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Health Care

Out of the Darkness

In 2020, suicide took 45,979 lives in the U.S. — one death every 11 minutes, and twice the number of homicides.

Many factors enter into someone’s decision to end their life, which can often seem like the best decision to make the pain go away; these factors include, but are not limited to, mental and physical health conditions; stress from harassment, divorce, financial crisis, or other life transitions; loss, abuse, neglect, and/or trauma; or family history of suicide.

Even though suicide rates actually dropped 5% from 2019 to 2020, the isolation during the pandemic caused more mental-health issues; in fact, one in five adults dealt with a mental-health issue in 2020. And isolation is the number-one symptom of suicidal ideation, according to behavioral-health professionals who spoke with BusinessWest.

“The isolation may have been comforting to people. They don’t have to leave the house. Then that may have been comforting, not having to face different outside factors,” explained Elizabeth Therian, program director for Behavioral Health Network (BHN). “But on the flip side, the pandemic also increased a lot of the risk factors, such as domestic-violence situations, and increased anxiety for a lot of people, like this big fear of the unknown virus that there wasn’t much known about.”

Cristina Rivera, director of Outpatient Services at MiraVista Behavioral Health Center, agreed and added that increased substance use was another factor during the pandemic because of the lack of support for many people. Other common symptoms include, but are not limited to:

• Talking about wanting to die, great guilt or shame, or being a burden to others;

• Feeling empty, hopeless, trapped, extremely sad or anxious, or unbearable emotional or physical pain;

• Changed behavior, such as making a plan or researching ways to die, taking dangerous risks (including driving fast or recklessly), displaying extreme mood swings, or eating or sleeping more or less; and

• Saying goodbye or giving away important things.

One symptom that can be overlooked is anger and agitation, a state often not associated with depression.

“Most people don’t really express depression or being sad in a typical way, like isolating or not talking to anybody or withdrawing themselves,” said René Piñero, vice president of Behavioral Health and Clinical Operations at the Mental Health Assoc. (MHA). “But a lot of times, if you see somebody who is more irritated or gets angry more easily than usual, then those are typically signs that somebody might be going through something and they just haven’t talked about it with somebody.”

Mental health and suicidal ideation often causes a person to feel some sort of guilt or shame, and they repress the feelings, causing them to isolate from friends and family even more.

The stigma is especially high among men and the elderly. Males make up 49% of the population, but nearly 80% of suicides, and people over age 85 have the highest rates of suicide among all age categories (20.86 per 100,000 individuals).

Mental health for older generations has been seen as taboo and a topic that shouldn’t be discussed; it is often looked down upon negatively. And displaying emotions of sadness or asking for help is often seen as a weakness amongst men.

But in order to combat the mental-health epidemic that was worsened by the pandemic, a more positive light needs to be shined on the importance of getting help and treatment when necessary. And that starts with a conversation.


It’s OK to Ask for Help

The first step to destigmatizing suicide and suicidal ideation is to talk about it.

“Often you’ll hear people say, ‘I have asthma,’ or ‘I have diabetes.’ And it’s not anything that people would think twice about sharing,” Rivera said. “But someone struggling with severe depression or anxiety or maybe bipolar schizophrenia, those are things that are a little bit more difficult to speak about. The more people normalize and talk about their diagnosis, the more welcoming as a community we will become.”

“A lot of times, if you see somebody who is more irritated or gets angry more easily than usual, then those are typically signs that somebody might be going through something and they just haven’t talked about it with somebody.”

René Piñero

René Piñero

One positive from the pandemic was the rise of telehealth communication, allowing people to talk to a licensed therapist or behavioral-health specialist over video-chat platforms. It allowed them to connect from the comfort of their homes, making it easier to talk about what they’re going through.

Another option is the Behavioral Health Help Line created this year through the state Department of Mental Health and operated by the Massachusetts Behavioral Health Partnership. Meanwhile, Community Behavioral Health Centers offer immediate care for mental-health and substance-use needs, both in crisis situations and more routine settings. Crisis services are available around the clock for anyone in Massachusetts experiencing a potential mental-health emergency and are entirely insurance-blind, meaning anyone can access services, regardless of insurance coverage.

If therapy, medications, and traditional services aren’t working, people have the chance to participate in outpatient and inpatient treatment programs.

Outpatient programs are structured, non-residential, psychological day programs that address mental-health disorders and substance-use disorders that do not require detoxification through a combination of group-based psychotherapy, individual psychotherapy, family counseling, educational groups, and strategies for encouraging motivation and engagement in treatment.

MHA, BHN, and MiraVista all offer outpatient treatment programs; BHN and MiraVista specialize in adolescent mental-health programs as well.

“It is very important from a young age to speak about feelings and how we cope with them. Giving people different tools to be able to cope with those feelings is important,” Rivera explained. “There is such a need in this area, and that’s one of the reasons why we wanted to open that unit.”

Inpatient treatment programs are the most intensive level of treatment for individuals suffering from mental health and addictive disorders. It offers 24-hour care in a safe and secure facility, making it best for patients with severe mental-health or substance-abuse issues who require constant monitoring. The highly structured inpatient environment emphasizes understanding the signs of psychiatric illness, rapid stabilization, developing strategies to avoid rehospitalization, and discharge planning. Patients in inpatient care programs can work on rebuilding life skills without exposure to negative influences that fuel the urge to continue destructive behaviors.

MiraVista offers inpatient treatment to youth (ages 13-18) and adults who need the extra care. Dr. Negar Beheshti, chief medical officer for MiraVista and TaraVista behavioral health centers, told BusinessWest that patients stay five to seven days, on average, at its inpatient facilities in Holyoke and Devens.

“Usually, when people get to a point where they need inpatient psychiatric care, they are at a point where they are not going to be safe in the community, meaning that they have extensive or significant unsafe thoughts of self-harm or harm to others, or they’re so compromised by their psychiatric symptoms that they’re really unable to function out in the community, and do need that level of care in an inpatient unit,” she added.

Behavioral-health practitioners and nurses are able to provide education around diagnosis, symptoms, coping strategies, and medication while a patient is under MiraVista’s care. Patients are also given one-on-one check-ins with therapists and psychiatrists to discuss their feelings, medications, and concerns.

Beheshti said this setting is also an opportunity for patients to share their experiences with others in the program, and they can learn from one another about different strategies that may or may not work.


Reap What You Sow

Gould Farm in Monterey, in the Southern Berkshires, is a twist on inpatient treatment programs, but on a more long-term scale.

Founded in 1913, Gould Farm became the first residential therapeutic community in the nation dedicated to helping adults with mental health and related challenges move toward recovery and independence through community living, meaningful work, and clinical care.

In a community of about 90 people, ‘guests,’ as residents are called, stay from nine to 12 months to help them get re-accustomed to life.

“People, prior to coming here, kind of lose relationships with themselves and others. And this is a way to step back into that and return to relationships with other people and with themselves,” explained Tamara McKernan, Admissions director and clinician on the farm. “There’s a level of trust here, where people stepping out of the hospital have kind of had everything taken away, and need to step back into feeling trusted and able to do things.”

During their stay, guests have a structured schedule; they do many of the same things they would in any inpatient program, like check-ins with therapists and clinicians, group work, and activities that ground them, but they also have jobs on the farm: working in the dairy barn or making cheese; tending the gardens, forestry, and grounds; working in the kitchen; and more.

Gould Farm reflects a more holistic approach to mental-health issues, in which people develop purpose and learn transferable skills to become more independent.

McKernan told BusinessWest that guests are often referred to Gould Farm if outpatient and/or inpatient treatments, therapy, and medications aren’t working anymore. The sense of community and responsibility helps guests take the next step of gaining control of their life.

In order to destigmatize mental health on the farm, everyone works closely together — even the faculty and staff helping to run the farm. Their families grow up around the guests to make the experience seem more normal.


Words Matter

When it comes to mental illnesses or suicidal ideation, part of breaking the stigma is being aware of the words we use.

“Oftentimes, we’ll hear people say, ‘I’m bipolar.’ But it’s not who you are,” Therian said, noting that ‘I am a person that has bipolar disorder’ is more accurate. “It’s similar to the way we wouldn’t say, ‘I’m high blood pressure.’ It flips that a little bit when you look at it that way.”

Piñero agreed, adding that the work “crazy” is often used when talking about mental-health services, especially inpatient and outpatient treatments.

“It’s about letting people know that there’s no such thing. It’s just people dealing with stressors or dealing with medical conditions that are based on mental health or behavioral health. And that what we’re here to do, to provide assistance, provide help,” he said. “All of us, at some point or another, could be dealing with some type of issue, and all of us could benefit from these types of services. So it’s just making it something that’s more normal and general to everybody.”

One of the best ways to help a loved one in crisis is asking them if they’re all right. The professionals who spoke with BusinessWest expressed that people may feel they will offend someone, or they’re scared of the answer, or feel like it might give someone the idea of suicide, but it just opens the conversation for that person to be vulnerable and honest. If a friend or loved one shows a worrisome change in behavior, one shouldn’t hesitate to ask and get help for that person if they’re willing to accept it.

McKernan added that helping someone look for moments of joy and using grounding techniques can also help them through the moment.

Mental-health healing is not linear, he and others stressed, and some days will be more difficult than others. Being educated on the warning signs and symptoms of suicide and suicidal ideation can help save the life of a loved one.

At the same time, no one who has lost someone to suicide should feel it’s their fault — even though avoiding guilt is easier said than done.

The bottom line is, untreated mental illness can lead to suicide, and speaking up is the first step to getting help. “The brain is like any other organ,” Beheshti said, “and we really need to honor it and respect it like any other organ.”

If you or someone you know is having suicidal thoughts or ideations, call or text 988 or visit 988lifeline.org for more information.



By Kimberley Lee


The death of Peter Robbins resonated with me. He was tapped to be the first voice of Charlie Brown as a child actor in the early 1960s when Charles Schultz began to adapt his popular “Peanuts” cartoon strip for TV and movies.

I grew up with these shows, and so did my children, but it was not just nostalgia that made me take notice of Robbins’s death. His family announced on Jan. 25 that the 65-year-old Robbins had died the week before by suicide. He had long struggled with both mental-health and substance-use disorders.

MHA, the Mental Health Assoc., is the organization I work for, whose behavioral-health outreach clinic and residential programs have long offered support and treatment to individuals with such dual diagnoses. It was especially disheartening to read how the life of Robbins, associated through the 1970s with a character that brought much entertainment to the screen, ended.

The cartoon strip itself was sometimes subtitled “Good ol’ Charlie Brown,” and the world Schultz created was a self-contained one about childhood. Its ups, downs, and misplaced crushes were depicted by characters who were very animated, even in print. No adults are featured, but the characters struggle with plenty of personal issues that often follow into adulthood. Some, like Lucy, can be bossy; some are a bit vain, like curly-haired Freida; and some are self-absorbed, like Schroeder on his piano. Everyone is just trying to fit in or fit into who they are, including Snoopy, Charlie Brown’s beagle, who often retreats into his own world on top of his doghouse or into his imagination, where he fights the Red Baron as the Flying Ace. There is also Pig-Pen, who tells Sally, Charlie Brown’s younger sister, he doesn’t appreciate that name he has been tagged with because of his appearance, but neither does he like the rain to wash away that appearance from a day of playing in the dirt.

They are a complicated bunch, defying stereotypes in their own ways of being and thinking and friendships across neighborhoods and interests.

Schultz, who died in 2000, wondered if his characters would resonate through time, and they do, as Charlie Brown embodies a little bit of all of us emotionally as he navigates this world of personalities. And, of course, should he need advice, there is Lucy, who sets up a Psychiatric Help booth, where she gives her version of professional help for five cents. It is a world in which the timeless troubles and alienations of childhood are on display, but also one in which the characters cope and carry on with their pursuits and come together.

I grew up with all the animated specials, including A Charlie Brown Christmas, It’s the Great Pumpkin, Charlie Brown, and A Charlie Brown Thanksgiving, and, again, so did my children. Each time these classic movies aired, those 30 minutes provided an opportunity for us to be together as a family, to make a connection, to embrace each other emotionally.

In our house, emotional connectedness happens in other ways as well. For example, once a week, my husband and I pull our girls together (now that they are in college, this is done remotely), we all unplug, and we just simply and sincerely ask them, “how are you?” And not just physically, but emotionally. Their answers have been honest and transparent and emotional at times.

It gave them, at an early age, a green light to talk openly about how they feel from a mental-health perspective, and there was no stigma, no shame, no hesitancy in doing this.

We all know that challenges to mental health start young, and the sooner we address them, the better the outcome.


Kimberley Lee is vice president of Resource Development & Branding for the Mental Health Assoc.


Health Care

A Different Kind of Health Crisis

Dr. Gaurav Chawla

Dr. Gaurav Chawla describes suicide as “a very unfortunate, tragic outcome of a complex set of circumstances.”

It’s a common, but certainly not universal, refrain when an individual takes his or her own life.

Friends and relatives will say they didn’t see any signs that this was coming, said Kate Hildreth-Fortin, program director, Emergency Service & Mobile Crisis Intervention with Behavioral Health Network (BHN). Or they’ll say that they could not see any apparent reason for this outcome, that the individual in question seemed outwardly happy and was enjoying life.

That’s what people said about celebrity chef Anthony Bourdain, designer Kate Spade, comedian Robin Williams, and countless others, famous and not at all famous.

“But almost always, there are warning signs, and there are reasons,” said Hildreth-Fortin, one of many who spoke with BusinessWest about a subject that is timely, immensely complicated, and a true healthcare crisis probably on the same level as the one involving opioid addiction.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide, and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Timely not just because of those celebrity suicides several months ago — although they always help bring attention to the problem — and not just because of a recent report from the Centers for Disease Control and Prevention on the growing problem.

It’s timely because the numbers continue to rise, as does the overall toll from suicide, which goes well beyond the individuals who take their own life, said Dr. Gaurav Chawla, chief medical officer at Providence Behavioral Health Hospital, part of Trinity Health Of New England, who estimated that six lives are directly impacted by each suicide.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide,” he went on, “and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Getting back to the numbers, they are eye-opening and quite alarming:

• The most recent surveys show there are 45,000 completed suicides in the U.S. every year;

• That number has steadily risen since the start of this millennium, with suicides up a total of 28% since 2000;

• Massachusetts has the third-lowest suicide rate in the nation, but the rate of suicides in the Bay State has increased 35% since 1999, well above the national average;

• Women attempt suicide at a higher rate than men, but men complete suicide at a higher rate than women;

• Firearms are used in more than 50% of suicide attempts;

• Middle-aged white men (those in their 40s to mid-50s) have the highest suicide rate, particularly when they are single, but there is another peak involving individuals over 84; and

• Among individuals ages 14-34, suicide is the second-leading cause of death after accidents.

Perhaps as disturbing and frustrating as the numbers themselves are the forces behind them. They are numerous, often difficult to see, and very difficult to combat.

But there are common denominators of a sort. For starters, suicide usually results from a combination of factors, not one in particular, said Chawla, who summed things up succinctly, noting that “there is never one reason for someone to take their life; suicide is a very unfortunate, tragic outcome of a complex set of circumstances.

Kate Hildreth-Fortin

In almost all cases, Kate Hildreth-Fortin says, there are warning signs with someone contemplating suicide.

“You will often see the assumption that undiagnosed mental illness or inadequately recognized or treated mental illness is the cause,” he went on. “However, that is a myth; 50% of the suicides do not have a diagnosed mental illness behind them.”

As for what is behind them, that list is obviously quite long, said Hildreth-Fortin, and could include biological and genetic factors, increasing stresses of life, relationship crises, financial and occupational stressors, poor coping styles, increased substance use, and many others.

Another common denominator is that those contemplating suicide generally feel trapped in a life that does not bring them happiness or make them fulfilled, said those we spoke with, adding that this descriptive phrase can be applied to people at every age, every income bracket, and every walk of life.

Slicing through it all, such individuals need a way out of that trap and can’t find one or are unwilling to try, said Chawla.

“Suicide is a confluence of circumstances that lead one to conclude that they’re trapped in a hopeless circumstance, sometimes without purpose, in a painful existence from which there is no other way out,” he told BusinessWest.

Meanwhile, providing a way out, especially to those suffering from behavioral-health issues (and that’s a large percentage of those who contemplate or complete suicide) is made more difficult by the persistent stigma attached to seeking help for such conditions, and then finding help in a system plagued by a shortage of resources.

These are the reasons why this is a healthcare crisis, even if the same politicians who are quick to give such a label to the opioid epidemic are mysteriously reluctant to do the same with suicide.

For this issue, BusinessWest takes a long, hard look at suicide, going beyond the numbers in a quest to explain why they continue to rise, and also looking at how area professionals are helping those who are in that aforementioned ‘trap’ and need a way out.

A Failure of the System

Hildreth-Fortin, like the others we spoke with, said that, while it is somewhat regrettable that it often takes celebrity suicides like Bourdain’s and Spade’s to bring heavy media attention to the problem of suicide, she’s happy for the attention and a chance to bring the conversations to the forefront, instead of the background, where they have been for too long.

That’s because a brighter light needs to be shone on this crisis to bring about any kind of change in the current trends. With that attention, she said, there is hope that the stigma attached to mental-health issues and seeking help for them might be diminished; hope that more resources might be brought to bear to address the crisis, as has happened with opioid addiction; hope that friends and loved ones might become aware of the warning signs — what to do when they see and hear them; and hope that those feeling trapped might be more persistent in finding a way out.

That’s a lot of hoping, but in this battle, those fighting it will take whatever help they can get, especially with regard to that stigma concerning mental health.

“Suicide is a word we use every day; it’s something we deal with every day,” said Hildreth-Fortin, whose program handles roughly 1,300 assessments a month, and 70% of these individuals, in her estimation, have suicidal thoughts. “There’s a lot we can do with prevention; we need to reduce the stigma, improve education, and treat suicide the same way we would diabetes — ‘what can we do to help someone?’”

Chawla agreed, and said the stigma attached to both suicide and mental illness and seeking help for it often contributes to a lack of understanding concerning why someone commits suicide.

That is certainly the case with celebrities such as Bourdain, Williams, and others, he went on, adding that, to most of the rest of the world, these people seem happy and content with their lives.

But it’s not the world’s perception of these individuals that matters; it’s how they view themselves, and this is true of people across all income levels and social strata.

“It’s about perceptions of who you are, how you fit in your world, and how meaningful you find your existence,” he said. “That’s what ultimately leads to or doesn’t lead to such acts.”

But while suicide is seemingly an individual act, it isn’t, and each act represents more than one person choosing that tragic outcome.

“Suicide is taken as one event by one individual, and that’s not what it is,” said Chawla. “It is the final outcome of the failure of the system. Along the way, there are many lives affected, there’s a lot of loss of function, and there is opportunity that’s missed.”

Hildreth-Fortin and others at BHN agreed, and said one huge key to perhaps reducing the number of suicides is to seize opportunities rather than miss them.

And there is quite a bit that goes into this equation, she noted, listing everything from proper training of police officers, teachers, and others to being aware of the many warning signs; from knowing what questions to ask those at risk (and asking them) to knowing how to respond to the answers to those questions.

And this means not overreacting or underreacting, and, above all, connecting people at risk with services that provide help, said Hildreth-Fortin, who, like Matthew Leone, assistant program director of the crisis unit at BHN, is trained in something called QPR, which stands for question, persuade, refer — the three basic steps in suicide prevention.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help,” Leone explained, adding that, in his role, he does a lot of training in the community on how to recognize suicide.

Which brings him to those warning signs. There are many to watch for, some subtle, some most definitely not, he said.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help”

They could and often do include people saying ‘goodbye’ or ‘nice to know you’ on Facebook and other platforms, individuals giving away possessions, young people suddenly drawing up a will, people losing interest in things they enjoy doing, a decrease in performance at school, and many others.

“A more overt sign might be when they start stockpiling medication or another means of following through on their plan,” Leone went on, adding that, in addition to these warning signs, which are clearly red flags, there are also risk factors.

And there are many of those, he said, starting with being a middle-age male. Others include financial distress, depression, divorce, loss of a job, being given a terminal diagnosis, and, of course, a combination of some of these.

Questions and Answers

The next part of the equation is knowing what to do when warning signs are recognized, or with someone who outwardly seems at risk, said Hildreth-Fortin.

She acknowledged that having a conversation with such an individual and asking the questions that need to be asked is awkward and often very difficult (some fear that just asking the questions can help promote a suicidal act) but it needs to be done.

“A big piece of QPR training is teaching people how to ask the question, to get someone comfortable with asking someone if they’re suicidal,” she said, adding that this training is often given to first responders and educators, but parents, spouses, friends, and employers also fall into the category of individuals who need to ask questions and need to know how to ask and also how to respond.

Questions should focus on what thoughts people are having, how often they’re having them, and whether they’ve acted on these thoughts in any way before, said Hallie-Beth Hollister, assistant program director, Community Relations for BHN, adding that the answers will generally reveal just how at-risk someone might be.

Jenni Pothier

Jenni Pothier says those working with those contemplating suicide need to create a comfortable, non-judgmental, open space for dialogue to occur.

One key, she went on, is not asking leading questions that would enable the individual to give the answers the questioner might be looking for.

“Don’t say, ‘you’re not thinking of killing yourself, right?’” she said by way of example.

But, as noted, recognizing warning signs and asking the right questions are only parts of the equation. Responding to the signs and the questions to the answers is another big part, said Leone, adding that that many people balk at asking questions, or especially difficult and specific questions, because of anxiety about the answer.

“‘What do I do if the answer is yes?’” is a question that unnerves many, he went on, adding that there’s a reason for this; the response can be complex.

“We talk with people all day who mention that they’ve having suicidal thoughts,” he explained. “Some have the intent to follow through, others do not; some have vague suicidal ideation where there’s no real plan to it.”

Which is why overreaction is possible and should be avoided.

“Many times, with suicide, when someone says they’re having those thoughts, instead of starting a conversation, it ends the conversation,” he explained. “People will jump in and say, ‘we need to get them to the hospital, we need to get them help now,’ when the person is just reaching out to talk about it for help.

“And this overreaction can have a negative effect to it because then the next time the person is experiencing those thoughts, they may not say anything,” he went on, adding that the key is generating the proper response given the individual’s risk factors, warning signs, the strength of the connections in his or her life, and other factors.

Jenni Pothier, director of the Tenancy Preservation program for Springfield-based Mental Health Associates, agreed. In the course of her work, which involves helping individuals who are at risk of homelessness — a stressful situation to say the least — the subject of suicide often comes up.

“Because we know that suicide includes risk factors like poverty, experiencing potential homelessness, and a lack of access to resources, people are in crisis,” she explained. “So we’re assessing people regularly for suicide.”

And those assessments involve asking those questions mentioned above, asking them in an effective way, and responding in the appropriate manner.

“As practitioners and clinicians in the community, you need to create comfortable, non-judgmental, and open spaces for dialogue to occur,” she explained, “so people can express to you how they’re feeling without the fear of the stigma or that you’re going to instantly call 911 to get them hospitalized if they say they’re contemplating suicide or having suicidal ideations.”

Bottom Line

As she talked with BusinessWest about suicide and, more specifically, the problems many have with asking the questions that must of asked of someone at risk, Hildreth-Fortin related the story about an educator who, during a QPR training session, admitted not only that she would have difficulty asking such questions, but also that she would be upset if someone put those questions to her child.

“I had a real hard time responding to her, because it spoke so greatly to the stigma attached to this,” she said. “If your child had a stomach ache, you wouldn’t have a problem with him going to the nurse. You talk about what hurts, what kind of pain it is … we have to treat suicide the same way we would any medical symptom. We have to talk about it.”

It will take a confluence of factors and a great deal of resources to reverse the current trends on suicide, but getting people to talk about it and respond to the talk is the big first step, said Chawla, adding that only by doing so can those missed opportunities he mentioned become real opportunities to do something about a true healthcare crisis.

George O’Brien can be reached at [email protected]

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