For most, the road to suicide starts with severe depression, a disorder that affects the brain's ability to regulate moods.
It's a medical problem like any other, but it carries a stigma that can inhibit the sufferer from speaking out and loved ones from asking what's wrong.
The results can be devastating. In America, someone commits suicide every 17 minutes, according to The Colorado Trust, an independent grantmaking foundation.
"If you take 10 people in a room, one of those people will have, in their lifetime, a serious mood disorder, either major depression or its sidekick, bipolar disorder," says Steve Bell.
Bell lost his mother to suicide, and he suffers from bipolar disorder. He's also president of the Depression and Bipolar Support Alliance of Colorado Springs, an all-volunteer group whose main focus is providing support groups for locals suffering from mood disorders.
In the Springs, there's an unusually large need for a group like this: Among the largest 54 urban areas in the U.S., Colorado Springs has the second-highest suicide rate, according to a just-released report by the National Association of County & City Health Officials.
The DBSA offers eight groups and is planning two more, one specifically for veterans, the other for parents of bipolar children. Bell says the support groups, along with proper medical treatment and therapy, can help put lives back together.
People in groups find bonding and support, which can be especially helpful given the shame that can accompany a diagnosis of mental illness.
"We're not going to treat you like you're from Mars," Bell says.
But support groups, Bell notes, are for long-term needs, not crisis situations; those are best handled at a hospital. Also, to attend a support group, you have to have acknowledged a problem. Sometimes that requires a little help; Bell's wife first led him to a professional.
People around a suicidal person usually know something is wrong, Bell says. They just don't know what it is. "Depression looks like this: if you have a friend or family member and you just notice that they're not themselves," he says.
The state public health department's Suicide Prevention Office says risks for suicide include mental illness, significant loss, pressure to succeed, family problems, poor self-esteem, a family history of suicidal behavior, and having lost a loved one to suicide.
Be concerned if your loved one shows common signs of being suicidal, such as talking about death or suicide, withdrawing from people and favorite activities, changing eating or sleeping habits, acting depressed (or suddenly happy after a long period of depression), giving away prized possessions, performing poorly in work or school, and using drugs and alcohol.
Davida Hoffman, network director of Pikes Peak Mental Health's child and family team, says kids show different signs.
"Children will act out oftentimes behaviorally when they're depressed," she says, noting kids may become aggressive, irritable or hurt themselves.
If you suspect something is wrong, ask your loved one pointed questions about his or her feelings, and help him or her seek help. Call 911 if the need is urgent.
Talk about it
"I knew nothing about suicide indicators or suicide risk or depression before my son died," LaRita Archibald says.
That was 30 years ago. At the time, there were few resources for those grieving a suicide, so she started HEARTBEAT in 1980 as a support group for survivors.
"[My husband] said, 'I don't want you to be disappointed if nobody comes,'" she remembers. "Before the year was up, people were coming from across the mountains and across the plains."
HEARTBEAT now has 48 chapters. Archibald has co-founded a second local group, the Suicide Prevention Partnership of the Pikes Peak Region, which focuses on suicide prevention and education and provides a crisis hotline. She's working on starting another group to help families of suicide victims through the early stages of grief.
Archibald says all sorts of people are at risk, even those who have recently sought help or appear to have recovered from depression. Medication, she says, can prove troublesome. Depressed patients who are released from the hospital often want prescriptions to work right away, but they generally take weeks to kick in, which can lead to frustration and hopelessness. Other times, people do so well on medication that they think they can live without it and abruptly stop taking it, leading to severe depression.
It's a complex group of problems that can be addressed only if people open the lines of communication.
"It's awfully hard to ask a family member or a friend [about being suicidal]," Archibald says, "but you need to acknowledge that you're seeing things that bother you."
If you're struggling with mental health issues:
Another Life Foundation, 216-7238, anotherlifefoundation.org
Depression and Bipolar Support Alliance of Colorado Springs, 477-1515, dbsacoloradosprings.org
If a family member is struggling with mental illness:
National Alliance on Mental Illness (NAMI) Colorado Springs, 473-8477, namicoloradosprings.org
If you've lost someone to suicide:
HEARTBEAT, 596-2575, heartbeatsurvivorsaftersuicide.org/index.shtml