Cindy Uken's reporting on Montana's suicide epidemic was undertaken with the help of a California Endowment Health Journalism Fellowship from the University of Southern California's Annenberg School of Journalism.
MILES CITY — It has been more than four years since the last youth suicide in the Miles City public school system.
It was Aug. 25, 2008. The student was 14-year-old Nicole McFarland.
Scott Rapson is on a mission to ensure that she was the last.
The part-time high school counselor knows that statistically it will be improbable to sustain that. At a rate of 26 suicides per 100,000 people, Custer County has the second-highest suicide rate in the state, behind Deer Lodge. That is more than twice the national average.
Though Rapson knows of at least three suicide attempts in the past year, none have completed the act. That, Rapson said, is progress in a student body of about 500 youth. He credits implementation of the SOS -- "Signs of Suicide" -- program, a nationally recognized suicide prevention initiative designed for high school students. More than 150 SOS kits have been distributed to schools throughout Montana by the state Department of Public Health and Human Services.
The kits are one tool aimed at helping reduce the number of youth suicides in the state. In Montana, between 1999 and 2009, suicide was the second-leading cause of death for children ages 10-14 and adolescents ages 15-24, behind unintentional injuries like auto and farm accidents.
In the two years between 2010 and 2011, 57 youth ages 15 to 24 killed themselves in Montana.
State health officials believe the kits could be part of the reason for a reduction in risky behaviors, as suggested by the most recent Montana Youth Risk Behavior Survey.
The primary teaching tool of the SOS program, which is generally taught in ninth-grade health classes, is a video that teaches youth how to identify symptoms of depression and suicidal thoughts in themselves or their friends, and to respond effectively by seeking help from a trusted adult. The program has shown a 40 percent reduction in suicide attempts, according to the American Journal of Public Health.
“The premise is to have students watching out for each other,” Rapson said. “Teachers and counselors don’t have our pulse on every single kid, but kids have a pulse on kids.”
Since implementation of the program, school counselors now receive more referrals from students than from teachers about kids who might be at risk.
One came from 16-year-old Josiah Kaderis, a sophomore. A friend of his was cutting, a form of self-mutilation. Concerned, Kaderis confided in a school counselor. Admittedly, the friend was peeved with Kaderis for telling, but Kaderis makes no apologies.
“I want a friend who is alive and well,” Kaderis said.
Marissa Singleton, 17, a senior, recalls the days before the SOS program. Two school acquaintances killed themselves. After their deaths, and the initial frenzy that followed, the incidents were never again discussed. The issue was depersonalized with discussions about statistics, she said.
“I didn’t know them well, but it affected me,” Singleton said. “It affected the whole community.
A friend told Bailey Naylor, 16, a junior, that his life was horrible and that he was contemplating suicide. Naylor confided in a school counselor and the boy is now getting the help he needs.
“I am proud of what I did,” Naylor said.
The program has provided students with a safe way to discuss anxiety, depression and thoughts of suicide with each other. They are no longer taboo topics. That is especially important in this small community where parents may encourage their children not to air the family’s dirty laundry, discuss their emotions or seek professional help out of shame.
“There is also an old idea out there that if you talk about suicide, it gives kids ideas,” Rapson said. “That is a total myth.”
During 2010, at least 227 Montanans killed themselves. In 2011, the number dipped slightly to 225, although Montanans kill themselves with greater frequency than residents of any other state in the nation.
An estimated 15 Montanans attempt suicide every day.
The problem is so prevalent that mental health leaders characterize it as a public health crisis.
The crisis has many causes: 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; a largely rural population where support groups and family member can be far away, and the prevalence of firearms.
This "cowboy up" mentality and the inaccessibility to resources are literally killing people, Rapson said.
“Even if kids do acknowledge having a problem or issue, how do we then get them the help they need?” he said. “That’s a huge issue in this area, being rural. To ask a family to drive their kid 80 miles each way to come see a therapist, that’s a big ask for a family.”
The SOS program is helping fill some of the void. So is a new website, www.letstalkmilescity.org, that was launched in September and already has generated more than 16,000 hits. It is designed as a self-help resource for those who do not feel comfortable talking to anyone.
Rapson is also involved with the “Let’s Talk Miles City” campaign, which is dedicated to preventing suicide among teenagers. Several students play roles in the production.
Rapson remembers 2008, when suicides were so rampant in the district that the issue was placed on the school board agenda. Rapson, who attended some of the meetings as an intern working on his master’s degree, remembers some of the “gut-wrenching” discussions. Grieving, exasperated parents demanded to know what school administrators were doing to help stop the death toll.
“We have a responsibility to do as much as we can,” Rapson said. “We did need to make some changes. Things needed to improve.”
School leaders know the day will come when, despite their best efforts, a student will end his or her life. They are ready. A response team of teachers, counselors and administrators has been organized and trained.
“Where we were probably frowned upon as a community for not doing enough, I now feel like we’re leaders," he said.
SOS "Signs of Suicide" is a 2-day secondary school-based intervention that includes screening and education. Students are screened for depression and suicide risk and referred for professional help if needed.
Students also view a video that teaches them to recognize signs of depression and suicide in others. They are taught that the appropriate response to these signs is to acknowledge them, let the person know you care, and tell a responsible adult. Students also participate in guided classroom discussions about suicide and depression. The intervention is designed to prevent suicide attempts, increase knowledge about suicide and depression, develop desirable attitudes toward suicide and depression, and increase help-seeking behavior.