Reducing suicide deaths takes a community
On Nov. 30, 2018, AJ Holzscheiter took his own life.
He was just 18 years old.
AJ wasn’t alone. In fact, the following year, which is the most current confirmed data available, 109 Vermonters took their own lives.
Those deaths occurred across all ages and incomes.
According to the Vermont Department of Health the 2019 suicide death rate was 15.3 per 100,000 people, which is down from 2018 which was 18.8 per 100,000. “This is encouraging but just like with the national data, we can’t say yet whether it’s going to turn into a trend. We don’t have the preliminary suicide death data for 2020 in Vermont yet. 2019 was similar to previous years in terms of who died by suicide, with males dying about 4 times more often than females, and most of the people were over age 25.”, noted Tom Delaney, PhD, Assistant Professor, Department of Pediatrics, UVM Larner College of Medicine.
The Vermont Suicide Prevention Center reports that the rate of suicide in Vermont ranks 18th nationally and is the second leading cause of death for ages 15 – 35.
Most deaths by suicide had noted risk factors
Research from the Centers for Disease Control and Prevention suggests there are several risk factors for suicide, including: individuals with a family history of suicide, personal history of suicide attempts, a mental health diagnosis, feelings of hopelessness, isolation, history of alcohol and substance use, having experienced maltreatment as a child, easy access to lethal means, and stigma around seeking mental health treatment. The following information is from Vermont’s Violent Death Reporting System (VTVDRS), which collects information from death scene investigation reports.
Impact of COVID on suicide
The COVID pandemic has been a major disrupter of life as we knew it. In relation to suicide, Delaney stated, “We’re still early in the process of understanding the impacts of COVID-19 on self-harming behaviors and suicide. We know from earlier pandemics and other large scale social disruptions that suicide rates sometimes decrease in the months immediately after the population starts being impacted, and in some cases (like for the 2018-20 influenza pandemic) there was a rebound effect where suicide rates later went up. The CDC data for 2020 currently only goes through August of 2020, and does not show a spike in suicide deaths.”
Community approach in addressing suicide prevention
One of the ways that the challenge is being addressed is through the Zero Suicide Initiative, a research-based model for reducing suicide deaths that provides not only a guide for treatment, but also assessments of mental health agencies own capabilities and areas for improvement.
As one of the three original pilot sites for Vermont’s Zero Suicide initiative, Northwestern Counseling & Support Services (NCSS), which serves Franklin and Grand Isle counties, has trained clinical staff in key programs on suicide assessment and management.
“There are so many different pathways to suicide,” said Dr. Steve Broer, Director of Behavioral Health Services at NCSS. “We’re concerned about older Vermonters. We’re concerned about individuals from the Abenaki community. We’re concerned about veterans.”
Both nationally and regionally, most people who have died by suicide have not sought help from a mental health provider in the months leading up to their death, but nearly half had seen a primary care provider within a month of their passing.
That connection with a medical provider creates an opportunity to reach people. Taking advantage of that opportunity means training medical providers and other providers to screen for suicide risk. NCSS has counselors embedded in primary care and some specialty practices around the region so that when a patient is identified who needs mental health services, they can be connected with someone immediately rather than simply given a number to call.
“We’ve been developing our model in primary care and specialty care practices over the last nine years and are learning that our embedded behavioral health staff are often the first contact patients have with a mental health provider,” said Deana Chase, Program Manager for NCSS Integrated Behavioral Health Services. “In the last year we offered services to approximately 435 patients who said this was the first time they have sought mental health services. Our providers are also able to facilitate contact with other essential services at NCSS and the community to start a plan of care to address needs.”
Typically, during non-COVID times, just 8 percent of NCSS services are provided at the agency’s main office. The rest are out in the community, including in schools and working with local law enforcement agencies.
It’s all about meeting people where they are.
NCSS also meets people when they are in need, operating a 24/7 crisis hotline (802-524-6554). Clinicians who work on that hotline arrange to meet patients in person when necessary, regardless of the time of day. In addition, NCSS is one of a network of organizations which answers the national Suicide Prevention Lifeline (800-273-TALK).
The hotlines aren’t only available to people in crisis. Family and friends can also call for information, advice and support, including how to improve safety in their homes by identifying and removing the means to kill oneself.
That often means securing firearms.
Most gun deaths in Vermont are self-inflicted. Also, firearms are the leading means for ending one’s life in Vermont, especially among men.
“In terms of methods used for suicide, more than half of the people who died used a firearm, and this was more common in males than females. The rate of Vermonters who die by suicide using a firearm is higher than the national rate: 55% versus 50%”, noted Delaney.
NCSS offers free trigger locks and advice on how to secure weapons so that everyone in the home is safe.
One of the populations in Vermont most at risk is the Abenaki community. Official numbers are hard to obtain because many families and funeral homes don’t check the Native American box when completing a death certificate, but members of the community know their suicide rate is high.
“We would go through the death certificates and we know who our people are,” said Brenda Gagne, a leader of the Abenaki Nation of Missisquoi and coordinator of the Circle of Courage Afterschool Program in Swanton.
NCSS has partnered with the local Abenaki community in a long-term project that will begin with interviewing members of the community and health care providers to identify barriers that might keep Abenaki community members from accessing mental health services.
The aim is to create infrastructure and programming focused on culturally sensitive care for Abenaki populations.
That includes awareness of trauma inflicted on the Abenaki historically, as researchers have found that successive generations still show evidence of anxiety and behaviors resulting from traumatic events such as mass starvation or killings.
The Abenaki were targeted in eugenics programs in Vermont in the first half of the 1900s. Discrimination experienced in schools and targeting by state agencies deepened that trauma.
“We’ve been told not to air our dirty laundry,” said Gagne. “It’s born into us.”
Broer believes that a fear of being hospitalized may prevent people of all backgrounds from seeking help. “The reality is most individuals who experience suicidal thoughts, feelings and behaviors can be effectively treated in our community,” he said.
Getting to zero suicides means addressing risk factors, identifying early signs of distress that lead to suicide and knowing how to prevent self-harm.
The challenge is to get that information into the community, which in turn means overcoming the fear that discussing suicide will somehow give someone the idea of dying by suicide.
“In fact, the opposite is true. Research shows that asking someone you fear is suicidal if they are considering suicide is one of the best things you can do,” said Lance Metayer, Team Leader for School-based Services at NCSS.
“Be really direct, open and honest,” he advised, and remember that the person you are speaking to is “probably the most vulnerable they’ve ever been in their life.”
“If you suspect someone is at risk for suicide, don’t leave them alone and reach out to family and mental health service providers,” Metayer said.
Ninety percent of those who die by suicide were also suffering from a mental illness such as depression or anxiety, according to Metayer. “A mental health challenge isn’t something that’s permanent. You can get better,” he said.
Identifying those at risk and connecting them to mental health services is too big a task for mental and physical health care providers alone. That’s why NCSS is actively training community members in Mental Health First Aid, which teaches people how to identify and respond to someone in need of mental health services. It’s ideal for people in human services, law enforcement, pastors, or anyone interested in being able to assist someone in need.
NCSS also offers a version for people who work with youth, such as coaches, educators and camp counselors. This year, NCSS is part of a national pilot training teens in mental health first aid. Another program, Umatter, trains community members specifically on suicide prevention.
Just as with physical health, mental health clients, including those at risk of suicide, need a care plan that involves all care providers, mental and physical.
Once a person has been identified as at risk for suicide, the first step is a safety plan detailing steps the person will take when thoughts of suicide arise. The person at risk is directly involved in creating the plan.
Individuals receive treatment based on identified best practices for those at risk of suicide from a team that often includes health care providers as well as mental health counselors.
The Franklin Grand Isle Suicide Prevention Task Force is bringing together a broad swath of the community to focus on prevention efforts such as the partnership with the Abenaki and the Afterglow Initiative launched by the family of AJ Holzscheiter to educate parents and medical service providers about youth suicide prevention.
“While there is still much to learn about strategies to reduce suicide deaths,” said Broer, “one finding is clear: it takes a community to reduce suicide deaths.”
About Northwestern Counseling & Support Services, Inc. (NCSS)
Since 1958, NCSS, a private, non-profit, human services agency has been serving Franklin and Grand Isle Counties. NCSS provides intervention and support to children, adolescents, and adults with emotional and behavioral problems; a mental health diagnosis; adolescent substance use; and an intellectual disability or developmental delay. Over 500 staff members help over 4,000 people each year in 18 locations in collaboration with community partners. NCSS’ 24/7/365 crisis team and mobile outreach is available to meet the needs of Franklin and Grand Isle County children, adults, and families in crisis by calling 802-524-6554 then press 1.
www.ncssinc.org NCSS… we’re here for you.
This article is part of a series being produced in collaboration by members of the Vermont Care Partners statewide network of sixteen non-profit, community-based agencies providing mental health, substance use and intellectual and developmental disability support. To find an agency near you visit https://vermontcarepartners.org/agencies.