The first time I had a sense that the darkness was gathering was in the fall of 2012, 10 years into our marriage. Our beloved dog was ill, and we weren't sure if she'd recover. She turned the corner, but once my husband, Bill, started a downward spiral of anxiety and lack of sleep, he was unable to turn it around on his own.

Bill began calling in sick to work. One day, he called me at my job and said, "I think I need to go somewhere." I left immediately and we went to the ER.

On the way in the car I asked him, "You don't feel like you'd do anything to hurt yourself, right?"

He replied, "No, but I feel like that would feel better than this does."

In my head I thought, "That's a yes."

Since the hospital didn't have a psychiatric unit, and it was a holiday weekend, Bill was transferred to a local psychiatric center. We sat in the waiting area, with people wandering about who were hallucinating and talking to themselves, and I thought, "How did we get here?" Bill stayed through the long weekend and emerged with a plan to see a psychiatrist, which he did, and things got back on track, for a while.

Complicating matters was Bill's kidney disease, at home dialysis, in-center dialysis, then a kidney transplant, combined with a family history of mental illness, and the trauma of being sexually abused when he was a teenager. Bill had survived so much, but in March 2016 he decided to stop taking his medication because he was feeling better. He even weathered the death of our beloved dog that April. Although we were all devastated, he didn't seem any more affected than the rest of us. Summer passed uneventfully.

Bill didn't tell me he stopped taking his medication until fall, when he was starting to spiral again, feeling the normal pressures of life and work. Bill died of depression in October 2016 when he took his life at age 48. Our son was 13.

When the final spiral began, Bill did try to get help. His psychiatrist was booked several weeks out, so although he made an appointment and the doctor again prescribed medication, which he started, I suggested we call the center where he had his kidney transplant. Surely, they could help sooner because they have a vested interest in making sure the kidney transplant is successful — in other words, that he doesn't die. I thought that if Bill had a different medical issue, diabetes or heart disease, certainly they'd treat him.

I made the call, and a nurse told me they couldn't help him, that he needed to see his psychiatrist even though I told her there was a significant wait. The day he died, Bill had an appointment with his psychiatrist at 10:30 a.m. The appointment card was still in Bill's wallet when I got it back from the police. It remains in his wallet in my closet.

It's vitally important that we raise awareness and share numbers for suicide hotlines, but what can be done for those who have sought treatment, who are on medication, who go to therapy but for whom the thought of death is still more appealing, less painful, than life?

News of the death of Kate Spade (and days later Anthony Bourdain), and hearing that she too, was actively seeking help has brought everything back vividly. We need to talk more openly about mental health and its role in the overall health of patients. Mental health should not be compartmentalized. That would be a start.

Angela Pause Smith lives in Albany.