The phone rang at 6 a.m. The voice on the other line only said a few words that Terry Mullan needed to take action.

The voice belonged to a man we will call John to protect his privacy. He told Mullan he was up all night with a loaded gun, and he needed someone to give him a reason not to use it.

Mullan jumped in his car and spent the next 12 hours talking to John.

According to the American Foundation for Suicide Prevention, suicide is the 10th leading cause of death in the United States with 44,965 deaths each year. For every suicide there are 25 attempts, cites the foundation. In Washington, 1,137 people take their lives each year, according to the foundation’s data. For more info, visit afsp.org.

In San Juan County, the average suicide rate from 2013 to 2015 was four, according to reports by the San Juan County Coroner’s Office. However, in 2016, there were six suicides and in 2017 there were four.

According to the San Juan County Sheriff’s Office, suicides attempts are more frequent: 15 in 2012, 17 in 2013, 15 in 2015, 19 in 2016, and 21 in 2017.

The coroner makes the final determination in the manner of death. Local statistics could be low due to suicides being listed in the Sheriff’s Office system as “death investigations.”

“With death investigations, we may see signs that point to a suicide, but until the Medical Examiner looks into it we don’t always know for certain,” said San Juan County Sheriff Ron Krebs.

Prevention

According to the Suicide Prevention Lifeline organization, in order to know how to prevent suicide, one must understand the risk factors involved, which include: mental illness, substance abuse, a history of trauma or abuse, major physical illnesses, loss of job, family history of suicide, loss of a relationship, easy access to lethal means and exposure to others who have committed suicide.

Another factor of concern is finding help for those with mental illness and substance abuse problems who do not have access to health care.

The Suicide Prevention Lifeline’s website also lists the warning signs when it comes to a loved one threatening self-harm. These signs include:

– Talking about wanting to die or to kill themselves

– Looking for a way to kill themselves, like searching online or buying a gun

- Talking about feeling hopeless or having no reason to live

- Talking about feeling trapped or in unbearable pain

– Talking about being a burden to others

– Increasing the use of alcohol or drugs

– Acting anxious or agitated; behaving recklessly

– Sleeping too little or too much

– Withdrawing or isolating theirself

– Showing rage or talking about seeking revenge

– Extreme mood swings

Read more at suicidepreventionlifeline.org/how-we-can-all-prevent-suicide.

If you have a friend or a loved one who displays any of these signs, the Suicide Prevention Lifeline staff urges you to call 1-800-273-TALK.

The organizations also list ways you can interact with someone who is expressing suicidal thoughts, including including listening and using non-judgmental language, removing means like weapons or pills and not acting shocked or being sworn to secrecy. Read more at suicidepreventionlifeline.org/help-someone-else.

Gary Waters, a behavioral health consultant at the PeaceHealth Peace Island Medical Center on San Juan Island, advises that the best way to prevent suicide is to seek medical help. Behavioral health is another term for mental or emotional wellbeing, including anxiety, depression, stress or self-harm. At PeaceHealth, medical doctors are integrating physical and mental health when they treat islanders.

“Many doctors at hospitals prescribe pills and send them [patients] on their way,” said Waters. “We know that people can transfer emotional distresses into physical problems and vice versa.”

So if you visit a doctor at the medical center and express thoughts of self-harm, you will also be treated by a behavioral health consultant.

Waters has worked on the island for three years. He has more than 42 years of experience in wellness education, crisis prevention and treatment for mental illness.

“Many people don’t see an option out,” he said. “I try to find that option and give an opportunity.”

According to Waters, resources are available beyond counseling like prescription medications, and if needed, people can be admitted to a higher level of care.

PeaceHealth provides free services for people in need to be transported to a treatment facility off the island.

If someone is having difficulty accepting help, Waters said it’s important to tell them, “I’m here anytime you want to talk.”

If the person has the intent and the means to harm themselves, it’s necessary to get them to the ER or call 911.

“You have to break that glass to make sure the person is safe,” said Waters.

He stressed that often the best prevention is to initially get them to see a medical doctor, as often people trust doctors who deal with physical ailments. The stigmas related to suicide can also prevent people from talking about their feelings, said Waters.

“If you are talking to someone and they want to hurt themselves you can say, ‘You know, I really care about you, and I feel very responsible to do something. I think you need to talk to your doctor today,’” he said.

It’s OK to ask someone if they are thinking of hurting themselves, added Waters; that does not increase the risk.

For Mullan, his experiences with Alcoholics Anonymous made him an ideal candidate to receive a call for help.

“The coping skills I gained from the program helped me,” said Mullan, explaining that he learned how to talk and listen to other people going through hardships.

John and Mullan were more acquaintances than friends, but they knew each other from AA so their knowledge of one another’s past was intimate.

“We weren’t close friends so that might have been why he reached out. Sometimes, we worry our friends will judge us,” said Mullan. “It takes a lot of courage to reach out to someone outside of your circle.”

Resolution

The morning John called Mullan, they eventually sat on Buck Mountain overlooking the Salish Sea, and he listened as John talked about his life.

“I told him all the reasons he needs to live … his wife, business, friends and family,” recalled Mullan. “Often people don’t realize how suicide has a cascading effect.”

Mullan’s advice to islanders who have a loved one in crisis is, “Say yes immediately. If you get the call, just say yes.”

If you need help, contact the following services:

Nationally

The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress, and prevention and crisis resources for you or your loved ones at 1-800-273-8255 for more info, visit suicidepreventionlifeline.org.

Locally

Mental health crisis services are available 24 hours a day, seven days a week through the 24-Hour Mental Health Care Crisis Line (toll-free) at 1-800-584-3578, as well as the crisis chat at www.imhurting.org.

Compass Health, located in Friday Harbor, is a private, nonprofit behavioral health agency that provides outpatient mental health and substance use disorder services in San Juan County for children and adults. Services include psychiatric evaluations, medication management and referrals to residential treatment off the islands. For outpatient behavioral health services in the county, contact Compass Health at 360-378-2669.

The Orcas Community Resource Center administers the Community Wellness Program, which offers low-cost access to mental health care for approved, uninsured Orcas Island residents. Program participants are eligible to receive 12 counseling sessions for a sliding scale copay of $5-$30 per session.