116 3rd St SE
Cedar Rapids, Iowa 52401
Daniel Jasper of Cedar Rapids wasn't counted among Iowa's 423 deaths by suicide in 2011. The 16-year-old was in a residential program at Boys Town, just outside Omaha, when he walked away from the campus in late August.
'He called my wife the next morning and begged her to pick him up,' said David Jasper, Daniel's father. 'He called back 10 minutes later and said, 'Mom, I can't do it anymore. Tell my friends and family I'm sorry, I love you. Goodbye.' '
Daniel's body was found about six weeks later in a nearby wooded area. His death certificate, from which state health departments compile their annual numbers, was issued in Nebraska.
'I don't want to seem hopeless, but we tried every damn thing under the sun to help him,' recalled David Jasper. 'For some people, their rock bottom is dead.'
As the national suicide rate was surging by about 30 percent over two decades, Iowa was one of 25 states to see an even higher increase. Iowa's 2014-16 rate of 16 suicide deaths per 100,000 population — up more than 35 percent from 11.8 in 1999 — was 31st in the nation.
Iowans age 45 to 64, most of them men, accounted for 37 percent of the state's suicides in 2016. Young adults 25 to 44 were 35 percent of suicide deaths, and those ages 10 to 24 comprised 15 percent.
Men age 45 to 54 had the highest suicide rate of any age and/or gender group last year, at 29.2 per 100,000, according to the National Institutes for Mental Health, with white males the highest.
'It's the most unbearable heartbreak you could ever imagine,' said David Andrews of Pleasant Hill in Polk County. His son Jake died by suicide in November 2014. 'I had a doctor tell me it's like having a brain injury.
'It's very difficult for people to understand what myself and my family have and will go through. I just try to tell people what to look for.'
Official numbers probably don't tell the entire story.
'Not every person who dies of suicide in Iowa is recorded as a suicide,' explained Ryan Nesbit of Ankeny, co-chairman of the American Foundation for Suicide Prevention's Iowa chapter. 'I talk to a lot of small-town EMTs around the state and I'll show them the data of how many people have died by suicide in their county and they'll say it's triple that number.'
Nesbit suspects many, perhaps most, deaths listed as substance abuse likely are suicides. He's one of a relatively small group of Iowans whose firsthand experience led them to push for improved access to mental health resources and care.
Iowans working against suicide are cautiously hopeful some new efforts may stem the rise among the most at-risk groups. Many also are harshly critical of the state's mental-health policy during the period that saw the increase.
'We're ranked very poorly as far as access to mental health services,' said David Brown, a specialist in human sciences and family life for Iowa State University Extension and Outreach. 'We're among the worst in the country.'
'You're going to have some bureaucrat somewhere telling you 'no', and there's no recourse,' David Jasper said. 'You have insurance companies telling you 'no.' That's what makes it such an intractable, hard-to-solve problem. There are no easy answers. Criminalizing addiction and mental health issues and throwing them in jail isn't the answer either.'
Each death by suicide represents a family and dozens, probably hundreds, of friends and community members — whose experience is tragically immediate. Andrews estimates each suicide touches about 100 people on a personal level.
'Friends, family, colleagues at work,' Andrews said. 'Whether it's misplaced or not, you carry guilt for the rest of your life. You say, 'I was supposed to go out to dinner with him, maybe I shouldn't have skipped it that week.' '
'The agrarian imperative'
The effect is magnified in a smaller community, where each loss is proportionally larger and the increase has been especially acute. Of the 10 Iowa counties with the highest suicide rates, nine have fewer than 17,000 residents.
'It's communities impacted by economic turmoil,' Mike Rosmann said. 'Communities that are 2,000 down to about 300 are those most impacted. They are losing their Main Street businesses, they're not big enough to maintain a nonfarm population to support the community.'
Rosmann, a clinical psychologist who manages his family's western Iowa farm near Harlan, has taught and written extensively about suicide among farmers, who have one of the highest rates of any occupation. What he calls 'the agrarian imperative' puts them uniquely at risk in rural areas that are among the most poorly equipped to deal with their stress.
'They work alone, trust their own judgment, and they tend to not reach out very well for assistance,' he said. 'The same factors that make them successful work against them. They don't know how to build a support system, and they tend to endure on their own.
'Farmers are inclined to overreact to stress, to try and quell any threat to their operations. That propensity wears them out and anxiety is replaced by depression.'
'Part of it is making sure that the services are there and accessible and people can pay for them,' said Corrine Peek-Asa, a professor in the University of Iowa's College of Public Health who's researched rural suicide. 'But we also have to address the stigma to seeking that help.'
Mental health services tend to concentrate in the state's larger cities, where they're cheaper and easier to deliver to a larger population.
'There's just the travel to obtain services,' ISU's Brown said. 'Folks in rural areas are less likely to have insurance, and they're less likely to identify mental health issues.'
Rural communities also have their own social and cultural dynamic.
'One thing we know about the rural population — there's a very large stigma about mental health,' Brown said. 'We don't want to talk about our problems with anyone.'
Again reflecting the logistics of service delivery, rural counties often lack the mobile-crisis response teams that cover the state's more populous areas. The two-person teams, available within an hour of a reported crisis, were dispatched 1,943 times last year in the seven counties covered by the Cedar Rapids not-for-profit Foundation 2.
'Whenever someone's suicidal, it's usually a short term when it's at the most acute,' said Cheryl Plotz, director of Foundation 2's crisis center. 'That connection to others is absolutely lifesaving.'
Johnson County's teams were dispatched 619 times in fiscal 2018, compared to 57 in 2015, the service's first year. About halfway through the fiscal year, 'we already have 430 as of January,' said Sara Sedlacek, communications and development director for CommUnity Crisis Services. The agency provides the mobile-crisis service as a subcontractor.
'We're averaging probably 60 calls a month,' Sedlacek said.
When Larry Tranel came to northeast Iowa 20 years ago to advise dairy farmers on production and marketing, his doctorate in psychology may not have seemed relevant.
'It's been a great skill to have these last few years,' Tranel, Iowa State Extension dairy specialist for 16 counties, said one morning this spring. 'I would probably say the last year has been the worst year that I've had, just in dealing with farm stress.'
With its reach into every Iowa county, the Extension Service is boosting its suicide prevention efforts. Agents distribute packets of information on mental-health resources at field days and similar events. On May 1, Brown began managing all the agency's human services and mental health programs, developing a statewide curriculum and seeking grants to fund it.
'What we're really trying to do is the preventive-medicine approach, and let them know help is available,' Tranel said. 'Stress is kind of a normal thing — it's how we deal with it that's important.'
'A hard problem'
That Daniel Jasper was in a program across the state from his Cedar Rapids home could be taken as evidence of Iowa's shortcomings in mental health.
'I don't want it to become a partisan issue,' his father said. 'It's a mess, and it's a hard problem to deal with.'
Diagnosed with anxiety and depression at 13, Daniel Jasper began using marijuana and other drugs soon after, according to his father. Repeated suicide attempts led to a cycle of rehabilitation programs, relapse and crises. After one attempt, Jasper petitioned juvenile court to place his son involuntarily. That made Daniel Jasper technically a Medicaid recipient, although his father's insurance continued to cover the cost of his treatment.
'It did cover everything, but Medicaid was the backstop to that if the treatment center wasn't paid through my insurance,' Jasper said. As Daniel's condition grew worse despite repeated stints in Iowa treatment programs, David Jasper settled on Boys Town.
'We couldn't find anything that was going to long-term meet his needs,' he said. 'I needed a place to put him until he graduated from high school, and/or turned 18.'
After Boys Town accepted Daniel, David had to petition the state Department of Human Services to place him in the out-of-state program.
'That's where the state started interfering greatly,' Jasper said. 'All I ever talked to was a clerical staff member — some unelected, unaccountable bureaucrat.'
Finally, a mutual acquaintance enlisted the help of then-Gov. Chet Culver's wife, Mari, who is from Marion. A letter was written.
'Magically, a week later Daniel was granted an exception to policy,' Jasper said.
Hotlines have been a first defense, supplemented more recently by online chat lines. Staff at both Foundation 2 and CommUnity Crisis Services answer calls from around the world.
'Whenever someone's suicidal, it's usually a short term when it's at the most acute level,' Plotz said. 'That connection to others is absolutely lifesaving.'
Young people have driven 'massive growth' in text and online chats, said Sedlacek. CommUnity's chat activity was up from 1,878 contacts in 2013 to 13,586 last year.
Out in the countryside, psychologist Rosmann is optimistic about $50 million for rural mental-health services in the new federal farm bill. The money is earmarked for farm crisis hotlines/helplines, training for community organizations and follow-up counseling for troubled farmers who lack insurance. The program was based on work between 1998 and 2014 by a consortium of Midwestern states, including Iowa.
'It became the model,' said Rosmann, who worked on the earlier project. 'I'm pretty hopeful something is going to be addressed.'
Where to find help
If you are having thoughts about suicide or have a friend or family who has, here are some websites and numbers you can call for information:
National Suicide Prevention Lifeline
24 Hour Crisis Hotline, Online Chat
Your Life Iowa
24 Hour Crisis Line, Chat and Text Support
Call: (855) 581-8111
Text: (855) 895-8398
Iowa Help Line 24/7
Text: (855) 800-1239
Chat or text: 24/7
Text: 9 a.m. to 3 p.m., Monday through Friday
Iowa Warm Line
5 to 10 p.m. every day
Iowa Concern through the Iowa State Extension
Treatment Advocacy Center