Stopping suicide: Nevada lags behind nation in prevention programs

Stacy J. Willis

Friday, Nov. 23, 2001 | 12:52 p.m.

Terri Greenfield's husband, John, heard voices. They were "like country-western songs" stuck in his head, repetitive.

He was detoxing. It had been three days since he had come off a drinking binge. At 25, she said he was trying to quit for good.

He told his wife about the voices. She told two doctors. "They said he'd get through it, to just stick it out."

Terri sought mental-health care for her husband at the Veterans Administration hospital. He was put on a waiting list.

On the third day of his sobriety, she and their 2-year-old child found him in the garage, dead from a self-inflicted gunshot wound.

What caused John's death: A flood of unmanageable emotions? A biological glitch? Spiritual decimation?

Or a community ill-prepared to protect its members from its sixth-leading cause of death: choice?

"I think the mental-health system and his own personal physician dropped the ball," Greenfield said.

Nevada has the highest suicide rate in the nation -- a fact that just sits there, year after year, for more than a decade, untouched. Other characteristics of the state change: its economy rises and falls, demographics change, political interests come and go. And all along, people keep killing themselves.

In 1998, 397 people committed suicide; in 1999, 429. Nevada is the only state in which more people die by suicide than in car accidents. The suicide rate is more than double the national average.

Doubtless, many would like to think the causes of suicide are not endemic to Nevada.

But theories abound about why Nevada is the perennial front-runner. Some say Nevadans' reputed fend-for-yourself mentality makes suicide a more likely option than seeking mental-health care or even finding it in a state that ranks among the lowest in mental-health care expenditures.

Or maybe it's the state's high number of senior citizens with potential health problems. Or -- as one suicide prevention volunteer said -- maybe Las Vegas is "like the Golden Gate Bridge. Sometimes people want to die somewhere memorable."

Or maybe it's the state's more obvious trappings: the gambling or the round-the-clock availability of liquor or the transient population that has little social support.

Nobody knows for sure.

And it may be easier not to know -- to sit and ponder the old-as-time mystery of suicide rather than look at the issue as a preventable health problem. If the community doesn't know why someone killed himself, there is less responsibility imposed on it. Maybe it's simpler to leave the stigma, the shame, the mystery intact.

"And that is the attitude that we need to defeat," says Linda Flatt as she rapped her fingers on a stack of suicide-prevention research papers on her kitchen table in Henderson.

Flatt's 25-year-old son, Paul, killed himself in 1993. Today she is trying to organize the state's struggling assortment of suicide-prevention programs. She attends national suicide-prevention conferences but is almost reluctant to hand out business cards that declare her a "community organizer."

"I don't want this job," she says. "I work at a dental office."

Flatt is steady in the way one would imagine a person who has lost a son to suicide might never again be, excusing herself from a conversation about his death to answer the telephone and say, "I'm so sorry to hear that," to yet another suicide survivor. They call her day after day: She leads Central Christian Church's suicide-survivor group.

"Suicide is preventable," she says after hanging up the phone. "It took me several years to believe that. I didn't want to believe that it was preventable because that would mean that I could have done something (for Paul), and I didn't want to admit that. I wasn't ready to go there."

"But it is preventable."

Red tape

Whether a government is responsible for, or capable of, saving its citizens from themselves is debatable. Some say a person's life is his own to take -- and that government is better equipped to fund cancer research or promote immunizations than to reach into and alter individuals' psyches.

Nevertheless the government has stepped into the suicide-prevention picture in recent years, led in part by a suicide survivor from Searchlight: Sen. Harry Reid.

One morning in 1972, Reid's father shot himself, leaving behind a wife and adult children. In 1997 Reid "came out" at a political forum -- a congressional hearing -- as a suicide survivor.

"My dad killed himself. And we as a family covered it up and kept it quiet," Reid said. "It was really hard."

He began a political crusade to bolster prevention efforts.

But good intentions commonly are confused by politics. Four years later, suicide-prevention efforts appear to be mired in bureaucracy at every level.

Reid introduced Senate Resolution 84, which passed unanimously. But the resolution was limited to "proclaiming" suicide prevention and mental health care to be a national priority.

Similarly, Surgeon General David Satcher issued a national "call to action" to Americans.

It consisted of a five-stage plan: Defining the problem; identifying causes and risks; developing and testing intervention; implementing broad-scale intervention; and evaluating its effectiveness.

Four years later the nation is still in stage one.

In 1999 Reid helped to secure $1.5 million in federal funding over three years to establish in Las Vegas the national Suicide Prevention Research Center under the Centers for Disease Control and Prevention.

But three years later the center's physicians report that it hasn't achieved what it was intended.

"Our progress is slow," says Dr. Thomas Shires, director of the University of Nevada School of Medicine Trauma Institute and co-director of the Suicide Prevention Research Center.

"The CDC was undergoing a lot of changes, and we were waiting for its permission to go ahead with certain parts of the research, such as interviewing friends and relatives (of suicide victims), which would help identify behavior that leads to suicide, and would then be useful in prevention."

Instead, the center has been limited to studying demographics of the already dead.

"The death information is just a small part of the picture. That's the top of the pyramid. The number who are hospitalized for attempts is bigger, and the number who consider it (suicide) is bigger still. We have much more data to compile," said Dr. Alex Crosby, a medical epidemiologist in the CDC Division of Violence Prevention, which oversees the center.

In September the government renewed the center's funding at $1.2 million to continue research for three more years.

"The role of the government in suicide prevention is essential," Reid, who is the Senate majority whip, said. "And the suicide rate in Nevada will continue to be stable or go up until we learn more about it."

Mental health

What we do know: In the three years the Suicide Prevention Research Center has struggled to achieve its ideal purpose 1,100 Nevadans shot, hanged, poisoned, asphyxiated or jumped to their deaths.

Statistically, you are more likely to kill yourself than to be murdered. For every two homicides in the United States, there are three suicides. Every 17 minutes someone in the United States kills him or herself.

More than half of all suicides are committed by men, ages 25 to 65. Males are four times more likely to kill themselves than females, according to the surgeon general's office. Twice as many Americans die from suicide than from AIDS. Every day more than 1,500 Americans attempt suicide.

The majority of suicides are believed to be a direct result of treatable depression; some studies -- such as one in the August 1997 Journal of the American Medical Association -- report that as many as 95 percent of all suicides occur during a depressive episode.

Reid's dad was probably depressed, the senator said.

"He was always a very withdrawn and quiet man, and he drank too much," Reid says. "We don't know all the reasons he did it. But as we look back, we see the signs."

The path to suicide prevention requires the availability of mental-health care.

Satcher identified that fact four years ago, pointing to certain preventive steps as goals: "Effective clinical care for mental, physical, and substance abuse disorders, easy access to a variety of clinical interventions for the help-seeking individual, restricted access to highly lethal means of suicide, strong connections to family, community and medical support, skills in problem solving, cultural and religious beliefs that discourage suicide and support self-preservation."

Nevada ranks among the nation's lowest in expenditures for mental-health services.

Recently the state temporarily reduced Clark County's mental-health services because of a shortage of psychiatrists. The state employs only six psychiatrists in Southern Nevada. Nine state psychiatrists have resigned in the last two years for a variety of reasons.

Nevertheless, the state increased funding for mental-health programs from $116.9 million this fiscal year to $136.7 million next fiscal year, an increase of 16.9 percent. It will rise to $146.9 million the following year, an increase of 7.4 percent.

Local problems

Imagine oneself desperate enough to fumble through the Yellow Pages looking for the word "suicide." What if, after taking the huge step of calling the Suicide Prevention Center of Clark County hotline, the caller receives a shrieking fax tone instead of a human voice?

Over the course of two weeks this fall, the Sun placed 20 calls to the only local suicide hotline -- a hotline recently given $10,000 by Clark County and $5,000 by Las Vegas. Eleven calls went through to volunteers.

One call went unanswered, two calls received fax tones and six calls went to an answering service.

Of those that went to the answering service, five were referred to another organization's out-of-town suicide hotline, and one caller was asked to leave a message.

The quagmire of suicide-prevention efforts is not limited to federal or state politics. Those who find themselves involved behind the scenes in local prevention also face administrative problems.

The Suicide Prevention Center of Clark County has been struggling for years. There is a lack of volunteers, funding and, sometimes, of functioning.

"It takes a lot of effort to make that call in a desperate moment," says Greenfield, who has called the line for help herself. "Can you imagine getting an answering service and being told that someone will call you back -- that's bad enough -- but then what if they don't even call you back?"

"I'm afraid that someone is going to call and is going to get really discouraged and kill themselves," Greenfield said.

Dorothy Bryant, a UNLV-trained psychologist, has been operating the center for more than 30 years, but struggles to keep a stable of volunteers on line.

"We need more funding," Bryant said. "Basically there is a lot of apathy toward suicide. People are shocked to hear that we get over 5,000 calls a year with one telephone line."

In 1999 Nevada became the first state to appropriate money for a statewide suicide-prevention hotline. It awarded $100,000 to the Crisis Call Center in Reno.

Sometimes calls from Clark County -- should they not be answered by Bryant's organization -- are referred to the Crisis Call Center, a statewide, toll-free line accredited by the American Association of Suicidology.

And while the Reno line is well-regarded in the prevention community, it too struggles to keep enough volunteers on the lines, according to Misty Allen, the center's director.

"It's going to take more than just a hot line to address the problem. It takes a multitude of services," Allen said.

Hope

In the wee hours of the 2001 Legislature, lawmakers passed a bill that created a legislative committee on suicide prevention.

The committee's first meeting took place earlier this month at the Sawyer State Office Building in Las Vegas; dozens of health and government officials filed in wearing suits and carrying slides for lengthy statistical presentations.

Flatt showed up with a quilt. On it were pictures of smiling, vibrant men and women who committed suicide. One was her son. Flatt hung the quilt so that lawmakers could see the photos while they listened to testimony.

"You have to remember we are talking about people," she said of the faces on the quilt.

After a day of discussion -- more statistics, more groping for answers -- the committee and activists say they are developing a plan.

The idea is to streamline prevention efforts at all levels -- local, state and federal -- and develop a functioning, collaborative state prevention program.

Satcher will be invited to speak to the state committee this spring.

"We need something that is more than just research," Sen. Ann O'Connell, R-Las Vegas, the committee chairwoman, said. "We need to develop significant programs. We need to set up mandated training for anybody who may come in contact with a suicidal person: doctors, police, firemen, teachers, counselors."

"That's what we're going for: a proactive plan," O'Connell said.

"After one meeting, the information seemed to say that there is no common thread among all the suicides in this state.

But I can't believe that," O'Connell said. "I just can't believe that."

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