The Patriot-News (Harrisburg, Pa.)

Fifteen-year-old Mark was cutting himself with a razor. When his mother noticed the evidence on his arms, he denied it, then relented and told her the truth.

“He said it was to make him feel alive,” Dottie Wormser, of New Cumberland, Pa., remembers of her son.

Then a teacher at Cumberland Valley High School found Mark’s online journal. “Should I kill myself,” the freshman had written, “or have someone else do it?” That led to a meeting with a guidance counselor, where Wormser told her son she was frightened for him. Mark said she was making too much of it, and threatened to walk out.

Two months later, on Nov. 15, 2000, he killed himself at home. His mother found his body. His suicide note said he didn’t want to be remembered and that his belongings should be thrown out or given away.

“I never knew my son was hurting that much,” Wormser said.

Suicide takes more than 30,000 lives a year in the U.S., twice as many as AIDS. Worldwide, according to the World Health Organization, it kills more people than war and homicide combined.

The tragedy in those numbers, experts say, is that most suicide deaths are preventable.

An estimated 90 percent of victims suffer from mental illness, and “mental illness is treatable,” points out Michael Fitzpatrick, executive director of the National Alliance for the Mentally Ill.

But three years ago, the New Freedom Commission on Mental Health, a special panel appointed by President Bush, concluded that mental illness was underrecognized as a health threat and that the mental health care system was “in chaos.”

“The system is not oriented to the single most important goal of the people it serves – the hope of recovery,” the commission found.

One problem is a worsening shortage of medical professionals specializing in mental health care.

Nationwide, the American Psychological Association estimates that 8,800 people leave the profession each year, with only 2,500 coming out of colleges and universities to replace them. In a report released earlier this year, the association warned that, without financial support from Congress, there will be fewer highly trained psychologists to meet the public need.

Pennsylvania, where the Wormser family faced Mark’s crisis, has 5,658 licensed psychologists for 12 million people, according to the Department of State. But these professionals are concentrated in the larger cities. Nearly 3 million Pennsylvanians live in a county where there is fewer than one psychologist for every 5,000 people.

Hospital space is also in short supply.

Pennsylvania alone has lost more than 3,000 psychiatric beds – 31 percent – since 1995.

The 1990s showed a similar trend nationally. Between 1992 and 1998, psychiatric beds in state-run hospitals declined from 93,058 to 63,525, a drop of 32 percent, according to an analysis published by the National Association of Psychiatric Health Systems. During the same period, the number of private psychiatric hospital beds dropped 23 percent, from 43,684 to 33,635. Though more recent counts were not available, experts said the trend has not reversed.

Administrators blame managed care, which sets reimbursement limits for treatment. Since psychiatric care is complicated, it often requires more time than HMOs allow.

“A general acute psychiatric unit barely pays its way and, in most cases, the units are closed because something else can be done in its place with a higher profit margin,” said Dr. Corey Rigberg, a psychiatrist and vice president for medical affairs for PinnacleHealth System.

When the mental health system doesn’t work, the slack is picked up by family doctors and hospital emergency rooms, which are too often unable to meet the need.

But there are signs of change.

The U.S. Department of Health and Human Services and the surgeon general have developed the National Strategy for Suicide Prevention, which outlines ways to improve mental-health care and reduce suicide deaths. It calls for strategies to reduce the stigma attached to mental illness, to reduce access to guns and other means used to commit suicide, and to develop effective clinical and professional practices as well as prevention programs.

Two years ago, the death of Garrett Smith touched off an effort to stem youth suicide. Smith died in Utah, where he was a college student, one day before his 22nd birthday. He had suffered from bipolar disorder and undergone medical and psychiatric treatments.

His father, Sen. Gordon Smith, R-Ore., pushed Congress to set aside $82 million for suicide-prevention programs. Bush signed the Garrett Lee Smith Memorial Act in 2004.

The bill provides money to schools and grass-roots groups trying to reduce youth suicide and mental-health problems. It is in schools, mental-health officials say, that they have the best chance of identifying at-risk kids and steering them to help.

In Pennsylvania’s Cumberland Valley School District, select staff members are trained to recognize symptoms that could indicate a suicide risk, said Mary Riley, assistant superintendent.

Riley said team members watch for signs of distress and can serve as contacts for students concerned about a friend. They can refer the youth to a counselor or work with the family to find treatment. Cumberland Valley also provides teachers with a list of students treated for illnesses, such as depression.

Still, Riley said there is only so much the school can do without parent support. Though most parents welcome help, some don’t want their children in the programs, afraid of embarrassing the family, she said.

“The more well-known the parents are in the community, the less they want it to be known,” she said.

Indeed, shame and stigma remain obstacles even amid efforts at reform.

“Mental health is the last illness to come out of the closet, like cancer was in the 1950s,” says Fitzpatrick, of the National Alliance for the Mentally Ill. “We need a generation of that discussion to begin to normalize mental illness, to understand that people recover from it if they have treatment.”

That discussion can begin with the families of suicide victims, who often are filled with self-doubt and anger, says Ned Hoffner, a social worker with PinnacleHealth and former facilitator of a suicide survivors group at Polyclinic Hospital in Harrisburg, Pa.

“The death to suicide is a loss that is probably much, much different than any other loss people experience,” he said. “The nature of suicide, that someone would take their own life, leaves a loss … that is qualitatively different. It is never going to go away for these people.”

In the months after Mark’s suicide, Dottie Wormser became obsessed with the fear that her oldest son would kill himself, too. Eventually, she began to think about taking her own life.

“I often say that Mark took himself out of his own personal hell and threw me – and his dad and his brother – into mine,” she said.

Wormser attributes her survival to Hoffner’s Suicide Survivors Group. Members said things she was already thinking and it helped, she says. Meetings became a haven where she could go and not worry about being judged.

She joined the group shortly after her son died. Today, she leads it.

(Garry Lenton is a staff writer for The Patriot-News of Harrisburg, Pa. He can be contacted at glenton(at)patriot-news.com.)

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