The Final Leap (17 page)

People choose to take their lives and it affects their families, but it also affects people like me who have to pick up what is left.

—Former U.S. Coast Guard crew member

Because the Golden Gate Bridge lacks a suicide barrier, the only safety net for jumpers is the one that's provided by the dogged efforts of mental health workers, the police, and the Coast Guard. These helpers and responders, on the front lines of crisis, often try valiantly to forestall tragedy. Their efforts save lives, but the need for a physical deterrent to make their work more efficacious is vital.

San Francisco has one of the oldest and busiest suicide hotlines in the country. Founded in 1962, the hotline receives 70,000 calls annually. Of these, 7,000 are actual suicide calls and 700 are deemed high risk, meaning that the caller has a plan, access to means, and probably has made a previous attempt. Frequently the plan involves jumping off the Golden Gate Bridge.

Eve Meyer has been executive director of San Francisco Suicide Prevention, which operates the hotline, since 1987. What strikes her isn't so much the nature of the work, it's that there's never any letup. “Count to 35 slowly,” she says. “Before you finish, someone somewhere in the United States will attempt suicide. Every 17 minutes, an American dies by suicide. Suicide is the eighth leading cause of death in the U.S., and the second leading cause for college-age students.”

She says that the reason why people call her agency is because they are in pain, but the pain comes and goes. Sometimes it seems unbearable, but then it subsides. People don't want to die, but when the pain is at its worst, they don't want to live with it, either. “The question is,” Meyer says, “what do we do for people who are in so much pain that they want to kill themselves? Do we say that the problem doesn't exist? Or do we recognize it and say, ‘This is bad. It can't continue.' ”

Historically, according to Meyer, humans have chosen the former. “From the first to the tenth centuries,” she says, “they buried you at the crossroads with a stake through your heart if you killed yourself. Your family lost its possessions. That stigma continues to the present. We are culturally programmed not to hear the word
suicide
.”

At the same time, “asking about suicide opens up a door,” Meyer says. “It offers a suicidal person an opportunity to think, to feel, to explain, perhaps to cry. It's a chance for someone to consider a dangerous decision one more time. Without asking, without taking that risk, nothing is prevented.”

San Francisco's suicide hotline was founded under unusual circumstances. In 1961, an Episcopal priest named Bernard Mayes was working as a news anchor for the British Broadcasting Corporation (BBC). On assignment, he traveled to the United States to cover a story about suicide. America had a much higher suicide rate than England, and San Francisco's suicide rate was nearly three times the national average. In trying to find out why, Mayes learned something that stunned him: suicidal people in the United States had no one to talk to. While a network of community crisis lines manned by a federation of volunteers who called themselves “The Samaritans” crisscrossed Great Britain, providing easy access to people who were feeling hopeless and depressed, no such service existed in America.

Mayes cancelled his return ticket home and began training some of the people he had interviewed for the BBC story. Then he bought a red phone and installed it in a flophouse in San Francisco's low-rent Tenderloin district. Finally, he printed match-books with “Call Bruce” on the cover. Inside, the matchbook explained that “Bruce” was there to talk with people who were feeling down. Members of Mayes's group distributed the match-books to bars throughout the city. When someone called “Bruce,” the red phone rang in the flophouse and one of the volunteers that Mayes trained answered it. That's how San Francisco Suicide Prevention was born.

Today, prospective phone counselors at the agency receive forty to sixty hours of specialized training before they handle their first call. This is the standard for all crisis centers that operate nationally certified suicide hotlines. By comparison, psychiatrists, psychologists, therapists, and other mental health professionals aren't required to take any training in suicide prevention to attain or retain professional licenses. Zero. Training in child abuse and domestic violence is mandatory, but training in suicide is optional despite the fact that most practicing clinicians have at least one suicidal patient in their caseload. For years, the American Psychological Association's massive
Diagnostic and Statistical Manual of Mental Disorders
, the bible of psychiatry in the United States, has not provided any information to doctors on how to assess patients for suicide risk.
¹
This may be one of the least understood facts about suicide prevention in our country. In many instances, volunteer caregivers are better trained and have more experience helping people who are suicidal than licensed professionals. Volunteers are there to listen, their time isn't rushed, and they have learned to suspend judgment. Most importantly, they're willing to ask about suicide because they're not afraid of the answer.

“I get the feeling that you're thinking of killing yourself. Is that right?”

“Do you have a plan for how you'd do it? Do you have a time frame?”

“Have you put any part of your plan into action?”

Suicide rarely comes up in normal conversation. The stigma is so strong that most people—including physicians—miss vital signs because they haven't been trained to look for them. Studies show that nearly half the time, suicidal people see a physician within one month of killing themselves. Yet the doctor focuses on diagnosing the cause of a patient's physical pain, not mental anguish. Patients who speak of ailments that may seem imaginary from a physical point of view can be facing deeper, less visible hurt that's even harder to bear. If doctors don't do any probing, either because they don't know how or because they're afraid of what they'll find, the health and safety of their patients is jeopardized.

A case in point is Olivia Crowther, a twenty-three-year-old woman who jumped off the Golden Gate Bridge in June 2008. Prior to her jump she told doctors of “low moods” she experienced regularly and requested antidepressants, which were prescribed for her. Two months before she died she told her primary care physician that she wasn't sleeping well and questioned “the point in life.” Her doctor didn't consider that she might be contemplating suicide. From outward appearances, she had everything to live for. She was pretty, well educated, and worked in the magazine industry. Only after her body was found in the water under the bridge, still wearing an iPod and shoulder bag, did her parents discover her intentions. While searching her computer they found that she had visited Web sites on ways to die by suicide.

According to
JAMA
, the Journal of the American Medical Association, training physicians to recognize and treat suicidal behavior is one of the two most effective ways to prevent suicide. The other way is to restrict access to lethal means.

Eve Meyer says that one doesn't have to be a mind reader to determine suicidal intent. Suicide is thought about much more often than people know. “Most people who are suicidal,” she says, “leave a trail of clues that—tragically—become most obvious after it's too late. The clues are right there all the time, though; they can be read if you know what to look for.” She ticks them off. “People who are thinking about suicide often allude to it indirectly. They may make statements that are not taken seriously, but should be, such as ‘When I'm not around anymore' or ‘I'll be going away for a long while' or ‘I wish I could never wake up.' ”

Another clue is putting one's affairs in order. “People who are planning suicide often wrap up their personal, business, and financial affairs quite openly,” Meyer says. “Actions such as making or changing a will, closing bank and investment accounts, and assembling financial documents are often misinterpreted.” The person isn't showing new or renewed interest in his or her life; rather, loose ends are being tied up so that family members and friends don't have to deal with them.

Then there's the giving away of prized possessions. While people may be delighted with these gifts, says Meyer, “they miss the ominous underlying message: the giver won't be alive to use them anymore.”

The clue that is most critical is when people acquire the means to kill themselves. This speaks to the issue of capacity, to the ability to overcome the human instinct for self-preservation. This clue is the easiest to miss, Meyer says, because unconsciously people deny it. Examples are buying a gun, stockpiling medication, or visiting bridges or other jump sites in person or via the Internet.

“Putting these clues together is a horrifying process,” Meyer says. “What if you are wrong? What if you are right?” If you're wrong, the person may lose all trust in you. If you're right, you descend a dark hole and need to summon every ounce of training to see that both the caller and you get out.

At least hotline counselors have the advantage of knowing that callers are reaching out. Part of them wants to die, but another part wants to live. If there wasn't a part that wanted to live, they wouldn't have called. Phone counselors acknowledge the two parts, then talk to the part that wants to live.

I asked Meyer about what keeps her going, and how she has been able to stay in this field so long. “If you saw a child or an animal run into the street,” she says, “and you got them to safety before a car would have hit them, you would feel wonderful. Saving someone from suicide feels the same way—if not even more so. Who wouldn't do this for as long as possible?”

I then asked her if there was any particular call that stood out in her mind. She thought for a minute.

One thing to know about her is that she has a dry sense of humor. On occasion she does stand-up comedy at San Francisco night clubs. She tells me about a person who came from out of town specifically to jump off the Golden Gate Bridge. The person was staying in an expensive hotel, not a Tenderloin flophouse, and called San Francisco Suicide Prevention's hotline. The crisis counselor contacted the police, then talked on the phone with the caller for two hours, only to learn that when the police arrived at the hotel, they didn't know which room the caller was in and didn't want to knock on every door so they ended up leaving. Meanwhile, the counselor convinced the person to go shopping since San Francisco has many famous stores. The caller verbally contracted with the counselor to do that, to shop rather than jump. That's how the call ended.

“We nearly lost them to the bridge,” Meyer says. “Instead, we lost them to Macy's.”

Over the years, Meyer has used logic as well as emotional arguments in an attempt to convince people of the need for a suicide barrier on the bridge. Because neither has brought about any kind of change, she now tries a different tact.

“If one or two golden retrievers jumped off the bridge,” she says, “people would get serious about a safety railing. The public would demand it. Because it's lonely, troubled, depressed souls who are taking their lives, though, no one seems too concerned.”

The reference to golden retrievers might sound whimsical, but among people who work for human service agencies it carries a lot of truth. There's a strong belief that the public, in general, is more sympathetic to the plight of animals than people—especially people who are afflicted by something so misunderstood as mental illness.

Meyer notes that recently there was an international outcry when a woman in Bosnia threw five puppies in a river. The country is war-torn, tens of thousands of people there are hungry and homeless, yet the international community focuses on the deaths of five dogs. That has to change, Meyer and others say. A dog may be loyal and obedient, a comforting companion, while someone who's clinically depressed may seem impossible to know in addition to being difficult to deal with, but behind the illness is a human being with feelings the same as anyone else. People who are mentally ill shouldn't be defined by their illness, just as someone in a wheelchair shouldn't be defined by an inability to walk. The illness or disability is part of who they are, but it's by no means all of who they are.

Another way to look at the issue, Meyer says, is to imagine that the Golden Gate Bridge doesn't exist. A pagan god comes to San Francisco and says, “I'll build you the most beautiful bridge imaginable. People will come from near and far to see it. It'll be one of the wonders of the world. In return, you have to sacrifice 30 people a year. Do you accept it?”

Once, on her way to a Bridge District hearing, Meyer was stopped in the parking lot by a barrier opponent. He said that instead of a suicide barrier, the district ought to put up a diving board on the bridge to make it even easier to jump. “Say that again,” Meyer replied. “Say that they ought to put up a diving board on the bridge so that my son can jump.”

When nameless, faceless people die, the lives of others continue uninterrupted with little or no thought of the deceased. When someone you know dies, especially when it's someone you love and the death could have been prevented, it's different.

Dr. Mel Blaustein is the medical director in the psychiatry department at St. Francis Memorial Hospital in San Francisco. Typically, he sees twenty-four patients each day, at least fifteen of whom express suicidal thoughts. When someone says that he or she plans to jump off the Golden Gate Bridge, Blaustein asks, “Why the bridge?” After all, there are lots of ways to kill oneself. Some of the responses, he says, include “It's classy,” “It's quick,” “It's fail-proof,” “It's the way,” and, “You're with all those people who jumped before.”