GILLETTE, Wyoming — As she pulled into the Force Road suburb, Trish Simonson felt her mother's intuition kick in.
Something was wrong. The lights were off, but her son, Kaden, hated the dark.
Her mind raced.
Was it a robbery?
What if someone had hurt Kaden?
She rushed inside and flipped on the light. The dogs were huddled strangely on the floor. She called out, but Kaden didn't answer.
What if ... ?
She made her way toward the back of the home, to Kaden's room. The lights didn't work, and it was dark — but not enough to obscure the view.
Kaden was dead. He had shot himself.
He was just 15.
"In half a second he was gone," she said.
It was two days before Mother's Day and they had planned to see a movie together. Now she was instead planning his funeral.
"As a mom, our only job is to make sure our kids are OK," Simonson said. "I feel like I failed."
But some would say it is Wyoming that's failed. Since 2000, the Cowboy State has averaged nearly twice the national suicide rate, according to the Wyoming Survey and Analysis Center.
Going back 25 years, Wyoming's suicide rate has never dipped below sixth in the nation, said Spring Wilkins, community prevention professional with the Prevention Management Organization of Wyoming.
Everyone from suicide survivors to law enforcement officers has said more needs to be done. The problem got the attention of the governor, who earlier this month sent a press release stating that he's asking state employees to complete online suicide prevention training.
Locally, Wilkins has trained more than 5,000 county residents in suicide awareness in the last few years. It's not enough.
Campbell County Coroner Laura Sundstrom sees the ugly side — the worst result — of when mental illness gets the better of a person.
"There's no help," she said at a recent meeting for Campbell County elected officials. "We need to look at our mental health system. Other states have quick access to a mental health facility. We don't. Our closest one is WBI (Wyoming Behavioral Institute) in Casper."
She said Kaden's suicide was No. 6 of 13 and he was one of two teenagers who killed themselves last year.
Based on the county's suicide rate, there was a 1-in-10 chance that those who died in Campbell County last year did so by their own hand.
"No one wants to acknowledge we have a problem," Sundstrom said, "But it's here and when you don't talk about it, there's more suicide."
Complicating matters is what's known as the suicide contagion effect, in which every suicide survivor is at a higher risk of committing suicide themselves, Wilkins said. In a small community like Gillette, up to 30 people are profoundly impacted by each suicide.
Simonson is aware of the phenomenon.
When Kaden died, a part of Simonson went with him. Now she's haunted by his memory.
"When a mother finds her child that way, it's an image that never leaves you," she said. "That is something I suffer from every day."
Since that day, she's cried many tears.
"After Kaden died, I fell into a huge depression and couldn't get out of bed, couldn't eat, it was just a fog," she said. "I didn't know if I wanted to be here anymore."
The state of mental health
Suicide is only one indicator of a growing and complicated mental health problem, one that's spilled into the streets.
In 2015, Campbell County deputies and Gillette police officers responded to 93 mental illness calls. They also responded to 60 calls for suicidal people, including those who committed the act, records show.
That doesn't include calls for drug or alcohol abuse, which officials say often go hand-in-hand with mental illness.
But the problem's not limited to Gillette or even Wyoming.
Jeffrey Rice, director of mental health services at Campbell County Health, said the whole country is experiencing an increase in mental illness.
"Geriatric patients are using mental health services 10 to 15 percent more than 10 years ago, bipolar disorder is up about 400 percent in young people and the suicide rate among soldiers is at an all-time high," Rice said.
Mental illness has become so prevalent that one in four individuals has or will have a mental health issue of varying degrees, said Sandra Hollenback, National Association of Mental Illness president for Campbell County.
The figures could be low. Because of the stigma associated with mental illness, its conditions are significantly under-diagnosed, said Andy Fitzgerald, CEO of CCH.
"It's a significant issue and it's honestly one people don't like to talk about," Fitzgerald said of the stigma. "It seems more like a weakness than a disease."
The problems we face
There are a number of treatment facilities in Gillette, the largest being Behavioral Health Services of CCH, but even combined, they're not enough.
"There's almost an unending demand for the full range of behavioral health services," Fitzgerald said. "It's almost overwhelming at times because you want to be able to help everyone in the community that needs it."
More care is needed, he said.
"Look at the number of people at the Way Station, look at the suicide rate and the police blotter. I think you can come up with the conclusion it's not adequate," he said. "It's a tremendous problem in our community, in our state and in our nation."
Gillette has no long-term inpatient treatment center.
The hospital has six adult beds for short-term inpatient stabilization of those who pose a danger to themselves, others or are gravely disabled, Rice said.
Six beds aren't enough. The adult inpatient facility is full about 30 percent of time. When that happens, CCH often will house patients in the emergency section, Rice said.
For patients who need more care, CCH is responsible for transporting them to other facilities such as those in Casper or Evanston. But getting people into those facilities in a timely manner can be difficult, Rice said.
"There have been instances when there are no beds available anywhere," he said, adding that some patients have remained at the hospital for two months.
And that's just for long-term inpatient services.
Paul E. Demple, executive director at Northern Wyoming Mental Health Center, said about 350 people were committed to the state hospital last year. In contrast, more than 27,000 used some form of outpatient service.
But if you use the 10 percent figure, with a population of almost 600,000, about 60,000 residents would need care.
Even if there were more facilities, they would still have to be staffed. And that creates another problem.
The hospital has eight therapists, two psychologists, a psychiatrist and physician assistant who can provide medication, Rice said. It also has three tele-psych doctors who can see patients if there's an overflow.
Despite paying well, it isn't easy to retain staff, Rice said.
While Gillette may be great for those looking to hunt or fish, in Rice's opinion, it lacks the culture and arts that students fresh out of medical school might crave.
Hollenback said her son has been through three doctors over the years.
"Even if we could afford it, I don't think there are the number of counselors out there to meet that need," Fitzgerald said.
The demand is so high, just getting an appointment can take time.
The average outpatient appointment wait time at CCH is four days, Rice said, but when out-of-state patients transfer in, or if patients want a specific therapist, the wait can be up to six weeks.
If patients are in crisis or going to run out of medication, there is an open access walk-in clinic Mondays, Wednesdays and Fridays that will see people that same day, Rice said.
The cost of care
Like any medical service, treating mental illness is costly.
Garry Becker, chairman of the Campbell County Commission and a retired physician, said the irony is that those who require mental health care are often least able to afford it.
He also said many doctors are reluctant to go into the field because other specialties pay more.
"From a business point of view, psychiatry is a slim profit margin," Rice said. "Add in a faltering economy and an unwillingness of the state to fund it and you've got a perfect financial storm."
Demple said mental health services often lose money.
"I have some people paying $7 for a service that costs $110," he said.
That's true at CCH, where Rice's department lost about $800,000 last year.
While CCH absorbs the loss, for now, other facilities have reduced or stopped services altogether.
Wyoming Medical Center stopped its mental health services about a year ago because it wasn't profitable, Fitzgerald said, adding that many other organizations in the state have followed suit.
State funding cuts haven't helped the situation.
Since 2010, the state has cut funding for non-core mental health services by $4 million, Rice said.
Demple said more cuts could be on the way.
Under state law, people who are a danger to themselves or others are involuntary held at facilities until they can be stabilized. The process is called a Title 25 hold. CCH handles those in its six-bed facility.
During the past few years, facilities have run over budget on Title 25 cases, Demple said.
Despite the overrun, the Legislature's Joint Appropriations Committee recently voted to remove $11.3 million from the Wyoming Department of Health's budget that would have funded the Title 25 system, according to newspaper reports.
The fiscal constraints haven't stopped CCH from trying. While other places have cut funding, it has expanded services.
In the last two years, CCH spent $800,000 on expanding inpatient services, including adding two adolescent inpatient beds, Rice said, adding that about another $100,000 has been spent on outpatient renovations this year.
"We provide more now than we ever have," Fitzgerald said. "I would say we do more than most communities as far as hospital-based service is concerned."
Still more is needed
While the problem of mental illness has been acknowledged, there's little argument that not enough has been done.
That's because while money is a big part of the problem, it's also the solution.
"Additional funding allows you to add services and locations and provide access," Fitzgerald said. "But I don't see that happening anytime soon."
CCH's hands are tied in the matter. Fitzgerald said if it were to increase services, it would have to bear the costs. Those are costs it can't afford to take on. CCH has written off $12.2 million so far this year.
"At some point you have to say this is what we can do without driving the loss even greater," Fitzgerald said.
For now, CCH works with what it has.
"We can't be all things to all people," Fitzgerald said. "There are always going to be some services we can't offer. In this case, it's really an affordability issue. We simply can't afford to do it as an organization."
Rice said he doesn't think any facility in America is equipped to deal with the demand.
His department's budget is about $10 million, of which about $2.1 million comes from the state, he said.
To meet all the mental health demands of the community, Rice guessed the department would need a budget of $25 million to $30 million.
Life after death
Four bracelets and a semicolon tattoo to promote awareness of suicide and mental illness adorn Simonson's arms. Just as the semicolon allows a sentence to continue, so too, does Simonson's story.
Since Kaden's suicide, Simonson has gained a better understanding of what people in mental distress have to endure.
"It gave me just a little window of what people are going through," she said. "I'm so angry that Kaden did this and I think it's probably the worst way that someone can leave the earth, but my eyes were opened on how someone can get to that point."
She's become more involved in advocacy. She's joined groups and started scholarships for students who overcame obstacles and struggles.
She said more dialogue is needed.
"When people ask us how our son died, we don't skirt around it," she said. "We tell people he killed himself, and that's where the conversation begins."
It's a difficult conversation to have.
"You wonder if people think that you were a bad parent or what was going on in your home that your child didn't want to be here anymore."
Simonson dismissed the macho self-reliance affiliated with Western culture.
"The bravest thing a person can do, the way to Cowboy up, so to speak, is to tell someone," she said.
But she's not a bureaucrat or policy-maker focused on statistics or budgets. She's a real person, a mother who lost her son.
"I miss him sitting on the kitchen counter while I cooked dinner. I always would make him scoot over," she said. "I miss everything about him."
She had to figure out how to live when the one she lived for was gone.
"You never get over it. Time doesn't heal it, but you get to a point where you can finally get out of bed in the morning," she said. "I finally just had to realize that I could either lay on the couch and die or I could go out and try to live my life and still be sad."
While she's moved on, she's not the same.
"Everything is different. I'm in counseling and my husband and I have insomnia," she said. "We don't eat a lot of the same meals we made for Kaden."
Kaden's suicide left her with more questions than answers.
Kaden was smart, witty and popular, she said. He didn't say anything or act strangely before the suicide. He didn't leave a note.
Simonson thinks it might have to do with an immune system disorder he had, hyper IgD syndrome. The condition required monthly treatments at a cancer center that Kaden endured since he was 6. It was with him all his life.
"He hid it from friends," she said. "I think a lot of times he wasn't able to be a kid."
Kaden died May 8.
"Some days are still really bad," Simonson said. "I spent a long time seeing him everywhere, at the lunch table he used to sit at, or in the commons with his friends, or sitting on the brick wall waiting for me after school."
Now for the most part, she visits him at the cemetery.
"It's hard to go. At first, it was comforting. I felt like maybe I was closer to him," she said. "But now I realize how far away he is. The headstone really puts a finality on it."
This year, the anniversary of Kaden's suicide falls on Mother's Day.
"It probably will not be a good day," she said.
Simonson keeps Kaden close to her heart.
She can still smell him when she walks in his room.
It's hard to let go, to say goodbye, and Simonson still has a basket of Kaden's unwashed laundry.
She can't bring herself to wash it — to wash away what's left of Kaden.
Information from: The Gillette (Wyo.) News Record, http://www.gillettenewsrecord.com