COVID-19. Social distancing. At-home learning and sheltering. The elections. Layoffs and furloughs.
This year, the stress of all those has been added to already emotionally difficult situations, such as aging, isolation, drug use, social media shaming. Those alone made preventing and treating suicide difficult enough for professionals.
According to 2017 Centers for Disease Control and Prevention statistics, suicide is already the 10th leading cause of death in the U.S., with a 35 percent rise in the suicide rate from 1999 to 2018. It is the second leading cause of death for youth and young adults between the ages of 10-34 years old. An estimated 1.4 million people in the U.S. attempted suicide in 2017.
Suicide was the 11th leading cause of death in Alabama in 2017, with 834 citizens lost to suicide, as compared to 601 deaths due to homicide, according to the Alabama Department of Public Health (ADPH).
But this year's added pressures are also beginning to to lead to concerns of additional stress on mental health, with suicides possibly rising, something noted early in the pandemic.
In May, the Washington Post reported, "Nearly half of Americans report the coronavirus crisis is harming their mental health, according to a Kaiser Family Foundation poll. A federal emergency hotline for people in emotional distress registered a more than 1,000 percent increase in April compared with the same time last year. Last month, roughly 20,000 people texted that hotline, run by the Substance Abuse and Mental Health Services Administration. Online therapy company Talkspace reported a 65 percent jump in clients since mid-February."
Psychology Today said in June suicides had already been seen from potential coronavirus patients awaiting test results, health care professionals and those affected by the pandemic-caused economic downturns.
Austin Tucker is seeing some of the trends, and expects them to continue. He is a psychiatric nurse practitioner with Northwest Alabama Psychiatric, which works through Walker Baptist Medical Center in Jasper. He works in the geriatric unit, the inpatient detox unit and with outpatient psychiatry cases. He also worked as a psychiatric nurse for 10 years in the adult psychiatry unit.
"Definitely, the COVID has played a role. There has been an uptick and we have definitely seen that on a national level as far as suicide rates are concerned," Tucker said. "Isolation is probably one of the number one risk factors. It's not the number one, but it is certainly in the top 10 of risk factors for individuals. ...
"But we have seen an uptick with the isolation that COVID has caused with people not being able to visit, with family members not being able to get out and do their normal routine, and especially for the elderly in that age range. That plays a huge impact of what goes on in their everyday schedule."
Tucker said what surprised him going into the profession is that the age range of 65 years or older is always the biggest age segment in society prone to suicides, especially in the United States. Not surprisingly, that is also the age group most affected by the coronavirus.
"A lot of people think you adolescents is the highest number, when in fact 65 years or older is the highest suicide rate in the nation," he said. "However, with COVID, the adolescent rate has gone up as well."
A higher rate of admission has been seen in the hospital's geriatric psych unit for issues such as suicide, simply due to visitations and social interaction being cut off, Tucker said.
"It is extremely important with any age to have human interaction to help prevent suicide in anyone, but certainly those who are at risk," he said.
Tucker said in looking at main reasons for contemplating suicide or having attempted in the past, relationships and finances are the two major ones, along with drug abuse and loneliness.
Finances "is a big one," which can go back to the layoffs and closures disrupting lives this year, he said.
According to ADPH, 69 percent of suicides in Alabama involved firearms, and he said those are the most lethal cases. However, Tucker also noted overdoses, usually taking a handful of pills, are often dealt with in treating patients.
As for what to look for in suicidal people, studies and experience show that people contemplating suicides may not talk about their feelings to others.
"There are some things you can go by as far as behavioral triggers," he said. "Sometimes people may say, 'I feel like going to sleep and never waking up,'" or they may make a vague statement, such as, "I would rather be dead than deal with this."
Being older and alone, possibly from the death of or divorce from a spouse or other relative, can be a problem - especially in rural areas like this. Tucker said, "For some reason, rural areas are a big risk factor. You would think it is the city areas, but it is actually the rural area."
He agreed that is only more stressful when one considers the seemingly larger death rates that have resulted since the pandemic began, leaving many widows and widowers.
He also pointed to someone who has a psychiatric history of depression or anxiety, or even a trauma history. "Veterans are a huge deal, especially in that age range," he said.
"So anyone in those categories, people may want to take extra care to make sure those people are OK, especially in situations like COVID." He said those left alone by death during the pandemic may need to be checked on to give them the interaction they need and to see if they are alright.
"And a lot of times - more times than not, people will actively give you - they want somebody to know. They will actively cry for help. And in some of those situations, people use the suicide hotline and things like that or call the unit. Many times, I've had people just call me at the hospital," Tucker said. "Other times, they just need that person to poke and probe a minute and get it out of them."
He said just having lunch with someone or having a conversation with someone "can make a world of difference," he said. "A lot of times it doesn't have to be anything big. It can be a phone call - just something that somebody has to let somebody know that somebody is listening, somebody is there, that they are not completely alone."
Tucker noted that while many people are busy these days, it still takes "being cognizant of people you know who are in those situations."
Meanwhile, especially in the adolescent world, online social media and texting also is playing a factor, such as in shaming.
"A lot of suicides, as far as young people are concerned, and high school and college age, sometimes it does have something to do with bullying or what they call cyber bulling," he said. "We see a lot of that. That plays a big role."
He thinks that will continue to grow with technology, and noted the role of "keyboard warriors" who can remain anonymous with online identities.
"At least when I was growing up, you either insulted somebody to their face or you didn't - and you probably regretted it if you did," Tucker said. "But nowadays you can do it and be somewhat anonymous. So now there is a lot more of it than there used to be." He thinks many people type it on the internet "it is not nearly as hurtful, but in fact people are taking a lot of these things seriously."
He also noted that there was "no doubt" the elections this year have also caused stress Americans are feeling. "It is a big deal," he said. "The election plays a role." He said mental health professionals will see cycles with factors such as elections.
"You will see an uptick in agitation and psychotic events, and a lot more drug use, and that plays a big role in this area, especially where we live," he said. "There is a very big drug use problem and we have a big opioid problem, as well as amphetamines and things like that. We deal with that on a daily factor."
He said the local staff is seeing "an extreme amount of drug related (inpatient cases), either psychotic events and even suicide events. So it is a big deal around here."
Tucker said the challenge facing resources for suicide and mental issues is in the amount of funding cutbacks, "and if it is federal, there are even more cutbacks." Facilities in Alabama have been closed or cut back. Insurance can also be a problem.
"As far as in patient (cases in hospitals), people can get care without insurance," he said. "There are programs to work that out with individuals through the hospital. So they shouldn't feel like, 'I can't get admitted in-patient at the hospital because I'm not insured.' We always encourage people at that point if you feel suicidal, don't worry about a bill. The hospital will work that out with you. There are options. There have been people to say, 'Well, I can't pay.' They should never feel that is not an option."
He said there are also options for outpatients.
"We are the only private psychiatric office here in Jasper. We are it as far as outpatients," he said. "I would probably go as far as to say nine out of 10 people who are getting psychiatric care are getting it from their primary physician, and the primary physicians are overloaded."
As a result, the industry needs more help and recruitment to treat others. "We definitely need some PR, because not a lot of people want to do this," Tucker said, thanks in part to perceptions passed on in movies and TV "in a horror sense," like "One Flew Over the Cuckoo's Nest."
"We need to be getting the right image of psychiatry out to people that it is not necessarily what they think it is going to be."
Stigma is the biggest problem in psychiatry, as people treat that different from any other branch of medicine. Patients many times tell him from the outside, "I guess you think I'm crazy." He tries to tell patients this is an issue in their brain.
"Emotions are part of your brain," he said, noting they simply have a malfunction that needs treatment or medication. "It is just another organ in your body," much as one would see a cardiologist for heart issues.
"If you are feeling suicidal, the number one thing we tell everybody is to go to your nearest emergency room," Tucker said. "That is another thing people need to understand: If that hospital does not have psychiatry, they will find you psychiatry. They will get you to where you need to be. Walker Baptist has an inpatient adult psychiatry unit and a geriatric (unit). If you need child adolescent, they will get you to Children's (of Alabama in Birmingham). They are not going to let you go without getting you some help."
He said while therapy or medication, or a combination of both, can be used in treating the problem, and that a combination of both can lead to better remission. However, medication can be altered over time, and sometimes it can be tapered off so that they don't have to be on it for life. Tucker said the staff would usually use benzodiazepines like Xanax, and try to not get to more addictive drugs due to the drug problem in this county.
If you or someone you know is considering suicide, call the following numbers:
National Suicide Prevention Lifeline: 1-800-273-8255.
Northwest Alabama Mental Health Center Crisis Line: (205) 302-9000 or 1-800-489-3971.
Northwest Alabama Psychiatric: (205) 384-0141.