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4 | TheBucknerClarion.com March 2017 Suicide is a scary word. Just say it, and those around you visibly step back … if not physically, then mentally. It's uncomfortable and the impulse is to avoid it, to look the other way. In 2007, I learned this first-hand when a close family member, my father, took his life. It was so unexpected, and yet it wasn't. In retrospect, there were many contributing factors in his death that are consistent with national data about suicide in this country. My father was depressed. As he got older, he had chronic health issues that affected his ability to do physical tasks and his pride in being self-reliant – the one who could get things done. He isolated himself from other people, including his family, and was socially ill at ease all his life. (We think he may have had undiagnosed Asperger's syndrome, a condition associated with uncomfortable social interactions, lack of eye contact and inability to relate to others emotionally – all hallmarks of his personality.) A month or two before he died, he visited with his doctor about depression and extreme lack of sleep. He was given prescription medications to treat his symptoms. He lived in a small, rural community of less than 3,000 people. He owned a rifle and he used it to kill himself on a Sunday morning in 2007. His story mirrors many aspects of the larger American story. According to the experts, depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Guns are used in half of all suicides, making firearms the leading cause of death by suicide. Fifty-one percent of rural households own a gun, compared with 25 percent of urban homes, providing greater access to lethal means in these communities. Gun ownership is not the only reason suicide is on the rise in rural areas. In small towns or remote areas, people may feel a greater sense of isolation and generally have more limited access to health care professionals and mental health treatment programs. The Department of Health and Human Services reports that 55 percent of counties in the United States — all of them rural — do not have a single psychologist, psychiatrist or social worker. "Suicide rates tend to be high in rural areas in part because there is greater access to firearms, high rates of drug and alcohol use and few health care providers and emergency medical facilities," says Julie Goldstein Grumet, PhD, director of prevention and practice at the Suicide Prevention Resource Center in Washington, D.C. Like my dad, about 45 percent of people who committed suicide visited their primary care provider within the previous month. Primary care doctors can play an important role in suicide prevention by asking questions and guiding their patients to seek additional care. Family members can also play a role. It's a difficult problem, even when resources are available, because there is often a stigma associated with seeking help for psychological or substance abuse problems. Compounding this, one study indicated rural regions in the Great Plains and Mountain West have cultures that value individual autonomy and self-reliance. This may prevent those who need help from asking for it. According to the Centers for Disease Control (CDC), the incidence of suicide in America is at a 30-year high, with more than 44,000 deaths from suicide in 2016. The suicide rate has increased in every age group below 75 since 1999, including men, women and children. Overall, more men die from suicide than women. Looking inside the numbers, suicide rates are higher among the poor and unemployed. The unemployed are, in fact, 72 percent more likely to commit suicide than people who are working. In the state of Missouri, the rate of suicide is above the national average, outnumbering homicides by more than two to one in 2013 (latest data available). The decision someone makes to end his or her life is very personal. For some it's planned over a period of time, and for others it's an impulse to escape that can't wait another day. Either way, it's a complex web of interactions that lead to pain, hopelessness and despair. As Karl Menninger, psychiatrist and founder of the Menninger Foundation in Topeka, Kan., stated: "Hope is a necessity for normal life and the major weapon against the suicide impulse." The American Foundation for Suicide Prevention (https://afsp.org/ ) lists warning signs that may signal the need for intervention, as well as helpful guidance that can be used to save lives. The National Suicide Prevention Lifeline is available 24 hours a day, 7 days a week. All calls are confidential and toll-free. Call 1-800-273-TALK (8255), or for the deaf and hard of hearing contact the Lifeline via TTY at 1-800- 799-4889. Many people won't act on their own behalf. According to the American Foundation for Suicide Prevention, only one in five will ask for help. They are in a dark place and may not be capable of seeing a better tomorrow. If you have lost someone to suicide, know someone who is struggling with depression and feelings of hopelessness, or if you yourself are in need of help, you are not alone. Shine a light of care and compassion on this difficult subject, and contact the Lifeline, go online for additional resources, or contact a health care provider in your area. Sources and Additional Reading: Centers for Disease Control and Prevention National Institute for Mental Health American Foundation for Suicide Prevention Society for the Prevention of Teen Suicide Pew Research Center American Psychological Association State of Missouri Statistics New York Times, April 22, 2016. U.S. Suicide Rate Surges to a 30-Year High CNN, June 2, 2016. FDA requires 'black box' warning on painkillers New York Times, November 3, 2015. Small Towns Face Rising Suicide Rates The Atlantic, March 10, 2015. The Growing Risk of Suicide in Rural America Business Insider, November 12, 2012. Keeping Up With The Joneses' Could Lead To Suicide A Story of Suicide in America and Rural Communities By Janet Buie, Contributing Writer

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