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By Art Holliday

ST. LOUIS (KSDK) - Michelle DiMarcellis thumbs through a Webster Groves High School yearbook, pointing out numerous pictures of her daughter Anne. "She really was super involved in high school. She was in all kinds of organizations."

From the time Anne DiMarcellis was voted Biggest Class Clown at Webster Groves High School in 1990, to dropping out of college as a freshman, something went horribly wrong.

"I got a phone call from the Maplewood police, which is a terrible way to let somebody know that their child died," said Michelle. "They called to tell me she committed suicide."

According to Anne's mother, her daughter had struggled for years with depression and alcohol abuse. She dropped out of college as a freshman after just one semester and returned home. She was living alone in an apartment when she took her own life.

"Somebody in the building had given her a gun because she was afraid this guy who had raped her would come back. I don't even know if she knew him. And somebody in the building gave her a gun and she shot herself," said Michelle.

She says depression runs in her family, including her son, Bob DiMarcellis.

"I still suffer from suicidal thoughts, not that I act on them," said Bob. "There is hope after really dark periods in someone's life who has depression and that's why I want to share. If you do have suicidal thoughts and you do have depression to talk about them and seek help."

For those left behind, the suicide of a loved one causes long-lasting pain.

"I think knowing her, it was her way to end the pain and I don't think I realized the pain she was in until I went through the depression after her death," said Michelle. "As a parent you want to be able to control the situation and you can't. It's a hard lesson to learn."

During this decade, there's been a disturbing shift in death by injury. According to the American Journal of Public Health, in 2009 suicide surpassed car crashes as the leading cause of death by injury in the United States.

Survivors of suicide all may spend years wondering why? Experts cite a number of causes: severe depression, the end of a relationship, an incurable illness, economic conditions like losing a job, bullying, and in the case of military suicides, multiple deployments to Iraq and Afghanistan for post-9/11 military personnel leading to post traumatic stress disorder.

"When you get to that place where you're considering ending your life, it's just a place of desperation, a place of 'I have no other way out' which is one of the reasons what we do is so important. We are the mental health safety net," said Angela Tate, director of clinical services for Behavioral Health Response.

Tate supervises a staff of clinicians who man phones for a psychiatric crisis hotline 24 hours a day. Of the thousands of phone calls received each week, Tate estimates 70 to 80 percent involve potential suicides.

"There is always hope. There is always something that can be done," said Tate. "We are here to provide that safety net. Counselors are here 24-7. We are always here. Often times people feel like 'I don't have anybody'. We are here, we don't close."

Tad Shields and his colleague, Monique Maxey, are veteran clinicians for Behavior Health Response, used to helping people considering suicide. They both talked about the challenges of speaking to someone on the phone who wants to end their life.

"It's a pretty heavy feeling, especially when they're talking about 'I'm holding these pills' or 'There's a gun on the table' and I'm trying to decide what to do," said Shields. "We really believe it's best to ask them directly and we'll use the words, 'Do you want to kill yourself' or 'Are you thinking about suicide?' They can't think about tomorrow, they can't think about ten minutes from now. They can't think about loved ones. It is just this pain and I want it to end."

"I know that someone has to take charge of the situation and be calm," said Maxey, "but at the same time, I don't want to make it seem like I'm the expert about what's going on in their life, and it's important that I let them have time to talk about what they feel like they want to share. They may know they need mental health services, but they don't know which way to turn, who to call, just really, sometimes they call and say how can you help me? Some people are calling for loved ones. We receive that a lot. Where they're concerned about a loved one that's not getting mental health services. They've expressed thoughts about committing suicide and they want to know how to help them."

Defense Secretary Leon Panetta has called military suicides an epidemic and says there are no easy answers. In 2012, military members committed suicide at a record pace. According to Associated Press figures, 349 members of the military killed themselves, almost one suicide per day.

In 2005, Marine helicopter pilot Major John Ruocco killed himself, leaving behind his wife Kim and two sons. Kim Ruocco says her husband lost friends who died in helicopter training exercises and in combat.

"Even though we talked a lot about getting help, he never did," she said. "He never did go get help. He died instead of going for treatment. Like so many suicides, it was the perfect storm of everything seeming to go wrong at the same time."

Ruocco says her husband appeared to be depressed after returning home from deployment in Iraq.

"The first time I saw him when he came back, it was pretty evident that he was not okay. He came home on Thanksgiving, and was not enjoying the things he used to enjoy. He was not sleeping well, he was agitated, he was short-tempered with the boys. He was just having a hard time."

Ruocco, who now lives near Boston, is director of a suicide prevention program, TAPS: Tragedy Assistance Program for Survivors. She describes a military culture that discourages soldiers like her late husband from admitting they are having mental health problems.

"Being a military wife, I knew very well not to tell anyone that he was struggling for fear that it would interfere with his ability to be promoted, his ability to fly. He had worked really hard to become a pilot," said Ruocco. "I just hope that veterans and their families know that there's treatment out there that works. If you go early, and you get help you can get better. You can reconnect with your family, you can feel better, and you can maintain your career. I think if my husband could have gotten help in those early years, right after the initial trauma, then he would have addressed that, he would have talked to his peers about it, gotten some help, that he probably would be alive today."

"In the military culture, we've got this phrase, 'suck it up and drive on,' that, for so many years, was prevalent," said Capt. David Spears of the Missouri National Guard. "Personally as a chaplain I have counseled a number of people who have discussed or contemplated suicide. It's a scary moment when somebody acknowledges 'Yes, I'm thinking about killing myself.'"

Capt. Spears believes he's helping change the military culture he described. He is also an instructor for a suicide prevention program called ASIST. The program helps military leaders identify soldiers at risk of killing themselves.

"So often we feel that is the answer. Suicide, killing myself is going to make all this go away," said Capt. Spears. "But in reality it's not making any problem go away, it's only breeding a bigger problem for those who are left behind. And, it's heartbreaking to think that anybody could feel like they're completely without hope, and there's so many resources out there. People willing to help, if they just know that there's a need."

Suicide Hotlines:
Behavioral Health Response Crisis Line: 1-800-811-4760 or 314-469-6644
Teen hotline KUTO: 314-644-5886
Life Crisis Services: 314-647-4357
Life Line: 1-800-273-8255

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