As Suicide Prevention Awareness Month comes to a close, HCA Healthcare sat down with The Jason Foundation to offer perspective on the youth suicide epidemic. Read on, join the conversation and help raise awareness on suicide prevention.

On July 16, 1997, Clark Flatt’s world was turned upside down. His 16 year-old son, Jason, committed suicide.

22 years-later, Flatt has turned his heart-breaking experience into an unstoppable organization that is determined to raise awareness around the youth suicide epidemic – The Jason Foundation.

What began as a modest way to sound the alarm on the often-stigmatized topic of youth suicide has since propelled into a nationwide non-profit supplying students, parents and teachers with the tools and resources to identify at-risk youth.

Clark Flatt, president of The Jason Foundation (left) and Eric Paul, president of HCA Healthcare’s behavioral health services (right) recently sat down at our corporate office in Nashville, Tennessee to discuss the current state of the youth suicide epidemic.

The Jason Foundation has also championed legislation in 20 states – The Jason Flatt Act – requiring all educators in the state to complete two hours of youth suicide awareness and prevention training each year in order maintain their licenses.

The concept of a Jason Foundation affiliate office began at a Nashville-based HCA Healthcare facility in 2001. Through the early 2000’s, HCA Healthcare supported The Jason Foundation through board involvement, volunteerism and by building local programs.

Formally, HCA Healthcare teamed up with The Jason Foundation in 2013 to provide education to our communities about youth suicide and now boasts 13 HCA Healthcare affiliate offices across the nation. These offices serve as hubs where parents, teachers, guidance counselors, students, churches and other community organizations can obtain educational materials and learn about training programs available through The Jason Foundation.

HCA Healthcare, comprised of 184 hospitals across the U.S. and the U.K., encompasses 19 children’s hospitals. “In 2018, nearly 19,000 youth between the ages of 13 and 19 presented in HCA Healthcare’s emergency rooms either with suicidal ideation or suicide attempts,” said Eric Paul, HCA Healthcare’s president of behavioral health services. “When you do the math that equates to 52 kids per day that are visiting our emergency rooms due to youth suicide.”

Fast facts: Suicide is the tenth leading cause of death in the United States and second leading cause of death for young people ages 10 to 24. It’s also one of the leading causes of preventable deaths in the U.S.

“It’s actually scary when you look at some of those stats,” notes Flatt. “We appreciate that HCA Healthcare looking at those figures and seeing how suicide is impacting families nationwide. One thing that we’re encouraged about in the suicide prevention community is that suicide is now being looked at as a public health issue.”

14 HCA Healthcare behavioral health colleagues from across the country recently attended training with The Jason Foundation to learn how to continue to make a difference in the communities in which they serve.

HCA Healthcare is proud to partner with and support The Jason Foundation by playing an active role in the vital effort to end youth suicide. Students, adults, and community members are encouraged to reach out to our affiliate offices to learn more about The Jason Foundation, access resources and get the training to identify and assist at-risk youth. In 2018 alone, HCA Healthcare helped to support over 200,000 educator trainings in the communities that we serve.

We are also committed to raising awareness for those in need of behavioral health treatment and ensuring that access to resources is easier for both patients and physicians.

Brandi Daw, director of behavioral health physician and provider relations at affiliate Eastern Idaho Medical Center, recently had the opportunity to team up with The Jason Foundation to educate at an event with over 21,000 Boy Scouts of America youth and parents in attendance. Her Jason Foundation training, “opened a beautiful door to allow me the opportunity to share this much needed information with so many others.”

Affiliate Colleton Medical Center in Walterboro, South Carolina recently hosted their Second Annual Suicide Prevention Summit. The hospital was lit up teal and purple, colors representing suicide prevention awareness.

Paul reminds us that the work we do to end youth suicide is not over. “Youth suicide is a very serious epidemic that is touching all lives in America and we’re glad to be a part of The Jason Foundation and work with you all for years to come.”

“You guys are making The Jason Foundation. If it wasn’t for you guys we wouldn’t be as effective as we are,” adds  Flatt. “We’re family.”

 What you can do to spot the subtle warning signs of suicide 

Some people might assume that anyone contemplating suicide would be struggling with an obvious or serious mental health issue, such as severe depression. In fact, many people who commit suicide don’t have a known mental illness, and there usually isn’t just one determining factor that prompts someone to take their own life. The circumstances that result in suicide are usually complex and may involve one or more life challenges, such as chronic pain, substance abuse or other serious health issues, financial strain, legal problems, trauma or relationship troubles.

This may help explain why some people seem shocked or baffled by the suicide of someone close to them. But in most cases, including some that seem inexplicable, there are clues—some more subtle than others, according to Cesar Figueroa, MD, a psychiatrist with affiliate Coliseum Medical Centers in Macon, Georgia.

Cesar Figueroa, MD, a psychiatrist with affiliate Coliseum Medical Centers in Macon, Georgia

“Any changes in someone’s personality, behavior or how they express their emotions can be an indication,” says Dr. Figueroa. These changes can often appear mild.

“Sometimes outgoing people suddenly become quiet, less talkative,” Figueroa notes. “Someone who usually laughs a lot may stop showing emotion or start crying more often. Someone who is usually calm may suddenly become very easily agitated or start doing risky things.”

Understand the range of possible warning signs

Obvious signs that someone is suicidal may include dramatic mood swings, talking about being in unbearable pain, aggressive behavior or feeling trapped, hopeless or like a burden to others. But there are other changes which, when considered together or put into context, could be an indication that someone is considering suicide, Figueroa points out.

Some more subtle warning signs that shouldn’t be ignored may include:

  • Avoiding social situations more often and for no particular reason
  • Indifference about slipping performance at work or school
  • Increasing use of alcohol, or new or worsening drug abuse
  • Giving up on personal hygiene and positive habits, like following a healthy diet and exercising
  • Being more careless about taking medications properly and no longer keeping chronic health issues, like diabetes, under control
  • Driving recklessly or engaging in riskier behaviors
  • Talking about feelings of guilt, shame or hopelessness
  • Unusual purchases, such as buying supplies, objects or weapons, that wouldn’t normally be needed but could be used for self-harm

Having a preoccupation with death, which may include giving away possessions, saying goodbye to family and friends and oddly-timed estate planning, is another possible red flag.

Making a will is probably not an alarming thing for people if it’s happening at the right time in their lives,” Figueroa says. But when people start talking about death more often than not—especially at a time when they seem to be under a lot of stress—it shouldn’t be dismissed, he explains.

Consider risk factors for suicide

In collaboration with The Jason Foundation and Palm Beach State College, affiliate JFK Medical Center held a community outreach event in 2018 to raise awareness of suicide and encourage students struggling with depression to seek help. Over 1,000 students were provided information on resources available in the community.

Anyone could be at risk for suicide but there are certain factors aside from mental illness which could make some people more likely than others to take their own lives. It’s important to consider these known risk factors when assessing behavioral changes and other warning signs, according to Figueroa. Risk factors for suicide include:

  • A personal or family history of suicidal thoughts or behaviors
  • Identifying as lesbian, gay, transgender or another sexual minority
  • A history of childhood abuse or trauma
  • Stressful life events, such as a financial loss, divorce or death
  • Chronic pain
  • Military service
  • Traumatic brain injury

The more risk factors people have, the more likely they are to commit suicide, Figueroa adds. He notes that in some cases, people contemplating suicide are motivated by a misguided sense of altruism, believing that their death would be in the best interest of their family or loved ones.

Know what pushes people to suicide

Millions of people admit they’ve thought about killing themselves, but far fewer have come up with a plan or gone so far as to actually act upon it.

“I think most of us have at some point in time thought, ‘Life is so hard right now. I wish I were not here,’ or ‘I wonder what would happen if I die,’” Figueroa says. But it’s the persistence of underlying problems and ongoing stress that for some people can make these thoughts progress from a fleeting notion to a plan and intention to commit suicide, he explains.

“Between genetics and how you learn to cope with stress and distress, I honestly believe that we all have a breaking point,” Figueroa adds.

Don’t dismiss your concerns

Sometimes, the idea that someone would not only contemplate suicide, but also follow through with it, may be hard to accept, according to Figueroa.

“Let’s face it, to admit to yourself that someone you love might actually take their own life is pretty scary. I think by nature we try to say, ‘No, this is not real.’”

If you believe that you or someone you know is at risk for suicide, trust your instincts. Don’t be afraid to ask direct questions, such as ‘Are you thinking about hurting yourself or dying?’ Having this candid talk won’t make someone more likely to take their own life. It could actually have the opposite effect. Giving someone the opportunity to open up about their feelings may reduce the risk that they act on suicidal thoughts.

People considering suicide can also reach out to the Crisis Text Line by texting ‘HELLO’ to 741741. They will be connected with a person who will listen to their concerns without judgement. They can also call the National Suicide Prevention Lifeline at 1-800-273-8255.

If you’re with someone who is actively considering suicide, do not leave them alone. Call 911 right away or take them to the nearest emergency room.

“If you’re concerned about someone, consider it an emergency,” Figueroa advises. “When you take action, the worst case scenario is that people go to the ER and they’re okay and referred for outpatient care,” he points out. “But the best case scenario is that you save a life.”

With more than 60 inpatient programs and 160 outpatient programs across 18 states, HCA Healthcare supports a connected network of behavioral health centers. We provide a wide variety of treatment options to meet the needs of patients including adult, geriatric and child/adolescent programs, as well as telehealth and community need programs in select markets.