This is the third in a series on suicide, who it affects, how it affects them and where people can turn to for help.
Since Jan. 1, 2013, there have been 10 suicides in Custer County. Two of the suicides were female. Eight were male. Seven of those suicides were done with a firearm. Two of the deceased hung themselves. One overdosed on drugs.
All 10 of these suicides were responded to by a member of the Custer County Sheriff’s Department, a member of the Custer Ambulance Service, or both.
When one thinks of the people suicides affect, first responders probably don’t leap to mind first, if at all. But as human beings with human emotions, first responders who arrive at a suicide call—some grisly scenes, most with frantic family on scene already—suicide calls can be among the most traumatic of calls.
Custer County Sheriff Marty Mechaley has been in law enforcement for 25 years, and as such, has responded to many suicide calls. From teenagers to the elderly, he has seen virtually every age and walk of life choose to end their own life.
For Mechaley, it’s not something that gets easier.
“It’s terrible. There’s nobody here that ever wants to go to one or ever wants to see it,” he said. “And we go to every suicide. There is not an option.”
Ruth Airheart of the Custer Ambulance Service has been working on ambulance crews since 1992 and has spent the last 15 years in Custer. She estimates she has responded to 15 suicides, give or take, in that time. Like Mechaley, she has seen suicide run the gamut of ages and types of people.
“Sometimes it’s hard to wrap your head around what drove them to this point, to make them do this or feel this way is their only option,” she said.
It’s common that first responders heading to a suicide call don’t initially know suicide was completed or attempted. The sheriff’s department may know only that there is a gunshot wound. It can be the same way for an ambulance crew.
Suicide scenes can be frantic: patients clinging to life or already dead, family and friends hysterical, nobody sure what to do or how to react. Mechaley has been working to open the airway of a suicide victim while a family member was on top of him screaming into his ear to help the dying person.
That’s one of the biggest, and hardest parts of responding to a suicide—family and friends on site reacting to the event through a virtual kaleidoscope of emotion. Whether it’s shock, rage or profound sadness, first responders have seen it all.
“In a lot of cases I’ve been involved with, there was nothing that could be done from our (ambulance service) standpoint. Then it becomes more of an assist with recovery and provide whatever we can for the family,” Airheart said. “If there is nothing we can do for the patient our focus is on the family.”
Airheart said trying to find the right words to say to assist the family is a fool’s errand. Still, they do their best to provide comfort as the family tries to come to terms with what happened.
“They’re struggling immensely. We’re not going to make the pain go away, but we try to do something,” she said.
The five stages of grief manifest themselves over the course of minutes, wrapped in a blanket of raw emotion few have ever had to deal with and, ideally, would never have to deal with.
“That sometimes is the hardest part to deal with,” Airheart said. “In EMS, we come across these things. We didn’t cause the event—we are there to mitigate what we can. Sometimes we can, sometimes we can’t. Sometimes there are things we just can’t fix.”
If the emotion that comes out is rage, it can be directed at anyone and everyone. First responders, the victim—those left behind sometimes lash out, looking for someone to blame. If an elderly person who committed suicide was recently given bad news from the doctor, they can be the focal point of a family’s rage. The only predictable thing is the unpredictability.
“Anytime we have to deliver a death message it’s difficult. It’s even more difficult when it’s a suicide and the family is there and saw the person or the condition of the person, depending on how they committed suicide,” Mechaley said. “It’s all very, very real.”
If there isn’t blame being assigned, Mechaley said, there is sometimes denial or wild explanations about what happened. For instance, a family member may rationalize that someone who shot themself saw mountain lions on the property, grabbed a gun to go take care of the lion, slipped, and the gun discharged and shot the person.
Depending on the method of suicide, the scenes first responders arrive to can be troubling to say the least. For a new EMT or a new deputy, that can make it especially difficult.
“It affects all of us. I’ve seen people who went to their first suicide scene, depending on how it was done, and it affected them very badly,” Mechaley said. “We would much rather try to aid someone to keep them from doing it than have to go to that scene. A new officer sometimes doesn’t realize what we actually have to deal with. I’ve seen people quit over that.”
In a town the size of Custer, the trauma of dealing with a suicide can be exacerbated by the fact that those responding frequently know those who have committed suicide.
“The worst part is when you know them personally,” Mechaley said, adding that suicides of teenagers or younger children are especially tough to respond to. “I have been around here long enough sometimes I have to go to these calls and I know the people who did it.”
“There is a connection to every patient we come across,” Airheart said. “It’s different for every people. We’re a small community, and there’s a good chance someone on that call knows that family or that person we deal with.”
Airheart recalls several years ago when a couple of younger children both committed suicide during a very short time frame. Some of the younger members of the ambulance service knew the deceased and were shaken up by the events.
The vast majority of first responder units have counseling and debriefing available to anyone who is having a tough time with a call they responded to and may be having a tough time processing or dealing with.
In the world of EMTs, seeing gruesome scenes is a part of life. The carnage from car wrecks, a severed limb from a saw or any other accident many only see in horror movies are a way of life. Seeing those things over and over can have a cumulative affect on a first responder, Airheart said. Some develop thick skin and it never gets to them. Others wear their emotions on their sleeve and have a more difficult time.
“We try to keep an eye on each other as far as watching that. It’s not likely it’s a single event that triggers something in somebody; it becomes a cumulative thing,” she said. “We’ll come back (from a call) a lot of times and talk about it.”
Post Traumatic Stress Disorder (PTSD) is common in first responders. PTSD can be a large contributor to suicides, but is often only associated with veterans. Roughly 20 veterans a day commit suicide nationwide, according to data from the Department of Veterans Affairs, accounting for 18 percent of all suicides in America. Veterans make up less than 9 percent of the U.S. population.
PTSD is not limited to veterans, however. The carnage first responders see takes a toll, and for some, counseling is the only way to cope with that carnage. It wasn’t long ago that showing “weakness” was frowned upon, Airheart said.
“There was a culture through EMS, fire and even law enforcement for years that you just suck it up. You don’t cry about this type of stuff. You don’t feel,” she said. “We’re still human. It’s OK to feel bad about those things.”
Not all suicide calls have an unhappy ending, however. There have been calls, Airheart said, where the attempted suicide was thwarted by first responders.
From Jan. 1, 2013 to Feb. 16 of this year, there were 127 credible incidents involving mental issues that do not include the aforementioned suicides. A mental health call can be something as simple as someone calling the sheriff’s office and saying someone had posted an ominous message on Facebook hinting at harming themselves.
Of the 127 such calls, 57 percent were from within Custer city limits. Seventy of the calls were females, 57 were males and 19 were not from Custer County. Too often suicidal people travel from out of town to attempt or commit suicide in the Black Hills for reasons only known to them.
For ambulance service personnel, dealing with a person who attempted suicide but was unsuccessful can be a complex situation. There have been times the ambulance has transported such a person to Rapid City for further treatment. Sometimes, the victim wants to talk, and ambulance service personnel will engage. Sometimes, they don’t say a word. That’s OK too.
“It can be hard. It’s not an everyday realm for us,” Airheart said. “It’s like, ‘I don’t want to be the one to say the wrong thing.’ You’re very conscientious about what you’re saying. It can be a very volatile situation.”
Not surprisingly, there have been people over the years first responders have had to deal with frequently for mental health issues. Getting people the help they need isn’t as easy as grabbing them and taking them to a health care facility.
State statute determines how those who are suicidal, mentally ill, or both are handled. If a qualified mental health professional determines someone needs immediate intervention because they are a threat to themselves or others, they can be taken into custody and put on a 24-hour hold. In addition, anyone 18 years or older can petition for the person they are worried about to be involuntarily committed. A mental health professional determines whether or not the person is an immediate threat to themselves or others, or has a mental illness.
Mechaley said over time, those who the sheriff’s office continually deal with develop a distrust for the sheriff’s office.
“They don’t really want to talk to us. A lot of people want to seek out help on their own or a voluntarily basis. If they want to voluntary talk to someone, that’s great,” he said, saying the involuntary committal process can drag on for hours and while sometimes a necessity, is not the best way for anyone involved.
Mechaley said he believes there needs to be more done to address mental health issues, including having a full-service treatment facility on the western side of the state. The only such facility in South Dakota presently is located in Yankton.
“They need to have a good, quality place where they can get long-term care,” he said. “Not a 24-hour hold the cops throw on them. Actual long-term care.”
Airheart said broken bones can be fixed and bleeding can be stopped, but the mental health aspect is something first responders can’t address and is a overlooked and underfunded part of the overall health puzzle.
“There is a lot of research in the field, but what makes somebody tick? Everyone has different trigger points,” she said. “What makes them do it? In some cases there are drugs or alcohol. It’s hard to wrap your head around.”
Mechaley said it’s important for people to know how bleak their outlook may seem. They have people who care about them and love them. No matter how bad it seems, it’s really not that bad.
“You have people who can be damaged by this for years. Seek help from family and friends. If you’re not comfortable with that, seek help with us,” he said. “I always encourage someone getting voluntary help. That’s the best route.”
You can never know exactly what a person was thinking when they commit suicide, short of a suicide note (which Mechaley said are rarely left), but those left behind to pick up the pieces of a suicide feel the pain for years after. Whatever is happening in that moment, Mechaley said, the person committing suicide does not consider the ripple affect their death will cause.
“What they think at that time is very bad and the end of the world truly isn’t. But that’s how they feel,” he said. “It’s something that’s never going to go away. I do think the more people get educated about it and aren’t afraid to talk about it, it will get better.”