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When suicide occurs, it has an intense ripple effect throughout a community, and the way it's handled varies. A group of health care professionals and others who activate when suicide happens are working on a best practices plan for the community to handle "postvention."
Elaine de Mello, supervisor of training and prevention services for the New Hampshire chapter of the National Alliance on Mental Illness, held a seminar at Juneau Youth Services on Wednesday.
Representatives from several local agencies, including the Juneau Police department, the Juneau Alliance for Mental Health, Inc., the National Alliance on Mental Illness, the SouthEast Alaska Regional Health Consortium, Bartlett Regional Hospital, the Juneau Community Suicide Prevention Taskforce, the Juneau Alaska Native Suicide Coalition, the Southeast Alaska Suicide Prevention Taskforce and others attended the event.
Postvention is the response after an incident, such as suicide, to deal with healing and reducing future suicides.
Now, the group will work to develop a postvention plan to have better outcomes in the wake of suicides.
This will help address best practices for helping the community heal, but also prevent future suicides. de Mello spoke of contagion, where exposure to suicides statistically increases others attempting or taking their own lives. Another element will also consider how to best help suicide survivors - family, friends and anyone else impacted by the person's death.
It also will look at best practices for handling the media and terms to use. de Mello said when Marilyn Monroe died, her suicide was highly glamorized, and in the 30 days after her death there was a 12 percent increase in suicides. Conversely, when Kurt Cobain killed himself, his wife and mother strongly condemned his death and there was no statistically significant increase in suicides.
de Mello discussed the importance of understanding what suicide is - a public health problem. She said taking the right actions after a suicide can be a prevention for future youth suicides. Statistically, a person who knows someone who has died by suicide is more likely to complete or attempt suicide themselves. Nationally, there are more than 33,000 confirmed suicides each year. In Alaska, between 2003 and 2007, there were 694 cases of confirmed suicides. In age groups 10-34, it is the second leading cause of death. For ages 35-44 it is the third leading cause of death and for ages 45-54 it is the fourth.
"Our project is focused on youth, but we do look at all age groups" she said. "If a grandparent commits suicide, it sets a legacy."
In postvention, everyone in the different elements of health care, law enforcement, social services, media and funeral direction needs to have a role in the plan, she said.
"If we have youth at risk, we've got to surround them with people who can respond," de Mello said. "There are so many sectors of the community that can get involved in such a proactive way."
de Mello said it's important for people to realize suicides occur largely because of a mental illness - 90 percent of them nationally. She said that does not mean most people with mental illnesses will die by suicide, however proper treatment and support is key in prevention. She said when people complete suicide, they aren't in their right frame of mind.
Nationally, 25 percent of suicides also involved alcohol or substance abuse, de Mello said.
JPD Lt. Kris Sell said it's rare they see a suicide that isn't also impacted by usage of alcohol or some other substance.
de Mello said it's important for people to reach out and start noticing and acting when others are struggling. She brought up a case where a man would have not attempted suicide if someone had reached out to him when he was visibly distressed. He survived the attempt, and now tells people his story, encouraging them to reach out to people in distress.
Sam and Gayle Trivette also participated in Wednesday's discussion. The Trivette's son Pete died by suicide in June of 2007.
The Trivette's learned of Pete's depression and suicidal thoughts shortly before he took his own life and they sought medical help, but the medical intervention didn't have enough time to work.
"We were afraid to ask Pete if he was thinking about suicide," Sam said when he learned of Pete's depression. "We did not ask him if he had a plan. That was a horrible mistake."
Aside from people needing to be more open about seeking care and asking the tough questions, Sam also said he felt insurance company preapproval before a person can see a health care professional for mental illness needs to change. He also said people need to be educated as to what they can do to help. Sam said his son's girlfriend and friends all saw the depression, but didn't know what to do. That has changed in the schools with their SOS program.
Another important element for Sam is they realized immediately Pete's friends felt responsible.
Sam said they not only provided outreach for Pete's friends, but the Trivette's friends came by daily and took care of everything. He said some people don't want to see anyone after such a tragedy and that is a mistake.
de Mello said when a family can be open after a suicide, other people are more open and it allows healing to take place.
Pam Watts, director of Juneau Mental Health Alliance, said when a young person or even an adult confides in another when having thoughts of harming themselves, some ask to keep it a secret.
"That poses a dilemma for a lot of people," she said. "They feel like they're betraying their friend, when in fact, they may be saving their friend's life."
If you or someone you know is in crisis or emotional distress, call the National Suicide Prevention Lifeline at 1-800-273-TALK or the Alaska CARELINE at 1-877-266-HELP.
Contact reporter Sarah Day at 523-2279 or at sarah.day@ juneauempire.com.