For starters, we need to talk about suicide. We need to not be afraid to say the word “suicide,” because the word “suicide” will not kill anyone. We need to clean up societal problems that increase the likelihood of suicide, not just push the responsibility for prevention onto the mental health profession. We need to worry less if a homeless person wants to live by choice under a bridge and more about the social bridges of connection, kinship, and community collapsing all around us.
By Dana Grande
Out of all the ways to die in Pittsburgh, 446 of them are bridges.
There’s the Ft. Pitt, Smithfield, Warhol, Birmingham, and Clemente. There are yellow bridges, brown ones, some connecting downtown to the North Side, some connecting the South Side to further South, many holding the potential to connect life with death.The Forbes Avenue Bridge collapsed under a city bus and five cars on January 28, 2022, and while no one died then, the incident activated the gephyrophobia (“fear of bridges”) of many people around the city. Gephyrophobia can be as crippling as a terrifying fear of airplanes, perhaps more so, especially in Pittsburgh, the “City of Bridges.” The ‘Burgh boasts more spanners than any other city in the world; they are a necessary part of everyday life there, inescapable, part of the geography and landscape.
To former mobile mental health therapists and suicide interventionists like me, bridges play a unique role. They represent not just infrastructure but also a way people end their lives. In Pittsburgh, sometimes daily, people either threaten, attempt, or succeed in suicide by bridge. Before I myself became gephyrophobic after a near-fatal car collision on the Hi-Level Bridge, I traversed through different Pittsburgh neighborhoods to crisis callers’ locations with ease, over bridges and railroad tracks, through tunnels, and up steep alleys, caught in standstill traffic, my beeper (then years later, my cell) blaring, my boss wondering why I wasn’t in Squirrel Hill or Homewood yet for the crisis call. I was a mobile practitioner when community mental health services became big in PA, when deinstitutionalization of state psychiatric hospitals, coupled with rising healthcare costs, spurred a movement toward delivering care outside traditional spaces. The philosophy behind the home- and community-based mental health movement was that conducting services in clients’ natural environments would help them integrate their treatment into their regular places of living and keep support around them more readily.
I often met clients at their kitchen tables. Sometimes I saw them at school, in libraries or coffee shops, in parks and diners, in hospital emergency rooms, and occasionally, on or under bridges. I was there at 3 p.m. and 3 a.m. Sometimes I had a colleague with me; other times I went solo. Sometimes the police met me. I visited clients for individual and family therapy and/or suicide intervention, for most of 1996-2008.
When someone plans to jump from a bridge, especially in the “City of Bridges,” time is critical. Granted, the Golden Gate Bridge in San Francisco takes more lives by suicide than any singular bridge in the country. But while no one particular Pittsburgh bridge claims more American lives than some others, Pittsburgh’s options exist in just about every neighborhood and suburb. I’ve worked as a mental health therapist in both Pittsburgh and Cleveland, and I can attest to the fact that in Pittsburgh, I’ve had significantly more clients with suicidal ideation say they might jump from a bridge, than their Cleveland counterparts. Ease of access to means is one indicator of how likely a suicidal person will try an option. For instance, in places with cliffs or waterfalls, locals are more likely to try these methods than people who would have to travel out of their way to get there. (The method most commonly tried in most locales is pills, but those are not the most lethal. The most lethal is firearms. A person who lives in a home with a gun is much more likely to die by suicide than someone who does not).
Cell phones in the early 2000s were not as trackable as they are now, in 2025. Location is key when a person feels suicidal. If a person called and said they were peering down over the Ft. Pitt Bridge, they were at least locatable; however, on the Ft. Pitt, crisis workers, police, and ambulances have an extremely difficult time cutting through traffic and getting to the person, due to the bridge coming after a tunnel and being part of a major thoroughfare. Conversely, the Hot Metal Bridge, on the South Side, can be accessed from smaller streets, more readily from both sides.
Occasionally, however, callers will say they are heading to a bridge but won’t say which one. Those who don’t want to be found represent the most serious of suicidal people. Once I got a call from a man who just said he was “in a semi.” He said he was going to drive his truck into the side of a bridge. I tried cross-checking the phone number online but it was registered to someone in Oklahoma. The best I could do was alert 911 that a potentially lethal semi was out there. Fortunately, there were no reports of semis colliding into bridges that day, or the day after that. I hope the man eventually found the help he needed. Not everyone does.
Friends and family members who have lost people to suicide by bridge have asked the question: Why don’t more of Pittsburgh’s bridges have barriers on them, to prevent people from climbing? A ride through the city will show that some bridges have them and others do not. In 2019, a mother of three stopped her car on the Homestead Grays Bridge, which connects Homestead to Pittsburgh, and jumped over the side. Her death sparked the creation of a movement called Chalk for Change, which tries to raise suicide awareness and encourage city officials to erect more barriers on bridges. Activists also leave positive messages, written in chalk, on the rails of bridges that state words such as, “You are worth it.”
The Homestead Grays (also known as the Hi-Level) Bridge is one of the region’s tallest, but it’s not just the highest ones that entice people. In “Epidemiology of Low-Level Bridge Jumping in Pittsburgh: A 10-Year Study,” researchers concluded not only that plenty of people jump from lower bridges, but also that most of them survive. Only four of Pittsburgh’s bridges are over 70 feet tall, and the living-after-jumping rate of bridges 50 feet high or less was 82 percent. Of the 74 subjects, 80 percent were male, mean age 34.3 years, “who lived near the bridges from which they jumped or fell.” The main cause of death after jumping was drowning, and of those who perished, very little pre-hospital care was of benefit, leaving the researchers to conclude that better emphasis on prevention is needed.
For starters, we need to talk about suicide. We need to not be afraid to say the word “suicide,” because the word “suicide” will not kill anyone. We need to clean up societal problems that increase the likelihood of suicide, not just push the responsibility for prevention onto the mental health profession. We need to worry less if a homeless person wants to live by choice under a bridge and more about the social bridges of connection, kinship, and community collapsing all around us.
As a therapist, I believe the biggest predictor of successful mental health outcomes is the number of good quality relationships (family, friends, clergy, mentors, teachers) a person has. Some of the most severely mentally ill list their mental health workers as their main support. To use the bridge theme, sometimes we are the only “bridge” they have toward social trust. Yet it is also true that bridges separate. Most Pittsburgh neighborhoods exist a bridge or two or five away from each other. Want to meet a friend for dinner? Go through a tunnel, squeeze into one lane of traffic by the orange barrels, cross one bridge, then another. Pittsburgh has distinct neighborhoods that have separate vibes, and bridges can present either a connect or a disconnect, depending on one’s view.
Regardless of whether they represent a nuisance or a convenience, of all the ways to save lives in Pittsburgh, bridges help mental health interventionists get from the home office to wherever a client needs them.
Never in my career did I work the city more than during my time as the Clinical Lead for a Community Treatment Team (CTT). In the late 2000s, due to budget cuts, some remaining state psychiatric hospitals rapidly closed their doors. Pennsylvania designated funds for several Community Treatment Teams (CTTs), also called ACT (Assertive Community Treatment) teams, in response to the rapid shutdown of multiple hospitals throughout the Commonwealth. Each CTT had a psychiatrist, nurse, therapist, vocational specialist, drug/alcohol counselor, case manager, director, administrative assistant, and clinical lead and served 100 persons struggling with severe mental health needs. All team members were responsible for seeing daily all 100 clients on their roster. Some clients had been inside hospitals 10, 20, 30+ years before referral to CTTs.
State hospitals halted their closing processes briefly in 2007, after a recent discharge jumped from a Pittsburgh bridge. A day later, another discharge walked down train tracks and allowed a train to hit him. Investigations raised legitimate questions about the feasibility of keeping ex-longterm-state-hospital patients safe in the community. Other former patients became victims of rape, robbery, or homicide; died prematurely of heart attacks, cirrhosis, stroke, or heroin overdose; perpetrated crimes; or transferred to other locked facilities, like jails or private hospitals. CTTs did amazing work, but ultimately, the community-based care paradigm had its limitations.
I visited hospitals, shelters, and group homes several days a week to get rapport with the clients, as a way to build relationships with who I was helping. I’d bring them cigarettes and coffee; we’d eat cannoli and discuss the Pirates. We’d take a ride to the Strip District or shop in Robinson. Once, talking with a client I had just met, she suddenly slumped over in her chair, and I heard a slow drip-drip-drip. I realized I was standing in a pool of blood. I couldn’t yell for assistance. I remember slipping in the blood when I tried to run for help. Someone saw me waving my hands and called 911. In the patient’s hand was a sharpened soda can tab. Her eyes were closed. She left a peaceful smirk on her face.
That day permanently changed my zest for community-based work. I went from an eager advocate for creative, compassionate interventions to a dispirited, fearful, numb, and exhausted nihilist. I began getting angry at my clients’ problems and started sleeping in late for work. I had nightmares about blood on the walls; I doubted my whole career and my own worth as a person; I went from lively extrovert to skipping out on social events. What I didn’t have was insight into how much of what I’d seen and done in my career was deeply unsettling. What I did have–It took my own therapist to make it clear to me–was depression and PTSD.
To reduce my exposure to further traumas, I went to work at an administrative desk job, still in mental health. Then came my own near-death on a bridge.
Of all the ways to die in Pittsburgh, head-on collisions 109 feet above water are not recommended.
In spring 2012, I was on the Hi-Level/Homestead Grays Bridge (the same one referenced earlier, which prompted Chalk for Change). The way it was told to me was that a young man, about 19, with a steering wheel and a death wish, careened across the median and slammed into my vehicle, head-on. My body got away with back pain, bruising, whiplash, and some glass in my arm, but my brain didn’t fare as well. About 24 hours after the accident, I developed a brain bleed in the right temporal lobe, causing years of visual rehabilitation, physical therapy for vertigo, bouts of face-blindness (not recognizing faces of familiar people), severe mood swings, hallucinations, loss of ability to read music, amnesia for the months before and after the accident, and long-term gephyrophobia. There was also the survivor’s guilt. The other driver got a forever loss of time, a permanent coma.
When my wife got a job opportunity in Cleveland, I said “yes” to moving, one reason being I’d get a break from so many bridges and reminders of difficult memories. With time, medication, and therapy, my feelings of dread when driving on a bridge eventually (mostly) dissipated; I now work as a therapist in an office, not in the community, occasionally still intervening with suicidal people. Pills and guns tend to be the potential means I hear about most in NE Ohio, and so far here, I haven’t heard any ideations about bridges. (However, be clear: Suicides by bridge do happen in the Cleveland region. Despair doesn’t confine itself to one city or another).
Fortunately, most people who think about suicide never attempt. Luckily there is “thanatophobia” (“fear of death”). For people who consider bridge-jumping, a big deterrent is also “acrophobia” (“fear of heights”). However, if someone tells you they are considering suicide, believe them. Keep them talking and stay with them. Try to remove any means the person says they have access to, like pharmaceuticals, firearms, or car keys. Remember there are willing professionals ready to help, either by calling emergency services at 9-1-1, the suicide hotline at 9-8-8, or if the person already is linked to a mental health agency, some agencies have an on call crisis line of their own. Then listen with all of yourself. Don’t try to talk the person out of their thoughts or use “reverse psychology” and dare them to do it. Both may only strengthen their resolve. Make sure to thank the person for trusting you.
Sometimes I go back to Pittsburgh to visit loved ones. I’ve rekindled my affection for the city, but oddly when looking up the Allegheny and the Monongahela Rivers, the almost symmetrical lines of bridges look like stitches drawing together the opposite sides of a wound. Community mental health work is taxing but also saves lives. We who hit the Pittsburgh roads, bridges, and tunnels with our cars and our adrenaline easily know how to engage with people and their psychic pain, and we must either learn to cope with what we see and hear, move on to other aspects of the field or new fields entirely, or just stop caring. I feel fortunate to have found joy and compassion again, but not everyone gets there. I dedicate this essay to Dr. S., fellow CTT road warrior whose desk abutted mine and whose papers would end up spread out on top of my case notes. Dr. S. killed himself. Perhaps he too suffered compassion burnout and job-related trauma. His family did not release details.
The mental health field will always need people who have compassion, who also know how to set limits for themselves. I myself no longer work far from home and never past 5 p.m., because my brain still gets fatigued. I may never go back to community work. But the need is still there for street-based, home-based, shelter-based, bridge-based interventionists. It is still there, because the world needs people who can build others up while talking people down.
Dana Grande (she/her)’s poetry and creative nonfiction celebrate her Rust Belt roots and probe how illness and health complicate embodiment. A psychotherapist, improv theatre performer, percussionist, and former English teacher, Grande is a graduate of The College of Wooster, Youngstown State University, and Cleveland State University. Her first publication was a clue card in the board game Clever Endeavor, and since then, she’s appeared in the Pittsburgh Post-Gazette, Views and Voices magazine, and Survive and Thrive: A Journal for Medical Humanities and Narrative as Medicine. Originally from western Pennsylvania, she now lives in Cleveland, OH with her wife, two hounds, and an eclectic pen collection.
