year, the Centers for Disease Control and Prevention reports.
A report released in June by the Centers for Disease Control and Prevention shows suicide is on the rise and calls it a significant public health concern. From 1999 to 2016, the suicide rate in the United States increased by nearly 30 percent. In Colorado, the rate grew by 34.1 percent.
Following the economic downfall in 2008, Colorado’s suicide rate spiked, said Sarah Brummett, the state’s director of suicide prevention. Since 2009, the rate of suicides in Colorado has been about 20 per 100,000 people compared to the national rate, which has hovered around 13 suicides per 100,000 people, Brummett said.
“Here in the West, we tend to have a very strong, rugged, individualistic mentality,” she said. “But it also works against us in terms of reaching out and getting help when we might be struggling.”
In Douglas County, a generally affluent region where the median household income is $109,292, the suicide rate is generally lower than the state’s. In 2015, the county’s rate was 16.3 cases per 100,000 people, according to the Colorado Health Institute, which studies health care trends across the state.
In 2017, 44 people in the county died by suicide, data from the county shows. In 2016, the number was 57. And in 2015, suicide claimed the lives of 58 people. The number of youth suicides in the county has ranged from three in 2015 to six in 2017. The population with the highest suicide rate in the county year-to-year is white men between the ages of 40 and 59.
Data shows that the numbers of suicides in a region will spike and decrease over periods of time because of what’s known as the contagion effect, when exposure to suicide or suicidal behaviors within a family, peer group or through media reports may result in a rise in suicide, Romann said.
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At the moment, “suicide in Douglas County is trending down,” said Romann, adding that the decreasing numbers may not necessarily indicate the trend will continue. “By my experience, it comes in at a steep curve and leaves as a gradual curve.”
During her time as county coroner, Thomas said 50 percent of people who died by suicide were being treated or taking medication for a mental illness.
Nationally, about 90 percent of people who die by suicide experience mental illness, most often depression, bipolar disorder, anxiety or schizophrenia, several mental health organizations report.
But Andrew Romanoff, president and CEO of Mental Health Colorado, the state’s largest mental health advocacy organization, says that number should be 100 percent.
“Suicide is an inherently irrational act,” said Romanoff, explaining that even if a person who dies by suicide hasn’t been diagnosed with a mental illness, his or her mental state is not stable.
One in five people in the U.S. have some type of mental illness, though the majority does not receive the care they need because of stigma, cost and accessibility, according to the Centers for Disease Control and Prevention.
Suicide carries a complexity that is difficult to make sense of or find a solution to, said Brummett. She and other mental health experts emphasize there is no single cause.
“If there was one cause, then we would have invented a seatbelt or a vaccination for it,” Brummett said. “But there is not. It’s so much more complex, and it doesn’t require just a clinical fix — it requires a community response at the community level.”
‘I felt so alone’
Emerson Mallery was 15 years old when a classmate he considered a close friend spread a rumor about him at school. He withdrew from his friends and family. He bottled in feelings of hurt, shame and sadness.
He feared that if he opened up to his family and friends, they would view him as “stupid or less of a person.”
An overwhelming sense of loneliness, he said, led to thoughts of ending his life. He did not follow through with his plan.
“The hardest part was not being able to talk to anyone about being lonely or sad,” said Mallery, who just completed his junior year at Highlands Ranch High School. He has a gentle smile and passion for science and gardening. “What would people think? Would their opinion of me change?”
A nationwide survey of high school students in the U.S. found that in the past 12 months, 16 percent of students reported seriously considering suicide and 13 percent created a plan, the Centers for Disease Control and Prevention reports. In 2015, 9.7 million adults reported serious thoughts of suicide.
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In Douglas County, 14.1 percent of youths considered suicide in 2013, according to a survey conducted by the state’s department of public health and environment. That means, in a class size of 25 students, for instance, about three would contemplate suicide. The county did not participate in the 2015 survey because of time conflicts with standardized testing. Results of the 2017 survey, in which Douglas County did participate, are expected to be released in early July, survey organizers said.
A society in which mental illness is too often stigmatized and viewed as a defect makes it difficult for individuals to express feelings of hopelessness or thoughts of suicide, limiting access to help and care, mental health experts say.
Thoughts of suicide, they say, are often linked to underlying problems that can be alleviated through therapy and medication, if necessary, or by simply talking to a friend, family member or trusted adult.
Said Thomas: “People need to know that there is help and that there is hope.”
Dr. Eileen Twohy, pediatric psychologist in the Pediatric Mental Health Institute at Children’s Hospital Colorado, said many suicides are impulsive. She emphasized the importance of identifying protective factors, which are what make a person's life worth living — friends, family, a job, school, a pet, healthy coping skills, having a sense of purpose.
"A lot of our approach to suicide is thinking about what puts a person at risk. Arguably just as important is what are this person's reasons for being alive," said Twohy, who works primarily with youth and families. "These are the things you can pull from in a moment of crisis to remind yourself you have a reason to be here."
Kristen Torres, a 2016 graduate of Chaparral High School, was 14 years old when she made plans to die by suicide. She struggled with anxiety and said she was bullied through middle school and high school. During her freshman year, a group of girls ditched her at homecoming, leaving her feeling isolated and lonely.
The night Torres planned to end her life, she was alone at her house. Her parents were traveling out of the country. Luckily, Torres’ grandmother called, asking her to dinner.
Soon after, Torres confided in a friend of her parents about her suicidal thoughts. The friend advised her to reach out to a school counselor, who recommended she be evaluated at a hospital. Since that day, Torres, now 20 and thriving at Colorado State University, has seen a therapist off and on.
“I refuse to be ashamed about (mental illness) because one in five people experience it,” said Torres, who radiates confidence and a sense of passion when she talks about mental health.
This summer, she is interning at an eating disorder unit at Children’s Hospital Colorado. At college, she is double majoring in clinical counseling psychology and marketing.
“If you feel like you are going down a dangerous path," she said, "reach out.”
The importance of identifying stressors
Again, mental illness, paired with a variety of lifestyle stressors, plays a role in most suicide cases, mental health experts say.
Stressors in Douglas County, Romann said, resemble those of the nation: changes in a relationship status, loss of a job, finances, trouble with the law, severe depression.
Romann and her chief deputy, Nick Lobello, both of whom have worked in low-income areas, describe Douglas County as a bedroom community that resembles other suburban areas across the country. There is no single identifiable stressor that is the cause of suicide, they said.
They emphasize the importance of identifying stressors.
“We know that mental illness and stressors, and some combination thereof, create the mindset in the individual that (suicide) is the only option,” Lobello said.
Twohy, who works with youth, agreed, and noted that the pressure to succeed can be a risk factor for young people.
"Any time kids feel a lot pressure and have opportunities to be hard on themselves or to feel like they are falling short — that puts any of us at risk for mood concerns," Twohy said. "The pressure to succeed could potentially be associated with emotional pain, and emotional pain is associated with suicide."
Other factors also put a person at risk for suicide, according to the National Alliance on Mental Illness.
Those include a family history of suicide, substance abuse, intoxication, access to firearms, gender — men are four times more likely to die by suicide — age, a history of trauma or abuse, isolation and a recent tragedy or loss.
“It’s natural to want to have an explanation,” Brummett said. “But when we say it was bullying or a breakup, we are minimizing the other things that were going on in those kids’ lives, and we are also presenting a dangerous narrative for other kids who are experiencing those things.”
She emphasized that most people who have thoughts of suicide don’t die.
“The vast majority get better and recover, and the same is true for our youth,” Brummett said.
Mallery’s plan changed when he realized he would leave behind a mother and father who care deeply for him, a younger sister, friends, classmates. So he expressed his plan and emotions to his mother.
For the next four months, he saw a therapist every other week.
And it helped.
He learned how to acknowledge and share his feelings with the people closest to him. He found a new sense of confidence and made new friends.
“There are other people out there that have been through similar things,” said Mallery, who has high hopes for his future. After high school, he wants to attend Arapahoe Community College and hike the Colorado Trail. “There are a lot of people that care.”
Douglas County also stands out in its focus on suicide prevention, said Phyllis Harvey, program coordinator for Youth Education and Safety in Schools (Y.E.S.S.) Program, created in 2009 by the Douglas County Sheriff’s Office to teach students in Douglas County schools about topics of teen relationships, digital safety and substance abuse.
The program hosts trainings on suicide awareness for parents called safeTALK and Applied Suicide Intervention Skills Training (ASIST). The trainings are held throughout the year.
“I think we are way ahead of the game when it comes to suicide prevention,” said Harvey, 49, who grew up in Douglas County and had thoughts of suicide when she was young.
Today, she said, the way the community talks about suicide is different.
“It was not something that was talked about,” Harvey said of her experience. “People didn’t recognize it as well as they do today. It’s important that our community knows that our elected officials care about it, and we are doing everything we can to let people know that there is help and hope.”
A ripple effect
When a person dies by suicide, the lives of loved ones left behind are forever altered, mental health experts and community leaders say. The impact is felt by immediate family members, friends, classmates, teachers, coworkers, peers, neighbors — an entire community.
Nearly a year has passed since Johnnie Medina’s 24-year-old daughter died by suicide. Most nights, he sits on the edge of his bed, close to tears, as he remembers her.
She was a free spirit with an infectious laugh, the Parker resident said. She wasn’t afraid to try anything. She accepted people from all walks of life.
She also struggled with depression.
The most difficult thing for Medina is knowing his daughter will never call him “Daddy” again, he said, tears welling in his eyes.
“To lose a part of yourself that you created is brutal,” said Medina, who wears a bracelet with a stone from the ankle bracelet his daughter was wearing when she died. “I felt like for a long time I couldn’t breathe, like my soul had been ripped out of my chest.”
Romanoff joined Mental Health Colorado three years ago, three months after he lost his 35-year-old cousin, Melissa, to suicide. He doesn’t want any other family to go through what he went through, he said.
Melissa was his cousin, but he thought of her as a sister and best friend. His life is forever changed.
“For my family, that event was the most seismic event in our lives,” Romanoff said. “It’s an enormous black cloud that has hung over our family for the last 3 1/2 years, and to some extent, it will forever.”
To prevent these types of tragedies will take a community effort, mental health experts and leaders in Douglas County say.
"The rates of suicide and suicidal ideation are so high that it's our responsibility to understand that this is everybody's problem," Twohy said. "I think that kind of mindset helps us to not be judgmental."
Talking about mental health and emotions, Twohy and experts say, along with making connections to other individuals are paramount. So, too, is being aware of warning signs — changes in behavior, appearance and expressions of hopelessness.
“You just need to pay attention to the people around you,” Thomas said. “If you get the feeling that something isn’t OK, it’s OK to ask them if they are thinking about hurting themselves.”
Explicitly asking someone if he or she is having thoughts of suicide will not plant a seed in that person’s mind, mental health experts say.
“That is a myth. Asking someone directly doesn’t give them that idea,” said Stephanie Crawford-Goetz, a psychologist and mental health director for the Douglas County School District. “If they didn’t have that idea, they won’t get it. If they did, they will feel a sense of relief.”
For the loved ones left behind when someone dies by suicide, Romann emphasizes the importance of forgiveness.
“This is not your fault,” she said. “Be educated but give yourself forgiveness. It is not your fault that your son, your best friend, your neighbor, your school principal died. You have the right to live your life.”
Since making plans to die by suicide five years ago, Torres has learned to put her mental health first. She recognizes what makes her anxious: school finals, friends, stress.
When she feels anxious, she texts her therapist to schedule an appointment. She shares with her parents and friends how she is feeling, and she expects the same from them.
Recently, when a friend came to Torres expressing thoughts of suicide, she made sure her friend was safe and called the state’s crisis hotline.
Always take the threat seriously, Torres said. The statement is echoed by mental health organizations nationwide: Suicidal thoughts or actions are not a plea for attention and should not be ignored.
But Torres wants people who are struggling to know that it gets better.
“It’s going to pass,” she said. “You’re not going to feel this way forever. You’re definitely worth it to a lot of people.”