People used to talk about self-inflicted deaths only behind closed doors, said Kristie Scheel, suicide prevention coordinator for the Missoula City-County Health Department.
Montana has a high rate of suicide, and those who work in the field of health now have a different philosophy when it comes to the problem.
"There's no question we're talking about suicide now as a public health crisis," Scheel said.
Last week, two members of a high-risk group completed suicide in Missoula. Jame Wallack and Sam Edelman both were transgender people. In response to their deaths, family members are calling for tolerance, and advocates and public officials are stressing the need for education and compassion.
"The best thing we can do is really just show acceptance and love for each individual," Scheel said.
Edelman was a student at the University of Montana, and Wallack was a former student at Missoula College.
Cathy Joy, assistant director of counseling services at UM, said counselors have a proactive response plan in place for crises, and they also respond based on unique needs that arise on a case-by-case basis.
For instance, counselors have been available in Miller Hall for students, and in at least one case, a therapist is talking with a class. The mental health professionals also review their files and reach out to individuals who might have been affected by a particular death or be at risk themselves.
"We're already in a high-risk state, and then you add being a minority, like being in the transgender community, and that amplifies that risk even further," Joy said.
She also said UM conducts "gatekeeper training," where it teaches people about suicide prevention and tries to reduce the stigma around access to mental health services.
In some respects, being in college is a preventive measure for younger people, she said. That's because people who have a sense of community are less likely to take their own lives, and college provides that support.
"It's not perfect, certainly, and there are gaps, but there is a community sense here that someone who is 18, 19 and not in college does not have," Joy said. "So there's even more isolation outside of college."
Bree Sutherland, executive director of the Gender Expansion Project, said "coming out" isn't easy in Montana, and even its larger cities remain rural. Nationally, at least 45 percent to 51 percent of transgender people attempt suicide, and some early findings from new research suggests the rate is even higher, she said.
"For those that are first coming out, even Missoula can be very alienating," Sutherland said. "If you don't know where to look for support or where to find resources, it can be really difficult."
The Gender Expansion Project aims to connect people to existing services, and its general membership is more than 150 in Missoula, with Billings and Bozeman not far behind. In all, some 300 or 400 people are actively getting support, she said.
"Oftentimes, what we see with those groups is we see a lot of people very early on in transition coming and getting the support that they need, working through the hardships they're struggling with and their individual transitions, and transitioning," Sutherland said. "Then, they just kind of go on and live their life."
Education is key to reducing the stigma around being transgender, she said.
"Can we have inclusive sex ed that recognizes that there are LGBTIQ'd people and that there are trans people, and that gender and sex and sexuality aren't the same?" Sutherland said; LGBTIQ stands for lesbian, gay, bisexual, transgender, intersex, and queer and questioning. "Simple things like that can raise awareness."
And she said youth education is especially important.
"Let's intervene in this process before they get to a place where they are so ashamed of their identity that they are suicidal," Sutherland said.
Oftentimes, she said, transgender people attempt suicide because they feel alone and don't believe people understand them, so awareness is critical.
Other groups that are at high risk of suicide are middle-aged males, elderly people, Native Americans and military veterans, in addition to transgender people, said Scheel, of the Health Department.
"We're seeing more youth in high school and college age who are transitioning and really struggling with acceptance and just feeling a sense of community through that process," Scheel said.
And she said people who are harassed and bullied have a higher rate of suicide, but a sense of community is a protective factor.
On Saturday, the Gender Expansion Project is holding an open house from 8 a.m. to 10 p.m. at 127 N. Higgins Ave., Suite 202, to show support for transgender people, and their friends and family members. Sutherland said people who are in distress should know they have a community, and they do not need to drown their feelings in drugs and alcohol.
"We will not ever accept suicide as an answer," she said. "We will persevere as a community, and we will do anything in our power to help our community."