As the director of the Tennessee Suicide Prevention Network, Scott Ridgway depends on two dozen devoted volunteers and a reliable car.

“I’m driving 2,000 miles a month,” Mr. Ridgway said. “If we’re really going to address the issues of suicide, we need more staff to cover the areas.”

The 24 volunteers who represent eight regions of the state are devoted to the work they are doing, Mr. Ridgway said. Regional representatives for the network meet monthly, and the entire council comes together three times a year to plan suicide prevention strategies and work in their communities to spread the word.

“That’s the key to making this work,” Mr. Ridgway said. “This group is passionate about their mission.”

The state funds the 9-year-old network with a $140,000 grant, said Lygia Williams, who oversees suicide prevention efforts through the Tennessee Department of Mental Health and Developmental Disabilities.

“TSPN really is our flagship for looking at lifespan issues at a community level,” Ms. Williams said. “Spreading that information widely is an excellent way of reducing stigma.”

However, the statewide group is working against rising suicide numbers.

Between 1996 and 2006, the number of reported suicides in Tennessee increased nearly 22 percent, from 710 to 866. And Tennessee had the highest suicide rate in the Southeast in 2005, according to a January report from the American Association of Suicidology.

Staff Photo by Meghan Brown -- Gloria Hastings facilitates Suicide Isn't The End, a local support group for relatives of suicides at Christ Unity Church. Mrs. Hastingsí brother, Allen King, died of suicide in 2005.

To be most effective, a broad suicide prevention and mental health awareness campaign is needed to inform people about warning signs of suicide and how to respond across all age groups, Ms. Williams said. And as long as suicide is a taboo subject, prevention is a challenge, she said.

“We still have a long way to go,” she said. “It’s a lifespan issue that we really need to look at, suicide from young children to elderly people, and look at those kind of prevention efforts and the stigma issues and addressing those.”

But while a broader mental health education campaign might help dispel some of the stigma surrounding depression and aid in suicide prevention, the mental health care system is not prepared to treat a deluge of new patients, said Dorthy Stephens, vice president of services at the Fortwood Mental Health Center in Chattanooga.

“We continue to struggle with having enough providers,” she said. “If people call and we can’t get them an appointment in a reasonable time, it defeats the purpose. If you do a prevention program advertising and publicizing, you have to have a place people can come today.”

Across age groups

In addition to the work of the suicide prevention network, the state is in the third year of a three-year federally funded program called Tennessee Lives Count.

The $400,000-a-year effort involves training 14,000 people who work with at-risk youth to recognize and respond to the warning signs of suicide. The program marks the first time Tennessee has received any federal money for suicide prevention, Ms. Williams said.

The state also gives $83,500 a year to the Jason Foundation, a youth suicide prevention effort launched in 1997 by a Hendersonville, Tenn., father who lost his 16-year-old son to suicide.

The organization he started at his kitchen table now has 67 offices in 29 states, including one in Hamilton County, Clark Flatt said. In July, the Jason Flatt Act of 2007 took effect, requiring principals and teachers in Tennessee to receive two hours of annual training in youth suicide prevention.

The organization has trained 22,000 educators in Tennessee on the warnings signs of suicide and how to respond, Mr. Flatt said.

“We decided to create these seminars not to scare people but to educate them about the danger of youth suicide,” he said.

Though the number of people ages 15 to 24 who have died by suicide in Tennessee has been stable from 1996 to 2006, suicide is the third leading cause of death in that age group. Each week, he hears from at least one parent who has lost a child to suicide, Mr. Flatt said.

“The problem is so large, no one organization can fix it,” he said. “Hopefully we can encourage each other.”

Meanwhile, the percentage of middle-aged and older adults who have died by suicide in Tennessee has increased steadily.

Between 1996 and 2006, there was a 71 percent increase in reported suicide among people ages 45 to 54 in Tennessee. Reported suicide also was up 58 percent in those ages 55 to 64, and 46 percent in those ages 75 to 84.

Sam Bernard, a Chattanooga psychologist who is chairman of the Tennessee Suicide Prevention Network advisory council, said a focus on preventing suicide in young people long has been the norm.

“It’s been more romantic to save the children,” he said. “We need to put a spotlight on the middle-aged and older folks.”

Improving access to care for older people and making mental health care an equal part of health care coverage are important steps in preventing suicide, said Mark Shively, manager of adult outpatient services at Fortwood.

“Mental health coverage has always been more limited,” he said.

U.S. lawmakers are considering a bill that would increase the percentage of mental health care treatment Medicare covers from 50 percent to 80 percent. Another measure under consideration would require parity in coverage for mental health care treatment.

There is less stigma surrounding mental illness and suicide than there once was, Ms. Williams said, but there is still a long way to go. And progress in overcoming some of those perceptions might account for part of the increase in reported suicides, she said.

“There has been in the past that tendency for coroners to put ‘accident’ just to save face, so to speak, for the family,” she said. “I’m not really sure how much of an increase there is or if there’s just more acceptance and better reporting.”

That doesn’t mean, however, that the stigma is gone, she said.

“It’s still the ‘s’ word, but I think people are much more sophisticated,” Ms. Williams said.

Though it may be more often acknowledged, suicide still is underreported, Hamilton County Medical Examiner Frank King said.

“There’s a whole gray zone between suicide, accident and unknown,” he said. “Some cases are not so clear.”

Seeking support

A couple of months after her brother’s death, Gloria Hastings went in search of support groups for people dealing with the loss of a loved one by suicide. She found just one in the Chattanooga area.

“I thought there would be tons of support groups,” said Mrs. Hastings, an East Ridge resident whose 46-year-old brother, Allen King, died in 2005.

Eventually, several members of that first support group split off and formed another group, which is facilitated by Mrs. Hastings.

“The first group just grew so large, and the needs became so varied,” she said.

But two groups are not enough, Mrs. Hastings said. For each suicide, there are roughly eight people directly affected, she said. In just Hamilton County, which has about 36 reported suicides a year, that means 288 people who are what she calls “the walking wounded.”

“We could use additional groups in our community, a group for adolescents, one facilitated by a clinician,” Mrs. Hastings said.

Aimee Venable, a Ringgold, Ga., resident, is working with an area representative of the Tennessee Suicide Prevention Network to try to create a suicide survivors’ support group for children and teenagers. Since her former husband died by suicide in November, their four children have dealt with tremendous stress and anxiety, she said.

“Try being 14 and everybody’s talking about you,” Ms. Venable said. “There has to be something out there for those kids.”

Mrs. Hastings said it is important for survivors to have a place to talk openly about their grief.

“(In a support group) what people get is a safe venue, an immediate sense of connection,” she said. “There’s no need for small talk.”

Survivors also need help in the immediate aftermath of suicide, which is a bewildering time, Mrs. Hastings said.

A group of volunteers in the Chattanooga area are forming a “postvention” response team made up of counselors and people who have lost loved ones to suicide, Dr. Bernard said. The mission of the team is to go to the scenes of suicides, where family members and friends are likely to be traumatized and confused, to offer them support.

“We want the families to know they don’t have to go through this alone,” Dr. Bernard said.

Several members of the team have been through training and now are launching an effort to reach law enforcement, funeral homes, medical examiners and dispatchers to let them know they are available in Hamilton and nine other area counties.

Mrs. Hastings said she was inspired to participate by the kindness emergency responders showed her the night of her brother’s death.

“Survivors need help, and it needs to start early,” she said. “There are no magic words, there are no pat answers. You can only listen with an open, receptive mind.”

SUPPORT GROUPS:

Suicide Isn’t the End

* When: first and third Wednesday of each month

* Where: Christ Unity Church, 105 McBrien Road

* Phone: (423) 867-7384

* E-mail: stratcat@comcast.net

Living After Suicide

* When: first Thursday of each month

* Where: Memorial Hospital

* Phone: (423) 629-6897

* E-mail: jpowell@bellsouth.net

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