SAN ANGELO, Texas — Jana Anderson, 63, recalls pulling weeds on her yard one afternoon when an unmarked green car pulled up in the driveway. Two men stepped out and approached her nervously.
A police detective and a justice of the peace asked to speak with her husband before the three went inside the house and sat in the living room where Mr. Anderson had just woke from a nap.
“They looked at my husband, and they talked to my husband the entire time and never looked at me,” Anderson said, her eyes welling up with tears as she remembered the scene. “They knew I was the mother and I would probably get hysterical.”
The authorities had come to tell the Andersons that their 22-year-old son, Christopher Anderson, had committed suicide in his apartment.
Suicide occurs at the crossroads of important medical and social shortcomings — overstressed mental health resources, cultural stigmas against seeking help, inadequate understanding about why people choose to take their own lives and the prohibitive cost of medication. Although the suicide rate in Tom Green County has declined somewhat since the 1990s, it remains persistently 40 to 50 percent above the state and national averages.
In the 12 years since 2003, more than 160 people in the county have killed themselves, nearly all leaving behind grieving families like the Andersons who wonder why their loved ones chose to deliberately end their lives.
“The night that he died, he just left the house and said, ‘I’m going to go out with some friends for a little bit. I’ll be home tomorrow,’ ” Jana Anderson recalled, her voice quivering as she wiped away tears.
“He went home to his apartment. He had a rifle that my husband had lent him to go hunting, and he shot himself with that rifle.”
The reasons why Christopher committed suicide 14 years ago remain incomprehensible to this day to his parents.
“I’m not sure why he got to the point where he couldn’t take it anymore,” Jana said. “Christopher always felt like he wasn’t good enough, and he did express to me sometimes about things like that, but I never thought that it was that bad.”
Christopher was a student at Angelo State University and an only child who Jana said was a popular personal trainer with an effervescent personality. There were no indications that he was suffering internally, nor where there warnings that he had planned to kill himself, she said.
“I can see that I might miss it (the signs), but everybody else could not have missed it,” she said. “If it had been obvious that he was really depressed somebody would have seen it. But nobody did.”
Data from the Texas Department of State Health Services, Center for Health Statistics shows the average suicide rate in Texas in 2012 was 11.1 people per 100,000 population; Tom Green County, with its population of slightly more than 100,000, has averaged about 15 deaths a year in the last decade.
The highest recorded suicide rates in the county were recorded in the 1990s, a trend so alarming it prompted suicide awareness campaigns and the establishment of a mental health deputies program with the county sheriff’s office. That attention toward mental health awareness could have contributed to lowering the suicide rate temporarily, and the county fell below the state average in 1999.
Community attention toward suicide awareness has subsided since then, but the county remains above the state average each year, said Dusty McCoy, executive director of West Texas Counseling & Guidance.
Pinpointing the reasons is a problem because the local research and data are insufficient, McCoy said.
“We don’t know (why),” he said. “I don’t think there is a silver bullet that we can identify here.”
“I think the main goal is figuring out why these people are falling through the cracks, where does our focus need to be, and what is exactly going on with these suicide rates,” McCoy said.
The ‘bootstrap’ mentality
Experts say although suicide cannot be predicted or prevented with certainty, many suicides are the result of undiagnosed or untreated chronic depression, often masked or worsened by alcohol or drug abuse that victims resort to as a means of self-medication.
Anhedonia — a psychological condition characterized by an individual’s inability to experience pleasure with everyday activities that most people would enjoy — may be a contributing condition in some cases.
People in West Texas might have a particular aversion to seeking treatment for depression. The prevailing culture fosters a “bootstrap” mentality that has been passed down for generations, McCoy said. It’s “having the belief that you’re weak if you seek help, and it’s a sign of weakness to come see somebody and talk to somebody about your problems.”
That stigma prevents people from pursuing counseling and thus perpetually allows depression to fester, culminating in suicide, McCoy said.
“The last thing we want to do is label it crazy. People can ultimately tell that they’re not where they want to be,” he said. “When we start to look at why people are committing suicide, those labels that ‘I’m weak, I’m crazy’ is probably one reason why our suicide rate is so high.”
Those suffering from depression and addiction are likely to end up in jails, prisons or homeless shelters instead of hospitals where treatment is available. Even when they seek treatment, community mental health centers can be overwhelmed with the demand for adequate or long-term care. People without medical insurance have additional obstacles to overcome in seeking access to treatment or medication.
Resources on the street
Sgt. Quentin Williams, of the Tom Green County Sheriff’s Office’s mental health unit, said call volumes have skyrocketed for his unit. Williams and five other deputies respond to emergency calls specifically related to people who are suicidal or deemed mentally unstable.
The unit receives calls, for instance, when people make suicide threats, claim to hear voices or go into crisis without their medication.
“I actually believe (it’s because) people can’t afford their medication. They’re expensive,” Williams said. “And some people will tell you, when it comes to paying rent or getting medication, they’ll say, ‘I want to pay my rent.’ ”
The mental health deputies are dispatched to the scene of the crisis and take people wherever they need to go to get immediate assistance, Williams said. The purpose of the mental health unit is to help divert people in mental distress from jail and toward medical treatment.
“Some people are ashamed. They’re not going to sit there and give you much,” he said. “The only thing we can do is give them the resources to help them get assistance with their medication.”
Williams said there are not enough hospital beds in the city to accommodate patients at the behavioral units. People are taken primarily to Shannon Medical Center or River Crest Hospital, or, if care is not available at those facilities, to other local medical facilities or places where help is available — as far away as El Paso.
Keith Muncey, another mental health deputy, sees many of the same faces time and again on his calls. People ultimately return to the same environment that provokes a crisis, whether it be financial or emotional, Muncey said.
“Most of this stuff is short-term,” he said. “It’s (treatment) only short term. That’s why we turn back around and pick them up again and provide that short-term care again and back to where we were originally.”
MHMR Services of the Concho Valley, an agency that includes a medical group practice specialized in outpatient psychiatry care and contracted by the state, pays for a three- or 10-day contract treatment plan with the hospitals and provides medication alternatives for impoverished people who don’t have medical insurance, said executive director Gregory Rowe.
The agency’s primary mission is to assist in early detection and intervention for people in mental distress and help with jail diversion for those who run into trouble with the law, Rowe said. MHMR tries to reach and work with children and adults through education and counseling as a preventive measure before people cross the Rubicon and consider suicide, he said.
“It could be lots of behavioral or psychiatric issues, and of course those kinds of things can lead toward suicide,” he said. “It can lead toward hurting others, so what we’re trying to do is work with those individuals and try to address and prevent those things from escalating.”
The demand for those services is high. The screening process and psychiatric evaluation for its clients can take weeks, and MHMR is the only agency that offers extensive mental health services to the indigent population in the seven counties around San Angelo.
The puzzle of self-destruction
How can the community, and particularly the medical community, treat suicidal minds as a preventive measure?
American psychiatry is facing a quandary in that challenge, said Dr. Glen McFerren, medical director of the psychiatric unit at Shannon Behavioral Health, who has been practicing psychiatry for 33 years.
“The problem is, it’s one of these things where there’s grossly inadequate funding to try to get the kind of treatment that they need,” he said. “There’s the legal aspect of it, makes it exceedingly difficult to do what we (doctors) need to do.”
McFerren said psychiatry also falls short in this challenge, and the process remains more art than science.
“If you get checked in with pneumonia, I give you a chest X-ray (and) you’re ready to go,” he said. But “I can’t draw blood that says if you’re suicidal. I can’t do an X-ray that tells me if you’re depressed. All I know is what you’re telling me.”
McFerren said a sizable number of people in San Angelo who have no prior history of psychiatric disorders or treatment may still be in some social, situational rut that drives them to the brink of despair. Deciding an appropriate level of care for people in this gray sphere is problematic.
“That’s a real difficult population to address. The tendency is to get them on the right medicine. But it’s not a medicine issue,” he said. “Antidepressants don’t work when you’re giving it to people who don’t have a chemical imbalance. This is situational. This is not psychiatric.”
For some people, medicinal treatment is impotent because people become overmedicated with psychotropic drugs they essentially did not need in the first place, he said.
“Pretty soon, they become what I call lost in the medicine, where you don’t know anymore if what you’re seeing is something the medicine is supposed to treat or is it being caused by the medicine,” he said.
That illustrates the risks and benefits because every medication prescribed is a double-edged sword, he said, and meanwhile, attention and resources are drawn away from individuals with significant, demonstrable psychiatric illnesses. The system is inefficient and ineffective for many, he said — treatment does not end when people are stabilized, yet insurance companies can deny service as long as patients are no longer actively suicidal or homicidal, even if they are delusional, hear voices or see things.
Physicians do not have legal authority to hospitalize or ameliorate a person’s treatment without consent, McFerren said.
“I can’t give people medicine if they say no. I can’t treat them. I have to go through another court hearing to give meds, and that’s another process,” he said. “The laws are such that we can’t. Medicaid denies (them), … (but they’re) not ready to go.”
McFerren said it leads to sad and frustrating experiences for the physician.
“My feeling is it is a completely broken system. It’s just completely broken. And the people who want to pass legislation, designate how you’re going to do it, don’t have the slightest clue what’s going on,” he said. “You wouldn’t think it would be that hard to recognize (and) to make resources available to treat people with mental illness. … It’s just not that easy.”
Red flags and cries for help
Learning to recognize the warning signs and immediately treat the underlying causes is the most effective way to prevent suicide.
When it comes to deciphering whether someone is suffering or contemplating suicide, McFerren said, “to me 80 percent of this is common sense.” It can help to look for cries for help or changes in behavior when it comes to activities that would normally be pleasant, McFerren said.
People today often take to social media to make fatalistic statements just before leaping into the breach.
Additionally, asking someone who appears to be depressed, “Do you feel depressed?” usually elicits a yes or no response, McFerren said. However, people often are unwilling to overstep personal boundaries, more afraid of offending people than addressing a concern.
“People need to just get over that hurdle. Don’t be afraid to ask. You’re not going to give them any ideas,” he said. “The worst thing that can happen is that people say ‘no.’ ”
It is important to understand that depression is a feeling that some people have always had and believe it will never go away, he said.
For those who have nothing to look forward to and feel hopeless every day, said McFerren, death is perceived as a relief.
Paradoxically, people with depression are in the most danger when they start to feel better again, McFerren said. Those who were too depressed to get out of bed but begin to regain spirit and become active again also may regain the energy to hurt themselves, he said.
Although indicators and signs typically exist, ultimately there is nothing someone who is suicidal cannot hide.
For Jana Anderson, the confusion and pain from her son’s suicide linger.
“A lot of things kind of just happen. … I didn’t want it to be true. It was just incomprehensible to me and sometimes it still is. But it also makes me very aware of other situations,” she said.
She cannot find closure because she can only guess at the reasons Christopher killed himself.
“There are lots of things that I regret. I guess it’s the same thing with anybody you lose. You wish you told them more often that you loved them,” she said. “You wish you had taken it more seriously when they were upset about something. You regret everything. And it never goes away.”
Find the original story at reporternews.com.