The rate of suicide among people who are homeless is estimated to be nine times higher than the general population of the United States.

The homeless often combine a number of risk factors, including being a veteran or experiencing anxiety, stress, isolation, loneliness, major mental illness, substance abuse, unemployment or past trauma.

Knowing all of this, Amy Baker, the executive director of Clatsop Behavioral Healthcare, plans to add two more people to a small team of recovery allies later this year.

The recovery allies’ job is to reach out directly to people with substance abuse issues who may not be ready to engage with services. Though the focus is on substance abuse, allies would go where high-risk people, including those who are homeless, already are: hospital emergency rooms, the county jail, or the streets of Astoria.

But Baker said far more resources around suicide prevention and awareness are needed.

Oregon’s suicide rate is above the national average — and has been for the past three decades. More than 800 people killed themselves last year and more people died by their own hands in 2017 than in traffic crashes or by drug overdoses or firearms. Of the 379 deaths recorded in Clatsop County in 2018, nine were the result of suicide, according to the Oregon Health Authority.

‘Breaking the Silence’

This month, newsrooms across Oregon produced “Breaking the Silence,” a weeklong reporting collaboration on suicide and prevention strategies.

Clatsop County, like many in the state, has struggled to find adequate resources.

Local resources like the county’s Juvenile Department have not had funding specifically for suicide prevention and awareness for many years, nor does the county have a strategic plan or specific strategies around the topic, said Jill Quackenbush, prevention supervisor for the department.

While the Juvenile Department and agencies like Clatsop Behavioral Healthcare can help people struggling with suicidal thoughts through other programs, part of the challenge with addressing the homeless is that they are a population on the margin, Baker said. There is little research around what successful suicide prevention programs look like for these groups.

Clatsop Community Action, which offers a number of services and housing programs, often catches homeless people in the middle of a dark place. When people come in to use the agency’s phone, caseworkers have overheard conversations where they talk about committing suicide, or the subject will come up in routine case management interviews and assessments.

“We see a fair number and immediate intervention is really needed,” said Elaine Bruce, the group’s executive director.

Sometimes a homeless person they’ve been working with will come in one day looking really bad, Bruce said.

“We ask them if they’re OK because you never know what has happened to them out in the community. Homeless people can get victimized a lot … People are kind of scared of homeless people, but actually they’re the ones that get victimized.”

If someone appears to be seriously contemplating suicide, the agency’s first step is to contact Clatsop Behavioral Healthcare’s mobile crisis team. But the crisis team serves the entire county and may not have a crisis worker nearby. In that case, the first responder is a police officer, who can drive the person to the hospital to wait.

‘Lost’

Alan Evans, the director of Helping Hands, which provides re-entry and substance abuse treatment programs to the homeless, believes an internal poll of the nonprofit’s clients would reveal that most of them have contemplated suicide at some point.

“There’s not a road that leads to our door,” he said. “You come to us or get sent to us because you are lost.”

It’s a struggle Evans knows personally. He grappled with suicidal thoughts and made several suicide attempts earlier in his life when he was homeless, dealing with mental health issues and addicted to drugs.

Because of the difficulties inherent in such a life, “in the back of people’s minds, suicide is an option,” he said.

For Evans, one of the more crushing realizations was the fact that he did not have anyone to call. His long history of problematic behavior had eroded his social support and pushed people away.

One of the most important first steps organizations like Helping Hands can take with clients is simply to listen, while at the same time removing some of the stresses of living on the streets.

“Sometimes just offering them an ear and a place to live is just enough to make that thought of suicide go back in the mind,” Evans said, adding, “We look at how we can build a foundation for a person to at least give them the hope that change can happen.”

Baker and others believe most people are aware of the services available to them in Clatsop County. But Baker said homeless people likely face the same stigma, the same reticence to seek help, that nearly everyone experiences when struggling with depression and suicidal thoughts.

“For all the things you may think about when you see someone who is homeless, you’re still talking about a human being who may experience despair to the point that they want to end their lives,” she said.

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