A Last Resort: A look at mental health and suicide


In recognition of Suicide Prevention Awareness month, this is Part I in a two-part series looking at the link between suicide and mental health, the need for care in Cottage Grove and availability of mental health care services.

On Oct. 3, 2016, 33-year-old Matthew Kegler of Cottage Grove fatally shot himself.

That morning, at about 3 a.m., Kegler called 911 because he was experiencing an “acute psychotic episode” and told a responding Cottage Grove police officer that his dog was among those urging him to kill himself.

A neighbor and the officer escorted Kegler to the PeaceHealth Cottage Grove Community Medical Center.

By around 4 a.m., a doctor, who was already familiar with Kegler because of a previous suicidal case, had placed Kegler on a 12-hour mental health hold after speaking with the officer.

Just after 5 a.m., a worker from South Lane Mental Health arrived to evaluate Kegler. The worker allegedly determined Kegler was not a danger to himself nor in need of emergency care and around 6 a.m. Kegler was discharged from the hospital.

Twelve hours later, police responded to concerned calls from Kegler’s neighbors to find the man dead in his apartment.

The case raises questions about the state of mental health care in Cottage Grove and whether enough quality resources are available to deal with such situations. For those left behind in the wake of Kegler’s suicide, there is clearly work to be done.

This July, a lawsuit was filed in Multnomah County Circuit Court by attorney Chad Stavley on behalf of Kegler’s family, listing PeaceHealth and South Lane Mental Health as defendants in a $2.5 million case.

The lawsuit faults the health organizations with ignoring warning signs and describes the South Lane Mental Health worker as an “unlicensed intern.”

Executive Director of South Lane Mental Health Damien Sands declined to comment on the details of the case, but clarified that the term “intern” is a bit of a misnomer as it applies to the mental health field.

“There’s a misunderstanding about how licensure occurs,” Sands said. “It reads like this is a person who’s still going through school, but nothing could be further from the truth. This was a qualified mental health professional who was very skilled.”

PeaceHealth released a statement in response to the lawsuit.

“PeaceHealth extends its sincerest sympathy and condolences to the family and loved ones of Mat-thew Kegler,” it said in the statement. “Due to the pending litigation, we respectfully refrain from further comment.”

While the lawsuit seeks to prove culpability, the final ruling will ultimately be unsatisfactory insight into the state of Cottage Grove’s mental health needs and services, particularly as they apply to suicide, and the defendants in the case will continue to play a vital role in the community’s quest to define those parameters.

Nationally, suicide is the tenth leading cause of death with more than 47,000 occurring in 2017. This means that for every murder in the United States, there are about three suicides and 75 suicide attempts.

The relationship between suicide and mental health is not clear-cut and an ambiguity exists between the two phenomena. Suicidal thoughts do not necessarily indicate that one is living with a mental illness and, conversely, having a mental health issue does not imply that one may be suicidal.

Many risk factors contribute to suicide (access to lethal means, substance abuse, a history of trauma or chronic pain) and the Centers for Disease Control estimates that 46 percent of people who die by suicide had a known mental health condition.

Among mental health conditions, depression is often associated with suicidal thoughts and the American Academy of Suicidology estimates that about two-thirds of people who commit suicide are depressed at the time of their death.

The National Institute of Mental Health defines depressive episodes as “a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration and self-image.”

In addition to chronic depression, many psychiatric conditions including psychosis, substance abuse, bipolar disorder and schizophrenia are linked to suicide.

For any community, access to mental health services which can identify and recommend treatment for this wide variety of conditions is a substantial step toward minimizing suicide risk.

 

Need for Care

The need for these services is apparent in Cottage Grove, a city which has twice the suicide rate of Lane County.

In 2018, the Department of Health and Human Services reported that Lane County had been exceeding the national average of suicides for the past 30 years. The county is currently hovering around 80 suicides per year on average and that number has reliably been trending upward.

Other small cities Florence and Junction City were also reported to have rates double that of the county, which squares with statistics reporting rural communities to have much higher suicide risk simply because of a greater prevalence of gun ownership.

From a mental health perspective, part of the trouble in rural areas may lie in having services which address the bottom rung of human needs.

For the youth-oriented nonprofit Looking Glass, the goal is to help youths meet basic needs so that the process of addressing mental health can even make it onto the radar.

“A lot of the youth that we see aren’t really even focused on mental health because they don’t know where their next meal is coming from,” said Amanda Hampton, program supervisor of the Looking Glass rural program. “Or if you’re sleeping outside in the pouring rain without a tent or a tarp, going to therapy or seeking counseling services – even if it’s something you know you need - isn’t a number one priority.”

Cottage Grove has its share of unhoused or hungry denizens with mental health needs, but it is not always the case that providing mental health services is the magic bullet for the situation. For the segments of this population who find themselves disadvantaged due to their mental health challenges, the need to address basic shelter and food stability finds priority over the very condition which landed them in their current station.

By this standard, the degree of need in the community can also be measured by the robustness of a safety net which allows for that basic stability.

“If those needs are being met, then we can focus on seeking mental health services or counseling or whatever that looks like to help with PTSD (post-traumatic stress disorder),” Hampton said.

For first responders in the Cottage Grove Police Department, the problem on the ground is all too apparent. 

“I think it’s fair to say that our country — and Cottage Grove is not an exception — has a mental health crisis because that kind of care takes money and money’s tight,” said Police Chief Scott Shepherd.

Finding the right place for people with particular mental health needs can be a challenge.

“I guess one thing on the wish list would be that we always want our local hospital to have more room – not just one dedicated room,” Shepherd said. “There are times that the hospital in town will call us and tell us they’re on ‘psych divert,’ which means that if we have anything that would normally go to them, we have to go to the University District to deal with that.”

The University District refers to an acute psychiatric unit on the campus of PeaceHealth Sacred Heart Medical Center in Eugene. Taking someone from Cottage Grove to the unit for inpatient care is a process that could see an officer out of town for a few hours.

“When there’s only two people on and one person is going to be gone for three hours, that is hard from an operational standpoint,” Shepherd said.

Shepherd also noted that people from the homeless and transient population in the area tend to display a higher-than-normal degree of mental health challenges.

“And that’s troubling because we really don’t have a place for them to go,” he said.

Underprivileged members of society are not the only ones at risk, however, as any high-profile case of suicide will make evident. Given the right set of circumstances, nearly anyone can be beset by chronic depression.

 

A Downward Spiral

Local resident David Smith (not his real name) moved to Oregon from the Bay Area several years ago.

“In the Bay Area, I ran a research and development lab surrounded by PhDs inventing a 3D measuring system for the Secret Service,” he said.

A steady decline in work, however, convinced him to move north.

“I stopped getting high-paid work. I was sort of aging out of the system,” Smith said. “Rather than wait until I was completely displaced, well, there was cheaper rent here.”

Work in Oregon, however, was often unsatisfactory compared to his former position and Smith suffered psychological damage from one of his jobs, a condition which followed him on future job hunts.

Finally, when a manager job prospect fell through, years of a steady downward snowball effect had reached a critical point.

“I was hanging in there. I was paying the bills. Things were okay, but having that setback,” Smith remembered. “At that point, savings were gone and the stress of having that failure and not having a support network … knocked me out.”

Self-care quickly declined and a state of hopelessness began to set it.

“I had fallen into a really deep depression and I have PTSD which went undiagnosed for a really long time,” Smith said. “I had a long history with depression and had done a lot of therapy which didn’t necessarily cure me. … But that wears you out and not having help to get through the really difficult emotional circumstances just leaves you less able to respond.”

In Smith’s case, he shut down completely.

“When it came to not being able to pay that month’s bills and I was going to have to let the power be turned off, I started making plans to just live outdoors,” he said. “Eventually, if you’re under pressure long enough, I think your resilience falls apart.”

Smith also lived with frequent pseudo-seizures, his body locking up as many as a couple dozen times a day when “invasive thoughts” would trigger an event.

“It was pretty disruptive,” he said. “I kind of made an active decision that if nothing happened to repair my circumstances, then that’s it. I tried to live a good life, I had done what I was going to be able to do and I wasn’t going to get to do anything else.”

Smith had gone as far as planning where and when to end his life, giving himself a one-year deadline before deciding to go through with it.

“So I had a date to make a date,” he said. “You stop seeing possibilities and you know your pain ends. The pain begins for other people, though.”

Eventually, Smith's daughter moved in with him, coming up from the Bay Area to be with her father. At her urging, Smith decided to walk into South Lane Mental Health for help.

The National Suicide Prevention Lifeline provides 24/7 support for those in distress and can be reached at 1-800-273-8255.

Editor’s Note: Part II of this series will look at the availability of mental health services in the community and whether local needs are being met.

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