Tom can barely remember a time when he didn't want to kill himself.

A longtime Rio Grande Valley resident, Tom, 56, has battled severe depression for much of his life. Thoughts of suicide plague his mind almost daily. While driving his car, he thinks about swerving into a telephone pole. Sometimes he considers buying a gun, or downing a bottle of pills.

He's already attempted suicide twice, and said he might try again.

According to Tom, who requested his last name not be used, there are many others like him in the Valley — people with crippling depression and relentless thoughts of suicide. And many of them feel like they have nowhere to turn.

"We need to get more information out, and let people know where to get help," said Tom, who belongs to a Valley support group for people with mental illness.

In general, suicide rates in the Valley are lower than the statewide average, the Texas Department of State Health Services reports.

According to causes of death listed on Texas death certificates, the suicide rate in Cameron and Hidalgo counties hovers around five per 100,000 people, compared to about 10 per 100,000 people in Texas.

But that doesn't mean there are fewer suicide attempts, or fewer depressed and suicidal people, experts and advocates say. Not only are the severely depressed out there, but they have few places to go because the region doesn't have enough mental-health services, they said.

"We're underserved, period, for mental health," said Joseph McCoy, a McAllen psychologist. "Things are better than they were before ... but there's still a need."

How serious is the problem?

The Rio Grande Valley has an ongoing shortage of psychiatrists, psychologists and mental-health providers, according to data from DSHS. Cameron County has only one psychologist per about 33,000 people, and Hidalgo County has one per about 20,000. Only a few psychiatrists practice in Cameron County, and about 15 practice in Hidalgo County, according to Texas Medical Board records.

But the need is great, even if it's hard to fully determine its extent, health providers said.

Getting a clear picture of a region's actual suicide rate can be tricky, said Leticia Canchola, director of nursing for Southwest Mental Health Center, a children's psychiatric hospital in San Antonio. Canchola trains teachers, counselors and parents in suicide intervention.

Sometimes, it's not clear whether a person intended suicide or whether the death was an accident, Canchola said.

"You don't know if the person was thinking of suicide beforehand — it's hard to capture that," she said.

So just because the Valley's death rates from suicide seem to be lower doesn't mean the population is less at risk, experts said.

"We don't know if the person committed suicide and the family won't talk about it, or if they're afraid to say anything ... because many insurance companies won't pay if it's suicide," said Stephanie Contreras, sponsor of the Rio Grande Valley chapter of Mental Health America of Texas, formerly the Mental Health Association. "There's a stigma attached."

Certain segments of the Valley's population are especially at risk for attempting suicide, said Merily Keller, a founding board member of the Texas Suicide Prevention Council, a coalition of agencies and organizations trying to reduce the suicide rate in Texas.

For example, more Hispanic, adolescent girls have attempted suicide than any other group, according to studies, Keller said. In 2007, about 14 percent of Hispanic girls in grades 9 to 12 attempted suicide, according to a Centers for Disease Control and Prevention report.

Older adults and adolescents of all races are also vulnerable, Canchola said.

Adults aged 70 and older accounted for about 12 percent of suicides in Texas from 1999 to 2003, according to the Suicide Prevention Resource Center. Nationwide, suicide is the third leading cause of death for youth ages 10 to 24, according to the CDC.
These are the people who could potentially fall through the cracks, advocates said.

"We're always concerned about the access to health care in the Valley," Keller said. "There are so many people without insurance that could go without treatment."

‘Better than before'

Although advocates say the Valley needs more mental-health services, the situation is improving, they said.

Earlier this year, the region's public mental-health provider, Tropical Texas Behavioral Health, began deploying mobile, crisis-outreach teams that make "house calls" to patients in crisis. Each team consists of trained social workers or counselors well versed in helping people who are suicidal, said Coni Aguirre, Tropical Texas chief administrative officer.

Tropical Texas also has a 24-hour crisis hotline, and the staff now has more extensive training, officials said.

The organization has received $1.7 million in state funds to implement these crisis-intervention programs.

Programs like these could help reach more people who are suicidal, said Contreras of Mental Health America. However, the teams aren't yet fully staffed, she said.

"I think it's the best (help) we've seen yet, but it's just getting started," Contreras said.

Aguirre confirmed that the teams have some vacancies, but they're still able to deploy quickly when needed, she said.

Contreras and McCoy said they'd like to see the region have its own suicide hotline that could quickly refer people to services beyond Tropical Texas. Some people might not call the Tropical Texas line because they're afraid of being committed or hospitalized, Contreras said.

Another program that could help address suicide rates in the Valley is an initiative launched by the Texas Suicide Prevention Council.

A few years ago, the council launched the "Question/Persuade/Refer" program, which offers training for educators, parents, police officers or anyone interested in preventing suicide.

These workshops teach people how to spot someone who might be suicidal and convince them to get help, Keller said.
"It's something anyone can do," Keller said of the training.

The council hasn't previously offered these workshops in the Valley, but plans to do so soon, she said.

Contreras is planning to undergo the training, and is grateful that Texas is looking at ways to prevent suicide in the Valley and statewide.

"That way, we can get out the message that there is hope, and that treatment works," she said.