A Deadly Equation: Suicide in the West, Part II

Suicide Prevention Comes Down to Dollars, Attitude and Access

By Brian McDermott, 3-09-06

	Photo by Brian McDermott Maureen O'Malley, pictured in her basement office, is the coordinator of the Missoula City-County Health Department's suicide prevention network.

This is the second part of a three-part series exploring suicide rates in Montana and the Rocky Mountain West. Click here to read Part I: "A Deadly Equation."

By 5 p.m. on a new autumn day last October, about two-dozen people stood in the park, waiting for the county's inaugural Suicide Memorial Awareness Walk to begin. It was a big moment for Maureen O'Malley, the coordinator of the Missoula City-County Health Department's suicide prevention network. Her position is less than three years old, and she is charged with the weighty task of decreasing the number of suicides in Missoula County. The job is 15 hours a week. Part-time.

The need for suicide prevention, however, has been constant throughout Montana's history. The Treasure State's suicide rate has been higher than the national average every year since 1910, save for two. In 2003, the most recent year from which statistics are available, the only states that had a higher suicide rate than Montana were Wyoming and Alaska.

O'Malley's budget is anemic. There was a $10,000 governor's grant given to her office and to four other Montana counties last year. Otherwise "it's a matter of eking some dollars out of the current health department budget," she said.

O'Malley's equivalent until November in Cascade County was Susie McIntyre, who puts the fiscal woes more bluntly. "Suicide prevention in Montana can come down to money, and yet we haven't invested in it in any systematic way," she said.

O'Malley does what she can. Besides the suicide awareness walk, O'Malley tries to make it easier for people to get mental health services. She speaks to whatever group will have her. She trains police, firefighters and teachers to recognize suicidal behavior with the hope of preventing it.

Palpable results can be hard to see. What she saw with a month left in 2005 was that Missoula County was already about 20 percent above its average yearly number of suicides. By the year's close number of suicides in Missoula County hit 23. The number of people who killed themselves in Missoula County this year would form a circle almost exactly the size of the one that formed in remembrance at St. Anthony's Parish in October.

The question, then, is why there are so many suicides in Montana and the Rocky Mountain West. Those tackling the subject agree on some general causes.

The first is that there are not enough psychologists and psychiatrists working in Montana. Fifty of Montana's fifty-six counties are underserved by mental health clinics -- a geographic area more than twice the size of Florida.

Based on 2005 U.S. Census estimates, there is one registered psychologist per 4738 people in Montana. In Colorado, there is one registered psychologist per 2149 people.

"Not a day goes by when I'm not turning people away," said Dr. Vince River, a psychologist who started a practice in Polson five years ago after moving from Chicago. He moved back to rural Lake County to be closer to his family, and since then his schedule has been booked solid. Many psychologists, he said, cluster in cities for a better quality of life and also because many rural residents do not have health insurance. Medicaid reimbursements for mental health services are low, so psychologists earn significantly less money. "There's a need for three of me," he said.

Even in a county like Missoula that has adequate mental health services, with 56 state-licensed psychologists living in the county, "if you live in Florence or Seeley Lake and you don't have a reliable car, or money to buy gas, then you're underserved," O'Malley said. Roosevelt County, in eastern Montana has only one licensed psychologist. Lake County has three and Cascade County has 18.

The second reason is the stigma that being treated for depression, or any kind of mental health problem, is a sign of weakness. As Mary Borris of Ronan, who has lost a brother, a stepson and a cousin to suicide said, "they think it's a sissy disease."

McIntyre, in Cascade County describes it as common Montana mentality -- a frontier idea that you should be self-sufficient and that keeps people from asking for the help they need.

"Mental health isn't real -- it's more of a character flaw. They feel like they have to cowboy up," McIntyre said. The Missoula Suicide Network estimates that 60 percent of those who commit suicide suffer from clinical depression.

The third reason is easy access to guns, which unlike pills give victims no time to change their mind. Household gun ownership in Montana is well above the national average of 50 percent, with some estimates putting the number as high as 90 percent. More than half of suicides nationwide involve a gun.

These problems are "part of who we are," said O'Malley. They are entrenched. They are not easy to fix.

Mary owns one thing that belonged to Stephen, her stepson who committed suicide in 2004 in a Havre jail. It's an American flag with the "End of the Trail" figure -- duplicated from the famous 1915 statue by James Earle Fraser recalling the Trail of Tears -- overlaying the stripes. Like the Native American on horseback, the flag droops as it hangs on her bedroom wall.

Nationwide, Native Americans have the highest suicide rate between the ages of 15 and 24. In Montana, whites and Native Americans have nearly identical suicide rates. Mary, a Chippewa-Cree, blames the suicide rate among Native Americans on many of the same factors affecting the statewide rate. A macho culture, high rates of drug and alcohol abuse, and non-existent job opportunities become factors in Native American suicides, she said.

Feeling defeated is tempting when dealing with suicide. The problem in Montana appears intractable -- the rate was the highest in the nation a few years after Montana became a state in 1889, and it will be high again in 2005. But for O'Malley, there is cause for hope. Montana won a $400,000 federal grant -- "quite a coup," O'Malley said -- to work on preventing youth suicide. The state will soon empanel a group to help prevent suicide- perhaps the first step in centralizing and improving state action against its ninth leading cause of death.

Individually, Dr. Vince River feels his presence in Polson makes a difference, however modest. "It's very humbling work," he said. As the on-call psychologist for the county jail and the county sheriff, "I swim in the soup most days in regards to suicidal thoughts and suicide," he said. There are people who need nothing more than empathy and to know that someone else understands their pain. "There's so much need," he said.

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