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Suicide prevention efforts shifting toward at-risk group: middle-aged men

'Men hide it; women ask for help'
Sunday, August 21, 2011 | 12:01 a.m. CDT; updated 5:09 p.m. CDT, Saturday, May 5, 2012
Scott Wilson places his bike onto a bike rack Aug. 11 to prepare for his journey to Colorado. Wilson will be biking to the top of Montezuma Peak to spread the ashes of his friend who committed suicide in 2009, at the age of 51.

COLUMBIA — For the past 15 years, Scott Wilson has gone on a mountain biking trip to the Colorado Rockies, so he knows what to take: a spare inner tube for his bike tires, a pump, a water bottle, his bike helmet, shorts and gloves.

This year, when he left Aug. 10, he had something else to carry up the slope of Mount Montezuma — valuable cargo that didn't make the journey back to Missouri: the ashes of a good friend.

Where to turn for help

At least 90 percent of people who die by suicide have a diagnosable and treatable mental illness.

If you or someone you know has thoughts of suicide, call the U.S. National Suicide Prevention Lifeline: 800-273-TALK (8255).

Missouri hotline: 800-395-2132.

The Missouri Psychiatric Center at University Hospital: 884-1300.

For more information and resources offered through MU, visit www.asklistenrefer.org/mu/urgent.

To read more about recovery from and treatment of mental illnesses, go to the National Alliance on Mental Illness’ website or go to the Columbia chapter’s website.

To read about or speak to trained volunteers about resources and referrals, call 800-950-NAMI (6264).

If you or someone you know is experiencing the following risk factors or warning signs, call one of the listed resources or 911 if the worry is immediate or the situation is a crisis.

Risk factors of suicide, according to the American Foundation for Suicide Prevention:

  • History of depression or mental illness.
  • Alcohol or drug abuse.
  • Family history of suicide or violence.
  • Physical illness.
  • Previous suicide attempts.
  • Feeling alone.

Warning signs of suicide, according to the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center:

  • Unrelenting low mood.
  • Feelings of pessimism, hopelessness, anxiety.
  • Feeling trapped or in unbearable pain.
  • Sleep problems.
  • Withdrawal.
  • Increased alcohol or drug use.
  • Recently developed impulsiveness or taking unnecessary risks.
  • Talking about suicide or expressing a strong wish to die.
  • Giving away prized possessions.
  • Sudden or impulsive purchase of a firearm or other lethal means.
  • Unexpected anger or extreme mood swings.

Warning signs for an immediate suicide crisis, according to the American Foundation for Suicide Prevention:

  • Precipitating event: one that is particularly distressing, such as death of a loved one, major career change or divorce.
  • An intensive emotion that is coupled with existing depression, such as desperation, need for “relief,” rage, inner pain, anxiety, guilt, hopelessness, sense of abandonment.
  • Changes in speech: statements that are similar to “My family would be better off without me,” or speaking in a way that suggests a goodbye.
  • Changes in action: buying a gun or other lethal means, or getting legal affairs in order.
  • Deterioration in function: either professionally or socially, substance abuse, loss of control, outbursts of rage.

To read more about suicide prevention, visit:

To read more about mental health topics, go to MentalHelp.net.


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Wilson, 48, and a group of cyclists already spread most of Mark Volek’s ashes on part of the MKT Trail in 2009. Wilson, though, has a more specific commitment to Volek to fulfill on the mountainside of Montezuma.

“We always had a spot where we would always hang out up there and catch our breath,” Wilson said. “He told me if anything ever happened to him, I should spread some of his ashes on that spot.”

Volek took his own life on April 4, 2009, at the age of 51. His story is one of many that are converted into the statistics: almost 35,000 deaths per year, nationally.

According to data from the Centers for Disease Control on the American Foundation for Suicide Prevention website, suicide rates have risen for every age group above the age of 25 over the past several years:

  • In 2007, the latest year for which national data are available, 45- to 54-year-olds had the highest rate of suicide at 17.7 per 100,000 people. It was the highest rate for that age group since 1977.
  • Suicides among the age group 55 to 64 increased the most, to 15.5 from 14.5 , the highest rate since 1990.
  • Suicide rates for 25- to 34-year-olds also rose, to 13.0 in 2007, from 12.3 in 2006.

Although those rates include both genders, men generally commit suicide four times more often than women, even though women make more attempts. Men tend to choose more lethal means to commit suicide, such as a firearm.

Still, this group, broadly referred to as "working-aged" men, has received little attention. Experts who study suicide have said that not only are men not receiving individual help, but national suicide prevention efforts are also just beginning to shift away from hot-button issues that have dominated the discussion of suicide for more than a decade, namely suicide among adolescents and the elderly.

“People often overlook the importance of suicide deaths of working-aged men,” said Sally Spencer-Thomas, founder of a suicide prevention organization, the Carson J Spencer Foundation. “But the effects of each of these deaths ripple out. They are fathers, neighbors, people in our workplaces.”

The loss of a man in middle age can affect generations on either side of his own, as usually sons, daughters and their grandparents must face a father’s death.

So, why aren’t men getting the help they deserve — the help that could save their lives?

There are countless factors — environmental, biological, chemical or genetic — that can develop over a lifetime and lead a person to suicide.

At least 90 percent of people who commit suicide have some type of underlying mental disorder — usually depression, bipolar disorder or substance abuse, all of which are treatable.

Too often with men, those factors are not addressed from the beginning. The result is a family tragedy.

Suffering in silence

“If you think it's hard for a guy to ask for directions, then consider how much harder it is to ask for help with suicidal thoughts,” Electa Draper wrote in a column in the Denver Post about suicide among men.

“It is the way that the male population is raised,” said Greg Boyt, program director for Daybreak Treatment Center, a long-term care facility in Columbia. "It’s kind of ingrained into the male species that we just generally won't seek out help.”

That, Spencer-Thomas said, is the dangerous double jeopardy for men in that age group: The men who are most at-risk for suicide are the least likely to ask for help.

Experts in the mental health field blame society’s gender roles or, more specifically, the notion of the ideal man.

He's a self-reliant, beer-drinking breadwinner. Captions for a picture of such a man could read “Rub some dirt in it” or “Real men don’t cry.”

"It’s viewed as somewhat ‘less than’ if you do ask for help," Boyt said. "You’re not a capable caregiver or provider for yourself or for your family if you are acknowledging that you can’t take care of basic needs for your own self.”

Cindi Keele, executive director for the Missouri chapter of the National Alliance on Mental Illness, said men in managerial positions are particularly reluctant to ask for help.

“They are afraid people would find out and would view them as weak or not as capable, and that could be a problem in their career,” she said.

Spencer-Thomas said the general consensus in the mental health field is, “Men hide it; women ask for help.”

Keele said, “We find that women in those age groups tend to know more about health, and tend to seek mental health help, but men tend to view mental health help as a weakness."

Jim Bogar, who leads a grief support group out of Camdenton, said his group has far more women than men. He acknowledges he has a much easier time talking with women about deeper issues.

“They’re far more open than men are to getting help with personal problems that can easily bring tears,” he said. “Men have an ego that just won’t quit.”

Two buddies

Mark Volek and Scott Wilson met in 1991 through local triathlon activities but really bonded as single fathers over their sons.

Their sons were just months apart and were raised together during the summers when each boy lived with his father.

“He was my son’s father, and I was his son’s father,” Wilson said.

The two friends worked through many construction and landscaping projects together. Wilson remembers once cutting down 25 thorny locust trees by hand with Volek, using only an old band saw.

“That’s the big hole in my life with Mark, is having a project together,” he said. “Just working in the dirt, hauling rocks. He was one of the few guys I could actually work with because he had such a strong work ethic.”

The pair began traveling together in pursuit of extreme sports. They traveled to Colorado each August.

“Colorado was our thing," Wilson said. "Whether it was mountain biking or skiing, that was our vacation.”

The year before his death, Volek sold his home in Columbia and moved to Colorado to bike and ski. Wilson remembers receiving an email from Volek that said he had seen Lance Armstrong training on Montezuma.

At the time, Wilson thought his lifestyle change meant, “This guy’s finally finding some bliss.”

Money and misery

Money doesn't guarantee happiness, but the lack of it — especially during the past three years of the recession — has had an impact on mental health, particularly among middle-aged men.

Spencer-Thomas said the typical person calling a suicide hotline used to be a teenage girl. Increasingly, it is a middle-aged man in financial distress.

“Mental health conditions are made worse by stress, and we are in a stressful economy right now,” Keele said.

Some of the highest suicide rates ever were recorded during the Great Depression, but experts don't cite a direct, causal link between the suicide rate and the economy. Specific aspects of a failing economy, such as unemployment or foreclosure, can increase a person's distress.

"The research supports the relationship with unemployment, but there's not a lot of evidence historically that recessions affect suicide rates,” said Alan Berman, executive director of the American Association of Suicidology.

Because the last national data available are from 2007, researchers cannot determine yet the effects the current recession has had on suicide rates. Mental health practitioners, however, have witnessed an impact.

“Anecdotally, it appears very clearly that the recession is a huge contributor to the suicide problem," Spencer-Thomas said. "Financial strain increases the distress for men in particular.”

The threat of unemployment can cut to the core of a middle-aged man, in his societal role of breadwinner and provider. If a man feels his value is determined by the amount of bacon he brings home, economic strain can exponentially raise his worries and deplete his sense of self-worth.

“For a lot of men, they’re going through a very stressful time, and they’re concerned about their ability to make an income and support their family,” Keele said. “Men tend to be wrapped up in their professions.”

The Family Counseling Center, Quality Improvement Director Susan Schopflin said, had a change in clientele at the beginning of the recession.

"During the beginning of the fall of the economic crisis and housing problem, there was a short period where (middle-aged men) were seeking treatment due to suicide ideation because they lost their home and were going into foreclosure,” she said.

Boyt said that at Daybreak Treatment Center, the current population is mostly men and the majority of the population has attempted suicide at one point.

The economy has been a major contributing factor to the mental health problems of most of the patients at Daybreak.

“Quite often, the economy and socioeconomics is one of the main driving factors that have contributed to the downfall of their coping skills, their substance abuse, so on and so forth,” Boyt said.

Men will often cope with stress through substance abuse, acting out sexually or with anger, Spencer-Thomas said.

The breaking point

Spencer-Thomas — considered one of the leaders in suicide prevention in the mental health field — started the Carson J Spencer Foundation in memory of her brother, who committed suicide in December 2004. He died two weeks before his 35th birthday.

Carson was an entrepreneur. He and a friend from college started a successful national insurance company based out of Denver and Seattle.

“He was very much a man’s man — tall and handsome, charismatic and funny, but yet at the same time was very deep,” Spencer-Thomas said. “He had an incredible sense of trust, and that’s why his death was so devastating.”

Carson had been diagnosed with bipolar disorder at the age of 19 but had managed his illness until a few months before his death, when he had a manic episode.

Spencer-Thomas described that time as “a really out-of-control phase for him.”  He went on a spending spree that burned through his finances quickly. His company began to fail.

One triggering event for his suicide was when his accountant finally told him he was broke.

There were physical expressions of his unrest until the day of his death. He trembled, couldn’t sleep and was always cold, often needing to wear a wool coat indoors.

“On the morning he died, he woke up calm,” Spencer-Thomas said, making a soothing, sweeping gesture. He put on a business suit and left the house, telling his father he was going out to meet with his business partner.

Living up to expectations

Even without economic strains, some middle-aged men tend to feel pressure about their careers.

Men build an identification around their careers and incomes, Spencer-Thomas said.

“ ‘Am I a provider, am I a leader?’ That can be a big issue for a man in his middle ages,” Schopflin said.

Spencer-Thomas said a career can begin to feel like a set of golden handcuffs for some men. They might not feel satisfied in their profession anymore, but they feel trapped by the money or prestige.

“Often with high-performance men, they climb and climb the ladder of success. Then they realize that they lost connections with people,” Spencer-Thomas said. “When men in leadership positions have a crisis, they have fewer people to lean on. They are particularly vulnerable to be in isolation.”

Another factor that could add tension for men in the workplace is the more firmly established role of women in the labor force.

Spencer-Thomas said the shift in gender roles can be confusing for middle-aged men. “Now, women can handle a lot on their own. Men don’t feel as needed, which is a hard place for a man to be,” Spencer-Thomas said.

Funding the prevention

Sometimes it is not so much the willingness of men to ask for help, but the availability of resources once they do.

In Missouri, Daybreak Treatment Center and Preference Family Center in Kirksville are the only long-term, in-patient mental health care facilities.

Preference is now closing because of a lack of funding.

Keele said more resources directly intended for men are necessary. “We don’t have a lot of resources specific to this age group. … The approach to suicide prevention that we’ve been using doesn’t work for everyone,” she said.

Boyt agreed but pointed out that "the issue would be the funding the effort. It comes back to the dollar sign and the economy,” he said.

The Family Counseling Center is one of the only mental health care providers in mid-Missouri that provides services on a sliding-scale basis, based on the client’s income. That is particularly helpful when someone loses a job or insurance.

One of the consequences, though, is that the waiting list has gotten longer and longer.

“We have people calling in who are very depressed and very much in need of help, who may have to wait as long as eight weeks, and that’s just unacceptable. … They can deteriorate significantly in those eight weeks,” Schopflin said.

The wait is especially risky when a middle-aged man has finally, hesitantly come forward to ask for help.

“Maybe a wife or family member has finally gotten through to him about making that call, and then he has to wait eight weeks — the whole deal may fall apart,” Schopflin said.

Spencer-Thomas likened current suicide-prevention efforts for middle-aged men to the youth-focused efforts in schools about 15 years ago.

“There are pockets, organizations that are focused on males and on men’s mental health issues … but there’s not really a national campaign,” Berman said.

In 2003, the National Institute of Mental Health created a campaign that attempted to change the stigma around men asking for mental health help.

The campaign was called Real Men Real Depression. It featured the voices of several men who had experienced depression and highlighted the courage it takes to ask for help.

But Berman said the campaign’s success was never evaluated.

Thoughts and actions

Volek was getting counseling and was on medications. He was taking all the right steps, Wilson said.

And he was able turn to Wilson and other friends for help. He told Wilson about his problems, especially in the three or so years leading up to his death, as his distress worsened.

“He’d have his good days, but he was not afraid to articulate a bad day to me,” Wilson said. “We talked about everything. He was my closest friend.”

He even talked to Wilson about his thoughts of suicide.

“The first time that came up, I said, ‘The thought of you not being around scares the hell out of me,’ ” Wilson said, shaking his head as he recalled the conversation.

Three months before his death, Volek moved back to Columbia. One afternoon, he and Wilson finished up a tiling project in Wilson’s kitchen, and Volek asked Wilson to go have a quick pint, just like any other evening. Wilson already had plans with his wife, Laura.

Before the friends parted, Wilson hugged Volek and told him he loved him.

Around 9 a.m. the next morning, Wilson learned of Volek’s death.

“It was the loss. I knew I would never see him again. It wasn’t shock, it was just a kick in the gut,” Wilson said of that moment.

Before he left for Montezuma on Aug. 10, Wilson was frank about his purpose.

“It’s not really a closure thing. He’s dead. He’s an ex-person," he said. "But I’m going to go over there, not mourning him, but celebrating his life.”

Wilson is at peace about the role he played in his friend's life. He listened and tried to be consistent with his friendship. He didn't play the role of another therapist.

“I told him: ‘You’re alive. You’re choosing life,'" he said. "'That’s the best thing.’"


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Comments

Mike Vandeman August 21, 2011 | 9:38 p.m.

Mountain biking and other extreme sports appear to be an effort to fill a void -- one that cannot be filled in that manner. One moment of thrills can also lead to a lifetime of pain and disability, if not outright DEATH. For more information about mountain biking and its impacts, see http://mjvande.nfshost.com/mtbfaq.

(Report Comment)
Daniel B August 22, 2011 | 8:46 a.m.
This comment has been removed.

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