Time and distance. Kelly Asher-Smalt believes if only there had been more time and distance between her sister and a gun, Terry would still be alive. 

They would be riding motorcycles down Western New York highways, like they’d always talked about. They’d be reminiscing about raising their children in the same home, watching the cousins grow and, one day, becoming grandmothers together. Terry would have been there for Kelly’s wedding. 

“She was so kind, she was so good, she did so many things for so many people,” Asher-Smalt said. “She was like two kilo tons of TNT in a 115-pound body.” 

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But Teresa Smith died by suicide on July 16, 2011, becoming one of the 19, 990 Americans who ended their lives with guns that year, according to data from the Centers for Disease Control and Prevention. She was 49 years old.

Today, more than half of all gun-related deaths in America are suicides, making firearms the leading – and most fatal – method of suicide in America. The year Terry died, 33 other people in Monroe County, an hour east of where the sisters grew up, died of suicide by gun, accounting for 41 percent of all suicide deaths in the county that year. 

“Sometimes a song will play or there’s a smell in the air and it will be like it just happened,” Asher-Smalt said. “It never hurts any less but it does hurt less often, that’s the only comfort I can give to others.” 

Terry’s suicide shocked her family, and particularly Kelly, who talked to her older sister on the phone almost daily. Their brother, PJ, had been born when their mother was just 17; Terry was born a year later; Kelly a year after that. Both sisters had their first children as teenagers, and lived together after dropping out of high school. They were used to relying on each other.

But their paths diverged when Asher-Smalt joined the Air Force at 17 and was stationed in Texas. Five years later, she left the service and moved back to Western New York to work as a federal immigration officer. As Kelly pursued her education relentlessly, first attaining her high school accreditation then advancing to two bachelor’s degrees and ultimately two master’s degrees, Terry provided for her children by working odd jobs, often waitressing or bartending. 

Terry, left, and Kelly photographed together in Western New York, where they grew up, at 33 and 31, respectively. Courtesy Kelly Asher-Smalt.

“If I needed two dollars and all she had was two dollars, she’d give it to me without hesitation,” said Terry’s eldest daughter, Jeane Hoar, who depended on her mother’s support when she had her first child at 19. Terry would drive hours to watch her grandson’s baseball games. And just months before her death, Terry was there to witness the birth of Jeane’s daughter.

Hoar described her mother as “quick with the jokes, very entertaining. She was the type of person who could be struggling with so many things and you would never know it because when she was in the room you were always happy.” 

But for two years before her death, Terry was struggling. Treatment for recurring migraines had spiraled into a prescription opioid dependency, which led to treatment by a physician specializing in pain management. Although she wasn’t considered addicted to opioids, according to her medical records, Terry was prescribed suboxone, a common treatment for opioid dependence. In the days immediately leading to her 2011 suicide, she’d been weaning off suboxone at the advice of her doctor, whose medical license was revoked by the state in 2016 after uncontested allegations of repeated negligence in failing to adequately evaluate and/or document patient therapy. 

Kelly said she didn’t learn about Terry’s treatment, or her attempts to taper off suboxone, until after her death. She got the impression from their frequent phone calls that things were improving for her sister. Terry had just gotten her motorcycle license, and her daughter planned to give her a bike. She and Kelly looked forward to riding together, side by side. On one Tuesday phone call, Terry was feeling under the weather, but said her side business selling thrifted goods on Ebay was going well. 

“Everything just seemed okay to me,” Asher-Smalt said. “The next day I got a phone call from her boyfriend and he told me she had been hit by a car.” 

Terry’s boyfriend reassured Asher-Smalt that her sister was OK, and that she was released from the hospital with just a few bruises. There was no mention of the bleeding in the back of her skull or indications that she’d tried to harm herself. But the next day, Terry’s boyfriend called again to say Terry was having some breakthrough pain, and they were heading back to the hospital with her father and stepmother. Jeane couldn’t go with them; she had to drive home to care for her newborn daughter. 

She hugged her mother goodbye for the last time, and told Terry’s boyfriend to put away his guns.

“Collect every gun,” Hoar remembers telling him.“What’s the point if you are going to leave one fucking gun behind? Guns are just so fucking final. They’re just final.” 

Terry was released from the hospital again around 4 a.m. the next day. At five minutes to 7, Asher-Smalt’s daughter, Lindsy, called her: “She said, ‘Mom, Aunt Terry’s dead.’” After the call, Asher-Smalt said, she felt as if her body was moving on its own, rushing itself to her car and driving to Terry’s house while her mind was unable to process what was happening. At first, she thought Terry must’ve had complications from the car accident.

But as she drove up to her dead sister’s home that warm July morning — to a crowd of crying people, Terry’s boyfriend on the porch swing, her niece in the living room where Terry’s blood had already been cleaned off the Western-style wooden panels — Asher-Smalt saw the hearse pulling out of the driveway. Her father, in shock, told her he’d checked on Terry around 6:15 that morning. Twenty minutes later, he said, Terry had shot herself with one of her boyfriend’s 17 guns, left behind their headboard after the others were moved to the loft of their barn for safekeeping.

“If the guns hadn’t been there, I think she would’ve gotten past whatever it was,” Asher-Smalt said. “It was the perfect storm. Had there been time and distance from those lethal means, I don’t believe she would’ve done it any other way.”

Witnesses to her accident told the responding police officer that Terry had walked in front of the car that hit her, which pointed to a potential suicide attempt. Strong Memorial Hospital, where she was treated, has a Comprehensive Psychiatric Emergency Program, which would have allowed Terry to be held under state law for 72-hour mental health supervision if deemed a risk to herself. But although the officer told the attending physician about the witness reports, Terry was released the same day as the accident. (While hospital officials initially denied police statements, communications director Teri D’Agostino ultimately apologized, telling The Batavian that the “staff did know about the information that she may have intended to harm herself.”) 

“They either treated her differently or just didn’t view her as a person,” Asher-Smalt said. She believes hospital staff let their preconceptions of who Terry was keep them from treating her like they would any other mental health patient. “They didn’t document her suicide attempt. They didn’t hold her for 72 hours, even when it’s the law. They were negligent based on their own prejudice and their inability to see past that.”

The family filed a wrongful death suit against Strong Hospital, but the depositions took three years to begin. Terry and Kelly’s father had Alzheimer’s by then, and the family lost. The judge assigned fault to Terry and her boyfriend. 

“The only thing I can really think of off the top of my head that has been proven to [reduce] suicides in communities is reducing access to lethal means,” said Amy Barnhorst, vice chair of psychiatry at the University of California, Davis. Barnhorst runs the BulletPoints Project, a public health program that helps train medical professionals on reducing firearm injuries, including how to identify at-risk patients and the intricacies of firearm laws. But if patients still have access to weapons at home, she said, there’s always a risk of releasing them from the hospital.

“Sometimes you know that person is going to leave the clinic or the emergency clinic or wherever they are and go home and be high-risk again, maybe in a week, maybe in a month, and if they have access to firearms that means any attempt they make is likely to be fatal,” Barnhorst said. 

For 1 in 4 people, the time between deliberating sucide and making an attempt is fewer than five minutes, according to a report by the American Association of Suicidology. In Terry’s case, withdrawal from opioid treatment and the physical pain from the car accident converged with a lack of psychiatric attention and access to lethal means, a fatal intersection.

In 2017, when 32 people died by suicide using a gun in the county where the sisters grew up, the Erie County Suicide Prevention Coalition launched the Time and Distance initiative to address suicide deaths by gun, in partnership with the Erie County Department of Health. The program trains community members on preventive measures and warning signs for self-harm, like unbearable pain and increased substance use or feelings of hopelessness. It also uses a Google map of firearm storage and safety locations for gun owners who may experience a mental health crisis, or who live with someone at risk — one of only a handful of national initiatives with such a community partnership in place. 

Celia Spacone is the coordinator for the Erie County Suicide Prevention Coalition. Brandon Watson for The Trace

Asher-Smalt was already a 10-year veteran of the Health Department when Terry died. After her sister’s death, her work as a community wellness coordinator took on greater personal significance, and she joined the initiative to help educate gun owners about suicide prevention and firearms. 

“I wanted to make sure that this could turn tragedy into hope for other people, but it wasn’t worth the sacrifice,” Asher-Smalt said. “I still don’t have my sister.” 

She and Celia Spacone, coordinator for the Suicide Prevention Coalition, represent the initiative at local gun shows, educating gun owners about safety and suicide prevention. Attendees are receptive to Asher-Smalt, Spacone said, because she is a gun owner who spent time in the military and law enforcement. They share with her their own losses and struggles, sometimes finding themselves in tears. And the pair always emphasize how vital it is to store firearms safely, particularly when there’s a risk someone may harm themselves.

“Time and distance are our two friends,” Spacone says. “You don’t want to have a lethal method available.” If someone with suicidal ideation goes down to the basement and the firearm isn’t there, “the amount of time to find that next option may be enough to save someone’s life.”