Nineteen.

That number represents how many suicides took place in Nevada County in 2019 and again in 2020.

In a year of financial strain and social distancing, suicide rates remained unchanged in Nevada County between 2019 and 2020.

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Across the country, things were different. Nevada County Behavioral Health Director Phebe Bell said the national suicide rate dropped 5.2% in 2020.

Bell said while the suicide rate can reflect acute stress, it is not the only barometer for the community’s mental wellness.

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HIGHER RATES OF INTAKE

According to its website, the Nevada County Behavioral Health Office collaborates with existing social service providers to offer outpatient counseling, medication services and case management to those struggling with mental illness. Crisis data is collected by Bell’s office internally, as well as externally through local law enforcement, hospitals and treatment centers.

Nevada County Behavioral Health is geared toward meeting the needs of those in the community who are seriously disenfranchised — Medi-Cal patients with significant mental illness and substance abuse.

The local, private mental health care providers responding to the needs of those whose situation does not merit state intervention are operating at capacity.

Sierra Burton, of Sierra Family Therapy, said she has hired five additional clinicians on the west side of Nevada County since the pandemic hit in March 2020.

“Our intake calls doubled. I hired 50% more clinicians and currently we’re all full again,” Burton said. “It’s been really intense.”

Although numbers indicate suicide rates remained unchanged between 2019 and 2020, the severity of people’s “personal issues” has observably increased, Burton explained.

“We’re talking severe depression, anxiety, substance abuse, self harm, suicidal ideation — those kinds of issues,” Burton said.

Paige Thomason, director of marketing and communications for the Tahoe Forest Health System, said that a generalized “screening for depression” offers a better indicator of society’s general mental health than suicide rates. Screenings, she said, are up.

“We have actively added services to accommodate the increased need,” Thomason said, adding that health insurance is no longer a barrier as her health system provides care to all patients regardless of their ability to pay for behavioral or mental health services. “We are experiencing an increase in new patient intakes who have never sought treatment before.”

Thomason, in North Lake Tahoe, said her health system also observed a significant rise in first time mental health patients since the pandemic began.

“There are a number of patients coming in who are having significant symptoms of anxiety and depression interfering with work and overall functioning,” Thomason said. “Their backgrounds are varied — it cuts across all socioeconomic levels.”

According to Thomason, medical professionals will be able to recognize and understand the impacts of the pandemic long after any obviously visible conclusion of COVID-19’s presence is made in the community.

Thomason said even over the course of the last 16 months, the symptoms of the pandemic’s mental health crisis has changed significantly. At first, the district served patients suffering the acute stress associated with loss of livelihood, either through unemployment or business closures.

Thomason said the lack of social connection certainly had an impact on mental health patients as well.

Now, the financial woes are far from over, Thomason said, but the source has changed.

“Currently, we’re seeing business owners whose businesses have survived but they cannot maintain a workforce,” Thomason explained. “Some cannot afford the high cost of living and have moved out of the area.”

Thomason highlighted childcare providers charged with “managing behavioral issues and mental health needs in kids at rates beyond their capacity” as well as teachers who have taken on their own stress along with that of their students.

Considering the long-term fallout of the pandemic is overwhelming, Burton said.

“I feel, metaphorically, a little like how the dam starts cracking and you put your finger in that and then in another crack and another,” Burton said.

Thomason said it was “difficult to determine” whether the hospital received more or less patients during the pandemic with the intent to self harm because of the influx of new residents as well as the newly launched TFHD Behavioral Health program.

SUICIDE VS. SUICIDALITY

Kristina DePue is a psychology professor at the University of Nevada-Reno. DePue said noting the difference between suicidal ideation, or thoughts, and suicidality is an important nuance in the community’s mental health assessment.

DePue defined suicidality as actually taking action on intrusive thoughts, like “life is better without me.”

“We know actual mental health got worse,” DePue said. “It is interesting that suicide attempts have gone down.”

Those predisposed to subclinical depression are experiencing increased hopelessness and despair due to current environmental factors, she added.

“Subclinical depression, meaning you don’t normally need medication but you’ve got some depression features,“ DePue explained, adding ”When you lose your job, you’re isolated — living alone or with someone else — then you’re inundated with the global pandemic (and the condition is exacerbated).“

DePue theorized that the low suicide rate could be the result of increased access to resources via telehealth.

Teresa Crimmens, the deputy director of Sierra Community House, said the exact effect of the pandemic on the public is hard to measure — because of the breadth, depth and the recent consolidation of services under one organization. However, that effect is obvious.

CRISIS LINE CALLS RISE

Crimmens said 2020 was Sierra Community House’s first year in action after consolidating four social service organizations in the North Lake Tahoe Region. Just in time, she said, to meet the needs of an unprecedented crisis that would affect many dimensions of people’s lives.

“We saw a two-fold increase in the sheer number of calls we’ve received to the (crisis) helpline,” Crimmens said, referring to the comparison of data collected since the organization first formed in July 2019.

Crimmens said the crisis calls varied in theme but addressed basic needs in the form of food or housing support; mental health, including suicidal thoughts; as well as an in-house legal aid which helped answer legal questions particularly useful amid the pandemic regarding employment and tenants’ issues.

In 2020, Crimmens said the crises line received 1,004 calls. Forty-nine percent were related to domestic violence, 5% were sexual assault-related, 36% related to basic needs including food or housing, 5% were explicitly mental health, and 5% were made for legal counsel.

Crimmens explained, “all the calls are oriented around suicide prevention” as the organization continues to dedicate itself to helping North Lake Tahoe residents survive the multidimensional fallout of the pandemic.

“Our goal is to help individuals and families reduce stressors,” Crimmens said. “We recognize how each of these basic needs — if they’re not met — can contribute to a deterioration of mental health. It’s upstream.”

Sierra Community House’s multi-pronged approach to the crisis response involved talking about deteriorating relationships between tenants and landlords amid rampant joblessness and an eviction moratorium, Crimmens said.

“Seemingly, in the context of COVID-19, what came out around was intimidation and harassment on the part of the landlord,” Crimmens said, adding that landlords also dealt with a sense of helplessness as they lost passive income.

Priya Kannall, Mental Health Services Act coordinator for Nevada County Behavioral Health, said her office observed about a 15% decline in total calls to the Nevada County Behavioral Health crisis line from 2019 to 2020, and when comparing the first quarter of 2020 to the first quarter of 2021.

Kannall specified that the behavioral health crises line is a mental health crisis line — as opposed to the Sierra Community House 24/7 line which serves those facing “broader” issues like those in economic crisis or domestic violence crises.

Kannall said roughly one-fifth of the crises line calls to her office in 2020 were made regarding someone with suicidal thoughts or in need of immediate mental health care.

“The majority of other types of calls were by those seeking referrals to mental health or substance use disorder services, or needing assistance with their current mental health treatment plans,” Kannall said.

Crisis assessment averaged 176 a month between November 2019 to February 2020, as well as each month from November 2020 to February.

Bell said although the data does not indicate any positive correlation between COVID-19 and suicide — so far — her office is monitoring the situation closely.

“We’re going to pay a lot of attention as we transition out of the more restrictive state in the upcoming months,” Bell said. “It’s more important than ever that people know our services are available.”

Rebecca O’Neil is a staff writer with the Sierra Sun and The Union, a sister publication of the Sun