San Antonio, Texas NP Joseph Vine must be a descendant of the Unsinkable Molly Brown. After a brutal bout with Covid-19 left him in a medically induced coma for two months last year, our Nurse of the Week proceeded to push through a lengthy recovery period. Now, glad to be back treating youngsters at his pediatric urgent care clinic, he says, “I’m almost back to where I was before.”
But Vine endured a frightening ordeal in the interim between “before” and now. In June 2020, Covid entered the life of the 41-year-old father of three. Coughing and gasping for breath, he reached the ED at Northeast Baptist Hospital – just barely. “I was feeling so horrible,” he told News 4 San Antonio. “I was sure I had Covid, and basically as soon as I got to the ER, they were telling me they were going to have to intubate me.” His prospects for survival were dubious. In fact, Vine’s wife Anayuri said, “They thought he was not going to make it.” The couple had been married less than two years and Anayuri had recently given birth to a girl when Vine was admitted. Suddenly, her husband was inaccessible, lying comatose in the ICU and breathing with the aid of machines. For Anayuri and the baby, he had effectively vanished. “I couldn’t see him for two months,” she recalled.
Vine survived, after spending 56 days on a ventilator. His return to consciousness in August 2020 was met with relief – and relieved surprise – by his wife, friends, and doctors. He recalls, “I actually came out of it, which they never thought I would do… They were like, ‘Wow, he’s actually awake!’ A lot of people didn’t expect that to happen.”
When Northeast Baptist finally discharged him in October last year, Vine, like many post ICU patients, was almost as helpless as a newborn infant. (The NP, who has no insurance, had to cope with financial helplessness as well. He emerged with nearly $2 million in medical costs, and friends helped raise the funds for his rehabilitation treatment).
When he came home, Vine was suffering from nerve damage, and his right foot was entirely out of commission. Doctors warned that the foot might never regain its function. “They said,” he recalled, “If it’s not going to be here in 48 hours from when we first observed it, it’s most likely not coming back at all.” However, drawing upon the special reserves of discipline, determination, and “Yes I can” attitude that allows nurses to do what they do, the NP learned to walk again before his baby daughter Charlotte had mastered crawling. Charlotte – who was born just five months before Vine entered the hospital and is now 21 months old – had to become reacquainted with her father when he finally came home. She will be able to keep pace with Dad better than most toddlers, as he’s still wearing a foot brace, but Vine cheerfully remarked, “… I’m a lot more mobile now. I’m very encouraged. I think it’s going to come back even more.”
As his recovery progressed, Vine started treating patients via telehealth while still on a walker. By January 2021, he returned to the clinic on a part-time basis and transitioned to full-time two months later. “Being here and making a difference and helping people was a motivating goal to get back to. I missed the connections with my patients.” Since his recovery from Covid, Vine is also well-positioned to comfort families when one of his young patients contracts the disease. “When I talk to families, they’re often nervous, scared. It may be their first time that this has touched their family. I’m able to give them advice or help relieve some of the symptoms and talk about the course, and then also follow up with them… kind of being part of their process to make sure that nothing’s getting worse for them. That seems to really help them.”
New data from the Texas health department released on November 7 proves what health officials have been trying to tell vaccine-hesitant Texans for months: The COVID-19 vaccine dramatically prevents death and is the best tool to prevent transmission of the deadly virus.
“We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
—Dr. Jennifer A. Shuford, state epidemiologist
Out of nearly 29,000 Texans who have died from COVID-related illnesses since mid-January, only 8% of them were fully vaccinated against the virus, according to a report detailing the Texas Department of State Health Services’ findings.
And more than half of those deaths among vaccinated people were among Texans older than 75, the age group that is most vulnerable to the virus, the study shows.
“We’ve known for a while that vaccines were going to have a protective effect on a large segment of our population,” said Dr. Jennifer A. Shuford, state epidemiologist. “By looking at our own population and seeing what the impact of the vaccines have been on that population, we’re hoping just to be able to reach people here in Texas and show them the difference that being fully vaccinated can make in their lives and for their communities.”
The state health department study covers most of the positive cases and COVID-19 deaths reported in Texas among residents from Jan. 15 to Oct. 1. It’s the first time state officials have been able to statistically measure the true impact of the vaccine on the pandemic in Texas — which has one of the highest death tolls in the nation. The majority of Texans ages 16 and up didn’t become eligible for the vaccine until late March.
State health officials also found the vaccine greatly reduced the risk of virus transmission, including the highly contagious delta variant that ravaged the state over the summer.
Only 3% of 1.5 million positive COVID-19 tests examined since mid-January occurred in people who were already vaccinated.
State researchers matched electronic lab reports and death certificates with state immunization records and measured cases and deaths since mid-January, a month after the first shots were administered in Texas.
The study was done using data similar to those used by other states that conducted similar studies and methods recommended by the U.S. Centers for Disease Control and Prevention, Shuford said.
And while the outcome was not particularly surprising, Shuford said, officials hope that the new data will increase trust in the benefits of the shot.
“Texas is a unique place; it’s got a lot of diversity, geographic and population-wise,” Shuford said. “We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
In Texas, it literally requires a disaster — like a pandemic — before the state records precise information about vaccinations. As a result, there is a record for every single COVID-19 vaccine dose of the name and age of the person who received it plus the date it was administered. Normally, vaccination records are shown to schools by parents, but details of all vaccinations are not regularly kept by a state registry in Texas, unlike nearly every other state, because it’s a voluntary system.
However, state officials still don’t have official numbers on how many vaccinated people were hospitalized with COVID-19 because hospitals are not required to report that level of data under state law.
But the state’s largest hospital districts and counties have reported that at least 90% of the hospitalized Texans with the virus were unvaccinated.
The state’s new health data comes as Republican state leaders grapple with local cities and school districts about masking, which has been proven to reduce transmission of the virus, and with federal officials over vaccine mandates.
About 53% of the Texas population is fully vaccinated. More than 70,000 Texans have died from COVID-19 since the pandemic began.
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Mandi Cai contributed to this report.
Disclosure: University of Texas System has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
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About 40% of Texas nursing home workers are unvaccinated and could face dismissal or quit their jobs under a federal vaccination requirement for the industry..
Texas nursing homes, crippled by a pandemic that ravaged their residents and decimated their workforce, are asking the state for $400 million in federal coronavirus relief to address a staffing crisis in the system that cares for the state’s oldest and most fragile residents.
Industry advocates fear the federal vaccination mandate could mean the potential exodus of tens of thousands of workers from facilities across the state before Halloween.
“We know we are going to lose additional staff when that vaccine mandate comes out,” said Becky Anderson, head of clinical operations for Focused Post Acute Care Partners, which runs 31 nursing homes and employs about 2,500 workers in Texas. “We just have some staff that are very adamant that they will not get the vaccine.’”
The federal rule comes at a time when the industry is already struggling with a shrinking workforce due to burnout, low pay, increased expenses related to the pandemic, and competition from other health care providers, administrators say.
According to recent surveys by the Texas Health Care Association and LeadingAge Texas, two nursing home industry groups in Texas, facilities across the state have seen a 12% decrease in their workforce in the last year. At least one-third of survey respondents are turning away new admissions due to staffing shortages, the survey says.
For the facilities, staffing shortages mean higher costs for overtime and an inability to grow or maintain patient population levels. Facility operators are also facing a pressing need for higher salaries and more money for recruiting tools, industry advocates said.
“The environment providers are operating in today isn’t sustainable,” said George Linial, president and CEO of LeadingAge Texas. “Texas cannot continue to kick this can down the road. A strong commitment and investment by lawmakers will pay huge dividends for the people we serve.”
However, it does not appear that help from Texas officials, either with emergency funding or staff, is imminent.
There is no bill filed in the current special session of the Legislature, which ends in just over two weeks, that would funnel any relief funds to nursing homes.
Texas has about $16.7 billion in American Rescue Plan Act money, and about $7.2 billion is marked in legislation to shore up the state’s unemployment fund, which was overloaded last year by record claims.
The funding request by the nursing homes includes $400 million to help recruit and retain workers, and an additional $350 million to pay for new infection-control measures and maintain them permanently for future crises.
For the remaining $8.5 billion available, requests from everyone else outside the nursing home industry amount to nearly eight times that much, budget officials say.
The nursing homes’ effort to get that funding has not gotten very far, sparking industry concerns that nursing homes will start shutting down.
Already, the nursing home workforce crunch is forcing admission caps, which is having a ripple effect on hospitals that are already at capacity with COVID-19 patients. With nowhere to transport patients well enough to leave a hospital but still too ill to go home, hospitals are now often required to house patients longer than they would have if they’d had a nursing home spot available, said Kevin Warren, president and CEO of the Texas Health Care Association.
It has also placed more burdens on families that may not be equipped to care for an aging relative much longer or older Texans whose medical needs are best met in a skilled nursing facility rather than through costly home care, he said.
“I am concerned that without additional funding necessary to recruit and retain current staff and develop opportunities to bring new employees into the profession, we will see continuously increasing access-to-care issues with expanding admission restrictions, closures, small independent owners being forced to sell, and bankruptcies,” Warren said.
Meanwhile, New York state lawmakers are considering sending medically trained National Guard members to fill vacancies in struggling nursing homes. So far, there are no similar plans underway in Texas to use the military branch to supplement staffing in any of the state’s 1,200 nursing homes.
A spokesperson for the Texas Division of Emergency Management, which oversees the state guard, referred questions about potential help for nursing homes to the Texas Department of State Health Services.
A DSHS spokesperson said that nursing homes with staff who are out sick with COVID-19 or that are overwhelmed with COVID patients can ask the state for help, but the facilities aren’t reporting high numbers of active cases.
While Texas has paid for thousands of relief workers this summer to send to hospitals that are struggling with a similar staffing crisis, Abbott has not announced a similar program for nursing homes.
In an effort to reduce the deadly impact of the virus, both state and federal governments imposed stringent safety mandates on nursing homes that changed daily, sometimes hourly, at the height of the pandemic last year.
The homes struggled to supply tests and personal protective equipment to staffers at their own expense, and some made extensive modifications to their air filtration systems, their building layouts and their staffing plans to respond to the health crisis.
Meanwhile, the cost to run a Texas nursing home has risen dramatically during the pandemic. Safety protocols and the ongoing staffing problems have meant budgets for Texas nursing homes have risen by 25% in the past 18 months, according to the survey released on Tuesday.
And even more trouble lies ahead. About 75% of Texas nursing homes are operating at a loss, the THCA/LeadingAge survey said.
These staffing challenges at nursing homes are not limited to lower-paying or entry level positions. Every one of the 31 facilities run by Focused Care in Texas has openings, and the vacancies go all the way to the top, Anderson said. Three facilities have no administrator, and another handful are without a director of nursing, she said.
Bonuses for referring new employees and extra shifts can help attract and retain staff, but about 90% of nursing home residents use Medicaid or Medicare, which keeps budgets limited and pay for most entry-level positions between $10 and $15 an hour.
There is also a shortage of applicants for work that was already difficult and now that work comes with the extra safety requirements and gear needed to treat a COVID-19-susceptible population. Any new worker finds themself working longer overtime hours because of the hiring shortfalls and all of that contributes to employees quitting within a month or two of being hired, she said. The problem has gotten so bad that the company is updating its orientation program to find a way to better prepare new hires for the difficult environment, Anderson said.
The high turnover, especially among new hires, “is quite alarming,” she said. “It’s always been hard work, but it’s even harder now with everything going on, and just the exhaustion.”
According to the U.S. Centers for Medicare and Medicaid Services, about 65% of nursing home staff are currently vaccinatednationally. A recent rise in cases among nursing home residents, both in Texas and across the country, driven by the highly contagious delta variant, prompted the federal agency to announce in August that all nursing home employees be vaccinated in order for their facilities to continue participating in the Medicare and Medicaid program.
Those rules are expected to come out later this month.
Anderson is casting an anxious eye on that moment, when potentially 40% of her workforce could become ineligible for employment.
About 62% of the staff and 81% of the residents in Focused Care facilities across Texas are vaccinated, Anderson said.
But while the rates of resident vaccinations are fairly high across the system, they range widely among the staff depending on the facility, state numbers show.
Statewide, the vast majority of nursing homes that have fewer than 40% of their staff fully vaccinated are located in rural areas — mainly east Texas, where counties have some of the lowest vaccination rates in the state.
By contrast, most of the nursing homes with more than 90% of staff vaccinated are in the Rio Grande Valley and in El Paso, which have some of the highest vaccination rates in the state.
Warren, the head of the nursing home advocacy group THCA, said that while administrators work every day to convince their staff to get vaccinated, it is a near-impossible task to move them off the belief system that causes them to reject or fear the vaccine even though it’s free and widely available.
Much of it, he said, has to do with where they live.
“There is that relationship between the vaccine rates within the community and within the facility,” Warren said. “When folks in these facilities are working 8, 10, 12 hours a day, on their days off, they’re spending time with their families and friends in the community. So if that same prevalence of concern and distrust of the vaccine is present in that community, it’s only furthering their own hesitation.”
Normally, Beaumont, Texas RN Vaughn Mugol sings to his bedside patients on the Christus St. Elizabeth’s oncology unit. On Monday, though, our Nurse of the Week wowed the likes of Ariana Grande, John Legend, and Kelly Clarkson during his audition for The Voice.
Using vocal chops that have cheered patients since 2017, Mugol performed a moving interpretation of Ed Sheeran’s “The A-Team.” All three judges turned their chairs in support of him, and Mugol chose Grande as his coach. All three judges were also surprised to hear that Mugol’s usual audience is his bedside patients. An admiring Legend remarked, “I feel that what you did required a lot of seasoning that one doesn’t expect from people who haven’t performed on big stages.”
The 27-year-old Mugol has always used his vocal talents on the oncology unit. In his Voice introductory video, he said, “At those vulnerable moments, usually I open up and sing to them when I know that they need it. To be able to help people with the healing process is very rewarding.”
However, John Legend may take some consolation in knowing that the Christus oncology unit has not been Mugol’s sole performance space. Prior to his network debut, Mugol often performed at local parties in Beaumont’s Filipino community – and previous auditors are not surprised that all three Voice judges wanted to be his selected coach. Melanie Lanuza, a family friend who has known Mugol since his childhood, says “We always sing karaoke at our Filipino parties, and I was surprised that he was so young and wanted to sing. None of the other kids were interested, but he wanted to sing. He blew me away even when he was so young.”
Paul Guidroz, chief nursing officer for Christus, proudly says that he spotted Mugol’s talent early. “In their orientation,” he remarked, “I spend time with all the new nurses as they begin their residency program. And in that session… I shared with him that, ‘Hey, I hear that you enjoy singing.’ I said, ‘Don’t lose that passion. You never know where it might take you.’”
Katy Kiser, communications director for Christus Health, cheered on their musical RN, saying of Mugol: “He’s an amazing nurse and he has full Christus support for his courage to go and sing on a national stage… We are all #VoteVaughn over here.”
“Our staff have been cursed at, screamed at, threatened with bodily harm and even had knives pulled on them…. It is escalating.”
—Jane McCurley, chief nursing executive for Methodist Healthcare System
When the security guard at Methodist Hospital San Antonio met the visitor at the door of the children’s emergency room on a Saturday afternoon in early August, the officer’s request was simple: The man needed to get a temperature screening to make sure he showed no early signs of COVID-19 before entering the hospital.
The man refused, became agitated and began angrily shouting, pulling out his camera to record the guard and hospital staff.
The scene got so tense that San Antonio police were called, but the man — whose identity and reason for wanting to enter the hospital weren’t included in a police account of the incident — stormed off in anger before the officer could arrive.
It was, relatively speaking, a small blow-up, but Texas hospital workers and health care officials say incidents like it have been rising in both number and intensity this summer as tensions boil during the delta-fueled fourth surge in COVID-19 hospitalizations.
“Our staff have been cursed at, screamed at, threatened with bodily harm and even had knives pulled on them,” said Jane McCurley, chief nursing executive for Methodist Healthcare System, speaking at a press conference five days after the incident in the children’s ER. “It is escalating. … It’s just a handful at each facility who have been extremely abusive. But there is definitely an increasing number of occurrences every day.”
Nurses and hospital staffers are historically vulnerable to workplace violence due to the nature of their jobs, where they deal with people who are having bad reactions to street drugs or mental breaks and often have to give bad news to patients or family already in extreme pain or emotional distress.
“[We’ve had] people being punched in the chest, having urine thrown on them and inappropriate sexual innuendos or behaviors in front of staff members.
The verbal abuse, the name-calling, racial slurs … we’ve had broken bones, broken noses.”
—Karen Garvey, Parkland Health & Hospital System, Dallas
But the pandemic has exacerbated the stress that can escalate into threats and violence, as people are now contending with not just the virus but also job loss and other stresses, said Karen Garvey, vice president of patient safety and clinical risk management at Parkland Health & Hospital System in Dallas.
Parkland Health & Hospital System, Dallas.
Garvey said confrontations at Parkland just this year have included “people being punched in the chest, having urine thrown on them and inappropriate sexual innuendos or behaviors in front of staff members. The verbal abuse, the name-calling, racial slurs … we’ve had broken bones, broken noses.”
Visitors and patients assaulting hospital staff “was an epidemic before the pandemic — it was just silent to the public,” she added. “Health care workers have been dealing with this for years, and it’s become more pronounced with the COVID pandemic.”
The pandemic-related rise in tensions across the U.S. is not unique to the hospital industry. Airlines are reporting an increase in aggressive passengers as flight attendants take self-defense classes. Police are reporting an increase in violent crime and road rage incidents.
A similar phenomenon emerged last year when retail and grocery workers became front-line enforcers of mask mandates and limits on gatherings and indoor activities. And it resurfaced last month when parents aggressively confronted teachers at schools over oft-changing mask rules.
But unlike airlines, which can permanently ban passengers, hospitals are more limited in how they can respond or prevent those instances.
A 2013 Texas law made it a felony to assault an emergency room nurse, but legislation that would have expanded that to include nurses in other areas of a hospital died in the Texas Senate earlier this year. A bill addressing the issue is currently being considered in Washington by the U.S. Congress.
With hospitals reporting historic nursing shortages as the pandemic drags on, the fear is that the “alarming rate” of escalation will be the last straw for nurses who are physically worn out after fighting a pandemic for 18 months, thin on compassion for people who need care after choosing not to be vaccinated and afraid for their own personal safety, said Houston pediatrician Dr. Giancarlos Toledanes.
“With the escalation of this violence toward health care workers, we’re going to lose the workers that are deemed essential,” Toledanes said. “If the problem continues to compound, then I think it’s going to make it much more difficult to staff these hospitals.”
“Tempers are high”
The Texas Department of State Health Services doesn’t track incidents of aggression against hospital staff outside of its regular surveys, the next of which will be done next year, a spokesperson said.
But as health officials across Texas watch hospital ICUs and pediatric units overflow with record numbers of mostly unvaccinated people, they say the surge in aggression toward health care workers is obvious.
Many of the problems being reported in recent months include disagreements over masking and screening protocols that people don’t have to follow in other places, particularly after most mandatory protocols were banned in recent months by Gov. Greg Abbott, officials said.
Confrontations are sometimes caused by hours- or days-long waits in emergency rooms that are so full of COVID-19 patients that there is no room for anyone else, health care workers said.
“Tempers are high,” said Carrie Kroll, director of advocacy for the Texas Hospital Association. “To the point where some systems are putting a security guard at check-in because family members are getting so abusive over the masking and some of the other screening things they need to do.”
Families are often upset when they can’t visit someone due to COVID-19 rules that limit the number of people who can be bedside or even come inside the hospital, said Serena Bumpus, director of practice at the Texas Nurses Association.
“When our family members are sick, we want to be there by their side, and it’s not that easy to be by our loved one’s side anymore because of this increase in the number of COVID patients in our facilities,” she said.
At the Katy campus of Texas Children’s Hospital west of Houston, Toledanes said some parents get verbally abusive over rules that require them to wait for COVID-19 test results before more than one parent is allowed into a room with a sick child.
“With their child in the hospital and they’re the only ones handling everything, it obviously gets stressful,” he said. “It’s escalated a lot more, especially now that we’ve gotten a little bit stricter with our policies” due to the surge.
Health workers face online harassment
The threats follow health care workers online as well, and often have to do with philosophical differences over what have become political hot buttons such as masking and vaccinations, Toledanes wrote in a recent column for the online medical magazine MedScape.
“Online, healthcare workers, who advocate for masking or vaccination, are often subject to death threats, threats to family members, and verbal abuse on social media,” he wrote. “Veiled threats of ‘we know who you are’ and ‘we will find you’ follow physicians who advocate for masking in schools.”
At Parkland, some of the administration’s actions to protect the workers include a staff of six mental health peace officers — known as the Law Enforcement Intervention for Environmental/Patient Safety staff — who are specially trained to respond to high-risk incidents, Garvey said. Administrators have developed a flagging system in the patient record which identifies patients who have been identified as known risks to staff, she said.
Some hospitals have hung signs in hallways reminding families to be courteous and patient with the overworked staff.
In mid-August, the escalating reports prompted the Texas Hospital Association to take to social media with an image of an exhausted nurse’s face, mask pulled below her chin.
“Don’t forget the person behind the mask,” the image reads.
McCurley said that the increasing violence this year is made worse by the contrast in attitudes workers are seeing now compared with a year ago, when the public seemed to understand that nurses and hospital staff were standing between them and the deadly pandemic.
“We were seen as health care heroes and our community responded with love and support, food and gifts, drive-by parades, buses and motorcycles and airplanes, and we felt so much love and support. It gave us the courage to go in and face our own fears of the unknown in the beginning,” McCurley said at the August press conference. “Today, those health care workers are experiencing abusive behavior by patient families. It’s unfathomable that it’s occurring, and it has to stop.”
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Disclosure: Texas Children’s Hospital and the Texas Hospital Association have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
Rafiah Maxie has been a licensed clinical social worker in the Chicago area for a decade. Throughout that time, she’d viewed suicide as a problem most prevalent among middle-aged white men.
Until May 27, 2020.
That day, Maxie’s 19-year-old son, Jamal Clay — who loved playing the trumpet and participating in theater, who would help her unload groceries from the car and raise funds for the March of the Dimes — killed himself in their garage.
“Now I cannot blink without seeing my son hanging,” said Maxie, who is Black.
Clay’s death, along with the suicides of more than 100 other Black residents in Illinois last year, has led locals to call for new prevention efforts focused on Black communities. In 2020, during the pandemic’s first year, suicides among white residents decreased compared with previous years, while they increased among Black residents, according to state data.
But this is not a local problem. Nor is it limited to the pandemic.
Interviews with a dozen suicide researchers, data collected from states across the country and a review of decades of research revealed that suicide is a growing crisis for communities of color — one that plagued them well before the pandemic and has only been exacerbated since.
Overall suicide rates in the U.S. decreased in 2019 and 2020. National and local studies attribute the trend to a drop among white Americans, who make up the majority of suicide deaths. Meanwhile, rates for Black, Hispanic and Asian Americans — though lower than their white peers — continued to climb in many states. (Suicide rates have been consistently high for Native Americans.)
“Covid created more transparency regarding what we already knew was happening,” said Sonyia Richardson, a licensed clinical social worker who focuses on serving people of color and an assistant professor at the University of North Carolina-Charlotte, where she researches suicide. When you put the suicide rates of all communities in one bucket, “that bucket says it’s getting better and what we’re doing is working,” she said. “But that’s not the case for communities of color.”
Research shows Black kids younger than 13 die by suicide at nearly twice the rate of white kids and, over time, their suicide rates have grown even as rates have decreased for white children. Among teenagers and young adults, suicide deaths have increased more than 45% for Black Americans and about 40% for Asian Americans in the seven years ending in 2019. Other concerning trends in suicide attempts date to the ’90s.
“We’re losing generations,” said Sean Joe, a national expert on Black suicide and a professor at Washington University in St. Louis. “We have to pay attention now because if you’re out of the first decade of life and think life is not worth pursuing, that’s a signal to say something is going really wrong.”
Rafiah Maxie pages through a scrapbook on July 9, 2021, in Olympia Fields, Illinois. She and her son, Jamal Clay, made the book together. Clay died by suicide at age 19 in 2020. (Taylor Glascock for KHN)
These statistics also refute traditional ideas that suicide doesn’t happen in certain ethnic or minority populations because they’re “protected” and “resilient” or the “model minority,” said Kiara Alvarez, a researcher and psychologist at Massachusetts General Hospital who focuses on suicide among Hispanic and immigrant populations.
Although these groups may have had low suicide rates historically, that’s changing, she said.
Paul Chin lost his 17-year-old brother, Chris, to suicide in 2009. A poem Chris wrote in high school about his heritage has left Chin, eight years his senior, wondering if his brother struggled to feel accepted in the U.S., despite being born and raised in New York.
Growing up, Asian Americans weren’t represented in lessons at school or in pop culture, said Chin, now 37. Even in clinical research on suicide as well as other health topics, kids like Chris are underrepresented, with less than 1% of federal research funding focused on Asian Americans.
Suicide is the leading cause of death for Asian Americans ages 15 to 24, yet “that doesn’t get enough attention,” Chin said. “It’s important to continue to share these stories.”
Kathy Williams, who is Black, has been on a similar mission since her 15-year-old son, Torian Graves, died by suicide in 1996. People didn’t talk about suicide in the Black community then, she said. So she started raising the topic at her church in Durham, North Carolina, and in local schools. She wanted Black families to know the warning signs and society at large to recognize the seriousness of the problem.
The pandemic may have highlighted this, Williams said, but “it has always happened. Always.”
Pandemic Sheds Light on the Triggers
Pinpointing the root causes of rising suicide within communities of color has proven difficult. How much stems from mental illness? How much from socioeconomic changes like job losses or social isolation? Now, covid may offer some clues.
Recent decades have been marked by growing economic instability, a widening racial wealth gap and more public attention on police killings of unarmed Black and brown people, said Michael Lindsey, executive director of the New York University McSilver Institute for Poverty Policy and Research.
With social media, youths face racism on more fronts than their parents did, said Leslie Adams, an assistant professor in the department of mental health at Johns Hopkins Bloomberg School of Public Health.
Each of these factors has been shown to affect suicide risk. For example, experiencing racism and sexism together is linked to a threefold increase in suicidal thoughts for Asian American women, said Brian Keum, an assistant professor at UCLA, based on preliminary research findings.
Covid intensified these hardships among communities of color, with disproportionate numbers of lost loved ones, lost jobs and lost housing. The murder of George Floyd prompted widespread racial unrest, and Asian Americans saw an increase in hate crimes.
At the same time, studies in Connecticut and Maryland found that suicide rates rose within these populations and dropped for their white counterparts.
“It’s not just a problem within the person, but societal issues that need to be addressed,” said Shari Jager-Hyman, an assistant professor of psychiatry at the University of Pennsylvania’s school of medicine.
During this time, suicide deaths among Hispanic Texans climbed from 847 deaths in 2019 to 962 deaths in 2020, according to preliminary state data. Suicide deaths rose for Black Texans and residents classified as “other” races or ethnicities, but decreased for white Texans.
Marc Mendiola often heard his classmates at South San High School say they were suicidal. In 2017, Mendiola and his classmates began advocating for mental health services at the school. (Photo: Marc Mendiola)
The numbers didn’t surprise Marc Mendiola. The 20-year-old grew up in a majority-Hispanic community on the south side of San Antonio. Even before the pandemic, he often heard classmates say they were suicidal. Many faced dire finances at home, sometimes living without electricity, food or water. Those who sought mental health treatment often found services prohibitively expensive or inaccessible because they weren’t offered in Spanish.
“These are conditions the community has always been in,” Mendiola said. “But with the pandemic, it’s even worse.”
Four years ago, Mendiola and his classmates at South San High School began advocating for mental health services. In late 2019, just months before covid struck, their vision became reality. Six community agencies partnered to offer free services to students and their families across three school districts.
Richard Davidson, chief operating officer of Family Service, one of the groups in the collaborative, said the number of students discussing economic stressors has been on the rise since April 2020. More than 90% of the students who received services in the first half of 2021 were Hispanic, and nearly 10% reported thoughts of suicide or self-harm, program data shows. None died by suicide.
Many students are so worried about what’s for dinner the next day that they’re not able to see a future beyond that, Davidson said. That’s when suicide can feel like a viable option.
“One of the things we do is help them see … that despite this situation now, you can create a vision for your future,” Davidson said.
A Good Future
Researchers say the promise of a good future is often overlooked in suicide prevention, perhaps because achieving it is so challenging. It requires economic and social growth and breaking systemic barriers.
Tevis Simon works to address all those fronts. As a child in West Baltimore, Simon, who is Black, faced poverty and trauma. As an adult, she attempted suicide three times. But now she shares her story with youths across the city to inspire them to overcome challenges. She also talks to politicians, law enforcement agencies and public policy officials about their responsibilities.
Growing up in West Baltimore, Maryland, Tevis Simon dealt with poverty and trauma. She attempted suicide three times as an adult — but now uses her story to teach and inspire others. (Photo: Tevis Simon)
“We can’t not talk about race,” said Simon, 43. “We can’t not talk about systematic oppression. We cannot not talk about these conditions that affect our mental well-being and our feeling and desire to live.”
For Jamal Clay in Illinois, the systemic barriers started early. Before his suicide last year, he had tried to harm himself when he was 12 and the victim of bullies. At that time, he was hospitalized for a few days and told to follow up with outpatient therapy, said his mother, Maxie.
But it was difficult to find therapists who accepted Medicaid, she said. When Maxie finally found one, there was a 60-day wait. Other therapists canceled appointments, she said.
“So we worked on our own,” Maxie said, relying on church and community. Her son seemed to improve. “We thought we closed that chapter in our lives.”
But when the pandemic hit, everything got worse, she said. Clay came home from college and worked at an Amazon warehouse. On drives to and from work, he was frequently pulled over by police. He stopped wearing hats so officers would consider him less intimidating, Maxie said.
“He felt uncomfortable being out in the street,” she said.
Maxie is still trying to make sense of what happened the day Clay died. But she’s found meaning in starting a nonprofit called Soul Survivors of Chicago. Through the organization, she provides education, scholarships and shoes — including Jamal’s old ones — to those impacted by violence, suicide and trauma.
“My son won’t be able to have a first interview in [those] shoes. He won’t be able to have a nice jump shot or go to church or even meet his wife,” Maxie said.
But she hopes his shoes will carry someone else to a good future.