Creating connections:
Solutions to youth suicide in La Plata County

Emma Harmon wasn’t planning to try to take her life when she started driving north on U.S. Highway 550 one February night in a snowstorm.

“I just felt so out of control, at that point. It was like an impulse decision,” Harmon said.

At the top of Coal Bank Pass, she could not get past the snowplows, so she pulled over and tried to kill herself.

When she woke up hours later in the hospital, she was angry she hadn’t succeeded.

“I screamed to God. I was like, ‘You have to help me. If you are not there, fine, let me die. Otherwise, you have to change my life, and you have to change it right now, ’cause I can’t do this anymore.”

A week later, Harmon found out she was pregnant with her son, Kian.

“I was like, ‘That’s it. That’s my answer. I have to get better now. I have to change, and he’s my saving grace. He’s my miracle. He’s almost 4 years old now. He was everything. Without him, I wouldn’t have changed,” she said.

Harmon was 20 years old the night she tried to take her life in February 2014. Since then, she has returned to school at Pueblo Community College and has a job with San Juan Basin Public Health as a SafeCare provider, working with the parents of young children. She is pursuing her associate degree in psychology and plans to get a master’s degree in psychology.

She has depended heavily on friends and family for support in her recovery, and goes to therapy for her borderline personality disorder.

“There is hope. I am living proof of that,” she said.

Improving the relationships young people have with adults and their peers is a key suicide prevention step, according to a Centers for Disease Control and Prevention report.

In La Plata County, numerous suicide prevention efforts are promoting connection at school, in clubs and with behavioral health providers.

This series will explore youth suicide prevention programs and initiatives that have been successful outside the area and that have started in La Plata County. It will also explore new local ideas founded in the last year.

Young adults and adolescents represent a small percentage of those who die by suicide. However, in recent years, as more young people have died, the community has become increasingly concerned.

In May 2017, a community summit on suicide prevention hosted by San Juan Basin Public Health drew about 700 people.

Since then, agencies and nonprofits focused on preventing suicide and other risky behaviors among youths have repeatedly heard the need for greater connection.

Promoting connection requires honest and open communication about tough subjects, such as suicide, said Breeah Kinsella, interim director for Celebrating Healthy Communities.

“Things like suicide are really scary for people. It’s scary for me sometimes, but just being honest about the fact that it’s scary ... allows a young person to feel connected to the truth that you are speaking,” she said.

A local and national problemSince 2015, 12 people younger than 25 have died by suicide in La Plata County. Five of the deaths happened in the first seven months of this year, according to La Plata County Coroner’s Office records.

Dengler Frey

Connections are key to preventing youth suicide across La Plata County

Dengler Frey

“What we’re experiencing is sort of a microcosm of what’s really happening across the entire nation,” said Mary Dengler Frey, regional health connector at the Southwestern Colorado Area Health Education Center.

Nationally, suicide is the second leading cause of death for people between 15 and 24, after accidental injuries, according to the CDC.

The Durango Police Department has responded to a growing number of people with suicidal thoughts in recent years, and about 35 percent of those calls in 2017 came from people younger than 25. The youngest suicidal person the police worked with last year was 9 years old.

The La Plata County Sheriff’s Office has responded to 739 suicide-related emergencies from 2012 through July 2018.

Some of those calls come from Safe2Tell, an anonymous hotline promoted by local school districts that allows students to report suicide threats and other issues, such as child abuse, bullying and drug or alcohol use.

The rise in suicide reports may be attributed in part to greater awareness about the hotline, but there are other causes at play, said Kathy Morris, safety and security coordinator at Durango School District 9-R.

“I think it’s a multilayered issue,” she said.

Mental illness, depression, hopelessness, self-harm and substance abuse can all put someone at risk for suicide, said Cathrine Frank, an architect of a program in Detroit that became the basis for the national Zero Suicide Initiative.

Traumatic brain injury, an inability to sleep, physical and sexual abuse, relationship problems, bullying and a history of suicide in a person’s family are also among the factors that can contribute to a person’s suicide risk, she said.

Anxiety and depression are also on the rise in La Plata County and nationally.

Between 2010 and 2015, 33 percent more teenagers nationally exhibited high levels of depressive symptoms, and 31 percent more died by suicide, according to a 2017 study published in Clinical Psychological Science.

Bayfield counselor Amy Miglinas said she has observed a rise in anxiety and depression among students during the last 11 years. It is likely a mix of factors are contributing to the problem, she said.

“We expect a lot of our young people these days to be able to achieve,” she said. “The competition for college and scholarships, just the pressure that’s out there to be something, I think is a lot bigger than it used to be.”

She also believes social media plays a role in rising depression and anxiety.

The study in Clinical Psychological Science found a clear link between the time teens spend on electronic devices and depression.

Teens who reported spending the most amount of time on social media and the least amount of time in face-to-face social encounters reported the highest levels of depression.

Those using electronic devices three or more hours per day were 34 percent more likely to experience suicidal thoughts or attempt suicide, the study found.

While mental health needs are on the rise, the region has a shortage of behavioral health care.

For example, those on Medicaid are more likely to face longer wait times for behavioral health care if they are not in crisis, Dengler Frey said.

Prevention effortsIn La Plata County, schools, clubs, primary care doctors, Axis Health System and Mercy Regional Medical Center are all working on suicide prevention in different ways.

Several schools have adopted Sources of Strength, an evidence-based program that focuses on social supports, such as family support, positive friends and mentors, that can help youths lead healthy lives.

Pediatric Partners of the Southwest and other medical practices are integrating behavioral health care into their medical care and screening patients for depression.

On average, about 45 percent of people who die by suicide often have seen their primary care doctor within the month before their death, according to a literature review in the American Journal of Psychiatry.

Axis and Mercy have both adopted a goal of zero suicides among their patients as the number of people in crisis has risen dramatically in the county.

The changes that both health care providers are working on to achieve zero suicides are based on a national model that has seen success elsewhere.

Teens and college students are building relationships through clubs, such as the Four Corners Rainbow Youth Center, the Communities Overcoming Depressed Youth Project and the Wellness Peer Advisory Council at Fort Lewis College.

These clubs can create safe spaces to discuss suicide and other hard topics.

Healthy Kids Colorado survey data from 2016 showed 69 percent of teenagers in La Plata County don’t feel valued by the community. A Communities that Care survey in 2017 found 74 percent of adults in the community say they are connected to teens.

“There’s clearly a gap in our community. People aren’t feeling connected,” Kinsella said.

Journey to stabilityHarmon’s struggles started long before her suicide attempt. In middle and high school, she struggled with her unofficial diagnosis of borderline personality disorder. The condition amplifies all emotions, including depression.

“I hated having a mental illness, and everyone in my school knew I did. I was the freak. I was the outcast, which made it worse,” she said.

She tried many different counselors and was told repeatedly to reach out for help. But she had trouble investing in her therapy.

In 2011, Harmon enrolled at Fort Lewis College as a double major in psychology and public health, and at first, she loved it. Then in spring 2013, she fell into depression, stopped going to classes, and by the winter semester, she was dismissed from school.

In January 2014, she suspected she might be pregnant.

An argument with her boyfriend about the possible pregnancy prompted her spontaneous drive north on U.S. Highway 550 that snowy night. On her way up the pass, she texted several people to say that she was sorry but she was planning to kill herself, Harmon said.

“I felt like that day it was the worst day in my life, and I remember feeling so suffocated and it felt like there was no way out. There was no tomorrow. There was no more light,” she said

One of Harmon’s friends got in touch with her mom, who found Harmon on the pass in time to save her. Her mom drove her to the emergency room, where she was treated and received a mental health evaluation and outpatient care the next day at Axis Health System.

She went on to seek out her own therapist, and she felt stable for about three years before she had a relapse into depression.

But this time, she knew to seek help. She was working during the day and therapy can be expensive. So, she searched online for a different option and found Better Help, a counseling service. She pays $65 a week for the online service, and it allows her to video chat with a counselor at times that are more convenient for her. She is also interested in going back to group therapy.

She expects depression will always be part of her reality.

“I am a depressed person. I have a personality disorder, which is part of who I am,” she said.

Harmon advises those who may be struggling with mental illness to be honest with people around them about how they are feeling.

“A lot of people make mental health and mental illness super weird. It’s like they tiptoe around it, and I don’t think it needs to be tiptoed around,” she said. “I would rather people ask me questions about how I’m feeling and the thoughts I’m having.”

During her recovery, she relied on her family to love her back to life, she said.

“They brought me French fries and watched Netflix with me. I wasn’t looking for my family and friends to fix me, and I still don’t. I just I want them to come alongside me,” she said.

HHHStephanie Allred, a mental health counselor with Axis Health System, says these actions can guide people who may be in a position to help someone struggling with suicidal thoughts or actions.

Don’t be shy: Are you worried about someone? Have you noticed changes that concern you? Tell them what you notice and ask them if they are OK.

Be informed: Counseling and substance-use treatment is health care, and people who use it get better. Know what resources and support are available.

Reduce access to lethal means: Increase the safety of those around you by securing firearms and disposing of old medications.

Instill hope: Problems in life can feel insurmountable. Any problem can be solved with the right support.

Be a role model: Demonstrate the things that keep us strong, such as balanced eating, getting enough sleep, exercising, staying connected with others and minimizing alcohol and drug use.

Dear readers,

Today, we bring you the first of a six-part series about youth suicide in La Plata County. Specifically, we are bringing you stories focused on solutions for education, services and prevention of suicide among youths ages 10 to 24.

The number of suicides among all ages and genders in the county has increased in the last five years. This includes youths ages 10 to 24. Our community has collectively grieved every loss of family members, friends, neighbors, co-workers, students – even acquaintances. People routinely ask why this is happening, what is being done and what can be done.

This series of written and audio stories is not focused on problems. Instead, the stories are focused on effective responses to problems.

There are many local efforts in place or being put into place to help youths at risk. We look at those efforts and tell you about how they work. We also take a look at other non-local efforts that are evidence-based solutions.

Series explores how suicide-prevention efforts work

To broaden our storytelling and to reach a wider audience, we have collaborated with Sarah Flower, an audio journalist who works for KDUR, the Fort Lewis College radio station. Flower and Durango Herald staff writer Mary Shinn collaborated on this solutions journalism project. Shinn wrote stories and Flower produced audio stories. This project has been supported by a grant from the Solutions Journalism Network, a nonprofit dedicated to rigorous and compelling reporting about responses to social problems.

In addition to being available to listen to the audio stories on our website, the audio stories will air on KDUR (91.9 or 93.9 FM) at 5 p.m. Monday through Friday beginning Oct. 1. They will also air on KSUT and KUTE public radio stations.

We will provide a unique way for you to comment on our stories online. We want to learn about what emotions you may have felt after reading or listening to a story. Each story will have the option for readers to briefly share their reaction. Registration is not required to comment, but comments will be moderated. Editors will select which comments will be published.

During the publication of the series, these stories will be free to all non-subscribers.

Finally, the reporters and editors who worked on this youth suicide series will explain to our community how we did it and what we learned. Please join us at our Durango Diaries storytelling event at 6 p.m. Oct. 23 at Durango Public Library, 1900 East Third Ave.

Thank you for reading.

Amy Maestas is executive editor of The Durango Herald.

Human connection is the No. 1 protective factor for preventing suicide, according to mental health experts. In this story, youth from all walks of life in La Plata County talk about how they find connection in this community. KDUR’s Sarah Flower has the story:

Youth suicide is a topic that impacts every culture and knows no boundaries. While it affects some communities more than others, the Latino community has statistically seen lower rates nationwide. Faith and family play strong roles in protective factors for Latino youth. Alex Rodriguez is a graduate of Fort Lewis College and moved to Durango when he was 11 years old. In this story, we look at his journey and those protective factors that enable him to persevere. KDUR’s Sarah Flower has the story:

Dr. Heidi McMillan wanted to offer integrated behavioral health care at Pediatric Partners of the Southwest about five years ago to help meet the needs of patients and to address the shortage of mental health care in the community.

“Families in crisis would bubble to the surface. Kids would end up in the ER, and kids would be failing school,” she said.

Often, the clinic would end up trying to help families pick up the pieces, but the clinic didn’t have a formal system to address or prevent these events, she said.

In the beginning, McMillan envisioned a program that would focus on a group of about 20 families, but she quickly realized that would not be enough. About 10 percent of children have a mental health need, and the practice has about 26,000 patient encounters in a year, she said.

Grant funding allowed the clinic to hire behavioral health providers about four years ago, and a second grant allowed it to offer appointments with specialists via a live video stream. Among those specialists is a psychiatrist who can see patients twice a month.

In recent months, the clinic started to introduce behavioral health care screenings for patients at key turning points in life and started to track those with highest risk of a crisis, such as risk of suicide, significant school failure or a hospitalization of another kind.

Pediatric Partners’ plan to improve behavioral health care was developed through a Johns Hopkins University program aimed at trauma prevention and treatment.

To help directly address youth suicide in the community, four months ago, the clinic started behavioral health screenings for patients about to start middle school.

McMillan

Pediatric Partners screens for risk, teaches resiliency

McMillan

“This is our biggest hope to contribute to suicide prevention,” McMillan said.

At these visits, a behavioral health provider will meet with patients and their parents, along with a doctor or physician’s assistant, to talk about adolescent developmental health issues and screen the patient for depression and substance use.

The special emphasis on mental wellness will be the focus of visits that happen at transition points in life – when a child turns 1 month old, 6 months, 18 months, before entering kindergarten, middle school, high school and college, she said.

Adverse childhood experiencesPediatric Partners’ focus on behavioral health is built on a large Kaiser Permanente study that found people who have experienced four or more adverse childhood experiences, such as physical abuse, sexual abuse, neglect and some forms of family dysfunction, are far more likely to die by suicide and experience chronic health problems, such as diabetes, heart disease and substance use.

Adverse childhood experiences can cause a fight-or-flight response in children, and that can cause constant production of cortisol, a stress hormone. High levels of cortisol can cause weight gain, increased blood pressure and it can change a child’s biology at the cellular level, McMillan said.

The American Academy of Pediatrics called on doctors in January 2012 to start screening children for these experiences.

Doctors and therapists at Pediatric Partners have spent the last year trying out different questionnaires to screen for traumatic experiences and other adversity.

The initial study on adverse childhood experiences focused on adults, and it asked them to reflect on their experiences as children. A clinic in San Francisco adapted that questionnaire for children and had some success with it.

However, at Pediatric Partners, health providers found the questions were not appropriate for those families experiencing trauma. Some would say they did not have any adverse childhood experiences or they became upset because they were not ready to address them.

“Most practices have not figured out the right way to do it because it’s so hard to screen families in a sensitive, supportive way. That’s why it’s taken us a year to do this,” McMillan said.

So the clinic shifted to a screening with 14 questions developed at Children’s Hospital Colorado that allow health care providers to ease parents into the topics involving trauma, and it has worked well, she said. The questionnaire draws on social determinants of health, such as housing status, food security, transportation and health insurance.

Each question allows clinic staff to recommend a resource to help meet the need in question. For example, they will write a “prescription” for food.

Education around resiliencyAbout six months ago, the staff launched behavioral health screenings for 1-month-old children, because a new baby can add financial and emotional stress. But parents also tend to be excited.

“They are primed to be the best parents they can be,” McMillan said.

The screenings will also be done when children turn 6 months old, 18 months and before kindergarten.

At appointments with 1-month-old children, both a primary health provider and therapist meet with family members to explain how they can build resiliency in children that will allow them to overcome adverse childhood experiences.

“The single most important resiliency factor is a caring adult who is consistent in a child’s life; that may be a parent, that may be a grandparent. Often, it’s a coach, so sports are really important,” she said.

The clinic staff illustrate the relationship between adverse experiences and resiliency with a beach ball filled with air.

“Every experience your child has that’s resiliency-building, whether it’s a dance performance, a soccer game, you know, time with a loving parent or grandparent or teacher, puts air into this beach ball,” McMillan said.

When adversity comes along, the resiliency will allow them to bounce back, she said.

The practice also screens new mothers for depression for the first year after a baby is born because a new mother’s depression is strongly linked to developmental delays, she said.

The clinic plans to start screening children for social determinants of health, such as housing status and economic stability, before kindergarten, and with parents’ permission, staff plan to be in contact with teachers and counselors at elementary schools so the staff can understand a student’s home situation.

“If a child is undergoing trauma, not dramatic trauma, but just ACEs (adverse childhood experiences), just enough that their fight or flight system is active, the thing that shuts off is cognitive function, so they can’t focus,” McMillan said.

Caring for teensDuring the new appointments for middle school students, staff do not screen for social determinants of health; they talk about what patients can expect in middle school and screen them for depression and substance use.

The staff will also explain the effects of social media. Facebook and other online platforms can be addictive because notifications trigger a release of dopamine in the brain. However, screen time doesn’t build resiliency, and it can make users more detached. It can also lead to negative social experiences.

“Certainly, kids are very affected by bullying online; they are very affected by comparing themselves with that imaginary ideal that’s promoted online. We know this by speaking with hundreds of kids,” McMillan said.

The staff also recommend apps for anxiety and other methods to deal with stress. They may directly address suicidality and what to do if a friend is suicidal, if appropriate.

“It’s going to be hard to measure outcomes as far as ‘is this preventing suicidal thoughts or actions in the middle school population?’ But beginning the conversation in a way that normalizes these conversations at a well-child visit, I think, is a good approach,” she said.

Behavioral health providers will also attend checkups with incoming high school freshmen who will be screened for their adverse childhood experiences. At that appointment, the behavioral health focus will be on their future plans.

“Kids are less likely to be suicidal or depressed if they are engaged and have goals,” McMillan said.

Families most at riskTo better serve families and children who are in a crisis of some kind, whether it be suicidality or a different kind of hospitalization, the clinic started tracking each family based on their risk level seven months ago.

The risk levels are determined by mental health needs, how well the family is functioning and their social determinants of health.

“It’s intended entirely to support families, and it’s entirely confidential,” she said.

Those patients with highest level of risk are often the patients with most adverse childhood experiences.

The practice has found it has more than 100 patients in crisis or “knocking on the door” of a crisis, McMillian said. Families in these top two categories are considered to be in the practice’s “child wellness home.”

Assigning levels of risk to families allows for good communication across departments in the medical practice.

“This allows us to communicate in the office so that each department will look through the lens of potential stress or trauma in others’ lives and provide compassionate support,” she said.

For example, if a family at the highest level of risk is late, the front desk will know to call, she said.

Those at the highest risk level will have a behavioral health provider and a care coordinator attend all of their appointments, McMillan said. If they can’t make it to their appointment, they will have the option of speaking to a provider via a video-chat on their cellphone.

Over time, the practice hopes to see patients’ risk levels decline through treatment and as the staff refers families to nonprofits that meet their needs outside of health care.

Other primary care clinics, such as Mercy Family Medicine and Pediatric Associates of Durango, have also hired behavioral health professionals to see patients.

Much of Pediatric Partners’ integrated behavioral care is grant-funded, and it is unclear exactly how it will be maintained. However, McMillan said the practice is committed to having at least one full-time behavioral health therapist on staff.

Across the state of Colorado, psychiatric hospitals do not have enough space to care for all the teens who need to be stabilized because they are in crisis.

Most teenagers are admitted to an inpatient facility when the risk of committing suicide becomes so great that the fear is they might die if they are not admitted, said Frank Lotrich, medical director of West Springs Hospital in Grand Junction, the only psychiatric hospital on the Western Slope.

Axis Health System provides some inpatient care for adults in its Acute Treatment Unit at Crossroads in Grandview, but it cannot care for teenagers and children. Those patients must be transferred out of the area, said Molly Rodriguez, Regional Crisis Team and Acute Treatment Unit manager.

Axis is a private nonprofit health care system that provides physical and behavioral health care. It also serves patients in crisis across a five-county region at Crossroads.

In most cases, staff members at Axis work with families on how to safely care for their teens at home because it can be traumatic for teens and children to be placed in a psychiatric facility, said Stephanie Allred, senior clinical director. Even if the area had an inpatient facility, Axis would try to keep children and teens at home, she said.

“They need their parents and their caregivers and their natural family supports,” she said.

In 2016 and 2017, 8 percent of the 1,327 patients in crisis who sought care from Axis Health System were transferred to a psychiatric hospital outside the area. Children and teens accounted for 3 percent of the total, according to data supplied by Axis.

The psychiatric hospitals that accept teens and children are located in Grand Junction and on the Front Range.

Some patients in crisis must be held at Mercy Regional Medical Center for their own safety before they are transferred, said Paul Gibson, Mercy’s director of emergency services.

Mercy has one safe room for people who must be held for their own safety while they wait for a psychiatric bed.

If needed, other rooms can be made safe for patients at high risk for suicide by removing cords and any equipment that could be used as a weapon, Gibson said.

“We are not only protecting them from the equipment that’s in there, but we are also watching them as well. A lot of times, we’ll utilize what we call a sitter, who will just sit and watch the rooms,” he said.

On average, safe rooms are in use every day, said David Bruzzese, Mercy’s spokesman.

Mercy plans to remodel three new rooms for suicidal patients, where medical equipment that could be used in a lethal way can be easily stored behind foldable doors.

“We will have garage doors, essentially, that will fold down over all of that equipment,” he said.

Construction is expected to start Oct. 15. It will bring the total number of safe rooms to four. The rooms will be dual purpose so hospital staff can care for other patients in the spaces as well, Gibson said.

Patients in crisis may stay at Mercy for a few hours or a few days while they wait for a psychiatric bed elsewhere, he said.

In September, Mercy started providing mental health evaluations with psychiatrists for people in crisis via a live video chat through Specialists on Call, a company in Virgina, Gibson said.

Not all patients need to see a psychiatrist, but the service should eliminate some trips out of the area, he said. The psychiatrists will be able to see patients in the highest need throughout the hospital and prescribe them medication, he said. But they will not be able to provide ongoing care.

At West Springs Hospital in Grand Junction, where some local patients must go for care, there are 32 psychiatric beds to serve the entire Western Slope and areas of eastern Utah, Lotrich said.

Every morning at West Springs, staff members review a list of people who have been referred to the hospital and prioritize who can be admitted, he said.

“That triaging process is not a pleasant thing to do, and we would prefer not to do it,” he said.

There are times when patients can be admitted right away, but often, the hospital has a wait time of several days, he said.

Patients stay an average of 6.3 days at the hospital while they are evaluated and start treatment that can be continued outside the hospital, he said.

In December, West Springs plans to open a new 48-bed facility that will have a dedicated wing of 16 beds to serve teens, and the new beds should help reduce wait times, Lotrich said.

A state Crisis Steering Committee recommended in a formal report in June that the state Department of Human Services increase the number of beds for teens and children. The committee was not charged with determining how that should be done.

mshinn@durangoherald.com

Rachel “Rage” Domingos struggled with trauma, mental illness, addiction and bullying before she died by suicide in 2015. She was 23.

Her mom, Ginger Domingos, now sees a clear link between her daughter’s sexual assault when she was 12 and her later trials. However, at the time, it was not clear how severely the trauma had affected her daughter, she said.

“She hid it well,” said Ginger, who lives in Bayfield.

The Domingos family reported the assault, and the district attorney filed charges against Rachel’s assailant. He was found guilty. But Rachel faced repercussions from her peers in middle school, Ginger said.

“She kept coming home crying and telling me they were calling her names and it was her fault because she hurt this other family by filing charges,” she said.

Ginger told her daughter to stand up for herself because the assault was not her fault, she said.

Rachel was later suspended from Bayfield Middle School three times for fighting. Her attitude eventually earned her the nickname “Rage.”

In high school, she was a flyer on the high school cheerleading squad. But she continued to be bullied and publicly heckled during games.

Ginger tried to enroll her daughter in Durango High School to give her a fresh start, and when that was unsuccessful, she enrolled her in an online school, she said.

Rachel graduated from high school a year early and landed an apprenticeship at a tattoo parlor in Phoenix, her mom said.

But her struggles continued. She had bipolar disorder and she self-medicated with various drugs, leading to a heroin addiction.

At one point, Rachel moved home to Bayfield, and her mom tried to help her get sober.

“I couldn’t get her any help. There were no clinics. Psychiatrists were all full,” she said.

Rachel fought her addiction hard and attended group sobriety meetings, Ginger said.

But looking back after Rachel’s death in Phoenix, Ginger thinks her daughter’s vision of herself was broken when she was 12 years old.

“She had the hope. She had compassion. She had all those key things, but she didn’t think much of herself,” she said.

Ginger wants others to know how much harm that kind of trauma can cause, she said.

After her daughter’s death, Ginger sought grief care through Heart Beat, a support group for those whose loved ones have died by suicide, and through a online group called Parents of Suicide.

“You just have this great need to be with people that have that same experience,” she said.

She also started a business in Rachel’s honor called Lady Dingo Embroidery because Rachel used to suggest ideas for crafts that Ginger would make, she said.

mshinn@durangoherald.com

Hundreds of patients go to Axis Health System in crisis each year in La Plata County, and the numbers have risen dramatically in recent years.

In 2014, Axis staff assessed about 500 patients in crisis, and four years later, that number rose to about 890, according to Axis. About 180 of the patients in fiscal year 2018 were younger than 18.

These patients may be exhibiting high-risk behaviors or present a danger to themselves or others, said Molly Rodriguez, Regional Crisis Team and Acute Treatment Unit clinical manager.

Rodriguez

A health care model to reach zero suicides

Rodriguez

Rodriguez cannot say why Axis is seeing such a rise in patients, but a greater awareness of services could be contributing. Axis is a private nonprofit health system that provides crisis care and physical and behavioral health care across the region.

“My hope is that it’s becoming less of a stigmatized issue,” she said.

When a patient in crisis walks into Axis’ Crossroads facility in Grandview, within 15 minutes, a crisis therapist will start to assess them or provide an intervention, she said. Suicidal patients who call 911 are taken to an emergency room where Axis staff will meet them, and in some cases, an Axis mobile crisis team will meet patients in their homes, Rodriguez said.

Mercy Regional Medical Center’s emergency room has seen a similar rise in patients in crisis. Often, patients in a suicidal crisis must be physically evaluated at the hospital before they can be released to Axis for care, said Paul Gibson, Mercy’s director of emergency services.

About a quarter of the patients who come to the ER in crisis are adolescents, he said.

To better serve patients, both health care providers are adopting a national model called the Zero Suicide Initiative, promoted by the Suicide Prevention Resource Center to reduce suicides in health care settings. Zero Suicide provides guidance about how to improve care by including suicide survivors in planning, training employees in effective therapeutic methods and using data to inform changes in health care.

Drastically dropping ratesThe Zero Suicide Initiative is based, in part, on the success seen at Henry Ford Health System in Detroit, an urban system with 30,000 employees. The system has inpatient units for children and adolescents, and all of its psychiatry clinics employ pediatric psychiatrists and clinicians.

About 18 years ago, the staff set out to reduce the number of patient suicides to zero despite some daunting statistics.

About 15 percent of people with a major depressive disorder will die by suicide, and about 20 percent of those with bipolar disorder will take their own lives, said Dr. Cathrine Frank, chairwoman of psychiatry and behavioral health services at Henry Ford.

When it came to setting a goal to improve care, zero suicide was the only one that made sense, she said.

“If you have less than a goal of zero, I mean, is that my friend? Is it your relative? How is any goal other than zero acceptable?” she said.

In 1999 and 2000, the average suicide rate for patients treated by behavioral health services at Henry Ford was 100 per 100,000. It was less than 30 per 100,000 from 2002 to 2010, according to data provided by Henry Ford. In 2008, Henry Ford’s behavioral health services achieved its goal of zero suicides.

Other hospitals that have adopted the Zero Suicide model drastically dropped their suicide rates as well, said Julie Goldstein, director of the Zero Suicide Institute. The institute estimates about 400 to 500 health care organizations have adopted the model nationally, although it is difficult to track, she said.

The health care organizations that adopt the initiative generally adapt it to fit their population, and it generally takes about two years to see suicide rates decline, she said.

Assessing risk, providing helpTo achieve the ambitious goal, Henry Ford behavioral health staff, which includes pediatric psychiatrists, started assessing every patient’s risk for suicide and assumed all of their patients were at some risk of suicide, Frank said.

“I think still internationally and across the United States, most people rely on asking a patient if they are suicidal, and if they say, ‘No,’ you say, ‘Boy, that’s good,’ and you go on,” Frank said.

The Henry Ford staff determines a patient’s risk factors for suicide and then works with the patient to address those factors.

Risk factors can include depression, hopelessness, self-harm, substance abuse, a history of suicide in a person’s family and relationship problems, among other issues. They started asking about additional risk factors, such as traumatic brain injury and identifying as a transgender person, as the research around them developed.

A patient’s level of risk determines how quickly they should begin psychotherapy or how quickly they should see a psychiatrist for medication, Frank said.

Staff members work with patients to reduce the risk of suicide by removing weapons from their home, educating patients’ families about the warning signs of suicide and providing self-management tools, such as books, websites and apps, she said.

Some warning signs of suicide include talking about wanting to die, extreme mood swings and withdrawal, according the Suicide Prevention Resource Center.

The health system also established a consumer advisory panel to guide its work, started drop-in support groups, set up secure email for patients to communicate with their providers and included patients’ suicide risk into their electronic health records, among other steps, according to an article in the Joint Commission Journal on Quality and Patient Safety.

Henry Ford also trains all of its clinicians in dialectical behavioral therapy because it is a proven method to address a patient’s suicide risk, Frank said.

Axis staff also use dialectical behavioral therapy because it helps individuals develop skills to manage emotions, improve relationships and develop better approaches to solving difficult problems in life, said Stephanie Allred, Axis’ senior clinical director.

“Considering suicide is an attempt to solve problems that seem unsolvable,” she said.

Changes at AxisThe changes Axis is making through the Zero Suicide Initiative apply to its entire patient population, Allred said.

Allred

A health care model to reach zero suicides

Allred

Since adopting the initiative last year, Axis has stopped treating thoughts of suicide as a symptom of other mental health conditions and started to identify and address suicide risk factors first, she said.

“Whatever is driving that urge to consider suicide is what we’re really targeting pretty intensely,” she said.

The suicide risk factors for youths can differ from those for adults and can include problems with peers, for example, she said.

Axis also changed how its staff assesses suicide risk. Staff members now monitor a patient’s risk of suicide at every therapy session and track suicide-risk screenings into electronic health records, Allred said.

To ensure that patients are receiving an appropriate level of care, the health system also runs a risk report weekly to see which patients have a moderate to high risk for suicide.

Clinicians at Axis work with patients on safety plans that identify a patient’s risk factors and specific steps to take, such as locking up firearms and disposing excess medications, as well as specific coping mechanisms and people to call.

If a patient calls the Axis crisis line in the middle of the night, the crisis therapist will review the steps of this plan with the patient, Allred said.

Axis is also training non-clinical staff, such case managers, billing staff and people who work at the front desk, to look for suicide warning signs, she said.

“For example, if a patient calls to cancel an appointment and perhaps makes a reference that they won’t be needing any more appointments, the staff member would inform a clinician who would follow up with the patient,” she said.

The health system’s staff successfully provides crisis intervention for hundreds of people each year, she said.

“We are able to intervene, connect them with supports to help them build that sense of connection or solve the problems that seemed insurmountable to them at the time. That is inspiring for us,” Allred said.

In 2016 and 2017, Axis completed 1,327 crisis assessments across its five-county region, and about 50 percent of those in crisis received follow-up care from Axis within one or two days, according to data provided by Axis. The Acute Treatment Unit at Axis cared for 17 percent of these patients. The unit cares for patients for an average of five days and stabilizes them.

Axis transferred 8 percent of patients in crisis out of the area for care, and the final 25 percent received outpatient care, had their needs met by the crisis intervention or could not be reached, according to data provided by Axis.

The health system follows up with 95 percent of its patients in crisis either by phone or in person, said Brian Ensign with the Acute Treatment Unit at Axis.

Getting started at MercyA Zero Suicide initiative is just getting started at Mercy as Centura Health, the hospital’s parent company, introduces changes at all of its locations, said Doug Muir, director of the Behavioral Health Service Line.

Mental health care is one of the major needs that Centura has identified in all the cities that it serves, he said. The system operates 15 hospitals in Colorado.

As part of the initiative, Centura is introducing depression screenings at all of its primary care clinics, he said. The pediatric clinics will screen patients 12 and older.

The health system also plans to work with the state Office of Suicide Prevention on its efforts, he said.

mshinn@durangoherald.com

More than half of about 400 Fort Lewis College students surveyed in the spring reported feeling so depressed it was difficult to function at one point within the last 12 months.

The striking statistic demonstrates the rising rates of anxiety and depression among FLC students and their peers across the country.

“I think college is just an overwhelming time in general. It’s a huge transition. You are all of a sudden by yourself without any of your previous friends,” said Natalie Wilcoxen, a psychology major at FLC. “Life feels really real, and you are trying to figure out what you want to do. I think there are a lot of existential questions that come up when you start college, and I think that’s really overwhelming.”

Wrona

Anxiety, depression rise among college students

Wrona

Many students are balancing multiple jobs and family obligations in addition to their classes, said Megan Wrona, an assistant professor of psychology.

“It’s easy for us as faculty and staff to underestimate how much students really have on their plate that can contribute to some of the struggles we see with mental health,” she said.

Results from the National College Health Assessment have helped raise awareness about student needs and helped staff members at the Student Affairs Department identify anxiety as a priority to address, said Kendra Gallegos Reichle, the coordinator for Student Wellness Initiatives at the college. FLC staff, who work in student affairs and health, use the student data on an ongoing basis to determine how well they are serving students.

Gallegos Reichle

Anxiety, depression rise among college students

Gallegos Reichle

The survey found 68 percent of students felt overwhelming anxiety in the last 12 months compared with 47 percent in 2010.

Staff members want to ensure that students are screened for symptoms of anxiety and receive treatment for those symptoms, said Amie Bryant, a licensed clinical social worker and certified addiction counselor with the FLC Counseling Center.

“Reducing symptoms of anxiety in a lot of ways is an individual thing,” Bryant said.

Bryant

Anxiety, depression rise among college students

Bryant

Even if anxiety continues to rise among students, it wouldn’t necessarily mean that the college’s programs aren’t working, Gallegos Reichle said. The trend is a national problem that is not unique to the college, she said.

A larger trendDepression and anxiety can put young people at risk for suicide. In Colorado, suicide rates among those 20 to 24 years old have risen every year between 2007 and 2016, according to the state health department. The data show 52 people in this age group died in 2007 and 100 died in 2016 across the state.

In La Plata County since 2012, six people in their early 20s have died by suicide, according to data from the La Plata County coroner. Five of those deaths have happened since January 2017.

Emily Dee, 22, Giancarlo Vigil, 23, and Calvin Maupin-Rickman, 23, attended FLC.

While college students are reporting more anxiety and depression, simply attending school can help prevent deaths by suicide because students are interacting with peers, staff and professors, who may be able to help intervene if a student is in crisis, said Benjamin Locke, executive director of the Center for Collegiate Mental Health.

Studies have consistently found since the 1980s that rates of deaths by suicide in college are about half that of the general population, he said.

“When people leave campus, a lot of times the community of concerned folks may be reduced,” he said.

While students are living on campus, the most effective suicide prevention for colleges requires a comprehensive approach that includes building awareness about how to seek help, identifying at-risk students and offering counseling, according to research compiled by the American Foundation for Suicide Prevention. The foundation also suggests restricting access to firearms, the roofs of tall buildings and other common means of suicide.

FLC started the year with an “Inside Out” themed event at orientation. It drew on the popular Disney film that explores emotions and highlighted the school’s options for mental health support.

A mental health awareness week is also planned this year as part of the Student Union’s programming, Gallegos Reichle said. It will start Tuesday and feature a meditation event, a suicide intervention training and a talk by Kevin Hines, a suicide attempt survivor, who jumped off the Golden Gate Bridge in California.

“(Mental health) is on people’s minds, and it’s not just staying there. It’s coming out and people are talking to each other about it,” she said.

FLC offers students five counseling sessions they pay for through their student fees, Bryant said. The school is adding a counseling position this year to bring the number of senior staff to seven. The center also employs between six and nine interns who meet with students.

The counseling center serves 20 to 25 percent of the student body each year, and it does not have a waiting list, Bryant said.

Students in crisis are seen immediately, and those who walk in can schedule an appointment within a week, she said.

The college also employs a psychiatrist and a psychiatric nurse, who can help students manage medications for mental health disorders if needed.

Gallegos Reichle said students who get in trouble in the dorms for violations like alcohol or marijuana use are required to attend one-on-one peer counseling with a psychology student.

The counseling helps students focus on making positive change and exploring the reason for their actions.

“It always ends up being more about a deeper issue,” said Wilcoxen, who counsels other students. Her counseling sessions often focus on being overwhelmed or feeling lonely, she said. The peer-to-peer counseling is open to anyone who is interested.

Training students to interveneThe college has offered suicide intervention training for a long time, but it has become more intentional in the last year and a half, Gallegos Reichle said.

Over the summer, the college offered its first Mental Health First Aid training for staff, and it has offered another one since. The eight-hour training covers some of the signs of mental health disorders and mental crisis and how to encourage someone to seek professional help.

Gallegos Reichle said she would like students to be ready to help their peers in crisis by asking them if they are considering suicide, walking with them to the counseling center or calling a crisis line with them, going with them to the emergency room or calling 911.

“I would like them to be open-minded and non-judgmental,” she said.

If a student is aware one of their peers is in crisis but the individual is unwilling to seek help, students can fill out a student-of-concern form online to report it.

The school does about three suicide intervention trainings per year for students, and it is planning to put on a Youth Mental Health First Aid Training in October. The eight-hour trainings cover common mental health challenges for youths, adolescent development and how to help people in crisis.

Gallegos Reichle would like to expand the opportunity for students to get trained in suicide prevention by offering it online for those who want to take the training on their own time.

The school’s grant office is looking for opportunities to help pay for this training, she said.

HHHKevin Hines will speak at 6:30 p.m. Oct. 12 at the Fort Lewis College Community Concert Hall. For more info visit fortlewis.edu/kevinhines or call 247-7508.

A free Youth Mental Health First Aid training will be held from 8 a.m. to 4 p.m. Oct. 27 at Fort Lewis College Jones Hall room 140. The class is limited to 30 people. To register, call Royce Tranum at 749-6052 or visit https://goo.gl/forms/qJN0TZ2OQe6xQ0nk2.

Character Counts is a national educational model that works to establish a positive school climate and instill critical academic, social and emotional skills, as well as core character traits. Ignacio School District uses the model as part of its effort to reduce bullying. It also creates a connection among students and school staff, said Ignacio High School student Elizabeth Valdez. KDUR’s Sarah Flower has the story.

Students learned to see their lives as heroic journeys in Shane Nelson’s humanities class at Animas High School last year.

“It was really great because a lot of us didn’t understand life at all. ... We didn’t understand that hard times are a part of life and that there’s always a way through or a way around,” said Annabelle Mick, a junior.

The curriculum was built around author and teacher Joseph Campbell’s theory that heroes across cultures and time periods share a similar journey into the unknown where they face challenges, temptations and transformation. During the year, Nelson also asked his students to reflect on their own lives.

“We definitely became more like a family than friends because we knew everything about each other,” Mick said.

Students found the class helped them re-engage in school.

“A student sent me an email saying that because of our class – and this was only about a month in – she had stopped cutting (herself) and she wanted to come to school,” Nelson said.

Later in the year, a school counselor screened Animas students for suicide risk and depression. While the survey could be anonymous, many students put their names on the documents.

“When they put their name on it, they are literally telling you, ‘I want help,’” he said.

The small class sizes at Animas, a school of about 250 students, allow teachers to closely monitor teens. They will work with nonprofits, health care providers, parents, law enforcement and other groups if a student is in crisis.

“We do not take crisis lightly and do not assume to handle escalated, extreme risk and emergency situations without specialized support for the student and their families,” Nelson said.

After last semester, the need to teach greater character development, resiliency and life-coping skills as part of traditional classes was clear to Nelson.

“You can have academic rigor and excellence and infuse character development at the same time,” he said.

Project BasecampThe humanities class and Nelson’s previous experience in wilderness therapy inspired him to create a school-based suicide prevention and character development program called Project Basecamp. The program is designed to prevent mental crisis, encourage students to advocate for themselves and build strong bonds between students.

The Colorado Education Initiative selected Project Basecamp as one of the 10 most innovative ideas in education in the state, and Nelson had the chance to develop it over the summer with other Colorado educators.

He launched his idea this fall as a psychology class at AHS called adolescent development, with some students who were hand-picked and others who were randomly selected. The semester-long course has a fluid curriculum, but Nelson expects to teach aspects of the hero’s journey and incorporate rafting and camping trips as well.

As a small school with a project-based learning model, AHS lends itself well to the outdoor experiences that will help reinforce the classroom lessons, Head of School Sean Woytek said.

“There is a ton of research out there that shows if you get students out into nature and get them into a little bit more uncomfortable situations, they are able to really dig into the topics and be able to understand them and remember them, internalize a lot better,” he said.

The class will also allow students to put what they learn into action, he said.

Each student will be expected to contribute to a mental health guidebook for teens and create their own project that communicates what it is like to be a teenager today, in their opinion. Students are making movies and writing songs and poems for their creative project, Nelson said.

As part of the work on the guidebook, Nelson asked his students to identify some of the causes of depression and risk factors that can lead to suicidal ideation as well as possible preventive steps.

They identified many of the same risk factors listed by the Centers for Disease Control and Prevention: bullying, isolation, abuse and neglect, isolation and drug use. Their strategies to prevent suicide, such as consulting doctors and therapists, developing coping skills, engaging in the community, supportive family and having positive outlets, can also be found on official prevention sites.

Nelson wants to see the class forge connections among students so they can see that they struggle with many of the same issues and are on a similar journey.

[image”4]“Every assignment that’s going to be given will have a foundation that will cause introspection, growth, communication with each other and self-knowledge, and we are going to temper that with wilderness experiences,” he said.

The value of going outsideAs a the founder of a wilderness therapy company, Nelson saw experiences in the outdoors make dramatic changes in the lives of his clients.

Research into quality group wilderness therapy programs have shown they can lower anxiety and depression, improve feelings of self-efficacy, increase interpersonal skills and increase a person’s ability to share their problems, said Megan Wrona, assistant professor of psychology at Fort Lewis College.

The shorter group excursions Nelson is planning are considered adventure therapy, and they are not as well-studied as wilderness therapy, which generally involves weeks outside and formal group therapy with a behavioral health provider, Wrona said.

She expects the effects would be similar and improve relationships between students because they are spending time outside of their comfort zone.

“It just builds more of that collaborative relationship because you are forced to be able to rely on each other in a way that’s different than when you are in a classroom,” she said.

Simply spending time outside is also shown to help improve a person’s mood, she said.

Nelson plans to incorporate weekend excursions and longer summer trips in Project Basecamp. The summer programming will be open to all teens in La Plata County. He expects most of the recruitment will likely be through word of mouth, as his students recruit their friends.

“Project Basecamp is designed based on my 100 percent fundamental belief that the wilderness and the outdoors is the most therapeutic resource we have, and students who get out there and get dirty and fall down and get up become resilient, self-confident teens,” he said.

Because Nelson’s project was selected by the Colorado Education Initiative, he will have support tracking the difference the class makes in students’ self-esteem and improved mental health. He expects curriculum focused on character development and mental health will lead to better grades, he said.

Students will be surveyed before and after the class and at the end of the school year to see if the results lasted. The class will be offered first and second semesters so it can be refined for the second group, he said.

Nelson’s long-term goal is to have a piece of land adjacent to the open space around town to use as a space for the students to meet. He would like students to build yurts on the property so they have a sense of connection to the area.

Project Basecamp is raising money for gear and summer trips at GoFundMe.com/all-forward-wilderness-therapy.

When teens across the social spectrum, from band members to basketball stars, get involved in suicide prevention, more students are likely to consider asking adults for help.

That is the premise of Sources of Strength, a suicide prevention program developed in rural North Dakota and used in schools across the country.

“It really does have the potential to go very deep and reach every single corner of a school,” said Michelle Gonzales, a counselor on special assignment at Jeffco Public Schools on the Front Range. Some Jeffco schools implemented the program four years ago, and it spread across the district as it changed the culture at schools, she said.

Durango School District 9-R introduced Sources of Strength this fall in its middle and high schools after extensive research, said Leah Tanke, coordinator of school counseling. Bayfield High School and Animas High School have also started the program.

Tanke

Durango, Bayfield schools start new program to prevent suicide

Tanke

The Colorado Attorney General’s Office offered the schools a grant for the program based on the rising number of reports about suicide to the statewide Safe2Tell hotline.

In District 9-R, the number of suicide threats to Safe2Tell rose from six in the 2012-13 school year to 31 in the 2016-17 school year, based on data provided by the district.

The increase may be driven, in part, by greater awareness because the district has promoted the number, said Kathy Morris, safety and security coordinator for 9-R.

When school district staff train students in Signs of Suicide, a suicide and depression prevention curriculum, reports tend to spike and counselors clear their schedules after the trainings to work with students who are concerned, Tanke said. The Signs of Suicide trainings encourage students to talk to an adult if they see signs that a fellow student may be dealing with more than sadness. Counselors have done the training at Miller Middle School for two years and at Escalante Middle School for a year. Similar trainings were done previously.

Unlike an intervention training, Sources of Strength does not focus on the signs and risk factors for suicide. Rather, it emphasizes how to recover from abuse, addiction and other struggles, said Scott LoMurray, deputy director of Sources of Strength.

“Ultimately, our goal isn’t just to keep people alive, but it’s really to help people live healthy lives and full lives,” LoMurray said.

The program emphasizes eight strengths: family support, spirituality, positive friends, mentors, healthy activities, generosity, medical access and mental health.

The founders selected the eight strengths based on scientific research and conversations with people who attempted suicide, experienced severe addiction, depression and abuse, he said.

“It’s really hopeful in its tone and tenor. And really highlights the fact that the vast majority of people who struggle with feeling suicidal do not go on to die by suicide,” LoMurray said.

The program is based on a peer-mentorship model, meaning that each year, students are selected to be trained in Sources of Strength, so they learn about their own strengths and plan campaigns to spread positive messages. The program provides some templates for students to use or they can build their own.

In Jeffco schools, students wrote and delivered notes to adults in the building they would consider consulting with if they were having a hard time and posted the names of adults they trust publicly on a wall, Gonzales said.

“Campaigns like that start closing the gap between adults and kids,” she said.

Since the program has been introduced in Jeffco schools, some principals have seen the culture in their school change.

LoMurray likened the Sources of Strength model to the spread of habits through a social network. For example, if you are friends with a smoker, you are more likely to smoke.

In the same way, hope, resiliency and healthy coping can spread through a social network, he said.

“We’re not training our students to be these junior psychologists and counselors to go out and fix all of their friends, but rather equipping them and empowering them to be these agents of social change. ... They are the patient zero of an epidemic of health,” he said.

In Jeffco schools, the success of the program has varied. Some schools have seen their cultures flip and others have struggled. The schools that have seen the most success with the program are those that strategically selected youth leaders across every single social group, including the leader of the smokers’ pit, Gonzales said.

“It will go as deep and as far-reaching as the school is in strategically selecting our peer leaders,” she said.

The program can prompt short-term change in four months, a scientific trial showed, but the culture shift can take much longer, LoMurray said.

In rural North Dakota, Claudette McCleod has run a Sources of Strength program in the public schools for 12 years through Turtle Mountain Outreach of the Turtle Mountain Band of Chippewa.

At the first two meetings, only a handful of kids showed up, so she went to the basketball coach and asked him to help her recruit the basketball team and the cheerleaders to lead the program.

“I made it cool. I had to make it cool if I wanted it to be successful,” she said.

Since then, youth leaders who participated in the program have gone on to become employees with Turtle Mountain Outreach, she said.

She attributes the program’s success to consistent meetings that help students build relationships with the adults in the group.

The program can also lead to less school conflict, violence and harassment, LoMurray said.

Sources of Strength has not been shown to decrease suicide rates, and he is not aware of any program that has been able to show a reduction in suicide rates because the size of a study needed to show a reduction in rates would have to be so large, he said.

However, the program is working on a study that may show whether it is associated with reducing suicide attempts, he said.

In Durango, District 9-R plans to implement the program for at least three years and evaluate whether it is making a difference through disciplinary referrals and surveys that ask kids about how connected they feel to adults and other kids at school, Tanke said.

“We want kids to have adults that they feel connected to and are comfortable going to with concerns,” she said.

The district would also like to see the number of students reporting to adults that they are thinking about hurting themselves decrease as a result of the program, she said.

For Veronica Krupnick, talking to other students about mental health and thoughts of suicide at Fort Lewis College was a healing experience.

The 2017 FLC graduate started attending the Wellness Peer Advisory Council two weeks after starting school because she was a public health major and she found a niche there.

“My dad likes to tell me: ‘Make your mess your message.’ And I think that group really allowed me to do that, and in that I also had a lot of self healing,” she said.

Before she turned 10, Krupnick was exposed to domestic violence, child abuse and substance abuse at her home while living in Arizona and then in Albuquerque, she said. She also struggled with suicidal feelings from the time she was 7 until she was about 19.

“Accomplishing, like, normal life has been a huge deal. Having an 8 to 5 job and a house and a car was this giant accomplishment,” she said.

She worked as a pharmacy technician in the operating room at Animas Surgical Hospital up until this fall when she moved to Santa Fe to be close to her sister. She is now job hunting for a position that would let her work with at-risk youth.

Krupnick, 22, was adopted when she was 10 and reconnected with her biological Hopi family in recent months. Talking with her mother and grandmother, she found that they also experienced trauma.

“I think suicide in the Native American community is just one symptom of the problem. It’s not like if you take care of this one issue that it’s all going to be better. There’s so, so much there – so much trauma and pain. We need more people to talk about it, if anyone is going to heal moving forward,” she said.

She considers herself lucky because her adoptive parents got her into counseling, and they also provided an open environment where she could talk about her traumatic experiences.

“We were so open in the house. I was able to bring that into my school life of being open with everyone else just because I had talked about it so much,” she said.

Krupnick was the only Native American student in WellPAC when she started school in 2014, but three years later, Native Americans represented about a third of the students attending, in part because she invited so many of her friends to go with her.

It was also a time of growth for the group in general, she said.

“We had a handful of really dedicated students that made it their mission to reach to their friends,” she said.

Now, Native American students represent about a quarter of the group, WellPAC adviser Kendra Gallegos Reichle said.

WellPAC is focused on helping students live a physically and mentally healthy lifestyle in the most holistic and nonjudgmental way, Krupnick said.

In some cases, students aren’t ready to talk to a counselor, but if they can be comfortable talking with their friends about their mental health, that can be a first step, she said.

The group also organizes events.

For example, during homecoming for several years the group put together a healing wall and offered students the opportunity to write down their worries and struggles anonymously and nail them to the wall. Students could post their worries for others to read, and it offered them a way to see that they were not alone, she said.

They invited a Native American tribal leader to bless the wall and then burned it to symbolize releasing those worries, Krupnick said.

Some Native Americans are taught to be stoic and not to complain, but that can be harmful, she said.

“These are huge traumas that people never talk about, and that’s going to affect your life at some point,” she said.

Those who experienced four or more forms of childhood trauma are at an increased risk for alcoholism, drug abuse, depression and suicide attempts, according to a Kaiser Permanente study of 17,000 people.

Connecting to cultureNationally, the suicide rate among Native American and Alaskan Native youths between ages 15 and 34 is 1.3 times the national average at about 19 deaths per 100,000 people annually, said Pamela End of Horn, national suicide prevention consultant with Indian Health Service, headquartered in Maryland. However, the rate is likely higher because of under-reporting, she said.

Each of the 573 Native American tribes in the United States is different, and some of them, especially tribes in the Southwest, have a tendency not to talk about suicide because it is taboo, she said.

In those cases, the agency tends to focus on wellness instead and help tribes foster meaningful connections between their youths and each tribe’s cultural identity, she said.

“We really try to focus on it from the perspective of connectivity. How do we reconnect, rekindle and re-energize cultural aspects to really create that feeling of hope and purpose? As well as really help Native youth to really reconnect to who they are as an indigenous person,” End of Horn said.

The agency also encourages tribes to look for ways to incorporate suicide intervention trainings, such as Question Persuade Refer, in a culturally relevant way, she said.

QPR is similar to CPR for suicide prevention. It teaches students to recognize common signs that someone might be experiencing suicidal thoughts. The curriculum also covers how to question someone about suicidal feelings, persuade them to seek treatment and refer them to a professional.

Intergenerational Intertribal program used by Southern UtesIn Ignacio, the Southern Ute Indian Tribe has hosted several QPR trainings and Mental Health First Aid trainings through a five-year grant program called Intergenerational Intertribal (I2) Positive Solutions for Native Health, said Rachell Tenorio, the director of the program with the Albuquerque Area Indian Health Board.

The program was designed specifically for tribes in the Southwest, and it is aimed at reducing substance abuse and suicide ideation among Native American youths who have experienced trauma. It is also intended to promote positive cultural identity and promote mental wellness.

“We feel strongly that by honoring youth for who they are that can contribute to a decrease in substance use and mental health outcomes,” Tenorio said.

The program is funded by a $1 million grant from the Substance Abuse and Mental Health Services Administration. It is the first grant the Albuquerque Area Indian Health Board has received to address suicide, she said.

The Southern Ute Indian Tribe and the Rainbow Band of Navajos are both participating in the grant program.

To build cultural identity, the health board staff recommends two programs to tribes, Cultural and Drugs Don’t Mix and Storytelling for Empowerment.

The Albuquerque Area Indian Health Board staff is working with Southern Ute Indian Tribe members, including teens and elders, on a digital storytelling project that may be an outlet for youths to talk about suicide, she said.

“We all have strengths individually, like our own stories to share,” Tenorio said.

The focus on connecting youths to their culture to prevent suicide has not been studied extensively, but it is rooted in the historical experiences of Native American tribes and their ability to persist despite colonization, she said.

Among the Southern Ute Indian Tribe’s members, there has also been more conversation in general about the topic, including a community meeting in August, said Beverly Bowman, the program coordinator.

“Just that is a big step toward prevention,” she said.

As part of the grant, members of the tribal community will also become trainers in Applied Suicide Intervention Skills Training and SafeTALK so they can hold trainings for the tribe, Bowman said. The trainings focus on how to recognize signs of suicidal feelings, intervene and create a safety plan for people feeling suicidal.

I2 also set up an intergenerational community advisory panel of six people, including elders, youths, social services personnel and others, to guide the prevention work, Tenorio said.

“They provide us direction and make sure what we’re doing is culturally relevant and sensitive,” she said.

While suicide is a tough topic, tribal adults and elders are interested in how to ask if someone is feeling suicidal, where to refer them and what behaviors a person at risk of suicide might exhibit, Bowman said. The trainings are addressing those questions.

Bowman doesn’t change the Question Persuade Refer training when she presents it to tribal communities. But she will include statistics about suicide among Native Americans before presenting the training, and afterward, she emphasizes that Native American traditions and culture can help prevent suicidal behavior, she said.

Staff at the Albuquerque Area Indian Health Board would consider the program successful if, at the end of the grant cycle, the Southern Ute Indian Tribe continued suicide prevention work on its own, Tenorio said.

The Southern Ute Indian Tribe offers several solutions-oriented programs and support for suicide prevention and care, but the tribe would not agree to be interviewed for these stories.

mshinn@durangoherald.com

Many of Charlie Stein’s friends who are gay, lesbian, bisexual, transgender and queer have attempted suicide or considered it.

Those feelings and attempts are not uncommon. A 2016 study found almost 30 percent of gay, lesbian and bisexual high school students surveyed across 25 states had attempted suicide in the past 12 months, while only 6.4 percent of the heterosexual students had attempted suicide, according to a Centers for Disease Control and Prevention report.

As a transgender teenager, Charlie is a member of an even higher-risk group for suicide, but he has never battled those thoughts.

“My perspective on it was, I’m going to do this thing and I don’t care who tries to stop me. ... It was, I’m not going to live any other way, but it was also never, I don’t want to live anymore,” he said.

Charlie, 17, found support among his family and online. A supportive family dramatically reduces a transgender person’s likelihood they will attempt suicide.

The 2015 U.S. Transgender Survey found that 54 percent of transgender people in unsupportive families had attempted suicide, while 37 percent of those in supportive families had attempted suicide.

Charlie also connected with his peers in the LGBTQ+ community at Four Corners Rainbow Youth Center in Durango.

“I could walk up to someone in the community, the LGBTQ+ community, and we would just automatically connect because we share that experience,” said Stein, a senior at Animas High School.

The Rainbow Youth Center and Gender and Sexuality Resource Center at Fort Lewis College fill similar roles by connecting members of the LGBTQ+ community with caring peers and adults, which can lower their risk for suicide.

Stucka-Benally

LGBTQ students find support within community

Stucka-Benally

The Rainbow Youth Center was founded three years ago by Jennifer Stucka-Benally and Sarah St. John, who were working in Durango School District 9-R schools as counselors and found many youths were coming out to them. They were joined early on by Rowan Blaisdell, a co-director and co-founder of the center.

They held focus groups to determine what the students needed.

Students in those groups unanimously said they needed a safe place to go outside school that would be free from bullying, harassment and discrimination, said Stucka-Benally, co-director of the center.

Since then, the center has created a sense of belonging and normalcy for those who may not be accepted at home and may feel uncertain about future discrimination they could face, Stucka-Benally said.

Blaisdell

LGBTQ students find support within community

Blaisdell

The center also connects students with caring adults, and that can help reduce their risk of suicide, Blaisdell said.

“It’s a massive problem, but there is a solution, and that’s to make sure that you’re seeing those kids that are around you and accepting them for whoever they say that they are and not questioning it,” he said.

The first program the center started was a drop-in night on Mondays for teens to play games, do art projects and hear speakers from the community.

The center also offers Tea Time for teens who identify as transgender, gender-nonbinary and gender fluid, to discuss issues they might face, such as being called by the wrong name or pronoun, Stucka-Benally said.

“Can you imagine somebody just walking up to you and using a totally different name or pronoun all the time? It would feel like nobody is even seeing you for who you are,” she said.

This year, the center started a playgroup for nonbinary youths from 5 to 11 years old and a support group for parents of nonbinary children that meets at the same time.

The group was inspired by parents of transgender youths who requested support from the center.

In some cases, young children can face gender dysphoria because of the disconnect between the gender identity on the inside and how other people are perceiving them. These feelings can lead to self-harm, self-mutilation and suicidal ideas at a young age, Blaisdell said.

At the playgroup, children leave these feelings behind, Stucka-Benally said.

“They get to just be kids with each other without any fear or concern that they’re going to be discriminated against, oppressed, that some kind of violence is going to happen to them,” she said.

The center draws teens, children and parents from across the region. But for teens who cannot get to the center, the staff will pair teens with trained mentors, and the pair will spend at least three hours a month together, Stucka-Benally said.

The Gender and Sexuality Resource Center at FLC, known as the G-Spot, also offers a safe space for everyone to socialize, said Nancy Stoffer, coordinator of the center.

“The queer culture is multidimensional – there are musicians and athletes and politicians and parents. It’s just one part of one’s life, and yet it is an important part,” Stoffer said.

Stoffer

LGBTQ students find support within community

Stoffer

The center holds weekly Teas at the G, which can draw between eight and 20 students to discuss a variety of topics, such as coming-out stories, the biology of the brain and the history of queer art.

About half the students who visit the G-Spot are allies, which helps confirm to LGBTQ+ students that they are going to be accepted by others regardless of their orientation, Stoffer said. Faculty members also hold office hours at the G, she said.

About 140 faculty and staff across the campus have participated in a Safe Zone training, so they know how to provide LGBTQ+ students resources and support if they need help. Those with training have stickers in their offices, which can help students feel less lonely, she said.

“They may never bring it up, but just knowing that this person is on their side is going to make a difference,” she said.

Charlie surveyed students in the Gay Straight Alliance at Miller Middle School and at the Rainbow Youth Center. He found students believe adults do support them, but they don’t show it in a visible way, through events or other activities, he said.

“I think we are better than most communities. I think we have a leg up and we are already very supportive. We just need to start showing it,” he said.

While there are many resources online and in the community, Charlie said that listening to youths is one of the best ways to reduce the risk of suicide among teens.

“I would say that to parents, just listen to your children; schools, listen to your students; and friends, listen to your friends,” he said.

mshinn@durangoherald.com

Tye McClish’s daughter, Lily, was 13 when she died by suicide in Moab, Utah, in January 2017.

“The hardest thing for me is there is not going to be any more pictures. There is not going to be any more memories,” McClish said.

The eighth-grader loved riding her horse, and she was a gifted artist who was always doodling.

“She had a huge smile and laughter. Even being depressed, she could light up a room with her laughter and smile,” her father said.

Lily had struggled with depression. She was bullied at school because she identified as a lesbian, McClish said.

However, the day she died, there was no indication that she planned to take her life, McClish said.

Shortly after Lily’s death, McClish started to attend counseling with Judy Austin, a grief specialist.

“I have never had this pain in my life before, and it’s not going anywhere. And for me, I’ve had to get comfortable with it in my space,” he said.

The regular counseling has allowed him to be more open with his emotions than he has ever been, he said.

For people who lose someone to suicide, grief counseling is important because they are far more likely to die by suicide themselves.

A study in the United Kingdom with 3,400 participants found that adults whose loved one died by suicide were 65 percent more likely to attempt suicide than those who lost friends or family members in other ways.

Youths exposed to the death of a classmate are also more likely to consider suicide and attempt it. About 14 percent of students exposed to suicide are likely to consider suicide themselves. While only 5 percent of those in the same age group reported considering suicide, a Canadian study found.

Grief can be isolating, and that is one way it can feed into a cycle of more suicides, Austin said.

Austin

Grief care a crucial support for the bereaved

Austin

The need for grief care is also a bit at odds with American culture, which tends to put the focus on getting back to normal and going back to work, she said. But sometimes, the bereaved don’t understand how big an impact a loss can have on them.

There is also a tendency to want to escape, cover up or fix difficult emotions across our culture, she said. But part of grieving requires acknowledging difficult feelings.

“We only gain resilience by knowing we can hold the depths of sorrow, despair, depression. ... It’s not permanent, we will always come out of it. But unless we have that lived experience and people around us have that lived experience, we don’t always know that,” she said.

Austin opened The Grief Center of the Southwest Colorado in 2007, and it became a formal nonprofit in 2015. The nonprofit provides grief counseling to anyone who has lost a loved one regardless of the manner of death or how much time has passed since the death occurred. Services are offered on a sliding fee scale.

Counselors from the center also visit schools, businesses and organizations when a death has occurred. This includes going to Durango School District 9-R schools to support staff and students after a death by suicide, Austin said

Initially, counselors comfort the bereaved, listening without judgment, and offer them a list of possible options for grief support they can seek later, such as support groups and therapy.

The Grief Center has had an exponential increase in the demand for its services over the last three years likely because of an increase in traumatic losses, such as suicides, substance-related deaths, homicides and car crashes, Austin said.

To react, the Grief Center plans to expand its services with a new satellite office that will open this fall in Bayfield Town Hall, she said.

LOSS Teams In many communities across the United States, volunteers who have first-hand experience losing a loved one to suicide are among the first to respond to a death by suicide, and they can immediately recommend locally available grief care to the bereaved.

This response model was started by Frank Campbell, the executive director emeritus of the Baton Rouge Crisis Intervention Center. He founded the first Local Outreach to Suicide Survivors Team, or LOSS Team, in 1998.

Before founding the team, residents took an average of 4.5 years to seek care at his center. With the new team, the average time to seek care decreased to less than 60 days, he said.

The trained LOSS Team volunteer is one of the most valuable people to respond to a suicide because their presence can help bring hope to someone who has just discovered or witnessed a suicide, he said.

“(The bereaved) look up at the person with the LOSS Team and they lock eyes with that person and, I mean, it is just that dramatic. And they routinely say, ‘Oh my God. You know what I’m going through,’” Campbell said. “What happens in that moment I describe as the installation of hope.”

He was initially unable to start the program in Baton Rouge because the coroner was concerned about the potential contamination of the scene while a death was under investigation.

However, Campbell said he built a friendship with the deputy coroner who was eventually elected coroner and who was willing to work with the new team. His LOSS Team has never caused a problem at a scene, he said.

Reducing the amount of time it takes for a person to seek help can prevent additional mental health problems that people who experience such a loss can develop, such as anxiety, post-traumatic stress disorder and substance abuse, Campbell said.

When La Plata County Sheriff’s deputies respond to a death by suicide, generally two members of the victim resources team responds, said Kathy Brush, victim resource coordinator.

The team will provide emotional first aid because the bereaved are not ready for counseling right after a death, she said. Most people are in shock and can’t retain much information.

“We are present with them. That is our main focus,” Brush wrote in an email to The Durango Herald.

In the days after the death, staff members with victim resources will call the family and recommend therapists, clergy or Heartbeat, a support group for those who have lost loved ones to suicide, Brush said.

HeartbeatThe day Michelle and Tony Gelles’ only daughter, Savannah, died by suicide, one of the many people they talked to that day recommended Heartbeat.

The two started to attend the group a week later. The La Plata County chapter of the group was started in 2013 for people who have lost loved ones to suicide. It is now overseen by the The Grief Center.

“Everyone is experiencing the same thing, so we don’t feel alone,” Michelle said.

Savannah Gelles

Grief care a crucial support for the bereaved

Savannah Gelles

Savannah was spontaneous and spunky, and an adventurer who enjoyed boating, camping and riding horses.

“She was the rock in our little family of three, always wanting to keep us all positive,” she said.

Savannah started to struggle with the symptoms of borderline personality disorder, a condition that can magnify a person’s emotions, when she was 13 or 14.

The Gelles family immediately sought treatment and feel they did as much as they could for Savannah, Michelle said.

She describes her grief at the loss of her 22-year-old daughter as complicated.

“It’s a roller coaster of unpredictable emotions and reactions,” she said.

Ginger Domingos also started to attend Heartbeat meetings after her daughter, Rachel, died by suicide in 2015.

“It was really good to share how you’re feeling and confirm that you are not going crazy. I literally hurt so bad that I swear it cracked my heart,” she said.

Heartbeat was founded in 1980 by LaRita Archibald in Colorado Springs, and she has observed the difference the groups can make, although they are not a replacement for therapy.

“Many survivors tell me ... being in this group saved my life,” she said in an email.

In addition to attending the support group, Domingos found support through an online email group called Parents of Suicide. The international group allows her to read the stories of others who have experienced a similar loss and keeps her from feeling alone in her grief, she said.

“I think that’s been lifesaver,” she said.

mshinn@durangoherald.com

Across Colorado and in La Plata County, coalitions are working on new efforts to reduce underage drinking, drug use, violence and other problem behavior among teens. It’s work that could also help prevent suicide.

About 50 Communities That Care coalitions in the state are following a model developed at the University of Washington that is scientifically proven to reduce problem behaviors over time, said Kate Jones, Thriving Youth Programs supervisor at San Juan Basin Public Health.

The efforts are funded through marijuana taxes, and the state set aside $9 million in 2017-18 to fund the coalitions, according to the state health department.

A study of 24 small towns across seven states found that students from communities with active coalitions were 25 percent less likely to have participated in delinquent behavior, according to the Center for Communities that Care.

The study, started in 2002, tracked students in the fifth grade and showed results by the time students reached eighth grade. The study is ongoing, and it has shown children from those communities were less likely to participate in substance abuse, violence and other behaviors into adulthood, according to a study published in the American Journal of Public Health. There are now 118 Communities That Care coalitions operating in 15 states

Preventing youth suicideWhile studies haven’t directly proved the model reduces youth suicide rates, a Communities That Care coalition in the city of Tooele, Utah, successfully employed the model to prevent suicide in recent years, said Heidi Peterson, who oversaw the coalition.

About five years ago, four teenagers died by suicide in Tooele, a town of about 33,000 people 40 miles west of Salt Lake City. Around the same time, survey data showed an increase in depression and thoughts of suicide among teenagers.

The deaths and data prompted the Communities That Care coalition to make suicide prevention a priority, Peterson said.

The effort started in 2015, and Tooele County, home to about 63,000 people, was the only county in the state to see its suicide rates decline in 2017, Peterson said.

The 2017 suicide rate data is not yet publicly available. But Tooele County’s suicide rate for those older than 9 dropped from 43 deaths per 100,000 in 2014 to 15.3 per 100,000 in 2016, according to data provided by the state of Utah. State officials caution the population of the county is small, so the rates can vary dramatically when the difference in the total number of deaths each year is not significant.

The group set out to train 1,500 people per year in Question Persuade Refer, which is designed to be similar to CPR for those experiencing suicidal thoughts. The coalition started by training every high school sophomore in the county and offering free monthly trainings to the public.

“It was our goal to saturate our community,” Peterson said.

In three years, the community trained about 7,000 people, far outstripping its goal because residents continued to request sessions.

QPR teaches participants to recognize statements and behaviors people may exhibit when they are feeling suicidal. For example, those at risk of suicide may allude to their feelings by saying: “Everyone would be better off if I wasn’t around,” according to the QPR Institute.

Trainees are also taught to take three steps laid out in the name of the program. They learn how to question suicidal people about their feelings, persuade them to seek professional help and refer them to local providers.

The sessions also require participates to practice asking direct questions about thoughts of suicide, according the QPR Institute.

A study of about 400 people who work in child welfare, education, the juvenile justice system and similar professions found QPR training tended to fade a bit from participants’ memories after six months. The study completed in Tennessee recommended annual trainings be required for teachers and principals.

Training clergy, teachersThe coalition found of all the different people in teenagers’ lives that they could talk to about suicidal thoughts, members of the clergy were last on the list, Peterson said.

So the coalition worked closely with the Mormon church and other faith-based organizations to train their leaders in QPR. It was warmly received by those faith leaders, who put the training into practice.

“They could talk to these people that they were concerned about and trust they were using the correct steps to bring them help,” Peterson said.

The coalition had 75 faith leaders come to the first training and 150 attend the second.

The group also introduced efforts at local schools to train teachers and administrators on the best steps to take after a suicide to prevent additional deaths, she said.

“The objective of postvention is to help process that grief in a way that turns it to healing and hope and prevention for others,” she said.

The coalition had been working in the community since the early 2000s and had already built partnerships with key groups, including the health department and the mental health authority, which allowed it to work efficiently, she said.

Building La Plata County’s coalitionThe local Communities That Care coalition plans to help young people understand that underage drinking and drug use is harmful. The group chose those goals based on Healthy Kids Colorado Survey data, said Jones with San Juan Basin Public Health, who started work in 2016.

The coalition is not focused on suicide intervention, such as QPR, but on prevention work that will keep teens from becoming suicidal at all, Jones said.

The coalition’s work is built on a positive youth development strategy developed by the Center for Communities That Care that involves teens as equal partners, Jones said.

The model requires adults to provide quality extracurricular activities, teach teens the skills to succeed and praise them for specific achievements.

The strategy also encourages building strong relationships between adults and teens to motivate teens to meet clear standards for behavior, according to the center.

To help build relationships between adults and teens, the coalition is educating coaches, parents, law enforcement, business owners and others about what to expect from youths, she said.

Jones

Communities That Care coalitions aim to create healthy connections

Jones

“The biggest thing positive youth development brings to a community is really getting adults to see the opportunities that are available in each stage of (teen) development,” Jones said.

While some adults might say that teens are frustrating to work with because they are unpredictable, the model helps adults see difficult moments as opportunities for growth, she said.

Communities That Care is also promoting groups that may not be as well-known as sports, such as comic book or gaming clubs.

If a student can’t find a group that interests them, the coalition will encourage the student to start one, Jones said.

“We don’t ever want to tell them what to do. We empower them to come up with some of these ideas and then we help them implement them,” she said.

Communities That Care is collaborating with Celebrating Healthy Communities, another countywide coalition, to encourage healthy relationships between adults and teens and involve teens in prevention work.

After seeking input from at least 150 teens in La Plata County, the coalitions found that young people want the community to listen to their ideas and give them opportunities to participate in promoting a healthy community.

Adults must trust that teenagers are the experts in what it means to be a young person and not limit their involvement to one-time projects, said Breeah Kinsella, interim director of Celebrating Healthy Communities.

“Kids are fully capable of not only telling you what they need, but also getting what they need and accomplishing tasks if we give them the right guidance and leadership,” she said.

Building relationships takes commitment, vulnerability, honesty and trust, she said.

“Real, honest connection does not come in the form of a ding from your phone. And so it takes time, relationship building is not easy,” she said.

Creating connectionsThe two coalitions developed the Youth-Adult Partnership Series to empower teens to advocate for themselves and teach teens and adults to work together.

During one workshop, adults and teens discussed the positive impact an adult had on their lives and the qualities that person possessed. The teens also gave presentations to adults about how they can better show they value and listen to youths, Jones said. Two workshops had been held as of September and more are in development.

The two coalitions are designing a survey to follow up with those participating in the workshops to see if the workshops helped improve their community engagement, she said.

Communities That Care wants to ensure teens can advocate for themselves, identify and talk to a trusted adult and talk to peers they might be concerned about, she said, in an email.

The coalition also provides teens information about brain development and how it affects what teens experience throughout their adolescent years, Jones said.

The model can be expected to bring about change in the next five to 10 years, Jones said.

She expects to see substance use among teens decline and their participation in the community increase.

She wants teens to feel as through their time, energy and effort is not only valuable but necessary for the community’s health and future.

The coalition in La Plata County has completed the first three steps of the Communities That Care model. The first step is to get community stakeholders involved. Once coalition members are recruited, they must learn about how to prevent risky behaviors among teens and write a vision statement. In the third phase, coalitions must review data from youth surveys and decide how they plan to encourage healthy behavior.

This month, the coalition planned to review a community action plan about how to achieve its goals, and it will likely start implementing the plan shortly, Jones said.

“I believe a coalition, such as this one, is successful when we have built it to a place where youth feel like they are the ‘captains of the ship,’” Jones said.

mshinn@durangoherald.com

After hundreds of people gathered for a summit about suicide last year, San Juan Basin Public Health started organizing a communitywide effort to work at reducing the suicide rate.

Based on feedback from residents who attended the summit, health department staff decided to involve law enforcement, schools, youths, health care institutions, churches, nonprofits and other groups in suicide prevention efforts.

Warner

San Juan Basin Public Health sets ambitious goals for suicide prevention

Warner

“Our takeaway was that one focused intervention to try to prevent suicide wasn’t going to really make a difference. That’s how we really landed on the model of collective impact,” said Laura Warner, director of health promotion services.

The model brings together different sectors of a community to solve a complex problem through a common agenda, she said.

“It’s considered to be a best practice in that nonprofit, social-change world, but the evidence base behind it is kind of fledgling,” she said.

The model can help sustain social-change movements by involving multiple organizations and spreading out the workload, said Mary Dengler-Frey, regional health connector for the Southwest Colorado Area Health Education Center.

“If we can each do one little part of the whole collectively, we can move the needle and we can really make an impact,” she said.

The La Plata and San Juan Counties Suicide Prevention Collaborative has drafted ambitious goals.

However, the collaborative is in its initial organizing phase, and it has not drafted an action plan that will lay out strategies to achieve all of its goals, said Claire Ninde, spokeswoman for the health department. The department is also seeking more data to inform its process, she said.

The collaborative’s current goals are:

Building awareness about suicide and mental health.Identifying a protocol of care that would be followed by all health care agencies when someone experiences a mental health crisis.Hiring a mental health advocate to improve the coordination of mental health agencies.Fostering meaningful connections between individuals.Providing free suicide intervention trainings, especially for youths and teens. Writing a plan for a community-wide response to suicide that would guide many groups, including law enforcement, media, faith-based, schools and mental health providers. The plan would outline how to support those bereaved by a suicide and prevent contagion.mshinn@durangoherald.com

After Cody Ledford, an Escalante Middle School student, died by suicide last year, his family asked everyone who was concerned to send donations to La Plata County 4-H in lieu of flowers.

The request raised $20,000 and prompted the family to start the CODY Project, short for Communities Overcoming Depressed Youth Project, said Rhonda Ledford, Cody’s mom.

While an intern for the La Plata County 4-H office, Tyllor Ledford, Cody’s sister, started the organization about a month after her younger brother died in May 2017.

“I don’t want another kid to feel like my brother must have felt, being lost and not thinking they have any other choice but to end their own lives,” said Tyllor, a junior at Texas Tech University.

She remembers her brother as outgoing and caring.

“He would always do stuff for everybody else before himself. Like if he had a dollar in his pocket, it was a dollar spent on one of his friends or someone else,” she said.

The family decided to start the suicide prevention project through 4-H because Tyllor and Cody were longtime members of the organization, and the group of about 300 members countywide had seen other losses.

Since 2016, 4-H members, Cody, 14, and Thomas “T.C.” Rockwell, 13, have died by suicide. A former 4-H member, Ethan Kremer, 12, died by suicide in May.

The deaths have touched many lives within the 4-H community and generated support for the project, Rhonda said.

‘We can work as a bridge’The CODY Project is run by a few adult advisers and about three teenagers, who recruit other teens to participate in events. The group is working to prevent suicide by holding mental wellness trainings for 4-H members and working to create more open communication about suicide among 4-H members and in the community.

The group also brings teens and professional suicide prevention groups together at events.

For example, the CODY Project has hosted San Juan Basin Public Health, a group organizing communitywide suicide prevention efforts, and Axis Health System, which provides integrated physical and behavioral health care.

Before the CODY Project, no one organization was trying to bring together different groups working on suicide prevention, Tyllor said.

“We can work as a bridge or a glue that brings in all these pieces together,” she said.

Teens are a linchpin in suicide prevention because they may notice strange behavior their peers are exhibiting that adults may overlook.

“They know so much more about this situation than we give them credit for, and they know how important they are in this,” Tyllor said.

Teens who are struggling with their emotions may also be more inclined to talk to their friends than their parents, she said.

In Cody’s case, he confided in friends that he was feeling suicidal after the death of T.C. and two concussions, which can be a risk factor for suicidal thoughts.

His friends told a school counselor about Cody’s thoughts, who told Cody’s mom, Rhonda. Rhonda took Cody to Axis for crisis care and later got him into private counseling, Rhonda said. Tyllor credits Cody’s friends for lengthening his life.

Once the Ledford family began sharing their story about Cody’s death, Tyllor found many others were willing to talk about depression, suicide attempts or deaths by suicide.

“Everybody has been affected by this, and once you bring it up, you think: ‘Oh, why is this so scary. If all of us are affected by it, why are we so scared to talk about it?’ Just like, all of us have hair and we talk about how we do our hair,” she said.

Events open communicationShaylee Owen, 15, who helps run the CODY Project, has seen the group’s efforts to open up communication about suicide pay off in the last year.

“It has helped people feel like they can talk about it and not be shamed for that. So that’s definitely made a difference,” said Shaylee, a Bayfield High School sophomore.

The CODY Project has planned its events on the anniversaries of 4-H members’ deaths, which helped reframe what would otherwise be bad days, Owen said.

The events serve as reminders that friends and loved ones can miss those who died, but also enjoy memories of them, she said.

On the anniversary of Cody’s death, the group held a Mental Health Mardi Gras in May 2018 that featured games such as human foosball, a yoga class to help address anxiety and opportunities to talk with health professionals.

Even though suicide is a serious topic, Tyllor said she wants to create environments that ensure attendees are not daunted by the subject and can feel comfortable discussing it.

Shaylee’s mom, Jessie Kugle, took a similar approach when she led a mental wellness workshop for 4-H members at a regional leadership event. She showed a funny video to demonstrate how no one would ask you to shake off a broken leg and you shouldn’t shake off a mental health condition.

She has also led a discussion about how students can take care of their mental health, encouraged them to talk about how they are feeling and recommended people they can talk to about it.

Kugle’s best friend died by suicide many years ago, and she struggled with depression and suicidal thoughts herself afterward. Shortly after Cody died, she shared her story with 4-H members and talked with them about the grief process. She has about 20 students who now feel like they can confide in her.

“I don’t sugarcoat anything, and I’m 100 percent real with them,” she said.

Seeing awareness buildStrong relationships among teens and between teens and adults are a key suicide prevention step and the focus of many prevention efforts across La Plata County.

Adult leaders in 4-H have also participated in Question Persuade Refer trainings, which cover how to question suicidal people about their feelings, persuade them to seek professional help and refer them to local mental health providers.

Kugle said she observed greater awareness about suicide risks while she was at the La Plata County Fair this summer, awareness she attributes to the CODY Project. After a 4-H participant was kicked in the head by a steer, many fair attendees were sensitive to the link between concussions and suicide, she said.

The CODY Project is in the process of developing its mental wellness curriculum for teens.

Tyllor would like to see trainings happen monthly or bimonthly with professionals and incorporate social media literacy trainings, she said.

While social media can function to connect family and friends, it can also have an isolating effect, she said.

“You see pictures of a person’s picture-perfect life, where everything is all fine. ... And you think, ‘How come I’m not like that?’” she said.

She also sees a need for more mental wellness education in elementary schools that would teach students to accept feelings of sadness or anger and how to process them.

Tyllor is studying agriculture and applied economics, but founding the CODY Project sparked her interest in health care, particularly work similar to the community organizing she has done with the CODY Project.

She describes the work as having no end, but she celebrates small successes, such as when other groups seek out the CODY Project for partnerships and she sees people she doesn’t know wearing CODY Project wristbands.

“The passion is spreading throughout the 4-H community and it’s very awesome to see,” she said.

The CODY Project meets at 6:30 p.m. every third Wednesday of the month at the Extension Building at the La Plata County Fairgrounds, 2500 Main Ave.

A bike ride in memory of T.C. Rockwell, who died by suicide, will be held at 6:30 p.m. Nov. 8. Riders will meet at Rotary Park and cycle to the fairgrounds. Food, games, music and mental health resources will be set up at the fairgrounds.

mshinn@durangoherald.com