The Washington PostDemocracy Dies in Darkness

For months, he helped his son keep suicidal thoughts at bay. Then came the pandemic.

One in 4 young adults have struggled with suicidal thoughts since the coronavirus hit, CDC says. “I could see the storm coming,” says a father.

The surviving family of Christian Robbins — father Ted, mother Sarah, sister Sophia and brother Ethan — try to celebrate his life daily in Richland, Wash. (Leah Nash for The Washington Post)

He visits the grave every day.

And every day, Ted Robbins asks himself the questions that have plagued him since the night his 16-year-old son killed himself, one month into the pandemic.

What if Robbins hadn’t canceled their family vacation? What if their school hadn’t closed down? What if his son Christian could have leaned on his best friends through this rough patch, as he had in the past?

But one question haunts him the most: “What if the pandemic never happened — would my son still be alive?”

As the pandemic continues into the holiday season, rates of anxiety, depression, and suicidal ideation are rising. (Video: The Washington Post)

Since the coronavirus arrived, depression and anxiety in America have become rampant. Federal surveys show that 40 percent of Americans are now grappling with at least one mental health or drug-related problem. But young adults have been hit harder than any other age group, with 75 percent struggling.

Even more alarming, when the Centers for Disease Control and Prevention recently asked young adults if they had thought about killing themselves in the past 30 days, 1 in 4 said they had.

America’s system for monitoring suicides is so broken and slow that experts won’t know until roughly two years after the pandemic whether suicides have risen nationally. But coroners and medical examiners are already seeing troubling signs.

In Arizona’s Pima County, officials have sent two health bulletins alerting doctors and hospitals to spikes in suicides. In Oregon’s Columbia County, the number of suicides by summer had already surpassed last year’s total. In the sprawling Chicago suburbs, DuPage County has reported a 23 percent rise compared with last year. And in the city itself, the number of suicides among African Americans has far surpassed the total for 2019, even as officials struggle to understand whether the deaths are being driven by the pandemic, racial unrest or both. What has shocked medical examiners in Chicago is the age range — from a 57-year-old deputy police chief to a 9-year-old child.

Since Christian’s death, many parents have called his father Robbins for advice, and several of Christian’s classmates have confided about their own struggles with suicidal thoughts.

On a recent visit to the cemetery in Richland, Wash., where Christian is buried, Robbins found two teenage girls he recognized from Christian’s funeral sitting at his grave. One was sobbing.

The girl said she, too, suffered from depression and was wrestling with suicidal thoughts. She had called a hotline, but the local crisis center had only 16 psychiatric beds for teens and all were full. She was put on a waiting list.

“You don’t know how bad it is right now,” she told him. “Almost every one of my friends has thought about it.”

A broken system

From the moment the coronavirus arrived, it has exposed and deepened every crack in America’s foundation. But when it comes to suicide prevention, the country’s system was already falling apart.

Even as suicide rates have fallen globally, they have climbed every year in the United States since 1999, increasing 35 percent in the past two decades. Still, funding and prevention efforts have continued to lag far behind those for all other leading causes of death.

Then came the pandemic.

Experts warned that the toxic mix of isolation and economic devastation could generate a wave of suicides, but those dire predictions have resulted in little action.

“Sometimes, I just want to grab people and shake them awake,” said Robbins, as he walked up the well-worn cemetery path on a recent Friday to the shiny bronze marker bearing his son’s name.

He said Christian had been struggling for months with depression and early symptoms of bipolar disorder. During a particularly bad period last year, they had rushed to a crisis center — afraid Christian might hurt himself. So Robbins was vigilant about how the pandemic might affect his son. “I could see the storm coming,” he said.

Robbins listened from his home office as Christian talked and laughed with his siblings, monitoring changes in his mood. They played games together, watched movies, talked on long drives. Every night, he wrapped his son in a fierce bear hug and told him, “I love you.”

“I remember thinking to myself that Friday before he took his life, ‘This covid situation is bad, but it’s going to be okay. He’s going to be okay,’ ” Robbins said.

He discovered only later from notes on Christian’s laptop just how badly the pandemic was fraying his son’s mind. Because of the virus, Christian could no longer hang out every weekend with his three best friends, who had helped him through past bouts of depression. His son told him that a voice inside was whispering how worthless he was, how he was hated by everyone.

Throughout the pandemic, Robbins pointed out, President Trump and conservatives have repeatedly cited fears of suicide as they pushed to reopen businesses. But they and Democrats have done little about it, even as prevention groups begged for help. Since the crisis began, $175 billion in emergency funding has been allocated to hospitals and other medical facilities, but less than 1 percent of that has gone specifically to mental health and substance abuse services.

Now winter is approaching, bringing another wave of infections, another surge of fear, uncertainty and devastation.

“Why aren’t school districts reaching out to students they know have problems?” Robbins said. “Why aren’t we, as a country, doing anything about this part of the pandemic that’s killing people we love?”

‘Stuck in life’

What makes this moment especially perilous for young people is that their suicide rates were already rising faster than those of any other group. Between 2007 and 2018, suicides increased 56 percent among teens and young adults.

The pandemic could accelerate that trend. A federal study in August on the coronavirus’s mental impact found that the youngest people surveyed had the highest rates of increased anxiety, depression, substance use and other mental health problems.

“At that age, you’re looking for your place in the world, searching for your identity,” said Jonathan Singer, a suicide researcher and president of the American Association of Suicidology. “To be stuck in life right now, not able to get a job, not able to plan and see a way forward — to be home and feeling like you’re a burden — it’s challenging.”

Brad Hunstable was working in his home office April 17 when his younger daughter ran in yelling that her 12-year-old brother had hurt himself.

Hayden had never struggled with depression or mental health problems, Hunstable said. But just before the pandemic, his son — an avid player of the video game Fortnite — had tossed his controller and accidentally broken the family’s flat-screen TV.

At the time, Hunstable and his wife told Hayden that he would have to earn a new monitor by doing extra chores and being kind to his 8-year-old sister.

For weeks, their son held up his end. “I was so proud of him. He was learning, evolving. He was becoming a man,” Hunstable said.

But on that April afternoon, Hunstable later found out, his son had broken the replacement TV and become furious with himself.

It happened just four days before Hayden’s 13th birthday. Hayden had planned to celebrate on Fortnite. After schools shut down, the online game became his main connection with friends

“I think he felt like he ruined his birthday,” Hunstable said. “You combine that with not seeing others, not being able to do the sports he loved and the stress of everything going on. It was a perfect storm that led to this one impulsive act, an act he couldn’t take back.”

Coming to grips with that reality has been hard. “I was so mad one day, I took a baseball bat to a tree and just smashed it for hours,” said Hunstable, who lives in Fort Worth.

When people ask about his son, he tells them, “Covid killed my son but not the way you think.”

In recent weeks, Hunstable has urged other parents to talk openly to their children about mental health. He created a nonprofit to push schools to do so, too.

Research shows that even modest interventions — such as asking people if they’re okay — can reduce suicides.

Large-scale studies found that when hospitals asked emergency room patients if they had had suicidal thoughts and then followed up, it cut the risk of suicidal behavior by half. Adding such screening questions during the pandemic — at schools, primary-care offices and hospitals — could save thousands, experts say.

Lowering barriers to mental health care would also reduce deaths, experts say. Much of the problem, however, lies in the unequal way America treats mental health compared with physical illnesses.

“Why isn’t there a mental health leader on the coronavirus task force?” said Vaile Wright, clinical research director at the American Psychological Association. “Our physical and mental health are completely intertwined, and we need to treat them that way.”

One of the few actions undertaken by U.S. leaders this fall — after a decade of discussion — was to authorize a three-digit number, similar to 911, for people to call during a mental crisis. But the 988 number won’t take effect until July 2022. And crisis centers in charge of those calls are facing severe cuts because the pandemic has decimated state and local budgets.

A brewing storm

Suicidal thoughts are not the only sign of a crisis.

Other maladies bubble up first: alcohol consumption, anxiety, depression, unemployment, homelessness, domestic violence, post-traumatic stress disorder, drug use. All of them elevate suicide risk.

Experts compare the effect to a storm that takes time to build and crest but has a tragically long tail once it hits. Because of that, it could take years for the full mental impact of this pandemic to play out.

In the years after the 1918 flu pandemic, suicides appeared to rise, but records from that era are sparse and unreliable. Studies of natural disasters have been similarly inconclusive.

Immediately after a crisis, suicides sometimes decrease briefly because of a “pulling-together effect.” In the first six months after the Sept. 11, 2001, terrorist attacks, suicide rates among New Yorkers declined.

A similar phenomenon was evident in some regions this spring. Connecticut — one of the few states that maintain real-time suicide data — registered a 20 percent drop during the first half of this year. Rates in Massachusetts have been relatively flat.

But countries that track suicides more closely than the United States said they are starting to see sharp upticks. Japan said suicides in August increased 15 percent. Nepal has similarly reported increases. Thailand recently said its suicides have risen 22 percent compared with the year before. Thailand’s Health Ministry has directed police to monitor social media to find people in distress and is setting up a reporting system to get suicide statistics faster. “We definitely cannot wait,” a ministry spokesman said.

For a glimpse at what lies ahead for the United States, most experts say, the most applicable data comes from past economic disasters.

Studies have established strong correlations between suicide and financial pressures such as unemployment, eviction and displacement — all of which have risen sharply during the pandemic.

In the two years after the 2008 Great Recession, America’s suicide rate increased four times as fast as in the eight years before.

“But we can’t and shouldn’t treat a rise in suicide as inevitable,” said Colleen L. Carr, director of the National Action Alliance for Suicide Prevention, “because there are things we know that can reduce it.”

Desperation and a gun

Pamela and Dan Kaiser say the haphazard way America has handled the pandemic contributed to their son’s death. But they also question why it was so easy for their son to buy a shotgun on the day he decided to kill himself, even as other businesses were shut down.

“How are gun shops considered essential in the middle of a pandemic?” asked Pam Kaiser, 59, from her home in Traverse City, Mich.

Nearly half of all suicides involve firearms. And as pandemic fears have grown, so have gun sales.

During the first eight months of this year, more firearms were sold than in all of 2019, according to an analysis of FBI data by the research group Small Arms Analytics. The country is on track this year to have the most gun sales ever.

For months, Aaron Kaiser, 24, had been struggling with depression and anxiety. There was a suicide scare last year — a note his mother found in his room.

When the pandemic hit, his parents were initially relieved. “We were all under one roof. We could take care of him, watch over him,” Pam Kaiser said.

Then Aaron’s therapist closed her practice. He became increasingly irritable and withdrawn. The college where he was taking classes shut down. His father got laid off from the company where he had worked for 27 years, and Aaron told his parents he felt like a burden.

His mother called a long list of mental health programs — as far away as Colorado — trying to get him treatment. But in the early weeks of the pandemic, her calls went straight to voice mail.

One day, she found a sticky note in Aaron’s room that said simply: “I’m sorry. I love you all.”

Alarmed, she called Aaron on his phone, and he dismissed it as an old note. He asked if they needed anything from the grocery store. He didn’t come home the next day.

Pam called the police while Dan checked their family’s credit card activity online to see where Aaron could be. His heart dropped when he saw a charge for $560.67, at a gun shop a few miles from home.

Before Dan could even print out the statement, a sheriff’s deputy was walking up their driveway to tell them about the body discovered in a nearby park.

“For the rest of our lives, we will blame ourselves for not protecting him,” Pam said. “But how was it that easy for my son to buy a gun on the day he decided he wanted to kill himself?”

Roughly 90 percent of suicide attempts by guns are fatal. In contrast, only 4 percent of attempts by all other means result in death. A study of 26 million death records found that gun owners were nearly four times as likely to die by suicide as people who do not have guns.

“If people are buying guns during this pandemic for a sense of safety and security, they need to know what the risks are,” said David M. Studdert, a Stanford University professor who led the study.

‘It’s not too late’

It has been seven months since that night Ted Robbins’s son sneaked out and shot himself.

He keeps a jar of pictures by his bed and a cast the funeral home made of Christian’s hand. Every night before he sleeps, Robbins places his hand into his son’s.

He found an online support group and told its leaders he wanted to help others struggling in the pandemic. Last month, Robbins received an urgent call: a father, whose 16-year-old daughter had just killed herself.

Robbins listened as the man described his daughter’s loss of hope — with so many still dying from the virus, protests in the streets, America at war with itself. He listened as the man second-guessed every choice he made in the final days of his daughter’s life.

He recognized the rawness in the father’s voice. An hour into their conversation, Robbins told the man the kind of thing he has struggled for months to say to himself: “You loved her. You did everything you could. You didn’t cause her death.”

Before he hung up, Robbins promised to add the man’s phone number to a growing list of struggling families Robbins checks on amid the pandemic.

In daily visits to his son’s grave, he often tells Christian about these people he is trying to save.

“There’s so many kids out there, so many families that still have a chance. For them, it’s not too late.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.