Antoinette Steinbarth has had nearly 19 years to think about the day her husband jumped off the Skyway to his death.
She knew her husband, Andy, had bipolar disorder, but it was largely under control. The young couple had just spent a great weekend together – the happiest they’d had in months. She thought nothing of letting him take the family car to work instead of driving him, as she usually did.
“I'm gonna be 49 this year and I was 30 back then,” she said, “so as I mature, I look back and I wish I could have had the opportunity to do things a little bit differently. I didn't understand my husband’s illness. Nobody explained it to me.”
Times like recent weeks in the region, when two suicides and a suicide attempt have been in the news, can bring extra weight for Steinbarth and others who have lost loved ones in similar fashion.
Still, she and leading mental health experts say there is hope – and help – for those who may be on a path toward suicide, as well as their families and loved ones.
"Obviously, these are very tragic situations," said Jessica Pirro, CEO of Crisis Services of Erie County, which operates a 24-hour crisis hotline, 834-3131. "A lot of times people express suicidal thoughts. But sometimes they just need support."
Suicides rarely make the news. Most media outlets limit stories to those involving well-known figures in the community or to provide accurate information in cases where the death or attempt was done in public. There were three such incidents in Buffalo Niagara in the last five weeks.
A Canadian woman died by suicide June 6 when she jumped off the Peace Bridge.
A man committed suicide July 1 by jumping from the Liberty Building downtown.
A Canadian man attempted suicide early Tuesday by going over the 188-foot-high Horseshoe Falls.
The names and ages of those who died have not been released by law enforcement officers on either side of the border.
These incidents occurred during an era of concerning suicide rates. U.S. rates climbed 25% from 1999 to 2016, and nearly 29% in New York State, according to the Centers for Disease Control and Prevention.
More than 47,000 people in the United States died by suicide in 2017, more than twice the number of those killed by homicide, according to the CDC.
That is an average of 129 suicides every day in America – roughly the same number that take place each year in Erie County, said Dr. Yogesh Bakhai, chief of service in psychiatry at Erie County Medical Center.
Suicide is the second-leading cause of death for those ages 10 to 34 and fourth-leading cause for those ages 35 to 54. There are as many as 25 attempts for every completed suicide, the CDC estimates.
More than three times as many males as females die by suicide, though three times as many females as males attempt it.
Ninety percent of all people who die by suicide have a mental health disorder at the time of their death – though only about half have been diagnosed with one.
At Crisis Services, hotline counselors handled more than 5,600 suicide-related calls in 2018. So far this year, the rate has remained about the same – just over 2,700 for the first half of the year, Pirro said. The calls included people who were having suicidal thoughts as well as people seeking help for someone they were worried about.
That's something people in the suicide prevention community strongly encourage.
"The first step, really, is having a conversation with the person that you're concerned about," said Steinbarth, who went back to school after her husband’s death and became a licensed mental health counselor. "Don't bypass that person. Respect that person enough to have a conversation with them."
But don't just tell them that they should seek help, mental health counselors say.
"You want to find a way for them to get some treatment. It may be through calling the hotline or reaching out to Mental Health Advocates of WNY to get a referral," said Dr. Celia Spacone, coordinator of the Suicide Prevention Coalition of Erie County.
And if a suicide attempt seems imminent, call Crisis Services or 911 immediately, they say.
Bakhai, also vice chairman of psychiatry in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, has no direct knowledge of those involved in the recent public suicide-related incidents – but he wouldn’t be surprised if none of those involved had ever seen a psychiatrist or mental health counselor.
Steinbarth and Bakhai said those contemplating suicide often leave clues in their language and behavior that they are struggling with life itself.
Risk factors for suicide include a diagnosed mental illness, substance abuse, a family history of suicide, a serious medical condition or severe pain.
Situational risks include the death of a close loved one, a big financial hit or loss of a job, a relationship breakup, an arrest, or bullying. Access to methods of suicide during these periods can raise the risk.
The best way to prevent suicide is through early detection, diagnosis and treatment of depression and other mental health conditions. People in the throes of a mental health crisis do not think clearly and need help from a professional – as do those suffering from any health crisis.
Most, but not all, of those who die by suicide exhibit warning signs, according to the American Foundation for Suicide Prevention.
At the same time, Steinbarth said, loved ones shouldn't feel it's their responsibility to prevent suicide – and that's where hotlines, counselors, therapists and support groups can all help.
"They need to be aware of what other services are available," she said. "You're not God."
'Cannot predict the future'
It's important for people to realize that sometimes suicides can't be prevented, health experts said.
The grieving process – particularly early on – leaves many who have lost loved ones wondering whether they could have done anything to change the outcome, to have extended a life of someone they miss badly.
Steinbarth did so herself, but she said time, support from others and working in the mental health field after her husband's death have given her greater perspective.
Life can be a grind, she said, and in the end, you do the best you can to help a loved one maneuver through such challenges as mental illness, addiction and trauma.
“As a clinician, my job is to do the best I can, and I cannot predict the future,” Steinbarth said. “I cannot read someone's mind. I don't have that skill, and neither do family members.”
Erie County was recently selected to take part in a state project to review suicide deaths to look at patterns or trends to help create prevention and outreach effort. "The more we can learn the stories of our community, it might help us to create a more targeted effort for prevention and outreach," Pirro said.
Steinbarth once supervised the Crisis Services Outreach Team and is now director of the Spectrum Human Services Assertive Community Treatment Program, which helps those with serious mental illness better navigate life in Erie, Niagara and Cattaraugus county communities.
Studies have shown that have family survivors of suicide fare better when they find a new purpose in life, whether it be to support others who have gone through something similar or to find other channels to make lives better for people or other living creatures.
Steinbarth said she is proof of that. She has largely come to terms with the loss of her husband. She has a fulfilling career. She started a new relationship six years ago, one that helps her look ahead and better deal with the gut-wrenching feelings that can come when she looks back to 2000.
“I couldn't have done anything about it but wish I would have had the opportunity to do it,” she said. “I feel like I'm doing more about it now. I feel much more productive now than I did then. My husband isn't the one who's benefiting from it, but other people are.”