Suicide is, for most of us, an uncomfortable subject, one we’d rather not talk about.
But last week, two prominent people took their own lives — designer Kate Spade and chef/author Anthony Bourdain — and that’s sparked a national conversation on the topic.
Adding to the discussion, the Centers for Disease Control (CDC) released a report showing that the rates of suicide are on the rise in nearly every state.
This certainly is true of Benton County, which saw a spike of 48 suicides in 2017. It’s the most in the county in 10 years.
The victims ranged from their teens to 101. More than half were by gunshot, followed by hangings and overdoses.
Otherwise the victims had little in common, said Benton County Coroner John Hansens. They lived in all parts of the county and cut across racial and economic lines.
And already this year, Kennewick police are seeing more suicide attempts. Police have responded to 53 attempts, nearly a third more than at this time last year.
The trends hold up across the state.
From 2014-16, Washington’s suicide rate was 15.1 deaths per 100,000 people. That is 19 percent higher compared to 1999-2001.
The new federal report shows Benton County had 21.2 deaths per 100,000 people in 2015. Franklin county had far fewer at 11.5 deaths per 100,000.
Suicide is the eighth-leading cause of death in the state, and the second-leading cause for ages 15 to 34.
In Puget Sound counties outside the Seattle metro area, the rate has gone up the most, by about 29 percent since the period from 1999 to 2001.
The smallest increase is in the southwestern part of the state, at 11 percent. In the Seattle metro (King, Pierce and Snohomish counties), the rate increased by 15 percent.
So why are suicide rates on the rise?
“That’s the question that’s at the front of everyone’s mind in suicide prevention,” said Christopher DeCou, senior fellow at Harborview Injury Prevention and Research Center, which is affiliated with the University of Washington and Harborview Medical Center in Seattle.
“The unsatisfying answer is that no one is exactly sure why the rates are continuing to go up, despite the tremendous effort to try to understand the reasons people hurt or kill themselves,” he said.
This was echoed by Cameron Fordmeir, the manager of outpatient services at Lourdes Health in the Tri-Cities. He noted it’s rarely a single event that pushes a person into killing themselves. Problems such as financial troubles, family issues and legal challenges can combine overwhelm a person.
It’s important to keep in mind that suicide, while not predictable, is often preventable, DeCou said.
“Many people, when they hear about a suicide — especially a celebrity suicide — they think it’s something that happens out of the blue, that it’s sudden,” he said.
In fact, research shows that the process leading up to a person inflicting self-harm is very gradual, and there are many potential points of intervention along the way.
Data show that rural places have consistently higher rates of suicide than metropolitan areas. The Seattle area suicide rate is 13.7 deaths per 100,000 people, the lowest in the state.
Nationwide, Montana has the highest suicide rate, followed by two other sparsely populated states, Alaska and Wyoming. The lowest rates are in the more urbanized Northeast: New Jersey, New York and Massachusetts, in that order.
A major factor behind this difference, DeCou says, is that there’s less access to health care, particularly for mental health, in rural areas. Other risk factors for suicide that can be higher in rural areas include social isolation, rates of alcoholism or drug abuse, and gun-ownership rates (nationally, about half of all suicides are carried out with a firearm).
The suicide rate for men, both in Washington and nationally, is more than three times higher than for women. One of the factors behind that higher rate is that men are much more likely to use a highly lethal means, such as a gun.
Although the suicide rate for men is much higher, the rate for women has been increasing faster. We see this at the state level and nationally, but the reasons behind are not well understood, DeCou says. Women represent about one out of four suicides in Washington, up from one out of five.
Among racial or ethnic groups, both in Washington and nationally, Native Americans have the highest rate of suicide, followed by whites. Latinos, blacks and Asians have a significantly lower rate.
White middle-aged men (age 45 to 54) are a particularly high-risk demographic, representing one out of eight suicides in Washington. Other groups known to have alarmingly high suicide rates nationally are veterans and transgender people.
DeCou said that when a particular subpopulation has a higher rate of suicide, it’s important not to conclude that there is something inherently more at risk about people in that group, but instead to look for the reasons behind it. For example, among Native Americans, limited access to resources and historical trauma are factors that contribute to the increased risk of suicide.
Leaders throughout the state have not sat quiet while the rate has increased.
It has been an issue close to the heart of state Sen. Sharon Brown, R-Kennewick, who wrote about the suicide of her sister’s husband in January 2016. Since then the she has led multiple efforts to increase access to treatment.
Brown sponsored the Youth Behavioral Health Protection Act. The bill received unanimous support in the senate and near unanimous support in the house.
It removed a bureaucratic obstacle preventing Medicaid-eligible patients from seeing a primary care physician and a mental health professional during the same visit.
She returned last session with a new bill, this time aimed at college students. In the wake of Washington State University quarterback Tyler Hillinski’s Jan. 16 suicide, Brown was looking to provide students and staff with resources to prevent suicides.
Specifically, Brown’s bill (SB 6514) asked the the state Department of Health to collaborate with the Washington Student Achievement Council to develop a central place where college staff and students can learn more about how to deal with people that may be suicidal.
The bill passed both houses and was signed off by the governor.
“Every student dealing with stress, every veteran on campus suffering from post-traumatic stress disorder must know they can reach out for help and if they do, that critical aid will be there for them,” Brown told the Herald.
Brown’s bill was one of six advocated for by Forefront Suicide Prevention. The organization treats suicide much like a public health agency might treat any preventable disease.
“Suicide is the most preventable cause of death,” the organization said on its legislative agenda. “The steps we take to spread this message — and build it into systems and communities can lessen its toll.”
Forefront is one of the organizations leading efforts to attempt to curb the suicide rate.
In 2012, Washington became the first state in the nation to require all health-care providers — from physicians to physical therapists to pharmacists — to complete training in approaches to suicide risk assessment, management and treatment. This is an important step in prevention because, while many people who die by suicide do not receive mental health counseling, they commonly interact with other types of health-care providers in the months before the suicide.
Forefront is also involved in the Safer Homes initiative, a public-health campaign to educate individuals on safe storage of firearms and medications. Placing a barrier between a person who is having a mental-health crisis and the means to access guns or medications is a key approach to suicide prevention.
In addition to other suicide-prevention programs, Forefront provides support to people who are grieving the loss of someone to suicide through their Forefront Cares program.
Kennewick police remind people there is help available, either by calling the National Suicide Prevention Lifeline at 800-273-8255, calling 911 or using the directory of services available at win211.org.
“Today we responded to yet another preventable death,” Kennewick police said in a recent Facebook post. “Please learn the signs and seek help. Don’t leave your friends and family with a feeling of guilt. Help is available. Don’t be afraid to speak up.”