And How You Can Help Make It Happen
For years, Dr. Lisa Horowitz and I co-presented on the Ask Suicide-Screening Questions (ASQ) tool, originally validated by the National Institute of Mental Health (NIMH) for youth. Dr. Horowitz is one of the principal investigators behind its development. Now, this lifesaving tool has also been validated for adults.
In these presentations, I would tell the story of my son, Charles, who visited three medical settings in the two weeks before his death by suicide.
Not once was he screened. Then Lisa would take the stage and teach attendees how to use this evidence-based screening tool to identify those at risk and connect them to care. Dr. Horowitz was instrumental in my being invited to speak at the National Institute of Mental Health (NIMH) on suicide—the first time a non-clinician was asked to do so.
What happened with Charles exactly?
Charles was 20. He had relapsed after just one day in recovery at a sober living home. Their protocol was solid: take him to a hospital for a physical, then to a psychiatric facility for a suicide screening, followed by helping him check in to detox. After that, he could return to the recovery house. (We didn’t know about the suicide screening part until later.). Things didn’t go according to plan.
After the physical exam at Hospital #1, he was taken to Hospital #2 for the screening.
They turned him away, saying, “We don’t take ‘those people’ anymore,” referring to those with substance use disorder.
That moment crushed him. He felt like human garbage.
Charles already felt worthless. This just confirmed it.
Friends told us he wore his despair like a second skin. He was deeply depressed. And he posted a series of tweets and posts on Facebook. This was one of them.
This was not his first medical visit in that final stretch
Here are Charles’s three trips to clinical settings:
- A sprained ankle (three weeks before his death)
- A physical exam was conducted before detox (two weeks before his suicide).
- A trip specifically for a suicide risk screening. (Two weeks before his death.)
Not one provider asked if he was thinking of suicide. And those were missed opportunities.
I’ll never know if one brief screening would have saved his life. But I do know this: Charles wanted to be asked. Most do, as I later found out.
80% of youth who die by suicide see a healthcare provider in the year before their death, and 40% within four weeks (Ahmedani et al., 2014). Medical settings are often the last stop before a tragedy—and the best chance to intervene.
Every medical setting should be screening for suicide risk
Validated tools like the ASQ make that possible. They help healthcare providers identify who is at risk and connect them to lifesaving care. Consider this:
This is why I’m so passionate about this work. And why I hope you’ll join me and Dr. Lisa M. Horowitz, Ph.D., M.P.H., for this important session. This event is in memory of Charles Aubrey Rogers, who died by suicide, 4/26/1995-6/5/2015.
Webinar: Hosted by AnneMoss Rogers of Mental Health Awareness Education, with NIMH scientist and presenter, Lisa M. Horowitz, Ph.D., M.P.H., MPH, In this webinar, attendees will gain practical insights into how this evidence-based tool is used in clinical settings and how research is being translated into action to ensure people of all backgrounds are identified early and connected to life-saving mental health support.
AnneMoss Rogers is a leading wellness and suicide education expert and one of the top mental health speakers and suicide prevention speakers. Known for her powerful, motivational keynotes, AnneMoss combines her personal story of loss with proven strategies to help organizations build a wellness culture that drives results and saves lives. She speaks at conferences, workplaces, K-12 schools, and universities, delivering impactful presentations that inspire change and promote mental health awareness.
AnneMoss does this work in memory of her son, Charles, who struggled with anxiety, depression, and addiction, and died by suicide at age 20 in 2015.
I agree with the comments about us not knowing what we know now.
Before our loss, we knew what we knew but in a limited way.
After our loss, we sometimes learn things that were hidden or we see the ‘Signs’ that were missed when the person was alive. Our connection goes beyond the limited knowledge that we then possessed, to one that grows as we become privy to the things once hidden from us, and possibly not yet even felt or known by the one now gone, at that time.
Many of us learn things as we go through emails, private papers, medical records and even a search for on-line posts. We become aware of things as others share with us their private conversations once engaged in by our people with family or friends.
By understanding this difference of Awareness between the Before and After, we may gain a little insight that will lift our guilt and show us that we were not responsible – either by ignorance or a failure to act – as we only knew what was there in front of us. The things that we know now, these only are known to us now because we have gone through the experience of a loss to suicide. This is why we beat ourselves up for we take on board this new knowledge as if we were always aware of it (which we weren’t) and apply it back before our loss. . Even if we had an inkling, I would suggest that very few of us expect the person to take their own life.
Our minds tend towards familiarity else we would forever fret whenever a person is out of our sight. We would find it unbearable if we always stressed about what may come as opposed to what just is. Our familiarity is what brings peace to our lives.
I have explored this idea further in an unpublished article that I wrote (still working on it to some degree) which I am happy to share if you like.
Definitely share. Thanks for your insight. Always good
My son died by suicide. He had a dr apt a few weeks before & was asked these questions & he lied. After his death I found out that my other children have also had suicidal ideations (I guess depression runs hard in my family which I was unaware). I asked them about these questions at the dr office & they reported that it is the biggest joke, that they would NEVER answer honestly. I do however feel that a standardized test like the BASC should be given to every 16-18 year old (not sure what age) because this test will detect depression and the way it ask questions makes it difficult to just lie.
When they first started doing the ASQ here in pediatric practices we asked that very question. And their feedback was that the kids usually don’t lie with this screening. But obviously there are exceptions. I think my son wanted to be asked and he wanted to tell.
Do you know what screening they used?
I will ask this question in the webinar. I just wrote it down.
It runs in my family, too. I lost a first cousin to suicide in 2020. And another family member attempted two years ago. I’m sorry we are both in this club. And I know it feels scary knowing but also good to know as well.
I will look up the BASC. I think that is a behavioral screening and not specifically a suicide screening right? Thank you for commenting.
So I now understand I can judge myself back then with the knowledge I have now. But it took a while to get there.
Can or can’t?
Cannot. Thank you I will edit that. I should not leave comments using my phone! So many typos and errors when I do. But it’s way to easy to gain all the knowledge and look back and pass judgment on yourself. But honestly. We all do the best we can do. And it’s counterintuitive for us to think that we can’t talk someone out of suicide. What’s more, it’s unfathomable for us to think that a child who grew up in a nice family would seriously consider suicide.
Anne, you’re so right. Other people’s stories have helped me with all the hindsight questions, and your honesty and vulnerability in sharing Charles’ heartbreaking journey have been invaluable. I accept that some questions will never get answered on most days, but they are essential nonetheless.
I am sending tons of love and hugs to all who are on this brutal path of living with suicide loss. ❤️
Thank you. You have come such a long way. And you’ve done the hard work to get there. Our sons will always be part of our lives but we have both learned to carry grief and walk beside it while still enjoying life and helping others.
My son Randy told his estranged wife he was going to kill himself. When i asked him about this (not knowing what I know now about what to ask/what specific words to use), he calmly and quietly replied “that’s enough ma”.
It will be 2 years next week since his suicide; he was 39 and a father of three girls.
If I had told him that no feelings are permanent, would that have helped stop his spiraling negative thoughts?
He refused to go into a rehab for his addiction and ultimately decided to take his life using fentanyl.
I am wrangled in guilt and shame for not knowing the right words and being more informed. It is truly devastating to have just let him slip away.
My suicide support group tells me there was nothing I could have done to change his decision.
I don’t think I will ever accept this notion. I’m stuck in grief.
I have a member of my suicide loss support group who did all the things. She knew her daughter was suicidal, they had a safety plan, a therapist, she checked in and she said the right things and her daughter still died by suicide. What I am saying is that sometimes we can prevent suicide and sometimes we can’t.
And what’s more the number one issue of any new member of the group is the guilt and shame, the what ifs and coulda woulda shouldas that are part of the healing from suicide loss process.
You are doing something for you, simply by having the courage to post this comment, share your pain and your honesty about where you are in your process. I hope it helped to write and share it. Sometimes that brings people some clarity relief. Someone else will read that and think “that’s how I feel.” So putting it out there helps someone else who had been through this feel less alone.
Honestly how we prevent suicide is listening and asking questions. Like “I am so sorry. How long have you felt this way?” But even then nothing is 100%. And an addiction increases risk of suicide by some 10-15x. I know many overdoses are not accidental but can’t be ruled intentional because of lack of evidence like a note or declaration. My son was in withdrawal when he took his life. He didn’t use drugs to kill himself.
So telling him “no feeling is permanent” is likely too logical for someone in suicidal thought. The hardest part of my training was recognizing that we can’t talk someone out of it. It took me years to figure it all out. I certainly was not going to to figure it out tangled in the emotional turmoil of my child’s opiate addiction. So I now understand I cannot judge myself back then with the knowledge I have now. But it took a while to get there. Groups, writing, running, talking to others got me there eventually