For many, suicide is a dark, frightening subject to be avoided, but knowing what to say and how to act when faced with those who may be contemplating ending theiar lives may save their lives.

Replacing such fear with knowledge, empathy, concern, care and directness can be the difference between life and death for someone in crisis, a mental health expert contends.

“Don’t be afraid to ask the hard questions,” Duane Piccirilli, the Mahoning County Mental Health & Recovery Board’s executive director, advised.

Piccirilli was among those who spoke at a one-hour in-person and virtual forum Dec. 21 at the Mahoning County Courthouse that was aimed at addressing the local suicide rate, especially in people age 70 and older. At that time, Mahoning County’s suicide rate was 49 deaths for 2023. After the conference, however, four more confirmed suicides in the county were reported, bringing 2023’s total to 53, according to the Mental Health & Recovery Board, which gets its figures from the Mahoning County Coroner’s Office.

Of the four most recent deaths, three of them were over 70, he noted.

According to the latest figures, 87% of last year’s suicides in the county were men. Twelve of the 53 deaths were 70 and older, which represents the highest number for age groups last year, the latest figures show.

“Men are great at hiding their feelings and are taught that expressing their feelings is a weakness,” Piccirilli said.

The two most common types of lethality in 2023 were gunshot wounds to the head and hanging, which accounted for 25 and 12 of the suicides, respectively, according to the figures.

The national suicide rate last year was 14.3 deaths per 100,000 people but jumped to 21 per 100,000 among people 75 and older. For men in that age category, the figure was 43.7 deaths per 100,000, according to the Centers for Disease Control and Prevention.

Mahoning County suicides rose each year from 2020 to 2023, likely attributable in part to the COVID-19 pandemic, which caused many people to be isolated for long amounts of time, to worry more acutely about their futures and to be subjected to a barrage of war coverage and other violence on TV while feeling helpless to change anything, Piccirilli explained.

He noted that the high suicide rate among older people is because many of them feel isolated and alone after the deaths of friends, family members and other loved ones. Additional factors are various physical ailments, and some lose most or all of their independence and suffer from depression, along with a sense of hopelessness and purposelessness.

Common warning signs of suicide are making direct or indirect statements about wanting to die; strong feelings of guilt, such as the belief of being a burden to others; unbearable physical and / or emotional pain; feeling trapped, depressed and isolated; and drastically changing behavior patterns. Such patterns include researching ways to kill oneself and formulating a plan, saying goodbye to friends and loved ones, giving away cherished items or heirlooms, displaying extreme mood swings and engaging in risk-taking actions such as driving extremely fast and recklessly or using drugs and alcohol more often, according to the National Institute of Mental Health.

Another potential warning sign can be found if someone who’s dealing with a crisis suddenly and inexplicably appears happy and content. That could mean the person has finalized a detailed plan to commit suicide and is at peace with it, so it’s critical to directly ask if that person is still considering suicide, many experts say.

“You don’t leave anyone alone if they’re suicidal,” Piccirilli stressed, adding that those considering ending their lives, as well as concerned others, can call 988, the national suicide and crisis lifeline.

Another local resource is Help Network of Northeast Ohio, which also is a 988 center, and it can be reached at 330-747-2696.

HOW TO HELP

Brenda Heidinger, the Mental Health & Recovery Board’s associate director, noted that locally, across Ohio and nationally, “men have a tendency to choose more lethal means,” though women generally make more suicide attempts.

Gleaning true suicide numbers occasionally can be difficult because “sometimes they can be hidden behind an accident,” such as someone who intentionally ingests a lethal amount of medication, but the action is thought to have been accidental, she explained.

To address the suicide problem, the MCMHRB has used trauma-informed training in which law enforcement personnel, schools, agencies and organizations are taught what to look for in a potentially suicidal person — and how to react and respond.

The MCMHRB also has a close partnership with the Mahoning County Health Department and Direction Home of Eastern Ohio, a nonprofit organization that assists older adults and those with challenges in Mahoning, Trumbull, Columbiana and Ashtabula counties to maintain their happiness, health and independence at home.

“I think that all of us coming together is a safety net for everybody,” Joe Rossi, Direction Home’s chief executive officer, said.

Rossi, who also attended the Dec. 21 forum on suicide prevention, noted that his agency has a program to assist people in crisis, including those contemplating taking their lives.

“I know that social isolation has a huge effect on the mental health of a lot of people,” Rossi said, adding that 68% of the suicides last year in Mahoning County were those 50 and older.

Plans are in the works to get educational materials related to suicide into the community. In addition, Direction Home intends to conduct two educational sessions this year, possibly in May and September. The latter one will focus on helping veterans, another population for which the suicide rate is high, Rossi explained.

Also this year, efforts will be made to train professional people to ensure they’re up to date on suicide facts and how to recognize it.

“We want to make sure all players are involved with us,” Rossi continued.

QUESTION, PERSUADE, REFER

Another valuable component of suicide intervention is what’s called question, persuade and refer training. Such 60- to 90-minute sessions are geared toward helping people identify signs of suicide, learn to ask the correct questions, persuade the person to seek help and, when necessary, make appropriate referrals, Angela McClellan, executive director of the Coalition for a Drug-Free Mahoning County, noted.

QPR training assists people in understanding the signs of suicide and is vital because many are afraid to ask, don’t know how to respond or fear saying the wrong thing. Directly asking if someone is considering suicide will not give the person the idea to follow through with it; on the contrary, it will show the person in crisis that “someone cares enough to ask,” McClellan explained.

QPR’s website draws a parallel between its training and CPR, calling the latter “an emergency medical intervention” and QPR’s efforts “an emergency mental health intervention.”

Even though it may feel uncomfortable, it’s essential to make a direct inquiry about the possibility of suicide, as opposed to skating around the problem, she advised.

“Saying something like, ‘You’re not thinking of hurting yourself, are you?’ presents a stigma,” McClellan pointed out, noting that it’s more effective to ask neutrally to avoid placing the person on the defensive.

In addition, every police department in Mahoning County has an officer who has received crisis intervention training, she continued.

Piccirilli praised the partnership between his agency and others in an ongoing effort to help those who see no other way out of their pain and crises than ending their lives.

“The Mahoning County Mental Health & Recovery Board, the Mahoning County Public Health Department and Direction Home are all combining our resources, both financial and staff, to address this issue,” he said. “It’s outstanding teamwork among the Mahoning County organizations.”

Also, the MCMHRB is in a pilot program with other Ohio counties that are working with a Hudson-based foundation to get 988 and 911 services more closely aligned with each other, Piccirilli said.

In the meantime, ordinary people must know they can be equipped with the knowledge and ability to save lives, he stressed.

“Everybody can be a gatekeeper, and everybody needs to be,” Piccirilli said, adding, “One death is too many. This is unacceptable.”

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