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Shelby Rowe on her suicide attempt: "I wanted to live, I just didn’t know how to anymore. And I think that’s something that a lot of people miss, they think that individuals who are suicidal want to die."
Jasper Colt, USA TODAY

The Centers for Disease Control and Prevention released new numbers last week showing that the nation's suicide rate is up 33% in less than 20 years. Suicide is a growing problem, yet stigma often prevents people from talking openly about it. 

Shelby Rowe attempted to take her own life almost 10 years ago, but she survived. She is one one of millions of Americans who survive suicide attempts and go on to live full, healthy lives. USA TODAY enterprise reporter Alia Dastagir interviewed Rowe, a leader in the field of suicide prevention, for USA TODAY's Surviving Suicide project. Rowe and Dastagir answered questions about suicide during a Reddit AMA Monday. 

Below are some of the highlights, edited for brevity and clarity:

Q: I survived two attempts. Do you still think about it? If so, what helps to dissuade yourself?

Shelby Rowe: I'm so glad that you survived! ... I don't have recurring thoughts of suicide but I do know other survivors who have daily struggles with thoughts of suicide. I have had times since my attempt that I've had acute feelings of loneliness and isolation, but I reach out to my supports/safety plan right away. I hope that I never have to live through another suicidal crisis.

For me, reaching out and talking about my feelings early helps. When I start feeling like no one cares or that everyone would be better off without me, I reach out to people that I know can remind me that I am loved and needed. Feeling disconnected/isolated and feeling like you're a burden are two of the biggest risk factors. ... The antidote - stay connected to my purpose and to my people. My people include my tribe, my family, my friends, and my professional community. The bigger my "safety net" the better I feel. 

Q: How did you knew you hit rock bottom?

SR: I'm not sure "rock bottom" is the best description of what I felt. It was more of a seeing there was hope and a different direction to go. For months, I had been overwhelmed with thoughts of "I can't live like this." It was a few days after my attempt when I started to see that I could let go of some of the things in my life that were bringing me so much pain. I could live differently.

Waking up after my attempt and seeing how worried my kids were was certainly humbling. Overall, it was hope for a new future that saved me. My fear of being in that much pain and despair again keeps me motivated to live a healthy, well-balanced life.

Q: I'm not suicidal, but often times the idea of going to bed and not waking up the next morning seems like a blessing. Is this common before I would reach a point where I go into a crisis?

SR: Although you are not having thoughts of suicide, feeling that not waking up would be a blessing could be a sign of depression. Oftentimes with brain health, we seem to think that we don't need help until it's a crisis. This isn't true. When we start noticing symptoms is when we need to talk with our health care providers so that we don't have to ever experience a life-threatening crisis. I'm so sorry that you're struggling. If life ever feels like it’s not worth living, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). The call is free and confidential, and crisis workers are there 24/7 to assist you. There's so much stigma and misinformation that we seem to forget that our brains are part of our bodies. If we notice a lump on our hand, we go to the doctor right away. No one would think of letting it get to be the size of a grapefruit before ever seeking care and getting a diagnosis. Having feelings of not wanting to wake up is a significant symptom, and I encourage you to seek help before it becomes a life-threatening crisis. 

Q: What advice would you give if someone told you that they were suicidal?

Alia Dastagir: Experts told us that if someone tells you they're thinking about suicide, you should actively listen. Don't act shocked. Don't minimize their feelings. And don't debate the value of life. You should try to focus on their reasons for living. A question you could ask: "What's kept you safe up to this point?" ... You don't have to have all the answers. We know it can feel scary if someone says they're feeling suicidal. You can call the National Suicide Prevention Lifeline (800-273-8255) and they can talk you through other ways you can help. One of the most important things you can do is be there, and when you learn someone is struggling continue to be there. Also encourage them to seek additional support, which could include reaching out to a mental health professional or a support group. 

Q: What is the best way to care for someone after an attempt? Does this advice differ based on your relationship to that person (sibling vs. distant cousin vs. coworker, etc.)?

AD: Suicide survivors often experience a lot of discrimination and shame which can make it difficult for them to talk about their feelings. They worry people will judge or avoid them. The National Suicide Prevention Lifeline says if someone you know is a suicide survivor these are things you can do to help (no matter what the relationship):

  • Check in with them often.
  • Tell them it's OK for them to talk about their suicidal feelings.
  • Listen without judgment.
  • Tell them you want them in your life.
  • If they start to show warning signs, ask directly if they're thinking about suicide.
  • Call the Lifeline for advice on how to help.

Q: How did you beat depression?

SR: Learning how to talk about my fears and my pain has helped a lot when it comes to beating depression. For me, staying safe involves staying focused on my purpose and connected to my people. My people includes all sorts of connections — my ancestors, neighbors, family, professional colleagues, etc. I see my mental health as the same as someone else's diabetes or heart disease. If I do my part to maintain a healthy lifestyle and get help when my symptoms are minor, I can keep myself safe from life-threatening suicidal episodes. So far my strategy is working. It's been since 2010 since my attempt and I hope I never have another. 

Q: Reading about Chester Bennington it's clear that he suffered with a lot of dark thoughts for many years before he took his own life. In a way, it sort of seemed inevitable. As someone who hasn't been in a great place mentally for the last year or two and barely feels like they're getting any better, what can you tell me by way of an alternative narrative to suggest that things can get better? 

SR: Although it can seem inevitable, there is hope. The fact is that most individuals who think about suicide never attempt (researchers say that there are up to 280 for every person who dies by suicide), and most individuals who survive a suicide attempt (70 percent) will never make another attempt. They survive. That path is different for each one of us, but often includes taking our lives in a different direction. Depression and bipolar disorder, along with other mental health conditions, like diabetes, can deteriorate over time if not managed well. They can even become fatal. Fortunately, most mental health conditions respond very well to treatment. Many individuals experiencing a suicidal crisis, including me, don't necessarily have a desire to die. The pain creates tunnel vision that makes it seem impossible to survive. Once the pain level subsides, even a little bit, the survival instinct usually takes back over and life finds a way. Any time you're having thoughts of suicide, it's a life-threatening situation and it must be taken seriously.

I am sorry to hear you are going through so much right now, but your life does matter. Don't hesitate to call the Lifeline at 1-800-273-TALK (8255). If you are outside of the United States, please visit iasp.info to find out about service providers in your country. 

Q: What do you think is the best path forward in fixing the cultural reasons behind suicide, like toxic masculinity and being overly image-conscious?

AD: People I spoke to for this story say culture is such a big part of it. Isolation raises the risk of suicide, and nearly half of Americans say they sometimes or always feel alone. Increasing smartphone use has been linked to suicidal thoughts in teens. You mention toxic masculinity, which at least one of the survivors I spoke with said was a barrier to him asking for help when he needed it (though he didn't use the exact term!). He is an active duty National Guardsman who survived a suicide attempt a little over a year after 9/11. He grew up on a farm in Missouri and never saw his dad cry. He didn't know how to cope with his pain, because he had never been taught how. Experts say our attitudes about seeking help need to improve. People need to feel like they don't have to endure things alone. They need to feel connected to other people. 

Q: How prevalent of a cause of suicide/depression/suicidal ideation is economics (worrying about getting a job, not earning enough, etc.), and how should one handle such a case?

SR: Feeling as if you're a burden to others and that you're disconnected are significant risk factors for suicide, and a job loss or a period of underemployment can trigger both of those feelings. Helping someone to expand their sense of purpose and value beyond their paycheck can help to buffer against the risks to their mental health caused by the lack of employment. Connecting with family (or tribe, in my case), friends, and community groups are also helpful.

Q: What positive trends do you see in our society that encourage you we're going in the right direction to lower the suicide rate and what would you like to see but don't see?

AD: On positive trends, people who work in suicide prevention have said that one of the interventions that is showing real promise is training primary care doctors and other medical staff in suicide prevention. There's an initiative called Zero Suicide that is working to bring suicide prevention into health systems, and in places where their framework has been adopted, there has been a 60% reduction in suicides. There has also been some good work done around means safety, which refers to the "how" of suicides. Restricting someone's access to guns during a suicidal crisis, for example, can be lifesaving.

People I interviewed for this project said they would like to see more conversation, publicly and privately, about suicide. Less fear and less stigma, overall. We know that isolation is a risk factor for suicide, and feeling connected to other people protects against suicide. So on an interpersonal level, reaching out to people who you think may be struggling is important. At a macro level, it's important to make sure suicide prevention programs include ways of promoting connection. 

SR: I echo Alia in that I'm very encouraged with the work that is being done in health care settings to put brain health on the same level as other health conditions. By adding mental health screening and brief interventions into every health care encounter, early identification and treatment is possible before it becomes a life threatening crisis.

I would love to see more peer-to-peer support for both attempt survivors and for their families. There is not much happening in the field of suicide prevention in this area and I think it is key to fostering recovery and healing. We humans do not heal in isolation. We heal in caring communities. When we do more in society to promote the healing of those who are struggling and to acknowledge their successes, it will become easier for those who are struggling to feel safe reaching out for help and sharing their pain.

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