Karl Rosston

Karl Rosston

Montana DPHHS

BILLINGS – A statewide review team tasked with looking into Montana’s drastic suicide rates presented its first round of information Monday, drawn from the state’s 243 completed suicides during 2014.

Karl Rosston, Montana’s suicide prevention coordinator and a member of the Montana Suicide Mortality Review Team, spoke on the findings at the fifth annual Conference on Suicide Prevention, held at the Mansfield Health Education Center at St. Vincent Healthcare.

“This is not just a single incident,” he said of Montana’s worst-in-the-nation suicide rates. “This is 100 years of data. It’s a cultural thing. It’s going to take a cultural shift in thinking to address this.”

Rosston cautioned that no inferences should be made yet from the data, saying that it represents just one year’s worth of numbers and that it will take another year or two to properly identify potential patterns.

The team’s summary report covers all of 2014 and looked at 243 of the state’s suicides – about 20 per month – which resulted in a rate of 23.8 per 100,000 people, the highest in the United States.

The seven-member team was appointed by Gov. Steve Bullock in 2013 and charged with looking at the factor’s driving Montana’s high suicide rate and making recommendations on preventing deaths.

Of the state’s completed suicides, 81 percent involved males, while nearly a quarter were veterans, surpassing the national rate of 20 percent. The most common age group was 55 to 64 years old, with 51 suicides.

Rosston noted that the 21 involving American Indians represented almost 9 percent of the state’s suicides, while Indians make up just over 6 percent of the state population.

Among other data, three-fifths of Montana suicides during 2014 had no identified mental health disorders and 70 percent had no identified criminal history.

Rosston said one often-overlooked number is that 40 percent of Montana’s completed suicides involved people with severe medical problems, including terminal illness or chronic pain.

“We have to change something with this issue ... with people who are tired of the pain, who didn’t want to have another surgery,” Rosston said.

The report was compiled largely using information from coroner reports, and then further detailed through follow-up requests. Rosston said there has been a lack of consistency from county to county in the amount of information provided by coroners and that it has been an ongoing challenge to get everybody to completely fill out the uniform report sheet.

While the numbers are preliminary, he said there’s no single contributing factor to the state’s high rates but described Montana and the Northern Rockies as “a perfect storm” for conditions that might help to foster the problem.

Those factors include the state and region’s social isolation; easier access to firearms, with 63 percent of Montanans owning a firearm versus 37 percent nationally; Montana’s highest-in-the-nation alcohol consumption rate; and socioeconomic issues relating to poverty and limited access to health care.

Rosston also noted studies that link higher elevations to higher suicide rates and a long-held stigma surrounding talking about mental illness and suicide in Montana.

Rosston focused on preliminary actions that could help reduce suicide risk in Montana.

That starts, he said, with increasing community awareness and training in suicide awareness.

“We find it very relevant in our state,” Rosston said. “How many people showed signs and people weren’t able to recognize it?”

Other actions could include providing immediate resources for survivors, depression screenings by primary care providers, universal prevention training for all health care providers, firearm safety programs, earlier referrals to hospice services, depression screening as part of drunken-driving convictions and utilizing elders in American Indian tribes to impart cultural wisdom and traditions.

They also include wellness check and crisis intervention training for law enforcement, depression screening and suicide prevention training in schools, providing coping and resiliency development to elementary children and adding a statewide American Indian suicide prevention coordinator.

Rosston was one of several speakers at Monday’s conference, presented by the Suicide Prevention Coalition of Yellowstone Valley and Billings Clinic.

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