Martin Manley was a sports reporter and statistician in Kansas City.  Before his suicide this month, he spent over a year building a vast website.  The site gives Manley's reasons for killing himself and recounts much of his life.

A fascinating look at someone's life and the thought process of suicide.  Head over to CNN to read the full story.

The Miami Ad School created a series of thought provoking posters aimed at suicide prevention in LGBT youth.  With the tagline “Words Can Kill,” the images demonstrate how bullying with hurtful and derogatory slurs can have serious consequences.  The images are disturbing and shocking, yet serve as a powerful reminder that bullying isn’t always physical.  Just this week a 16-year-old named A.J. Betts from Iowa became the fifth student in five years to take his own life at his school. As his mother said in the wake of his passing, “even if we can save one more life from bullying, that would be a success.”

Visit the The Miami Ad School to see the posters.

A great article by Boston Globe Correspondent Karen Weintraub talking about how the Military is monitoring social media to cut the suicide rate.

"Nearly every day, an active-duty service member takes his or her own life, causing waves of grief among families and peers.  And each day, on average, 22 military veterans in the United States commit suicide.  Roughly one in five Americans who commit suicide is or was in the service.  The military has been working aggressively since 2007 to try to stem suicides, but everyone agrees there will be no easy fix.

Now, however, big-data specialists, including the Newton software firm Attivio Inc., are collaborating with military suicide experts to try to address the problem by using social media to monitor veterans for signs of despondency.

The specialists said they are identifying key words and phrases that suggest someone is spiraling downward, while developing an analytics system that could examine thousands of online posts and alert medical specialists and family members when a veteran’s comments indicate he or she is at risk of committing suicide.

Relatively few people come out and say they are suicidal. But by tracking the postings of veterans who agree to participate in the system, organizers hope eventually to identify those at high risk, and to intervene early enough to make a difference.

The program, called the Durkheim Project after the man known as the father of sociology, Emile Durkheim, is developing algorithms to determine which phrases or combination of phrases are most predictive of suicide attempts.

“It’s the words they are using that’s the reliable signal,” said Chris Poulin, the director and principal investigator of the Durkheim Project and a predictive-analytics expert.

Although Poulin would not reveal the precise phrases the Durkheim Project has identified, suicide researcher Craig Bryan, a University of Utah psychologist who is advising the project, said that the coded language of the suicidal often includes phrases such as “You’d be better off without me,” “I messed everything up,” and “I can never be forgiven for my mistakes.”

Moreover, behaviors such as buying a gun or giving away belongings can help to identify at-risk veterans and are often reported on social media, Bryan said.

In the first phase of the project, which was just completed, Poulin and colleagues developed a language-driven predictive model to estimate suicide risk.

They based their research on doctors’ notes from the records of three groups of veterans: those who had committed suicide, those who had psychiatric challenges but were not suicidal, and those with no apparent psychiatric issues.

From the doctors’ notes, Poulin said, it was possible to distinguish between the three groups.

Those whose psychiatric problems were not life-threatening tended to talk about their eyesight, for example, or their preoccupations and personal hygiene. Those who were healthy talked to their doctors about muscle or joint pain or eating disorders. And the suicidal discussed their agitation and fears, along with their need for painkillers.

In the next phase of the Durkheim Project, Poulin and others will test the predictive quality of those insights among as many as 100,000 service members and veterans who agree to have their social media and mobile posts shared.

This kind of varied language, as well as the shorthand used on social media, can be extremely challenging to analyze, said Sid Probstein, the chief technology officer for Attivio, which is responsible for that analysis.

How those phrases change over time can also be a warning sign, Probstein said, so a huge amount of data has to be gathered from text messages, Twitter, Facebook, and other social media outlets and analyzed.

This kind of analysis of so-called “natural language” has been possible only recently, Probstein said, “so it’s really only in the last decade that you could imagine doing something like the Durkheim Project.”

Facebook, which helped debug the program, will assist in recruiting volunteers, Poulin said. The military provided a two-year start-up grant for the research.

Eventually, those whom the project identifies as at-risk will be automatically linked to resources in their area to get help, and their support network will be notified.

Users will be able to opt in and out of the system, so their privacy will not be compromised by the data analysis without their knowledge, said Poulin, who also worked with former colleagues at the Geisel School of Medicine at Dartmouth College.

“You don’t just get the person to opt in, but you get their friends and family to opt in, and let family know this person is suffering,” Poulin said.

If they do not have such support in their lives, there are scripts that can be read to at-risk people that have been shown to help, he said.

Even people who feel alone will leave a footprint on Facebook or via a text, Poulin said. “Their social network may be very small, but not so small that they don’t use a phone,” said Poulin.

Bryan, associate director of the National Center for Veterans’ Studies at the University of Utah, said the pressures on the military have increased exponentially over the past decade, as wars in Iraq and Afghanistan have dragged on and downsizing has meant service members doing more with less, increasing their stress and suicide risk, both during their service and after retirement.

Multiple deployments also take their toll on service members, who may be away from home for most of six or seven straight years, said Kelly Posner, director of the Center for Suicide Risk Assessments at Columbia University.

In combat, service members are distracted by the urgency of their tasks. Now that the wars are winding down and they are back home for good, “they’re having to face what they saw, what they did, what they didn’t do, their unmet mental health risks, their families that have not been together,” she said.

Suicide, she said, is the fourth-leading cause of death for those ages 18 to 64, and probably the most preventable, “but we need to keep working hard.”

By using observable behavior, the Durkheim Project may help the invisible become visible, Bryan said.

“That is really one of the missing links in suicide prevention, both inside and outside military.”"

Liz Szabo wrote an article about the relationship between guns and youth suicides.  It brings up plenty of questions and is a good starting point for discussion.


Study: Many suicidal kids have access to guns at home
Nearly 20% of children and young people at risk for suicide say there's a gun in their home, new research shows.  And among these youth, 15% know how to get their hands on both the gun and bullets.

"That's a volatile mix: kids at risk and the means to complete suicide," said Stephen Teach, who will present the study Monday  at a meeting of the Pediatric Academic Societies in Washington.

Pediatricians devoted special attention to gun violence at the meeting, including a special symposium Saturday. Thomas McInerny, president of the American Academy of Pediatrics, also focused on gun violence in his plenary
address.

More than 1,900 young people in the U.S. ages 5 to 19 committed suicide in 2010. Nearly half of these suicides involved firearms, said Matthew Miller, an associate professor at the Harvard School of Public Health, who spoke at the symposium. Suicide is the third-leading cause of death among teens ages 15 to 19, according to the Centers for Disease Control and Prevention (CDC).

In Teach's study, doctors interviewed 524 young people ages 10 to 21 who were treated in pediatric emergency rooms, either for a physical or psychiatric health issue.

These findings  may actually underestimate the real risk, said Miller, who wasn't involved in the survey.

Research suggests that about one-third of children live in homes with a firearm, Miller said.  And about 1.5 million children live in a household where guns are kept loaded and unlocked, Miller said.  It's possible that some young people interviewed for the survey were unaware that their parents own guns.

Guns are the most lethal form of suicide. According to the CDC, 85% of suicide attempts with guns prove fatal, compared with 1% to 2% of attempts made by slashing one's wrists or taking pills.

Reducing teens' access to guns can be life-saving, Miller said. Studies show that many teen suicide attempts are impulsive. One-fourth of teens who survived a suicide attempt said they thought of suicide just five minutes before making the attempt.

For many people, suicide is a passing urge. Fewer than 10% of those who survive a suicide attempt go on to kill themselves, Miller said.

The findings underscore the importance of screening  young people for depression and suicidal thoughts, as well asking about guns in the home, said Teach, associate chief of emergency medicine at Children's National Medical Center in Washington, D.C.

Teach and his colleagues have developed a four-item questionnaire that can be used to screen all teens who come into the ER or primary practice clinics.

Screening all teens is important, because up to 40% of youths who kill themselves have no known mental illness, said study co-author Jeffrey Bridge, an associate professor of pediatrics at Ohio State University. In the survey, doctors found that nearly half of young ER patients with psychiatric complaints were at risk for suicide, as were about 10% of those who had a medical or surgical issue.

According to research by the CDC, 8% of high school students have attempted suicide in the past year. In comparison, less than 1% of adults ages 18 to 54 have attempted suicide in the past 12 months.

The American Academy of Pediatrics recommends that doctors ask children's families about guns in the house and talk about ways to keep kids safe, McInerny said. 

The National Shooting Sports Foundation agrees about keeping guns secured, spokesman Bill Brassard said. Parents should store firearms locked, unloaded and stored separately from ammunition, which also should be locked, he said.

Research shows that keeping a gun in the home increases the risk of suicide by nearly five times, Miller said.  Yet educating parents about the risk of guns and suicide can help.

In a survey of 106 parents of severely depressed adolescents, doctors asked if there were guns in the home and, if so, counseled parents about safety.

Two years later, 27% of the parents who received the counseling had taken the guns out of their homes. Among parents who weren't counseled -- because they didn't own guns at the time of the interview -- 17% acquired guns.

In the past two years, six states have considered bills to prevent doctors from asking about guns in the home or recording that information into medical records. Only Florida's bill passed. That law never went into effect,
however, because it was blocked by a judge.

A great article in the Manila Bulleting by Rhea Bernardino on ending the cycle of suicide.             
 
  
Last March 16, the nation was rocked by the tragic death of University of the Philippines-Manila student Kristel Tejada who decided to end her life.

The 16-year-old Behavioral Science freshman’s dreams of becoming a doctor were crushed when she was forced to file a leave of absence from UP Manila for not being able to pay her tuition balance. She drank silver jewelry cleaner.

Her death sparked outrage and calls from the UP community, youth sector and even from lawmakers for a change in the payment system of the state university. Subsequently, the UP Manila administration has decided to lift their “no late payment” policy.

But while Kristel’s death paved the way for the review of alleged restrictive and repressive policies and reforms in the public educational system, it also became a precursor of a series of suicides by students who were also
encountering problems with their studies.

One was 14-year old Lee Young Gunay who shot a bullet through his head in his parents’ room in Batangas City. He was reportedly bullied by his classmates in Saint Bridget College where he was a high school sophomore. Lee was also said to have been suffering from depression after failing his Math class.

Two weeks after, two more students from Batangas City committed suicide. Like Lee, Don Benedict Pamintuan and Daveson Beron also used a gun to end their misery. College freshman Don shot himself for failing four of his subjects in De La Salle University-Dasmarinas. He was set to transfer to Batangas State University (BSU) the next school year. Daveson, on the other hand, found out that he was not included in the list of graduates at the BSU where he was a Mechanical Engineering student and so he shot himself in the head in his own room.

These string of suicides have alarmed various sectors, especially psychologists who believe that the lack of awareness on depression and suicide and its preventive measures hampered the help that they could have gotten.

Dr. Eleanor Ronquillo, one of the resource persons for psychiatry of the Natasha Goulbourn Foundation (NGF), says that depression is “highly curable” and that suicide is “highly preventable.”

The Natasha Goulbourn Foundation was founded by fashion designer Jean Goulbourn in memory of her daughter Natasha who suffered from depression and died in 2002. Since its inception in 2007, NGF has been working to spread awareness about depression in the Philippines to prevent a similar tragedy from
happening again.

DEPRESSION AND SUICIDE

One could be in a crowded room full of depressed people but would never notice it.

“They may just be like you and me,” Dr. Ronquillo describes people who are suffering from the mental illness. “They may be well-dressed, walking well,” and when they start to speak with her, ultimately they would know that “something is wrong.”  The WHO, she says, considers suicide as a major public health problem. “One person dies every 16 seconds so that translates into an estimated one million people dying from suicide every year.”

The first step towards treating depression is awareness, according to NGF.

“Depression does not depend on the weight of someone’s problems, or on the failure of weakness of a person. But rather, it is disorder,” points out Dr. Ronquillo who has counseled various people aged 10 to 82.

According to her, when the triggering factor comes, the chemicals in the brain which influence emotions change and result in an imbalance.

“A suicide does not happen immediately just because of one incident. There are many factors which lead up to that decision. It may just be that Kristel’s failure to pay her tuition is the triggering factor for her demise,” she says. Other factors may include lack of social and family support, a person’s personality.

Depression, she adds, can also be hereditary.

For a suicide to happen, depression should be present in that person.  However, there are exceptions when people commit suicide due to psychosis or when they are under the influence of drugs.

SIGNS AND SYMPTOMS

Depression is sometimes mistaken as an act of attention-seeking. But Ronquillo says these people really need the attention and all the help they can get.

People should be on the lookout for persons who verbalize their intentions of dying, those who have sudden withdrawal syndromes and abrupt mood changes, and those who engage in risky activities as they may be suffering from depression and may lead toward suicide.

“They would say ‘Pray for me.’ Or ‘I’m going away.’ Some even lock themselves in their rooms, not wanting to talk to anybody. Sometimes they would ask where to buy guns or they would collect pills or get drunk and drive very fast at night,” she says.

This was evident with Kristel and Don Benedict, who left suicide notes for their families.

Dr. Ronquillo also enumerates three factors for a suicide to be possible.  First, the person must experience a “deep, aching, psychological pain.” Second is that there should be a doable method of suicide present, and lastly, the person must have guts.

“That is why some result to drinking (alcohol) because it gives them the guts.”

COPYCAT SYNDROME

The copycat syndrome was speculated by Dr. Ronquillo as maybe the reason why there were more suicide cases after Kristel.

“They imitate what they see. Like with Kristel, they see that and they identify with her so they copy what she did. It’s like idolizing one person.  This is dangerous because teenagers have that kind of vulnerability and
impulsiveness. It’s because in our brain, we have the thinking part and the emotional part. The adolescents have a developed emotional part but not yet the thinking part,” she explains.

Dr. Ronquillo says that these copycats could have thought that Kristel was lucky because her problems were over.

A FAMILY PROBLEM

Like all aspects, treatment should start with the family who should also consider one of its member’s problem as their own concern.

“A family member should say ‘we.’ ‘Let us go and see how we can get help.’ It should be ‘we’ instead of just the person with the problem. When one has suicidal tendencies, we recommend hospitalization to protect the person from himself,” she says.

The family should also constantly reassure the person that they love and accept him as depressed people often feel unloved and rejected. A suicidal person should always have someone with him 24 hours a day, she advises.

Once the family’s care for the person is assured, that’s when the foundation comes in.

“The foundation conducts advocacies and seminars to raise awareness among people. They maintain a hotline which should be called by people when there is a crisis, to prevent suicide from happening. The hotline is a brief crisis intervention. Before the end of the conversation, they refer the person to a therapist.”

COPING MECHANISMS

Dr. Ronquillo says a depressed person usually undergoes three levels of coping. The first is the biological level where he should be able to take care of himself. He should get eight to 10 hours of sleep, exercise, eat the right
kind of food, and maintain a balanced diet.

In the psychological level, the person must not dwell anymore on his problems. The highest form of that level is the spiritual sense. “When all else is lost, and that remains, the person is okay.” However, she says the spiritual
factor does not work when the person is experiencing “major depression” because of the chemical imbalances in the brain. Even priests commit suicide.

“No one is exempt. No one is immune. It is like you can’t pull yourself out from the situation you’re in,” she says.

Surrounding themselves with people, nature and the world comprises the third level which is the social level.

Dr. Ronquillo says the family of the suicide victim may also get depressed as a result of the tragedy sooner or later so they also need intervention.

As with Kristel’s suicide, she said that it has happened and that no one was to blame.

“None should be blamed; not even UP, not even the government, the manufacturers of the chemical, the parents, the persons who bully her, nor the teachers who did not give her an admission. No one and not even herself. Some people who have the automatic reaction to point their fingers at someone should avoid this,” she stresses.

Dr. Ronquillo says that the family should be able to get over it, move on, and indulge in activities where they can bond together.

(The NGF has also teamed up with the World Health Organization, Department of Health, Department of Education, Department of Social Welfare and Development as well as educational institutions such as University of the Philippines, Ateneo de Manila University and Miriam College in maintaining the Information and Crisis Intervention Center (ICIC) HOPELINE. The telephone hotline is accessible 24 hours a day, for people who may need help. It works on a referral system: those who man the phone lines assist the callers and refer them to counseling centers and hospitals. The hotline numbers are (632) 804-HOPE (4673), 0917-558-HOPE (4673), 0917-852-HOPE (4673) 2919 (toll-free number for GLOBE and TM subscribers)

Last year Russia passed a law giving the government powers to control and blacklist certain websites that it deemed to be harmful to children.  It went into effect in November, and the New York Times reports that authorities have begun cracking down. There appears to be a particular focus on sites containing information pertaining to suicide — both Facebook and Twitter have agreed to remove such content in the past few weeks. YouTube, however, filed an appeal in February over a takedown notice; the video in question depicted a woman using makeup and a razor blade to make it appear as if she had cut her wrists, but Google argued that the clip was intended as entertainment.

Outgoing FCC chairman Julius Genachowski has said the legislation signals "a troubling and dangerous direction" for the internet in Russia, and speaking to the Times, journalist Anton Nosik called the laws "absurd, harmful, and absolutely unnecessary" — while playing down the likelihood of a broader enforcement across the web. The government, for its part, argues that the bill was designed to protect children from harm by blocking pages on drugs, suicide, or child pornography. While there's no clear indication yet that the Putin administration has or will employ the new laws to stifle political opposition online, it's not surprising that many in Russia are feeling uneasy about the new powers afforded to the Kremlin nonetheless.

We've updated the Resources for Everyone page with two great sites! Check them out below!


RehabInfo, the most trusted rehab referrals. If you have reason to believe a friend or loved one needs treatment for a substance abuse problem, mental health disorder or a behavioral issue, chances are, they do. By the time you begin to notice behaviors out of the norm in the individual in question, they likely have been suffering with their conditions for sometime. It’s commonplace for a person with an addiction or mental illness to attempt to hide it from friends and loved ones for as long as they can. For this reason, it’s important for you to recognize the signs and symptoms of any issues that might require rehab.
http://www.rehabinfo.net/

Substance Abuse and Mental Health Services Administration (SAMHSA) is a resource to find alcohol and drug abuse treatment or mental health treatment facilities and programs around the country.
http://findtreatment.samhsa.gov/

A week ago I shared a blog from Karen Pilarski.  She's shared another wonderful entry that I wanted to share entitled 'Labels Don't Stick'.  It's a great post and a great piece to use to start talking about how we perceive one another.

I've put a few paragraphs here and you can follow the link to read the full entry:

Labels Don't Stick 
By Karen Pilarski
 
I once found a can of food buried in my pantry. It was dusty and expired a year earlier.  The label was completely torn off. I had no idea what was in that can of food. My only thought was that it was old and should be discarded. A bout of braveness took over and  the can was opened. Needless to say it was a slimy and green version of what I  want to say was peaches?

Yes, I’m going to compare people to expired cans of food. People don’t stay the same. The marks of life show in  dings and dents, displayed on the surface.  I’m not the same person I was years  ago.  I’d like to hope somewhere in the span of time my personality has evolved  into something more positive. It is unfair to stamp someone a certain way  because of how they were when growing up. I’m guilty of labeling people I’ve  dealt with based on perceptions of the past.

I remember this mean girl  from high school choir. I made the mistake of being funny and making a goofy  face in a picture. She called me out in front of the class and said I was ugly.  I went home in tears.  I wrote her off as a cruel bitch. The end of the year  before our graduation she came up to me and apologized and said
I wasn’t ugly. I  wonder what made her see the error of her way.  Maybe the choir teacher put her in her place. Possibly she realized she hurt my feelings?  I’m sure she would  have been hurt if she heard me say she looked like she hit a few ugly branches on the ugly tree.  Fast forward a decade and she is hopefully a responsible  member of society. Perhaps she learned that words hurt people.  Labels hurt people.

TO READ THE FULL ENTRY...

I received a DM the other day from Karen Pilarski.  She shared a wonderful post she did about LISTENING.  Such a simple and thoughtful act. One that so many miss in the hectic running around of life.

A big thanks to Karen for writing and sharing it!

I'll share the first part here and implore you to follow the link to read the full post:


It’s a Sad Day When Facebook is a Better Listener 
Karen Pilarski

Have you ever walked down a hall and someone passes you by and says “Hi, how are you?” They don’t stop to wait for the answer. In fact before lips part to make a  sound the person is long gone. Another scenario is mumbling out a response such  as “Ok, I guess.” The person responds with “That’s good” as they quickly  vanish  from sight. I wonder why people seem to care less now. Even Facebook is courteous and asks how I’m doing. It seems there are more responses coming from a white text box than an actual human being. What happened to the art of listening?

Listening requires more than just hearing words and nodding.  It requires ‘listening’ to the other person’s non verbal cues. Is the person covering their face as if to say they want to hide from everyone? Is the breath full of long deep pauses? It is understandable each person’s world is full of commotion and noise. Constant beeping of phones and blinking messages in the email take up time. For that troubled soul, all that is needed is a sympathetic smile or just simply asking how they are and waiting for an answer. I would think a person could take the second to do this.

I went to the doctor today and it might as well been done over the phone or via email. The doctor didn’t ask what was new and just wanted to get the general exam done. I’ve been to this doctor for years! I mentioned I felt run down and tired and the doctor simply just mentioned “Oh, well I’ll check your blood tests.” There was no asking if I have been stressed or having lack of sleep. The doctor didn’t listen. The doctor just wanted to get through with exam quick and go to the next appointment.

To read the full post:
http://karenpilarski.blogspot.com/2013/03/its-sad-day-when-facebook-is-better.html

The voice of the caller to the emergency call is nearly incoherent  from grief. Words, interrupted by heaving sobs, do not come easily for her.  Slowly, the emergency dispatcher eases details out of her.

"911, what is your emergency," the dispatcher calmly asks. "Ma'am, ma'am, I can't understand you, what is your address? ... What is the problem? What is going on?"

Two parents shout and cry over the phone, giving scattered details. After a few more moments, the pieces of the puzzle become clear: A teenager has committed suicide overnight, and the parents have found the body.

The mother hands the phone to the child's father. He sounds numb and repeats everything two or three times: They have been trying to perform CPR. They provide their address — the location of the body.

Calmly,  the dispatcher sends rescue workers to the scene on the west side of Columbus,  while talking the desperate parents through the steps of the  resuscitation technique.

The December phone call is just one of many. Local dispatchers and emergency workers have handled hundreds of similar calls in recent years, where people either committed suicide or were planning to harm themselves. But, Bartholomew County saw a dramatic rise in the number of suicide-related emergency calls over the past three years, a spike of 61 percent from 2010 to 2012.

City and county officials tell The Republic the rising numbers lead to heightened concerns over the safety of rescue workers because of the danger of a suicidal suspect using a weapon to attack an officer. And it takes a mental toll on those who receive and respond to the calls.

Ed Reuter, director of the Bartholomew County Emergency Operations Center, keeps track of three types of  suicide-related calls:

Suicide threats: A victim is planning to take his or her own life.

Suicide attempt with injury: A victim has taken steps to harm himself, whether through drugs, weapons or other means, but is still alive.

Suicide: The victim has killed himself or herself.

While the number of calls of suicide attempts and threatened suicides are up dramatically, the number of actual suicides in Bartholomew County has remained consistent during the past decade, at about 11 a year.

The  first line of help when a suicide-related call comes into the center is the dispatcher who takes the call, Reuter said. Where suicide-related calls used to come in every couple of days, now it is nearly a daily occurrence according to the statistics. Responding to any call is a complicated dance of questions, empathy and information gathering, Reuter said.

In a case in which a suicidal victim calls in, dispatchers are trying to talk subjects out of hurting themselves, while simultaneously gathering enough information to summon emergency workers to the location.

Although the dispatch center has a set of cards at each station outlining procedures for nearly every imaginable type of call, suicide calls require an especially personal touch, Reuter said. A loud, hysterical subject would require a different approach than someone who is crying and speaking softly, for example.

Dispatcher Angela Lee has been in her role for 24 years. In one call several years ago, Lee  spoke to a troubled victim for 22 minutes before the person committed suicide.

"You just become a friend over the phone. You become concerned about them and ask them why would they want to do that," Lee said.

"They are calling somebody to reach out. You just try your best to get to know them just a little bit. Find something that you might be able to pick on to get them to think on it."

Officers and deputies usually are the first to arrive on scene. Their first priority is to make sure the location is safe before paramedics and firefighters can come in to help a victim, police said. The worst case from a safety perspective is when a suicidal suspect is still armed when police arrive.

"Obviously someone who has overdosed on pills will require a little bit different response than someone who is threatening suicide with a gun or with a knife," said Todd Harry, deputy chief of the Columbus Police Department.

"If they have cut themselves or there potentially are guns in the house, our  officers will get there and assure that they don't have access to these weapons, they don't have a knife. If it is necessary, our officers will detain them with restraints or handcuffs. Generally we get there and make sure that everyone is safe and if there is medical attention required that we make sure that person gets that medical attention."

Every year, police go through training that includes a mental health component, covering a large number of topics, such as suicidal victims and those with autism, Harry said. Almost every shift now calls for officers to handle a mental health crisis of some sort, including suicide attempts or threats.

Officers are mindful of the "suicide by cop" phenomenon, in which suicidal suspects plan to act in such a way that police are forced to shoot and kill them,  Harry said.

"It is very, very real," Harry said. "Our ultimate goal is to get up there and set up a perimeter and call that person out and have a negotiated surrender, where we can convince the person to put their weapons away or put the weapons down and basically turn themselves over to us. The last thing we want to do is have it turn into a barricaded subject call where we have to activate SWAT and get negotiators involved. That is a very real possibility for those types of calls."

Among those who answer and respond to the calls, the suicide-related incidents are some of the most traumatic dispatchers and officers deal with, officials said.  The city and county both offer free counseling to employees who are having problems with these sorts of stressful situations.

Maj. Todd Noblitt, spokesman for the Bartholomew County Sheriff's Department, said  each officer deals with the stress of the situations differently. A deputy with  a teenager at home might have a hard time dealing with a teen suicide, where an  officer with an elderly parent could feel stress when the victim is a  senior citizen.

In Noblitt's years with the department, one thing that has changed is that police no longer put up a front that none of what they see in the field affects them.  Supervisors are sensitive to the stress officers feel and can suggest their subordinates seek counseling, Noblitt said.

"People sometimes think that cops are superhumans and that things don't bother them, but  the fact is cops are the same as anybody else," Noblitt said. "When you place an  individual in an abnormal situation, a suicide or a death of a child, being a  policeman or not doesn't matter. You are still going to feel those same types of  emotions, those same types of feelings.

"What happens, and why we do so much training, is because you are going to experience the same emotions and the same feelings, you need to be able to rely on  your training."

But just after the incident, there is no time for an officer or dispatcher to regroup before they move on to the next emergency.

"We cannot take them out of service for an hour, a day or whatever," Harry said.  "Once they leave that call, it is on to the next one."

Lee said she has learned to keep the stress of being a dispatcher compartmentalized from her life.

"It is my job, it is what I do," Lee said. "I don't take it home with me. I leave it there. Not to say that I don't care that just happened. But I don't take it home  with me."

Ashley Bear, a county dispatcher for about two years, said she also has learned to simply move on to the next emergency.

"Sometimes I make myself personally feel better by just silently saying a prayer for them and their family members, in my own mind and head, laying everything in God's hands. Because I have got to get going," Bear said. "On second shift, it isn't long until you get another call."