No one knows exactly why rural East Texas faces high suicide rates. And resources to help are scarce.

The mind of Keilan Banks is perpetually caught between two worlds. In one of them — what many of us would call the “real world” — he attends art school at a community college in Kilgore, a small town just southwest of Longview in East Texas. He works at a local Walmart four days a week wrangling shopping carts. The other world is one that Keilan alone can see: a frightening, shadowy place where faceless figures manifest and winged devils circle overhead. Disembodied voices sound from all directions, Keilan says, urging him to hurt himself.

Every so often the two worlds collide. And when they do, it can be explosive.

One morning last year, in late June, Keilan drove from his home in west Longview to a nearby trailer park where his aunt and uncle live; they don’t have a vehicle and had asked Keilan for a ride to run a few errands. Keilan had woken up in a foul mood that morning, so he wasn’t talking much as they traveled on McCann Road, a main thoroughfare that traverses the town’s northern half. His aunt, Catharina Jones, asked why he was giving them the silent treatment. Had they interrupted him? “I wasn’t busy doing nothin’,” Keilan responded. “I was just thinking about killing myself.”

He threw open the vehicle’s center console, reached inside and produced a knife, brandishing it as he punched the gas. “Gimme the knife!” Keilan’s uncle, Michael James White, shouted from the passenger seat. But Keilan held on to the weapon and kept driving.

From the backseat, Catharina managed to soothe her nephew. She doesn’t remember what she said, exactly, but it was enough to get him to stop the car and put down the knife. Michael snatched it away when he had the chance. Crisis averted, Keilan drove James and Catharina back to their trailer. He called his mom to tell her what happened and she drove him to the emergency room at CHRISTUS Good Shepherd Medical Center. Later that day he was taken to the Northeast Texas Regional Crisis Response Center in Atlanta, an inpatient mental health center an hour away in Texas’ far northeastern corner.

Keilan was already familiar with the facility. It was the same place he’d been sent less than a month earlier, a few weeks before his 21st birthday, when he made his first suicide attempt. In that incident, while working at Walmart, Keilan cut his arm repeatedly with a knife. He told a store manager what happened, showing him the injury, and the manager suggested Keilan go to the hospital. Another stint in the Good Shepherd emergency room. Another trip to the crisis center.

“[The voices] were telling me I was worthless. They were telling me I had to end it all,” said Keilan, who has been diagnosed with bipolar disorder and severe anxiety, and some days is so wracked by depression that he can barely get out of bed. “I was just so confused and they just kept pressuring me. … I just wanted it to stop.”

The pocket of East Texas that Keilan calls home is among the state’s regions hit hardest by suicide. The most recent federal data show that in Gregg County, which includes Longview, 335 people died by suicide from 1999 to 2017. The county had a suicide rate of 15 deaths per 100,000 people in that time period, compared to the average state rate of 11.4. Several nearby, more rural counties — including Marion and Morris counties, just north of Gregg — have even higher suicide rates.

No one knows for sure why this part of East Texas is especially susceptible to suicide.

Read the full Texas Observer story here.

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline.