A Suicide Crisis in Montana and Beyond

This year in Montana the suicides reached Paradise Valley, a scenic gateway to Yellowstone National Park. Two students in a local high school took their lives during a single week in February. A few days later, a middle-aged husband and wife killed themselves in Reed Point, population 185, an hour’s drive east. Over the following months—in what has become a devastating annual tragedy—suicide touched nearly every part of the state, from the northeastern plains and isolated Indian reservations to cities, cattle towns and college campuses.

Montana might be Big Sky Country, but public health experts have another name for the landscape. They call it part of the “Suicide Belt.”

“Montana has the highest suicide rate in the nation,” says Karl Rosston, suicide prevention coordinator for the Montana Department of Public Health and Human Services. He reels off the statistics with the grim efficiency of someone who’s discussed them hundreds of times in a years-long effort to solve an intractable problem–as he’s done.

“The fact that you live in Montana at least doubles your risk of suicide, across all age groups,” Rosston says. American Indians and Alaska Natives lead the state in suicides, with a rate 170 percent higher than the nation as a whole, state data shows. The rate for whites is 115 percent higher than the national rate. For young Native Americans, aged 11 to 24, the rate is a staggering 438 percent higher than the nation’s.

Montana has been in the country’s top-five for suicide for nearly 40 years, Rosston adds. “This is not going to go away quickly.”

It’s not going away quickly anywhere in the world, public health experts would say. Suicide has been increasing at an alarming pace across the country and the globe, a crisis linked to rising tides of depression, poverty, and other woes.

The incidence in the United States has reached levels unseen since 1986, according to a federal study released in April. The report from the National Center for Health Statistics examined data between 1999 and 2014 and found a marked rise in suicide deaths for all age groups under 75. The highest spike–an alarming 200 percent–was for girls aged 10 to 14. Second highest was a 63 percent jump for women aged 45 to 64. The rate for men in that age group climbed 43 percent, a level that reflects growing numbers of white middle-aged men taking their lives.

“Suicide is a major public health problem in every country and every community worldwide,” the World Health Organization stated in an unprecedented call for action, a 2014 study entitled Preventing Suicide: A Global Imperative. Nearly 1 million people across the globe take their own lives each year. Research shows each death can trigger a profound and complicated grief that leaves the bereaved at triple the risk of suicide themselves, creating a chain reaction of loss and trauma.

“You’re at higher risk of suicide if someone has committed suicide in your family, and that puts most of our children at high risk,” says Lester Dale DeCoteau, the suicide prevention coordinator for the health department at the Fort Peck Indian Reservation. Home to the Assiniboine and Sioux Tribes, Fort Peck is one of the most isolated reservations in America, a two-million-acre stretch of prairie in northeastern Montana interrupted by a few tiny towns, one with just 300 residents. “The whole tribe is a family,” DeCoteau says, “and so a suicide affects all of us.”

In the broader sense a suicide affects all of Montana, which led the 2013 state legislature to establish what’s believed to be the first suicide mortality review team of its kind. Led by Rosston, the panel reviews every suicide death in an attempt to identify specific causes and tailor prevention efforts accordingly.

Research points to many contributors. Among them: untreated depression or other mental illness; poverty; alcoholism and drug abuse; unemployment; a family history of suicide and/or mental health problems; exposure to trauma and violence; physical illness and chronic pain; and exposure to war, which has led to historically high levels of suicide among military veterans.

Poverty is particularly pernicious, experts say, because it creates distress while making it harder for people to get help. Low-income communities typically have little or no access to adequate mental health services and medical care, whether in town, in schools or in reach.

“There isn’t a single psychiatrist in all of eastern Montana,” Rosston says. The region he refers to is 42,000 square miles, with a distance from north to south that’s akin to driving from New York City to Virginia. In some cases, jails become de facto psychiatric units.

When people dial 9-1-1 in a suicide crisis they get a sheriff who has no secure facility nearby. “So now what happens? The best place they can take the person is to jail,” Rosston explains. The nearest in-patient psychiatric center might be an eight-hour drive away.

There is a significant stigma surrounding mental illness, moreover. Men, who comprise about 80 percent of suicides, are particularly vulnerable to thinking that getting help is a sign of weakness. “It’s a cowboy-up mentality–we don’t talk about our problems,” Don Wetzel Jr., a Blackfeet tribal member, says. “To me, stigma is the biggest problem,” he adds. “You can have a counselor and a psychiatrist on every corner, and if you have stigma, you still won’t get anywhere.”

‪Wetzel, the American Indian Youth Development Coordinator for the Montana Office of Public Instruction, works in schools on reservations around the state, where poverty levels are as high as 60 percent. He encourages students to open up, problem-solve, and start connecting to their tribal culture, which he says helps the most. “It gets them centered.”

When the center gives way, the results have been devastating. In 2010, six students on the Fort Peck reservation took their lives. Five seventh and eighth grade children killed themselves and 20 of their classmates attempted suicide.

The sixth to die was Dalton Gourneau, 17, a high school senior and star wrestler who dreamed of winning the state wrestling championship. On November 23, 2010, Wolf Point High School suspended him from the team because a counselor said she saw chewing tobacco in his pocket. “It broke his heart,” said Roxanne Gourneau, his mother. Dalton walked home and fatally shot himself a few hours later.

Possessing chewing tobacco was punishable by much milder punishments, such as a one-day suspension, Roxanne Gourneau, a tribal council member, said. “But they went right to kicking him off the team, the thing he cared about the most. Nobody in their right mind would do that to a child.”

Since her son’s death Gourneau has devoted herself to school reform and youth suicide prevention. She and other tribal members created a crisis response protocol for the schools that provides guidelines for helping at-risk students. Fort Peck teachers and other school employees have been trained to recognize warning signs and intervene to save lives. (Similar efforts, such as “You Can NOT be replaced” programs, have been implemented in schools worldwide.) “Education is the solution to suicide,” Gourneau says.

Students everywhere need help. A 2015 Montana Youth Risk Behavior Survey found that nearly 19 percent of high school students had seriously considered suicide during the prior 12 months. Nearly 9 percent of students across all racial groups said they’d made at least one suicide attempt. More than 19 percent of Native American students had tried to kill themselves.

Historic trauma has made suicide and depression deeply entrenched in Indian Country, Wetzel says. Until the 1970s American Indian children were still subjected to assimilation campaigns and sent to boarding schools where physical, sexual and emotional abuse was widespread; they were punished if they spoke their language. That, in addition to the loss of land, culture and lives over history, created hopelessness in generations of Native American parents. “And that gets passed along to children,” Wetzel says.

Hopelessness is an equal-opportunity scourge, however. Whites, who make up 90 percent of the population, have the second highest suicide rate in the state, one that’s been steadily climbing. Adults as old 85 and children as young as 11 have killed themselves. Schools are a continuing source of despair.

In Missoula alone, two high school boys took their lives within a month of each other this fall. A white 18-year-old at the University of Montana killed himself on the same day in February that one of the Livingston high school students took his life.

As of November, Montana’s death toll stood at more than 212, in a state with only 1 million residents. If Montana’s rate–25 suicides per 100,000 people–were shaved down to the national rate of 13 suicides per 100,000 people, there would have been 130 deaths last year instead of 267.

What is it about the Treasure State that inspires this much anguish? Sociologists, as it turns out, have called this part of the country the suicide belt for years. The term describes a swath of nine mountain west states from Montana south to New Mexico, plus an outlier, Alaska.

Suicide expert Matt Wray, a sociology professor at Philadelphia’s Temple University, traces the belt’s troubles to a “lethal mixture” of social isolation and poor mental health, fed by a lack of mental health services, high rates of alcohol and drug abuse, and—one of the more controversial suggestions–a large number of firearms

Numerous studies, including a comprehensive survey in 2016, show that high rates of firearm ownership are strongly correlated with high rates of suicide. The top states in the country for gun ownership, for example, are Wyoming, Alaska and Montana, which also happen to have the highest percentage of people killing themselves with firearms. Montana has more guns than people.

Easy access to firearms is a problem. A suicidal impulse can pass in as little as five minutes and might never return. Having a gun during those minutes can be fatal. (It’s a myth that people who don’t have a firearm will just find another method: Up to 90 percent of attempters do not go on to complete suicide, public health studies show.)

The 2017 state legislature will have the gun issue to consider and many others when it convenes Jan. 2.

The State Administration and Veterans Affairs Committee decided on Nov. 17 to offer two suicide prevention bills during the session. The measures would provide $1 million for suicide prevention efforts, including $500,000 for local groups that help military veterans. More than 50 veterans kill themselves every year, about one-fifth of the state’s total suicide deaths.

Lawmakers also will have a 109-page strategic suicide prevention plan to consider–the latest report from Rosston, compiled with help from the suicide mortality review team and others.

Among the major proposals, the plan recommends that all schoolchildren aged 11 to 17 be screened for depression. Suicide prevention and risk assessment training should be mandatory for primary care providers, the plan also says.

On the issue of guns–used in 63 percent of youth suicides in Montana–the plan asks for a declaration of “safe storage” standards for firearms (winning anything stronger than a declaration would be highly unlikely in the ultra-pro-gun state).

There have been many accomplishments–the report listed more than 30. Over 20,000 people have been trained in a suicide intervention program, including more than 3,000 teachers and school employees. Countless primary care providers, emergency room doctors, hospital staff, law enforcement officers, community members, and jail employees have received information and training to help them recognize suicide warning signs and save lives.

There has been progress in schools, Gourneau adds, for her part. Native American students are no longer locked up in the “room of tears,” a padded isolation room used for punishment decades ago. Those days are gone. Now the state is using behavioral programs, evidence-based practices, and scientifically tested intervention models to reverse the damage.

“Sometimes I think we make this too complicated,” she says. “Under all of this, the thing that prevents suicide is a simple act of kindness. That’s what schools need to offer our children. Apparently that’s one of the hardest acts to achieve.”

Amy Linn is a freelance writer and editor based in Missoula, Montana. She received an Alicia Patterson Foundation Journalism fellowship in 2015 to write about teenagers on death row. 

Editor’s Note: This article is part of a new effort at Spotlight on Poverty and Opportunity to feature reported journalism as part of its efforts illuminate news and trends in the field to promote a bipartisan dialogue.

The views expressed in this commentary are those of the author or authors alone, and not those of Spotlight. Spotlight is a non-partisan initiative, and Spotlight’s commentary section includes diverse perspectives on poverty.