When 17-year-old high school junior Thomas Smith initially sought support for his depression, his parents blamed his lack of dedication to God and said the pain he felt was a consequence of failing to live a godly lifestyle. Smith lived in a rural area near the Lake of the Ozarks where his father had established a church and became a Baptist preacher. The middle-class family had a longstanding stellar reputation in the town and lived in a fourth-generation farmhouse on the top of a holler with no neighbors. However, nearby there were methamphetamine manufacturers they purposely avoided. After someone under the influence of meth broke into the house when Smith was 12, the fear of violence fueled the Southern machismo gender dynamics within the family.

According to Smith’s high school girlfriend Krista Hanson, a 14-year-old freshman at the time, these dynamics created expectations for a role Smith didn’t necessarily want to fill. Though he hunted occasionally with his family, the only real gun safety education he received was during 8th grade.

Following the break-in, his father equipped himself, his wife, and Smith each with their own pistol, recommending it be kept under their pillows in case of another intruder. This is the same gun Smith would use to take his own life on March 11, 2018, not long after his father died of cancer. Despite multiple suicidal warning signs, his obituary reads, “He departed this life in St. Louis” with no further explanation other than that from family stating, “He couldn’t live without his father.”

“His lack of familial support and the shame he received talking about mental health had everything to do with his passing,” Hanson said. Though Smith sometimes struggled to make social connections, Hanson’s openness to discussing mental health allowed him to share with her his prior history of self-harm. With her support, he reached out to his godparents, but the need to retain the family’s pristine and godly reputation prevented them from taking much action.

Suicide Among Missouri Youth

Suicide is one of the top 10 leading causes of death in Missouri according to the Centers for Disease Control and Prevention (CDC). A study found a 21.8% increase in Missouri suicide rates among young adults 19-24 years old are associated with the repeal of the permit-to-purchase law. In 2017, CDC reported suicide as the second leading cause of death for children and young adults aged 10 to 24 years old, with Missouri ranking sixth in the nation in firearm deaths. While access to firearms doesn’t necessarily cause a suicide, experts historically observe that simply having a lethal weapon available can turn a bad situation into a fatal one.

According to America’s Health Rankings, the most significant risk factors for suicidal behaviors include mental health disorders, substance use disorders, and environmental factors. Environmental factors can include stressful life events and access to lethal means including firearms and drugs. Previous suicide attempts and family history of suicide are also factors that can increase risk of suicide among adolescents and young adults. Poverty also contributes to suicide, especially in rural areas where food and transportation deserts prevent access to necessities. People living in poverty and those experiencing homelessness struggle with mental health challenges due to prolonged stress and lack of physical care which in turn can lead to struggles coping and eventually suicide.

The combination of mental health challenges (and potentially substance use as they often coexist) along with shameful stigmas and access to lethal means can turn a preventable situation into a tragedy. Victor Schwartz, chief medical officer at suicide nonprofit The Jed Foundation, said in an interview that social media can also play a role among adolescents. According to Schwartz, using social media “in a way that detracts from face-to-face interactions” can be especially harmful to mental health. After lockdowns and virtual schooling for more than a year, it is reasonable to expect that the distanced interactions among Missouri youth will make an emotional impact.

Shame from Stigmas Can be Fatal

In rural communities, despite mental health services and other forms of support, many youth and adolescents are shamed out of seeking help. Historically, rural communities have been underserved and forgotten, especially as it relates to funding for basic needs such as health care, transportation, and broadband access, among other things. As a result, many residents within these communities are reticent to receive support – if it’s even available.

The stigmas surrounding mental health are often exacerbated among children, people of color, and those within the LGBTQ+ community. In many cases, the shame they experience prevents them from speaking up before they take their lives. A lack of support or fear of retaliation from loved ones, poor coping skills (often including substance use), and easy access to lethal weapons create a perfect environment for a struggling youth to take their own life – often before anyone realized a problem existed. Evidence from multiple studies shows an association between a firearm in the home and suicide of the gun owner, their spouse, and/or their children.

After opening up to his godparents about his self-harm, Smith’s godparents refused to intervene out of concern for the family’s reputation. Though they were careful not to make it a public spectacle, behind closed doors his parents were extremely judgmental. “That was the before and after moment for him of, ‘we don’t talk about this, I can’t talk about this’,” Hanson said. While not directly intervening, Smith’s godparents did offer him their home and company. Much of Smith’s connection to worship and his father’s church was through music. There he found joy writing and playing music with his godmother, a former pianist.

The death of his godmother, his breakup with Hanson around the same time, and attending University of Missouri in Columbia shortly after – the first time his life did not revolve around church and his father – led him to seek counseling. Smith reached out to Hanson during her second year of college and invited her out for ice cream where he gave an hour-long apology. He poured out regret for his actions in their relationship and thanked her and her family for talking about therapy and offering a safe space to talk about mental health. He mentioned seeing a school counselor and the relief that his parents didn’t have to know.

Two years later, Hanson received a message from a friend on Twitter. Smith had committed suicide. Apparently, his neighbors had been concerned they hadn’t seen him coming and going. A welfare check revealed he shot himself in his apartment with the pistol gifted by his father as an adolescent. His dog was already with a dogsitter, an arrangement set to last about a month, demonstrating a pre-planned suicide.

Despite the warning signs and pleas for help, an effort was never made to intervene, get him medical and emotional support, and acknowledge the dangers of gun use. Ultimately, the shame and stigma against mental health brought by his father rippled through the family, church, and surrounding communities. “It was an echoing chamber of the same ideas coming from the same family tree,” Hanson said. The shame and lack of education surrounding his experiences left him feeling helpless and alone and the pistol under his pillow offered him a way out. Adolescent suicide cannot be addressed without addressing the roles bystanders and family play, especially passing judgment and failing to intervene.

A Community’s Responsibility to Act

I distinctly remember several instances throughout my own adolescence when I recognized that something within me was “off”. One night in junior high around 3 a.m., unable to sleep, I scrawled out a note to my parents begging to stay home from school the following day. Nothing in particular was wrong, but I was inconsolable; I wasn’t sick, but I could not stop vomiting. The only description I could put into words was that my head felt consumed by white noise, like my brain was a television stuck on a static black and white channel that I couldn’t turn off. I felt terrified, insane, and like no one could possibly understand what I was experiencing. When my parents woke me up for school, and I discovered my desperate note underneath their door had gone unnoticed, the shame doubled down. My stomach sank as I scurried to collect and hide the note and I fought back tears as I prepared for school.

These feelings continued through high school and I continued to keep them secret. I reached a breaking point following an emotional falling out with a friend that left me feeling worthless and invisible. Because my family had a history of substance use, all of the medications were kept in tightly locked medicine cabinets or even hidden in safes of which I still don’t know the location. We never owned guns, so when the time came for me to take my life, my options were limited. I tightened a belt around my neck, intent on tying it over the bar in my closet to strangle myself as I had seen once on TV, only to realize the bar would not hold my weight. Following through with my plan without lethal means available meant I’d have to get my hands dirty. I desperately began pulling at the belt, wanting to end my life but terrified by what I would have to do. My mom suddenly knocked on my door and I panicked, throwing on a hoodie to cover the blue ring starting to form on my neck. I frequently think about what would have happened if I had access to something that would have completed the job in seconds.

I don’t blame my parents at all for not catching on to my struggles because I didn’t have the words to communicate them. Therein lies the problem – parents and children both lack the knowledge, terminology, and warning signs to be able to intervene or speak up. When children and adolescents feel shame from their family or otherwise feel unsupported, the likeliness of them to speak up decreases significantly.

Throughout the years in my Kansas school system, and beyond, multiple students committed suicide. One of the scholarships I received was in honor of a fellow dance team member who had taken her life, a scholarship provided by her mother to honor her legacy by supporting young women. Despite the number of incidents over the years, there was never an effort made by the school district to address suicide, firearm safety, or even mental health in general. An opportunity to both support grieving families and students as well as educate a community on the dangers of these intersections was grossly missed.

According to America’s Health Rankings, when someone dies of suicide, the ripples of loss are felt throughout not only the family and close friends but the entire community, even people the person did not know. Suicide within a community can affect anyone exposed to the loss, including inflicting trauma in varying degrees. Leaders within a community – in education, faith-based institutions, health care, among others – have a responsibility to the community to facilitate conversations that work to normalize mental health and reduce stigmas.

In April of this year, a fellow marching band member from Smith and Hanson’s high school committed suicide. His obituary, although similarly worded in that he “departed from this life,” also mentions a request for donations to the American Foundation for Suicide Prevention. He is the 17th person Hanson attended high school with in the Lake of the Ozarks who has died from substance use, drunk driving, or suicide.

Despite remaining in touch with various fellow students, band members and leaders, and teachers on social media, Hanson noticed no one has openly discussed any of these suicides nor the mental health challenges driving them. Students who seek support from the guidance counselor reported it as unhelpful, if not entirely harmful, “advice”; most students don’t attempt to seek help at all. “There are good people but few and far between. If you didn’t fit into that good, conservative, all-American boy/girl persona, you were not accepted.” Hanson said. “These kids are struggling. But there’s been no support or change to help them and the culture in that area is very much the same.”

Combatting Youth Suicide as a Community

As the COVID-19 pandemic continues, and with it continued job loss and financial strain, homelessness, and prolonged stress, we can expect that reports of mental health challenges and rates of suicide will continue to increase. There is a responsibility on everyone involved – at the individual, family, community, state, and national levels – to better understand the intersection of rural poverty, mental health, access to firearms and substances, stigma, and suicide. This includes an examination of gun ownership and safety both within the home and within the legislature, examining the curriculum surrounding mental health in schools, knowledge of and access to support services and resources for everyone in the community (especially those at highest risk), and breaking down stigmas surrounding mental health and suicide.

Those who can and are comfortable speaking transparently about mental health should when and where they can. Normalizing mental health and suicidal ideation helps deconstruct the fear and shame around it and allows others to feel less isolated in their struggles. It also creates a safe space for others who are struggling to ask questions, advice, and seek help taking the next step. By educating yourself and others on the warning signs and risk factors of suicide, you can also help spot a potential crisis before it’s too late.

For people who struggle to understand or believe the gravity of mental health, especially parents who were raised without knowledge or understanding of it themselves, it’s important to remember: no one is expecting you to be perfect or to have the right words and tools. Instead, what’s important is that you offer a safe and supportive environment for someone to open up. Stigma consumes mental health because it’s complicated, coexists with “negative” behaviors, is hard to pinpoint and diagnose at times, and can strain relationships. However, people struggling are not trying to be difficult or a victim on purpose; they simply want to exist as easily as it seems everyone else does.

For those who are struggling and can’t speak up: you are not alone. Call the 24/7 National Suicide Prevention Lifeline at 800.273.8255 to receive support in English or Spanish and learn more about resources available.

Warning signs of suicide, which should be handled delicately, include thoughts, discussion, planning and ideation, talking about feeling hopeless, trapped, or a burden to others, increased use of substances, reckless behavior or extreme mood swings, and withdrawing or feeling isolated. If you believe someone may be thinking about suicide, the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests you:

  • Call 911 or emergency mental health services if danger for self-harm seems imminent
  • Listen without judgment and show you care
  • Stay with the person until they are in a more relaxed and clear-headed state
  • Remove any objects that could be used in a suicide attempt, especially firearms or substances including medication
  • Call the 24/7 lifeline

Learn more about suicide prevention and find resources.

*Names in this article have been changed.