What comes after

A devastating loss sparked the creation of a supportive safe place for those dealing with mental health issues.

10:04 AM

Author | Julie Halpert

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Medicine at Michigan

Editors note: Ann Arbor-based journalist Julie Halpert's son died by suicide. She and her family hope his legacy will be the creation of a supportive space where young people with mental health issues can feel safe and less alone.

If you or anyone you know is contemplating suicide, please seek psychiatric emergency services.

My son struggled with occasional depression but felt no shame in sharing his challenges. In our progressive town, stigma is less an issue than it is in other parts of the world; my children's friends discuss their anti-depressants and new therapists in casual conversation just as they would mention their latest jeans purchase. He confided in us, and we were aware of his struggles, especially at the end of high school and in his first semester of college.

We always made sure he had a therapist he trusted and could connect with. During one of his particularly dark periods in college, I hired a U-M musical theater major who provided voice and piano lessons — an experience he particularly enjoyed. We paid for massages and reiki sessions. Whenever he began to isolate himself or seem exceptionally down, we spoke with his therapist. During two occasions when he was particularly desperate, we took him to the psych ER.

We thought we were doing all the right things.

And yet, our lives were forever changed on September 7, 2017. That was the day that my 23-year-old son, Garrett, died by suicide.

Our pain is still raw, yet my family and I are finding purpose and meaning amid Garrett's loss. We feel that Garrett would have benefited from a healing space, with a non-medical focus. We searched the Ann Arbor area desperately for this type of welcoming environment. But we never found it. So we decided to create the kind of place we think our son would have embraced.  

It is called Garrett's Space.

Garrett's big heart

Like many young people whose lives end this way, Garrett was adored by numerous friends and family members, and he knew he was loved. He was kind and the best listener, bright and talented, both a gifted poet and an incredible tennis player — ranked among the top in the state for his class during high school. A psychology major at U-M and a peer advisor in high school, he wanted to spend his life helping others with their mental health struggles. In a bitter twist of irony, he had been working at a foundation focused on preventing suicide among high school students just before he died.

When our son passed away, my husband and I initially attributed it to mental illness and said he had lost his battle with depression. But our daughters took issue with this characterization. They insisted his death was the result of difficulty living in a hard world, and I have come around to this realization. My son thought there was something wrong with him, but there was really something wrong with the world he lived in. The relationship between mental illness and suicide is complex. As the National Alliance on Mental Illness points out, "many individuals with mental illness are not affected by suicidal thoughts and not all people who attempt or die by suicide have mental illness." In Garrett's case, his heart was too big for this world.

Garrett as a young child. ( Photo courtesy Julie Halpert)

Even in the midst of my pain, I have so many happy memories of my son and his big heart and gentle nature. We took yoga on the beach classes together on our family vacations. He would look out at the lake, seeming blissfully content, taking in the wonder of nature.

What I miss the most is his sensitivity and thoughtfulness. Nearly every night until he left for college, he would knock on our door and walk into our bedroom before my husband and I went to sleep and say, "I love you," while giving us his trademark bear hug. He was excited to present me with gifts he knew I would enjoy: chocolate-covered cherries, a freshly baked quiche that he made, fresh flowers and a card that said, "I love you, Mom" on the last Mother's Day before he died. The night before his life ended, we were making chocolate chip cookies together and combing through recipes of dishes we could cook together that weekend.

In the depths of his pain, he needed a safe space that was as sensitive and thoughtful as he was. My husband and I often felt powerless in our desperate attempts to navigate the mental health maze, and we believe strongly that he would have been more willing to accept a warm, welcoming retreat atmosphere that incorporated holistic practices. We would have been happy to have sent him to this type of place anywhere in the country. But we couldn't find it fast enough.

At a loss to find a welcoming and supportive place that our son would have embraced, my husband and I established the nonprofit Garrett's Space to help turn the tide of suicide loss in our community. We plan to create a residential center for young adults facing mental health challenges that will have a non-medical feel. Set in nature, this haven will provide individual and group therapy, coping strategies for broken relationships, support for families, peer support from young adults experiencing similar challenges, as well as a range of holistic options focused on teaching healthy behaviors and promoting wellness, including art, music, yoga, meditation, and cooking.

Because we wanted to start helping young adults right away, this past April we rolled out programming virtually. Young adults meet twice a week for a mood and movement class and a support group with peers along with a social catchup with icebreakers and games. Several faculty and staff members affiliated with the U-M Eisenberg Family Depression Center are working with Garrett's Space in a supportive or advisory role; with their help, we hope to make Garrett's Space a model that can be replicated nationwide.

"Our community, others in the state, as well as throughout this nation, have a significant lack of intermediate care options for individuals at risk for suicide," said Victor Hong, M.D., assistant professor of psychiatry, medical director of psychiatry emergency services, and a member of the board of directors for Garrett's Space. "Our experiences with the individuals we treat tell us this leads to unnecessary mental health crises."

"Too many young people are dying by suicide," said Cheryl King, Ph.D., professor of psychiatry and psychology at Michigan Medicine and a member of the advisory council for Garrett's Space (read more about King's research below). "We need to be proactive in our efforts to recognize suicide risk, and we need to respond to each person at risk in a collaborative way — with effective treatments and services that are tailored to the person's risk profile, personal preferences and needs. By working to offer options that promote behavioral health and wellness, Garrett's Space is beginning to fill a critical gap in the services to our young people." 

( Illustration by Neil Jamieson)

Social media vs. authentic connections

Before Garrett's death, I covered mental health issues as a journalist, so I was well versed in all the research.

In 2015, for a Good Housekeeping article, I was assigned the heart-wrenching task of interviewing the freshly grieving mothers of two middle school soccer teammates who took their lives within a short time of one another. Two years later, in August, 2017, I met with parents who lost their 15-year-old son to suicide. That was for an article I wrote for The Ann Arbor Observer in response to an escalation of suicides in Washtenaw County. Just three weeks after that meeting, those parents were in my living room paying me a condolence call.

Too many other parents are finding themselves in a situation similar to ours.

My son is part of a frightening epidemic among young people. In Michigan, where I live, suicide is the second leading cause of death among those ages 10 to 24, a rate that has increased by 33%. Nationally in that age group, 4,600 are lost to suicide each year. In the county where I live, nearly 16% of 5,000 middle and high school students surveyed recently said they seriously considered suicide. According to a CDC survey, one-quarter of young adults surveyed during the pandemic indicated they seriously considered suicide during the prior 30 days.

Garrett's death shocked so many people because he seemed to be the last person who would have wanted to leave this world. "That could have just as easily been my son," was a common refrain we heard from many parents.

I now believe that the rise in depression and suicides among young people isn't necessarily because more of our children are mentally ill.  Young people today are growing up in a divisive environment full of turmoil. They face tremendous pressures to achieve and live up to their parents' high expectations. Social media can cause young people to feel inadequate compared to their peers' digital selves, which often display an artificial portrait of happiness. They're often connecting in a superficial instead of a meaningful way.

What you can do

Sometimes you can do everything right, and it's still not enough. Since you can't read your child's mind, it's often impossible to know what they're thinking and feeling. Based on my experience, I'm sharing some measures you can take to create a supportive, open atmosphere that I hope can help to head off some mental health struggles.  

Often since our son's suicide, we have been approached by parents whose young adults are struggling, and we try to provide guidance on where to turn. I have found that the following information and advice has been helpful to other parents, and I share it here to further build awareness.

  • Be proactive in order to counter negative influences. Send the message from an early age that you love your child because of who they are, not because of any external accomplishments.

  • Nurture authentic connections and friendships between your child and those they can bond with, whether it's through extended family, religious groups, sports or artistic pursuits. Fight the feelings of isolation by helping them find like-minded young people and those who just love them for who they are.

  • Create a village of other adults. A recent study by Cheryl King, Ph.D., professor of psychiatry and psychology at U-M, found reductions in suicides and drug overdoses among children who designated four caring adults who were trained to support them. The intervention is known as Youth-Nominated Support Team. Garrett's Space Wellness Group participants will be able to participate in this program, thanks to a grant from the Michigan Health Endowment Fund in support of a unique three-party collaboration among U-M, Washtenaw County Community Mental Health, and Garrett's Space. Having another adult to turn to in a crisis can be particularly valuable if children are reluctant to confide in a parent. Creating that village can help cultivate a sense of belonging, sending the message that they matter.   

  • Watch for warning signs, like if your child is withdrawing from family activities and self-isolating, seems uncharacteristically distant, or begins engaging in irresponsible behavior. Be on the lookout for changes in their physical appearance, school or work performance; or if they're sleeping too much or not at all. 

  • Let your child know that there is no shame in feeling sad or depressed. If you're observing any worrisome behavior, encourage your child to share any struggles they're experiencing — since letting you in allows you to get them the help they need.

  • Be particularly attuned to whether your child has experienced a breakup of any kind of relationship, either of a romantic nature or even with a close friend. These events can be incredibly traumatic, especially if your child is preoccupied with scrolling through social media where everyone appears blissful. Acknowledge their pain, listen to them cry if they'll let you, and normalize the situation, maybe even sharing a story of a difficult time you had as a young person experiencing the end of a relationship that meant a lot to you.

  • Trust your instincts. If you are the least bit worried about your child, seek professional help. Ask the therapist if it's possible to meet privately to let them know what you're observing in your child and ask if they can provide feedback on how best to help your child. Peer support groups are another option that can show your child that others are facing similar struggles.

  • If your child refuses to accept help and seems particularly desperate, ask whether they are thinking about killing themselves. Many parents think that asking the question will put suicide in their child's head, but, according to The National Institute of Mental Health, that's simply not true. If you have the slightest concern that your child may harm themselves, take them to the psychiatric emergency room.

I must live every day with the pain of knowing that, despite our best attempts, we could not save our son. Still, I believe that creating a loving, accepting environment sets a strong foundation. I hope and pray that you won't find yourself desperate for the supports we needed — and that didn't come fast enough.

We lost Garrett very shortly after he started spiraling downward. The most important piece of advice I can offer as a survivor of suicide loss is to be present with your child — both when they're happy and sad. Listen to them. Tell them often how much you love them and how grateful you are that they're your child. They may roll their eyes or appear not to be listening. But trust me, they are. I so wish I had the chance to hold my precious son in one more loving embrace. Instead, I'll have to settle for taking comfort in the many happy memories we shared before his life ended far too soon.

Additional research, programs and tools

The power of a trusted adult

King, a leading expert in child and adolescent suicide prevention, has studied teen suicide, and ways to prevent it, for decades. In 2019, she and her colleagues from the Department of Psychiatry reported some compelling findings of their study on Youth-Nominated Support Teams.

A Youth-Nominated Support Team is a group of trusted adults, chosen by a high-risk teen, to help the teen recover. These adults receive tailored education about the teen's mental health concerns and how they can be helpful to the teen. The idea is not to replace medications and mental health therapy, but to bolster them. "It's based on the simple insight that the adults in teens' lives are a powerful untapped resource," she said in a 2020 TEDMED talk.

The research team tracked deaths among hundreds of young adults who were hospitalized for suicidal thoughts or attempts during their teen years, and were enrolled in a study run by the U-M team in the early 2000s.

Half of the young people in the study had been randomly assigned to receive the extra support of a Youth-Nominated Support Team. The other half received the usual levels of care for the time.

More than a decade later, far more of the young people who got standard care had died, compared with young adults in the group who had received the extra adult support.

Although the study can't show cause and effect, it shows a strong association between this support team approach and a reduced overall risk of early death, and specifically a reduced risk of death from either suicide or drug overdose of undetermined intent.

—Kara Gavin

CASSY predicts teen suicide risk

King and her team, along with researchers at the University of California-San Francisco and the University of Pittsburgh, have created a screening tool that accurately predicts teen suicide risk. And in early 2021, they published results of a study in JAMA Psychiatry that validates the tool's efficacy.

The Computerized Adaptive Screen for Suicidal Youth is able to predict a suicide attempt within three months. CASSY is designed to be used in emergency rooms through a brief and efficient system that doesn't disrupt care. When an adolescent or teen is admitted for any reason — whether it's a psychiatric complaint or something unrelated like a sports injury — they complete a questionnaire on a digital device.

Adolescents are asked about suicidal thoughts but also other factors that may put them at risk, such as sleep disturbance, trouble concentrating, agitation, depression and hopelessness, and issues with family and school connectedness. The combination of risk factors is what determines a score for their suicidal risk level.

Follow-up questions are based on their answers so that the screening is tailored to the individual patient.

"About half of the youth who die by suicide have never received any mental health services and some die on their first suicide attempt," said King. "We saw an urgent need to improve proactive, universal suicide screening of young people."

—Beata Mostafavi

Inspired student helps others

Lily Dickinson, a student in Asheville, North Carolina, didn't know what to do when she began experiencing depression in high school. She was unsatisfied with the mental health support in her school and community.

After reading about the successful peer-to-peer programs at the U-M Eisenberg Family Depression Center, she made it her mission to create a program modeled on the one at U-M that would bring mental health awareness to her classmates and community, according to a story in the Asheville Citizen-Times.

Dickinson and her classmates spent three years developing a peer-to-peer program. In 2019, Dickinson began college at the University of North Carolina at Chapel Hill, where she continued to work on her goal of getting mental health education in school curricula in Asheville.

"We've seen a shift in the last decade in terms of this generation really getting behind the idea that other students need to be educated about this," said Stephanie Salazar, M.P.H., outreach and education program manager for the U-M Eisenberg Family Depression Center.

"I think the students are in a place where they can notice when their peers might be struggling," Salazar said. "If I came in and did a presentation, it would not be nearly as impactful than if they heard from their peers."

This article originally appeared in Medicine at Michigan.

More Articles About: Health Management anxiety Adolescent Psychiatric Treatment Mental Health Assessment Pediatric Psychiatric Treatment Community Health Patient Safety Health Screenings Children's Health Mental Health
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