Suicide: Rewriting the Conversation Around Those Who Were Left Behind

In this episode, we explore the aftermath of mental health crises through personal stories and expert insight. Featuring voices of Tamika Christy, Jack Register, and Ashley Holder, the discussion delves into grief after suicide loss, the challenges within mental health systems, and the emotional toll on caregivers and first responders. We also examine how trauma ripples through communities and the evolving ways we memorialize those we’ve lost online.

Key Segments & Topics

• Grief and Suicide Loss: Author Tamika Christy shares her experience after losing a loved one to suicide, confronting stigma and complicated emotions. The conversation highlights how a suicide’s impact ripples outward – one study estimates 135 people are exposed to each suicide death– and how social media profiles of the deceased often serve as “digital gravestones” where friends and family post tributes. Tamika reflects on navigating insensitive questions (like “Do you feel better now that she’s gone?”) and the journey of healing from trauma as both a loved one and caregiver.

• Mental Health Systems & Reforms: Jack Register (licensed clinical social worker and mental health advocate) discusses systemic responses to mental illness. He breaks down the rollout of the new 988 Suicide & Crisis Lifeline, which in its first year received about 4 million calls, texts, and chats – a 33% increase from the previous year – and improved answer times to ~35 seconds on average. Jack notes ongoing challenges for 988, including uneven funding and public awareness gaps. The episode also examines California’s controversial CARE Court program: a new civil court system that lets judges order treatment plans (medication, therapy, housing) for individuals with severe untreated psychotic illnesses like schizophrenia. Governor Newsom touts CARE Court as a “care-first” solution to help people before they become dangerous to self or others, but disability rights groups argue it violates civil liberties by forcing treatment and potentially fast-tracking noncompliant patients into conservatorships (loss of autonomy). Jack helps unpack this legal framework and the debate between public safety and personal rights.

• Caregiver Trauma & First Responder Perspectives: Ashley Holder, a first responder and trauma survivor, speaks to the emotional toll of responding to crises and caring for those with severe mental illness. She highlights the often overlooked suicide risk in serious mental health conditions – for instance, individuals with psychotic depression have a higher likelihood of suicide than those with non-psychotic depression, and research shows about 34% of patients with schizoaffective disorder (which combines mood disorder and psychosis) have attempted suicide in the past. Ashley and Jack discuss initiatives like Crisis Intervention Team (CIT) training for police, a 40-hour de-escalation program now adopted by over 2,700 communities nationwide, designed to improve law enforcement responses to people in mental health crisis instead of relying on force. Ashley also opens up about the mental health struggles among first responders themselves – notes that firefighters and law enforcement officers are now more likely to die by suicide than in the line of duty, due to chronic exposure to trauma and stress. The segment underscores the need for peer support, training (like CIT), and systemic change to support both those in crisis and the professionals who help them.

Resources & References

• Golden Gate Bridge Survivor Regrets – All 29 people who survived a Golden Gate Bridge suicide attempt later “regretted their decision as soon as they jumped.” (Mental Health First Aid training stat, reported by TeacherToolkit, 2022).

• Spanish Flu & Suicide Rates – U.S. suicide rates dropped ~24% during the 1918–20 influenza pandemic and then rebounded ~12% higher in the decade after (Chan et al., Prim Care Companion CNS Disord., 2021). This “pulling-together” effect during crises echoes Durkheim’s theory of social cohesion.

• DSM-5 vs. ICD-11 Definitions – Schizoaffective disorder in DSM-5 requires meeting criteria for schizophrenia plus a mood disorder, including at least 2 weeks of psychosis without mood symptoms (to distinguish from depression with psychotic features). ICD-11 takes a cross-sectional approach: the diagnosis is made only when full criteria for schizophrenia and a moderate/severe mood episode are present concurrently (for ≥4 weeks). Psychotic depression is defined as a major depressive episode accompanied by delusions or hallucinations (“mood-congruent” or “mood-incongruent” per DSM-5 specifier).

• 988 Crisis Lifeline Performance – In its first year (July 2022–July 2023), the 988 Lifeline answered ~4 million contacts (calls, chats, texts), 33% more than the previous year’s volume. Average response speeds improved (most contacts in ~30–40 seconds). However, the system faces challenges: many centers rely on short-term federal funds and need sustained state support, public awareness is still growing (only ~63% of Americans knew about 988 by mid-2023), and some callers remain wary due to privacy concerns and confusion with 911. (Source: Colleen DeGuzman, KFF Health News, 2023).

• CARE Court (California) – The Community Assistance, Recovery, and Empowerment (CARE) Court is a new California law (enacted 2022) creating a civil court process for certain individuals with schizophrenia or other psychotic disorders. It enables family, clinicians, or first responders to petition a court to mandate a 12- to 24-month care plan (mental health treatment and housing). Supporters, including Gov. Gavin Newsom, argue it’s a “no one left behind” approach to get help for those who are homeless or declining due to severe mental illness. Critics (e.g. Disability Rights California, ACLU) warn that it erodes civil rights, forcing treatment on people who may not consent and potentially leading to conservatorship if they refuse to comply. Legal challenges claim CARE Court violates due process and may not address the root problem (the shortage of voluntary treatment options).

• “Digital Gravestones” & Social Media Grief – Personal social media accounts often turn into digital memorials after someone dies. For example, Facebook allows “Memorialized” profiles (with a Remembering banner) where friends and family continue to post memories and condolences. By 2021, experts noted our online accounts “may become like our digital gravestones” – enduring virtual monuments to our lives. This trend raises new questions about managing one’s “digital legacy” and the role of social platforms in the grieving process (e.g. legacy contacts, auto-delete settings, etc.). (David R. Polgar, BuiltIn, 2021).

• Suicide’s Ripple Effect – According to a 2018 study (Cerel et al., published in Suicide and Life-Threatening Behavior), each suicide leaves behind a wide circle of people in its wake. On average 135 individuals are exposed (knew the person who died) and about 1 in 5 of those report that the loss had a devastating or life-altering impact on them. This updated figure (“not six”) underscores that the reach of a suicide loss extends far beyond immediate family – including friends, coworkers, classmates, clinicians, and community members who may also need support.

• Psychotic Disorders & Suicide Risk – Major depression with psychotic features and schizoaffective disorder carry elevated suicide risk. Patients who have experienced psychotic depression have a higher likelihood of future relapse and suicidal behavior than those with non-psychotic depression. For schizoaffective disorder, which combines mood disturbance and schizophrenia-like symptoms, studies indicate roughly 34% of patients have attempted suicide at least once. (By comparison, about 5–10% of those with pure schizophrenia die by suicide over a lifetime, and ~20% attempt, according to psychiatric research.) Careful risk assessment and integrated treatment (addressing both psychosis and mood symptoms) are crucial for these diagnoses.

• CIT – Crisis Intervention Team Training – CIT is a specialized 40-hour training program for law enforcement officers on responding to mental health crises. Launched in Memphis in 1988, the “Memphis Model” CIT program has now been adopted by over 2,700 communities across the U.S.. CIT training equips police to recognize psychiatric distress, de-escalate situations, and divert individuals to treatment instead of jail when safe to do so. Research shows CIT-trained officers use force less often and more effectively connect people to mental health services. (Sources: NAMI, 2020; Dupont et al., 2007).

• First Responders & Trauma – First responders (police, firefighters, EMS, 911 dispatchers) experience frequent trauma and high stress, which has led to disproportionate suicide rates in these professions. A 2021 CDC report noted that law enforcement officers and firefighters are more likely to die by suicide than in the line of duty. In addition, EMS providers have a 1.4 times higher suicide risk than the general public. Studies have found elevated rates of PTSD (e.g. ~1 in 5 dispatchers) and depression in these jobs. These findings have spurred initiatives like the Helping Emergency Responders Overcome (HERO) Act in the U.S., aiming to establish better tracking of first responder suicides and expand mental health resources (peer support, counseling) to this workforce.

Mental Health Rewritten, created by the OWLS Education Company, in collaboration with the Ummah Collective Group is hosted, written and produced by me, Dominic Lawson

Executive Producers Kenda Lawson and Dr. Whitney Howzell

Cover art was created by Alexandria Eddings of Art Life Connections. 

Some music was provided by DJ Krate Digga of the Mighty SoundChampz Crew