There is no time like the present – this week is National Suicide Prevention Week – to talk about Montana’s suicide rate. Our state’s age-adjusted rate is 23.7 per 100,000 in population, the highest in the land.
We’ve learned so much in Butte-Silver Bow since January 2014, when the county’s chief executive, Matt Vincent, called together a group of people representing various agencies after a third teen-ager had died by suicide over a six-week period. That group has evolved into what is now called the Butte-Silver Bow Suicide Prevention Committee, which is focused on why Butte-Silver Bow ranks among Montana’s top 10 counties for suicide rate and working to minimize suicide in our county.
Why is Montana’s suicide rate the highest in the United States?
Karl Rosston is the state’s suicide prevention coordinator, and he and his employer, the Montana Department of Public Health and Human Services, have looked at the data and the scenarios – death records, to be exact – to devise several reasons. Here is some of what we’ve learned.
First off, Montana is a large rural state whose small communities can be extremely isolated. The DPHHS information also says that Montana has a generational culture of accepting suicide as an option to resolve feelings of hopelessness, when an individual believes they are a burden to others.
While residents of New York City and Los Angeles talk freely and openly about seeing their therapists, in Montana there is a continued stigma related to seeking mental health services. Mental health conditions – depression, bipolar disorder, conduct disorder, anxiety disorders and others – are directly correlated with suicide risk. Living in a small town doesn’t help – the DPHHS information says people living in small communities actually shy away from seeking treatment due to concerns about confidentiality.
Another health factor correlated with suicide risk is a serious or chronic health condition, often accompanied by pain.
While the Affordable Care Act and Medicaid expansion in Montana will help, about 20 percent of Montanans remain uninsured – mental health services are difficult to pursue without coverage.
And then there are firearms. Montana has high availability, and firearms are the most common means of suicide. We also know that when people impulsively decide to die, firearms are a ready option. The statistics are telling in Butte-Silver Bow, where 55.5 percent of adults have a firearm kept in or around their home, much higher than the national prevalence of 34.7 percent. In Butte-Silver Bow households with children, 71.4 percent have a firearm kept in or around the house, nearly twice the national finding. (This is why the Butte-Silver Bow Suicide Prevention Committee has been distributing gun locks in the community – we want to mitigate this very available lethal means).
There are other reasons behind Montana’s high suicide rate – the state has high rates of alcoholism, underage drinking, binge drinking and drug addiction. The boom-and-bust nature of the state’s farm and ranch industry, and the difficulty in recruiting industry, lends toward an unstable employment market.
Altitude apparently plays into this issue. The DPHHS information says data from the National Violent Death Reporting System reveal that suicide rates are increased among people who live at high elevations than those living at lower altitudes.
Montana has a shortage of inpatient mental health treatment facilities and crisis stabilization beds. Reimbursement for outpatient services is considered inadequate by many providers. And Montana has a serious shortage of psychiatrists, especially child and adolescent psychiatrists.
In Montana, our youth are at risk for suicide (tragically, Butte-Silver Bow knows this to be a reality). In the 2013 Montana Youth Risk Behavior Survey, 7.9 percent of all Montana high school students had made a suicide attempt, and 12.1 percent of middle schoolers. In the past decade, suicide has been the No. 2 cause of death for children ages 10-14 and adolescents ages 15-24.
The mission of Montana’s suicide prevention office is laudable: “There will be a sustained reduction in the incidence, prevalence and rate of suicide and non-lethal suicidal behavior in Montana.” The office’s vision statement is respectable as well: “We value human life. We encourage all people and organizations in Montana to deal openly, collaboratively and with sensitivity for all cultures to minimize suicide. We are working to create an environment where everyone will have access to qualified resources for help when they are in need.”
Good work is happening in Montana and Butte-Silver Bow to address this horrific issue. The more we talk openly about it and collaborate to address it, the healthier our communities will be.
Karen Sullivan is Butte-Silver Bow Health Officer and Director of the Health Department. Her column, The Public's Health, appears weekly on The Montana Standard's health page.