Even With Mental Health Services, Sometimes Suicide Prevention is Impossible

Suicide Prevention Day was September 10. That day, my Facebook feed was emblazoned with posts about mental health, about suicide hotlines, about better resources and improved programs. All excellent and worthy causes.

But all I could think about was my college roommate, who took her own life at age 40.

Unlike a lot of the stories I read, my friend, Erin, wasn’t very young, didn’t have a drug or alcohol problem, didn’t have a long history of mental illness, and had a supportive network of family and friends. I’d been very close with Erin since sophomore year of college. She was an extremely bright, charismatic, self-deprecating, wildly talented, funny person. She spent days in her pajamas because they were comfortable, not because she was depressed. She always seemed to have a loving and supportive boyfriend (the one she had at age 20 was the one she married; they had two kids). Everyone loved her.

Sure, there were insecurities.

Her relationship with her family was unpredictable; she often said she just didn’t fit in with the rest of them, as she wasn’t a musician, hated skiing and the beach, wasn’t much of a reader and was prone to migraine headaches. Still, she tried hard to get along with them, slowly forging a closer bond with her father.

When her mother had a psychotic break due to undiagnosed bipolar disorder, Erin bravely faced it without flinching. She was a rock for her father and brother, and really tried to be a supportive daughter to her unstable mother. This was a challenge, because, by that time, she was a mother as well, and starting to suffer from anxiety over their safety.

It was not something I noticed much at the time since I lived in another part of the state and we spoke once or twice a week.

But then the economy took a turn, a big one. Erin called me, distraught.“My investment guy invested all our extra money in this one stock, “ she said. “Now it’s all gone. It’s all my fault.”

I didn’t know what to say.

While yes, the loss seemed serious, Erin and her family weren’t going to be homeless or starve; her husband had a good job, the house and expenses were manageable. But there was something about the loss of that nest egg, the loss of financial security (even though they were still fine), the lack of perceived safety, which triggered chaos in Erin’s brain.

Her anxiety over that financial loss threw Erin into a horrific depression.

It wasn’t a paralytic kind of chronic depression, but an actively frantic, panic driven one that denied her sleep, appetite, and coherent communication. I was very, very worried about her right before Christmas; I offered to come visit, to take care of her and her kids. But she turned me down, saying a visit would be “more stressful.”

I talked to her husband, and he was at his wit’s end about her. She wasn’t functioning anymore.

Erin was hospitalized right after Christmas. Her husband and parents checked her into a top-notch facility. She received excellent medication and therapy as they tried to stabilize what had turned into a psychotic situation.

She was there, I believe, a little over two weeks. She was sent home on medication but still refusing to substantively communicate. Her husband expressed frustration regarding their therapy sessions, where she would just sit in silence. I tried to call her many times, but it always went to voicemail (some of her other friends got the brush off as well; although a few enjoyed perfectly normal conversations, which led them to believe she was doing better).

Around Valentine’s Day, I started getting a bad feeling. I still couldn’t reach her. I called and left a message for her husband. He called back and immediately said, “She took her own life today.”

Erin hung herself in their closet. She had gone online and researched it, and then erased her computer history as she went. She waited until her husband took the kids out to do it.

Hanging oneself is the suicide method for the very seriously inclined: they mean to end it. It’s not a popular method among women.

Her funeral was just devastating. Everyone, whether they had spoken to Erin in those last weeks or not, was confused, hurt, and angry. Except for her two kids who, both being under seven, couldn’t really comprehend what was going on.

It was a Jewish service; instead of throwing dirt into the grave, each kid threw in a toy.

When I look at suicide prevention resources, I see lots of checklists that Erin already fit. Was she depressed? Of course: she’d been institutionalized. Was she withdrawn, experiencing anxiety, having mood changes and feelings of hopelessness? Yes, yes, yes, and yes again. For god’s sake, she had had an entire team of psychiatrists and psychologists observing and treating her, she was in therapy, everyone was aware that she was fragile.

What none of us knew, however, is that among those treated for depression in an inpatient setting, the suicide rate is 4% (twice as high than if Erin hadn’t been hospitalized). According to an article (Archives of General Psychiatry, Ping Qin MD, PhD, Merete Nordentoft MD, PhD, 2005), Suicide Risk in Relation to Psychiatric Hospitalization), the risk increases in the week or so after release from a mental hospital stay, a short stay compounds that risk further, and being female increases that risk even more. In fact, in the first week home from a hospital stay, women were 246 times more likely to kill themselves, and that risk remained pretty high for a month after discharge. Another study increased the risk time to three months after discharge.

Yet, this fragile, depressed, anxiety ridden woman was able to fool everyone. She didn’t discuss killing herself (not according to the friends she did speak with, at any rate). She instead deliberately, willfully, and carefully planned her own death.

I cannot imagine the pain she must have been in, in order to see suicide as a logical and desirable option. She had a loving partner and two children. She had every possible intervention at her fingertips, all the mental health field available to her, and yet no one could intervene.

No one was even given a chance.

It all haunts me. It makes me wonder what lurked in the depths of her psyche. Did any of us really know her at all? Did her mental illness change her so completely? At first, I think we all played “what if” games in our heads.

What if I’d gotten through on the phone? What if I had gone up and stayed with her? What if he had checked her computer history?

But that’s all just ego and fantasy in the end; the idea that you’d be the one to stop it, just like a hero. It was so much more complicated than that.

I miss Erin every day.

So, when you read the checklists about the warning signs of suicide, remember that sometimes they don’t present so obviously. And sometimes, the people most at risk for suicide are the ones who already have gotten the help, or so it seems.

After the hospitalization, when all seems better and the patient has actually gotten “help,” is perhaps when they need even more support and supervision.