Guns most deadly choice in suicide attempts

Laura Ungar and Chris Kenning | The (Louisville, Ky.) Courier-Journal

LOUISVILLE, Ky. -- After losing his job and his girlfriend, Michael Gousha drove to a rural spot in Bullitt County with a pistol he'd bought just days earlier. Parking near an old barn, he got out of the car, fired all the bullets but one, placed the gun to his head and pulled the trigger — ending his life at 23.

Trying to silence the voices in his head, Larry Lepine of Leslie County took handfuls of illegal amphetamines — but survived to rebuild his life.

Both men were distraught. Both suffered from mental illness. The difference was that one used a gun, obliterating any opportunity for a second chance.

While the recent shootings in Newtown, Conn., and Aurora, Colo., have focused attention on the risks of the mentally ill using guns to hurt others, statistics show they are far more likely to turn guns on themselves.

Suicides, which accounted for nearly two-thirds of U.S. gun deaths in 2010, are on the rise throughout the nation, and in Kentucky, where guns are prevalent and easily accessible.

While suicide attempts usually stem from temporary setbacks that, in time, seem less dire, access to guns makes the equation much more lethal — because those who choose a gun over pills, cutting or hanging to end their life almost never survive.

Experts are divided on whether stricter gun controls are the answer to curbing suicides, but they agree that family and friends can best protect loved ones struggling with suicidal thoughts by helping keep guns out of their hands.

"Often when people make suicide attempts, they see no other way out because their thinking is impaired. ... They want the pain to stop. They want peace," said Ramona Johnson, president and chief executive officer of Bridgehaven Mental Health Services in Louisville. "When they use guns, that's a pretty lethal method."

Statistics drive home the point:

-- More than 38,000 Americans, including roughly 600 Kentuckians, take their lives each year, and those numbers are growing. From 1999 to 2010, suicide rates in Kentucky rose 22 percent to 14.2 deaths per 100,000 residents. Indiana's rate rose 26 percent, to 13.1 per 100,000; the U.S. rate rose 15 percent, to 12.1 per 100,000.

-- Guns are used in about half of U.S. suicides, compared with 64 percent in Kentucky. And suicides involving firearms are fatal 85 percent of the time, compared with less than 3 percent for pills, according to the Harvard Injury Control Research Center.

-- Nine in 10 suicides are associated with mental illness, according to studies examining "psychiatric autopsies" of mental health history after death. But gun laws in Kentucky and Indiana allow all but a small fraction of the mentally ill to buy firearms from licensed dealers, or obtain them without restraints from family members, friends, gun shows or online.

-- For those who do survive a suicide attempt, studies show that 90 percent don't go on to die by their own hands later.

"Rage passes. Anxiety can calm," said Lanny Berman, executive director of the American Association of Suicidology. "Death doesn't lead to anywhere but death."

For Lepine, 45, suicidal feelings have subsided after he was diagnosed with schizoaffective disorder and began taking a new anti-psychotic medication. He asks relatives to keep their guns locked up when he is around, just in case his suicidal impulse returns.

"Thank God he didn't have a gun around" at his darkest moments, said Karen Gibson, one of Lepine's therapeutic rehabilitation coordinators. "He probably would have accomplished what he set out to do."

Gousha's mother, Missy Gousha of Mount Washington, is left with memories of her only child, who suffered from bipolar disorder and took his life in 2005. She fills her home office with mementos — photos, a framed baby outfit he once wore, model cars he built, even his wallet, with his last $20 still inside.

"It's always been me and my son and our dog. He's been the man of the house and my best friend," said Missy, 49, who divorced Michael's father when he was 10. "Now, it's just me."

Mental illness strikes

Gousha and Lepine were both diagnosed with mental illness as young men.

Gousha was generally a happy kid despite facing some hardship, said his mother, who used to work on a Ford assembly line building trucks. The family survived a tornado that destroyed their home in 1996, hiding together in a bathtub as Gousha repeatedly told his mom that he loved her.

In his late teens, Gousha's friends from Bullitt East High School saw him as "a happy-go-lucky jokester" who liked to draw cartoons and write rap songs, she said.

But shortly after he graduated in 2000, she said, Gousha told her, "I don't feel right."

She took him to his doctor, who referred him to a psychiatrist. He was diagnosed with bipolar disorder and prescribed Klonopin, a powerful anti-anxiety medication. He saw the psychiatrist regularly, and his medical records show he was never considered suicidal.

Gousha said her son seemed normal during his manic phases, but during his depressive phase, "He would want to stay in his bedroom and sleep a lot. He'd say, 'I hate my life.'"

Still, she said, he was good about taking his medicine and seeing his psychiatrist. He had a girlfriend, a job at a Kroger distribution warehouse, and plans to join the Marines. A month before he died, he was smiling and mingling at his cousin's wedding.

Lepine's early life, on the other hand, was tumultuous. His troubles began when he was in grade school, growing up in a modest home outside of Hyden, a small town in southeastern Kentucky.

His father worked at a gas station but struggled to support the family on minimum wage. Lepine said he often went hungry.

Around that time, Lepine started hearing voices. At 6, he said, he was molested. He never told anyone, but it was an experience that his case workers and therapists said created lasting trauma.

Feeling suicidal in the aftermath of repeated abuse, he said, he found his father's handgun and went into his bedroom, but couldn't pull the trigger.

As he grew up, his disorder caused hallucinations and depression, and he often had suicidal thoughts. He felt neglected and unloved at home, he said, and his father, who has since died, often drank heavily.

"I felt worthless. I did a lot of being by myself, a lot of walking and hitchhiking," he recalled. "I'd hear voices saying you'd be better off dead."

Because Lepine felt unworthy and neglected, he didn't give much thought to anyone missing him, he said, or how his suicide might affect his family.

After high school, he was diagnosed with schizoaffective disorder, a chronic and severe mental illness. Psychologist Brenda Hughes said the the combination of trauma and illness left him vulnerable to suicide.

Roger Smith, a therapist and patient advocate at Appalachian Regional Hospital, where Lepine has been involuntarily admitted as recently as 2010, said his condition causes periods of mania and deep depression that can be "very scary."

His mother declined to comment for this story. But Bill Watkins, who was Lepine's mental health case worker between 2004 and 2011, said he spoke with him many times about his experiences, and "he thought a lot about killing himself."

Preparing to die

Eventually, both Gousha and Lepine decided to act on their suicidal thoughts.

Lepine has trouble remembering dates, but he said he tried to commit suicide in grade school by taking pills he found at his house, but only got sick. "I didn't take enough, I guess."

Another time, he recalled standing with a knife to his neck in front of a mirror, but stopped before he hurt himself.

During his junior year at Leslie County High School in the late 1980s, he became deeply depressed and was tired of the voices in his head. With no gun handy, he took handfuls of pills he got from a friend, determined to end his life. Mental health experts say the common perception that using pills is "a cry for help" and not a serious suicide attempt is wrong.

"I really wanted to end it all, I couldn't take it," he said.

He woke, sick but alive — something he's grateful for today. His attempt seemed to release some of the suicidal pressure he felt, he said.

Looking back now, he said, "I was glad there wasn't a weapon around that time."

Missy Gousha didn't think her son had weapons around, either. She didn't keep them in her house, so when her son lost his job and broke up with his girlfriend around the same time, her worries were fleeting.

He wrote rap lyrics such as, "Can anyone feel my pain as I put this pencil to the paper," that she only discovered after his death.

She also didn't know that he had bought a pistol at a local pawn shop.

As part of the sale, Gousha had to fill out a "Firearms Transaction Record," from the U.S. Bureau of Alcohol, Tobacco and Firearms that included a list of questions, including one that asked: "Have you ever been adjudicated mentally defective or have you ever been committed to a mental institution?"

Gousha, like the vast majority of mentally ill Americans, truthfully answered "No." Kentucky law imposed no further restriction on his buying a gun.

Six days later, after clearing the federal background check required for firearm dealers, he picked up the gun July 13.

"I don't think you should be able to purchase a gun if you're seeing a psychiatrist like that," Missy Gousha said. "If we made it difficult, maybe he could've gotten through that day — and tomorrow would be different."

The gun debate

Advocates argue that the lethality of guns makes it paramount that more be done to keep them out of the hands of suicidal people.

They say studies back that up.

David Hemenway, director of the Harvard Injury Control Research Center, has conducted studies linking states with higher gun ownership rates to higher overall suicides. Other researchers have also found an increased risk of suicide in homes with guns, typically two or more times higher than in homes without them.

Jan Ulrich, Kentucky's top suicide prevention coordinator, said it's not that guns cause suicides, but they are so lethal that there almost never is "a second chance."

But Gary Kleck, a professor of criminology at Florida State University, disputes the link between gun ownership rates and overall suicide rates. He said that link can easily disappear once other factors are weighed, such as as divorce or alcohol consumption.

The National Rifle Association argues that those who want to attempt suicide will find a way if a gun isn't available, therefore rendering the issue of guns and suicide "not relevant to the debate over firearm laws."

Mental health professionals said they work to minimize access to guns, as well as other means, among those who are suicidal. Firearms are the most common means for men, poisoning for women, and suicide deaths are four times higher in males.

"We make every effort to have the patient give up the gun or give it to a relative under lock and key," Wright said.

Berman said he believes that message is circulating more widely and has helped push down suicide rates involving guns nationally — from about 65 percent 15 years ago to just over 50 percent today. The American Association of Suicidology recommends locking up guns and making sure ammunition is stored separately.

But Tony Zipple, president and chief executive officer of Seven Counties Services, goes further: "If I was the family member of a depressed person, I would not want a gun in the house. Period."

On a recent day at the therapeutic rehabilitation center where Lepine spends his days, he sat outside rolling cigarettes, dropping ashes into an old coffee can, and said his suicidal days are behind him.

After spending years "in and out of hospitals," Lepine began taking a medication called Invega about a decade ago, which has helped stabilize him. "The suicidal thoughts went away, the voices went away," he said, helped by psychiatric therapy and other support.

Lepine said many things keep him from slipping toward suicide — caring for his ill mother, talking with other patients at his mental health day center and telling his story after joining the National Alliance on Mental Health. He no longer feels worthlessness and sees setbacks as temporary obstacles that can be overcome, his therapists said.

Still, he stays away from guns, and his family "keeps them locked up."

"I regret taking them pills," he said. But "if you pull the trigger, that's it. ... If you're suicidal, you really don't need a gun around. ... That's a temptation."