It was early November 2014 when Fletcher had what she thought was a brilliant idea.

A professional woman in her early forties, Fletcher, (not her real name), appears to have every little thing buttoned up and in control, casually sitting in her spotless, uber chic condo in downtown Spokane.

In 2010, Fletcher, a single mother in her late 30s, had just finished graduate school at Gonzaga University. She started her own business practice in Spokane even though the Great Recession was in full force at the time, and there weren’t a lot of jobs in the city.

Still, she persevered, borrowed money for an office and staff; she was determined to get the business up and running.

However, after several years of making financial decisions based on faith that the business would thrive, she found herself hopelessly in debt.

“I was several years into the business and had gotten myself so far in over my head financially, it was absolutely hopeless,” Fletcher says.

Her solution?

What Fletcher calls her brilliant solution to her problems was suicide.

A taboo subject

Although the subject of suicide is deeply taboo in our culture, several high-profile suicides over the past year have forced the subject into mainstream discourse.

In 2015, there were 98 deaths in Spokane County attributed to suicide, according to the Spokane County Office of the Medical Examiner’s annual report, and those numbers have been climbing, for the most part, over the past 10 years.

From 2010 to 2014, 5,094 people in Washington lost their lives to suicide. Those who died ranged from age 10 to more than 85 years old.

Suicide prevention experts say there’s no single cause for suicide. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Mental illness such as depression, anxiety, and substance abuse problems, especially when unaddressed, increase the risk for suicide.

Sigrid Reinert, spokeswoman for the Washington State Department of Health in Seattle, says it’s a very serious public health problem in Washington State.

According to a report compiled by DOH called the Washington State Suicide Prevention Plan, the state’s suicide rate is “almost 15 per 100,000, 11 percent higher than the national rate. On average, three people die by suicide every day.”

Suicide rates in western states are consistently higher than the national rate, experts say. And while the reasons are not completely clear, they may include lack of access to healthcare, residential instability, unemployment, limited economic resources, higher suicide rates in rural areas, social isolation, mental illness, substance abuse and access to firearms.

The idea of suicide wasn’t new to Fletcher. She says she has experienced depression most of her life.

“I am one of those people who struggles with recurring depression and thoughts of suicide; I was probably five years old when I had the first fantasies about ending my life.

“There was no childhood abuse—just great loneliness after my parents divorced,” she says.

“My mom moved us to Minnesota because she got a job with the Mayo Clinic, but there was no other family there. I don’t know if it’s a gene or wiring. But I had a propensity for depression. I know that for a fact,” she says.

Fletcher, like many others, didn’t seek help from mental health providers.

“I felt like I had ruined all of my family’s futures. I thought, I can make this right; I can pay my mom back and leave a future for my husband and daughter. So I decided I didn’t know how or when but I knew the steps I needed to take if I was going to end my life,” she says.

The steps she took included taking out a $1 million life insurance policy, mortgage insurance on her house, as she pragmatically went about settling her affairs.

Ultimately she changed her mind about ending her life after three unsuccessful suicide attempts, but she continues to periodically experience depression, she says.

The voices of suicide attempt survivors and those who have lost loved ones to suicide, help explain how a person in crisis can turn toward suicide. “Many people feel negative or uncomfortable about suicide and those who have personal experience with it, because of the stigma around the issue,” Reinert says.

The DOH is implementing Suicide Prevention Plan workgroups throughout the state, including in Spokane, which was mandated by state legislation.

“The fact is that suicides are preventable,” says Sabrina Votava, a trainer for the Spokane-based QPR (Question, Persuade and Refer) Institute. With more than 10 years in the field, Votava teaches service providers to help someone in crisis, how to recognize signs of suicidal thoughts, and how to intervene and get that person help. Votava herself lost two of her brothers, Zach and Kacey, to suicide in 2003, six months apart.

“It’s critically important to ask the question—are you thinking about suicide, or ending your life,” Votava says. “It’s something that has a lot of negative connotation, but people are not likely to be honest if they don’t know how you’ll react . . . unless you open that door first. It’s best if you do open that door for them, no matter what the age.”

The next step in the protocol is persuading someone to keep safe by listening to how they got to the place they are, she says.

“Ask how they’re feeling and allow them to speak freely, which allows them to see how they got to this point. While you’re listening you may hear something that sounds like they’re uncertain, or there’s something that’s not finished, or not settled, or something that they really care about,” she says.

It could be something small even, that will help them have a tiny bit of hope, she adds.

Next is a referral to a mental health provider who can do a risk assessment.

“Ideally you want to go with them physically but if you can’t, do everything you can to make the arrangements and get a commitment from them to stay safe while you make the arrangements,” she says. “Say something like ‘I’ll make a phone call to Frontier Behavioral Health’ for example. And then make sure they have child care, transportation and whatever else they may need to go to that assessment.”

Votava says she understands how hard it is for people to say the word suicide, but says “it’s one of the most important things to do to help someone in crisis.

“You could also ask if they’ve ever felt like they wanted to go to sleep and never wake up, and a follow up question of whether they’re thinking about hurting themselves or killing themselves or ending their life,” she says.

“It’s probably a relief to them to say it out loud. We have concerns about asking because we don’t want to offend that person, and some believe that if they ask, and the person is not thinking about suicide, that asking could plant the idea,” she says.

“Research tells us that asking opens up that line of communication, and often times lowers anxiety for the person who is experiencing suicidal thoughts. There is zero research to support that idea that it’s planting the idea in someone’s head. That is an absolute myth,” she adds.

“You always can call a crisis line in the community. The hotline number to call in the Spokane community is (509) 838-4428. People can also call 211 for resources of any kind,” she adds.

It is important to listen with sincere concern for their feelings, suicide prevention experts say. “Let them know that they are not alone. Share your own feelings. If you feel that they may make a reckless decision, tell them that you are concerned. They need to know that they are important to you and that you care.”

Suicide Attempts
Non-fatal attempts of suicide are also a concern.

“Suicide deaths are just the tip of the iceberg in Washington, and experts generally agree that suicide and suicidal behavior are underreported. For every suicide death, there are three hospitalizations for self-inflicted injury and an estimated 225 adults who seriously consider suicide,” according to the DOH report.

Hospitalization rates for self-inflicted injuries vary. In 2010–2014, nine counties had rates significantly higher than the state rate: Clark, Cowlitz, Ferry, Pierce, Skagit, Spokane, Wahkiakum, Walla Walla and Yakima.

“In an average week, there are 65 hospitalizations from self-inflicted injury. Recent survey data tell us that more than 4 percent of adults and 20 percent of 10th graders in Washington seriously considered suicide in the past year,” the report states.

Votava says it’s uplifting to realize that 95 percent of those who attempt suicide and don’t die often get the help and treatment they need.

“It’s important to know that 90 percent of people who die by suicide are struggling with a mental health disorder at the time of their passing. And mental health disorders are treatable. And most suicides are preventable,” she says.

Judith Spitzer is an independent journalist living and working in the Pacific Northwest.