For at least 35 years, Montana has had one of the highest suicide rates in the nation, and a disturbing number of those self-imposed death sentences have been young people.
Between 1999 and 2009, suicide was the second-leading cause of death in Montana for young people aged 10 to 24, behind unintentional injuries such as auto accidents and drownings.
In the two years between 2010 and 2011, at least 57 Montana youth aged 15 to 24 killed themselves.
“It is a major public health problem,” said Dr. Keith Foster, medical director of psychiatry at Shodair Children’s Hospital in Helena. “We must break down the barrier that we shouldn’t talk about this.”
The reasons youth kill themselves are much the same as the reasons for adults: a shortage of mental health professionals and mental health facilities; the state’s high rates of alcoholism; a cowboy culture where seeking treatment may be seen as weakness; and the prevalence of firearms. On top of that, many teens are at an especially vulnerable stage in their emotional maturity.
Guns are the most common means of committing suicide in Montana, which ranks third in the nation for per capita gun possession.
This, said Dr. Barbara Stanley, a leading youth suicide expert from Columbia University, is where parents should be held responsible.
“Parents, even though their child just tried to kill himself, will not get rid of their guns," she said. "I almost consider it tantamount to neglect if a parent knows they have a suicidal child in their home and will not get rid of, or at the very least, figure out some way to secure a firearm.”
Suicidal urges tend to surface, crescendo and wane. If the gun isn’t present at the peak of the urge, the youth might find another way to cope, Stanley said.
“You would actually save lives because you give the suicidal urges a chance to come down,” she said.
Further compounding the issue with teens is the question of sexuality. Lesbian, gay and bisexual teens are much more likely to commit suicide than their heterosexual peers, research has shown. Students who question their sexual orientation report more bullying, homophobic victimization, unexcused absences from school, drug use, feelings of depression, and suicidal behaviors than heterosexual students.
Physically and verbally abused youth are also at high risk of suicide. Family history and a lack of parental involvement also play a role. That's not to mention the hormonal instability, impulsiveness, immaturity and lack of life experience common to many adolescents.
Suicide is an irrational action by a brain that isn't functioning properly, said Matt Kuntz, executive director of the Montana chapter of the National Alliance on Mental Illness. Suicide is just a symptom. Being isolated prevents that symptom from being treated and having guns available makes it more likely the suicidal thought will lead to a successful suicide. But the root problem is the suicidal thought and that the brain keeps having those irrational thoughts.
"It's important to remember that the human brain is still in development until an individual is 25 years old," Kuntz said. "While a young person may have all of the symptoms of suicidal thinking that an adult with depression feels, their brains are still developing the ability to ensure those thoughts don't lead to impulsive actions."
So prevalent is the issue of suicide among the state’s youth that Shodair Children’s Hospital in Helena increased the number of beds in its acute wing to accommodate the growing need. In 2006, it expanded its eight-bed unit to 20 beds. The average length of stay on the unit, which is reserved for the acutely suicidal, is 10 days.
The additional beds are an indication that some children are getting the help they need, said Foster, the medical director of psychiatry at Shodair.
“It’s important to realize that people get better," Foster said. “One of the major myths of mental illness is that people can’t get better. That’s not true.”
In 2011 alone, 577 youth were admitted to the unit. Another 223 were admitted to the residential unit, which is designed for those who are not acutely suicidal and where the average stay is two to six months.
“The important piece is that even with those numbers, we have children waiting to get into the hospital,” Foster said.
There are four board-certified child and adolescent psychiatrists on staff, with a fifth scheduled to start in February. The hospital is recruiting a sixth to keep up with the demand.
Similar acute-care facilities are located in Billings, Missoula and Kalispell and still there aren’t enough beds to accommodate the need, Foster said. There have been times when suicidal youths have been housed on pediatric floors of hospitals in the state.
The Psychiatric Center Youth Inpatient Unit at Billings Clinic houses 14 beds where the average stay is five to seven days. In the past 12 months, at least 509 youth have been admitted to the unit.
In 2011, in grades 9-12 statewide, 6.5 percent of Montana students surveyed said they had attempted suicide in the past year, according to the Montana Youth Risk Behavior Survey, a tool that measures suicide and depression among other risk factors.
The news is even worse for Montana American Indian students on or near a reservation where 11.9 percent said they had attempted suicide in the past year.
Still, the overall statewide result is the lowest it has been since 1997. In 2009, 7.7 percent of those in grades 9-12 said they had attempted suicide in the past year. The rate was at its highest, 10.4 percent, in 2001.
It’s too soon to tell if that’s a trend, said Karl Rosston, Montana’s suicide prevention coordinator.
“But that’s progress,” Rosston said.