Suicide: Outing Our ‘Hidden Secret’Volume 18, No. 1, Winter 2010
Suicide: Outing Our ‘Hidden Secret’By Larry Fox
Cape Cod (and the Islands)…a paradise jutting out into the Atlantic. A Norman Rockwell painting come to life.
But there’s one picture that would never make a Saturday Evening Post cover.
Some call it our “hidden secret.”
We’re talking about suicides at disturbing rates well above average compared to the rest of the Commonwealth.
Some statistics from state, county and national sources:
Mental health professionals prefer to use the term “completed suicides” and the most striking figures concern the “youth cohort” of 10 to 24-year-olds. Based upon recent statistics from the Massachusetts Department of Public Health, our rate is 1.5 times the state average and tied with one Western Massachusetts area for the highest in the Commonwealth.
Overall our average suicide completion rate of 9.4 for the five-year period ending in 2006 (the latest figures available) was nearly as bad, almost 1.4 times the rate for the Commonwealth over the same period. [Rates are based on number of completed suicides per 100,000 population.]
During this same five-year period, the 119 completed suicides reported in our Community Health Needs Area (CHNA) was six times the number of homicides and only slightly less—on average a differential of just under three per year—than the 133 motor vehicle deaths.
And this isn’t the worst of it.
According to Tim Lineweaver, director of behavioral health services for the Community Health Center of Cape Cod, the number of actual completed suicides is probably much higher.
“Our hidden secret has been hiding under the radar for some time,” he says. “Families often don’t want people to know because of the stigma. Suicides often do it by car and so there’s no way to tell unless they leave a note. Quite often deliberate drug overdose deaths are ruled ‘accidental’. And so the total breadth of the problem goes under-reported.”
Mr. Lineweaver admits that even mental health agencies sometimes can’t determine if a death was accidental or self-inflicted, although, he notes, through experience he often is able to tell from tell-tale hints included—or omitted—in the obituaries.
And then, of course there are the vast numbers of attempts that are not “completed” and which do not even get recorded unless the individual ends up in an emergency room or requires hospitalization.
Fortunately, something at last is being done to bring this “hidden secret” out into the open, the first critical step to solving the problem.
The Cape and Islands Regional Suicide Prevention Coalition (C&ISPC) was formed last year, bringing together a diverse group of community stakeholders, more than 75 in all at this point. The goal is to raise awareness, identify the vulnerable and create programs designed to reduce the number of these tragedies.
One problem Mr. Lineweaver cites is a shortage of psychiatrists on the Cape, which can lead to long wait periods for patients at risk to receive treatment, sometimes with fatal results.
Some other tendencies:
Mr. Lineweaver chairs the Coalition. Beth Albert, who heads the Barnstable County Human Services Department, is vice chair. And Maura Weir, also of the Community Health Center of Cape Cod, is project manager for the Youth Suicide Prevention Project, which is operating under a $300,000 grant from the Substance Abuse Mental Health Services Administration. The Community Health Center of Cape Cod is the Coalition’s lead agency.
Some steps already have been taken, including creation of a Post Trauma Stress Management team and educational initiative at Barnstable and Mashpee High Schools. All of these are addressed in additional articles on these pages
Why are the suicide rates on Cape Cod so high? Before you can fix something, you have to know why it’s broken. And one word kept surfacing as the Advisory Board of To Your Good Health, A Health Care Newsletter, discussed this disturbing issue during its most recent meeting at Cape Cod Community College.
The key word was “isolation,” repeated again and again, and in a wide variety of contexts.
Surprisingly, the isolation factor was not limited to geography or long, cold winters. Indeed, much of it related to demographics in which we are basically a community of strangers who moved here from somewhere else and to isolation within peer groups and as the result of family loss.
According to Mary McCarthy, founder of Hospice & Palliative Care of Cape Cod, “When a lot of people move here they leave their old neighborhoods where they are known and everybody knows them. Then they come down here and begin to face the isolation. And when one of them dies, they’ve really lost their sense of belonging.”
Rob Fessler, Director of Skilled Nursing Residences of Cape Cod Medical Supply, agreed. “There is also is the seasonal influx and outflux leading to a lot of people who don’t have that sense of unity from a close-knit community that you might have in other areas. Isolation tends to fuel that (despair), not just among the elderly, but also among younger adults who are away from their friends and peers.”
Isolation as a result of loss—dying, divorce, or even losing a home—is not just for the elderly. Kids Grieve, Too is not just a program at Hospice & Palliative Care of Cape Cod, it is a descriptive. “This can be a contributing factor for depression, which can lead to suicide,” said David Rehm, President/CEO.
“There’s also a socio-economic divide,” Dayle Lawrence, Clinical Director of Cape Cod Healthcare’s Human Services, explained. “There’s a growing gap here between people that have and those that don’t have. If you’re growing up where there are financial strains, where is your hope for the future? That can impact young people.”
“You retire here and then you don’t form any support groups,” said Dr. Arthur Bickford, medical director of Hospice & Palliative Care of Cape Cod. “It’s a set-up for something to push you over the edge.”
There’s also something in the New England psyche that also plays a part said Rosemary Dillon, Director of Allied Health & Gerontology at Cape Cod Community College. “So many of those older folks that retire to the Cape lose their community and family support,” she explained, “Then they move into a new neighborhood and, it being New England, it’s where we don’t mix well and we don’t know for sure whether we really want to get to know you.”
And then there is geographic isolation, such as on the islands where some Nantucket figures are off the board.
Jim Lyons, retired former President/CEO of Cape Cod Healthcare, recalled that years ago children who were at risk or had attempted suicide were treated at Cape Cod Hospital. “At that time the diagnosis was more around the isolation; that an adolescent got into some sort of negative situation with their peer group, usually bullying. Suicide loomed as a possibility out of the pain and there wasn’t the opportunity to go to another school or another place,” he recalled.
The school reference leads into another isolation, teenagers so anxious to become part of a group that they’ll follow their peers down a suicidal path.
“At Barnstable High School there have been several suicides where kids knew each other and were connected. Yes, we are very much concerned about the copy cat syndrome,” said Sue Rohrbach, district aide to Senator Rob O’Leary and an active supporter of the Suicide Prevention Coalition.
And then there’s the isolation of the alienated child, who feels the only way to get parents to “care” is by inflicting remorse through suicide.
“They feel they are somehow going to reap the benefit of people feeling sad when they are gone,” Ms. Dillon offered. “They’ll say, ‘Now she’ll understand how much she hurt me and so I’m going to be okay.’ This unrealistic thinking is such a hard thing to fight.”
“They’re not looking for real solutions, they’re just looking to end the suffering and pain,” said Ed Laroche, Executive Director of Cape Cod Healthcare’s Behavioral Health Services.
Dr. Ben Ianzito, staff psychiatrist at Cape Cod Hospital and consulting psychiatrist at the VA Medical Center in Washington, agreed, pointing out that “teenage brains are not yet developed to deal with complex emotionally driven behavior and they’re not amenable to conventional intervention. Breaking up with a boyfriend and your life is over?”
Yet intervention before any damage is done can be critical. “Suicidal kids come to the ER, yet the next day their attitudes are changed. Sometimes they just need a time-out,” Dr. Ianzito said. “Then the next day you start to address the underlying issues.”
“Where are the parents in all this?” asked Dr. William McDermott, former executive director of the Massachusetts Medical Society.
But then he answered himself with a poignant story that sometimes even the best parental oversight is not enough. It involved a friend, a trained certified psychiatrist, whose son committed suicide soon after enrolling in an out-of-town college. Years afterward, he still blames himself, “I should have noticed. The signs were there. I should have noticed.”
Yes, a completed suicide may stem from isolation, but it is never an isolated event, almost always creating more than one victim.