Experts hope new tool will reduce suicide

With Montana's suicide rate persisting in the top five for decades, health officials say they are excited about a new resource they hope will address the issue early - the Montana Crisis Action Toolkit on Suicide.

The goal for the Suicide Toolkit is that schools have available an all-encompassing, comprehensive instrument, Karl Rosston, suicide prevention coordinator for Department of Public Health and Human Services, said.

"We wanted to have an overall resource, not just for post-vention, but prevention, to give schools some tools to enable them to assess students who may be at risk and give them a checklist on exactly what they should do - as far as notifying parents, talking to kids - to reduce the risk of suicide contagion, that ripple effect that is often associated with school suicide," Rosston said.

Montana had the highest rate of suicide in the U.S. in 2014, and for nearly 40 years, it has consistently been in the top five for highest suicide rate, according to the American Association of Suicidology. The Suicide Toolkit, a combination of statical information and practical recommendations, is part of an effort to follow House Bill 381, which requires schools to have a standardized universal crisis response plan, Rosston said.

Havre Public Schools Superintendent Andy Carlson said the district uses the protocol QPR - question, persuade, refer - for students in suicide-related crisis. He doesn't know if the Suicide Toolkit is something the district will use.

The QPR approach is included in the Suicide Toolkit, Rosston said.

Since it had just been released November, no school districts have committed to its implementation yet, Rosston said Friday.

The Officer of Public Instruction created a committee on suicide prevention and Havre schools district leaders will be watching what comes of that, Carlson said. The Suicide Prevention and Response Negotiated Rulemaking Committee is expected to provide a recommendation to Superintendent Arntzen after the meeting, which was held Dec. 20. The minutes of that are being made available just today and there is no information yet as it relates to the toolkit, a spokesperson for OPI has said.

Dr. Scott Pollard is the leading author of the Suicide Toolkit. Pollard is a licensed psychologist, a nationally certified school psychologist professor at the Center for Psychological Studies, the author of multiple books on suicide and has served as the Prevention Director for the American Association of Suicidology.

Suicide is personal for Pollard.

"I'm a survivor of my father's suicide, but I only became passionate about the subject when I was faced with the suicide of three students the first semester that I was made the director of psychological services for a large Houston school district," Pollard said recently.

Pollard wrote in the American Association of Suicidology about seeing his father for the last time before he committed suicide:

"My recollection of the last day with my father is crystal clear even after 35 years. I was worried about his health, especially his alcoholism, but knew that I would be seeing him in a month for Thanksgiving. He shook my hand goodbye as he never was one for hugs and headed to his plane. I watched him go and was waiting for him to turn around and wave. He never turned to look back. Later that evening my mother called and her exact words were, 'Something terrible has happened!' The moment I heard those words I knew that my father had returned home and shot himself."

The Montana 2016 Suicide Mortality Review Team Report, part of the Suicide Toolkit, is an in-depth review of suicides statistics, a large portion of it based on 555 suicides that occurred in Montana between Jan. 1, 2014 and March 1, 2016. It comprises statistics from the 2014 National Vital Statistics Report (2015), the Center for Disease Control-WISQARS (2016), the Office of Epidemiology and Scientific Support and Montana DPHHS.

The report says there are multiple reasons people in Montana kill themselves.

"Access to lethal means, alcohol, a sense of being a burden, social isolation, altitude, undiagnosed and untreated mental illness, lack of resiliency and coping skills, and a societal stigma against depression, all contribute to the long-term, cultural issue of suicide in Montana," the report says.

The Suicide Toolkit lists practical applications, including screenings that can be used with every student.

Recommendations include universal screenings for depression starting at age 12. The Suicide Toolkit talks about what to do with a student after an attempted suicide and discusses the role bullying plays in suicide.

"One of the big interventions that we use is called the Columbia Safety Plan - created for students to allow them to have a plan of action if they think they are suicidal," Rosston said.

The Review begins with information about suicide being a national crisis before delving into its prevalence in Montana.

About 1,069,325 people a year in the United States attempt suicide. Since 2000, the suicide rate has increased 28 percent. The intermountain western states have the highest suicide rates, Montana persistently ranking at the top annually.

In Montana, there were 3,183 suicides from 1995 to 2014. During that period, Hill County had 46, Blaine 24, Chouteau 20. Numbers for Liberty were not available because fewer than 20 events does "not meet standards of precision or reliability," the report says. Yellowstone County, with 405 suicides, and Missoula with 349, recorded the most suicides from 1995 to 2014.

Of the 14 listed tribes, Chippewa Cree Tribe had the most suicides between 2014 and 2016, with 9, followed by six each for Salish Kootenai and Crow. The Chippewa Cree population, 3,323 at the 2010 census, is significantly smaller than both of those tribes.

Over the past 10 years, Montana is averaging approximately 19 American Indian suicides a year, for a rate of 27.3 per 100,000 compared to 200 suicides for whites over the same period of time for a rate of 22.11 per 100,000, the report says.

Most American Indian suicides, 83 percent, were committed by males. The age range with the most Native suicides is 15 to 24. Forty-five percent of Native suicides were committed by hanging. Toxicology reports indicate 56 percent of those who committed suicide had alcohol in their system and 36 percent had methamphetamine.

From 2014 to 2016, of the 555 overall known suicides in Montana, 440 were committed by males, 505 by whites and 42 by Native Americans, 350 by use of firearms and 108 by hanging.

Seventy-six percent of those who committed suicide had less than a college degree, and 53 suicides were committed by people between 35 and 64.

During the 2014-to-2016 span, a higher percentage of suicides happened in January, August and September, and a lower percentage in February and December. Based on identifiable criminal records, 86 percent of people had offenses, drug charges being the most common.

From 2005 to 2014, Montana's youth suicide rate per 100,000 people was 8.9 compared to the national average of 3.59. Firearm-caused suicide rate for Montanan youth was 5.56 compared to the national average of 1.41.

The report presented youth suicide information based on death certificates identifying the dead between 11 and 17 years old. Additional information was obtained from coroner reports, questionnaires, health records and information from families, the review says.

Of the 555 suicides in the report, 15 percent were committed by those aged 11 to 24. The age range with the most suicides were 55 to 64 with 19 percent.

Based on cases which mental health information was available, 83 percent had mental health issues, the most prevalent of them being depression.

A bill passed by the Legislature last year sponsored by Rep. Jonathan Windy Boy, D-Box Elder, set programs to help prevent suicides in Indian Country, of military veterans and among rural youth and provide grants to communities to fund suicide prevention efforts.

The new report is more directly connected to House Bill 381, although it is loosely connected to Windy Boy's bill, as well.

Identifying mental health problems is key, experts say.

"Suicide is not the sole issue, it's the end result of a bigger issue, and that's undiagnosed and untreated mental health issues," Rosston said, adding people can be treated if properly diagnosed. "So we're trying to raise awareness on the warning signs and how to intervene with people at risk and how to connect them to resources available at state or local level."

Montanans who are feeling suicidal can text the crisis text line at 741-741, or call the National Suicide Prevention Lifeline.