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When it comes talking about issues related to the aging population and caregivers’ needs, we must first have a frank discussion about mental illness and suicide.
A growing number of adults in the United States are suffering from mental illness and taking their own lives. Suicide is now a leading cause of death; suicide rates have increased by 31 percent since 2001. And at least 8.4 million people in the U.S. are caring for an adult with a mental or emotional health issue.
My father died by suicide at age 66. One drumbeat thought I had in the days following his death was: “I've been mourning him for years.” Over and over, I kept coming back to the thought that it felt like the father I knew died a long time before.
After my parents’ divorce, his behavior grew increasingly odd. He began to estrange himself, and when we spoke I could sense his fatigue and hear the obvious effects of drinking. He made a few attempts at communicating while I cared for my mother (his ex-wife) through cancer. She didn't want to see him, and I felt hurt and resentful that he had abandoned her (us) and I was left being the sole caregiver at such a young age. I told him I would contact him when I could, once I was less raw and overextended from caregiving. The rest of our conversations were signs of his failing mental health, which I didn't fully understand. I would receive nonsensical voicemails from him. In one conversation, he thought I was my mother (who had passed on at that time). At that point, I knew something was wrong — very wrong. And then he was gone.
After he died, I spoke with several people who had been more present in his life in his final years. They told stories that stunned me. “Well, he talked a lot about having PTSD from his military service,” said a friend. My dad was drafted for Vietnam but was sent home for failing the physical. He not only never saw active duty, I'm pretty sure he never made it out of Boston. As stories like this trickled out, I gained a greater understanding of his mental state. I wonder how aware his spouse was of his dysfunction (she never knew him in his more stable years) and how difficult it must have been for her to bear witness to his decline and passing.
Mental illness: The signs
Recognizing the signs and symptoms of mental illness isn't always easy. Generally, my father was functional. He worked hard, had friends, enjoyed golf. There was just this jumbo-sized elephant on his shoulder that only some of us could see and should not have ignored, like the alcohol abuse, increasingly erratic behavior and estrangement.
No one stepped in to say, “Something is not right.” Including me.
No one person can stop another from suicide. I read once that it is like thinking that you can stop a raging river by tossing in a pebble. As family members, concerned friends or present or expectant caregivers, we must all inform and prepare ourselves to address mental illness among our loved ones.
Resources that can help
The National Alliance on Mental Illness: an advocacy, education, support and public awareness organization. NAMI can help you learn more about mental illness and find support for yourself or your loved ones.
Al-Anon or Nar-Anon: services for friends and family of addicts. Addiction and mental illness commonly go hand in hand. If addiction is occurring with mental illness, you may benefit from additional assistance that can be found in the shared experiences of a support group.
Adult Protective Services: If you suspect that a loved one has an inability to meet their essential physical, psychological or social needs which threatens health, safety or well-being, contact your local Adult Protective Services agency. You may report your concerns about another's welfare and APS will follow up and recommend services if appropriate.
Suicide Prevention Organizations: The National Suicide Prevention Lifeline, the Substance Abuse and Mental Health Services Administration (SAMSHA), the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center, among others, can provide information and resources relating to preventing suicide or managing after an attempt or crisis. If there is ever an imminent threat of self-harm or suicide, call 800-273-TALK (8255) or call 911 immediately.
If you know that mental illness is or will be a factor in your life or relationships, here are some ways a person with mental illness (and their caregivers) may plan:
• Prepare an advance directive that accounts for mental illness (also known as a psychiatric advance directive). To learn more and see state-by-state forms and information, visit the National Resource Center on Psychiatric Advance Directives.
• Ensure that you prepare health care surrogate designations and living wills that are comprehensive and forward-thinking about other possible medical conditions. Mental illness does not always lead to suicidal ideations or attempts, but it can lead to other debilitating health effects. For example, people with depression have a 40 percent higher risk of developing cardiovascular or metabolic diseases. Free advance directive forms can be found in a variety of places, including here.
• Prepare durable powers of attorney or a trust that names a successor trustee to manage affairs during times of incapacity, and pre-designate a guardian or conservator should a court be called upon to appoint one. Talk to a qualified attorney in your state of residence to inform you on your options.
• Consider creating a wellness recovery action plan that you and your loved one can make together or that you can create independently. It can assist with ongoing wellness tools and creating a crisis plan as well as a post-crisis plan.
At his best, my dad was great: smart, giving, hardworking and funny. Those are his qualities that I choose to hold dear. And while my father's legacy is not his suicide, it has played a major role in teaching me how to be a mental health advocate for myself and others. Through open and honest conversations and planning, we will all be better served and prepared to address the present and growing reality of mental illness in many of our homes.