On June 20, Jeremy Carter woke up and decided he could not keep living. He was not angry or dramatic about it. He was numb. He was a little scared, but only because he was not feeling the kind of fear he thought you are supposed to experience.
“I went to my therapy appointment that morning and told my therapist I didn’t want to be alive anymore. They did what they were supposed to do and called resolve Crisis Services…I left the office before (they) arrived and drove to a bridge just outside Pittsburgh…When I got out of the car and started walking, I noticed a 988 suicide hotline sign bolted to the railing. I kept moving,” Carter wrote in an essay published in Pittsburgh’s Public Source. “As I climbed the rail, a woman stopped and shouted at me to get down and talk. It was all a blur and I have no idea what she said. But it was enough to break the fog, and I stepped off the railing. I turned around and walked back to my car…I was alive, but I had no idea what I was supposed to do next.”
Carter, a social worker residing in Allegheny County, was met with neglect from the industry. Working in mental health services offered him a baseline understanding of the flaws in the system, but nothing could have prepared him for how bad the problem was.
“Unlike some suicide attempts where you end up in the hospital and then are forced to go to treatment, mine was voluntary because police and first responders weren’t involved. It was two days after the attempt when I checked myself in for intensive outpatient. And I have to tell you, even though I am a social worker, I was scared to go in,” he said.
In order to receive treatment after the fact, he had to admit himself. That is something that takes a lot of courage, and many people do not end up pursuing that path. Admitting you need help, exposing yourself to that vulnerability, is scary.
“Going through the system, trying to get help, kind of made my mental health worse than it was when I attempted. That really made me want to shut down and give up on seeking help. Every door was closed. At a certain point I was like, ‘Why don’t I just give up?’ ‘Why don’t I just go back to how I was before and pretend like nothing’s wrong?’ But in time, after a lot of the events happened, I realized I’m not just going to give up and accept that the system is broken,” Carter said.
The culture surrounding the mental health industry can be counter productive. People are afraid to discuss severe topics openly; the system itself shies away due to fear of liability, and the public avoids talking about suicide out of discomfort. There is a common misconception that asking someone if they are having suicidal thoughts will plant the idea in their head. The reality is, they’re probably already thinking about it.
“I had a general awareness of it because so many clients reported that they kind of felt like they fell through the cracks. They often don’t complete treatment because it was traumatic and harmful to try to seek help. So when they’re traumatized trying to seek help, they’re not usually going to follow up on treatment,” Carter explained. “When I went through the system myself, I was shocked at just how inadequate the system was in terms of trauma-informed care providing resources. In my essay I pointed out they said I declined peer support and service coordination. I would never have declined that. It was eye opening to go through the system myself and see our clients were right. This is failing a lot of people.”
While group therapy services do exist in Allegheny County, most inflate victims’ fear of sharing their honest experiences and feelings. The fear of liability overpowers the ability to speak openly about suicide. A clinician or mandated reporter is always present, preventing people from feeling safe to talk about their thoughts.
“On the system and provider end, they do tend to shy away because of that fear of liability. Even my therapist that I went to, before my attempt, really kind of shied away when I started to bring it up; and then immediately called Resolve. It seemed to be systemic that even therapists shy away from it. That has to change,” he said. “The thing we need most is for you to talk to us, to let us know you care, and offer a listening ear,” he said.
While doing research into the services currently available to individuals struggling with mental health, one factor stood out: there were no peer-led support groups in Allegheny County.
“When I got out of intensive outpatient, I knew I still wanted some kind of support. The group therapy was not great for me. So, I started calling around different places. I called the county, I called Mental Health America, I called NAMI [National Alliance on Mental Illness], and everyone there told me, ‘it doesn’t exist.’ Then I talked to someone at NAMI, and I said, ‘Okay, I’ll accept that this doesn’t exist, but why not?’ They said, ‘Well, you know, we’ve had it as a goal for us for a few years, but no one’s really taken the lead to do it.’ And I said, ‘Then let me do it.”
It was there that the idea for Still Here was born.
“Still Here” is the first peer-led support group for adults in Allegheny County suffering from suicidal ideations. The sessions are in-person, and you do not need to live in the county to attend. Some people drive hours for this service, as nothing comparable exists in their county.
At the first meeting of Still Here, 20 people showed up. Everyone participated and shared their thoughts and feelings. It became very apparent that something of this nature was needed. Some enjoyed the meeting so much that they suggested meeting twice a month.
People suffering from suicidal ideations often have them without a clear plan or intention to commit; it is important they know others are going through the same thing. They are not alone. Instead, they are terrified of being pulled aside, and referred to crisis services, leading to conversations that don’t help. That is why it is important for support groups to be facilitated by someone familiar with such circumstances.
“When I asked different groups, including in Allegheny County, why didn’t this exist already, the answer I got from almost everyone was their fear of liability and risk. My answer back to all of them was, ‘so you’re scared of liability and risk for having this, but you ignore the liability and risk of not having it?’” Carter said. “Unfortunately there seems to be a barrier for agencies not to provide this, but they have no problem providing support groups for people who lost someone. To me, it’s as if the priorities were not there.”
After identifying what was missing from current mental health services, Carter began putting together his own peer-led support group for suicide attempt survivors and those struggling with suicidal thoughts.
“They were supportive, but wanted me to go through all kinds of steps because they were worried about liability too. It kept taking months and months. So I said, ‘I appreciate the support, but I’m going to move forward on my own because there’s four people dying of suicide per week in Allegheny County, and I’m not going to keep waiting,” he said.
Progress was far from linear. It was clear to him that this was going to be a big project to take on. Nevertheless, Carter stayed ambitious and kept working towards his goal.
After participating in a panel discussion about suicide prevention, Carter met a support group facilitator that was interesting in helping him with his project. With an experienced and enthusiastic hand ready to get to work, the process began to quickly unfold.
“As I started talking to more and more people, I found there’s a another facilitator with NAMI who also identifies as a peer with suicidal attempts and thoughts. He reached out and said, ‘I’m willing to do this on my own time too.’ My employer, UPMC, provided the space for me. It all started coming together the more I talked to people. I mean, it’s really just creating it from scratch when no one else wants to help.”
Peer support is by no means a substitute for therapy and medication. However, the reality is sometimes there are things someone may not want to share with their therapist. Teenagers especially may relate to the fact that it is difficult to open up to your parents, your friends, and other family members. There needs to be an open space in addition to a therapeutic environment.
The meaningful connection offered by services such as Still Here can help people reframe how they view themselves and their lives. For Carter, it has shown him how to appreciate the small things that make his day to day life so special.
“Taking my dog for a walk every day, playing a game with my husband, going out to meet with friends just to hang out. Holding on to those little moments in life has helped really ground me, especially when I’m having a bad day,” he said. “I really encourage people who are suffering with those thoughts to just kind of get out of the environment. You’re not going to feel better if you lock yourself in your room. Just get outside the house, do a little bit of socializing to get out of your own bubble that can feel so dark.”
