The Suicide Crisis
The number of suicides in America is growing, particularly in the West, but the issue rarely garners attention from most policymakers.
Year after year, suicide has claimed more lives in Utah to the point where it has emerged as a leading cause of death. More than twice as many Utahns now die by suicide than in traffic accidents, even exceeding deaths from diabetes.
The state lies in the middle of what has become known as the Suicide Belt, a region stretching from Idaho down to Arizona and New Mexico where self-inflicted deaths are more prevalent. Some communities there have experienced sudden spikes in suicide deaths that left officials seeking answers. But despite growing numbers of deaths nationally, it’s an issue that’s still largely off the radar in policy debates
National suicide rates have climbed each year since 2005, exceeding 40,000 deaths in 2012. A review of the latest Centers for Disease Control and Prevention (CDC) data finds that annual age-adjusted suicide rates increased in all but two states between 2007 and 2012. In 20 states, annual deaths increased by at least 20 percent over the five-year period.
In the Suicide Belt, several states are experiencing significantly more deaths than just a few years ago. One primary reason why suicides are more prevalent out West, experts say, is a lack of access to mental health care. In parts of central Utah, providers can be 100 miles away or more. Access to firearms and gun ownership rates are also greater in the region. One University of Utah neuroscientist even published research theorizing high altitudes cause changes in brain chemistry resulting in more mood disorders.
Faced with a rising number of deaths and one of the nation’s highest suicide rates, Utah lawmakers sought to bolster the state’s prevention efforts. Although local groups and agencies had been working on the issue, little statewide coordination took place prior to 2013, when the legislature established two new coordinator positions.
Kim Myers, Utah’s first statewide suicide prevention coordinator, provides support and technical assistance to local coalitions across the state. “None of us can do it alone,” she said. “We’re making sure to pull in everybody we can and think outside of the box.”
In the first two weeks in November alone, the state's Alpine School District experienced two suicides and three attempted suicides. Officials responded by convening a series of public meetings. Mental health experts were brought in to train parents, teachers, scout leaders and anyone else wanting to learn about suicide prevention. “We believe it takes an entire community to save a child,” said Dr. Greg Hudnall, who heads a Utah suicide prevention group.
Research hasn’t linked a single prevailing factor to steadily rising rates. But some of the more commonly cited culprits are the downturn in the economy, prescription drug abuse and returning veterans suffering from post-traumatic stress disorder.
About half of suicides nationally are committed with firearms, according to CDC data. A bill passed by Utah lawmakers earlier this year allocates funding toward brochures outlining suicide prevention and firearm safety tips. It also provides rebate vouchers for gun safe purchases using surplus funds from concealed-carry permit fees. Myers plans to help firearm safety instructors integrate suicide-prevention training into their courses.
While suicides are particularly severe in rural and Western states, rates aren’t nearly as high in densely populated areas of the Northeast and Mid-Atlantic. Wyoming, for example, recorded about 30 suicide deaths per 100,000 residents in 2012, the highest rate nationally, more than triple that of New Jersey and New York.
Regional differences in suicide rates also depend, to a degree, on an area’s demographics. From the 2012 CDC data, men were about four times more likely than women to take their own lives. Non-Hispanic whites recorded suicide rates more than double that of blacks and Asians, while Native Americans also die at noticeably higher rates.
Numbers tell a different story for suicide attempts, with women about three times more likely than men to attempt suicide.
If there’s one group that is especially at risk, it’s middle-aged and older white men. Suicide prevention efforts, however, typically aren’t tailored to this cohort. “We need to be more creative in how we get to them,” said the Suicide Prevention Resource Center’s Julie Goldstein Grumet. By contrast, Goldstein Grumet noted, youth suicide prevention programs have been in place for years, and the suicide rate for those under age 25 hasn’t accelerated as it has for other age groups.
One novel public awareness campaign geared toward men, created in part by the Colorado Department of Public Health, features a laid-back, fictional therapist who tells jokes. Visitors to its website, ManTherapy.org, can complete an “18-point head inspection” and learn about available resources. By using a tongue-and-cheek approach, the campaign seeks to help men overcome the stigma of seeking help.
At the state level, how agencies manage efforts to reduce suicides varies greatly. Only five fully fund dedicated offices for suicide prevention, according to the American Foundation for Suicide Prevention (AFSP). About a third rely on public-private coalition models, as is the case in Utah.
State-level leadership helps avoid duplicating resources, said Nicole Gibson of AFSP, but there’s no one-size-fits-all model. “Having a lot of groups working alongside decision-makers is a recipe for success,” she said.
Suicide-related legislation in states has focused largely on schools, where suicides are one of the leading causes of death among young people. Recent statistics illustrate the magnitude of the problem. Seventeen percent of high school students in the CDC’s 2013 National Youth Risk Behavior Survey reported they "seriously considered" committing suicide in the preceding 12 months, while nearly 3 percent made an attempt requiring medical treatment. About 22 states require suicide prevention training for educators, according to AFSP.
Other strategies have surfaced at the local level. Suicides remain a persistent problem for many larger transit systems, some of which now train employees to spot suicide attempts. The San Francisco Bay Area’s Caltrain, for instance, records an average of 14 fatalities per year, and about 90 percent are ruled suicides. A few New York counties have launched suicide prevention smartphone apps. An approach that’s gained traction in health care systems, known as Zero Suicide, has further been attributed to significant suicide rate reductions.
One of the emerging challenges advocates see is expanding the issue beyond the behavioral health system. First responders and clergy members, for example, might take what are known as mental health first aid courses. Even mental health clinicians still frequently lack suicide care training.
“It’s going to take much more of a public health perspective where more people take ownership,” Goldstein Grumet said.
Select a state below to view its annual suicide deaths and age-adjusted rates: