TWIN FALLS – On a mid-September evening, as the sun sank into the Snake River Canyon, several dozen strangers gathered at the Perrine Bridge to send a simple message.
Using pipe cleaners, they adorned the bridge with bright orange bracelets bearing two words: “Love yourself.” Afterward, they mingled quietly among themselves, some opening up to discuss the common tragedy they shared.
At the center of it all, doling out wristbands and comforting words, were siblings Kayla and Koby Gardner, who lost their brother Skyler to suicide in March. The Gardners organized weekly gatherings at the bridge each Thursday in September as part of a broader, ongoing effort by the Kimberly family to encourage open dialogue around mental health and suicide.
“By being vulnerable with our story, it has helped people be open with their own stories,” Kayla explained.
Suicide is on the rise across the country, and Idaho is no exception. The Gem State had the seventh-highest suicide rate in the U.S. in 2016, with about 21 suicide deaths per 100,000 people, according to data from the U.S. Centers for Disease Control and Prevention. In the Magic Valley, that rate was slightly lower – though still higher than the national average – with 18.6 suicide deaths per 100,000 people.
Statewide, it’s a significant increase from just a decade prior: In 2005, there were 16.5 suicides per 100,000 Idahoans.
“We are fighting an uphill battle,” said Kim Kane, director of the Idaho Department of Health and Welfare’s Suicide Prevention Program. “While there are far more efforts in place, the problem is larger than it was when we started.”
Thanks to growing awareness and a push in the statehouse to address the issue, there are more state-funded resources for education and prevention in Idaho than ever before. But lasting change doesn’t just come from government initiatives, advocates say. An effective, sustainable approach to lowering the suicide rate includes efforts like the Gardners’: grassroots campaigns to create a real dialogue around mental health.
“The focus is more on: What can we do to help whole communities make a difference in lowering the suicide rate?” said Elizabeth Fore, interim director for the Institute for Rural Health at Idaho State University. “I think we have to have the grassroots, because the funding is always going to come and go.”
‘Nothing taboo about it’
On a mid-September afternoon, a few days after the Perrine Bridge gathering, the Gardners – Blake, Wendy, and their children, Kayla, Koby, and Nathan – sat in their modern white and gray front room, redesigned by Wendy to be a more neutral space for the family after Skyler’s death.
They spoke fondly of their son and brother, a talented photographer who loved the outdoors and loyally backed Boise State football despite his family’s allegiance to Brigham Young University. But they also talked openly about Skyler’s struggles with mental health in the final years of his life.
“We had always encouraged him to seek professional help,” Wendy recalled. “But you can’t make a 30-year-old do something.”
Eventually, Skyler did get help. “But it took him a long time,” Wendy said. “I wish he could have had a few more tools in his bag so when this deep, dark moment came, he would have had some more tools to help him.”
The Gardners have shared Skyler’s story often over the past six months. Since creating a website that includes a brief biography of Skyler, links to mental health resources, and an order form for a “Love Yourself” bracelet, the family has heard from people around the world, with the site reaching as far as Germany and England.
“There’s nothing taboo about it,” Blake said. “We’re not hesitant to get physical help when we’re hurting, but society has put this stigma on mental health. Sometimes strength is being open.”
The Gardners say that by openly talking about Skyler, they hope to reach others going through similar struggles.
“In storms, there’s lighthouses out there,” Wendy said. “Somebody has to have that lighthouse lit so they can see.”
A regional issue
The six primary Mountain West states – Idaho, Montana, Wyoming, Utah, Nevada, and Colorado – regularly have some of the highest suicide rates in the country, though researchers have struggled to pinpoint exactly why. Some attribute it to an ingrained ideology of “rugged individualism”; others have suggested it could be related to the region’s high altitude.
Carolyn Pepper, a psychology professor at the University of Wyoming who studies suicide in the Mountain West, said that in a recent survey, participants from Western states like Idaho demonstrated higher levels of stoicism than those from other parts of the country. Respondents in Mountain West states were more likely to agree with ideas like “I tend not to express my emotions,” and “Sometimes suicide is the only escape to life’s problems.”
Older men, perhaps the most stereotypically stoic demographic, are among those most likely to die by suicide in Idaho and elsewhere. Of the 128 suicides in Twin Falls County since 2012, 97 of the deceased were men, and 60 of those men were older than 40, according to data from the county coroner’s office.
But suicide rates in the Mountain West are high across all genders, ages, and ethnicities.
“We think of this as being a culture of the cowboy, out on the ranch by themselves,” Pepper said. “But if you’re seeing it in groups where you’re not necessarily expecting to see it, that suggests that it’s a higher risk than just something you see in rural areas among a specific group of people.”
Why those rates are higher across the board – and rapidly rising – is a question that Pepper is gathering data to try to answer. There isn’t much existing research on the topic, though some theories exist. Pepper’s leading guess so far: economic factors, which can have a strong correlation with suicide rates.
“The states out here tend to have boom-and-bust economies and sometimes follow slightly different economic trends than the rest of the country,” Pepper said. “You combine the stoicism and reluctance to seek help with how one’s feeling about economic problems, and that could be what’s leading to higher suicide rates here.”
In the steadily growing city of Twin Falls, ample jobs and educational opportunities are available. But in rural areas with shrinking or stagnating populations, economic factors could exacerbate some of the social factors that can lead to suicide, such as isolation.
“As more young people and families move out of the rural areas, you’re going to see more people left behind who are isolated,” Fore said.
Mental health services
While perhaps compounded by certain ideological and economic factors, a long-standing stigma around suicide isn’t something that’s unique to Idaho or the Mountain West. Both suicide rates and efforts to raise awareness are on the rise nationwide.
But Idaho faces its own challenges when it comes to the availability of mental health resources. The entire state, including the Magic Valley, has been designated a Health Professional Shortage Area for mental health professionals by the U.S. Department of Health and Human Services, indicating a serious lack of psychiatrists, therapists, and other mental health care providers.
People seeking help in rural areas often have to wait weeks and drive miles for an appointment, said Michael Sandvig, president of Idaho’s chapter of the National Alliance on Mental Illness.
“The sad part about that is you could go into crisis before you could get the kind of help that you need,” Sandvig said.
It can be difficult to recruit mental health professionals to work in rural areas, and with psychiatrists in short supply nationwide, solving the shortage in Idaho may not be immediately realistic. But what the state can do is get creative with the resources it has, said Shannon Decker, executive director of the Idaho Suicide Prevention Coalition.
“I don’t think we have the ability to change that,” Decker said. “But what we start looking at is, how do we utilize the psychiatrists and health care systems that we have and make them more accessible to people outside urban areas?”
The Idaho Department of Health and Welfare’s Strategic Plan for 2019-2023 includes implementing in at least 10 health care systems in Idaho the Zero Suicide model, a national initiative to train health care providers to better recognize and assist potentially suicidal patients. While some hospitals have already begun implementing elements of the model, funding for the program would make training and execution uniform across the state.
The strategic plan also includes the goal of training 60 professionals and community members – known as “gatekeepers” – by July 2019. These gatekeepers should be able to identify warning signs for suicide and help connect at-risk people with resources.
“The suicide prevention initiative centers on education and outreach in acknowledgment that everyone has a role to play, including such disparate entities as schools, medical providers, and shooting clubs,” wrote department director Russell Barron in a July letter introducing the plan to Idahoans.
Increased use of “telehealth” technology, which would allow mental health providers to communicate via video with at-risk people living in remote locations, could also help alleviate the impact of Idaho’s mental health professional shortage, Kane noted.
“Telehealth is important,” she said. “But equally as important as making sure there are mental health providers is that we really just need someone to intervene that first time.”
This past legislative session, Idaho passed the Jason Flatt Act, which requires all school personnel to be trained in suicide awareness and prevention. The law is the latest in a series of steps taken by the state over the past decade to increase suicide prevention and education resources.
In 2012, the legislature voted to restore funding to Idaho’s suicide prevention hotline, which was shut down in 2006. Four years later, the state created the Suicide Prevention Program within the Department of Health & Welfare, with the goal of facilitating a more coordinated statewide approach to tackling suicide.
“It’s one of those issues that you do too little and kind of too late and then you realize,” said Rep. Maxine Bell of Jerome, co-chair of the Joint Finance-Appropriations Committee. “We’ve been a long time getting to a place where we should have had the attention put on it we’re putting now.”
In the years that Idaho was without a suicide prevention hotline, Idahoans could reach locally funded hotlines in Oregon and other states that volunteered to take Idaho calls.
“Obviously, there’s still somebody on the other end who can help save a life,” Kane said. “But better than that is making sure you have Idaho people with Idaho resources.”
Bell said she’s seen suicide awareness increase significantly since 2006, when the state closed its suicide hotline. She described national studies on suicide in Idaho since then as a “wake-up call” for legislators and other government leaders.
“We’re a little bit behind on that and a little bit behind on mental health, but that’s no reason to stay behind,” Bell said. “That’s a good reason to go ahead and get moving and see what you can do and do it right.”
The Idaho Suicide Prevention Coalition has begun looking into several potential pieces of legislation to introduce in the next session, Decker said, including a bill that would make gatekeeper training a requirement for nurses and legislation regarding worker’s compensation for first responders suffering from post-traumatic stress disorder.
Reversing the trend
While suicide rates have mostly increased across the U.S., they’ve remained steady, even decreasing slightly, in one state: Idaho’s neighbor to the south.
Nevada had the sixth-highest suicide rate in the country in 2016, according to data from the CDC. But it saw a 1 percent decrease in its suicide rate between 1999 and 2016.
Like Idaho, Nevada has struggled with limited mental health resources and a lack of funding, said Misty Vaughan Allen, suicide prevention coordinator for Nevada. She attributes the state’s slow but steady progress to a grassroots, “multi-pronged” push that spans across communities and organizations.
That push has emphasized training for community members and professionals who may come in contact with people who are suicidal: nurses; gun shop owners; school employees; military veterans. More than 15,000 Nevadans have been trained in suicide awareness, Vaughan Allen said.
“We have more communities knowing they have a need and wanting to have these skills,” Vaughan Allen said. “It’s not hidden anymore. People are wanting to know how to have that conversation safety.”
Now, the state is turning its focus to some of the same initiatives Idaho is considering, such as the Zero Suicide model.
“Even though we’ve held steady, we’re still very high,” Vaughan Allen said. “We want to make sure we’re keeping this momentum and the conversation in the forefront.”
‘How do we educate without promoting?’
At a recent meeting of the statewide Suicide Prevention Action Network’s South-Central Idaho chapter, members sat around a table brainstorming ways to spread their message.
The chapter has used radio spots in the past. But the challenge with radio, treasurer Lori Stewart pointed out, is it can be difficult to know who you’re reaching.
What if the group advertised on a music app like Spotify? Or a popular mobile game, such as Candy Crush Saga? Eventually, the table agreed to look into renting a billboard. But where? And what would it say?
The chapter, formed in 2004, leads suicide awareness campaigns and offers prevention and educational resources throughout the Magic Valley. The group regularly puts on presentations for churches, civic groups, and schools, and hosts a monthly survivor meeting at the Episcopal Church of the Ascension in Twin Falls.
“Suicide has always had a really bad stigma,” chairwoman Donna Stalley said. “I think the more we’re educated and the more we talk about it, the better we’re eliminating that stigma.”
Like the Gardner family, SPAN South-Central Idaho has distributed rubber bracelets in the past, printed with the words “We care” and the suicide prevention hotline number. The bracelets are especially aimed at young people, Stalley said.
“I’m concerned about kids.because (suicide) is so well-known now,” Stalley said. She said she worries that some media, such as the controversial Netflix show “13 Reasons Why,” have made suicide seem more appealing to adolescents. “How do we educate without promoting? That’s the key.”
A different approach
The statewide Suicide Prevention Program is trying a different approach to suicide awareness: targeting not vulnerable people themselves, but those around them. A campaign with the tagline “Rock your Role” asks people to directly engage with friends, family, or coworkers who show signs of being suicidal.
It’s an experimental approach to normalizing intervention that hasn’t been tried on a large scale before, Kane said, meaning the eyes of advocates around the country are now on Idaho. She compares the initiative to the “Friends don’t let friends drive drunk” campaign, which shifted the burden of responsibility from drunk drivers to their more sober friends.
“It’s much harder for someone who’s intoxicated or highly suicidal to see if they need to reach out,” Kane said.
One of several video PSAs with the “Rock Your Role” campaign opens with a bald man in a baseball cap knocking at the farmhouse door of a white-haired man in a flannel shirt.
“Hey, Pete,” the man in the cap says. “How you doing?”
The two men mosey past a red barn and end up at a fence, where they lean and gaze out at a field together, not speaking.
“I tried ending it all once before. Jim wasn’t going to let it happen again,” Pete says in a voiceover, as a flashback montage shows Jim going through a familiar routine alone: waiting for his friend by a fishing boat; driving down a country road in a pickup truck; greeting a waitress at a local diner beneath a yellowed “State champs!” newspaper clipping.
“When I stopped showing up, Jim showed up at my door,” Pete’s voiceover continues, a guitar strumming softly in the background. “He didn’t let me brush him off.”
Other PSAs stress the same message: the importance of reaching out to a friend, family, or coworker who may be suicidal. In one, a high school baseball player approaches a coach to say he’s worried about a teammate. In another, a police officer is helped by a colleague. But the video of Pete and Jim was crafted with a specific audience in mind.
“We knew that the one with the two older men was going to be critical for our frontier area,” Kane said. Extra care was put into the nuances of this video, Kane said, down to making sure the actors looked out at the field and not directly at each other as they stood at the fence – “because that’s not how older men talk to each other.”
It’s difficult to directly measure the effectiveness of campaigns like this one, Kane said, because it takes years for suicide rates to reflect change. The immediate impact of the PSAs will be gauged by surveying people who have watched them. But whether the new approach will be successful in changing the conversation long-term remains to be seen.
“It really just takes a really long time,” Kane said. “When we start to see the whole trend line start to go down, then we’ll know.”
Some tears were shed at the Perrine Bridge that Thursday night in mid-September, but the mood wasn’t somber. While some quietly shared personal stories amongst themselves, others laughed and joked, hugging strangers like old friends.
A few of the people who showed up that evening were family acquaintances, Kayla said. But most of the faces were unfamiliar to the Gardners. Some had heard about the gathering on social media, Kayla said. Many had also lost a loved one to suicide.
Between them, they hung 60 bracelets, the bright orange bands providing a startling contrast to the brown canyon beneath.
“I think we’ll need more next time,” Kayla remarked after the crowd had slimmed and only a few lingering friends remained.
The bracelets hung on the rails through the night and into the next morning until, one by one, they disappeared.
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