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According to the American Foundation for Suicide Prevention, 48,344 Americans died by suicide and an estimated 1.4 million attempted suicide in 2018. Nationwide, it is the 10th leading cause of death, while in North Dakota it is the ninth. Over the past few years, the number of deaths by suicide in the state have increased slightly, from 137 in 2015 to 154 last year.

When it comes to suicide prevention, early intervention is key, said Michael Rayel, MD, the newest addition to the Behavioral Health team at Trinity Health. Dr. Rayel is a psychiatrist board certified in general, geriatric, forensic, and consultation/liaison psychiatry.

“When you have suicidal gestures or statements, that’s already a complication of the ongoing emotional problem,” he said. “It’s important not to hesitate. The more you delay, the more they cope using drugs, the more the problems get worse and the more treatment is delayed.”

Dr. Rayel has developed CARE, a four-step process to serve as a First Aid intervention for suicide (as well as depression, anxiety, and other psychiatric disturbances).

CHECK for signs of any psychiatric disturbance.

This includes looking for any signs of depression, anxiety, psychosis, or inappropriate behavior, Dr. Rayel said. Also look for red flags. “Check for any shift or division from the person’s baseline. If a person is typically cheerful and becomes down, that’s not normal for the person,” he said.

Also look out for any functional declines, such as a person who was very hard-working but now their work ethic is slipping.

ANTICIPATE any complications.

“Sometimes, the complication itself is presenting the problem,” Dr. Rayel said. This can include suicide gestures, statements, or behavioral changes such as aggression. “It’s important to recognize and anticipate complications so we can prevent certain disturbances from worsening.”

REMEDY with early intervention.

“This is a very essential step,” Dr. Rayel said. “After you recognize the signs and see the possible complications, you have to do something.”

That remedy, he said, includes acknowledging there is an ongoing problem and that “the red flags are serious and are something important to be addressed;” being alert for any worsening of the psychiatric symptoms; and coping using techniques, such as anger management, improving communication, and “being involved in physical exercise and appropriate nutrition.”

EDUCATE yourself about ongoing issues.

Education is lacking and with so many misconceptions, people do not ask for help, Dr. Rayel said, adding that with education comes reduction of stigma and misconceptions.

“It also lessens shame and guilt. In addition it significantly lessens fear of the individual to address the issue,” he said.

Between 2012 and 2019 in the United States, rates of suicide increased from 12.4 per 100,000 to 14.5 per 100,000. During that same time, in North Dakota rates fluctuated, starting from 15.6 per 100,000. They went down the following year to 14.7 per 100,000 then up to 20.4 per 100,000 in 2019.

The most common cause of suicide is severe depression, Dr. Rayel said. He noted that if it is comorbid with drug problems, it increases the risk.

According to the National Institute of Mental Health, the following are behaviors that may be signs of suicide ideology.

• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty, hopeless, or having no reason to live
• Making a plan or looking for a way to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
• Talking about great guilt or shame
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable pain (emotional or physical pain)
• Talking about being a burden to others
• Using alcohol or drugs more often
• Acting anxious or agitated
• Withdrawing from family and friends
• Changing eating and/or sleeping habits
• Showing rage or talking about seeking revenge
• Taking great risks that could lead to death, such as driving extremely fast
• Talking or thinking about death often
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, making a will

At Trinity Health, inpatient and outpatient services are available for those suffering from depression or suicidal ideation. Services are provided by psychiatrists, psychologists, licensed independent clinical social workers, licensed professional clinical counselors, nurse practitioners, and clinical nurse specialists. Outpatient services, such as crisis counseling and individual, family and group counseling, are available at Health Center – Riverside, 1900 8th Ave SE, Minot. At Trinity Hospital – St. Joseph’s, located at 407 3rd St SE, Minot, inpatient services such as crisis stabilization are available.

The American Foundation for Suicide Prevention also provides opportunities for survivors of suicide loss to get involved through a wide variety of educational, outreach, awareness, advocacy, and fundraising programs.

If you or someone you know is suicidal, please call 2-1-1 or 1-800-472-2911, the Mental Health Association in North Dakota.