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Experts fear a deluge of suicides due to COVID

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Van Hedwall is director of programs at San Francisco Suicide Prevention. Photo: Courtesy Felton Institute
Van Hedwall is director of programs at San Francisco Suicide Prevention. Photo: Courtesy Felton Institute  

A San Francisco Suicide Prevention report on the calls it receives shows that between the end of February and the beginning of April — as the novel coronavirus began to spread in the community, workers were laid off en mass, and small businesses shuttered — the number of medium- and high-risk calls increased by 60%.

Meanwhile Van Hedwall, a gay man who serves as SF Suicide Prevention's director of programs, was hemorrhaging volunteers — the organization did not yet have a way to work from home after the city and surrounding counties issued a shelter-in-place order March 16.

"This is a pretty significant increase," Hedwall said of the higher risk calls.

"We didn't have a way for the call center to be remote until mid-April, so we were working in the office that first month of shelter-in-place," Hedwall said in a phone interview with the Bay Area Reporter May 19. "Because of that our volunteer force of 150 fell off, so we were having to run the center with just staff."

Volunteer rates have inched back up to about 80 people, Hedwall said, and after one of them connected SF Suicide Prevention with Cisco Systems they were able to start working from home — but that disruption (and the call center's new ability to screen out prank calls) means that quantitative data on the number of calls per se is not the most accurate indicator of the stresses people are experiencing in the present crisis.

The categories of calls that have increased — those that are medium- and high-risk — require more work on the part of the volunteer counselors than offering encouraging words.

"With medium- and high-risk calls we go into further assessment because if they are experiencing suicidal ideation we ask 'do you have a plan? A timeframe?' Hedwall said. "Sometimes in high-risk calls we have to get emergency services involved.

"The counselors have seen different types of calls, too, than those they routinely received in the past. For example, there has been an 8% increase in first time callers," he explained.

"The calls have been longer," Hedwall said. "Usually the calls are 15 minutes — we keep strict limits, you get 15 minutes, so we can attend to all the calls. Now they're lasting 20-29 minutes. The calls have taken a more acute flavor to them."

Crises can lead to suicide
Even before the novel coronavirus killed almost 100,000 Americans and made social distancing and sheltering in place household terms, health experts were already sounding an alarm about a disturbing rise in deaths by suicide.

Data from the Centers for Disease Control and Prevention released last year revealed that the national suicide rate in 2017 was the highest since 1942 (the first full year of U.S. participation in World War II), and that deaths by suicide had risen 33% since the turn of the millennium.

Suicide has always stalked LGBT people throughout human history — a way out of a hostile world lacking in understanding and compassion.

"Gay, bisexual, and other men who have sex with men are at even greater risk for suicide attempts, especially before the age of 25," a CDC website on the topic states. "A study of youth in grades 7-12 found that lesbian, gay, and bisexual youth were more than twice as likely to have attempted suicide as their heterosexual peers. Some risk factors are linked to being gay or bisexual in a hostile environment and the effects that this has on mental health."

Bullying is a common factor, as confirmed by a study released May 26. The Yale School of Public Health reviewed 10,000 teenage suicide records in the U.S. between 2003 and 2017 and found that "death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers."

"Death records from LGBTQ youths were about five times more likely to mention bullying than non-LGBTQ youths' death records, the study found," a news release about the study, published in JAMA: The Journal of the American Medical Association, states. "Among 10- to 13-year-olds, over two-thirds of LGBTQ youths' death records mentioned that they had been bullied.

While hard statistics can be hard to come by, a report last year from the Journal of Adolescent Health showed that as many as one-quarter of youth suicides could have been among queer youth.

(Before the novel coronavirus reached San Francisco, the B.A.R. was working on a story covering LGBT youth suicide and SF Suicide Prevention. Interviews and information from that are included in this piece.)

Experts have expressed fear that as people lose their jobs and businesses, suicide rates increasing is "inevitable."

According to the Washington Post, in April 2020 an emergency federal hotline for distressed people has seen an increase in calls of 1,000 times over April 2019 numbers. Furthermore, a Great Recession-era study shows there is a 1.6% increase in the suicide rate for every 1% increase in the unemployment rate.

The U.S. national unemployment rate in April was 14.7%, the highest recorded since 1939. Economic experts have been warning of a second Great Depression.

"We've been hearing about how shelter in place makes people feel hopeless," Hedwall said, referring to what counselors have heard. "People's feelings of hopelessness have risen, for sure. A lack of control — feelings of not being in control. People are being overwhelmed and thinking about not only shelter in place but also the possibility of catching this and how that makes them feel."

SF Suicide Prevention
SF Suicide Prevention's office is located in an undisclosed location in downtown San Francisco, where the B.A.R. met with Hedwall for the first time January 10.

"We were the first suicide hotline in the United States," Hedwall said. "It was started by a man named Bernard Mayes, Bernie we call him, who was a correspondent for the BBC and came over to San Francisco as a reporter. He noticed a high incidence of suicide here mostly because of the [Golden Gate] bridge, as it is a draw for folks. He felt it might be a good idea to do this."

The Golden Gate Bridge, Highway, and Transportation District board has approved a suicide barrier, officially called the Suicide Deterrent System, for the bridge. Work started on the project in 2019 and it is expected to be completed by 2023. Work on the barrier was not delayed by COVID-19, according to district officials in an email to the B.A.R. May 26, but the completion date was pushed back from 2021 to 2023 last November.

Mayes opened SF Suicide Prevention in 1962 on Polk Street.

"Mayes was also, in those days, a homosexual and was also an Anglican priest and also, was one of the founders of NPR — an interesting tidbit about Bernie," Hedwall added. Mayes, who was the first working chairman of National Public Radio, died in 2014 at the age of 85.

There is now a suicide hotline in every county in the U.S., Hedwall said, as well as the national suicide prevention hotline at 1-800-273-8255.

Hedwall has been the director of programs since 2018.

"A lot of small agencies are having to close their doors because of funding issues," Hedwall said. "We recently joined and merged with Felton Institute, a large mental health company that's been around for 130 years. They must have been doing social work with gold miners' families."

The agency has volunteers to cover most of the day shifts, and the 23 employed staff members take night shifts on the phone lines, Hedwall explained.

"We're open 24 hours a day, seven days a week, 365 days a year," Hedwall said.

Hedwall has been working with the queer community around the Bay Area for two decades. He said he used to run an AIDS research lab for UCSF, prior to when HIV was a manageable condition and before going to graduate school to become a therapist.

SF Suicide Prevention operates a phone line for the general public that covers both suicide and personal crises, and in addition operates a drug and alcohol relapse hotline and the HIV Nightline at 1-800-628-9240, which was founded in 1989.

"HIV Nightline is the oldest, and at the time was the only, national hotline for HIV information and support," Hedwall said. "Back then there were no medications for folks with HIV and disabling AIDS so people were up all night in pain and not feeling well and this was a line they could call to get support, which is a wonderful testimony to that line.

"Now, the line goes throughout the whole country and it's the only support line I know of nationwide for HIV. Folks who recently seroconverted can call the line and get support and it's also for folks who have questions. There are certain parts of this country, believe it or not, that do not educate our nation's youth around HIV prevention, how it's contracted. You'd be surprised," he added.

The agency is funded partly by the San Francisco Department of Public Health and partly by private donations.


The Golden Gate Bridge will get a suicide barrier in 2023. Photo: Rick Gerharter  

The role of schools in intervening for LGBT youth
The West Hollywood-based nonprofit the Trevor Project focuses on suicide prevention efforts in LGBT youth. In June 2019 it released the results of its first national survey on LGBTQ mental health, which found 39% of LGBTQ youth seriously considered attempting suicide in the previous year (which included more than half of transgender and nonbinary youth).

One might think San Francisco — known around the world as a mecca for queer people — might fare better; but a 2017 San Francisco Unified School District health survey obtained by the B.A.R. shows that while 12.8% of all students seriously considered attempting suicide, that number was 36.7% for LGB students.

The health survey also showed that while 10.5% of heterosexual students reported ever having been cyberbullied, 23.9% of LGB students reported so.

And while Hedwall mentioned lack of knowledge over AIDS in the context of other parts of the U.S., the percentage of SFUSD students who reported learning about the disease declined 10 points from 2007 to 2017.

Still, the survey did show a significant reduction in the reporting of anti-LGBTQ slurs by students, from 40.1% in 2011 to 19.7% in 2017.

All in all, the district is trying to level the playing field and reduce the effects of bullying and the stresses of growing up LGBT, officials said.

As the B.A.R. previously reported, 12 SFUSD high schools and select middle schools host Q Groups for LGBT youth. These are often run in coordination with the Lavender Youth Recreation and Information Center, or LYRIC.

According to LYRIC statistics, over 85% of the middle school participants — there were 62 last school year who attended 148 sessions — in the Q Groups said they were proud to be part of the LGBT community, reported "having a positive LGBTQ role model in my life who I can talk to," and reported "knowing what it means to be in a healthy relationship."

Seventy-three percent said they were comfortable seeking out information and support services about sexual orientation-related matters.

According to Erik Martinez, a queer man who serves as SFUSD LGBTQ programs coordinator, the Q Groups were put on hold in March due to the pandemic.

"At the moment, Q Groups are on pause — as are many of our other socio-emotional/psycho-educational student groups — pending further guidance from SFUSD regarding staff-student electronic communications and remote learning," Martinez stated March 31. "Our hope is to continue groups virtually through district-approved online platforms that are safe and secure. Once guidance is provided, we are fortunate to continue to have the support of our community partners, such as LYRIC and the Huckleberry Youth Services and Health Initiatives for Youth."

Since then, many of the groups "were able to resume in a virtual format," Mauro Sifuentes, a queer man who is an LGBTQ support services coordinator for the district, told the B.A.R. May 21.
"Unfortunately, some were unable to, primarily due to at-home safety concerns for our students, or because students experienced shifts in needs and priorities during the transition to remote learning," Sifuentes wrote in an email to the B.A.R. "It was inspiring to work with our SFUSD and [community-based organization] partner staff as we responsibly, diligently, and creatively found ways to connect with our Q Group participants, regardless of whether or not their school Q Group rebooted after school closures."

LGBT students also have access to wellness centers located at 19 SFUSD public high schools, which are available to the general population as well, though those sites are not open now. (Some of these services have moved into virtual space.) The San Francisco Wellness Initiative was created in 1999 following the Columbine school shootings to provide "safe, secure environments where students can talk confidentially and get support for the challenges they face," according to SFUSD literature.

When the facilities were open, 42% of the general population of SFUSD students accessed wellness services, according to Kevin Gogin, a gay man who is the director of safety and wellness for SFUSD school health programs, in a January 24 interview. This includes two-thirds of LGBT SFUSD students.

Martinez said that while he can't speak for the rest of the state's public schools, SFUSD has its own curriculum to discuss these issues that is "reflective of San Francisco and the needs of our students."

"In San Francisco we're really fortunate that since 1993-94, we've had policies in place for inclusive LGBT education as early as elementary," Martinez said. "At every grade level, teachers are required to approach these topics — mostly focused around LGBT families and different family formations — but also about gender and gender identity. ... By the time students get to middle school and high school you get a deeper discussion about identity and sexual health education."

But often LGBT students get bullied for other reasons too in ways that can be equally damaging — such as being called racial and ethnic slurs more than students who aren't LGBT, Martinez said.

Sifuentes said that in as yet unreleased reports, the district has been seeing fewer reports of "targeted homophobic language" but higher rates of "hearing homophobic language around them, which is translating into lower rates of feeling safe at school."

"What I'm interpreting that as is that lots of young people have internalized the idea 'I'm not supposed to call this kid this or that' but that we haven't really addressed the deeper, underlying homophobia that exists in our communities and broader culture and that needs a place to go," Sifuentes said. "They know not to call the gay kid 'gay' but they call the friend they think is straight 'gay' when there are gay kids in earshot."

Martinez said that general bullying behavior, not just specifically related to issues surrounding LGBT identity, has "increased across the board" in the last three years.

"There is an increased hostility in our schools," Martinez said. "Something about November 2016 that changed everything."

That was when Donald Trump was elected president.

Gogin blamed rising economic inequality.

"I also want to look at our city. Regardless of what's happening in Washington, D.C., our children absorb the anxiety their parents are experiencing of living here," Gogin said. "More crowded streets; greater homelessness, which affects our students; housing insecurity; employment bringing in enough of a wage for a family to live on; access to health care. All of these things children bring in and they just emote. That's where they are."

Laughs for Life
There were 101 suicides in San Francisco in 2017, including 33 at the Golden Gate Bridge. While there were fewer suicides in 2017 at the bridge, there were more interventions, according to the San Francisco Examiner.

Hedwall had told the B.A.R. that much of SF Suicide Prevention's funding comes from an annual fundraiser — Laughs for Life — which would have been held at the Regency Ballroom in the Polk Gulch on April 22.

The in-person event was canceled due to the shelter-in-place order.

"One of the things we tried to do for outreach for folks who would have attended was to do a few jokes online," Hedwall said on May 19. "A few people responded. Not much was happening there, unfortunately, but we are still doing it. Tell your favorite joke online and keep it clean. There's a donation number, too.

"We are kind of in a rough place," he said.

For more information on San Francisco Suicide Prevention, visit www.sfsuicide.org

Palo Alto University will hold an online LGBTQ town hall on COVID-19 and mental health Monday, June 1, from 3:30 to 5 p.m. To register, go to www.surveymonkey.com/r/lgbtqtownhall

The deadline to sign up is May 29.


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