- Associated Press - Sunday, May 7, 2017

SNOW HILL, Md. (AP) - Kim Klump didn’t see it coming.

And there were so many signs, she says.

Her son, Jesse, had become increasingly detached and distant.

“It was the long showers,” said Klump, of Snow Hill. “This was a kid with a buzz cut. He had no reason to take 15-minute showers. Little things like that I can look back on and know that was a sign.”

When Jesse committed suicide, she wasn’t the only one broadsided emotionally. Friends and other adults in his life hadn’t realized what was going on.

But instead of collapsing under her grief, Klump has focused on helping others be more aware of the signs of depression and risk of suicide, which means grappling with the stigma of mental illness so others can seek help and know what services are available.

The grief and despair the loss brought inspired her to found the Jesse Klump Memorial Fund, an organization dedicated to suicide outreach and education on the Lower Shore. In 2015, four people in Wicomico County committed suicide, three people in Worcester County committed suicide and no one in Somerset County committed suicide.

In total, suicide is the second leading cause of death for women and third leading cause of death for men ages 15-24 in Maryland.

And struggles with mental health are not confined to the Lower Shore.

In 2014, Sussex County saw 28 suicides, a rate of 14 per every 100,000.

“The goal - always - is to get help when people need it,” said Michael Barbieri, director of Delaware’s Division of Substance Abuse and Mental Health.

Knowing the signs of risk and getting help, experts say, is paramount to preventing tragedies. However, despite a wealth of resources available on Delmarva for people in crisis, stigma and accessibility still stand as barriers in rural communities.

“This is something society doesn’t talk about,” Klump said. “It’s something we are uncomfortable with, or deny is there.”

Knowing the signs

The signs of mental health struggles can be subtle.

It can be anything from no longer wanting to play a favorite sport, having trouble sleeping or simply growing distant and less talkative. Identifying these factors and stepping in can be a turning point that could prevent tragedy, experts say.

Prior to her son’s death, Klump said the signs were not obvious, but looking back she feels differently. Even counselors at Jesse’s school did not see the problem, she said.

“They just told me it was senioritis,” Klump said.

Nearly a decade later, Klump is aware that the signs were there, and identifying them is crucial to solving a problem.

The process of finding these issues can be tricky, but crucial to making a difference. The signs, Barbieri said, can include someone who typically dresses very well now appearing disheveled, or more obvious factors, such as a person consistently speaking about death or their own inadequacies.

Ron Pilling, treasurer for the Klump Memorial Fund and a former employer of Jesse at the Pocomoke River Canoe Company, refers to Jesse as a son he wishes he had. Pilling said he can point to behavior Jesse exhibited - such as becoming increasingly less interested in kayaking - that should have suggested Jesse was struggling with a mental health issue.

Pilling said now, he would have noticed the signs.

However, Jesse’s struggle with mental illness is not an isolated incident.

Mental health issues, including depression and suicidal thoughts, do not discriminate against anyone, no matter their gender, race or age, said Michelle Hardy, the director of the Behavioral Health Program at the Wicomico County Health Issue.

Hardy said it is crucial for health departments to educate the community.

“It is a challenge,” she said. “The local health department partners with schools, local law enforcement, the court system and the hospital to increase awareness to the community.”

The need for community engagement is crucial, and something Barbieri said is essential to subverting disaster.

However, the lower Eastern Shore counties of Somerset, Wicomico and Worcester suffer from a lack of resources to properly deal with mental health issues, especially for children.

The closest hospital for children who require inpatient services for their mental health issues is in Dover, Hardy said.

“What we try to do is get the community involved, to have conversations with people and if they see something, to say something so that person can get the help they need,” Barbieri said.

Breaking the stigma

Especially in rural areas, a stigma associated with suicide and mental health is apparent, and this culture can often serve as a hindrance for the needed community involvement, Barbieri said.

According to a 2015 study in the medical journal JAMA Pediatrics, the youth suicide rate between 1994 and 2010 was nearly double in rural communities compared to urban communities, or 19.1 per every 100,000 compared to 10.31. In rural Sussex and Kent counties, this phenomenon is echoed. In 2014, 12 people per 100,000 committed suicide in New Castle County. In Sussex, the rate was 14, and in Kent, 17.

“There is this very common way of thinking that you stick up for yourself, you take care of yourself,” Barbieri said. “But even in rural America this isn’t true. Farmers need help from workers on their farms, for example. Teaching people to offer assistance is important, as is teaching people to accept assistance.

“We’re not all islands, and we can’t do everything on our own.”

For many victims of mental health issues, their afflictions are not felt as something that is out of their control, said Lynn Sande, founder of eRace the Stigma, a 5k event benefiting suicide awareness.

Sande’s daughter struggled with mental health issues. When the family first started dealing with the issues, it felt like it was a reflection on the family’s values, she said.

“I know I felt that way when my daughter first started having issues,” Sande said. “People immediately, especially when it’s a child or a teenager, look at the parents and judge and say ‘What went wrong in that family? What did the parent do wrong that the child is having this problem or is making these choices?’”

Ultimately, this process only exasperates underlying issues.

People suffering from mental health issues are fearful of judgment, Klump said, creating a stigma around the issue.

“The stigma is something I liken to breast cancer 30 years ago - it was something that people didn’t talk about,” Klump said. “Now, it’s become something we know about, and want to talk about. It needs to become that way for depression as well.”

For Barbieri, the need to address these issues early is paramount.

He said when there is a mental health issue, his department is able to work with the person who is suffering.

“We can get a case manager out there to get them reoriented if someone calls about a problem,” he said. “It’s important for us to know ahead of time.”

Tough talks and recovering

The crucial step to addressing mental health issues is starting a dialogue, Klump said.

From conversation to treatment, the fight against depression is an arduous one, and one that often will loom over its victims throughout their lives.

“Even it just means them talking about their problems, even if it’s just getting them to talk about their hobbies - conversation is key,” Klump said.

And, for residents of the Eastern Shore and Sussex County, treatment is available.

The Wicomico County Health Department has a partnership with Sheppard Pratt Health System, a hospital system focusing solely in mental health issues near Baltimore, for a tele-doctoring service, meaning children can be seen by a psychiatrist at Sheppard Pratt without having to be there.

“This fills a gap where we have a shortage of nurse practitioners and psychiatrists to treat individuals in this area,” said Hardy, Wicomico’s Behavioral Health director.

The gaps in coverage expand to Somerset County, which shares many of the same providers who service Wicomico County, said Tammy Griffin, the director of Planning and Population Health for the Wicomico County Health Department.

There is a Core Service agency that vets programs coming into the counties.

“If it is a mental health or addiction agency, they request a letter of support showing the support for their entry into the county,” Griffin said. “We are seeing an expansion of providers coming into the area, which is needed as long as they are following the proper protocol for doing so.”

Services are also available for those who do not have insurance, said Lisa Renegar, the public health planner for Wicomico County.

People who are homeless, coming out of a psychiatric inpatient stay, receive benefits from the government for their disorder, are coming out of prison or jail, or are on conditional release can receive treatment no matter what, she said.

And, even if someone doesn’t meet these requirements, there are still options available, she added.

“They will go to Chesapeake Hospital because they treat everyone regardless of insurance coverage,” she said.

In Delaware, programs such as Restart offer opportunities for victims to seek assistance from service providers with a dedicated case manager.

In these programs, if a person has to go to a psychiatric site but did not need to go into the hospital, they could connect with a community provider, Barbieri said.

“They would manage the case, and stick through it with them,” he said.

And there is evidence that these programs are making a difference in the lives of those suffering from mental health issues, Renegar said.

If people are receiving mental health treatment and are on Medicaid, they have to fill out a questionnaire every six months about their treatment and their progress.

“The questionnaire does show that people are getting better,” she said.

However, regardless of what services are or aren’t available, someone has to make a call and seek them out.

Nearly everyone will have someone in their life impacted by suicide, said Pilling, Jesse Klump’s former employer. It is an issue that is universal, and for those with loved ones in crisis, there are resources to help.

“What people need is to know the signs, to know when a person might be on the verge of doing something, and being there for them and making sure they get help,” Pilling said. “You can make a difference.”


Information from: The Daily Times of Salisbury, Md., https://www.delmarvanow.com/

Copyright © 2018 The Washington Times, LLC.

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