It’s been six years, and friends still don’t know what to say to Bowling Green resident Sarah Skinner about her father’s suicide.

This week, they hushed conversations about actor Robin Williams, who was found dead Monday after hanging himself.

“They say, ‘I just don’t feel comfortable talking about it around you,’ ” she said. But “I would rather talk about it than not.”

Experts and advocates argue talking about suicide is what will bring change to the U.S. where 39,518 people died that way in 2011, placing it among heart disease and obesity as a leading cause of death, according to the Centers for Disease Control and Prevention.

Fourteen people in Warren County have killed themselves this year, according to the coroner’s office. In the state, 3,049 people died by suicide between 2007 and 2011, according to the Suicide Prevention Resource Center. The center estimates more than 76,000 Kentuckians attempted suicide during that five-year period.

“People don’t realize how big suicide is and how much it happens,” Skinner said. “You’re put in an ostracized category. … I think people are scared of it. I think they don’t want to know.”

LifeSkills operates a crisis line in southcentral Kentucky’s 10-county region. The help line handled 1,192 calls between July 1, 2013, and June 30.

Warren County Magistrate Darrell Traughber, who became a suicide prevention advocate after his son Houston killed himself nine years ago, said people don’t understand suicide. 

“A lot of people do not want to say the word suicide,” Traughber said. “I think it affects (people) differently than if I said (my son) died in a car wreck.”

Skinner’s father shot himself when he was 61. He was an alcoholic, bipolar and was seeing a counselor, she said. His journals, which she read after he died, showed “more of what he grew up with, how he was feeling. (Suicide) was his only release to get out of his own pain.”

Much of suicide prevention efforts are directed at young people. It is the second-leading cause of death for Kentuckians and Americans ages 15 to 34.

Traughber said: “We think (young kids) don’t understand that suicide is permanent. So many kids today are used to redoing and taking another turn. I don’t think kids who are 13, 14 or 15 years old realize that suicide is the absolute end.”

Williams’ death brought to light the increasing rate of suicide among middle-aged Americans. The 45 to 64 age group had the highest rate of suicide in 2011, the most recent year for which national data is available. The CDC reported that the rate of suicide among those ages 35 to 64 increased by 28.4 percent from 1999 to 2010.

Todd Noffsinger, a licensed counselor at Western Kentucky University’s Counseling and Testing Center, said he has noticed that college students are more open about their feelings and want to share. They have fewer barriers between them and counseling.

Millennials “seem to be very comfortable with expressing what’s going on in their lives. They actually take initiative,” Noffsinger said. “If we rewound the tape 20 or 30 years, it was, ‘Something’s wrong with me,’ and that further isolates that person.”

He said hopelessness and isolation are two of the biggest factors that lead to suicide.

“We do a lot as a profession to encourage people that counseling is a supportive outreach. It’s something that, evidence shows, makes the situation better. It’s something that can alleviate the stressors that are going on,” he said.

LifeSkills offers 24-hour walk-in mental health services to adults in the 10 counties it serves, including Warren. It also has a short-term residential facility for those experiencing a mental health crisis.

Stephen O’Connor, a psychological sciences professor at WKU, conducts research on methods of suicide prevention on various fronts.

“I really think we know what helps people not kill themselves. At this point, it’s about taking what we know and applying it,” O’Connor said. “The biggest thing is scaling up at a larger level.”

Part of his research involves intervening with people who survived an attempted suicide and are receiving care at Vanderbilt University Medical Center in Nashville.

We “take advantage of teachable moments,” he said. “There’s clarity sometimes after a lethal attempt if someone survives.”

He said people who want to kill themselves don’t want to be dead. They want to be free from what they’re feeling. Another aspect of his research involves a suicide-specific treatment plan, which includes counseling.

“There are real factors that make people want to kill themselves. Let’s talk about them, address them,” O’Connor said.

Mental illness and substance addiction are frequently present in cases of suicide, Noffsinger and O’Connor said, but labels and assumptions can cloud the conversation.

“The majority of people who have major depression aren’t suicidal, even though the majority of people who are suicidal have mental illness. But if we only focus on treating the mental disorders, we miss where they’re coming from,” O’Connor said.

Noffsinger said society gets “really hung up on a diagnosis.”

“The fact is that person is discouraged, hopeless, traumatized and they don’t know what to do,” Noffsinger said.

For friends and family, the important part of prevention is recognizing the signs and listening without judgment. Noffsinger said he knows not everyone seeks counseling when they’re feeling hopeless, but they might talk to a friend or visit a support group.

“Studies show the most powerful intervention is listening. It’s not giving advice, it’s not telling them what to do, it’s not even giving them an interpretation,” he said.

O’Connor said: “We think we understand something, but we really don’t. We create an environment where the messages aren’t accurate. Calling someone a coward … (we) don’t have a clue about what it means to be a person living in a desperate, suffering place.

“I think we could become a little more curious and empathetic.”

— Follow Taryn Phaneuf on Twitter at twitter.com/tarynphaneuf or visit bgdailynews.com.