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  • By Mar-Vic Cagurangan and Phillip V. Cruz Jr

Gruesome twosome: Amid suicide surge triggered by Covid-19, Guam is facing a shortage of mental heal

SN, a 56-year-old resident of Santa Rita, lately finds herself needing to talk to her counselor more often than she normally does. The combination of social isolation and the constant fear of getting infected by Covid-19— on top of “other tense, personal circumstances— heightens her anxiety and triggers her emotional meltdowns.

“Talking to someone helps me a great deal,” SN said.

SN was first diagnosed with major depressive disorder in 2012. “I had called an ambulance for myself, thinking I might have been having a heart attack. Turns out it was an anxiety attack. I stayed two nights and three days as an in-patient.”

She has since been seeing a doctor and a counselor regularly and taking prescribed meds for depression and anxiety. “I take them once or twice a day as needed,” she said.

Lurking behind the Covid-19 pandemic is an equally deadly crisis that has been relegated as a mere footnote to the main discourse on the coronavirus. In May, the World Health Organization warned of a looming mental illness crisis around the world resulting from the Covid-19 pandemic.

"Multiple lines of evidence indicate that the Covid-19 pandemic has profound psychological and social effects. The psychological sequelae of the pandemic will probably persist for months and years to come," according to a study published in the QJM International Journal of Medicine.

"Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use and other psychiatric disorders in vulnerable populations including individuals with pre-existing psychiatric disorders and people who reside in high Covid-19 prevalence areas,” the study said.


On Guam, treatment of mental health patients is a major challenge due to a shortage of mental health professionals, according to Theresa Arriola, director of Guam Behavioral Health and Wellness Center.

“There is a hiring delay due to an industry shortage of counselors/ substance abuse counselors, psychiatrists and psychologists. Funding is not an issue but rather shortage nationwide,” she said. “GBHWC gained (Health Resources and Services Administration) site designation last summer. It’s a recruitment tool. Individuals that work for us maybe eligible for student loan forgiveness.”

Even prior to the pandemic, Arriola said "the need for more mental health and substance abuse providers has always been an issue because of a nationwide shortage."

She said GBHWC is working with the Western Interstate Commission for Higher Education to establish a psychologist intern program to address shortage of psychologists. "Also recruitment tools like loan forgiveness program has helped as we have received interest to work at GBHWC as a result of it," Arriola said.

The Covid-19 pandemic’s toll on mental health is apparently beginning to show itself through an increased suicide rate on Guam during the first eight months of the coronavirus year. Numbers indicate that the mental sufferings caused by Covid-19 can be more fatal than the virus itself.

The Office of the Chief Medical Examiner has recorded 26 suicides from January to August, or an average of 3.25 a month. There were 15 suicides in the last three months alone– June (5), July (5), and August (5)– at the height of the Covid-19 outbreak that has sent people behind locked doors with no jobs to return to when the economy reopens.


As Covid-19 rages on, the number of cases this year is expected to surpass the 31 suicides recorded in 2019. There were 44 suicides on Guam in 2018.

While the suicide rate went down between 2018 and 2019, Guam’s suicide rate continues to be significantly higher than that in the U.S. mainland, according to Guam Behavioral Health and Wellness Center.

The agency said suicide risks are seen highest among youth and young adults; half of those who died by suicide in the last 10 years occurred in individuals 30 years and younger. “The families of those who’ve died by suicide are left to grieve the loss of their loved one and begin to cope with that loss as best as they know how,” GBHWC stated in a release.

The crisis hotline (647-8833/8834), which is open 24/7, has been swamped with calls. Arriola said since the start of the pandemic, the number of callers has increased. “As of Aug. 31, we had 2,945 calls since March 15 from when the pandemic first started on Guam,” Arriola said.

The average number of calls per month has increased 1,667 percent. On average, Arriola the crisis hotline receives 500-plus calls per month. Before Covid-19 struck the island, the hotline received a monthly average of 30 calls.

Arriola said 95 to 99 percent of calls received during this time are related to coronavirus-triggered depression, with some people asking, “Is it worth living?”

Arriola said the decrease in the number of suicides from 2018 to 2019 was the results of openness in the community. People started speaking more about suicide, which was once considered a taboo subject talked about in whispers. People have become more open about their feelings and are willing to work through them.

In observance of the Suicide Awareness and Prevention Month in September, the University of Guam held a Suicide Prevention Forum. "We hope to open the conversation on these issues so people can understand it’s OK to talk about mental health, depression and suicide,"

Dreamstorm Productions public relations director Hannah Cho Iriarte stated in a press release. "That way those suffering can get the help they need.

Guam has programs that train people to help those with suicide tendencies, such as SafeTalk. These trainings are designed to help people identify the signs of suicide. “Assist and Connect are other programs that can help with suicide prevention training, and Guam Behavioral Health can provide these trainings, too,” Arriola said.

GBHWC receives federal assistance from the U.S. Substance Abuse and Mental Health Services Administration. The agency, formerly known as Department of Mental Health and Substance Abuse, was placed under federal receivership in 2005 as the result of a lawsuit filed on behalf of individuals with mental disabilities. The lawsuit, filed in 2001, took the government to task for not providing adequate mental health treatments. Patients were locked up instead of being treated because the local government did not have the treatment facilities.

In November last year, the federal court finally lifted the injunction and reinstated local control over the department, which has since been renamed GBHWC. The court said the department has adequately addressed the issues stated in the lawsuit.

The crisis hotline is among the services provided by GBHWC to assist mental health patients. According to Arriola, the crisis hotline has been in existence for many years, but the pandemic has made it a lot busier. The crisis number has become as recognizable as 911, she added.

To deal with depression and other mental health issues, Arriola advises people to find hobbies that can cheer them up. “If you like petting animals, get a pet,” she added. Studies have shown that petting a pet can help relieve some anxiety.

She also added that taking a walk, as long as you practice social distancing and wearing a mask, can help alleviate some of the stress built up. The pandemic is real and staying cooped up in the home can be very taxing to people. People need to find a sense of mind to get through this, Arriola added.

SN, the Santa Rita resident, refuses to rely fully on medication. She embraces other coping mechanisms to ease her anxiety and get out of depression.

“I’m functional and energetic most of the time, even productive, but a little reckless some of the time,” she said. “Being an ocean lover drives me to familiar, and new, spots to enjoy along the shoreline. I do the household shopping, cooking, I even sing sometimes when doing housework. In spite of all the duties and difficulties in my, and all our lives, we carry on, for the love of God! I have adjusted well to being locked down because my head and legs, and my heart, remain free to roam, or work, remotely, right here at home, sweet home!”

Recognizing the warning signs of suicide will be critical in creating effective prevention messages. According to mental health professionals, signs may include, but are not limited to: withdrawal from normal routines, extreme mood swings, increased alcohol or drug use, and intensified risky or reckless behavior.

“Those at risk of suicide can be easily influenced by news and social media coverage. News media are encouraged to exercise caution and avoid sensationalizing details when reporting or sharing information on suicide,” GBHWC stated in a press release.

The agency encourages the use of appropriate language when discussing suicide. Certain phrases and words can undermine prevention objectives such as “committed suicide” or referring to suicide as “successful,” “unsuccessful” or a “failed attempt.” Instead use, “died by suicide” or “completed” or “killed him/herself.” It is easy for many to get carried away on social media and speak freely, and without filter.

However, the department urged content creators to exercise this same caution when interacting on online platforms. “How these messages are conveyed can help promote positive mental health attitudes and push the conversation surrounding suicide prevention. Safe messaging on suicide also means focusing on hope by encouraging positive coping strategies and linking the community to helpful resources,” GBHWC said.

Earlier this year, Gov. Lou Leon Guerrero signed an executive order establishing a GBHWC annex at the Department of Corrections.

The directive requires GBHWC and DOC to set up a satellite operation of the GBHWC within DOC facilities to be equipped with necessary personnel and resources to support programs to address mental health, and alcohol and drug concerns of inmates and detainees.

“The ideal community should be a community without the need for a prison. The reality is there is a need. Many of these individuals have mental health and substance abuse challenges. We need a holistic approach to rehabilitation,” the governor said.

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