Nearly 20 years after his last suicide attempt, Chris Wojnar sat in a waiting room with his then-wife and an ICU physician discussing end-of-life care for his daughter. She was attached to a ventilator and brain wave monitoring equipment following her own suicide attempt with uncertain odds of survival or long-term disability.

For his 13-year-old daughter, Wojnar never considered the financial burden of seeking medical treatment. He cared about saving her life.

“In the moment, I obviously didn’t give a shit about that,” Wojnar said. “It wasn’t until after she recovered, maybe a couple of months later, where all of a sudden the bills are coming in, and then you’re like, ‘Oh, fuck. This is ridiculous.’”

Wojnar’s daughter spent six days in the ICU and another week on the medical floor, followed by weeks in in-patient, partial hospitalization, intensive outpatient and outpatient programs. By the time she began outpatient treatment and Wojnar received the final bill, he owed roughly $175,000. 

Even after battling hospitals and insurance agencies to ensure bills were charged to the correct insurance account, Wojnar’s out-of-pocket costs tallied $35,000, something he still pays $175 per month to cover three years later.

“Imagine that you’re in the deepest, darkest time in your life, that you just don’t want to be here anymore, and then you happen to survive,” Wojnar said. “You may feel certain things, whether or not you’re angry, shameful, guilty or you feel renewed and happy to be alive. And then all of a sudden you get hit with the bills in the mail.”

The annual cost of nonfatal suicide attempts in the U.S. was $26.3 billion in 2020, according to research from the American Journal of Preventive Medicine. More than $13 billion of that was due to medical costs, with the other half being work loss and reductions in quality of life and mortality risk, such as wage reductions for dangerous occupations.

People under the age of 45 make up nearly 75% of the economic cost of nonfatal self-harm injuries, and hospital visits among younger people have increased since 2015.

As a teenager, Wojnar knew his four attempts racked up six figures in bills for his parents, but financial struggles weren’t limited to medical bills. He was out of work for treatment and had trouble maintaining a job during his recovery. He still pays $4,000 per year for medications.

And Wojnar said that’s without considering factors like pay cuts from short-term disability or common coping mechanisms like substance use that can further complicate the recovery process.

Now, as a nurse practitioner, Wojnar has seen patients that were homeless, jobless or bankrupt as a result of their suicide attempts. And his promise as a health care professional to do no harm becomes complicated when people in need refuse care because they can’t afford it.

Whether it’s offering discounted services or finding alternative care programs, Wojnar said his response to those people has become finding creative solutions to get people the help they need.

“Sometimes, we get into these rigid, hard boundaries, and the thing about boundaries is that they can be good, but if we don’t have some sort of individualized approach and lens, then we’re just doing the same thing for everybody,” Wojnar said. “I don’t think that’s individualized care. I don’t think that’s centered care. I don’t think that’s holistic care.”

Carson Spencer was someone who needed individualized care. He had managed a bipolar disorder and severe bouts of depression for much of his life and became a successful businessman. But in 2004, at age 34, he had his first manic episode, and he spiraled. 

Spencer’s mania caused reckless business decisions, the consequences of which sent him further into a depressive episode that left him in financial ruin and estranged from his family. Throughout his adult life, he had sought external resources like therapy and medications and found a psychiatrist to help him during his episode. He told his family he wouldn’t do anything to hurt himself.

That May, he even got a will together and got a life insurance policy, things he had previously believed to be bad business investments and things his family at the time celebrated as responsible decisions and forward progress.

“Carson, we will get through this,” said Sally Spencer-Thomas, Carson’s sister the last time she saw him. 

“But Sally, it’s madness,” Carson said. 

Spencer-Thomas later found one of Carson’s journals that read, “just hold on” near Dec. 7. 

“I believe new he was making some decisions then, and that he was trying to hold on until the date that the clause in the insurance policy said it didn’t exempt for suicide,” Spencer-Thomas said. “He missed it. He was too early.”

Carson died on Dec. 7, 2004. 

Twenty years later, Spencer-Thomas has led suicide prevention organizations across the world and said the best progress she’s seen to keep people alive and help them recover from an attempt has been through community.

“Peer support, I do think, we’ve seen more and more of it inside our hospital systems and in the community,” Spencer-Thomas said. “Those kinds of progress and alternative models to get people support are a bit more cost-effective than intensive in-patient hospitalization, which is just ridiculously expensive.”

That peer support has changed over the years as suicide rates have increased. For Sarah Gaer, a longtime suicide prevention advocate and current member of the Executive Committee for the Massachusetts Coalition for Suicide Prevention, it’s a double-edged sword to have more people relate to a problem she wishes no one had to relate to. 

“It’s discouraging, the numbers are discouraging,” Gaer said. “But the people whose lives had gotten better, they didn’t talk about these things because it could destroy their careers. Now, more and more people who have found some form of recovery are speaking out and giving the message to people who are suffering that recovery is possible.”

While many institutions seek to help people after an attempt, Gaer said the prevailing idea for people to seek help and let that help do its job hasn’t been enough to keep people alive. And in the process, it’s costing people money. 

Roughly 8% of suicide attempt survivors will reattempt, with the average time being 18 months later, according to a report from the National Library of Medicine, and there is a strong relationship between reattempts and survivors having people to reach out to. 

And if a person reattempts, they’re thrown right back into the financial hamster wheel for recovery they found themselves in the first time.

For Gaer, preventing reattempts comes back to having a community to lean on. Being a long-term anchor for your loved one can feel like a lot of pressure for people, especially when you don’t know how long that support will be needed. But Gaer said it’s not about being someone’s constant anchor for the rest of your life. It’s about being there for people when they need it the most. 

“The No. 1 thing that’s going to prevent it from turning that direction is to have someone who showed up. Sometimes it’s just one person and sometimes it’s just for a moment,” Gaer said. “People often think, ‘If I’m going to show up for someone, to show up for them every day, that’s a big commitment.’ Often, that’s not what it takes. It takes showing up at the right moment.”

If you or someone you know are in a mental health crisis, you can call the mental health crisis and suicide prevention line at 988.

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