Now with several years' worth of data, Montana's suicide review team will make recommendations to the 2017 Legislature to confront a statewide crisis that has consistently placed Montana's suicide rates among the highest in the country for 40 years.

The 2016 Montana Suicide Mortality Review Team Report gives a detailed look at Montana's suicide statistics — its crude rate of 22.33 suicides per 100,000 people from 2005 through 2014 nearly doubles the national rate of 12.22, and it's 2014 rate of 23.8 was the highest in the nation — while offering policy and legislative actions to address the problem.

"Our recommendations were based on our findings of, overall, where we saw patterns or what we saw the highest incidence of," said Karl Rosston, state suicide prevention coordinator with the Montana Department of Public Health and Human Services.

The recommendations cover training for primary care providers like nurses and doctors, screening, prevention efforts while also targeting efforts to reach Montana's American Indian population, which has a much higher suicide rate than the rest of the state and three times that of the U.S. native population.

Getting legislative action can help get resources and programs into a wide swath of public places and entities while enacting laws that boost prevention efforts, Rosston said.

"I think it’s safe to say that suicide is a public health issue," he said. "...All we can do is recommend. It really is up to the powers that be to determine whether they want to move forward with them."

Rosston said the team is recommending the PAX good behavior game — a program designed to give kids coping skills at an early age that has been implemented in other states, as well as a handful of European nations, and has shown to improve children's resiliency later in life — be implemented in all first- and second-grade classrooms statewide.

It's been used in some classrooms in Montana, but getting it into all of them — something legislative action could help greatly with — could help reduce future rates by addressing some of the underlying issues that lead to suicidal behavior long before they manifest.

"There's a growing list of research in the U.S. and internationally about the positive effects of the game with kids," Rosston said. "New Mexico went statewide with it in first and second grade and they saw positive effects within 30 days in implementation. We know from the research, from years and years of research, that early intervention has the best prognosis."

Many of the report's conclusions and recommendations come from having another year's worth of data to analyze. The 2016 report is just the second issued since the Suicide Mortality Review Team formed, and while Montana's rates are some of the highest nationally, the state's low population meant that just one year's worth of information made it difficult to draw solid conclusions from just the 2014 data.

"Nothing was too different, numbers-wise," Rosston said. "If anything, with a much larger sample size, it's been validated. Because our sample size went up so much, we were able to have an epidemiologist look at that and make some correlations."

The Montana Suicide Review Team was created by House Bill 583 in the 2013 Legislature.

The panel, which will meet at least eight times a year, will be made up of professionals, including a psychiatrist, psychologist, clinical social worker, a member of the clergy, a physician assistant, a tribal health department representative and a representative of the U.S. Department of Veterans Affairs. Each will serve a three-year term.

The team's first report, issued in 2015, analyzed the more than 240 suicides from 2014, while the new one encompasses information from 555 suicides, adding 2015 and 2016 through February to the 2014 data.

Among those conclusions is that, nearly across the board, Montana's rates in just about every category — overall, ethnicity, age, gender and a number of others — are often twice or three times higher than the rest of the country.

The state's rate of male suicides was 45 per 100,000, while the national rate was about 21. The state female rate was about 12, while national numbers were at about 6 per 100,000.

The report makes particular note of the state's American Indian population, which had a rate of 35.5 suicides per 100,000, three times higher than rest of the U.S. native population.

The report includes number of other factors, including relationship status, showing people who were single, separated, divorced or widowed had much higher rates; by education, which indicated that rates drop for each level of education a person has attained; by method, with firearms used in 63 percent; and age, which showed that that most suicides happened in the 55 to 64 age range, followed by the 45 to 54 group.

The report showed 27 deaths of youths age 11 to 17, as well as 121 veteran suicides — both active duty and retired, making up more than a fifth of the state's total suicides — over the same time.

It attributes Montana's high suicide rates to many factors.

"Access to lethal means (firearms), alcohol, a sense of being a burden, social isolation, altitude, undiagnosed and untreated mental illness, lack of resiliency and coping skills, and a societal stigma against depression, all contribute to the long-term, cultural issue of suicide in Montana," the report says.

Along with the report, the suicide review team issued in August the 2017 Montana Strategic Suicide Prevention Plan, which provides a framework for a long-term cultural shift that the team believes Montana needs to reverse its suicide rate.

Much of that hinges on public awareness, education, prevention and intervention efforts and aligning efforts — which Rosston said Montana has done — with goals laid out in the 2012 National Strategy for Suicide Prevention.

"This will be a slow change," the plan states. "There is a culture of suicide in Montana that has been evident for generations. It is going to take a cultural shift in thinking that starts with our young people, giving them the tools and skills necessary to cope when they reach the high-risk ages between their mid 20s through their 50s."

Rosston said that seeing how Montana's ongoing suicide prevention efforts align with national goals help show that it's doing the right things to get to the bottom of the issue, but that action is now needed.

"It reinforces in many ways that we’re not far off in knowing what we need to do," he said. "We’re in line with what the national goals are. Now we can say, 'OK, we now have a better idea of what needs to be done." But it’s no longer that we can sit here and say, 'We have no idea why this is happening in our state.' What are people willing to do to address this?"

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