Suicide touches us all, especially in small, close­-knit communities like Durango. It seems we either know a family or know a family who knows a family where a suicide has occurred. According to data from the National Center for Injury Prevention, suicide is the second leading cause of death behind accidents for young people between the ages of 10 to 24. In Colorado, it is the first. In 2013, 17 percent of ninth- through 12th-graders seriously considered attempting suicide, 13.6 percent made a plan and 8 percent attempted. More than 13 percent of children have identifiable, impactful mental health concerns. These numbers are staggering. The problem is real.

We know that teens with mental illness, substance abuse and easy access to firearms are at greater risk. We also know that teens exposed to trauma and bullying are at greater risk. We know that those most vulnerable to bullying are those with disabilities, learning difference and lesbian, gay bisexual, transsexual, queer youths.

Interestingly, being a bully also puts one at risk of suicide. With increasing use of social media, bullying is amplified. A child can be relentlessly bullied from hundreds of miles away.

Excessive use of social media is also associated with depression and suicide. Youths are particularly vulnerable to this in that they are still developing their sense of identity as they are faced with unreal and impossible comparisons on Facebook or Instagram. Ironically, studies support a correlation between excessive use of social media and more antisocial behaviors.

With all that we know, why is youth and teen suicide on the rise nationally, and why is it more prevalent where we live? Mountain towns are disproportionately affected for a variety of reasons. Living at higher elevation is associated with increased incidence of depression. The higher cost of living typical of mountain towns puts added stress on families, with many having to work two or more jobs to support a modest lifestyle. Small mountain communities are often remote and isolated with fewer resources.

Timely access to quality pediatric mental health care is difficult to find because of cost and a shortage of qualified mental health providers. Many insurance companies do not reimburse for such care, and quality care is often an out-of-pocket expense, placing an additional financial burden on families.

Suicide costs our nation an estimated $44.6 billion annually. If we spent a fraction of that on increasing access to mental health providers, we could save both lives and money. Despite efforts to increase access to quality mental health care locally and nationally, fear and stigma surrounding mental health continues to impede access to care. This is one of the biggest barriers to resolving this suicide epidemic.

What can we do as parents, teachers, coaches, health care providers? Experts on suicide prevention recommend that we arm ourselves with knowledge and begin meaningful discussion. Given that nearly 90 percent of teens who commit suicide exhibit warning signs, learning these signs and intervening are crucial to saving lives.

Warning signs of suicide in teens include internet addiction, jokes about committing suicide, violent outbursts, skipping school, reckless behavior, loss of interest in activities, self­-deprecating comments and triggering events (Tools for Parents, Table 1).

It is important to recognize that talking about suicide does not plant a seed to act, rather, it has been shown to reduce the desire to act.

Speaking with our children about suicide can be a difficult thing to do. The Society of Prevention of Teen Suicide recommends that parents pick a time when they have their child’s attention, think ahead about what they will say, be honest, ask for their child’s response, listen and do not over­ or under­ react (Tools for Parents, Table 2). It is important to recognize that suicide is an attempt to solve a problem that the child feels is impossible to solve.

Here in Durango, we live in a caring community. We are lucky to have community partners such as Durango School District 9-R, La Plata Youth Services, Axis Health System and psychiatrists working toward reducing stigma of mental illness and suicide.

We’ve got a problem to solve together.

Heidi McMillan, MD, is a pediatrician with Pediatric Partners of the Southwest. She prepared this column in collaboration with PPSW’s Integrated Behavioral Health Team. Reach them at 375-0100.

Tools for Parents

Table 1. Recognizing the warning signs (the FACTs) can save lives
(From the Society for the Prevention of Teen Suicide, Inc. www.sptsusa.org)
FEELINGS seem different from the past (hopelessness; fear of losing control; helplessness; worthlessness; anxiousness, anger)
ACTIONS that are different from the way your child acted in the past (talking about death or suicide, risky behaviors, withdrawing from activities or sports, skipping school, or using alcohol or drugs)
CHANGES in personality, behavior, sleeping patterns, eating habits; loss of interest in friends or activities or sudden improvement after a period of being down or withdrawn
THREATS that convey a sense of hopelessness, worthlessness, or preoccupation with death (”Life doesn’t seem worth it sometimes”; “I wish I were dead”; “Heaven’s got to be better than this”);
SITUATIONS that can serve as “trigger points” for suicidal behaviors. These include things like loss or death; getting in trouble at home, in school or with the law; a break-up; or impending changes for which your child feels scared or unprepared.
Table 2. How to talk with your child about Suicide
(From the Society for the Prevention of Teen Suicide, Inc. www.sptsusa.org)
Timing is everything! Pick a time when you have the best chance of getting your child’s attention. A car ride when you have a captive audience or a local suicide that has received media attention can provide the perfect opportunity to bring up the topic.
Think about what you want to say ahead of time and rehearse a script if necessary. It always helps to have a reference point: (”I was reading in the paper that youth suicide has been increasing…” or “I saw that your school is having a program for teachers on suicide prevention.”)
Be honest. It this is a hard subject for you to talk about, admit it! (”You know, I never thought this was something I’d be talking with you about, but I think it’s really important”). By acknowledging your discomfort, you give your child permission to acknowledge his/her discomfort, too.
Ask for your child’s response. Be direct! (”What do you think about suicide?”; “Is it something that any of your friends talk about?”; “The statistics make it sound pretty common. Have you ever thought about it? What about your friends?”)
Listen to what your child has to say. You’ve asked the questions, so simply consider your child’s answers. If you hear something that worries you, be honest about that too. “What you’re telling me has really gotten my attention and I need to think about it some more. Let’s talk about this again, okay?”
Don’t overreact or under react. Overreaction will close off any future communication on the subject. Under reacting, especially in relation to suicide, is often just a way to make ourselves feel better.
Revisit the topic. ANY thoughts or talk of suicide (”I felt that way awhile ago but don’t any more”) should ALWAYS be revisited. Ask about the problem that created the suicidal thoughts. This can make it easier to bring up again in the future (”I wanted to ask you again about the situation you were telling me about…”)