Jeff Burkhead, Bert Nash Community Mental Health Center

Note: September is Suicide Prevention Awareness Month. Anyone struggling with thoughts of suicide should call the National Suicide Prevention Lifeline at (800) 273-8255 or (785) 841-2345.

As soon as they received the text message, they knew. And in that moment, everything changed. Forever.

I want you all to know I love you. Its my time to leave. Thank you so much for being such a supportive and loving family. Im sorry I have to do this. I have been planning this for a while and the time is here. I hid it well but I have been depressed for so long I dont even know when it first began. Just know theres nothing you could have done and this is my choice. As much as I love you I cannot be on this earth anymore. Theres something wrong in my head and I cannot bear it anymore. I love you. Thank you for all the laughs and good times we have all had together. You are the most amazing people and the best family anyone could ever have. Im so sorry to do this.

April and Richard Ramos

For April and Richard Ramos, Dec. 2, 2018, was a parents worst nightmare. Thats the day their second oldest child, Adam Miguel Juan Ramos, killed himself. He was 24.

Thats a day we will never forget, Richard said. Its so vivid in my mind, finding him.

Adam was alone when he died. His parents found him in the basement of his house.

Ive never cried so much in my life, Richard said. But thats OK, Adam deserves every teardrop.

The day before Adam died, he and his father watched Adams younger brother, Anthony, wrestle at a tournament in Kansas City.

We had a great day watching Anthony compete and cheering him on, Richard said. Adam was so supportive of his younger brother, true brotherly love.

Adams younger sister, Allison, was the last person in the immediate family to see Adam. They went together to a University of Kansas basketball game on a Saturday night. Adam died the following day.

I remember that night so well because he seemed so happy, Allison said. I made him take a selfie with me, which is now the last picture we have of him, so I am forever grateful I took that picture.

That smile was always on his face; he hid behind it really well, said Abigail, Adams older sister.

Behind his ever-present smile, though, Adam was hurting on the inside. He tried to kill himself by driving off the road when he was a freshman in college, though his family didnt know it was a suicide attempt at the time. His mom, April, who works in the mental health field, convinced Adam to see a therapist. He went a couple of times, but then stopped going, saying he didnt think therapy was for him.

Allison Ramos

I struggle with blaming myself, especially being in mental health, April said. The guilt has been really hard. My family has been great, reminding me that it wasnt anyones fault. They said he kept it from all of us.

After Adam died, Richard received a phone call from a high school classmate whose brother had died by suicide.

One thing he said that stuck with me was to imagine the pain they must have been in to want to end their lives, April said. Thats what has gotten us through it, that hes no longer in pain. I wish we could have helped him deal with that pain. But it helps to think that hes no longer in pain.

On what would have been Adams 25th birthday, Feb. 4, 2019, the Ramos family gathered with friends to celebrate Adams life.

Adam deserves to be remembered, Richard said. He brought us so much happiness in his short 24 years. We need to keep talking about him.

Talking about suicide can make people uncomfortable, but its important to talk about, to bring the subject out into the open.

This has to be talked about, Richard said. I know suicide happens way too often and I want to help change that.

Growing up in Charles Town, W. Va., Carter Gaskins family didnt talk about their feelings. His father was the strong, silent type.

My father was a big guy and he was the type of person who thought men didnt cry, Gaskins said. So I kept my feelings hidden. I think more of the black community holds this topic of anxiety and depression inside. We are taught to be strong and not to be emotional. Unfortunately, in the black community, we have to run faster to get ahead, so we don't have time to feel emotion. We just must keep running to be successful.

Carter Gaskins

Gaskins was a skinny, quiet kid growing up. From first grade through the 11th grade, he was bullied. Pushed off his bike. Punched in the chest. Called names. He didnt tell anybody about what was going on. He put on a good front, but when he was by himself, he would cry.

I would think, why am I not good enough? he said. Why cant I be a normal kid?

In his senior year of high school, Gaskins chose a different path. He started hanging out with people who were on the streets. They were his protection. He started sticking up for himself.

Thats when I got into things I shouldnt have, He said. Street life, fighting, hanging out all night, going to clubs and parties.

But he wasnt happy.

Depression hits you in different ways, Gaskins said. I was angry, frustrated, didnt care about nothing.

When his father, this big, strong guy who seemed invincible, became sick and started having his own mental health issues, Gaskins sunk deeper into depression. His father, because of his physical problems, ended up going on dialysis.

Seeing my father on dialysis, helpless, hopeless, I started having a nervous breakdown, shaking, crying, Gaskins said. In March 2009, I had my first panic attack and Ill never forget it.

Three months later, Gaskins father died after suffering a stroke during dialysis.

The depression was still there, Gaskins said. I used to ride motorcycles. I would sometimes ride at a high speed and think about killing myself. I had no fear.

One year after the death of his father, Gaskins met Shanice, the person who would become his wife. About a year later, they were expecting a child. The child passed away shortly after birth.

Thats when everything went black for me, Gaskins said. Everything was numb. It was like there was a huge cloud sitting over me. There were a lot of times I would be in the car holding a gun and just wanted to end it. I really didnt care about anything.

Gaskins and his wife separated and she moved to Lawrence, while he stayed behind in West Virginia. He ended up joining her here in Lawrence. The move changed his life.

It took my wife to get me out of that place. I put her through hell, but shes such a strong woman, Gaskins said. I had to deal with all of my pain and my frustration and face those things head-on.

And he discovered a new passion.

Thats the reason I got into photography, he said. There are a lot of people who deal with anxiety and depression and suicidal thoughts and they think no one cares about them. I take it upon myself, that its my job to show them how beautiful they are with my camera. You never know what someone is going through. I went through it, and I understand it.

When she was 13, Sierra Two Bulls contemplated killing herself.

It was really more self-harm; I cut myself, she said. What I really wanted was for the problems to go away, but not necessarily my life. I never attempted after that, but that became part of my journey. It was my familys addiction problems that really made me want to kill myself when I was 13.

Sierra Two Bulls

Two Bulls, an alumna of Haskell Indian Nations University and the University of Kansas, is an Oglala Lakota from the Oglala Sioux Tribe on the Pine Ridge Reservation in South Dakota. She grew up around her culture and traditions, but the poverty, addiction and despair are also a reality for her and her tribe.

As a Native person, we have ongoing intergenerational trauma caused by European colonization, the genocide, the boarding schools, and the forced removal from our land, Two Bulls said. Theres a saying, I have attended more wakes and funerals than graduations and other celebrations. That speaks to my reality. Suicide rates among American Indians/Alaska Natives are historically higher than those of the total U.S. population. We have that ongoing trauma.

Two Bulls experienced trauma in other ways as well. She is a sexual assault and domestic violence survivor.

Even though I come from a long line of resilient people, we still have ongoing trauma, she said. I have seen the effects of that.

In 2015, when Two Bulls was in graduate school at the University of Kansas, one of her best friends killed himself. Motivated by the loss of her friend and to earn her masters degree in Social Welfare, Two Bulls applied to do her practicum at Headquarters Counseling Center. Shes been a volunteer counselor ever since.

Its been a long journey, she said. Trauma and resilience have played a huge factor in my life. Thats what brought me to Headquarters and why Ive stayed.

Chris Maxwell has been working in the field of suicide prevention since 2013. His personal experience with suicide goes back further.

I had my own experiences between high school and college with a couple of suicide attempts myself and then went through my own recovery process, Maxwell said.

Chris Maxwell

Maxwell, who is director of public relations and media for the American Association of Suicidology in Washington, D.C., began working in the area of suicide prevention when he went through training to become a counselor for Headquarters Counseling Center in Lawrence, which is now Kansas Suicide Prevention HQ.

Now, looking back, I would say it absolutely influenced me to get into this line of work, Maxwell said. Through the Headquarters training, it became clear that this was something that was not only helpful for others but was helpful for me in processing and coping and connecting with others who had experienced similar things.

Maxwell found that opening up about his experiences was helpful when he was going through his own struggles.

Being more open and sharing how things are going and asking for help when I needed it was really big, Maxwell said. Its really hard to reach out and ask for help, and suicide is a hard topic to talk about. It can make you feel like youre a burden to those around you. But I found out I wasnt a burden; people really did want to know what was going on with me.

Maxwell said it is important for people to check in with each other, especially now during a pandemic.

With COVID-19, that isolation factor is huge, Maxwell said. We know that people are being impacted, we know that people are feeling worried. People are suffering in silence and not feeling like they have any way of dealing with their emotions. We need to be checking in on our loved ones all the time.

Amy Hammer is a member of the Dialectical Behavior Therapy team at the Bert Nash Community Mental Health Center. She experienced bullying and suicidal ideation when she came out as gay in high school. After taking a psychology class, she knew she wanted to help people who were struggling with mental health.

In college, she volunteered at Headquarters and learned a lot about talking to people who were considering suicide. She has been a DBT therapist for almost 20 years now; for the past five years, focusing on transgender individuals and how to help them. The transgender population is at a higher risk for suicide; though research shows that trans people are less suicidal when their families are supportive.

I love DBT because its a respectful treatment for people who have suffered from traumatic, invalidating experiences and environments, Hammer said. DBT has shown in many studies over the past 20 years to be really helpful for people who are struggling with intense emotions, suicidal ideation and self-harm. Ive watched countless people get much better, stop wanting to die, and build lives worth living.

Like cancer, most people know or know of someone who has died by suicide.

Almost everyone is touched by suicide, in some way, said Allan Bunch, vice president of communication and development for Kansas Suicide Prevention HQ. I challenge anybody to meet someone who has never been impacted by suicide.

For many years and still in some circles, suicide isnt talked about. Adding to the stigma and shame.

Suicide is OK to talk about, Bunch said. When were talking about suicide were not talking about anything that anyone should be ashamed of. Someone died because they were in pain and they sought to end their pain. Most people who are considering suicide actually dont want to die; its just the only way they can see ending their deeply intense emotional pain.

Like every other business and organization has had to do during the pandemic, Headquarters Counseling Center has adapted and adjusted. But its counselors remain as dedicated as ever.

Were all focused on day-to-day living and staying safe while we experience a global pandemic, and our volunteers are not an exception to that, said Jared Auten, training coordinator for Headquarters. Theyre certainly having their capacity stretched and challenged. So were conscious of trying to keep them supported. Weve been so grateful for our volunteers.

Typically, Kansas Suicide Prevention HQ has about 55 active volunteers at any given time. A standard shift is four hours; the overnight shift is eight hours. The number of calls per shift varies. Headquarters is part of a national network of more than 160 crisis centers that answer calls to the National Suicide Prevention Lifeline.

Our volunteers are regular people in the community who have an interest or a passion for suicide prevention, Auten said. The volunteer opportunity attracts people who have some connection to suicide.

Jared Auten and Rachel Schmidt

For Auten, it was his father.

My main motivation for getting involved with Headquarters was the death of my dad in 2006 by suicide, Auten said.

Auten was 13 at the time of his fathers death.

I wasnt initially told that he had killed himself; I was told a day or two later, Auten said. When I was told that my dad had died, I knew that he had killed himself, but no one was saying it. I didnt think it was a hunting accident, which is how it was presented to me. Every family, every community is impacted by suicide. But those stories arent always told. The other reality is as a society we really arent comfortable talking about suicide.

Talking about suicide isnt easy but its necessary, Auten said.

Mental health issues, like suicide and depression and anxiety, are not talked about among men. The attitude is that asking for help is not masculine and that its a sign of weakness, Auten said. We as men have to acknowledge there are aspects of masculinity that get in the way of us doing things that promote health and wellness.

When someone is experiencing suicidal thoughts, its important to have open and honest conversations about access to services as well as access to firearms and other lethal means, and to encourage family members to work collaboratively with the person who is at risk.

When someone died by suicide, its easy for others, particularly family members, to blame themselves.

Even when someone displays warning signs and ultimately dies by suicide, its no ones fault, Auten said. But that blame is definitely something that suicide loss survivors experience. You start questioning, what could I have done? Could this have been prevented? A lot of survivors go through the mental gymnastics of trying to make sense of it. Its important to be reminded that its no ones fault.

When Matt Jackson started as a counselor at Headquarters Counseling Center, he encountered something he had never experienced before.

Its a safe place, Jackson said. Its the first safe place Ive ever known.

Matt Jackson

Like other suicide counselors, Jackson has his own history with the issue.

I have a history of depression, a history of anxiety, Jackson said. At one point in my life, I actually got to the point where I had gone and bought a knife. I think I was maybe 18. I had given away possessions; there were certainly warning signs.

Dealing with being gay and growing up in the South as well as working through childhood trauma that he had to unpack over time, Jackson has healed and grown. As a counselor, he has shared from his own experiences when its appropriate and he thinks it will be helpful, but, mostly, he listens.

We provide a mirror of self-reflection that allows people to open, Jackson said. Its all anonymous. We do everything to protect the callers anonymity and our own anonymity. So its a forum, almost like a confessional. My role, as I see it as a volunteer counselor, is to be an assistant. Im assisting people, Im here to hear you. That person, whether they realize it or not, by calling, by reaching out, theyve already made a step toward surviving, toward life.

In 2019, Bill Harkness, a longtime board member of NAMI (National Alliance of Mental Illness) Kansas and board president, died by suicide.

It was a shock to everybody who knew him but a reminder that suicide can affect anybody, said Bill Wood of NAMI Douglas County.

After Harkness death, Gov. Laura Kelly issued a statement: Im deeply saddened to hear of Erics passing. He was a tireless advocate for the Kansas mental health community. He touched many lives with his unbridled passion for helping people who deal with mental illness every day access the help and support they need.

Eric inspired us during Mental Health Advocacy Day at the Capitol and other activities as part of his unwavering commitment to educate and increase awareness about mental illness.

Wood remembers his own personal experience with suicide, which occurred years ago.

It would be pretty unusual if somebody hadnt at least thought about it sometime in their life, Wood said When I was younger and not getting along with my wife very well, I was driving down the road one day and thinking about which telephone post am I going to hit. Fortunately, a little voice said, youre listening to a lie here; you can work this out. So, Im still alive.

Rachel Wolfe, an urgent care therapist for Bert Nash Community Mental Health Center, has talked with many clients whose lives have been upended by the COVID-19 pandemic.

While working with clients over the past several months, I have noticed a topic that frequently comes up in session routine, Wolfe said. In crisis therapy and individual outpatient therapy alike, we often support clients in developing healthy, supportive routines which are shown to positively impact one's mental health.

The pandemic has dramatically changed those routines.

Throughout the pandemic, people have had their lives, and specifically their routines, flipped upside down without any notice, Wolfe said. Clients have told me that they feel like their mental health, physical health, and lives as a whole are out of their control; and this is often where suicidal thoughts come in. Whether they live or die becomes one of the only things they feel they can control.

Although the pandemic has posed our clients with many unforeseen challenges, I also am hopeful that it has shown them that they are resilient, resourceful, and well-equipped to overcome life's inevitable challenges, Wolfe said.

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