Suicide uptick raises concern

LIHU‘E —Four suicides on Kaua‘i in less than a week have prompted concern by police and health workers that the COVID-19 crisis is moving in a dangerous new direction, with broad risks to mental health caused by joblessness, financial reversals and despair.

Existence of the sudden rash of suicides was confirmed Monday by the Kaua‘i Police Department Chief Todd Raybuck.

The four suicides involve young men in their 20s or 30s, and the deaths, in all cases, were by hanging, Raybuck said. While KPD — consistent with longstanding policy — did not release names of the victims, Raybuck said three of the suicides occurred in Kapa‘a and one on the Westside. The first incident occurred May 2 and the most recent was last Friday, Raybuck said.

The four deaths in such close time proximity bring to five the number of suicides on Kaua‘i this year. “The families are all, obviously, grieving,” Raybuck said.

While he said police investigations of the four incidents are in the very early stages, media inquiries suggest a possible link to the COVID-19 pandemic, and that the crisis may be the “straw that broke the camel’s back” for the four deceased young men.

“One of the things we have seen is there is a nexus between (many suicides) and drug use,” he said. “When you take substance abuse or drug addiction, which tend to create relationship issues, and financial problems, you come into the situation where we are today with COVID.”

Many experts agree that acknowledging suicide as a public health issue — especially in today’s pandemic environment — is key to addressing it, and that ignoring the problem for fear of spawning imitator incidents fails as a prevention strategy.

Nationally, experts at the Washington-based American Academy of Suicidology said the apparent suicide cluster on Kaua‘i may be among the first incidents in the country to demonstrate that a national mental-health crisis may be evolving rapidly.

“This is probably going to be the second wave of the COVID pandemic that we’ll see,” said Chris Maxwell, the organization’s spokesperson.

The social limitations imposed by the COVID crisis, including the need to maintain physical separation between people and the fact that many medical facilities have become harder to access, make suicide prevention even more difficult than it is in normal times, Maxwell said.

“For many people experiencing a suicide crisis, the first instinct may be to go to the hospital emergency department,” he said. “That is likely not the best scenario in the middle of a pandemic.

“The other aspect is working within the community to provide support for each other, which is very difficult to do in the current climate. We need to work to encourage people to check in, whether it’s phone, or text, or Zoom or Facebook.”

Dr. Annie Chung, a Lihu‘e psychologist, had a somewhat different view of the link between the COVID-19 situation and the recent suicides on Kaua‘i.

“COVID-19 is not the cause of these recent suicides but, clearly, it’s exacerbating some of the problems and challenges this community has,” she said.

“My experience in working in this community is that, especially for young men, part of it is cultural and not accessing support, and feeling like it’s not OK to do so. It’s young men feeling untethered to families or community and they resort often to alcohol and drugs, and they have really compromised coping skills. It’s extremely tragic.”

Maxwell and Dr. Eric Fleegler, a Harvard Medical School expert in suicide and firearms use, agreed that the current situation makes it even more important to try to separate the means of committing suicide from its potential victims. Fleegler is one of the authors of a new study published in the Annals of Internal Medicine that speculates that the COVID-19 crisis may spawn an “epidemic” of firearm suicide.

Classic approaches, he said, include removing firearms and drugs from the home. Locking up drugs and separating firearms from ammunition are valid strategies, said Raybuck and suicide experts, but complete removal from the household is a better approach.

“Everyone is a potential victim of depression here,” Fleegler said. “We need to make sure that people know this is a real thing and that people are going to be depressed, sad and overwhelmed. We are in desperate times. We need to be encouraging people to talk to each other. It’s very easy to just become more and more isolated if you’re not hearing from people. We need to reach out.”

Raybuck said that, while none of the four most recent suicides have involved guns, a fifth case — early in the year — did, and that gunshot suicides have long been common on Kaua‘i, just as they are in the rest of the country.

Internationally prominent researchers said Kaua‘i’s limitations in gauging suicide trends because of the island’s size are common in places with small populations.

Dr. Wolfram Kawohl, at the University of Zurich, whose team has been scrutinizing suicide in places like Kaua‘i since 2015, said that, in smaller locales, limited numbers require that local officials get as much information as possible on individual victims, especially on the frequency of suicidal thoughts before they killed themselves and the potential connections in each case to individual job loss.

Nevertheless, said Kawohl, “the medical community should prepare for this challenge now” in terms of documenting the connection between COVID-19 and suicides on Kaua‘i.

“Mental-health providers should also raise awareness in politics and society that rising unemployment is associated with an increased number of suicides.”

He said some research indicates that there may be as many as 20 unsuccessful attempts for every person who actually succeeds in committing suicide.

Historically, Kaua‘i averages about a dozen suicides a year. There were 25 in 2017 — a number so high for the island environment that it prompted speculation about a suicide epidemic here. The total dropped to 12 in 2018 and 15 in 2019, according to KPD figures. The 2017 spike has never been explained.

The recent spate of suicides also appears consistent with findings of a survey released in late April by the state Department of Health. It was based on in-person interviews with about 190 Kaua‘i households conducted by a team of volunteers on April 22 and 23. The data showed that:

• More than a third of Kaua‘i households reported they were very or somewhat concerned about being able to make the next month’s mortgage or rent payments, and 29% were concerned about paying for basic utilities;

• Nearly 57% of the households included at least one member who had lost his or her job or income as a result of the COVID-19 pandemic;

• Nearly 40% of households were experiencing high or moderate amounts of stress, and nearly 60% worried about contracting the coronavirus.

Marie Terry-Bevins, a North Shore psychologist and former president of the Hawai‘i Psychological Association, said that the emergence of tele-medicine as the COVID crisis has unfolded may offer some hope for access to mental-health care. Like physicians in general, many mental-health workers have quickly shifted to working with patients by phone, Facetime, Zoom, Skype, and other virtual substitutes for personal contact.

“If your truck is broken, you go to a mechanic. If your leg is broken, you go to the doctor,” she said. “If you have emotional issues, you need to see someone who can help you. It’s important that people realize you can get help. You are needed. You are special,” Terry-Bevins said.

Warning signs of acute suicide risk

There are several warning signs of acute suicide risk:

• Threatening to hurt or kill him or herself, or talking of wanting to hurt or kill him/herself;

• Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means;

• Talking or writing about death, dying or suicide, when these actions are out of the ordinary.

The are also expanded warning signs of suicide risk:

• Increased substance (alcohol or drug) use;

• No reason for living, no sense of purpose in life;

• Anxiety, agitation, unable to sleep or sleeping all of the time;

• Feeling trapped, like there’s no way out;

• Hopelessness;

• Withdrawal from friends, family and society;

• Rage, uncontrolled anger, seeking revenge;

• Acting reckless or engaging in risky activities, seemingly without thinking;

• Dramatic mood changes.

If observed, seek help as soon as possible by contacting a mental-health professional or call a local or national suicide-response hotline.

Source: American Association of Suicidology, suicidology.org/resources/warning-signs

Suicide crisis response resources

Here are some suicide crisis response resources

• National Suicide Prevention Lifeline: 800-273-8255;

• Hawaii Suicide & Crisis Hotline: 800-753-6879;

• If you believe a situation is at the stage of critical emergency: dial 911 or call the Kaua‘i Police Department dispatch line, 241-1711;

• Hawai‘i Crisis Text Line: Text “aloha” to 741741;

• American Association of Suicidology: suicidology.org;

• Life’s Choices Kaua‘i, Office of the Mayor: kauai.gov/Government/Office-of-the-Mayor/Lifes-Choices-Kauai/Programs;

• State Department of Health suicide resource website: health.hawaii.gov/injuryprevention/home/suicide-prevention/information/;

• Life’s Bridges Kaua‘i: facebook.com/lifesbridgeshawaii/ 651-6637

• For LBGTQ youth, The Trevor Project: thetrevorproject.org or 1-866-488-7386;

• Alliance of Hope (national program to reach family, friends and community survivors of suicide). Moderated, interactive website: allianceofhope.org (The organization is headquartered in Illinois, but its website is administered from Kaua‘i.)

• American Foundation for Suicide Prevention, afsp.org/chapter/afsp-hawaii/

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The Garden Island