I remember the day that my brother Joe, age 20, left our father’s house after saying he needed to change the oil in his car. He had already loaded his .22 rifle into a duffle bag. His next stop was Walmart, where he bought a 12-gauge shotgun. For years he struggled with depression. We all had a gut-wrenching fear that he might make another suicide attempt.  That evening he took his ex-girlfriend hostage, intent on killing her and then himself. An unexpected visitor arrived and the ex-girlfriend cried for help. Hostage negotiators with a Swat team spoke to him by phone. In the middle of the night he let her go. Shortly before 6:45am, he ended his own life.  In 1997, the year I lost my brother, approximately 30,535 people died by suicide. Around 90% of those people, like my brother, suffered from a treatable mental health issue. The American Association of Suicidology estimates that 2% of these individuals take someone else’s life along with their own.  My brother’s death was the lead headline in the Sunday edition of our local paper. I watched my grandfather clutch that newspaper as he sank back in his chair. “How can they call him a man when he’s just a boy ... my boy,” he sobbed.  Related: Surgeon general: I have no regrets about calling gun violence public health issue  We were lucky that Joe let his hostage go. We could apologize and did, and while we couldn’t make it right, we didn’t have to live with a murder. Still, there were people who gave us looks that suggested we were that family with those problems.  Families of people with mental health problems put on brave faces, encourage, cajole, and try to compensate for under-functioning loved ones. It’s exhausting, especially if support is limited. My family lived in a small town with few treatment options and my brother didn’t have health insurance. He’d gone to rehab for drug addiction a few years earlier, but in the months leading up to his death he grew agitated when anyone questioned what we felt was his skewed logic.  We didn’t know that male depression often looks like aggression, or how to navigate the complex mental health system. Our rights, as we understood them, were sleepless nights, support and involuntary hospitalization if it became clear he was an imminent danger to himself or someone else. But imminent means the crisis will occur within the next 24 to 48 hours. How often is anyone that certain?  I wish we had known we could call a crisis hotline, like the National Suicide Prevention Lifeline (1-800-273-TALK), and ask for help, even if Joe hadn’t made a direct suicide threat. But hindsight is 20-20. In a very difficult situation, we all did our best.  Mental health problems are complex. They can strike anyone at any time. While diseases like bipolar disorder and schizophrenia have genetic components, none of us is immune to head injuries, physical diseases that impair judgment or a rash of significant losses that feels like too much.  People living with mental health issues are more than their diagnoses. My brother made a terrible choice – one that I will never defend – but he was also the young man who got up at sunrise to shovel my grandfather’s walk. He was also someone I deeply loved.  It’s been almost 20 years since Joe’s death. I will never understand the emotional pain he endured or the choices he made at the end of his life. While the anguish of this loss has abated, the wound will never fully heal. To deal with the aching grief I still carry, I try to pass on the gifts given to me after Joe’s death.  At my brother’s funeral, a woman named Wendy pulled me close and whispered: “I know,” as I cried on her shoulder. Her son had died by suicide two years earlier. She didn’t want my family to believe we were alone. On that same day, my best friend, who’d known Joe and me since childhood, arrived at the funeral home to simply say: “I’m here.”  I called her the other day. While catching up, we discussed my brother’s death. “Do you remember all of the circumstances surrounding Joe’s suicide?” I asked, fully convinced that the only way she could have been such a vital support to me was by forgetting some part of the terrible truth.  “I do.” she said, her words soft, even, and filled with total acceptance. “I remember it all.”
Before the tragedy that changed my family, we struggled to find resources to help him. I wish we knew then what we know now