Some suicides come with little warning.
Keris Xavier Hannapel, a 20-year-old student at the College of Charleston and by all accounts a creative and vivacious young woman, was suddenly overcome on June 30 last year by a feeling of failure and grief, her father and sister said. That morning, Hannapel's boyfriend broke up with her, a final act in a relationship that never was very intimate. They had been growing distant for a while.
Soon after, Hannapel, who was called Kiki by family and friends, sent him a text message: "Goodbye. Maybe forever." She had fallen into the black hole of suicide, where no light shone.
At around noon, Kiki entered the bedroom of the Coming Street apartment she shared with her sister, Deryn, and a friend, and hanged herself from the closet door. Some hours later, Deryn and her boyfriend found Kiki, removed her body from the door and called authorities.
Suicide is now the 10th-leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. About 36,000 people in the U.S. kill themselves annually. Nearly 1 million attempt suicide each year.
For young people age 10-24, suicide is the third leading cause of death, according to the most recent data from the
CDC. And veterans are at increasing risk for suicide, especially as two Middle East wars come to an end, returning more and more members of the military to civilian life, VA officials say.
Adding to the concern of health care providers and VA administrators are recent budget cuts to the South Carolina Department of Mental Health, along with the impact of extended recession, joblessness and financial hardship among a growing number of American families.
And a recent flurry of reported local suicides -- bridge jumpers, passion killings and student deaths -- have heightened awareness and concern among civic leaders, law enforcement, school officials and parents.
To address the issue, the Rotary Club of North Charleston is convening a suicide prevention event on Friday, from 9 a.m. to 3 p.m., at the Charleston Area Convention Center. Rotary Club President Stacey Lindbergh said it's important for people to arm themselves with information about suicide.
"Statistics and clinical presentations by experts represent the general picture, but anyone who has suffered the tragedy of suicide by a loved one knows the real cost to their families and communities," Lindbergh said. "Suicide is preventable, and we hope that our efforts at the event will help launch a new awareness of suicide risks, connect and unite our community in our prevention efforts, and empower people with the resources to intervene and save lives."
A monster in the dark
But often it does not come out of the blue.
Four out of five people who attempt suicide have given clear warnings, according to the National Mental Health Association. It's difficult to make the connection between these behavioral indicators and the possibility of suicide because such behaviors don't usually lead to suicide and because suicide is such an extreme and final gesture that's hard for many to comprehend, experts say.
Kathy Ward, a nurse with Roper Saint Francis Healthcare, lost her husband, Jeff Ward, in July 2005. He was afflicted by long-term substance abuse and became increasingly depressed during the last several months of his life, despite counseling and regular AA meetings, she said.
What's more, he had just turned 50. Though he loved his 16-year-old daughter, Alex, and held a good job with Delta Global Services, his depression got the best of him, Kathy Ward said.
He felt like a failure and was overwhelmed with hopelessness, she said. "He felt that maybe things would be better if he weren't around." He had slipped into suicide's inescapable black hole.
In 2006, Ward attended her first Out of the Darkness Community Walk in Columbia, an initiative that supports the American Foundation for Suicide Prevention. Two years later, she was co-chairwoman, with Martina Mueller, of the newly organized Charleston walk.
On the first and third Wednesday of every month, she attends the free 7 p.m. Survivors of Suicide (SOS) group meeting at Heartland of West Ashley, 1137 Sam Rittenberg Blvd.
The gathering is facilitated by Trident United Way's 2-1-1 Hotline program, which not only offers "supportive listening and crisis intervention 24 hours a day," but organizes emergency response, provides training and sponsors this suicide support group.
Ward said the "survivors" of suicide -- parents, children, spouses, siblings, friends of all ages and backgrounds -- struggle to understand what motivated their loved one to end his or her life, an unnatural act for a species programmed by evolution to survive. They must satisfy themselves with informed speculation, "because we're not inside the brain of the victim," Ward said.
Mueller, a statistician at the Medical University, lost her boyfriend to suicide in 2001.
Recovery, she said, "is extremely difficult and can take you close to the despair that your loved one probably felt."
What's more, suicide can be insidious, eating away at the barrier that most people take for granted but which protects them from self-destruction, Mueller said. Once the suicide of a loved one is experienced, that barrier is removed. "Suddenly, it's possible," she said. It is no longer taboo. It is imaginable.
"Suicide is like the monster that lives in the dark," she said. "If we don't bring it out of the darkness it will stay in the dark and live there."
In November, Mueller and Ward oversaw the fifth annual Out of the Darkness Community Walk, which drew about 280 participants and raised more than $19,000.
Among the veteran population, the problem of suicide is acute enough to prompt the Veterans Administration to tackle it head on.
In October 2008, it launched a suicide prevention program that has rolled out to every hospital and military base, said Mark DeSantis, suicide prevention coordinator for the Ralph Johnson VA Center in Charleston.
The VA operates a veterans' crisis hotline, trains police, emergency responders, college officials and the staff of community organizations to recognize the signs of suicide and learn how best to intervene, DeSantis said.
In recent years, the VA estimates that 950 veterans nationwide attempt suicide every month. (Among the general population, the number is around 45,000.)
The VA Center's prevention efforts extend to community-based clinics and nonprofit partners, DeSantis said. All patients are screened for depression and mental health disorders when they seek emergency or primary care at the center. The goal is to catch people early on a path to suicide, even if that means more front-end intervention.
"We want them to seek help before it gets to that point," he said. "Really the front line is not when they see us here in mental health, the front line is the family," neighbors, friends and colleagues, DeSantis said.
Risk factors include more than depression and post-traumatic stress disorder, he said. Another suicide trigger is financial stress. The loss of a home or a job, or a sudden lifestyle change such as retirement can prompt suicidal thoughts.
The risk is most acute 30 days after discharge, DeSantis said. So veterans are carefully scrutinized during their first visits to the VA hospital once they return home.
The VA's efforts apparently are paying off. "We're seeing an increase in calls to the crisis line," DeSantis said. "Which is what we want." Annually, the patient population increases about 9 percent at the center, but the actual number of suicides has declined, he said.
Shock, anger, action
Clark Flatt, chief executive and founder of the Jason Foundation, is one of the scheduled speakers at Friday's suicide prevention event. He established the foundation, based in Hendersonville, Tenn., in October 1997, three months after his 16-year-old son, Jason, killed himself.
In his prior life, Flatt was a business owner "enjoying an upper-middle-income type of life, a house on a lake, a boat, two kids, wife."
Then one day he got a call from a friend of Jason's.
"Had I heard from Jason this morning?" the friend wanted to know, Flatt said. "The call stuck in my head. I started trying to locate him. Finally I went home. I saw his car. ... I knew if the car was there, he was there."
By then, Flatt was deducing that there was some sort of problem, perhaps with a girl.
He steeled himself for a heart-to-heart conversation.
"I went down the hall quick. I turned to go into the doorway and fell on top of my son. He had shot himself in the head."
Initially, Flatt felt anger, he said. He knew about the dangers to teenagers. He had attended seminars about drug and alcohol abuse, "but no one told me about suicide."
Since then, he has dedicated himself to informing people about the issue so that people might begin to address it openly and in the way they address teen pregnancy or substance abuse or behavioral disorders such as ADHD.
Today, the Jason Foundation has 87 offices nationwide, organizes seminars and offers training. Nearly 2 million people were reached last year, Flatt said. More than 150,000 teachers were trained "to identify and refer."
"If I had attended the same parent seminar, my son would be alive today," Flatt said. "In 1997, I could say, 'Gee, I didn't know all these things,' and my ignorance was one of the reasons we lost him. Today, ignorance isn't an excuse."
Finding a way to cope
On Jan. 13, Kiki would have been 21. The void left by her suicide has forced the Hannapel family, Mount Pleasant residents, to make an adjustment they could not have foreseen, a change that has caused anger and resentment to flare, and sometimes left them feeling overwhelmed, Edward and Deryn Hannapel said. They don't blame the boyfriend, of course. It is reasonable to assume one's girlfriend will survive a breakup, they both said. The breakup was the trigger, but the reasons for Kiki's death had everything to do with her.
She tended to form strong emotional attachments and felt that "she's losing everything because she's given everything," her father said.
Her coping skills were not fully developed, Deryn added.
Now it's the family that must find a way to cope. Edward Hannapel remembers the details of his time with Kiki and reminds himself that Kiki surely would have wanted happiness for her family. Lilian Hannapel, who idolized Kiki, keeps the memory of her daughter vivid and alive, close to her always.
Deryn Hannapel is coming to terms with feelings of neglect and anger, with a hardened heart and with a new appreciation for life's "small things." She's also getting very good at thinking through, and expressing, her thoughts and feelings.
Both father and daughter (Lilian Hannapel was away visiting friends in Florida) said they wanted people to understand that, sometimes, suicide is difficult to foresee.
"It can literally come out of the blue."