If tragedy is a bitter draught, then perhaps there is still the chance of distilling something better from it.
Actor Robin Williams committed suicide on Monday, Aug. 11, and his wife, Susan Schneider, said in a statement that he had been suffering from the early stages of Parkinson's disease, as well as anxiety and depression.
Dawn Brown, director of quality assurance at the Carroll County Health Department, Bureau of Prevention Wellness and Recovery, said that as thoughts turn to Williams' life, career and end, she hopes discussions address the very real problem of mental health issues and treatment.
"These conversations often happen after the death of a celebrity; but, unfortunately, people quickly go back to regular life without using the circumstance to educate themselves," she said. "While the circumstances are unfortunate, it does open the door for us to talk to our community about mental illness, to include awareness, education and a reduction in the stigma that surrounds it."
Brown believes many people struggle with mental illness in Carroll every day, be it depression or panic attacks, short-term or long-term, or chronic. Many times, all it takes is someone — a friend, co-worker, a loved one — to check in and see how they are doing, to offer to connect them with someone to talk to, but because it is often uncomfortable, these conversations sometimes go unspoken.
Brown said it is crucial that people come to understand mental illness is not so different from physical ailments, that it can be talked about and treated in the same way.
"Mental illness isn't talked about in the same way as somatic illness," she said. "If a friend or loved one has been in the hospital for surgery, afterward, you might show up at their house with a card and a casserole. But if someone just got out from a psychiatric hospitalization, nobody is showing up with a casserole."
According to Dr. Miguel Macaoay, chief of psychiatry and medical director of behavioral health services at Carroll Hospital Center, suicide is alarmingly common around the world.
"The numbers are astounding: A million people commit suicide worldwide each year, so it's one death every 40 seconds, I think the number is 36,000 a year in the U.S.," he said. "What contributes to suicide most often is depression and often co-morbid with the depression can be a substance abuse disorder. ... Depression in and of itself is the most common mental health disorder in the U.S."
Depression and suicide are common, but they are also very treatable, according to Macaoay, who adds that the treatments available will work, if people seek help or if those around them help them seek help.
"Suicide is a very serious condition," Macaoay said. "I think when it happens on a celebrity level, it brings forth comments of, 'Wow, they seemed to have it all,' but they are human as well and depression knows no discrimination."
The signs of severe depression are often quite noticeable for those close to someone, according to Macaoay. A person may lose appetite, interest or the ability to pursue work, or even enjoy recreation. Everyone feels the blues sometimes, Macaoay said, but when there are persistent symptoms of depression lasting for two weeks or more, that is a major depressive episode and could be cause for concern.
That point of concern is where many people lose their way, according to Brown. While even those who have no medical training have some inkling of how to help someone who is physically unresponsive or bleeding or vomiting — even if it just means calling 911 — oftentimes people don't know the first steps of helping someone with a mental illness. A good first step is often asking someone if they need help and then really listening to what they have to say, she said.
"It doesn't have to be a professional," said Lynn Davis, executive director of the Carroll County Youth Services Bureau. "Sometimes someone who is close to them, a mentor to them, someone that they respond to, that could help out."
The Youth Services Bureau provides psychological and substance abuse counseling to residents of all ages, and is one of the resources that people can reach out to if they need help beyond what a friend or family member can provide. Davis said it is important that people feel they can seek help, both for themselves and for their loved ones.
"I want people to feel that when they need a neutral party in order to talk about something that they can go ahead and do that. Just as we would go to our primary care physician if something physical was wrong with us," Davis said. "It might just be four to six sessions that sometimes help people get over a hump and move on with their life."
The Health Department can also help connect people to help for themselves or others, according to Brown, and for those who would like to learn more about how to help someone who is in the midst of a mental health crisis, Brown teaches a free course at Carroll Community College called Mental Health First Aid. The eight-hour course, split into two four-hour classes, helps laypersons identify various types of mental health crises and teaches ways they can respond even without psychiatric training.
Brown said it can almost be thought of as similar to training in CPR.
"People are trained in CPR for how to do an intervention for someone that is having a health crisis. They don't become a health professional, but they do develop a certain comfort level," Brown said. "Mental health first aid is the same way. We had a woman in our class that came back to us and said, 'A woman in the bank line was having panic attack, and I knew what to do.' "
The Mental Health First Aid course is held monthly through December and those interested can register through the Health Department.
There are times when no amount of lay training can help someone and when referring them to resources is not enough, Macaoay said, and that is when someone appears to be in clear danger of attempting or has actually made a suicide attempt. In those cases of immediate concern, there are two hotlines that can be called, the National Suicide Prevention Hotline at 1-800-273-8255 and the Maryland Crisis Hotline at 1-800-422-0009.
There is also the option of simply calling 911 or bringing a loved one — or oneself — to Carroll Hospital Center for a psychiatric evaluation. Macaoay said that sometimes people may hesitate to bring someone for an evaluation, afraid that person will be angry with them or might feel betrayed for being taken to get help. But in the end, it is a life that is in the balance, and Macaoay said a person who is not truly a danger to themselves will not generally be kept in an inpatient setting but referred to other resources while those who were genuinely on the edge will change their minds once the crisis has passed.
"We have patients on a regular basis that have contemplated suicide and many have taken that further step of acting on it," he said. "The majority of those patients, once they have worked through that immediate crisis, they will say, 'Thank you for helping me get through this. I realize now that my life is much more valuable and worthwhile. I don't need a permanent solution to a temporary problem.' "
Reach staff writer Jon Kelvey at 410-857-3317 or email@example.com.
•National Suicide Prevention Hotline, 1-800-273-8255
•Maryland Crisis Hotline, 1-800-422-0009
•Carroll County Youth Services Bureau, 410-848-2500
For more information on mental health services for yourself or a loved one, call the Carroll County Health Department at 410-876-4800.
For more information on the Mental Health First Aid course, go to http://www.mentalhealthfirstaid.org/cs/.
To register for the Mental Health First Aid course, contact Jim Bell at 410-876-4800 or firstname.lastname@example.org.