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FORSYTH COUNTY, N.C. — The suicide by a famous celebrity, such as Robin Williams on Monday, tends to be jarring because it adds a public element to what is an irrational decision based on private misery, local mental health officials told the Winston-Salem Journal. 

What seems to set Williams’ death apart is not just that he was an actor and comedian who entertained most of us as we grew up.

There was an illusion that Williams, 63, had things under control even though he shared his problems with depression and substance abuse through his comedy routines.

“We tend to think that people who have it all don’t deal with problems like the rest of us, and then we question how could they do this to themselves,” Andy Hagler, executive director of The Mental Health Association in Forsyth County, said Tuesday. “People think that because celebrities have wealth, they have avenues for help the rest of us don’t.

“However, the pain — both mentally and physically — does not discriminate. It is oftentimes associated with depression, along with co-occurring substance use, such as alcohol and/or drug use.”

According to the American Psychiatric Association, about 90 percent of Americans who commit suicide experienced a combination of depression and substance abuse.

“Again, it does not matter who you are, where you come from or how rich and famous you are,” Hagler said. “If you experience a series of losses, combined with severe depression and/or drug and alcohol abuse, then one can definitely be at high risk of suicide.”

The psychiatric association reports that about 36,000 Americans commit suicide each year.

It was the number 4 cause of injury death among NC adults in 2012 with 1,281 reported cases, including 37 in Forsyth, according to the N.C. Department of Health and Human Services.

By comparison, there were 565 reported homicides in 2012.

About 60 percent of suicides in N.C. occur by firearms, followed by hanging at 19 percent and poisoning at 18 percent.

Authorities on Tuesday said Williams took his life by hanging himself with a belt in a bedroom of his San Francisco Bay Area home.

Although suicide is predominantly associated with whites — including more than about 90 percent of the cases in North Carolina — blacks also often struggle to get help when they have suicidal thoughts, said Kenneth Todd Nelson Jr., a Winston-Salem native and New York actor who co-produced the documentary “Face of Darkness.”

Nelson said Tuesday he was leery of getting help for his depression. Too often in the black community, boys are taught to “suck it up” and “be tough,” he said.

As a result, people bottle up their natural feelings to the point “they began to fester in unhealthy ways,” he said.

“I do not know where I would be without medical help and the medicine that keeps me more balanced,” Nelson said.

Nelson said that for those who experience depression, “their reality is that their moods can shift in a moment’s notice, and thus change their whole outlook on life.”

“We could see that part of Robin’s healing process was the joy he found in making people laugh. Unfortunately, the demons he was living with apparently took away that joy and his sense of hope.”

Robert Mills, a retired Wake Forest University administrator, helps lead a grassroots bipolar disorder support group at First Presbyterian Church in Winston-Salem.

The group, which began in 2001, has helped more than 1,400 people by connecting the spiritual side of recovery with medicine and counseling.

“It’s often difficult to help the individual with manic-depression because the substance abuse can help dull their pain for a while,” Mills said. “People who have suicidal thoughts aren’t thinking rationally. When their brain is in disorder, no rules or boundaries tend to apply.”

Robert Rominger, a psychologist at Wake Forest Baptist Medical Center, said the suicide rate is highest among those ages 45 to 64.

“While females are more likely to attempt suicide, males are more likely to succeed, at least in part because they are likely to use more lethal means,” Rominger said.

Ann Akland, chairwoman of the Wake County chapter of the National Alliance on Mental Illness, said that one way to combat suicidal thoughts is for individuals experiencing depression to place their trust in a close group of family members or friends.

“It empowers these confidants to tell the person when they see their symptoms escalating so they can help get them into treatment and safety,” Akland said. “It may be as simple as a sleepover with family or friends, a chat with treatment professionals, a medication adjustment.

“In the most severe cases, it may require a stay in a clinical setting. But there are people all around who care and will help if they only know.”

Hagler, Mills, Nelson and others say they hope the attention raised by Williams’ suicide will spur lasting conversations and public action on mental health advocacy.

“I appreciate the way that churches and pastors reach out to their congregations in the black community,” Nelson said. “I encourage them to reach out to professional help when they are helping members who have needs beyond their means.”

Rominger said he “would like to think that this tragic loss will lead us to be more reflective about the role we might play in preventing suicide within our own social networks.”

Kevin Patton, chief executive of Old Vineyard Behavioral Health Services, said Williams’ death presents “an opportunity to educate the community that we need to do more to reduce the stigma associated with mental health, so people feeling hopeless will seek professional help and understand that it is not a personal defect.

“It is a disease that needs to be treated like heart disease, diabetes or cancer.”