HELENA — A couple of weeks ago, a 10-year-old died by suicide in Pablo, Montana.
That disquieting news was delivered to a group of public health professionals last week in Helena by Montana’s suicide prevention coordinator Karl Rosston, who then reminded everyone in the room that Butte, too, saw the death of a 10-year-old by suicide last March.
These appalling vignettes were part of an update by Rosston and others to a group of people who work to prevent suicide in their counties and our state. September is National Suicide Prevention Month.
“It’s through the roof,” Todd Koch said of Montana’s suicide rate — Koch is the state’s lead epidemiologist focused on vital statistics.
Rosston, Koch and state epidemiologist Hallie Koeppen began the presentation by providing national data. In 2016, the United States saw 44,965 suicides — 123 suicides per day, one suicide every 11 minutes. This translates to an annual national suicide rate of 13.9 per 100,000 in population. Males, Rosston said, kill themselves at a rate four times that of females, though females try to kill themselves three times more often than males. Firearms remain the most commonly used suicide method, accounting for nearly 51 percent of all deaths by suicide.
Contrast the national suicide rate with Montana’s, which in 2016 saw a rate of 25.6 per 100,000 in population. That statistic put Montana second highest in the country for suicide rate.
Rosston, who has made a career of studying suicide and preventing it, said there are many reasons Montana has a high suicide rate. More Montanans, he said, use alcohol as a coping strategy — those in Montana who die by suicide have alcohol in their blood at twice the national average. Montanans also have access to lethal means — nearly 65 percent of Montana’s suicides are carried out by firearm.
In Montana, there is stigma related to mental illness. “We see depression as a weakness, that we are a burden,” Rosston said. “If you think you’re a burden, how likely are you to ask for help?” Even if Montanans try to seek help, many of them have limited access to behavioral health services — many primary care clinics do not integrate behavioral health into primary care, and the state is home to too few psychiatrists.
“How many psychiatrists do we have in Eastern Montana?” Rosston asked the audience. He held up one finger — “One,” he said. “In Glendive. That’s a problem.”
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Many Montanans, Rosston continued, live in isolation — the state has 6.7 people per square mile, while the national average is 88.7 people per square mile. Montana is geographically vast — in some counties, response to 911 emergencies can be 90 minutes to two hours.
Montana is also home to a high concentration of groups susceptible to suicide — veterans, American Indians, and middle-aged white men. Rosston cited other reasons for Montana’s high suicide rate, including socioeconomics — 20 percent of the state’s children are living below 100 percent of the federal poverty level. A deficiency in Vitamin D has been correlated with an increased risk of depression. And altitude is being studied — “metabolic stress is caused by long-term oxygen deprivation,” Rosston said. “Worldwide, above 2,500 feet, you see a spike in suicides.”
Is there a silver lining on the suicide front? Yes — Rosston, Koch, Koeppen, and their colleagues are getting better at collecting data, and this will be true more than ever in 2019, when the National Violent Death Reporting System will allow for a more comprehensive examination of violent deaths — suicides and homicides — using multiple data sources and not just death certificates. This will include collection of information on items such as substance use, relationship problems and losses, various life stressors, crisis events, and other social factors. Researchers will be able to review past criminal histories, interactions with law enforcement, and other events directly surrounding the violent death.
A new advisory committee, similar to Rosston’s suicide mortality review team, will be formed, comprised of law enforcement officials, medical examiners and coroners, and state and local officials, all of whom will assist in data collection, analysis, and dissemination of findings.
“Data drives prevention,” Rosston said.
The more we know, the more we can prevent the horrific tragedy of suicide.
How do you react when someone you love or care about is potentially suicidal? Next week’s column will provide some proven strategies as well as information on free trainings available in Butte.
In the meantime, love each other. And love yourself.