Suicide spike over, county official says

For more than a year, health officials puzzled over the high number of suicides in Spokane County in 2004.

Some attributed the increase to turmoil in the public mental health system. Others said the 50 percent increase may have merely been an anomaly.

This week, the county’s medical examiner announced that suicides returned to “normal” levels: 62 people killed themselves in Spokane County in 2005.

“We had a couple years where our suicides went up,” said Dr. Sally Aiken, the county’s chief medical examiner. “It’s difficult to know why that has happened. There doesn’t appear to be a clear pattern.”

Amid the recent turbulence in the county’s public mental health system, the spike in suicides raised concerns.

Dr. Matt Layton, medical director at Spokane Mental Health, said the increase coincided “with dramatic changes in Medicaid” that resulted in hundreds of people with mental illness losing access to the public health system.

“I’m not saying that explains it all,” cautioned Layton, who has reviewed more than a half-century of Spokane suicide data. “There are so many different reasons why people get to that point.”

Typically, fewer than 10 percent of people who commit suicide were receiving mental health care before the event, Layton said.

The number of suicides in Washington has increased 13 percent since 2000, according to the most recent data from the state’s Department of Health. But the data can vary widely from year to year, and it has not been without controversy.

In the 1990s, an outspoken Spokane coroner allegedly declared suicides without ordering autopsies or finding suicide notes, relying instead on anecdotal evidence or drug and alcohol use.

Layton praised the current data collection system, which is managed by the medical examiner’s office.

Despite statewide increases, no county saw the dramatic jump that Spokane did in 2004.

From 1998 to 2003, the county had an average of just under 61 suicides, according to reports from the medical examiner’s office. In 2004, however, 95 people killed themselves in Spokane County.

“Generally, what we tend to do epidemiologically is to take a look at patterns over time,” said Dr. Lou Sowers, director of Child and Family Services at Spokane Mental Health. “But that is a huge increase.”

Even so, suicides may still be undercounted, according to medical experts. In Washington state, more than a hundred people die each year from undetermined causes. Some of those may be suicides, Layton said.

The number of suicide deaths may also mask the extent of the problem. For every completed suicide, there are six survivors, according to national statistics.

Among children, there may be a hundred attempts for every completion, Sowers said. In 2004, six people between the ages of 10 and 19 killed themselves.

More than 90 percent of victims suffer from a psychiatric disorder, but most are not receiving treatment in the time leading up to their death, he said.

“The stigma makes it hard for people to acknowledge that they have a very real medical condition,” Sowers said. “When people access treatment, it’s usually pretty effective.”

Because suicide can be driven by such a variety of issues, it can be difficult to determine a singular cause to the increase, said A.J. Hutsell, a suicide prevention specialist with the Spokane Regional Health District.

“It’s possible to have one year which the numbers skyrocket and then have those numbers go back to normal,” Hutsell said. “It makes me wonder if we’ll find out why.”