TYLER, Texas – In the heart of northeast Texas, Tyler’s rolling landscape is dotted with churches and historic homes, and the town is known for its roses and flower gardens. But the community is also clouded by a grim statistic, one that leaders are struggling to better understand and address.
Smith County, which encompasses Tyler and is home to more than 225,000 residents, has the highest suicide rate among the state’s 25 most populous counties.
From 2012 to 2016, there were 17 suicides a year per 100,000 people, compared to 12.2 suicides statewide in the same five-year period, according to the system researcher’s most recent analysis. from the University of Texas (UT), Eileen Nehme. (Nationally, the rate for 2016 was 13.5 suicides per 100,000 people, or about 44,000 deaths per year.)
Another report, also conducted by researchers from the UT system, found that the suicide rate in the greater 35-county region of northeast Texas was 43% higher than the statewide in 2014. .
These rates are age-adjusted. Since almost all causes of death vary by age, if you compared the death rate from stroke in an older population to the death rate from stroke in a younger population, you would expect the rate is higher in the elderly population. Age adjustment reduces the effects of age differences between populations.
Local and state leaders offer various theories about the region’s greater vulnerability. It suffers from a shortage of mental health services and higher use of opioids than in some other parts of the state. It also has a higher percentage of non-Hispanic white residents than in the entire state, a demographic with significantly higher suicide rates, and an ingrained mix of religious beliefs, individualism, and a strong sense of privacy that may prevent some from seeking treatment for depression and other stressors.
“I think the stigma is so big here,” said Valerie Holcomb, a professional counselor licensed by Tyler. “There is a kind of mentality of pulling yourself by your bootstraps.”
But in recent years, local efforts to address suicide rates have begun to intensify, according to Holcomb and others.
UT’s Health Sciences Center at Tyler, which provides medical services as well as training for new doctors, did not have a psychiatric unit until 2013. With the help of public funds, he added psychiatric beds and a residency program for psychiatrists. The Smith County Sheriff’s Office now employs two officers trained in mental health issues who frequently respond in an unmarked car without flashing lights or sirens and attempt to get people in crisis to psychiatric help without arrest or handcuffs.
Local efforts to fight stigma include a suicide prevention walk and an annual mental health conference in Tyler.
Perhaps most significant is the formation of the Smith County Behavioral Health Leadership Team, accredited in 2015, which holds meetings with dozens of local mental health officials at least every two months to discuss gaps and treatment solutions.
They describe a new openness to discussing the foundations of suicide – inextricably linked to mental health and addiction issues – and an increased effort to improve services and maximize those the community already has.
“I believe we’re on the right track — we’re not there yet,” said Dr. Jeffery Matthews, who chairs the department of psychiatry and behavioral medicine at the UT Health Science Center here. “We have a lot to learn and a lot to do.”
Smith County’s higher suicide rate may be partly shaped by demographics, as the statewide rate is three times higher among whites than among Hispanics or blacks, Molly Lopez said. , clinical psychologist and principal investigator of the Zero Suicide in Texas Project, a federal agency. funded initiative to initiate local prevention efforts. In Smith County, 60% of residents are non-Hispanic white, compared to 43% statewide, according to data from the US Census Bureau.
Opioid use may also contribute to some suicides, said Andy Keller, president of the Meadows Mental Health Policy Institute. The Texas-based nonprofit research organization recently completed a report on substance abuse in the state that showed Smith and some neighboring counties had experienced above-average rates of opioid-related deaths.
Opioid addiction, Keller said, both erodes one’s ability to build a happy, productive life and “lowers your inhibitions, so you’re more likely to act on your impulses.”
Dawn Franks, project coordinator for the County Behavioral Health Leadership Team, credits local attorney Doug McSwane and his wife, Mary Mozelle “Mo” McSwane, with providing much of the local momentum, after the suicide of their son in 2012.
Since then, other local professionals have shared their own stories, pulling suicide from the shadows, Franks said. “It was suddenly a time when people could start talking about it and not be ashamed of it,” she said.
Symptoms and stigma
Shortly after Patrick McSwane’s sophomore year at Texas Tech University, Doug McSwane received a disturbing phone call. His 20-year-old son wanted to know why his father had joined the mafia and authorized the implantation of a chip in Patrick’s head.
For nine years of ups and downs, Doug and his wife sought medical advice in Texas and elsewhere to help Patrick get rid of the hallucinations and delusions of schizophrenia.
“Patrick was a warrior,” Doug McSwane said. “He fought his illness with everything in him. And we lost.
Patrick McSwane (second from right), with his parents, Doug and Mary Mozelle “Mo” McSwane, his sister, Marcie, and his brother, Ryan, in May 2012, several months before his death. The family was celebrating Ryan’s graduation from Texas Tech University in Lubbock. (Credit: Janet Romine)
One of the most challenging aspects, as the couple recently described while sitting in the living room of their Tyler home, was the acute sense of isolation. Mo McSwane tried to share her ongoing worries about Patrick with friends, but didn’t make much headway. Religious beliefs and the stigma of mental illness, which she acknowledged are now beginning to change, can frame perceptions, she said.
“We are here in the Bible Belt,” she said. “I think sometimes people in churches think you can pray something. You wouldn’t say that to someone who was diabetic.
The first time Patrick threatened to kill himself, in 2004, Doug McSwane called the police, who took Patrick away in handcuffs. McSwane was then forced to testify that his son had to be involuntarily committed for his own safety.
“I think it’s the hardest thing I’ve ever done,” he said, choking.
After that, Patrick generally continued to take his medication, his parents said. He completed his college education at the University of Texas at Tyler and earned a master’s degree in psychology there.
But in the last year of his life, he took his medication more sporadically.
Patrick was sitting in one of the family cars on a country road outside Tyler, carrying his favorite cross, when he took his own life. “The policeman told us he was playing his Christian music as loud as he could,” his mother said. Music had always eased Patrick’s symptoms.
“We don’t know how he got the gun,” Doug McSwane said. “I had taken all the weapons out of the house.”
Fix the safety net
Grieving and wanting to shed light on mental health needs, Doug McSwane launched the first Peace of Mind Tyler Conference in 2014. He also co-chairs the Behavioral Health Leadership Team, which met in late March around sandwiches in the basement of an Episcopal church. .
In the entrance hall of the McSwanes’ home is a bowl filled with letters the couple received after the suicide of their son Patrick, who battled schizophrenia. (Charlotte Huff for KHN)
They heard an update on a long-term goal, to raise over $2 million to build a 48-hour psychiatric unit to help with immediate diagnosis and stabilization, easing pressure on local hospitals. A local pastor described an upcoming event for church leaders focusing on mental health issues faced by veterans.
Tyler — the largest city on a nearly 200-mile stretch from Dallas to Shreveport, Louisiana — serves as the medical center for this largely rural region of the state. During the meeting, Matthews described how the UT Health Sciences Center at Tyler now has 44 publicly funded psychiatric beds on-site and a staff of eight psychiatrists and four psychologists.
Meeting mental health needs in Smith and surrounding counties is still difficult, Matthews said later. “We have a waiting list to access our patient services even with” the new resources.
For their part, the McSwanes are now trying not to overthink the “what ifs”: if only there had been a trained mental health worker, or more psychiatric beds closer to home or less of the stigma that has isolated Patrick and the family.
But their silence ended around the time Patrick died at age 29.
Her siblings, Marcie and Ryan, wrote about their struggles with mental illness on Facebook. Doug McSwane spoke candidly at Patrick’s funeral. They were inundated with phone calls, visits and pans.
In the hallway of their home, a large bowl is prominently displayed, filled with the cards and notes they received. “I keep it, just like a representative of love,” said Mo McSwane.
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