At nearly twice the national average, Montana has the highest suicide rate among adults aged 45-64 among any state in the U.S. As of May of this year, 61 Montanans had already died by suicide, and in a 2015 Youth Risk Behavior Survey, nearly nine percent of high school students were reported to have attempted suicide in the 12 months prior to being surveyed. This staggering statistic is not a new trend, as the rate of suicides among adults and teenagers in this state has been steadily climbing over the last century. The alarming death toll has puzzled psychologists, sociologists and anthropologists, alike, and has prompted state- and nationwide efforts to better understand and combat this troubling pattern.
While depression is always the strongest predisposing factor to suicidal ideation and commission, other cultural and environmental factors unique to Montana contribute to the high suicide rate. With the rate of Montanan high school students attempting suicide above the national average of eight percent, social issues such as bullying, drug abuse and alcohol abuse are compound the psychological distress of depression that these adolescents may already be experiencing.
Similarly, the 267 statewide suicides in 2015 likely did not result from depression alone, but from factors such as local economics and mental health infrastructure, alcoholism, firearm culture, social isolation and, of course, stigma. Montana has a population of less than 7 people per square mile, which is scant compared to the national average of nearly 90 people per square mile, so the weak social integration among residents likely makes finding strong social support systems difficult, and, thus, detection of warning signs less likely. Moreover, Montana ranks near the top nationally in DUIs, binge and underage drinking and alcohol-related deaths. In 2015, 40 percent of the individuals who committed suicide in Montana had alcohol in their systems. Montana also ranks second for the percentage of its residents who own firearms, and roughly 65 percent of suicides in the state are carried out using some sort of firearm. Links have also been found between the change in altitude in the state the potential effects of long-term oxygen deprivation and subsequent metabolic stress on mental health.
Additionally, about 160,000 Montanans are uninsured, and about 20 percent of children within the state live more than 100 percent below the poverty line. So not only is their limited availability of and geographic proximity to well-trained mental health professionals throughout the state, but socioeconomic access to the resources that would best help members of the target population are rarely affordable for them. Not so unique to the state is the stigma and fear those dealing with depression and suicidal ideation face, preventing them for asking for help and seeking the proper resources that could help treat their depression and prevent potential deaths. The culture of secrecy and shame that unfortunately still sweeps the nation has stifled the normalization of mental illness as common and treatable health issue.
Efforts have increased to train internal medicine residents and primary care providers in to administer simple 10-question screenings to determine the mental health status of patients entering local clinics. Younger residents may also be receiving more resources in the near future, as local school districts, such as that of Billings Public Schools, added one professional mental health counselor to each of its three high schools at the beginning of this year. Mental health advocates are also lobbying for increased mental health screenings of students within the schools.
Because resources for on-site mental health professionals on school campuses are scarce, there may be a silver lining as telehealth and telepsychiatry gain prominence in use. Their affordability and efficiency could allow students and adult residents living in particularly rural parts of the state to easily access numerous mental health professionals remotely. Millennials, especially, could relate to the ease with which they could text or facetime a counselor or licensed social worker who could talk them through a particularly tough time without feeling like they have to step too far out of their comfort zones to open up to someone, even a stranger. Someone who is both physically and emotionally isolated because of their depression could still find, in this opportunity, an outlet to reach out, to speak up. As Karl Rosston, Montana Suicide Prevention Coordinator, said in an interview with the Northern Broadcasting System on Voices of Montana, “Undiagnosed and untreated depression is the major, major point that we are emphasizing. We know that depression is very treatable, but people have to be able to talk about it.”