by Eric Sharpe
Depression is an illness. Suicide is the shattering end game for people who suffer from depression and other mental health issues. Understanding the underlying factors of both are more important than ever as the suicide rate in the United States is the highest it has been in nearly 75 years. Worse, it is widely accepted that the rate of suicide is even higher than reported. A marked increase of poisonings, drug over doses, and liver disease (from the slow suicide of alcoholism) from 2000 to 2015 has revealed an epidemic in those realms with deaths in each of those categories doubling among adults aged 30-64.
Suicide happens in every ethnicity and every country in the world. In 2015, the United States ranked 48th out of 183 countries in per capita suicides. Sadly, and somewhat shocking, if Montana’s counties were nations of the world, two of those counties would rank 2nd and 3rd for highest rates of suicide on Earth. Another 14 would break the top ten. The suicide rate in Montana has consistently ranked in the top three of all states in the U.S. for over a decade. Montanans it seems, are in trouble.
It all obviously begs the question – why? As presented in the following, there simply isn’t a single answer to that question, but by looking at the data and some basic facts, we can at the very least begin to understand how a myriad of factors have created this crisis. According to a comprehensive study done by the Montana Department of Public Health and Human Services entitled “Montana 2016 Suicide Mortality Review Team Report”, 555 suicides were recorded between January 1, 2014 and March 1, 2016. Most of the data which follows is based on this report though several other resources were accessed. It’s quite the laundry list, but kudos must go to Montana’s DPHHS for tracking such data on a very difficult topic, for in the data, we can learn a lot about why Montana is in trouble.
Montana men are four times more likely to take their lives than women. The per capita rate for Montanan’s aged 35 to 44, (or people born between about 1960 and 1969) was 36.3 – about 25% higher than the national average for that age group. Education plays a factor too as 71.9% had less than a college degree. The most common method of suicide… firearm, at 63%. No other method comes close. The rate of Veteran suicides in Montana is 79% higher than the national average and represented 22% of all Montana suicides during the Jan. 1, 2014 to March 1, 2016 study period. Veteran suicides in Montana increased by 30% from 2013 through 2016. The vast majority of Montana’s suicides were white individuals, though considering per capita numbers, Montana’s native American population is, per capita, in worse shape. Though they represent 6.6% of Montana’s total population, 8% of all suicides were attributed to Montana’s Native Americans.
Health and Wellbeing
Of the 555 reported suicides, 47% had documented previous mental health problems, 69% of which reported depression as their primary mental health problem. Of the typical warning signs for a potential self-harming incident, 74% of all suicides were of people who had exhibited those signs. Some 35% were suffering from one or more of a number of chronic health problems including 10% whom reported suffering from chronic pain. Of those 555 suicides where toxicology reports were available (359) 85% tested positive for drugs or alcohol at time of death.
Time and location
Though one might assume the holidays result in more self-inflicted fatalities, September and August were the worst months in Montana accounting for 21.5% while December and February were the lowest totaling 11.2%. Keeping in mind this data is only for the 25 month period of the study, other indicators show that January has historically had a high rate of incidence in Montana. Nationally, May is the worst month. Yellowstone County, due to its large population, led all counties in raw numbers at 77 but per capita rates by county show that suicide rates are highest in Deer Lodge, Roosevelt, and Park counties. It should be noted that according to KGVO radio, by December of 2016, Missoula County’s rates had already increased by 75% over 2015.
According to an August 2017 Montana Youth Risk Behavior Survey Program survey, during the previous 12 month period, 9.5% of high school students attempted suicide one or more times. Nationally, that number was 8.0%. Teens and college aged students accounted for 8.6% of all Montana suicides. A Nate Chute Foundation study revealed that in 2013, 26.4% of high school students in Montana reported they felt so sad or hopeless that they stopped doing some of their usual activities. Statewide, 16.8% of students had seriously considered attempting suicide and 7.9% had attempted suicide one or more times.
The indicators of what may be driving high rates of suicide among Montana teens are a little more clear. Of Montana teens who have attempted to take their own lives, close to half were the victims of bullying and or teasing online and in person (46.2% and 45.8% respectively), 52.1% had at least one drink of alcohol in the past 30 days; 31.2% had been sexually assaulted in their lifetime. Nearly 30% had been accused by teasing of being homosexual. Though all these results are disturbing, compared to national results, Montana’s teen numbers are on average lower in all age categories by at least a single percentage point.
The answers as to why Montana has hovered in the top 3 states for such a disturbing category are elusive though there are many assumptions, all of which rightfully point to a combination of factors. But for Montanans, there are some unique issues.
Are the Mountains to Blame?
In researching this article, such a question seemed absurd. But the facts are rather alarming. The top 7 states leading the nation in suicide rates are mountain states. Some researchers have pointed to a real connection between altitude and suicide. According to Karl Rosston, Montana Suicide Prevention Coordinator, in a Northern Broadcasting System article; “At about 2500 feet we see a spike in suicide worldwide… The way altitude plays a role is through metabolic stress caused by long-term oxygen deprivation.” However, it may also be that independent people tend to live in/move to the mountains – and independence can often mean “alone.”
It seems obvious that social isolation and living in the remoteness Montana offers is problematic and certainly a likely driver of depression. When a person lives a life of isolation, every minute of every day is filled with self-conversation, and often, we can be our own worst enemy. We reinforce our doubts, frustrations, anger and negative assumptions through prolonged self-talk. Whether living in a remote location or simply isolating one’s self from society, this holds true. Eventually, that self-talk can lead to a very bad decision.
What may be happening in Montana is tantamount to a terrible combination of factors. Montana is a state of military service as 9.9% of all residents are veterans compared to a national rate of 6.8%.; Veterans are clearly more prone to suicide than the civilian population. Montana’s Baby Boomer population is larger, per capita, than 40 other states; Baby boomers are leading the nation in suicide rates. Whites and Native Americans far out-pace other ethnicities in rates of suicide; Montana’s white population makes up 89% of MT’s total (U.S. 76.9%) and its Native American population represents 6.6% (1.3% U.S.). (Black, Hispanics, and Asian Americans’ suicide rates average only about 5 per 100,000). Taken together, such factors may be part of the reason that Montana’s per capita suicide rate is higher than the nation.
Though we all know that teens are not adults, many still expect them to behave with the full set of coping skills of an adult. The heart crushing breakup for a teen is just that. To a parent, it’s simply lesson one in a long line of lessons to come. For teens, living in the moment is what they know, and as such, they tend to face many “unguarded moments” – moments they are wholly unprepared to face. Countless stories of a teen taking their own life as an impulsive act after a crushing breakup or a horrendous bout of on-line bullying litter the news. If they’d simply had a moment to step back from the edge to consider that such a moment is not long lingering and will pass into memory as a footnote of life, the most final course of action they would choose to take would not be taken.
Teens need to look at life like a yard stick. If we live to be just 72 years old (current ave. life span is 79 by the way), each half-inch on that yard stick represents one year of life. A 15 year old is only at the 7 and a half inch mark. But to them, their entire world, the rest of their life, is being lived within the window of a fraction of that inch. Do they remember anything about being 10 years old? Anything? Will they remember that crushing moment as a 15 year old when they are 20? Not so much. Time, especially for a teen, not only heals emotional wounds, but in some cases, wipes them entirely from memory. If only they knew that. There are so many inches of life left to live.
Losing the narrative
Of course, for an adult, looking at the yardstick metaphor can actually be depressing. But it should not be. Consider how long it took to get where you are in just the past 10 years. There is so much more to do. Just a few more years is a lot of life and it is never too late to start living.
The problem for adults may simply be the nature of our culture. No nation on the planet is more driven by the promises of potential – the American Dream. These implied, (and sometimes direct) promises inundate our lives through the internet, books, movies, news report, – even commercials reinforce these messages which tell us: “If you work hard enough, you will succeed.” “Dreams do come true.” “A better life is awaiting you.” These messages are essentially promising hope, which, unfortunately has been used to sell products and movie tickets. We tend to live our lives by this false narrative. Think about it. How many fairy tale princess stories can you count? But how many princesses are there (real and virtual via fame and success)? How often do we hear success stories of the person who worked hard and became wealthy and famous? What is not reported is that for every such story, there are tens of thousands who worked just as hard, if not harder, but didn’t succeed.
As people come to the conclusion that their dreams and aspirations are not going to come true, they either see that they’ve lived according to that false narrative, or, worse, they believe they failed because they were not worthy of it. When this happens, they find that they’ve lost their way; and they’ve no idea how to proceed. Changing the narrative of their lives could be the key to saving those lives.
Vast state resources have been dedicated to understanding and addressing Montana’s mental health crisis. The Montana DPHHS has led this effort and should be applauded for doing so. Unfortunately, these efforts have not seen much success. Billings Public Schools have also attempted to make a difference. According to the Billings Gazette, “the school district added a professional mental health counselor at each of the three high schools in January” of 2017. According to that article, “those counselors’ schedules have already filled up with troubled students.”
Solving the problem is not the goal of this article. One cannot presume to have such inescapable answers, especially when we tend to look for a grand one size fits all solution. But maybe, a host of small interventions could be the key? The simple act of locking down a firearm to prevent access by a depressed friend or relative could make a difference. Reaching out to a person in distress may be a turning point for them. Seeking help yourself could turn your life around. Getting just a little exercise could take the edge off. Perhaps it is a host of these seemingly small acts that are the keys to turning Montana’s epidemic around.
Solutions aside, words of encouragement can only be offered, even if seemingly trite. For teens, the best encouragement is to buy a yard stick. Really. Put it in your bedroom, and the next time some idiot bullies you, or you are heartbroken, look at it, and hopefully you may realize, the potential for life is far too vast to be fit into a moment of life, or even your days in high school.
For the adults: As far as anyone knows, we only get one life. If you find yourself beginning to believe it is a good idea to cut it short, please try to understand, though the brass ring dream may never happen, though you may be suffering from pain – physical or mental, though the fraction of an inch of life you are currently suffering in seems like forever, change is always possible. To live life for no other reason but to see what’s next, to experience what possibilities may unfold, to feel good for just one more day – someday – is reason enough to stick around. If someone tried to kill you, you’d fight them with everything you had. Maybe you need to start fighting yourself. But that fight requires action. You must seek out help in order to make that change happen. Counseling is a good thing. Participation in society is a good thing. Exercise is a good thing. Fighting to the natural end is a very good thing. We get one life. I hope you keep it.