From Leader to Leader – Suicide Prevention: Because Every Life Matters to God

by César De León Ph.D LMFT, Ministerial Director for the North Pacific Union Conference

Suicide is the 10th leading cause of death in the United States. It was responsible for nearly 45,000 deaths in 2016, with approximately one death every 12 minutes,1 many more people think about or attempt suicide and survive.  In 2016, 9.8 million American adults seriously thought about suicide, 2.8 million made a plan and 1.3 million attempted suicide.2 Suicide is a problem throughout the life span and is no respecter religious affiliation.  In 2016 study was done with a beginning hypothesis that results from an earlier study would likely be confirmed, however contrary to earlier findings, in this study involving 321 depressed and bipolar adults, past suicide attempts were more common among depressed patients with a religious affiliation. Additionally, suicide ideation was more severe among depressed patients who said religion is more important, and among those who attend services more frequently. 3 This study’s results make a strong case for encouraging spiritual communities to have open dialogues about depression, suicide and other mental health issues. Incorrectly assuming that church attending Christian youth or adults don’t struggle with suicidal thoughts is simply not true.  

Suicide is the second leading cause of death for people 10 to 34 years of age, the fourth leading cause among people 35 to 54 years of age, and the eighth leading cause among people 55 to 64 years of age. Suicide rates vary by race/ethnicity, age, and other population characteristics, with the highest rates across the life span occurring among non-Hispanic American Indian/Alaska Native and non-Hispanic White populations.Other Americans disproportionately impacted by suicide include Veterans and other military personnel and workers in certain occupational groups. Sexual minority youth bear a large burden as well, and experience increased suicidal ideation and behavior compared to their non-sexual minority peers. 4

If these statistics don’t make you shudder, then allow me to bring it closer to home. Though all states are reporting an increasing rate of suicide in all ages, the state of Oregon is reflecting one of the highest increments, with rates of 28.2% compared with 24% nationwide; 5 In Oregon a person commits suicide every twelve hours 6.   Several other states in the Pacific Northwest have the highest ratios of suicide in the country!  Did you know that the states of Alaska, Montana, Wyoming, Idaho, Oregon, Nevada and New Mexico are known as the “Alley of Death”? CNN recently reported a study that first appeared in JAMA (Journal of American Medical Association) indicating that suicide has become the second leading cause of death for young people between the ages of 10-19. 7

A bird’s eye view on suicide could lead one to conclude that most people who attempt suicide, do so because they perceive that life is not going to change, that things are going to get worse and that their problems will only get more complicated. Suicide incidents such as Anthony Bourdain and Kate Spade clearly indicate that fame and fortune are not antidotes against suicide and that people belonging to the elite subclass are not immune to the devastation that suicide leaves behind. Much of the country wondered how a world-renowned chef traveling to exotic parts of the world, eating the finest food on the planet and lounging in the most exclusive hotels could consider ending his life in the quaint, French village of Kaysersberg at the five-star, Le Chambard Hotel. Many also wondered how the acclaimed fashion designer, known for her chic personal and household accessories, who had built a global fashion empire worth $2.4 billion, could hang herself in her New York city apartment while her 13-year-old daughter was at school. 

Suicide is complicated, perplexing and deeply tragic.  As pastors, teachers, and lay Kingdom Builders, I am hoping we will become convicted as to the relevancy of this topic.  Like so many other uncomfortable subjects, this is one that must be addressed more openly and more frequently, from our classrooms and pulpits, if we are to make a dent in this alarming, growing epidemic. Sadly, even many good parents, don’t understand how depression and anxiety are manifested in the lives of their children and adolescents and how these can lead to suicidal ideation if they intensify.  A lack of clear and accurate information is often the reason many parents, teachers and even peers can very well miss the signs and symptoms of a suicidal person. Sadness, anger, irritability, change of demeanor, behavioral changes at home, at school and isolation; can all be red flags that should be identified and explored by not only parents, pastors or teachers, but also by well-informed peers.

Suicide not only impacts the surviving family members negatively, but it commonly leaves behind toxic shame that is frequently experienced by future generations.  Additionally, there is growing evidence that familial and genetic factors contribute to the risk for suicidal behavior. Major psychiatric illnesses, including bipolar disorder, major depression, schizophrenia, alcoholism and substance abuse, and certain personality disorders (particularly Borderline personality disorder), which run in families, increase the risk for suicidal behavior. 8 Thankfully, these factors are not a death sentence and this doesn’t mean that suicidal behavior is inevitable for individuals with this family history. What it does mean is that such persons may be more vulnerable and should take steps to reduce their risk, such as getting evaluation and treatment at the first sign of mental illness.

M.S. Kaplan, a specialist in the study of suicide has said: “Suicide is an effort to escape an intolerable opinion of one self.” 7 Perhaps this is one of the many complex reasons we are experiencing the alarming increased trend of suicide rates for youth in the United States, 12.7% for females and 7.1% for males.  This actually presents a change in patterns of suicide as the rates of male suicide have traditionally been higher than for females, since suicide data has been collected.  In 2017, men died by suicide 3.54x more often than women and white males accounted for 69.67% of suicide death in the same year.9  

It is also believed that cyber-bullying may be another factor contributing to the spike in young girls’ suicide, since they tend to visit social media sites more often than their male counterparts, which may make them more susceptible to experiencing an increase in the amount of negative thinking, which can lead to suicidal ideation and behaviors.

Dr. Gene Beresin, executive director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, believes that “Kids are feeling more pressure to achieve, more pressure in school, and are more worried about making a living than in previous years.” 7  Dr. Beresin believes that these factors alone, may not be so dangerous however, when put together with other factors, can become very lethal.

Another nuance in the tragic reality of suicide among our youth is the fact that girls are consistently using more aggressive means to commit suicide, like hanging or suffocation.10,11   This is just one way young girls are alerting us to the degree of emotional pain and stress they are experiencing in our society. When suicidal ideation saturates their thoughts, they become so convicted that life is not worth living that if they decide to act on their suicidal ideation, their suicide plan has become more lethal than previous generations when girls were more apt to poison themselves or cut their veins as their primary method of choice.12,13

Following is a list of precipitating factors, suicide prevention strategies, how to minister to the suicide victim’s family and other recommendations and resources to help you be a compassionate and competent resource in your ministry circle of influence.

I. Suicide among the youth

A. PRECIPITATING FACTORS

  1. Internal factors:
    • High score on the ACE (Adverse Childhood Experiences) Test
      1. History of physical, mental, emotional or sexual abuse
      2. History of physical, mental and emotional neglect or abandonment
      3. History of emotional trauma
      4. Adverse emotional consequences due to an early onset for use of drugs, alcohol, and/or pornography.  
    • Emotional chaos: Resentment, bitterness, betrayal, bullying, cyberbullying, toxic shame due to negative exposure in social media
    • Emotional disconnection: Few or no friends, a lack of emotional, spiritual or psychological resources
    • Constant battle with a poor self-image
      1. Lack of identity
      2. Lack of community: Few or no intimate, meaningful relationships.
      3. Lack of purpose: Few or no identified life goals or mission
    • Impairment in Mental Health:
      1. Depression
      2. Anxiety
      3. Bipolar disorder, borderline personality disorder etc.
      4. Psychosis
      5. Psychological dissonance and ambivalence such as: Sexual orientation conflicts, sexual practices that are incongruent with personal or religious beliefs, discord between genetic biology and sexual orientation.
  2. External factors:
    • Emotionally traumatizing events
    • Rejection from: romantic partner, parental, family, friends, peers, social circle
    • Personal losses: romantic partner, friends, relocation, pets, jobs, community
    • Drug and/or alcohol dependence
    • Dependence on pharmaceutic substances, legal or illegal
    • Disloyalty or betrayal from romantic partners, family, friends or co-workers
    • Feelings of vengeance towards someone who has caused pain  
    • Negative impact of media, or social media
      1. Pop-culture models or heroes that commit suicide: Mac Miller, Robin Williams

B. WARNING SIGNS

  1. Change in demeanor: An always cheerful person suddenly becomes withdrawn
    • Deepening depression
    • Anxiety
  2. Self hatred
  3. Self-inflicting wounds: Cutting and other forms of self-harm
  4. Changes in behavioral patterns towards family, friends, & school peers
    • Favorite activities or hobbies no longer hold interest
      1. Listening or playing music, sports, friendships etc.
  5. Significant changes in school performance: grades drop
  6. Physical and emotional distancing from:  Family, friends, romantic partners
  7. Isolation  
  8. Suicidal ideation
  9. Fixation on death or death related issues
  10. Asymptomatic: No overt signs or symptoms

C. PASTOR/TEACHER/PARENT/PEER INTERVENTIONS:

  1. Suicide Prevention Strategies
    • Secure a working knowledge of the relationship dynamics in the home of origin.
    • Secure a working knowledge of the stressing factors in the life of the young person.
    • Seek to be a friend; gain their trust.
    • Evaluate the emotional/psychological condition by assessing for and asking about:  
      1. Suicidal ideation: “Have you been thinking about ending your life?”
      2. Suicide plan: “Do you have a plan in place as to how you will end your life?”
      3. Suicide method: “Exactly how are you planning to end your life?”
    • Be ready to refer the young person to professional counseling.
    • Be ready to call the police so they can “51/50” the person, if necessary.
      1. Encourage the person to voluntarily admit him/herself into a hospital for psychiatric observation and evaluation for 36 hours, but if refuses, call 911 and report you are with a person who is a danger to his/herself.
    • Five steps to help someone in crisis:
      1. Ask—demonstrate empathic curiosity
      2. Keep person safe (don’t leave them alone until they are under supervision)
      3. Keep in mind that one of the greatest gifts you can give is the gift of your caring presence
      4. Help the person to connect with: You, God, a counselor/teacher/pastor, family, friends and/or any other source of emotional support
      5. Make sure to follow up to ensure they sought help or are receiving psychological help
  2. Ministering to the family of a suicide victim
    • Funeral arrangements
      1. Offer your assistance in funeral planning  
      2. Funeral service
        • Assist, if needed, in securing a funeral venue/church facility
        • Assist, if needed, with family member transportation
        • Assist, if needed, with lodging arrangements for traveling relatives
        • Assist with snacks or meals during wake and/or funeral gatherings
    • Personal Visits
      1. Come ready to listen actively
        • Avoid offering “advise”
        • Avoid “preaching” to the hurting family
        • Avoid judging or the use of condemnatory statements
        • Focus on providing the ministry of compassionate presence
      2. Be ready to facilitate an emotional catharsis by providing an escape valve for negative emotions, pain, desperation, bitterness, disillusionment etc.
      3. Primary challenge:  Facilitating a connection between the hurting family and God
        • Invite hurting members to come to God with their hurt, broken and disappointed hearts while being aware your presence and care are a tangible manifestation of God’s comforting presence
      4. Be ready to accompany the hurting family through the five stages of grief (Elizabeth Kubler-Ross): Denial, anger, bargaining, depression, & acceptance
    • Offer emotional & spiritual support as needed
      1. Schedule frequent post-funeral visits and/or calls to the family during the next 3-6 months.
      2. Demonstrate empathy: “The ability to identify with or understand the perspective, experiences, or motivations of other individual and to comprehend and share another individual’s emotional state” (The Free Dictionary by Farlex).
      3. Demonstrate compassion, kindness, and love to grieving family members and friends  
    • Offer spiritual care and support
      1. Make appointments to stop by and visit: Mostly listen  
      2. Use Scripture passages carefully and sensibly
        • Share Bible promises, thoughts, books, cards or articles that offer, healing, peace, comfort, encouragement and hope through prayer
      3. Involve the community of believers to pray for the family, to visit, call, share food etc.
      4. Keep in mind that grieving is a highly individual experience. There is no right or wrong way to grieve. How one grieves depends on many factors including one’s culture, personality, coping style, one’s life experience, one’s faith, and how significant the loss was. Professional counseling is often very helpful when death of loved one is a suicide.

II. Suicide among Adults

A. Precipitating factors

  1. Internal factors:
    • A high score in the ACE (Advance Childhood Experiences) Test
      1. Neglect and emotional and or physical abandonment
      2. Trauma
    • Emotional chaos
    • Emotional disconnection and lack of emotional, psychological & spiritual resources
    • A long battle against a poor self-image
      1. Lack of community
      2. Lack of meaning purpose and life mission
    • Impairment in mental health: depression, anxiety, bi-polar, borderline or other personality disorders, psychosis, etc.
  2. External Factors:
    • Loneliness: Recent loss of spouse, relative, close friend or pet
      1. A number of losses, usually in sequence: Personal losses + professional losses + financial losses
    • Divorce or separation
    • Drugs and alcohol abuse
    • Use of legal or illegal pharmaceutic substances
    • An inability to see a better future and a general feeling of hopelessness and helplessness
    • Failing health: chronic or terminal illness, loss or organ or body part
    • Social media Influence
      1. Pop culture role models or personal heroes who commit suicide i.e.: Anthony Bourdain, Kate Spade, Robin Williams 

B. Warning signs

  1. Change in typical demeanor: increased depression or anxiety
  2. Hate for self
  3. Changes in behavioral patterns with spouse, relatives, friends, co-workers, neighbors,
    • Loss of interest previously enjoyed activities: hobbies, music, sport, religious or social activities
  4. Physical and emotional distancing from: spouse, family, friends or neighbors 
  5. Social isolation
  6. Suicidal ideation
  7. Fixation on death and death related topics
  8. Asymptomatic: No identifiable symptoms

C. Pastoral Intervention

  1. See section I on suicide among youth

D. Ministering to families of suicide victims

  1. See section I on suicide among youth

III. Suicide Prevention Resources for pastors, teachers, parents & youth:

  • National Suicide Prevention Lifeline: Call: 1-800-273-TALK (8255) OR Text “HOME” to 741741
  • National Center for Injury Prevention and Control: Preventing Suicide: A Technical Package of Policy, Programs, and Practices
  • Crisis Connections School Resources
  • Recklessly Alive (website and blog by a once suicidal Christian millennial; great short videos to show at schools & churches for suicide awareness & hope)
  • Cru (Christian website full of testimonies and suicide prevention resources)
  • Suicide Prevention Workshops: at Western Seminary, email kbruce@westernseminary.edu
  • Suicide Prevention Resource Center (another rich suicide prevention resource specifically for faith communities wanting to do something!)
  • Just Between Us
  • The National Action Alliance for Suicide Prevention’s Faith, Hope, Life Campaign recognizes the broad range of faiths interested in praying for individuals who may be struggling with suicide or whose lives have been touched by suicide. Click here to download free resources to help your community participate in this event.
  • The National Benevolent Association organizes peer groups for leaders that provide an opportunity to cultivate support and encouragement, mutual dialogue, spiritual renewal, and peer-to-peer learning. The NBA also offers a “Mental Health Initiative and Affinity Group,” which supports the prioritization of mental health and wellness in the life of the church, establishing the necessary awareness and understanding required to counter stigma, and change the landscape of conversation regarding mental illness and disorders within the church.
  • The Center for Courage and Renewal provides programs that give those in ministry roles the opportunity to reflect and reconnect with their calling within an honest and non-judging community.
  • The Soul Care Institute facilitates a two-year journey of a group of peers. Over the course of two years, students will ‘come away from the front lines’ of their ministries, work, and family life in order to engage in retreats that are designed to re-fill their souls for ministry.
  • Gateway to Hope: A comprehensive, interactive training for empowering, educating and equipping clergy and peers with the tools to respond to those in distress and help build a community-based response to the mental health crisis our country faces.
  • Celebrate Recovery offers 12-step healing group programs specifically for members of the clergy

Recommended Reading:

  • “When the darkness will not lift” by John Piper
  • Link to a really insightful article
    “Who Pastors the Pastor? Even Ministers Suffer From Suicidal Thoughts.” by Kay Warren of Saddleback Church
  • Broken Minds: Hope for Healing When You Feel Like You’re Losing It by Steve Bloem (Kregel Publications, 2005)  This book shares a family’s struggle with mental illness while trying to find their place in the body of Christ.  Mental illness can be more subtle and much more prevalent than many expect. Christians who are clinically depressed or have been diagnosed with a mental illness can feel the guilt from Christian leaders who claim their problems are spiritual instead of physical or emotional.  This informative book is both scripturally and clinically sound as it breaks down old perceptions of mental illness and depression and provides hope for healing.
  • Mind Character and Personality” Vol. I, II by E.G. White

                                                        Bibliography:

  1. CDC. Web-based Injury Statistics Query and Reporting system (WISQARS). (2018) Atlanta, GA: National Center for Injury Prevention and Control. https://cdc.gov/injury/wisquars/index.html
  2. Substance Abuse & Mental Health Services Administration. (2017) Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use & Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990512/#R33
  4. Stone DM, Holland KM, Bartholow B, Crosby AE, Davis S, Wilkins N. (2017) Preventing Suicide: A technical package of policies, programs, and practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
  5. https://www.metropediatrics.com/oregons-rising-suicide-rate/
  6. https://lanecounty.org/UserFiles/Servers/Server_3585797/File/Budget/FY%2017-18%20Proposed/Oregon-Facts-2017.pdf
  7. https://www.cnn.com/2019/05/17/health/suicide-rates-young-girls-study/index.html
  8. https://www.hhs.gov/answers/mental-health-and-substance-abuse/can-the-risk-for-suicide-be-inherited/index.html
  9. https://afsp.org/about-suicide/suicide-statistics/
  10. Kaplan, M.S., McFarland, B.H., & Huguet, N. (2009). Firearm suicide among veterans in the general population: Findings from the National Violent Death Reporting System. The Journal of Trauma, 67, 503-507.
  11. Curtin SC, Hedegaard H, Minino A, Warner M, Simon T.  QuickStats: suicide rates for teens aged 15-19 years, by sex—United States, 1975-2015.  MMWR Morb Mortal Wkly Rep. 2017;66(30):816. doi:10.15585/mmwr.mm6630a6PubMedGoogle ScholarCrossref
  12. Curtis SC, Warner M, Hedegaard  H. Increase in suicide in the United States, 1999–2014. https://www.cdc.gov/nchs/products/databriefs/db241.htm. Published April 2016. Accessed November 17, 2018. 
  13. Karch DL, Logan J, McDaniel DD, Floyd CF, Vagi KJ.  Precipitating circumstances of suicide among youth aged 10-17 years by sex: data from the National Violent Death Reporting System, 16 states, 2005-2008.  J Adolesc Health. 2013;53(1) (suppl):S51-S53. doi:10.1016/j.jadohealth.2012.06.028PubMedGoogle ScholarCrossref

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