Facing Suicide

(light music) - Lonely.

Really lonely.

When you're depressed, man, the only thing you can think about is yourself.

I did have a lot of people there for me, but I was just pushing them away, you know, not even giving them a chance.

(rhythmic music) - The community has the role to play in preventing suicide.

You can come around that individual to remind them they're worthy.

There is help, there's a way through any challenge.

- If you're thinking about killing yourself, just know that you're loved, know that you're cared for.

Today might be hard, but tomorrow's a new day.

Well, do they know I'm Navajo?

It's all good.

(soft pensive music) (whistle blasting) (players screaming) (crowd screaming) - [Narrator] From all appearances 18-year-old Greg Whitesell was having an awesome year.

(crowd cheering) A standout point guard, Greg was co-captain of a legendary high school basketball team, the Arlee Warriors, the pride of Montana's Flathead Indian Reservation.

(crowd cheering) - What do you call a guy with a rubber toe?

- [Greg] Roberto!

- That's the thing about Greg.

He's the only class C boy in the entire state of Montana to ever play in four-state championships.

No other kid's ever done it.

He started, he played in all four of them.

- [Narrator] In 2017, the Arlee Warriors won Montana's fiercely contested division C state title.

- [Crowd] Arlee!

Arlee!

- [Narrator] In 2018, Greg and his team were expected to make lightning strike again, using their secret weapon, a super fast brand of the sport sometimes called Indian basketball.

Native rancher, Zanen Pitts, coached the Arlee Warriors through their most winning seasons.

- Indian basketball, it's extremely poetic to me.

I love the way that kids understand the rotations, how they understand how to transition with the ball to get it out, and that everyone's constantly in a flow, and it's kind of like herding Buffalo, and you can get behind a big bull Buffalo, and then bringing him out of the mountains or something.

There's lanes.

And you gotta see those lanes.

It's like basketball.

Like I'm constantly telling these boys, like, put more pressure to push your defender this way or to take pressure off or to get the basketball in front of the defense.

(crowd cheers) - [Narrator] As a standout basketball and football player, Greg held nothing back.

- [Guy] Let's go!

- [Zanen] He played with fire in his eyes at all times.

- [Raelena] You know, he's had many concussions through football, basketball, and the doctors would say, okay, you know, let him rest, and stuff like that.

But then he would get released.

But you know, as a mom, I would always be afraid.

Scared.

- [Narrator] Athletes have a lot to fear from concussions.

(whistle blasting) - When Greg got the head injury, it put him into a state of depression in a really bad way.

And he always has been a person that can get kind of emotional.

He can get really aggressive and really timid in drastic measures quickly.

But he also is super caring and super loving.

- [Narrator] To Greg's mom, her son seemed fine.

- I didn't know he was depressed.

I should have saw the signs 'cause he was always in his room and just kept to himself.

But you know, I didn't think anything of it.

You know, I thought, oh, he's a teenager, just going through it, and you know, he's just teenager.

'Cause I have five kids.

- [Narrator] That year mental health issues took a heavy toll on the Flathead Indian Reservation.

Montana's suicide rates are nearly double the national average.

Greg Whitesell's depression hit as suicide spiked in the town of Arlee and surrounding communities.

There would be 20 deaths in just 12 months.

(drum banging) (man vocalizing) Some in the community drew strength from traditions.

(group vocalizing) (person vocalizing) (axes hitting) - As long as your bottom straight, then you're good to go.

- Hello, committee.

(group cheers) Thank you, creator, for bringing us all together today.

We're gonna make some, we're gonna do some moccasins.

I'll help you wherever you want help.

When we do something like this, we do it with really good hearts and good thoughts on our mind.

And I kid you not, you start making a design like this and you start thinking thoughts about somebody that aren't very nice, I don't know about you guys, but my needle knots in about 30 seconds.

(Kathy laughs) And it's like, okay, get rid of that thought.

Have some good thought, good medicine.

(gentle music) Put it together.

This is what you're gonna sew.

And there's the moccasin.

- [Narrator] Making moccasins is a traditional craft that encourages sharing feelings.

- [Patty] Don't waste- - [Narrator] The suicides on the reservation were foremost in many people's thoughts.

- He didn't wanna afflict his anger and those emotions on anybody else.

He thought he was sparing us that, you know?

- I miss him.

When those cops went out to my house, I kept telling, "You need to go get him."

I wasn't sure what he was gonna do.

I tried to impress that on his pastor that I said, "You know, it's no accident-" - [Narrator] For Michelle Matt, everything changed the day she asked a friend to look for her brother.

- And he was driving up behind the house.

He saw my brother walking.

He got out and he yelled.

He said, "John, where are you going?

Where are you going, John?"

And he kept following him.

And John, he said, kept walking.

But when he got there, my brother had...

He was already dead.

(somber music) That moment though, I tell you what, the moment I saw was that was...

It just hurt.

It hurt so bad.

Oh God, it was awful.

(sobs) (birds chirping) - [Narrator] Almost everyone knew someone who had taken their own life.

They were dear friends and neighbors, parents, schoolmates.

Who wouldn't be saddened by such tragic news day after day?

Greg Whitesell was close to many who had died.

He too, developed thoughts of killing himself.

- [Anna Whiting Sorrell]I could cry now thinking about that, because he should have been protected from it.

He comes from a great family.

He was, you know, this successful basketball player.

My husband and I have been in this gymnasium watching him play, and he was my favorite.

(crowd cheers) - [Narrator] When teens are suffering, they are more likely to confide their feelings to their friends than to adults.

Peers have a unique opportunity to step in and make a difference.

Greg's friends were no exception.

One night, Greg sent a text to two of his closest teammates.

(uneasy music) They raced across the reservation.

- [Thomas Joiner, PhD]Suicide is a catastrophe for families.

And I don't think catastrophe is an exaggeration.

I think it's very apt to call it that, because it just shocks and stunts individuals and families.

They are confused and feeling searing emotional pain for months, if not years, sometimes even decades.

And this reverberates throughout generations.

- The CDC is approaching suicide as a public health crisis, because the rate in the United States has been on the rise since about 1999.

- [Narrator] Across the US, suicide kills more people than car crashes and twice as many people as homicides, about 47,000 a year.

For scientists, doctors, and that raises a crucial question.

- Okay.

- [Narrator] How can we identify the people who are most at risk and how can we help them?

- We have to develop a stabilization plan.

So you never have to go through an awful night like that again.

Suicide is ubiquitous.

No socioeconomic group, no subculture is immune.

(rhythmic drums music) - In the US, the largest number of suicides occur among middle aged and elderly white men.

In rural areas, many of those men are farmers.

- Welcome Dr. Michael Rosmann, farmer, psychologist to have a little two-hour meeting here about a subject that's important and often overlooked sometimes.

So we'll turn over to him, and thank you for coming.

- Thank you, Darren.

(audience applauds) Oh, you people are very kind.

Thanks.

This morning, we're going to talk a little bit about how farmers view their stress level currently and your wellbeing.

The signs of distress begin with worry.

Worry makes us gear up to deal with the threats.

If the stress does not remit or decrease, then we just completely wear ourselves out to the point that depression sets in.

(gentle music) - Chris and I got married on a fall September day.

The sun was shining.

It was a beautiful, beautiful day.

It wasn't too hot.

Wasn't too cold.

Kalee was born in September of 2006, and then we had Kahne in November of 2008.

Everybody buckled up?

And then it took me some work to convince Chris to have our third child.

And Kolbe came in November of 2013.

I felt like when we were living in town, my dreams were reality.

We had the perfect family.

We both had day jobs.

We had our evenings and weekends holidays free to spend together as a family.

Life was great.

(upbeat rhythmic music) But Chris had an itch to want to start farming because he had grown up on a farm.

And I was very reluctant, because I was happy with the life that we had.

We eventually moved to the farm in February of 2017.

(gentle music) Oh look, the baby lambs.

The farming was difficult from the moment we started.

Here's where we put the sows that are gonna be bred.

Here, kitty, kitty, kitty!

(light music) (sheep bleating) - Lots of good memories spent with Chris in here.

Lot of long days.

Just the joy of seeing new life when we'd have the baby lambs.

Had so much joy.

I do feel Chris present when I come here.

It can be overwhelming emotionally at times.

But other times it brings me joy, 'cause it reminds me of how hard he worked day in and day out.

Such a hard worker.

- What do you think is the most stressful circumstance that can cause farmers the greatest amount of stress?

Anybody wanna take a crack at that and say what you think?

Financial burden.

- Chris's main worry was the finances, and how bills were gonna get paid.

He didn't make it apparent to me about being depressed until probably the first part of May.

(uneasy music) (sheep bleating) (Amber sighs) Chris would send me text messages, Snapchats just about being sad and how he felt worthless and he didn't know how things were gonna work.

One of the last Snapchats that I received from Chris was a picture of him tightening his belt to the last belt loop.

He had lost som much weight.

- So what are the key symptoms that we look for?

For suicide, the first is when we become so upset for at least three weeks that we have not laughed at all.

We've not done anything that gives us pleasure.

A second danger signal is a feeling of hopelessness.

- Chris was worried about losing the farm and not being able to pass it on to his kids.

Chris would've been the third generation farmer and he did feel pressure of wanting to succeed, because his grandpa and his dad both had succeeded at farming.

- [Narrator] Rural communities across America face a critical shortage of mental health professionals.

Chris was lucky.

His family found help and he was treated at a behavioral health center for four days.

(thunder booming) Then he insisted on returning to the farm.

(thunder booming) - The night before he died, we had just finished up with chores.

Such a long conversation.

I never imagined it'd be my last one.

(gentle music) (phone rings) So at 8:12, my cell phone rang and it was our neighbor.

And Jim said to me, "Chris is breathing.

He's really slowed down."

I said, "What do you mean his breathing is slowed down?"

And he said, "Didn't Carol call you?"

And I said, "No, what's going on?"

He said, "Oh, Amber, Chris shot himself."

(solemn music) I remember crying to God, "I need a miracle."

'Cause I knew he wasn't gonna make it with what he did.

This was the hardest thing I've ever done in my life to this day was to tell my kids that their dad was never coming home again.

(woman vocalizing) Chris is gonna miss out on a lot of things, graduations, weddings, grandkids.

But I know he's keeping an eye and watching over us.

(audience applauds) - [Michael] And thank you very much and enjoy the Shelby county fair.

- [Narrator] Each year, some 15 million Americans think about taking their lives.

Many thousands, like Chris Dykshorn, do.

But many thousands more are pulled back from the brink by someone who steps in to help.

- [Michael] What do you wanna see Dave?

- Well, it's kind of a half circle.

So maybe we just head down to the tent or the show ring.

- Okay.

(phone rings) Hello, This is Mike Rosmann.

One person I know was so distressed that his wife called me and she said, "Can you come right over and help me?"

- That was the low of my life.

But I probably didn't sleep any of the night before.

So I was exhausted physically and mentally.

I couldn't think straight.

I remember yelling, "Lord, I've gotta have some help.

I've gotta have some help."

- [Michael] That that's a darn good animal there.

- [David] Yeah.

- [Narrator] Dr. Rosmann made a house call and listened to Dave describe his pain.

Together they came up with a plan to help him, fast.

- And then we found a way for him to get into the hospital immediately for evaluation.

And he remained there for several days of treatment that has followed up with occasional reliance on medications.

- When I think about what would've happened, if I had not gotten help, no way would I be alive today.

I don't know what would've happened to end my life or whatever, but I know that I wouldn't be alive today if I hadn't gotten help, because I couldn't live with that pain.

If I run into somebody that I'm seeing some signs of depression or any mental health issue, I would try to get them in a personal conversation 'cause I've led people to that same hospital that I know too, that had real good success.

- [Man] How you doing?

- [David] Enjoying the fair?

- [Man] Yep.

- [Michael] Not as much bad weather, really.

- [David] Not, that's right.

We've had fewer tornadoes out.

- Dave, don't jinx us- (Dave laughing) (people talking over each other) - He has learned how to turn his turmoil into an act of benefit to others.

He wants as his life's work partly to keep other people from becoming so depressed that they contemplate ending their lives.

- [Narrator] Dave's story and many like it show that suicide can sometimes be prevented with interventions and support from family and professionals.

And scientists hope they can point the way to helping people earlier, before they're in a crisis.

- That's 15 million Americans in 2019 with serious thoughts of suicide.

- [Narrator] It's a complicated challenge, because suicide results from a mix of causes, which are often different from one person to another.

But one factor is almost always present: a mental health condition like depression or substance abuse disorder.

- There are other risk factors as well, things that relate to impulsivity, aggression, experiences from the past, adversity, trauma, abuse.

So it is really important to understand that suicide has multiple risk factors that converge, that come together, and it's not really ever going to be one issue that causes suicide.

- [Narrator] Suicide's many causes make it hard to identify who is at risk and how to help them.

Scientists are investigating these questions from different angles, probing human behavior, trauma, and the role of drugs and alcohol.

For neuroscientists, there's only one place to start: in the human brain.

- My name is John Mann and I'm a professor of translational neuroscience in the departments of psychiatry and radiology at Columbia University.

(light music) So we started examining the biology of depression through collecting the brains of individuals who died by suicide.

This is the front of the brain, here's the back of the brain.

We cut the brain into big slices about the thickness of my hand.

And then we cut very fine slices that we mount on the slide.

So the tissue dries on the slide, and then we can do a variety of things in order to study what is exactly going on, structural and functional changes in the slice of brain of people who have depression and people who die by suicide in order to determine exactly what's wrong.

- [Narrator] Slides dyed blue show the cellular structure of the tissue.

Other slides indicate the presence of serotonin.

Serotonin is a neurotransmitter that is involved in regulating mood, decision making, and sleep, three important components of suicide.

Specialized nerve cells, or neurons, release serotonin into the brain.

Too few of these neurons, scientists once thought, make depression and even suicide likely.

They were in for a surprise.

- For years we thought the depression is due to a deficit of serotonin.

And when we actually went and tried to count the number of neurons and look at the amount of serotonin that was in those neurons, we found to our surprise it's the opposite that you have more serotonin neurons than the average person.

- [Narrator] But why did these brains have more serotonin neurons?

And why didn't those neurons relieve depression?

Mann and his colleagues think they have the answer.

To overcome a serotonin deficit that could result in depression or suicide, the scientists suspect the brain creates more serotonin producing neurons, but in depressed and suicidal patients, the strategy doesn't work.

The neurons produced by their brains don't function correctly.

- This is part of the brain where all the serotonin neurons are located, and you can see the serotonin neurons, they're these black blobs on both sides of this cleft.

We can use the computer to count the individual neurons in every section systematically all the way through.

- [Narrator] When they counted the neurons and mapped their location, they found another twist in the story.

In one part of the brain the irregularity is related to depression.

In another part, the irregularity is connected to thoughts of suicide and suicide attempts.

People with a brain profile that favors depression may never consider suicide.

A lot of patients with the abnormality causing suicidal thoughts probably won't die by suicide either.

But when someone has both abnormalities, Mann found something surprising.

The two abnormalities combined indicate the brain of a person who may be at increased risk for suicide.

And brain differences like these may help explain why people in a crisis suffer from a kind of tunnel vision.

They see fewer reasons for hope and few options other than suicide.

- The world is more threatening, more critical, and less helpful and understanding.

And then they're more vulnerable to criticism, which is why you see reports that bullying, critical comments at school have driven somebody to try and take their own lives.

And you may think, why would they have done that?

It's because what you see is not what they see.

- [Narrator] Mann is well on his way to applying his discoveries to save lives.

He'll look deeper into the brains of living patients with 3D scanning techniques.

He hopes to catch abnormalities in the brain before they can threaten someone's life.

But a big question remains: where did the risk of suicide come from to begin with?

(water murmuring) If you were thinking about suicide or if you or someone you know is in emotional crisis, please- - Call 988.

- Call 988.

- [Narrator] Call or text 988 any time for confidential free crisis support.

(cheerful band music) What many have long suspected has been confirmed by researchers: suicide runs in families.

Some of the evidence comes from studies with twins.

In one study, researchers looked at 176 pairs of twins in which one or both died by suicide.

They made an important discovery.

The risk of suicide was higher in identical twins who have identical DNA.

The findings can only mean one thing.

Some of the risk of suicide passes through genes.

- About 50% of the risk for suicide is heritable.

- You look at the Hemingway family, for example, and the genogram of that particular family, and there's depression and suicide and alcoholism, a family just plagued with tragedy and way too many suicides.

- So if you are someone who has a family history of suicide and you have some genetic loading for suicide risk, you may not know that because we haven't become very sophisticated yet as a society about recognizing like we do for heart disease.

We're much better at that.

- [Narrator] Most people with a family history of suicide never try to take their lives.

But those who have inherited a risk must be vigilant about additional risks in their environment.

Scientists know that it's genes plus life experiences that add up to suicide.

- There are a number of risk factors that are both internal and external, a family history of suicide, a prior suicide attempt, substance abuse.

And then there's these other pieces like unemployment, economic problems, financial problems, relationship problems, legal problems.

All of these are risk factors that put you at greater risk of suicide.

Again, it's important to remember that most people can survive and live through those.

Some can't.

- A significant proportion of the risk is genetic, but a significant proportion of the risk is also environmental, due to experiences that modify their genes in a process that we call epigenetics.

- [Narrator] As we age, the genes that we were born with are modified by our choices and life events, like what we eat, where we live, and our levels of stress.

(train rumbling) The discovery that experiences can change our genes was revolutionary and explains a lot about suicide.

It means that trauma, like an abusive childhood or alcohol use disorder, can influence gene expression and contribute to suicidal behavior.

In Montana, Greg Whitesell had no family history of suicide, but he had suffered recent concussions, and the tragedies on unfolding around him added to his depression.

Fortunately for Greg, he was part of a close knit community in a rich, sustaining culture.

(gentle pensive music) (man drumming and vocalizing) - Shot Barry, here we go.

- [Narrator] Today, Greg Whitesell and Darshan Bolan are two years out of high school.

They reminisce about the best and worst times of their lives.

- Do you miss high school, bro?

You miss high school?

- Yeah, I do.

This is so (indistinct).

I wish I would've got more outta high school, you know?

- Yeah, I wish I actually tried in high school.

- That's what you think.

You know, you're like, I wish I actually tried.

I wish I could go back.

(both laughing) Yep.

- You know, there's not a lot of things to do here, but there's a lot of back roads and there's a lot of mountains, so it's just nothing better than that.

(upbeat music) - We got news, bro.

- Really?

Oh, we talk about everything.

Bro, what- - Yeah.

Yeah, dude.

I, so- - Dude, I would've been like, bro, calm down!

About our feelings, about last night's game, about us playing ball.

I mean nothing's off the boards with us, you know, we're not afraid to talk about our feelings or anything like that.

(both laughing) - She hit me though.

So I was just checking, see where she's like.

We gotta come up here in the winter again, man.

That's so fun.

- What's up?

- We'll never stop wearing a hat, dude.

It's pretty hard.

(doors slam) Therapy, bro.

Like a hard reset.

And can you do on your phone?

This is my hard reset on my life to come out here.

Take in everything.

(cow mooing) What do you call a cow with no legs.

- Um... A walrus?

- Ground beef, bro.

- [Darshan] Oh.

(chuckles) - Bet you didn't know that one.

A walrus?

I don't even know what a walrus is.

- [Darshan] Those big, those big freaking- - [Greg] A hippo?

- [Darshan] No, not a hippo.

Walrus.

- [Greg] What?

- [Darshan] Yeah.

They got like the big fangs.

- Oh, from Ice Age?

- Age.

Yeah, it swims.

Yeah.

It swims.

It has like no legs.

- Is he right?

Sound the truth.

(crowd cheers) - [Narrator] In the winter of 2018, Greg, Dar, and the Arlee Warriors should have been on top of the world.

(crowd cheers) They were expected to be state champions again, but a lot more was riding on the title than just a trophy.

The suicides on the reservation numbered in the teens, soon to reach 20.

Watching the Warriors play gave the community a few hours of relief from the ordeal outside the gym.

For the players, it raised the stakes even higher.

(crowd cheers) - Their success started to excel at such a fast rate, it created a lot of pressure on them.

(judge whistles) It was hard on those boys that definitely know that they got to where they didn't want let anybody down.

- I remember the Arlee Warriors right in the beginning of those suicides, and we're trying to encourage and be supportive of the basketball team and support them.

There we go, Warriors, there we go - And it was like, we got to just step out of that, all that sadness and just be in a place that we could just do what we love and that's watch basketball.

Watch our Indian kids play basketball.

(crowd cheers) - [Narrator] The Arlee Warriors had become a light against the darkness that was overtaking the reservation.

Suicides came faster than caregivers could deal with them.

(light switches clicking) (siren blaring) - [Responder] Unit two to respond.

Suicidal.

(indistinct) by himself at this time.

- [Narrator] Anna Whiting Sorrell was the reservation health official in charge of community response.

- I convened people together in my office saying, "What are we going to do?'

And then there was another suicide.

And then there was another suicide.

And before, I don't even know if we ever said, "I think we're in an epidemic."

I mean, so we went from one to two to three and then I remember 17 and 18 and them being together, and we reached out to what we thought were the experts and really found that there wasn't really much out there for us to hang our hat on.

- [Narrator] As the suicide crisis deepened, the Flathead Indian Reservation suffered a common problem in America: not enough access to mental health professionals, and those who needed help, hesitated to ask for it.

- All of us have trouble reaching out and asking for help.

But I also think for Native people, it's deeper.

My grandma had polio when she was young, and she, I loved her, she died when I was five years old, and we have no idea if she died of a intentional drug overdose or not.

She was 42.

My mom died at 57 from cancer.

She had been recovering from her own substance abuse for maybe 10 years.

And I bring that up because I don't think that people really understand the deep historic trauma that Native people have gone through.

- [Narrator] Historical trauma is the psychological harm inflicted upon individuals and even whole cultures by harrowing experiences like slavery, the Holocaust, and violent colonization.

Through our genes that trauma can be expressed in alcoholism, mental illness, even suicide.

(person drumming and vocalizing) Historical trauma, contributes to why Natives have a suicide rate up to 10 times the national average.

- If you can't teach your own kids your own language, think about the trauma about then.

If you can't teach 'em your religion, if you can't teach 'em your songs or the music that you love, that's our most intrinsic belief system, right?

(woman humming) (gentle reed music) I would say that returning to our cultural ways is our only way out to get to the health and healing that we need.

And that is really what will prevent the next suicide.

(wind swooshing) (uneasy music) - I knew we're gonna gonna fall for that.

Shot.

I've known about 10 people who have killed themselves.

I was already kind of in a bad space, you know, I was already going through some things off the field.

It was just really hard time going on in my life.

Lonely, really lonely.

When you're depressed, man, the only thing you can think about is yourself.

And the only thing you can think about is, you know, what's killing you and what's eating you up inside.

And you know, I did have a lot of people there for me, but I was just pushing them away, you know, not even giving them a chance.

(gentle music) - [Narrator] But in the end, Greg pulled through.

His text reached two close friends and teammates.

- You know, two seconds after I sent that text, it felt like my two friends were right there, you know.

It's just, it's crazy to think about, 'cause I know I wouldn't be here if they would didn't come through and if they didn't knock on my door.

- [Narrator] One of his rescuers was Darshan Bolan.

- Yeah, like imagine just like driving up here by yourself and being able to look over that.

Have you came over here by yourself before?

- Yeah.

A couple times.

I don't think we lost the game.

- Well, peer to peer communication can play a really important role in youth mental health and suicide prevention, because among youth who are experiencing suicidal thoughts, about half of them are not telling anyone.

Among those who do, two thirds of them are only telling a peer.

They have a gut feeling about it.

Their friends are telling them about the hard stuff going on in their life.

- [Narrator] Often friends are concerned, but unsure how to help.

- [Raelena] Should we set the table outside?

- Yeah.

What do you need out there?

Come on.

- [Narrator] Fortunately, Greg's friends knew they needed to reach him fast.

Later, his mother took him to the emergency room.

He began therapy, ending his suicidal crisis.

And so, unlike some-20 others in his community that year, Greg didn't take his life.

- That's my back door.

- Remember that last week I threw it way up there and it landed up in the tree there.

- Yes.

(Raelena chuckles) Woohoo.

That's mine, sir.

Let go, let go.

How many (indistinct) you make mine?

- Okay.

Um, no.

It's got good.

- In my head, I was only worried about myself, but my mom would be living the rest of her life without me.

(pensive music) You know, my pain would be just be ending, but everybody else is around me would just be starting.

If you're thinking about killing yourself, just know that you're loved, know that you're cared for.

Today might be hard, but tomorrow's a new day.

You never know what's gonna happen tomorrow.

- [Narrator] If you are thinking about suicide or if you or someone you know is in emotional crisis, please- - Call 988.

- Call 988.

- [Narrator] Call or text 988 anytime for confidential, free crisis support.

- But yeah, we had the same fight song as Notre Dame and we just changed the words.

That's why when I hear Notre Dame's fight song, I think about Hunter Huss.

- [Narrator] For those who thought about suicide, friends can be a powerful force.

And so can family.

In Gastonia, North Carolina, Fonda Bryant and her son, Wesley literally stroll down Memory Lane in the neighborhood where Fonda and her relatives grew up.

- This is where I know you think your mom came here grown, but this is where many a day that when Spankie and Tut would come to when we were just little kids, and we'd come up here and hang out with grandma.

That was your great-grandmother.

And we'd come up here, sit on the porch and talk.

But we would just come out here and just run around.

And grandma still chopped wood and something that you would've loved, she fixed biscuits every day.

But she- - (indistinct) would make them every day.

- Because back in the day that's what they made.

She still had a wood stove and I never will forget one time, she tried to put a TV dinner in a wood stove and burn my TV dinner slap up.

Yeah.

I think that's what a whale sat right there.

Yeah.

That's the whale.

I didn't know they put something on here.

It says, "Be happy, for every minute you are angry, you lose 60 seconds of happiness."

I would take a picture of that.

That is really something.

Remind me of doing better when I'm not having a good day.

So when I was growing up in Gastonia, one of my classmates, Lisa, never will forget her.

I had on some shoes that had holes in them.

And I had put some cardboard in it to keep the dirt out.

Well, you know, when you walk, your whole shoe comes up and people can see it.

So Lisa asked me to walk in front of her so she could make fun of my shoes.

And I could hear the kids laughing in the background.

And that really, really hurt me 'cause it hurt me for the fact that I had to go to school like that and it hurt me because I felt like my mom was doing the best that she could.

So Lisa set the tone for my reason why I love shoes.

And I didn't even realize that.

It took me years to kind of realize why I love shoes so much.

These are really nice, 'cause they're kinda like heels, but they're not, and they're very comfortable.

They got the little sparkly stuff across the foot.

I actually have these in two colors.

This pair is just, it's kind of self-explanatory, and thank God they were marked down.

The color green for mental health stands for hope.

So of course, I had to have a pair of shoes with green.

I think probably the onsite of depression maybe started when I was around 15-16.

(airplane swooshing) My first suicide attempt was when I lived in Savannah.

My mom was, whew, it was difficult living with my mom.

I mean I lived with her, but then I moved up the street from her, and first off, I didn't even wanna live in Savannah.

When I moved down there, I hated it.

So altogether, probably about two times where I actually had a plan and two times where I seriously thought about this would be the best way for me.

Well, I guess, if I can have people to visualize the pain, I've had wisdom teeth removed, abscessed tooth, open heart surgery, hysterectomy, knee surgery, you could put all the pain together from all my surgeries that I've had growing up and combine them together, and it would not touch the pain that I felt on February 14th, 1995.

I had just had it.

And my mind was telling me, "You know, if you just take these pills, if you just go to sleep, everything will be over with.

Your son will be better off.

Nobody's going to care."

And that's how I felt.

But before I did that, I said, man, you know, somebody's gotta know about my pain.

And I called my Aunt Spankie.

We grew up three years apart, always been close, and I simply said, "You can have my shoes."

That's all I told her.

Hey, Spankie.

Hey, I didn't know you got your yard done, your thing done like that.

I knew you were gonna do it.

I knew you were gonna change stuff.

- During the course of the conversation she said, "You can have my shoes."

That was an instant indication that there was something wrong.

'Cause we are serious about shoes.

And I eventually asked her, was she planning to hurt herself?

And she said yes.

- But then she went into action like a super hero.

She took out the papers for me to be involuntarily committed.

There was a knock at the door and there was this big Black CMPD police officer, Charlotte Mecklenburg police officer.

"Are you Fonda Bryant?"

And I said, yes.

He said, "I came to take you to mental health facility."

And I'm like, "No, you're not."

- I just did what I did.

I didn't stop to think about who would be affected or who would be mad or...

I guess I really didn't care.

(uneasy music) - [Narrator] Fonda fought the policeman.

She gave up only after her son, then 12, pleaded, "Mom, you need help."

- There used to be two service providers Black Americans did not want showing up to your doors.

One was a psychiatrist.

The other one was a police officer.

And the concern was they both can lock you up.

Then you have the history of violence among Black Americans, particularly in police custody, where individuals were suggested that they hung themselves, they killed themselves.

So these sort of history plays out into the common experience of Black Americans and have an impact on their perceptions about mental health services.

- [Narrator] After her traumatic experience, Fonda got help.

- I've got your caseworker.

How about this?

How about we let you sit in the car and get you warmed up.

- [Narrator] And today efforts are being made to have law enforcement and mental health practitioners work together more closely.

- [Fonda] Why didn't he call Wesley?

- [Narrator] Although Spanky had helped her through the crisis, Fonda's depression didn't let up.

- We don't realize something as simple as brushing my teeth, combing my hair or taking a shower, takes- - [Narrator] Strong forces had converged in her life to bring her to the brink of killing herself.

They were forces one psychologist has spent his professional life trying to understand.

- You and Morgan are in a postdoc office together.

- [Narrator] Thomas Joiner is a clinical psychologist and researcher who studies the behavior and beliefs of people who die by suicide.

His examination of hundreds of patients inspired him to create a groundbreaking theory through explaining why people kill themselves and to help identify those who are at risk.

- It feels like a bear is squeezing the life outta you and- - [Narrator] It's called the interpersonal theory of suicide, and it suggests how social and psychological conditions can combine with tragic results.

- And she asked me again, "Are you going to kill yourself?"

And I said, yes.

- The interpersonal theory of suicide in a nutshell points to three processes that are key.

And the idea is that when those three processes all converge in the same individual, that's when death by suicide becomes likely.

- [Narrator] The first process is perceived burdensomeness.

That's the idea that one's death will be worth more than one's life to other people.

The perception of this feeling is true, though in reality it is almost never true.

Her depression convinced Fonda Bryant that her beloved son Wesley, then a child, would be better off without her.

- The perceived burdensomeness is the idea that everyone would be better off if you were gone.

That's the perception.

It's important to underline that word perceived, because they're mistaken about that.

- [Narrator] The second process in Joiner's theory is called thwarted belongingness.

That's the idea that you are alienated from others and hopeless that you'll ever reconnect.

- You might need to redo the barb wire.

- [Narrator] Though he was surrounded by a loving family and friends, Greg Whitesell was racked by feelings of loneliness and isolation.

- Thwarted belongingness is really just a long way of saying loneliness.

They feel disconnected and alienated.

Even if the exterior world around them is people.

For instance, they're popular, say, high school students or college students who are objectively popular.

And yet they feel very lonely and die by suicide at times, leaving everyone so puzzled.

How could that be?

They were popular.

And those two things, burdensomeness in low belongingness, when those co-occur, misery results and suicidal desire results.

- [Narrator] According to Joiner's theory, the desire to die by suicide results from the combination of feeling that you are a burden and feeling intensely lonely.

But he argues that a suicide requires a third ingredient, the capacity to go through with it.

- Suicide's hard.

It's very fearsome, physically difficult.

It's really, really against our natures to stare death in the face.

And yet that's what suicide entails.

Some people are able to do it.

Others are not.

And when somebody has capability and they're miserable enough because they feel so much like a burden and so alienated from others, that's when those three processes come together and that's when we see these tragic catastrophes.

- [Narrator] A deeply personal catastrophe prompted Thomas Joiner's work.

- When my father was 56, he died by suicide.

This theory, this day to day work really is not about my dad's suicide anymore.

What it's about is the fact that tomorrow in the United States over 100 families are going to be bereaved by this, a hundred just tomorrow.

And then, the next day.

And then, the next day after that.

And so on and so forth.

And that's just in our one country.

That's a human tragedy, and I want to prevent that.

(light tense music) - [Narrator] Caregivers and scientists seek to stop preventable tragedies that strike every day.

Others focus on public health strategies that keep people from ever considering suicide to begin with.

Everyone engaged in the fight agrees about the importance of one thing: seeing the signs of a suicide before it occurs.

- I think the biggest sign to look out for is if they're just not themselves.

I mean, if you can definitely tell that, you know, they're acting different, they're not talking as much, they're kind of isolating themselves.

- That means now they're really in their rooms, right?

They're really locking themselves up.

All the things they used to bring them joy don't bring them the same level of joy.

And at all times they might begin to express, and this is important, "I'm fine."

"I'm fine."

- Anybody talking about a sense of being hopeless, like there's no hope anymore for them, there's no future for them or that there's no purpose for them to be alive, no reason for them, they don't have anything left to contribute to their family, to their friends, to society, or to the world.

(bat hits) - [Man] There you go.

- The community has a role to play in preventing suicide.

Teachers have eyes on our youth for more hours of the day than probably most other adults.

Parents know their kids and their kids' patterns of behavior and what makes them tick.

Coaches are around our kids.

You can come around that individual with greater attention to what they may be going through and to remind them that they are loved, they're worthy.

There is help, there's a way through any challenge.

- [Narrator] An aware, engaged community may the most important defense of all against suicide.

Greg Whitesell's friends quickly reacted to his text.

Fonda Bryant couldn't hide her signs from her aunt Spankie, and Spanky instinctively did something experts urge us to do when we suspect someone is a danger to themselves.

- Ask the question.

- Ask the question.

- Ask the question.

- Ask the question, "Are you thinking about killing yourself?"

- The critical thing is to ask them directly, ask them very clearly, Are you thinking about suicide?

Do you just want to die?

Do you not wanna live anymore?

And I know that's really hard and I know people don't do this often and they don't like to do it, they're uncomfortable with it.

Even doctors don't like to do it.

- If you open the door of asking whether someone's come to the point where life isn't worth living, where they've considered dying by suicide, then there are a series of things that you can inquire about, in terms of, have you reached out to anyone else?

Is there, you know, family or friends or others who can help you?

Do I need to walk with you to the emergency department in the extreme?

(uneasy music) - [Narrator] For a suicidal person, the emergency department can be the first step on a journey to wellness.

It's where those at risk can be directed to life saving treatment.

But emergency rooms can be overwhelmingly busy.

Too often, patients in crisis are offered little counseling, then sent home.

If they seek counseling, it can take weeks to get an appointment.

That leaves a big gap between the crisis and care.

Scientists developed a life saving tool to fill that gap.

It's called the Safety Plan.

- My colleague Greg Brown and I developed a safety plan intervention.

And that intervention is used to help people who become suicidal to get through a suicidal crisis without acting on their suicidal feelings and suicidal thoughts.

- [Narrator] The safety plan is a worksheet of coping strategies that a suicidal person can follow to get through an emotional crisis.

- So there are six steps on the Safety Plan.

And the first step is to identify warning signs.

- [Narrator] Warning signs are thoughts that tell you you're headed for emotional trouble.

A patient may think life isn't worth living and nothing will ever get better.

Friends and family would be better off without them.

- So now we're gonna identify what your warning signs are so that you know that you need to grab the Safety Plan and start using it so that you don't make a suicide attempt, okay?

- [Narrator] For people in crisis problems can trigger dangerous impulses.

Patients must plan to distract themselves.

- We have them identify what are the things that they can do just by themselves, because a lot of times people get suicidal at night when they are by themselves.

That will take their mind off their problems that will engross them, distract them, even just for a little while.

And so they're really simple things.

It could be something like playing with their dog.

(light cheerful music) - [Man] Boy.

Good boy.

- You know, usually when I'm running, I'll put on some music, put on a podcast, and when I'm out for a ride, I'm kind of in a zone.

- Suicidal impulses or suicidal urges can be a very short duration.

The idea is that by doing these simple coping strategies, that we are actually even going to shorten that period of time that a person has the strong suicidal urges and the urge to act on suicidal thoughts.

- [Narrator] The coping strategies can stop an urge in its tracks.

- What I always say is time, the passage of time is your friend.

- [Narrator] The safety plan moves from self-help to asking for help from friends.

And finally, talking to a therapist.

Often self-help alone does the trick.

- Are you willing to do that?

Fantastic.

- [Narrator] The last step encourages patients to think about the thing they love most.

- The one thing that is most important to me and worth living for is.

- So what is that for you when you think about it?

- My kids, Jack and Sarah.

- Okay.

So why don't you write them down?

The whole idea behind it is that we want people to learn how to cope on their own as much as possible.

Of course we want them to reach out when they need to reach out.

We have people on the plan that they reach out to, but it's their own initiation for doing it.

- [Narrator] The Safety Plan is only the beginning.

For many patients the next step is to seek counseling for their suicidal thoughts.

Sadly, some people die by suicide before they can receive help or even make it to the ER.

That's because deadly means of suicide are all around us.

Firearms take an especially tragic toll.

In the US, the majority of gun deaths are not homicides.

They're suicides.

More people die by suicide from guns than all other means of suicide combined.

(clock ticking) - The thing that we understand that suicidal crisis is usually one to 10 minutes.

One to 10 minutes.

If you have a lethal means, it's more likely to result in death.

So if you have a firearm, you have a 95% chance of dying.

If you don't have a firearm and use some other means, right, you only have about five to 10% chance of dying.

So the means matter.

- If you are in a gun-owning home, that is a very important aspect of suicide prevention is to think about those firearms and making sure that they're stored safely and securely, ammunition separately.

And during periods of crisis, I would even go so far as to say, tried to have firearms outside of the home environment.

- [Narrator] During a crisis experts say, unload guns and take them to a trusted friend.

And don't stop there.

Lock up or dispose of prescription drugs and over the counter medicines.

Lock up or dispose of common household poisons.

How else can you prevent suicide?

Learn the signs, experts say, so you can recognize them in family, friends, and colleagues.

Ask the question: Are you thinking about killing yourself?

And never, ever leave someone in crisis alone.

Science has proven these steps save lives.

But what about preventing suicides in an entire community?

That would require coordination among multiple health and education services.

(light music) It may sound utopian, but there are places that show suicide prevention can work on a national level.

In response to one of Scandinavia's highest suicide rates, Denmark took steps to bring suicides down.

(alarm rings) - I get up at around nine every morning and make a pot of coffee.

From there, I start doing my research.

I'm a writer, write a lot of articles.

I'm a very curious person, and I love to, you know, embrace new knowledge.

I love to study different things and kind of be a nerd about it.

- [Narrator] Troels Torps' life wasn't always so orderly.

In his teens, he began suffering from extreme depression, and later, hallucinations.

Isolated and feeling like a burden to his family, Charles found himself in a dangerous spiral.

- I don't think that I actually wanted to die.

It was more a feeling of just kind of getting relief, kind of just make it all stop.

Just stop.

- [Narrator] Troels tried to kill himself three times.

Then, he grabbed a lifeline.

He let his father take him to a psychiatric hospital.

Copenhagen's Amger Psychiatric Center is one of 19 government run clinics devoted to people who have attempted suicide or are thinking about it.

At the clinic, therapists like Titia Lahoz explore patients' dangerous thoughts.

(Titia speaks in Danish) (patient speaks in Danish) (both speaking in Danish) Free psychiatric care in Denmark strikes a big blow against suicide.

So does reducing access to dangerous medicines.

- Medical doctors became much more aware of prescribing those and prescribing them in smaller amounts.

Making sure that people who had severe mental disorders, they didn't have large quantities of dangerous medication at home.

- [Narrator] Means restriction discourages other forms of self-harm.

Firearms are strictly controlled.

And barriers prevent people from stepping onto train in metro tracks and jumping off bridges onto tracks.

Blocking lethal means of suicide is crucial, because if suicidal people are stopped in their attempt, they often drop their plans to harm themselves.

Denmark tries to head off self-harm long before hospitalizations are necessary.

(children laughing) (light music) From a young age Danish children are encouraged to talk about their feelings, not hide them.

At many schools, they learn the good behavior game.

This classroom contest teaches self-control and emotional moderation.

While it's a simple game, it promotes lifelong mental health.

The teacher divides the class into two teams.

Whenever someone misbehaves, like talking to a friend or leaving their seat, the other team scores a point.

Children learn to recognize the desire to act up and to control it for the benefit of their team.

(teacher speaks in foreign language) - There are studies that have shown that the good behavior program is actually linked to a lower risk of suicide.

So from that sense, it's a good initiative.

(light guitar music) - Today, I live a modest life.

I would say, a simple life.

And that's how it should be for me.

(audience applauds) (Troels speaks in foreign language) - [Narrator] Troels modest life has not made him shy.

He shares his story of survival and resilience as an ambassador for a government sponsored organization called ONE OF US.

- In ONE OF US, we fight stigma by promoting inclusion and combating discrimination related to mental illness.

And we do that with big corps of ambassadors, and ambassadors in ONE OF US are all people WITH lived experience of mental illness.

- [Narrator] Stigma costs lives.

People who die by suicide usually don't seek help or even share their intentions beforehand, often due to the shame and disgrace associated with mental health conditions.

(Troels speaks in foreign language) - Troels is a really excellent ambassador in ONE OF US, because he worked through so many of his very serious mental health problems in a way that he is able to share it today and share it in a very reflected manner.

(Charles speaks in foreign language) (audience applauds) & (truck honking) (tractor rumbling) - [Narrator] In a country as vast and diverse as the USA, creating a national suicide prevention system like Denmark's would pose significant challenges.

But experts argue that we need to improve our fragmented system to make a real dent in America's suicide crisis.

More funding and better coordination, they say, could make a significant difference.

Meanwhile, in families and communities across the country, hope emerges from unexpected places.

(light hopeful music) Arlee, Montana, winter 2018.

All eyes are on the Warriors as they prepare to defend their title C division championship.

But first, the team punches a big hole in the stigma surrounding the disease that's been killing their community by making a video for social media.

- We the Arlee Warriors are dedicating this divisional tournament to all families that fallen victim to the loss of a loved one due to the pressures of life.

- We want you all to know that you'll be in our hearts and in our prayers as we step on the form to represent our school community and our reservation.

(crowd cheers) - And then after that, they ran out and played an epic game and we won and, you know, the fairy tale continued.

So we get on the bus that night and we're going home.

And my wife says, "Look, how many views this has!"

So I look at it and it's got like 100,000 views.

I'm like, whoa, this isn't even that good.

- [Narrator] That video spawn more videos.

And then a grassroots suicide prevention campaign called the Warrior Movement.

- [Together] Together we rise.

Join the Warrior Movement.

- [Narrator] Greg and his fellow athletes visit schools around the state to spread powerful messages of hope and unity in the face of suicide.

- Our message is one of courage, togetherness, and hope.

- I've been faced with depression and without the help for my two best friends, I wouldn't be standing in front of you here today.

(drum banging) - [Narrator] As for Fonda Bryant, she puts her hard won knowledge to work as a suicide reduction activist.

- If you have a friend, a family member, coworker, check on 'em.

Check on 'em.

It's the best deterrent.

How are you doing today?

More behavioral clues, giving away prized possessions.

Y'all heard what I said.

I called my aunt Spankie.

My shoes were my prized possession.

And I told her she could have 'em.

Oh my goodness, look at your shoes.

- Keep in mind that some of my shoes I cannot get to right now.

- Yeah.

I like these.

And they got a very unusual heel.

- Yeah.

I don't think I should say out loud how many pairs of shoes I actually have.

- Ultimately, I really get hope from those that are really close to death, that we can keep alive, that we can see that finding a way to connect with them keeps them alive.

And sometimes that is through therapy and sometimes it is just through a good listening ear.

Sometimes it is by checking in with them when they most need it and being there for them.

- Here we go!

Here we go!

Chris is still with us in a very big sense.

I never want my kids to forget their dad.

I am looking forward to seeing my kids grow and I don't wanna miss out in any part of their life.

Seeing my kids grow up is what gives me hope, hope of a bright future for each one of them.

- Hey, guys.

What gives me hope in the field of suicide prevention are the young people.

You know, I've got a lab of 20 to 30 students who are on fire.

They are so excited to be part of the solution, to be doing research and learning about this and going on to academic careers or going on as clinicians or working in the field.

- I am really, really proud to be a Salish woman sitting in this chair today that somehow I can help communicate to a broader world to understand how this epidemic of suicide has impacted my own family, certainly my community, my tribe overall.

And I am so indebted that people are willing to hear our story and help us get to a place of hope.

- The way that you start a contagion of hope is to start spreading stories of recovery, of spreading stories of resilience, of spreading stories of hope, because people don't think that you can recover from many different types of mental illnesses.

And you can.

(inspiring music) - [Narrator] If you are thinking about suicide or if you or someone you know is in emotional crisis, please- - Call 988.

- Call 988.

- [Narrator] Call or text 988 anytime for confidential free crisis support.

- You're gonna go that faster on this bump?

- Uh-oh!

- It's enough!

(both scream) - They not even look.