Washington has maintained the highest rate of youth suicides of all states in the country for several years. In an attempt to understand why it is so high and to determine how best to reduce suicide rates, the Washington State Department of Health issued a report, Washington State’s Plan for Youth Suicide Prevention in 2009. The report, which was updated in 2011 and again in 2014, publicized alarming data on the rates of youth suicide in Washington. It also created a plan of action for how to reduce youth suicide throughout the state.
On average, two youths die by suicide and 17 more are hospitalized because of suicide attempts each week in Washington, according to the 2009 report.
There were nearly twice as many youth suicides as there were youth homicides between 2006 and 2010, making suicide the second leading cause of death in Washington State for people between the ages of 10 and 24. In contrast, suicide was the third leading cause of death for people between the ages of 10 and 24 nationally, according to the Centers for Disease Control and Prevention.
The report noted that previous research has found that at least 80 percent of youths who attempt or complete suicide have a diagnosable mental illness. Unfortunately, many young people do not have access to much needed behavioral health care because of limited public resources.
“Suicide is not simply a personal tragedy but a tragedy for the entire community,” said an unnamed local public health professional quoted in the report. “The reason that suicide is a public health issue is because resources needed to successfully prevent suicide are beyond the reach of individuals and families alone.”
In an attempt to mitigate this disparity, Washington created its first Youth Suicide Prevention Plan in 1995. The plan focused on four key areas:
- Increase universal prevention by raising awareness about the problem of youth suicide and providing pertinent information to people of all ages.
- Improve selective prevention by teaching people how to identify a youth at risk of suicide and where to turn for help, ultimately promoting a crisis response to youth suicide.
- Improve indicated prevention by offering family support and tools to build skills in suicidal youth to teach them how to make different choices to cope with their stress.
- Evaluate the success of current prevention programs and activities.
The 1995 plan was fairly successful and lead to the founding of the Youth Suicide Prevention Program, a private, non-profit organization, in 2001. In 2006, the Washington State Department of Health received a three-year federal grant to support and evaluate prevention efforts and intervention activities.
In spite of these achievements, however, the rate of youth suicide did not decrease for a variety of reasons, including, primarily, the persistent perceived stigma surrounding suicide, which prevents open and constructive conversation, as well as lack of financial and public resources. Without these resources, youth often cannot receive the health care they need when at risk of suicide.
The Washington State’s Plan for Youth Suicide Prevention report, recognizing that there is still much to be accomplished, outlined a new plan in 2014 with five goals:
- Ensure that suicide comes to be recognized as not just a matter relegated to those directly impacted by it, but rather a concern that pertains to everyone in the community.
- Increase the number of youths asking for help and getting help when they need it.
- Teach the public how to identify at-risk youths and how to help them.
- Make care available to those who seek it.
- Promote the idea that suicide is a preventable public health problem.
Being aware of risk factors that influence youth suicide is one crucial way to reduce youth suicide. According to ChildMind.org, some of these key risk factors include:
- A recent and/or serious loss
- Lack of social support
- Behavioral health disorders, particularly mood disorders or trauma- or stress-related disorders.
- Struggling with sexual orientation in an environment not accepting of that orientation
- Domestic violence
- Child abuse
- Family history of suicide
- Prior suicide attempts
- Increased access to lethal means, including pills and firearms
- Stigma associated with asking for help
Another crucial aspect of Washington’s new plan is to make care more available. Accessing psychiatric and behavioral health services can be difficult, in part because of the perceived stigma surrounding mental illness. The cost of care is also a considerable barrier for many families. In fact, according to Reducing Suicide: A National Imperative, a report published in 2002 by the Institute of Medicine, “the demand for mental health services is more responsive to price than is demand for other types of health services.”
According to the Reducing Suicide report, there are still several effective ways to decrease suicide rates. For example, interventions at multiple levels — universal, selective and indicative — aim to “attempt to address risk factors and to enhance protective factors.” Reducing the availability of a suicide method, or even just reducing the potency of it, can help decrease suicide rates. This means decreasing youth access to firearms or potentially lethal medicines.
Comprehensive school-based programs can also decrease suicidal tendencies in youth. Unlike awareness interventions, these programs provide youths with the skills they need to cope in healthful ways with the stressors in their lives.
One such program, Reconnecting Youth (RY), targeted high school students who were at risk of dropping out or failing out of school. This is because, according to Reducing Suicide, around 25 to 40 percent of potential high school dropouts are also at risk for suicide. Students participating in the program took part in daily, small group sessions with a teacher or facilitator. At the end of a semester (or 90 sessions), students “experienced clinically significant declines in suicide-risk behaviors; significant decreasing trends in depression, hopelessness, anger, and stress; significant gains in self-esteem and personal control; and increases in social support,” according to Reducing Suicide.
Telepsychiatry is another way to bring behavioral health services to rural youth at risk of dying by suicide, and mental health centers in Washington State are beginning to offer these services. For example, the Walla Walla office of the Central Washington Comprehensive Mental Health center has made it possible for children and adolescents to see remote psychiatrists and other behavioral health providers through secure videoconferencing, according to the Walla Walla Union-Bulletin.
Increasing access to telepsychiatry services will also require telehealth parity. While some telemedicine services are covered by government health plans in Washington State, private health insurance companies will also need to need to begin to cover telepsychiatry.
Youth suicide truly is a preventable public health problem. By creating and funding more programs and services designed to help youth navigate day-to-day life and behavioral health challenges, health care organizations, schools and communities can reduce suicide rates and prevent suicide in youth long before suicidality occurs.
If you or someone you know is contemplating suicide, call the National Suicide Prevention Lifeline at 800-273-8255.