Copyright 2000 The Tribune Co. Publishes The Tampa Tribune
The Tampa Tribune
June 1, 2000, Thursday, FINAL EDITION
SECTION: NATION/WORLD, Pg. 8
LENGTH: 2115 words
HEADLINE:
Day after day, lives lost;
BYLINE: KARLA JACKSON,
of The Tampa Tribune;
BODY:
Every 17
minutes in the United States, someone commits suicide, leaving family, friends,
coworkers and doctors to wonder what they could have done to prevent it.
Suicide is a sneaky killer that stalks its victims inside their heads,
where its symptoms are often camouflaged by personal crisis.
For
Dick Brown, 53, the crisis was the loss of his frame shop and inheritance.
For Law Bush Jr., 34, it was a battle with addiction and AIDS.
For Harold Wetzel, 72, it was the debilitating effect of two strokes,
combined with a dependency on painkillers. Their suicides on three
consecutive days in December 1999 put a local face on a national tragedy.
Every year, for decades, some 30,000 people die, not of cancer or heart disease,
but of despair.
Suicide can be prevented, mental health experts
say, but not without a massive shift in the way the public, medical
community, insurance companies and government deal with it. Why there's no
help
The reasons suicidal people don't get help are both personal and
societal.
They are afraid to seek psychiatric treatment and be labeled
as "crazy." They fear the effects of mood-altering medication. Family and
friends disregard or don't know the warning signs of suicide.
More than
90 percent of suicidal people have some type of diagnosable mental disorder,
usually depression, but medical doctors don't routinely screen patients
for depression or ask about suicidal thoughts.
"We are not
aggressively diagnosing depression," said U.S. Surgeon General David Satcher
during an interview in Tampa in April. "Mental illnesses are real. One in
five Americans - 44 million people - experience some type of mental
disorder each year."
Satcher's report, "A Call to Action to Prevent
Suicide," released last June, has been heralded by mental health
professionals, politicians and the survivors of victims as an important first
step in reducing the suicide rate.
Even when depression is
diagnosed in a suicidal patient, limited coverage for
mental health services by managed care plans can restrict
access to therapy and medication in an effort to save costs.
"Our
system of care discriminates against those with mental illness," Satcher said.
"Parity of access is critical. Parity actually pays and we have to get
that message across."
There also is no universally accepted method among
mental health professionals for treating suicidal patients, which can
affect the consistency and quality of care.
Compounding the problem in
the Tampa Bay area is a dramatic drop in the number of hospital beds
available for psychiatric patients in crisis - particularly children -
since the February closing of the private Charter Hospital chain, due to
bankruptcy.
"Our walk-in evaluations have increased by 20 percent," said
Ray Himebaugh, director of emergency services for Children's Crisis
Services, a local evaluation and treatment program for uninsured children.
The program's 14 beds are the only in-patient crisis beds available for
children in Hillsborough County. The shortage is not as critical for
adults, but it is a problem, Himebaugh said. Charter had 68 beds for
children and 78 beds for adults.
"Any time you take that number of beds
out of a community, it's going to have an impact," he said.
For a person
who doesn't want to go on living, obstacles such as bed shortages and insurance
problems could make a life-or-death difference.
"There are
barriers. You have to want help. It's not going to come get you," said Anthony
Reading, chairman of the psychiatry department at the University of South
Florida.
"I think if people want to get help, help is available."
Raising awareness
First, someone has to recognize the warning
signs. More than 80 percent of people who commit suicide give some sort of
clue as to their intentions, according to statistics from the American
Association of Suicidology, a Washington, D.C.-based nonprofit
organization.
Yet in most cases, family members had no idea what was
about to happen.
Law Bush Jr., a shade-tree mechanic who lived with his
two young daughters and parents in their north Tampa home, displayed
several of the warning signs in the weeks before his death, but his
actions didn't seem unusual at the time.
He finished and delivered
a car he had been working on for weeks. He cleaned up his room. He gave
away his prized, leather Australian bush hat to a friend. He sat his mother down
for a long, heart-to-heart talk about how much he loved and appreciated
her.
"It was his final time with me," said Susan Bush. "At least he gave
me that."
Wrapping up loose ends, giving away prized possessions and
"saying goodbye" to loved ones are classic warning signs of suicide. Drug
addiction and terminal illness also increase the risk. Law was battling a
heroin addiction and had been diagnosed with AIDS a few weeks before his death.
On the afternoon of Dec. 9, while walking home, Law dove under the rear
wheels of a semitrailer truck near the intersection of Waters and
Manhattan avenues. Witness reports said it looked like he was diving into
a swimming pool.
"It's so amazing that you don't see these signs when
they are happening,"' said Bush, who is raising Law's daughters, now 8 and
5. "But at the time it didn't seem out of the ordinary. No one realized
the depths of his misery."
Vivian Brown, Dick's widow, recalled how he
would wake in the middle of the night and go sit on the living room sofa
in their Bayport Village town house to have a smoke.
"That last week
before he died, he would sit out there for hours," Brown said. "He must have
been planning it then. I could kick myself now for not going out there and
checking on him."
"The worst times are those early morning hours when
they can't sleep and everything seems hopeless and there's nothing to
distract them from their suicidal thoughts," Reading said.
On Dec. 10,
after Vivian Brown left for work, her husband walked out to a tiny patch of
pines in front of his home, put a pistol to his temple and pulled the
trigger. He left no note.
She knew he was depressed over the loss of
their business, Frames by Helen, which they started with an inheritance
from his mother. He had dropped more than 50 pounds in the last six months and
was prescribed medication for depression by his doctor. But he never
revealed to his wife or his doctor he was contemplating ending it all.
It wasn't until after her husband died that Brown learned he had
attempted suicide about 17 years earlier. A close friend confided he had
"talked him out of it" on more than one occasion.
A prior history of
attempts is a prime risk factor for suicide, as is a shameful or humiliating
event, such as losing a business.
"You've got to talk to your
family," said Brown's daughter, Jaclyn Smith, 21, who was very close to
Dick Brown. "We didn't know until the day of the service that he had tried to
kill himself before." Misreading the signs
More than 70
percent of people who attempt suicide have seen their primary care physician in
the month before the attempt.
However, diagnosing depression can
be tricky for medical doctors, said Bruce Bongar, a California
psychologist and professor who has published extensive research on suicide.
"It is especially difficult because each patient presents a unique set
of risk factors," depending on their life experiences, he said.
Suicidal people can also be reluctant to confide in a doctor they only
see for a few minutes, a few times a year.
"In these days of
managed care, the average physician has maybe eight minutes with a patient,"
said Reading. "It can be difficult for a patient to tell a doctor, "I'm
thinking about killing myself.' "
Managed care is not the problem,
according to the surgeon general. In fact, it is the managed care industry
that has proved equal coverage for mental and medical illnesses is
cost-effective, he said.
The time crunch in the doctor's office
can be offset by hiring a nurse or mental health counselor to screen
patients for depression and suicide risk.
"Primary care physicians could
do a better job of using a team approach," Satcher said.
Still, Bongar's
research shows that suicidal people are more likely to disclose their intentions
to a friend or family member than their doctor.
"People worry that
it will get on their record and they won't be able to get a job," Reading said.
"They worry if their boss finds out, they'll get fired, when, more often,
the boss wants them to get treatment." Treatment issues
That's not to say that a suicidal person who receives medication and
therapy will be perfectly fine and never want to kill themselves again.
Some 15 percent of people who attempt suicide eventually die from it,
according to Bongar.
While depression is treatable with a variety of new
medications on the market, they can take a few weeks to kick in. During
that time a suicidal person is at high risk.
Once they feel better, many
patients stop taking their medication, usually because of side effects
such as drowsiness and weight gain. They relapse back into depression, creating
a vicious cycle that seems unendurable and unescapable.
"Depression is the mental equivalent of pain. It's just as terrible as
severe physical pain," Reading said.
Railroad retiree Harold
Wetzel of Clearwater felt the double whammy of extreme physical and
emotional pain in the months before he died on Dec. 11.
Depressed
by partial paralysis after two strokes and plagued by arthritis, Harold walked
into his bedroom on the morning of Aug. 4 and shot a load of birdshot into
the roof of his mouth.
"I heard a pop," said his wife, Delorise Wetzel,
71, who was sitting at the kitchen counter. "I walked into the bedroom and
I said, "What in the hell are you up to now?' There was blood everywhere
coming from his mouth."
Harold's dentures prevented the birdshot from
piercing his brain, but his sinuses and upper palate were destroyed. He
spent two weeks in intensive care before transferring to a nursing home
and contracting a series of infections that killed him four months after
he shot himself.
Harold's treatment during that time cost more than $
500,000, paid mostly by the retiree insurance Delorise had from her
longtime job at GTE.
She was more fortunate than Vivian Brown, who
received a hospital bill for $ 12,000 for the time her husband spent in
the emergency room.
"I called Blue Cross and they said they don't cover
suicide. It's right there in the book," Brown said.
As bad as it
is for family and friends, treating a suicidal patient can be stressful for
mental health professionals as well. They are "low prediction, low
control" situations with life or death consequences, Bongar said.
Odds are 50-50 that a psychiatrist, over the course of a career, will
have a patient who commits suicide. Of those doctors, about half will be
sued for negligence by the victim's survivors.
"It's very difficult to
keep someone from killing themselves if they really want to do it,"
Reading said. "If someone is really dedicated to it, they can fool all of
us. All we have to go on is what they tell us."
Complicating
matters is that the mental health industry doesn't have a standard course of
treatment for suicidal patients, as they do for other illnesses. This lack
of consistency can mean less effective suicide prevention measures for
some patients.
"Mental health professionals are nice people who want to
help people, but they have to be told what to do," Bongar said.
A
panel of national experts on suicide is now formulating a standard of care,
which Bongar estimates could be implemented within the next five years.
The surgeon general's "Call to Action to Prevent Suicide" sums up his
three main recommendations to reduce the number of suicides into a tidy
acronym, AIM: awareness, intervention and methodology.
Awareness means
teaching the public to recognize the signs of suicide and seek help.
Intervention means doing whatever it takes to prevent a person in crisis
from attempting or completing suicide. Methodology means more funding for
research into effective intervention measures and the factors that protect
people from attempting suicide.
"The surgeon general's report
destigmatized suicide as something we can attack," Bongar said. "If we
could do those three things, we could lower the suicide rate in this country for
the first time in decades." Karla Jackson covers youth issues. She
can be reached at (813) 259-7606.
GRAPHIC: PHOTO (6C),
Family photo (2C) THE WETZELS Harol Wetzel was depressed by partial
paralysis and illness when he went into his bedroom and shot himself. "What in
the hell are you up to now," his wife, Delorise, demanded when she checked on
the noise. He died four months later. Above, gathered around a family scrapbook
are, from left, the Wetzels' grandson, Ed Warner; his father, Rodney; Delorise
Wetzel; and Marcy Warner, the Wetzels' daughter and Ed's mother.
NOTES: A CALL FOR HELP: THE FAMILIES
LOAD-DATE: June 7, 2000 
