Finding Hope: Tyler Paquet wants others to get the help he found so elusive

Each day that Tyler Paquet went to work after being discharged from inpatient psychiatric care, he would break down.

Paquet, then 24, had to leave his desk at a Laconia bank more than once because of the tightness in his chest, nausea, shaking, sweating and stuttering that came with his panic attacks. He walked in circles around the perimeter of the building, again and again, until he calmed down enough to go back inside.

Paquet had checked himself in at Parkland Medical Center in Derry because he was feeling suicidal. He wound up there two years ago, far from his Laconia home, because it was one of the few hospitals with an open bed for someone dealing with a mental health crisis, an ongoing problem in the state.

During his stay at Parkland, he participated in group therapy, meditation and yoga, and felt like he got a good start at identifying tools that would help him feel better. But the transition back home was harder than he expected: Paquet was on anti-depressants and seeing a therapist for the first time, and he still thought a lot about ending his life.

“One minute you’re in this hospital for 10 days, and the next minute you’re going to work as if nothing happened,” he said. “My mind was just so confused and all over the place. It was so cluttered that I couldn’t focus.”

Instead of going to therapy, Paquet, now 26, spent many days in his bed, too depressed to get up. He kept calling out of work, and worried that he was on the verge of being fired. Eventually, he quit.

Six months after he left the hospital, he tried to take his life.

The period of time after a patient is discharged from inpatient psychiatric care is one of the most heightened times of risk for suicide, experts say. The rate of suicide within the first month after leaving is more than 100 times the rate in the general population.

Two years after his hospital stay, Paquet says he needed more help after he left.

“I think there’s more that hospitals can do, rather than just push drugs on you,” he said.

New Hampshire has a critical need for more resources precisely at the time people are looking for help, parents and advocates say. The moment someone asks for help isn’t permanent and getting help quickly is crucial.

Most patients schedule an appointment with a therapist after they leave inpatient care, but only a quarter to half of those people show up, studies show. Many of those appointments are weeks away and the time between discharge and therapy can feel like an ocean of isolation. Offering a lifeboat is key.

Even small acts in psychiatric care can have a profound impact – research shows that something as simple as a sending a personalized follow-up card or a telephone call after discharge reduces hospital re-admissions.

That’s where people like Shannon Murano come in.

New Hampshire Hospital, the state’s psychiatric hospital, is one of the first in the country to have hired an aftercare coordinator to meet with patients before discharge and follow up with them in person for up to three months after. Murano’s position was created by federal grant money in 2014, and sustained as a permanent position at New Hampshire Hospital in 2016.

Murano works with patients ages 10 to 24 who have suffered serious suicide attempts. She travels across the state to meet with individuals in their homes, teach them about effective coping strategies and connect them with community supports such as therapy, yoga and art programs.

“It sounds simple, but it really does work,” Murano said. “Just letting people know that there’s somebody that cares, and you don’t have to fight this battle alone.”

Once a patient is discharged, Murano calls them on their first day home to check in. She makes plans to meet with the patient within seven days of discharge.

Parents sign a release that gives her permission to speak with school officials, primary care providers, private therapists, sports coaches and employers – anyone who has contact with the patient and has the potential to see warning signs.

She shares materials from NAMI NH on support groups for parents and information on the 24-hour suicide prevention lifeline, where callers have access to counseling and local mental health referrals.

One of the biggest components of Murano’s job is parent education. She teaches them to ask their children to update and rely on their safety plan – or a list of emergency contacts and coping strategies – and remove or lock firearms, medications and anything else that could be used for harm in a moment of crisis.

“Some families have been through multiple times, and are at wit’s end,” she said. “Some families have never been through this before, and just really feel like they need someone to talk to.”

She said parents are often nervous about how they should approach the subject of suicide with their children, but that addressing it head on is best practice.

“I always encourage parents and guardians to ask their kid directly and frequently about thoughts of suicide,” Murano said. “A lot of parents will say, ‘I didn’t know that I was supposed to ask directly about it. I thought that if I ask them, I might put the idea in their head.’ That’s a common myth that you hear often, but research tells us that it’s just not true.”

Murano verifies that patients are attending their appointments and taking medications if that is part of their treatment plan.

She also makes an effort to connect them with natural services: art classes or piano lessons available for a discounted rate or free, recreational sports teams at the local community center, or a military cadet program.

Murano meets families in person once a week for a period, and then more or less frequently depending on need. If a patient seems to be well connected in the community, she’ll call once a week instead.

She said her caseload is typically 15 to 20 patients. But still, there’s only one of her. Murano is currently on maternity leave, and other social workers at the hospital are working to fill her shoes while she’s away.

“It’s really imperative to check in with other members of the treatment team – the therapist, the school counselor, mom, dad, grandma, whoever’s involved to say, ‘How do you feel this person is doing? Do you feel like they’re well connected? Do you have any concerns?” she said. “Only when everyone is on board and the patient is feeling fully supported do we decide to end services.”

Paquet never had contact with Murano – but he wishes he had.

Tyler said the year since he attempted suicide has been hard. He still has panic attacks and struggles to make it to therapy appointments some days.

“It’s draining to have depression. It’s almost like, you just ran a 5K in a minute,” Paquet said. “It exhausts you.”

But he said he’s also seen vast improvements in his happiness. Little things, like walking his dog, which he got to help with his depression, and hanging out with his best friends, who he’s known since he was six years old, helps.

Paquet has been speaking openly about his attempt, and is planning on sharing his story at Winnisquam Regional High School this fall.

He said he doesn’t mind – and wants – people to ask him how he’s feeling. He wants them to care.

“I’m tired of people being like, ‘Oh, we don’t want to talk about a mental disorder.’ Because people think you’re going to snap or something,” he said. “I tell my friends that all the time – please ask me anything. If you think I look sad or depressed, or you think I’m spiraling in my head, say something – try to get me to talk. It’s really hard to tell someone that you just feel like you don’t want to be here in life anymore. But once you say it, it’s almost like a relief, like a weight lifted off my shoulders.”

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If you or someone you know might be at risk for suicide, contact The National Suicide Prevention Lifeline 24/7 at 1-800-273-8255.

For additional resources, visit NAMI New Hampshire's Connect Program at www.theconnectprogram.org.