Marisa Alexon's death in a Lakeville, Minn., garage was her second suicide attempt.

Marisa, according to her mother Shirley Gross, 74, of Fort Pierre, sat and talked with her three daughters early that morning. After they left the house, Marisa smoked a cigarette, had a cup of coffee, wrote a two-page letter, and walked into the garage and hanged herself.

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Her daughters found her body.

She was 43.

Marisa's sister, Tarilynn "Tari" Gerlach, 42, of Mitchell, was bowling with her children at the Village Bowl when she received the news from her mother.

"I got hysterical," Gerlach said. She barely recalls someone helping her change her shoes and leaving the building.

"I kind of remember almost chewing her out, swearing a lot and just being really angry," Gerlach said. "That was the hardest part for me, just letting go of the anger. It's so much easier to be angry at someone than to be sad.

"I finally came to the realization that if she had died from cancer, I wouldn't have been mad at her for that, so I couldn't be mad at her, because I knew how sick she had to have been for her to do this. She loved her girls so much."

While no one knew June 15, 2011, would be Marisa's last day alive, there had been a slow spiral of mental illness that began 20 years earlier. (See more information about suicide risk factors here.)

Gross, who has since become president of the South Dakota Chapter of the National Alliance on Mental Illness, planned to tell her family's story at the NAMI annual conference that concludes today in Spearfish. She hopes relating her story during National Suicide Prevention Week (Sept. 8-14) will help others avoid similar pain.

While some suicides are impulsive, Gross said, her daughter's was not.

"Marisa's death wasn't a reactionary suicide. She just couldn't cope any longer. She didn't want to die; she just didn't want to live with that pain."

Suicide, Gross said, ticking off the statistics, is an epidemic in the United States with 38,000 deaths a year. That exceeds, by about 5,000, the number of people who die annually from motor vehicle crashes in the U.S.

Gross believes much of the medical community is not sufficiently trained or equipped to deal with mental illness, and she thinks there's a shortage of psychologists and counselors. The stigma of mental illness is also a factor, she said, making it difficult for those who are ill to seek or accept treatment.

Marisa began exhibiting signs of mental illness in her early 20s. The demons of depression and anxiety stalked her on a daily basis, and she had trouble keeping jobs or maintaining a coherent direction in her life.

"She was a really vivacious person -- she loved everything and everybody," Gross said.

But her daughter's self-involvement with her mental illness was hard on relationships. Marisa began training to become a dental hygienist but decided against pursuing that career. In Minnesota, she worked with developmentally disabled adults.

"She did a very good job," Gross said, "but things became harder and harder for her; she just couldn't manage very well."

Marisa's ups and downs were eventually diagnosed as bipolar disorder, formerly known as manic depression. That diagnosis came after Marisa's first suicide attempt about five years before her death, when she overdosed on prescription medications.

"She was put on medicine but there were periods of time when she wouldn't take her meds," Gross said. Her daughter complained they made her feel groggy, tired and out of control.

While family members urged her to get more professional help, she never got the help she needed.

Marisa and her siblings returned home for their parents' 50th wedding anniversary in December 2010. Marisa, who was divorced, had met a man and seemed happy.

"We finally felt there might be a turnaround in her life," Gross said, but that relationship also soured.

Marisa repeatedly borrowed from her family to help her get by financially, but rejected her parents' pleas to come home where they could help her. She threatened suicide when her parents rejected her request for a large sum of money.

Alarmed, Gross contacted family members for help. Marisa told her siblings her threat was a ploy. "She said 'I just wanted to scare Mom,' " Gross recalled.

She took her life a few months later.

Gerlach feels guilty she wasn't more aware of her sister's pain, and wondered for a time why someone didn't do something to stop it, or why her sister didn't take her meds.

"If one prescription isn't working, you've got to work with your doctor to find one that does," Gerlach said.

Marisa's daughters did their best to comfort their aunt.

"Her youngest said, 'Aunt Tari, we always knew this was going happen. It was just a matter of when.' There were days, the girls told me, when her depression was so bad Marisa couldn't get out of bed."

Suicide is puzzling for those left behind, Gerlach said. Friends and family were uncertain about how to handle the death. Some wondered if they should mention to others how her sister died, or even if they should attend the funeral. Gerlach and other family members urged them to come.

"I told them, 'We still need your love and support.'"

What remains is an overwhelming sense of grief and loss.

"I just took it so hard. Why wasn't I and her girls good enough to stay around for?" Gerlach asked.

It troubles her that her sister will miss the birth of her first grandchild.

"I feel bad I got mad at her," she said. "Now I'm just sad for her."