A Last Resort: A look at suicide and mental health — Part II

For rural communities, networks can be life savers. This quality is all too salient for Cottage Grove, a city with double the suicide rate of Lane County.

“We see a higher correlation of suicidal rates between people who feel social isolation versus people who feel community connection,” said South Lane Mental Health Executive Director Damien Sands. “Community connection is that place in which a person feels engaged, supported and nurtured within their community.”

A strong network can go a long way for people in need of mental health care services and in turn reduce the risk factors which may lead to suicide. Much can be done therapeutically at the crossroads of suicide ideation and mental health services, however finding solutions to each challenge is not necessarily weighted upon a singular organization or service.

“Access to good therapy is a cornerstone of being able to get support,” Sands said, “but it’s also these other critical areas — employment, housing, faith-based support — it’s just community connection. It’s finding something within the community that binds you.”

Considering the range of factors which play into suicide risk and mental health, a robust system of care is one which can cast a wide net and have the tools to address a variety of problems from depression to drug abuse to post-traumatic stress.

A Network of Care

South Lane Mental Health serves what Sands estimates to be between 15 to 20 percent of the regional population. The nonprofit offers a broad variety of services, particularly for people who are facing resource challenges such as income or housing.

“I refer to it as more of a safety net provider,” said Sands. “Where we are uniquely focused is helping those who are struggling with some kind of substance abuse, helping the person who’s recently gone through some sort of tragic loss, being in a school setting to be able to give access to kids. … So the idea is about creating those access points in different arenas.”

Programs at the nonprofit run the gamut of general counseling, crisis services, case management, medication management, recovery services, supported housing and youth counseling.

With the understanding that not all who need help will willingly show up on the doorstep, the nonprofit is also proactive in its approach by employing efforts such as outreach on the street and staying engaged with other local entities.

One of those entities is the South Lane School District.

“It’s a very unique thing,” said Sands. “A lot of school districts don’t have this, but we are embedded within the school system.”

South Lane Mental Health counselors maintain a presence throughout the district, working with everyone from high school seniors down to kindergartners. Counseling may take the form of group therapy or one-on-one meetings, providing youths with easier accessibility to problem solving.

Though South Lane Mental Health appeals to a variety of needs, Sands emphasized that the broad scope of elements which play into one’s stability cannot be addressed by a single entity — it requires a combined effort.

“We are not a solution,” he said. “We are part of the solution.”

More such solutions may be on the way as an upcoming peer-led support program by the National Alliance on Mental Illness (NAMI) in Lane County seeks to provide group discussion-based services to the Cottage Grove area. NAMI has recently partnered with South Lane Mental Health to return services to Cottage Grove.

“NAMI is a great example of client-based advocacy,” said Sands. “Folks who experience mental health conditions can then have a voice for themselves and sort of speak up and build peer-to-peer relationships.”

NAMI’s peer-led services are conducted by two facilitators who guide groups of between four to 15 members through a discussion of issues they choose to address. The facilitators of support groups are not mental health professionals, but individuals who have self-identified as living in recovery with mental illness.

“We’re trying to get the word out that we’re looking for individuals to facilitate our peer programming, whether that’s a support group or an education class,” said Jennifer MacLean, executive director of NAMI Lane County. “All the programs are peer-led and free and confidential.”

NAMI’s outreach into Cottage Grove will provide people with resources and referrals, but will not include diagnosing, medication or case management.

“We just had one individual trained, so now we’re looking for a partner for her, so that way we can get, ideally, a weekly support group for Cottage Grove,” said MacLean.

For youth in the community, a support group of peers already exists at Cottage Grove’s Looking Glass branch as part of its rural program.

Looking Glass provides assistance for youths in the community who face challenges related to educational deficits, behavioral health issues, drug addiction and homelessness. The center aims to provide a space for youths to feel safe or just have someone to talk to.

Amanda Hampton, program supervisor of the Looking Glass rural program, acknowledges that the nonprofit sees its share of youth struggling with housing.

“The research shows that homeless youth are more likely to take their own life than their peers who are living at home with a roof over their heads,” said Hampton. “On top of that, the LGBTQ+ is more likely to be homeless and that population of people experiencing homelessness are also more likely to take their own lives than peers who don’t identify as LGBTQ+.”

The process of parsing out which avenues of aid would best serve someone who walks through the door largely depends on the individual’s stated needs.

“We are addressing mental health concerns in clients when it’s something that they have identified as a goal,” Hampton said.

The nonprofit offers service linkages to other programs in the community which address particular issues, serving as a guiding mechanism for the correct channel toward recovery while providing counseling of its own.

Two Looking Glass counselors from Eugene offer services in Cottage Grove, one a licensed clinical social worker and the other a licensed marriage and family therapist.

Looking Glass also tries to measure risk by identifying adverse childhood experiences such as poverty or domestic abuse.

“I think a lot of the youth we work with at the Looking Glass rural program are just trying to get their basic needs met,” Hampton said. “They’re in that survival mode.”

Meeting these basic needs can be a significant hindrance toward seeking mental health services.

“If we can provide food, provide a warm place, provide warm clothes, provide a place of acceptance and belonging … then we can focus on getting back to school,” Hampton said. “We can then focus on seeking mental health counseling or whatever that looks like to help with PTSD or some of those adverse childhood experiences.”

For some, basic needs include getting an ID or signing up for health insurance. Looking Glass helps with those processes as well.

“We’re really just trying to help break down and eliminate – or at least decrease – the amount of barriers that people are experiencing,” said Hampton.

There are limitations to the organization’s services, however.

“We are not diagnosing people,” Hampton said. “But we have protocols if someone came to us and said, ‘I am suicidal.’”

The nonprofit is not equipped, though, to deal with more severe mental health cases, such as a client mentioning that they hear voices.

For such cases, Cottage Grove does have access to PeaceHealth Medical Group’s Early Assessment and Support Alliance (EASA) program out of Eugene, a resource which identifies and offers support to young people who are at risk of developing psychosis or are experiencing early signs of psychosis.

Lorraine McKenzie is a licensed clinical social worker and a team leader with EASA.

“Our program has multi-faceted services and is designed to address each individual’s needs,” she said. “We hope to be preventative and capture young people before they have that first episode.”

EASA’s target is young adults ages 12 to 24 and offers a transition program which can last up to two years. Among its range of services, the program helps participants create structure in their social, occupational and private lives. The program will also send workers into rural communities as part of its outreach.

“We believe that recovery is achievable by all of our participants and that each individual can be empowered to develop goals that reflect their own concept of recovery,” said McKenzie.

The collective aid provided by Cottage Grove’s programs and services spreads across a wide landscape of needs. Even the Cottage Grove Police Department serves its own role in connecting individuals with that aid.

“I think it’s fair to say that we have people in our community that we contact on a regular basis,” said Cottage Grove Police Chief Scott Shepherd. “So we might have a little more insight on people because we’re a small town and that does help us determine what would be the best course of action.”

Though officers have training in de-escalation, their primary role in this capacity is to direct people to the care they need.

“I think it’s important to understand that in servicing mental health, I don’t know that we provide anything more than a mechanism to get people to where they may get help,” Shepherd said. “We’re not clinicians and we’re not doctors so we don’t have the ability to go, ‘Yes, this is bi-polar’ or ‘This is depression.’”

Even so, suicidal cases are potentially dangerous for officers and a degree of discernment is required in each situation.

“There are times when people are armed with whatever weapon they choose to grab,” Shepherd said. “We have to determine what is going to happen if we do nothing to taking them physically into custody and what all of that looks like in between.”

For less severe cases, the City of Cottage Grove has been known to strike deals with people who need a nudge in the right direction.

“The municipal court judge has sentenced people to time in our jail for certain crimes within town and he has offered time-for-time off their sentence if they are able to complete a mental health program,” Shepherd said. “I think that’s a huge thing because then you don’t get the snowball effect.”

Overall, Shepherd feels the police force’s close relationship with local organizations has helped direct the flow of people with challenges to the proper channels, much of which is owed to the relatively broad opportunities the small city offers.

“I don’t want to say it’s as good as it can be,” Shepherd said, “but I perceive that there are probably places that don’t have as much as us even though there are times that we want more. And I think that everybody that’s in Cottage Grove is pretty good about collaborating with each other.”

Unfortunately, the city still has its share of those who fall through the cracks for one reason or another. Shepherd recalled individuals with mental health needs who struggled even when care was provided.

“There are people who have received a lot of service. They’ve received housing. They’ve received treatment. They’ve been afforded opportunities,” he said. “I don’t know where that disconnect is there. I just know that there was housing and now there’s not. There were daily meds and now there’s not. So getting somebody a place to be is a good end goal, but it doesn’t ensure success.”

Whatever the reasons, it is still hard to argue that the city suffers from a dearth of programs. Local organizations like South Lane Mental Health provide a core support mechanism for the community.

“When I look at Cottage Grove, we have so many of these great resources,” said Sands. “The key is recognizing those people that are falling through the cracks and feeling ostracized by that community.”

For some, simply walking through the front door can make all the difference.

‘Soaking in the care’

Local resident David Smith (not his real name) found himself in a downward spiral of psychological pain and challenges which had grown to seem insurmountable since moving to the area years ago.

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

“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.”

At his daughter’s urging, Smith decided to walk into South Lane Mental Health for help.

Though Smith initially came in for help regarding a disability application, the nonprofit was quick to pick up on a deeper problem.

“They have a little 10-point test — really simple questions to gauge the danger of when someone is considering a suicide,” said Smith. “I didn’t have a schedule, but I had half the questions answered ‘yes’. I knew how and where I would do it.”

Though a premeditated schedule to end one’s life is certainly a red flag, some suicides can be owed to impulsivity as well.

“I was in that place where the last couple of pieces could have come together,” said Smith. “Fortunately, we were able to put it together so that I could keep making appointments.”

Smith’s first challenge was to identify symptoms and face difficult realities about his material and psychological needs.

“It can be discouraging to have to evaluate and document just how bad things are,” he said. “You have to acknowledge that you may never get to the level of contribution that you want or that those expectations demand, but it doesn’t mean you’re not contributing. People are still valid even when they’re not contributing.”

Smith recalls that it took some time for the therapy to start showing benefits, but the wait ultimately paid off.

“Time. Talking over what had happened. Being able to unload some of it,” he said of the healing mechanisms. “It put me back in a place where I could have some normal function. … So it did start to feel good.”

Now a year and a half into his therapy, Smith says his recovery is within grasp as he’s seen a dramatic change in his condition, both physical and mental. An issue with seizure-like symptoms went into complete remission this spring.

“Down to zero of the pseudo-seizures,” Smith said. “Then also the depression largely lifted and I was able to try doing things again. … I became convinced by the care that was happening to me that there was validity to me – that I was worth caring about. And so I began to see that it might be possible for me to participate again.”

One of the major steps in his recovery has been a commitment to get back into the workforce. In job searching, Smith has found vocational training.

“The school felt great. I got through it and I’m now looking for new employment,” he said. “I’m pretty confident that it’s going to wind up working out.”

If he hadn’t walked into South Lane Mental Health, Smith is certain nothing would have changed.

“No therapy, no vocational training, no employment prospects,” he said. “I would’ve just remained stuck.”

Part of Smith’s process was accepting the prospect of a new frame of mind.

“Their job is to change your mind — literally. So I needed help changing my mind about the futility of the circumstances,” he said. “I needed to change my mind and decided to open my heart a little to new possibilities. … In the same way that people will decide on a whim to do the suicide, I decided on a whim to break out and get a job.”

Smith also found revelation in the idea that the drive to find an end could be fulfilled by just ending that chapter of his life rather than his life altogether.

“It wasn’t required that that be the end of me,” he said.

The mere fact that someone showed interest and care in his well-being was also an uplifting and forward-moving ingredient to healing. Smith strongly encourages people to simply reach out, even if they have no intention to begin therapy.

“If you’re suicidal and unable to bring yourself to go in, at least make the phone call,” he said. “When you can’t be persistent, there are people who will be persistent for you.”

Smith credits South Lane Mental Health with its adaptability, working with his particular situation to find solutions.

“So whatever the issues are, they’ll start trying to work and find resources to ameliorate them,” he said.

For some, the humility required to reach out for help can be a hurdle, but Smith is now a proponent of healthy dependence.

“When you’re out of the internal resources to continue responding to your life, it works to borrow someone else’s to just carry on for a while,” he said. “And even if you feel like nothing is changing, it is changing. You’re soaking in that care and after a while it adds up.”

Moreover, soaking in that care is in itself proof positive of one’s validity and worth among others.

“When you’re suicidal, you start imagining nobody is going to miss you, but you will be missed. You will definitely be missed,” said Smith. “Even if people are actually upset with you and your normal interactions tend to be kind of negative, people don’t want you done and gone.”

In a small town, one mustn’t reach far to find support. Commitment by strangers to others’ well-being reverberates noticeably throughout the city and work among the local care providers sets the tone for establishing a harmonious network.

“I think that we have a great place here. I think it’s a good place to raise a family,” said Shepherd. “Like any place, we have problems. Mental health issues are one of them, but there are places that have it much worse and we’ve got it pretty good.”

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


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