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The Lonely Battle

New approaches to Idaho's suicide dilemma

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The numbers speak volumes. According to Idaho Vital Statistics, the number of completed suicides in Idaho in 2002 was over 60 percent higher per capita than the U.S. average. Our state bears the seventh highest per capita suicide total nationwide, and the second highest for adolescents. The number of completed suicides has increased in Idaho each of the last three recorded years (2000-2002), leading up to a 10-year high of 203 victims in 2002. Eighteen percent of high school students surveyed for the State Department of Education's 2003 Youth Risk Behavior Survey recall having "seriously considered" committing suicide within the last year, and 9 percent actually attempted it.

But these statistics don't say it all. On the contrary, they create a wake of difficult and distressing questions. For example, why are Idaho's numbers drastically higher than the national average--and why are they still rising, while the global rate decreases? Similarly, why are all intermountain states higher in suicides attempted and completed than the rest of the nation? And perhaps most tellingly, why do certain state demographics resort to suicide with such alarming frequency--including rural denizens, the elderly, and men in general, who are currently 71 percent more likely to kill themselves than women? The answers to these questions could be far-reaching, uncomfortable and may ultimately tell more about our cultural mindset toward mental health than about suicide victims--but according to many theorists and suicide prevention advocates, that is exactly the point.

"The thing about suicide is that you have to have an ecological approach; you can't just start in one place to understand it, and it's a mistake to say, 'It's only due to depression,'" explains Dr. Peter Wollheim, Boise State professor and author of the new report A Public Health Priority: Teen Suicide in Idaho. Wollheim's report, published by the local non-profit group Kids Count, is intended to be read, in the author's words, "by legislators, heads of state agencies, private non-profits, parents, educators, people in juvenile corrections, social workers, clergy, people who run Boys and Girls Clubs and even adolescents themselves." It is packed with the requisite harrowing statistics, but also a call to action that may seem striking to some readers--namely, that elevated suicide rates are not merely a collection of psychological aberrations that can be medicated away, but they are in fact a complex and very common result of interrelated biological, psychological, social and cultural risk factors that are not limited to teens.

Wollheim cites domestic abuse, rampant urbanization, stigmas surrounding mental illness and even cuts in school funding as elements conducive to a culture high in suicide. The keys he provides to battle such wide-ranging instigators are also quite broad, and proceed along a "public health" model, including increased education on the warning signs of mental illness among "community gatekeepers" like teachers and peers, positive modeling of help-seeking behaviors and a commitment to long-term rather than short-term treatments.

"There are no immediate returns in numbers," he admits. "Ten or more years out is where we'll see statistics on mortality go down. But [in the meantime], more people will be willing to talk about it using the 'S-word,' more communities will organize around the state, and eventually, we'll see fewer suicidal gestures and hospitalizations for attempts."

According to Wollheim's report, a key step toward realizing these initial victories lies in Idaho's willingness to draft a statewide Idaho Suicide Prevention Plan (ISPP)--only 20 other states have a similar plan. The plan was released in November 2003 by a group of government and nonprofit organizations including Idaho Health and Welfare, the Governor's office, the State Department of Education, Idaho Suicide Prevention Services and the Idaho Suicide Prevention Action Network (SPAN), all looking to extend ecological approaches like the one espoused by Wollheim. The plan is modeled, according to organizer and Health and Welfare Children's Mental Health Program Specialist Ross Edmunds, after the philosophy of a highly successful plan implemented by the U.S. Air Force in 1995, at a point when their overall suicide rate was almost identical to Idaho's (just over 16 deaths per 100,000 people).

Easily the largest such project to take place in Idaho thus far, the ISPP calls for, among other things, a comprehensive county-by-county survey of Idaho's suicide rates and proximity to common suicide corollaries like substance abuse, firearms and mental illness; the creation of an umbrella organization to oversee suicide prevention efforts statewide and, above all, a grassroots community-wide movement to increase awareness of suicide risks and de-stigmatize treatment for potential victims.

"[In the Air Force], the event that had the most impact was the chief of staff saying publicly that it is a strength for you, as a person, to seek help," explains Edmunds. "But I think there is still fear that if you go to schools, and you instigate an awareness or education campaign, it will give people the idea to go toward completing suicide. That is not accurate. If you take a general population and educate them, the 'gatekeepers,' about what to look for, then they will be able to identify it among their friends before it happens."

As the culmination of these claims, Idaho Department of Health and Welfare awarded a contract in August to SPAN, of which Wollheim is a founding board member, to formulate the first ever Idaho Suicide Prevention Council. This as of yet inactive organization will oversee the implementation of the ISPP throughout the state, relying largely on private contributions, and will proceed, in Edmunds' words, to "increase protective factors and decrease risk factors," rather than focus merely on the pathology of suicide.

"Obviously, the goal is to decrease suicides," Edmonds explains, "but I hope mainly for [the council] to begun bringing people together at a local level who are interested in doing things in their communities toward reduction of suicide. Just increasing awareness throughout our state would be a real challenge and a real accomplishment."

Within four to six months, predicts Dr. John Hanks, president of SPAN Idaho, an initial version of the council will be cemented, including "representatives from suicide prevention organizations, government and probably high-risk populations." By next fall, he hopes to hold the first council meeting and soon after begin circulating what he calls "the toolkit for suicide prevention" to communities, schools and at-risk populations around the state. Included in the kit will be collections of resources explicating proven methods to increase suicide awareness and dialogue and build resilience community-wide. According Hanks, "It's a resource compilation made to answer the question, 'What can I do to prevent suicide?'"

Perhaps most importantly, though, proponents of the plan insist that by taking a culture-wide approach to promoting life and health, not only the suicidal will feel the benefits.

"If you have communities with lowered rates of domestic violence and child abuse, with good birth weight babies and low divorce rates, you have low suicide rates--that's been shown," Wollheim explains. "But you also have less social dysfunction, less crime and a simply better community in which to live."

To obtain Dr. Wollheim's report, call Kids Count at 388-1014. To view the Idaho Suicide Prevention Plan, visit www.healthandwelfare.idaho.gov. or www.spanidaho.org