Addressing Suicide Prevention

"Suicide". The very mention of the word stops conversation. It is one of the last taboo subjects in a society where sex, addiction, crime, AIDS, political corruption and abortion can be discussed casually in social gatherings or the church narthex. Yet suicide is on the rise, those left behind suffer its aftermath, and we as Episcopalians must be willing to discuss this painful subject and reach out as to those in our midst who are wrestling with this issue. When we have the courage to name something---to learn about it, to speak of it, to raise awareness in others--we have power over it. With God's help, we can employ the power of His Word to address suicide prevention.

Each year at least 29,000 Americans take their own lives. This figure is likely to under represent reality, as many suicides are not reported as such. Only about 26% of suicides leave a note, and the social stigma and refusal of insurance companies to cover suicides causes many of the other 74% to be labeled "accidental death." At this writing, the latest statistics from the Centers for Disease Control (1999) indicate that suicide is the fourth leading cause of death among children aged 10-14, the third among young people aged 15-24, the second among adults aged 25-34, and the 11^th leading cause of death overall in the United States. More people die from suicide than from homicide. (In 1999, there were 1.7 times as many suicides as homicides.) Suicide rates per 100,000 population are actually the highest among Americans aged 65 and older. Each year nearly 500,000 people make a suicide attempt serious enough to warrant emergency room treatment. And millions have suicidal thoughts.

The numbers are staggering. But we know that each represents an individual whose life was unique. Since we believe that life is a gift from a loving God, and that Jesus Christ came that we "might have life, and have it more abundantly" (John 10:10), we grieve for those for whom life appears to be hell, a wasteland without hope. "When we would prefer to ignore, reject or shy away from those who despair of life, we need to recall what we have heard: God's boundless love in Jesus Christ will leave no one alone and abandoned. We who lean on God's love to live are called to bear one another's burdens and so fulfill the law of Christ. (Galatians 6:2)" (1) Our efforts to prevent suicide may indeed have eternal consequences.

All sectors of society are collaborating to support suicide prevention. Let us in the Episcopal Church of America work together to contribute to these efforts. As a church we can encourage individuals and congregations to learn more about suicide and its prevention, to work with others to prevent suicide, and to support those "survivors" who have been left behind after the suicide of a loved one.

Developing Awareness

If given a quiz on the myths and facts of suicide in our society, most people will fail. As a society we are generally unaware of the prevalence, high risk groups, warning signs, and basic prevention techniques for this cause of death. Suicide knows no social barriers. It occurs among old and young; men and women; people of all socioeconomic, ethnic and religious groups; the apparently mentally healthy and the mentally ill; and has no regard for the failures or the successful.

Yet the numbers show that some groups seem to be more at risk than others:

*White males accounted for 72% of all suicides in 1999
*Males are four times more likely to die from suicide than are females
*Females are more likely to attempt suicide than are males
*Suicide is on the rise more dramatically among Native American, Hispanic and elderly males than among other groups
*Although suicide among young children is a rare event, the dramatic increase in the rate among persons aged 10-14 underscores the urgent need for intensifying efforts to prevent suicide among people in this age group
*Some professions, including police, farmers, dentists and doctors, have been found to be at higher suicide risk than the national average
*Youth struggling with questions concerning their sexual orientation attempt suicide more frequently than others of the same age
*People living in a household with a firearm are almost five times more likely to die by suicide than people who live in gun-free homes

Suicide happens as a result of complex factors, each different for each individual. But researchers tell us that certain factors contribute greatly to the risk of suicide, including:

*Clinical depression and other mental illnesses. While most people who are depressed will not attempt suicide, the majority of suicides (over 60%) were depressed. If those who abuse substances and are self-medicating for depression are included, the percentage rises to 75 percent.
*Alcoholism: a factor in 30 percent of all suicides.
*With young people, the "fatal triangle": emotional upset, alcohol or drug abuse, and the availability of a firearm.
*Shockingly negative life events: loss of a job, bankruptcy, family crisis (death or divorce), acute or terminal illness, natural disasters, and post-traumatic stress disorder resulting from events like the 9/11 disaster, rape, assault or witnessing such events.
*Familial factors including history of suicide, substance abuse, physical/sexual abuse or mental illness.
*Prior suicide attempts or exposure to the suicidal behavior of others.

In every case, the above risk factors are combined with a sense of social isolation and hopelessness: the suicidal person doesn't think he or she has anyone who can help, anyone he or she can go to, for assistance. This may not be true in reality, but the suicidal person thinks it is true.

As Christians, we need to be aware of the danger signals, to overcome our judgmental attitudes, and to reach out in love and in the name of Christ to help or find help for each of these people. "To those who have been recipients of God's grace and kindness, there exists a responsibility to provide the same." (2) Suicide is one of the most preventable types of death, but we need to increase our awareness, and change our attitudes in order to help.

Many of our attitudes toward the issue of suicide come from a misunderstanding of the Church's historical position on the subject. None of the suicides mentioned in the Bible were actually condemned. And "throughout most of its first three centuries, the church apparently had little to say about suicide one way or the other. But by the year 250, many Christians were accepting the notion that to take one's own life, or to make sure that some oppressor took it for them, was not only an acceptable way to follow Jesus, but also a sure way to gain martyrdom." (3) In the late fourth century, St. Augustine offered the first attack on suicide as a sin. In 346, the situation (of increasing suicides among Christians) in North Africa prompted the first action to deny funeral rites to suicides. That prohibition continued in the Roman Catholic Church until 1983, and some Protestant congregations still follow this old practice. But this was not a Biblical practice, or prohibition. It was devised by men, in an effort to prevent suicides among Christians. A revisiting of these attitudes by church leaders has shifted the burden of judgment from men to God. Mainline churches now acknowledge the fact that the suicide was most likely not acting in his or her right mind, that the final judgment is up to God, and that we, as Christians, are called to "judge not, that ye be not judged" (Luke 6:37).

Many people labor under the misapprehension that suicide is not preventable. The set of beliefs that says that "if it's going to happen, nothing can be done" has actually been refuted by extensive research and experience. Many people whose suicidal intent or attempt was intercepted or interrupted have lived and gone on to successful, healthy lives. Most suicidal people actually maintain ambivalent feelings about wanting to die, and just want to escape intolerable pain and emotional stress. Intervention in their suicidal behavior will often be a turning point in their lives.

Misunderstanding of depression has been reduced by open communication about the nature and treatment of this illness. Although many people still see depression as a character flaw, the truth is that clinical depression involves a change in brain chemistry. It is a very common illness, with as many as 20% of adults experiencing such depression at some point in their lives. Depressed people usually cannot treat themselves, but depression is a very treatable ailment, responding to medication, therapy, or a combination of the two. To assume that a depressed person should be able to "snap out of it" is as absurd as the assumption that a diabetic should be able to "snap out of it" without medical help.

Common misunderstandings that may deter us from suicide prevention include the following:

*Myth: Persons who talk about suicide rarely actually complete suicide; they are just wanting attention and should be challenged in order to "call their bluff." The truth is that persons who talk about suicide are serious and may be giving a clue or warning of their intentions. They should not be challenged, but should be given assistance in obtaining professional help.

*Myth: A person who has made a serious suicide attempt is unlikely to make another. The person probably wasn't serious about ending their life. The truth is that persons who have made prior attempts and for whom treatment has been unavailable or unsuccessful are often at greater risk of completing suicide. A suicide attempt is a cry for help and a warning that something is terribly wrong, and should be taken with the utmost seriousness.

*Myth: Most people who take their life have made a careful, well-considered, rational decision. The truth is that persons considering suicide often have "tunnel vision": in their unbearable pain, they are blind to available alternatives. Frequently, the suicide act is impulsive. When their suffering and pain is reduced, and they feel some hope again, most will choose to live.

*Myth: Asking about suicidal feelings will cause a person to attempt suicide. The truth is that asking a person about suicidal feelings provides an opportunity to get help that may save a life. The listener should ask if the person has formulated a plan and has access to the means to carry it out. If the intent, a plan, and the means are there, the suicidal person should not be left alone but be helped to get treatment immediately, by calling 911 if necessary. (4)

*Myth: People who commit suicide leave notes. The truth is that only about 26% of those who die by suicide leave a note; the rest die by their own hand, but this is deduced by those who have found their bodies or in a few tragic cases, observed their deaths.

*Myth: People who die from suicide don't warn others. The truth is that out of every ten people who kill themselves, eight have given definite clues of their intentions.

*Myth: Once the suicidal emotional state improves, the risk of suicide is over. The truth is that the highest rates of suicide occur within three months of an apparent improvement in a severely depressed state.

The following Suicide Prevention Helpcard gives pointers on what to do when you are concerned about the threat of suicide for a specific person:

SUICIDE PREVENTION HELPCARD

If someone you know:

*threatens suicide
*talks or writes about wanting to die
*appears depressed, sad, withdrawn, hopeless
*shows significant changes in behavior, appearance, mood (either from being "normal" to being depressed or the reverse)
*abuses drugs or alcohol
*deliberately injures himself or herself
*says he or she will not be missed if gone
*gives away treasured belongings

You can help:

*stay calm and listen
*take threats seriously
*let him or her talk about his or her feelings
*be accepting; do not judge
*ask if he or she has suicidal thoughts
*ask how intense and frequent these thoughts are
*ask if he or she has a plan
*ask if he or she has a means to carry out the plan
*don't swear secrecy--tell someone
*assure the person it is okay and necessary to get help

Get help: You cannot do it alone

Accompany the person to your:

*hospital emergency room
*mental health services
*police
*family, friend, relative
*clergy, teacher, counselor
*family doctor
*or call your crisis line

Call your 911 number for emergency assistance or check the inside front cover page of your telephone book for local crisis services. The National Crisis Helpline is 1-888-284-2433 (1-888-SUICIDE). The National Youth Crisis Helpline is 1-800-999-9999. (5)

How the Church Can Help

Dr. Lucy Davidson, a psychiatrist in Atlanta who has served as consultant on suicide to the national Centers for Disease Control, cited four important areas where religious leaders need to be involved: (1) clergy and church-related counselors are often first to be sought out for help by suicidal persons, sometimes by those suffering from religious delusions; (2) they can help demolish the myths of suicide, such as that "talking about suicide will only plant the idea" (and thus aid in awareness and prevention); (3) they can refrain from glorifying victims of suicide, especially at funerals, while still providing support and encouragement to those left behind; and they can address the needs of caregivers themselves in times of crisis. Each of these special forms of ministry requires study and skill, which can come only when suicide is taken seriously by religious communities. (6)

Clergy and lay ministers alike must become articulate on the issues of the church's historical and contemporary positions on this painful issue, and must educate congregations about the questions of the sinfulness of suicide. We can agree that suicide is a sin, but let us remember that we are all sinners in one way or another. None of us is without sin. When debating whether suicide is an "unpardonable sin", one has only to refer to the words of Christ, quoted in Matthew 12, v.31-32, that say "Every sin and blasphemy will be forgiven men, but the blasphemy against the Holy Spirit will not be forgiven. And whoever says a word against the Son of Man will be forgiven; but whoever speaks against the Holy Spirit will not be forgiven, either in this age or in the age to come" (RSV). One preacher speaking on the subject of suicide says, "Is suicide an unpardonable sin? I must answer with a resounding no! Suicide destroys the body, but can scarcely blaspheme the Spirit." (7)

Too many survivors of suicide (those left behind) have experienced the shock and humiliation of a fellow Christian telling them, sometimes at the very wake or funeral itself, that "they must realize they will never see their loved one again because that person is burning in hell". If we do nothing else of merit in the war against suicide and its toxic effects, we should at least arrive at a consensus of forgiveness on this issue, and leave the judgment to God. As we read over Paul's list of things that cannot separate us from the love of Christ (Romans 8:31, 35, 37-39), we will find that death by suicide does not have the power to separate us from the love of God either.

Whoever among us experiences suicidal thoughts should know that the rest of us expect, pray, and plead for them to reach out for help. "Talk to someone. Don't bear your hidden pain by yourself." The notion is all too common that one should "go it alone." People are not supposed to be vulnerable, and when they are, they think they should conceal it and handle things on their own.

In the Church, however, we admit that we all share the "need of being made well." There is no shame in having suicidal thoughts or asking for help. Indeed, when life's difficulties and disappointments threaten to overwhelm our desire to live, we are urged and invited to talk with trusted others and draw upon their strength. When, on the other hand, a loved one talks to us of suicide or we sense that something is seriously amiss, we are called to be our brother's or sister's keeper. The experience may be frightening, and we may want to deny or minimize the suicidal communication. We may want to shy away because we feel unprepared to help someone with suicidal thoughts or think that we may make matters worse. Yet our responsibility is to listen, to encourage the person to talk, and to get him or her appropriate help. Beyond the crisis situation, we will want that person to hear the healing comfort of the Gospel and receive the care of the congregation. That care might, for example, involve creating an ongoing support network for the person and his or her family. (8)

Because clergy are often more approachable than other caregivers, pastors are likely to be called upon to counsel suicidal persons in hospitals, nursing homes, colleges and universities, the military, prisons, homebound situations, and church agencies. They will need to learn to discern whether the person's suffering is spiritual or has other causes, and can be instrumental in saving lives when they refer (and often accompany) suicidal people to health care providers for intervention and assistance. Their collaboration with other care providers in the community will help to illustrate the love of God and the support of the church in the real world.

And in the aftermath of a suicide, the personal suffering of the survivors requires a special ministry that the church should feel obligated to provide. Survivors do not want to hear that "this was God's will", for who can accept that a loving God willed such a horror? Perhaps He chose not to step in and prevent this, but surely He did not design this dark thing. As C.S. Lewis said in A Grief Observed, "Talk to me about the truth of religion and I'll listen gladly. Talk to me about the duty of religion and I'll listen submissively. But don't come talking to me about the consolations of religion or I shall suspect that you don't understand." (9)

Survivors want someone willing to wrestle and argue with them through their anger and guilt, without getting defensive or judgmental. In Suicide: A Christian Response, Gary Weeden, a U.S. Naval chaplain from Chicago, says, "Christian caregivers must stand ready to reflect the grace of God to people whose hearts are torn open (vulnerable), who are a part of a story that needs to be understood (listening), and whose emotional pain (grief unequaled) needs the soothing touch of God's compassionate Word." (10)

Putting Our Words Into Action

Suicide prevention is broader than responding to a crisis situation. Prevention efforts also aim to reduce or reverse risk factors and to enhance protective factors before vulnerable persons reach the point of danger. They go together with efforts to prevent drug and alcohol abuse as well as violence. Protective factors include:

*Effective and appropriate clinical care for mental, physical, and substance abuse disorders
*Easy access to a variety of clinical interventions and support for help seeking
*Restricted access to highly lethal methods of suicide
*Family and community support
*Support from ongoing medical and mental health care relationships
*Learned skills in problem-solving, conflict resolution, and non-violent handling of disputes
*Cultural and religious beliefs that discourage suicide and support self-preservation instincts. (11)

What can we do in our congregations and communities to prevent suicide? The following is intended to stimulate discussion, reflection, and action.

Let us first recognize that the day-to-day preaching, teaching, and living of the Christian faith in congregations contribute to suicide prevention in indirect yet significant ways. In the community of the baptized, we come to know that we belong to God and to one another. There we give thanks to God for life and for our new life in Christ, and we are empowered to persevere during adversities and to hope in God when all else fails. We learn that human life is a sacred trust from God. We are equipped to empathize with others in their suffering, and are prepared to act for their wellbeing. We are given a reason to live, forgiveness to start anew, and confidence that neither life nor death can separate us from "the love of God in Christ Jesus our Lord" (Romans 8:38). How, we might ask, do we do such things better?

When discussing love for others in confirmation classes, could we talk bout what to do if a friend hints at suicide? How does our congregation ensure that all members are known and none are invisible? How do we become more attentive to changes in a person's participation that may indicate personal distress or depression? How do we strengthen the bonds of community with persons going through stressful periods in their lives and with older persons living alone so they do not feel isolated and abandoned? Might we begin or further develop congregational health ministries, such as a parish nurse program or lay ministries focused on counseling support?

How do we honor the vocation of members who are social workers, psychologists, doctors, nurses, counselors, and other caregivers who often work with suicidal people? How do we find ways to assure them that when a person they are helping takes his or her own life, they are not responsible for not "saving a life"? We can also draw upon these caregivers as well as upon survivors and advocates for suicide prevention to help educate other members about suicide. What in our community, we should ask, are the cultural and social dynamics that lead to isolation and hopelessness? How do we address them? What are the resources in our community to respond to suicidal behavior? Do members know how to access them? We can join with other churches and community groups to help ensure that adequate treatment resources are available. And we can help spread the word concerning community resources, support groups and access numbers. Might we start a support group for survivors of suicide at our church?

We can encourage, use and learn from suicide prevention programs in our social ministry organizations and at our colleges and universities. How are our seminaries preparing priests to minister with suicidal persons? Should suicide prevention be a part of continuing education for clergy and church personnel? Could we create opportunities at events for youth, women, and men, and in our camping and retreat programs to learn about suicide and its prevention?

Addressing questions such as these will, in many of our parishes, highlight how little is known and being done in our own community. But many Episcopalians have been known for their community activism, and we can marshal the talent and energy in our congregations to help in the battle against suicide. Breaking the silence on this issue will have life-saving results for many of the suffering ones in our midst.

A Benediction used in our parish church in St. Charles says,
"Life is short and we do not have much time to gladden the hearts of those who
travel the way with us. So be swift to love, make haste to be kind, and as we go,
may the blessing, the peace, the love and the joy of the Holy One Who is in the
midst of us be in our hearts this day and forevermore."

"Amen," we say. We are not alone, abandoned, or without hope. The Lord's name is "Emmanuel," which means "God is with us." (Matthew 1:23)

References

1. Lifted with love from A Message on Suicide Prevention, Department for Studies, Division for Church in Society, Evangelical Lutheran Church in America, November 14, 1999, p.1.

2. Suicide: A Christian Response, Timothy J. Demy & Gary P. Stewart, Eds., Kregel Publications, Grand Rapids, MI, 1998, p. 463.

3. Sermons on Suicide, James Clemons, Ed., Westminster/John Knox Press, Louisville, Kentucky, 1989, p. 17.

4. A Message on Suicide Prevention, p. 3.

5. Adapted from the Suicide and Information Center online at www.siec.ca/helpcard.htm.

6. Sermons on Suicide, p.28

7. Sermons on Suicide, p. 141.

8. A Message on Suicide Prevention, p. 4.

9. A Grief Observed, C. S. Lewis, Bantam Books, Fifth Avenue, New York, NY, 1961, p. 28.

10. Suicide: A Christian Response, p. 463.

11. A Message on Suicide Prevention, p. 5.

Resource Books

After Suicide---John Hewitt

Before Their Time: Adult Children's Experiences of Parental Suicide---Mary Stimming and Maureen Stimming, Eds., Temple University Press, Philadelphia, Pennsylvania, 1999.

My Son, My Son---Iris Bolton, Bolton Press, Atlanta, Georgia, 1994.

Night Falls Fast: Understanding Suicide---Kay Jamison, Alfred A. Knopf, New York, New York, 1999.

Sermons on Suicide---James T. Clemons, Ed., Westminster/John Knox Press, Louisville, Kentucky, 1989.

Suicide: A Christian Response---Timothy Demy & Gary Stewart, Eds., Kregel Publications, Grand Rapids, Michigan, 1998

Suicide: Intervention and Therapy---Undoing the Forever Decision---Paul G. Quinnett, Classic Publishing, Spokane, Washington, 1992.

Suicide: The Forever Decision---Paul G. Quinnett, Crossroad Publishing, 1997.

National Suicide Prevention Organizations

American Association of Suicidology (AAS)
4201 Connecticut Ave., NW, Suite 408
Washington, DC 20008
(202) 237-2280
www.suicidology.org

American Foundation for Suicide Prevention (AFSP)
120 Wall Street, 22nd Floor
New York, NY 10005
Toll-Free 888-333-2377
(212) 363-3500
www.afsp.org

National Alliance for the Mentally Ill (NAMI)
2107 Wilson blvd.
Arlington, VA 22201
Toll-Free 800-950-6264
(703) 524-7600
www.nami.org

National Center for Injury Prevention and Control
Division of Violence Prevention
Centers for Disease Control and Prevention
Mailstop K60, 4470 Buford Highway
Atlanta, GA 30341-3724
(770) 488-4362
www.cdc.gov
DVPINFO@cdc.gov

National Depressive and Manic-Depressive Association
730 North Franklin St., Suite 501
Chicago, IL 60610-3526
Toll-Free 800-826-3632
www.ndmda.org

National Institute of Mental Health (NIMH)
6001 Executive Blvd.
Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
(301) 443-4513
nimhinfo@nih.gov

www.nimh.nih.gov

National Mental Health Association (NMHA)
1021 Prince St.
Alexandria, VA 22314-2971
Toll-Free 800-969-NMHA
(703) 684-7722
www.nmha.org

National Organization for People of Color Against Suicide
P.O. Box 125
San Marcos, TX 78667
(830) 625-3576
db31@swt.edu

The Organization for Attempters and Survivors of Suicide in Interfaith Services(OASSIS)
4541 Burlington Place, NW
Washington, DC 20016
(202) 363-4224
cthv45a@prodigy.com

SA\VE - Suicide Awareness\Voices of Education
7317 Cahill Rd., Suite 207
Edina, MN 55439
(612) 946-7998
save@winternet.com
www.save.org

Suicide Prevention Action Network USA (SPAN USA)
5034 Odins Way
Marietta, GA 30068
Toll-Free 888-649-1366
www.spanusa.org

Yellow Ribbon Suicide Prevention Program
P.O. Box 644
Westminster, CO 80036
(303) 429-3530
yellowribbon@aol.com

Chicago Area Suicide Prevention Associations

Community Crisis Center
P.O. Box 1390
Elgin, IL 60121
(847) 697-2380
cccpeace@earthlink.net

Connection Resource Services
3001 Greenbay Road
North Chicago, IL 60064
(847) 689-4357

Crisis Line of Will County
P.O. Box 2354
Joliet, IL 60434
(815) 744-5280

DuPage County Health Dept. Mental Health Division-Access & Crisis Center
440 South Finley Road
Lombard, IL 60148
(630) 627-1700

Ecker Center for Mental Health
1845 Grandstand Place
Elgin, IL 60123
(847) 695-0484

In-Touch Hotline - c/o University of Illinois at Chicago Counseling Center
2010 Student Service Building
Chicago, IL 60607
(312) 996-5535
www.uic.edu/depts/counselctr/counseling/intouch.htm

Suicide Prevention Services/Crisis Line of the Fox Valley
528 South Batavia Avenue
Batavia, IL 60510
(630) 482-9696
www.spsfv.org

Will County Mental Health Center
501 Ella Avenue
Joliet, IL 60433
(815) 727-8512
www.willcountyhealth.org