September is Suicide Prevention Month.

Suicide and mental health have been on a lot of people's minds, and stress and isolation from the pandemic have pushed some people into crisis.

That's this week on Nevada Week.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt and additional supporting sponsors.

(Kipp Ortenburger) Suicide has been a problem in Nevada for a very long time.

The CDC ranked Nevada seventh highest in the rate of suicide in 2019, and it's the second-leading cause of death for youth aged 15 to 24 in the state.

Now, the pandemic has made the mental health factors that contribute to suicide even worse.

Well, joining us to talk about suicide prevention are Reggie Burton, founder of the Avery Burton Foundation; Christina Gaglione, clinical supervisor for Serenity Mental Health; Michelle Paul, executive director of UNLV Practice, and Richard Egan, suicide prevention training and outreach facilitator for the State of Nevada.

Welcome to you all.

Before we start the conversation, we want to tell Reggie's story.

Now, we talked to him earlier about his son Avery who took his own life in 2017.

(Reggie Burton) Avery was an amazing young man.

I mean, I know I sound a little bit biased when I say it that way as his father, but he was an incredible kid, just super talented, smart.

You know, if you didn't know him, you would think from the outside looking in that he had his life in order and on a path that he was happy with.

In 2017 Avery graduated from UNLV with a degree in kinesiological sciences cum laude, just living his life doing what he wanted to do.

He wanted to be a doctor so the UNLV physical therapy program, just a really focused kid on what his goals were and what he wanted to do up until the point of graduation.

That's a moment of celebration for many families, high school and college graduation.

With Avery it was different.

There was something different about that graduation.

It was almost like getting to the finish line and realizing that he had won the race, and all of a sudden, there was this rush of stress and anxiety about what was next.

A few weeks after graduation, he came into my bedroom, which as a 22-year-old kid rarely happens, and just sat on the floor.

Furrowed brow, you could just see the stress, and said I don't feel like I want to be in graduate school.

I don't feel like I'll make a good doctor.

I don't think I'll be a good leader.

That was the beginning of what we now know was a major depressive episode or what we call an MDE.

And the other signs and symptoms were pulling away from friends, chores like laundry, he would literally sit on the foot of his bed with his laundry basket between his legs, just could not move.

He could not make it to the laundry room.

And out of the blue I get a text from his girlfriend basically letting me know that he had expressed that he had thought about taking his life.

We did what we felt any parent or family should do-- we tried to love him up.

And we said hey, you've been running the race, the marathon continues, you'll apply to grad school in December which is months away, let's go on vacation.

So we went to our favorite place down in Southern California where I'm from in L.A. and went to the beach, went to visit family.

It just wasn't the same, though.

As we got into the summer months in July, we realized that things were in crisis mode.

I got a text again letting me know that he had gone up to Hoover Dam, and that was his first attempt.

Unfortunately, there was a second attempt, and he was successful.

He took his life at Hoover Dam, and I still remember that day, you know, very vividly.

I was headed to a work function in Downtown Las Vegas and got a message that there was a post on Facebook, and something in my body, something inside me knew that he had left this Earth.

You know, it was just a very surreal experience walking up to the bridge, meeting with the law enforcement officials, and they were taking witness interviews and we got his phone from the ledge of the bridge.

And just standing there, and I don't know what made me ask, but I just asked the officer, I said do you think he could have survived?

And he said sir, we're 1,000 feet up.

I don't think so.

But I didn't want to believe that.

You know, Avery was-- he was a great swimmer, and I thought if anybody could do it, he could do it, that we would just find him, you know, maybe weeks later and somehow he made it to safety, but it wasn't to be.

Depression is like a thief waiting in the bushes, waiting in the parking lot.

When you don't expect it, it somehow comes out and it jumps on you, and if you're not prepared to protect yourself, to respond, that fight or flight, it can snatch you away, and that's what it did to my son.

-Reggie, I want to start with you.

Thank you for telling that story.

It's such an important story, and I know the reason why you're telling this story is so other parents can hear it.

I've watched this once, a second time I've watched it here, and the same thing comes out.

So many things to unpackage, but one main thing is the belief, the faith, the love are things you repeated through this clip, so important.

So important to a child's life, but then also potentially something that maybe makes you miss some of the signs that you're seeing.

Can you speak to that a little bit.

(Reggie Burton) Yes, absolutely.

You know, I think the one catchall phrase that I use is, you know, we do better when we know better, and when it came to depression and mental health, we didn't know very much at all.

I think in the years since what you saw in the clip and, you know, looking back, I mean, there were quite a few signs.

Part of our mission with the Avery Burton Foundation and writing my book, This is Depression, and talking to colleges, talking to schools, talking to students, talking to families, the main thing is we want to make sure that we warn people about the dangers of depression and give them tips to manage adversity and their anxiety, and probably most importantly is connect them with resources.

-And so important to this conversation too is this benchmark that happened in Avery's life, graduation, and as you mentioned, a future that was laid out for him.

This wasn't just a dead end, but yet that seemed to be a big marker.

In other parents you've talked to about this, I mean, are these benchmarks big concern pieces of this conversation?

-I don't know that they are but they should be, and we didn't realize it at the time, but we now know.

When I was doing research for my book, one in four college students suffers from depression, so Avery had joined a very important club relative to mental health, but he didn't know it up until the end.

I think we need to try to do better as parents, as families, to recognize those signs so we can get our young people, our adolescents help and one of the things I tried to do to better equip myself is I got certified in Youth Mental Health First Aid and also Adult Mental Health First Aid assisting adults.

So that's really something that's been able to allow me to speak more effectively and provide more support to families.

-That's great.

We'll talk about that in just a second.

I want to come back to the signs is such an important part of this conversation.

Christina, let's talk a little bit about these signs, and let's go all the way to the beginning of signs from sadness to maybe the beginning of depression.

What are some of the signs that we should be really aware of?

(Christina Gaglione) Well, I'm glad you're asking about the signs, because everybody knows what sadness looks like, you know, everybody experiences sadness and it can look just as sadness and situational.

But when the situation, you know, the sadness kind of disappears, or maybe they're not presenting with sadness, crying excessively or, you know, just what we typically look at when it comes to the symptoms of sadness, doesn't mean that depression isn't there.

The story that you shared about your son, Reggie, where the stress just got so much and he really started to isolate from things and not even able to do something as a simple function of laundry, you know, where that became so overwhelming for him, those are the signs that we have to look out for.

It's when they're not so visible, and they're not so apparent is when it escalates for them, the "no return."

-And that escalate part, let's talk a little bit about that, Rick, too.

This can happen very quickly.

I mean, this can happen almost overnight it seems.

(Richard Egan) Absolutely it can happen overnight.

Any changes in a person's behaviors, attitudes about oneself, the definition says for two weeks, but as a father, if I see a change in any of my children, I'm going to engage with that change and find out what's the driver behind it.

So when we see anything like the isolation or the changes in their ability to cope with daily life, we want to engage with those.

It may not be about suicide.

It may be about a life crisis that you can help with, but it's that clue that you need to have a conversation.

-Now, as parents, the helicopter mom or dad comes in here where you're on your child so much, and I mean, how much is so much here?

-When it comes to life and death and finding out if your child is going through a life crisis, I think it's imperative.

Yes, you still as a parent need to balance that.

I have a 27-year-old that I have to balance that with.

But when I see that change in her that she might need a conversation, I make sure I step out and have that conversation with her because as a parent, I still need to support every one of my children that might be going through something.

-Could I add something to that?

-Absolutely, yes.

(Michelle Paul) I think one of the myths about wanting to die by suicide is that it's just depression.

We think about-- I like to think about it in terms of sources of pain, so it can be emotional pain, it can be physical pain, it can be social pain.

So as pain increases, broadly defined, and hopelessness gets in there as well that this pain will be never-ending, that life is punishing, broadly defined, that is when you're going to have an increased risk of having the thoughts that death would be a welcome solution, for lack of a better word.

So when we're talking about what to look for, it's about looking for times in each other's lives when we might be struggling, and when we ask "how are you," we want to really mean it and stay tuned in.

And for one person, it might not be particularly painful but for a child, in this case we're talking about our teens, it might be, right?

So it's important to be attuned and to listen and to stop and ask and be open to the possibility that somebody is having some suffering, some pain.

-And let's talk more about that, how to approach someone, and of course you could be a parent and you could have intimate conversations with this person every single day, but this could be a neighbor of yours potentially too, you know, or a friend that you don't see a lot.

"How are you" is so important to this conversation but we all say that, and maybe we don't always mean it or we don't ask the follow-up questions.

Rick, what kind of questions, and again, how much of a deeper dive should we be asking on the simple "how are you" here?

-Simply, when you see somebody going through something, I like to use the term "is there something I can do for you," because obviously they're already going through something and if you change the wording just a little bit, perhaps you can come alongside that person and give them the chance to express that pain that they're going through.

When they start to express that pain that they're going through, there's probably some relief going on there.

And then if you get the gut feeling it's about suicide, you ask openly and directly, are you thinking about ending your life?

And if the answer is yes, you connect them to appropriate resources, and a gamut of resources not just one, because for a person to get to that point, there's many things going on so we want to address as many things as possible.

-I want to piggyback on something Michelle said, you know, asking that question is kind of a parent trick that I've learned over the last four years asking that question, how are you doing.

I've taken it a step further and I encourage parents to say "how are you feeling," and that way you get into more of a deeper emotional connection to try to understand their state of mind.

And then just to also add to what Rick is saying about resources, I want to emphasize cultural competence in therapeutics.

Cultural competency is something that's not often discussed, but one of the things that I talk about in my talks is that depression, anxiety-- mental health disorders, anxiety, it doesn't discriminate.

It doesn't care if you're rich or poor, Summerlin, Green Valley, male, female, it doesn't really care.

It's a real health issue, and you have to make sure that you're doing everything you can to direct people to resources that are culturally competent.

If they are an Asian family, well, don't just stop it there.

Are they Vietnamese, Filipino, Chinese, Korean?

Same thing with the Hispanic family and so on and so forth.

So I would really encourage cultural competency in therapeutics.

-Very, important.

Rick, I want to go to you because I think the next question anybody's going to ask is how do you find the right culturally competent services or resources here?

Do we have resources available that can kind of guide us in the right direction?

-We always need more resources, and the state of Nevada is working on bringing more resources here.

But to bring it home, I had this statement, we can utilize what we have more effectively.

So there's Nevada 211, there's places you can call to help with resources.

We found the counselors in the schools, they're very attuned to what is available in that area whether they go to UNLV or a high school or a middle school or elementary because those teachers and those counselors are in those communities, and they're very attuned to what might be available in that area.

When we go to the culturally competent question, ask the person because everybody's past is different and their past brings them to who they are today, and when it comes to suicide, that's very apparent.

So what I would always say is brainstorm with the person.

What could resources for you look like?

There's resources for them to do for themselves.

There's resources for them to work with others, and of course there's other resources out there that that individual might want, so ask them.

-One of those resources we need to mention here is the peer network, the peer network we have, most importantly, and as I just mentioned, one of the most important support systems for young people are their friends.

Now, the Hope Squad is a program used in CCSD schools that uses the connections to help kids who are struggling.

The Nevada Week team talked to a teacher and some students involved in the program at Bob Miller Middle School.

As the stressors of the modern world increase, so sadly do suicide rates, and young people are not immune.

Suicide is the second-leading cause of death for our nation's middle and high school students.

(Evan Paszek) I've seen around my friends and around people at the school how common things like different types of depression or self-harm, suicidal thoughts, things like that, how common that can be.

(Reed Gubler) People will just get really upset and overwhelmed about anything that could be going on with their home or at school.

There could be an issue with the family, and that can lead to depression which can lead to suicidal thoughts.

As a middle school counselor, Lauren Argier sees some students facing emotional problems, including thoughts of suicide.

(Lauren Argier) We see quite a few.

not so much attempts, but a lot of kids talking about it, and when we do hear kids talking about it, we have to bring them into our office and we do what's called a suicide protocol, and every year we see quite a few kids for suicide protocols.

During times of struggle, a sense of hope reduces feelings of helplessness and increases happiness.

Hope can save lives, and that's the goal of the Hope Squad at Bob Miller Middle School.

-Hope Squad is a peer-to-peer suicide prevention program.

Last year was our first year of running the Hope Squad.

It consists of about 30 members, 10 members from each grade level, sixth, seventh and eighth.

Hope Squad advisors train students to recognize suicide warning signs in their peers.

-Some major signs are like cuts on their arms.

Cuts on their arms could mean that they're upset with themselves, and they're trying to hurt themselves, or even just trying to be alone from the world, changing in their mood.

-Our goal is to be able to communicate with this student and be able to refer them to someone more specialized in this area that can help.

So for example a school counselor, someone like that, a trusted adult that we can refer them to so they can get the proper help they need.

It's a lot easier to open up to someone who you can see as more of a friend rather than some intimidating adult.

-When you are able to help someone like that and really possibly change their life like that, it feels good.

It feels like a sort of accomplishment that you accomplished, that you helped someone, that you got a new friend.

-Well, thank you, Heather.

Christina, I want to go to you.

Let's talk more about these proactive preventative measures, of course peer support being one of those.

What else should we keep top of mind here?

-I mean, talk therapy.

Therapy is always beneficial for anybody who could be struggling through something.

Going to a professional, going to anybody in their family who may be experiencing stress and needs just kind of an ear to lean on.

-An ear being so important to this conversation.

Of course we saw it in the clip how important those connections are.

Michelle, let's go to you.

On the training side of things, you're training the next crop of professionals.

What are some of the things that are really key you're looking at on the preventative side?

-So Nevada is 51st in the nation for access to mental health care, and one of the reasons is we don't have enough providers.

So at UNLV we have a coalition of various training programs that work to prepare the next generation workforce, and one of the things-- we have a couple of mental health clinics.

So in terms of access to quality care, we do have low-cost access on our UNLV campus at our training clinics.

With regard to our training, when we talk to students about how to work with suicide, we really ask them or teach them to collaboratively engage with their clients to really understand the drivers.

What are the drivers of pain, and then work on figuring out if we could reduce those drivers, let's do that.

Let's take suicide as a solution off the table, and let's figure out how we can solve some of those problems for you and increase hope and increase connectedness.

That's a huge one.

So these kids at Bob Miller, they're providing connection.

They're saying I see you, you matter, you're not alone.

-Yes.

Let's talk more about this, Rick, this conversation of what connection means in a social media world.

Maybe we can all say we are connected to one another that way, but I know that's not what this is.

What exactly is it when we're talking about something like connectedness?

-So "connectedness" was a term that was in a 2011 report from the CDC.

Connectedness can be the number-one resiliency factor for suicide.

And then over the past decade, a new word came out, "connectiveness," which brings in the social media aspect of it.

At the end of the definition of connectiveness, there's this balance between human connections and online connections, and you want to find a balance because social media can be a source of connection to family, especially if you're distanced from each other, but we also need to balance that with our human connections.

Some of our concerns here in Southern Nevada is 75% of our community members come from someplace else, and if they're coming here, are they rebuilding their connectiveness here?

Can we help our neighbors rebuild their connectiveness here?

Bob Miller Middle School, they actually have the Suicide Prevention Walk happening next Saturday, the 11th of September, which is the end of Suicide Prevention Week, the day after Suicide Prevention Day, and we've been doing this Suicide Prevention Walk for the Nevada Coalition for Suicide Prevention for about a decade at Bob Miller Middle School.

So they are on the front lines of it.

-Yes.

Well, thank you so much.

We really appreciate it.

If you or someone you know is in crisis and at risk for suicide, please call the National Suicide Lifeline at 1.800.273.8255 or text "hello" to 741741.

Now, veterans and members of the military can call 1.800.273.8255 and then press 1.

There are more mental health resources on our website at vegaspbs.org/nevadaweek.

Well, thank you as always for joining us this week on Nevada Week.

You can find us on social media at @nevadaweek.

Thanks again, and we'll see you next week.

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