Communities across N.C. work to curb suicides amid worsening mental health crisis
CONTENT WARNING: This article references suicide. Please take caution when reading. If you need mental health support, call or text the national suicide and crisis lifeline — 988 — or consult our mental health resources page.
By Rachel Crumpler
Rik Emaus came home one afternoon in August 2021 to find his teenage daughter distraught.
“She just had this absolute look of loss and pain that I’ll never forget,” Emaus said, recalling how he found his daughter sitting on the couch holding a picture of her and three friends in their middle school prom dresses.
She had just found out that one of those friends in the photo had died by suicide.
It was the first of three teenage suicides to rock Transylvania County in three months that year. The cluster of suicides brought the simmering youth mental health crisis to the forefront in the small western North Carolina county of about 33,000 people.
People in the county didn’t initially know how to respond. Silence dominated, Emaus said, as people feared saying or doing the wrong thing. There wasn’t a local group to turn to on the issue; the county’s small health department didn’t have funding for a mental health coordinator.
Emaus, a retired physician, sprang into action after the third suicide. He knew someone had to step up to tackle the unfolding mental health crisis to save other lives in the community. So, in early 2022, he brought county stakeholders together to form TC Strong — a county coalition of youth, school and community leaders working together to improve youth mental health.
“We needed to come together as a community,” Emaus said. “We had to be all in — in trying to understand why the suicides were happening, digging deeper to understand the youth mental health crisis and engaging our youth themselves to be part of developing solutions.”
Transylvania isn’t the only county in the state where kids — and adults — are struggling with mental health issues and suicidality. It’s a statewide and national problem that has become a leading cause of death in the U.S. overall, and it now is the second leading cause of death for people ages 10 to 24.
In North Carolina, addressing the worsening mental health crisis has been the focus of a 12-month UNC Chapel Hill initiative called “Our State, Our Wellbeing.” The UNC Suicide Prevention Institute and Carolina Across 100 — a five-year university initiative looking to work in all of the state’s 100 counties — partnered with 15 teams from 24 counties across North Carolina to identify and implement strategies to improve mental health and decrease suicides.
A map of the 24 counties participating in the “Our State, Our Wellbeing” initiative. During the 12-month project, the counties have bolstered suicide prevention strategies in their communities. Credit: Rachel Crumpler/NC Health News
The initiative’s organizers held a Statewide Summit on Suicide Prevention at UNC’s Friday Center on June 13, to discuss factors contributing to the mental health crisis and highlight work underway at the state and community level to curb suicide deaths. The summit drew 400 attendees from 61 of North Carolina’s counties.
Decreasing the number of suicide deaths is an urgent matter, said Patrick Sullivan, director of the UNC Suicide Prevention Institute.
“This is something that’s killing people every day,” Sullivan said at the summit, noting that the rates are as high as he’s seen in his decades-long career. “We need to address this aggressively and urgently.”
A worsening problem
Suicide is a growing issue in the United States; rates increased by 36 percent between 2000 and 2021, according to the Centers for Disease Control and Prevention. In 2021, 48,183 people died by suicide, amounting to about one death every 11 minutes.
The number of suicides ticked even higher in 2022, reaching an all-time high of 49,476 deaths for a rate of 14.8 deaths per 100,000 people in the population. In 2010, the rate was 12.1 deaths per 100,000.
In North Carolina, 1,412 people — including 104 youth ages 10 to 19 — died by suicide in 2021, according to the latest state data, a number that far outstrips the number of homicides (950) recorded for the same year.
These numbers make suicide the second most common cause of death for children ages 10 to 14 and the third most common cause of death for people 15 to 34, according to the state health department. Thousands more North Carolinians showed up to emergency departments with suicidal thoughts or after attempting suicide.
Map of suicide rates (ages 10 or older) in North Carolina by county of residence in 2021. Some pockets of the state are confronting higher suicide rates. Credit: NC Violent Death Reporting System 2021 Annual Report
Mental health experts say the worsening mental health crisis is driven by many factors, including isolation during the COVID pandemic, bullying, difficulty getting needed mental health care and other stressors.
“I think everybody’s anxious,” Sullivan explained. “The sense of security that all of us had 10 years ago is way less right now. There’s wars in places where there haven’t been wars. There’s things that are terrifying everybody — wherever you are on the political spectrum. I think that’s the human commonality.”
However, Sullivan said some population segments are disproportionately affected by suicide, with rates increasing fastest among people of color, younger people and people who live in rural areas. LGBTQ+ people and military veterans can also be at higher risk of suicide.
“There can’t be a one-size-fits-all suicide prevention,” Sullivan said. “Things have to be targeted to meet people where they are and at a certain point in time.”
Notably, firearms are involved in most suicides in North Carolina, accounting for 64 percent of deaths in 2021. This method of suicide exceeds the national rate of about 55 percent of deaths occurring by firearm.
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