By Dr. Kurt Michael | September 2023
Region 17 Comprehensive Center facilitates NWRISE, a network of small rural schools in Idaho, Washington, and Montana. In June 2023, NWRISE held its spring member convening. Participant schools identified youth mental health as a topic they wished to address. To support members, the NWRISE steering committee selected Dr. Kurt Michael, Senior Clinical Director at The Jed Foundation with expertise in rural school mental health and adolescent suicidology, as the guest speaker to lead a conversation on this difficult topic. The blog below is by Dr. Michael and provides a summary of his presentation on youth suicide and key prevention strategies.
Suicide deaths reached a record high in the United States in 2022, with many rural and western states—including Montana, Washington, and Idaho—reporting higher rates than the rest of the country. As a clinical suicidologist specializing in the nature and treatment of suicide risk among youth, speaking about this topic never gets easier and it’s hard to accept this trend as the growing cultural norm. In my more than 30 years of direct work with people who have experienced or are concerned about losing loved ones by suicide, I've learned and shared that suicide is complex and multi-layered, but also preventable. I had the pleasure of speaking to a group from NWRISE in June 2023 about youth suicide, specifically in rural areas.
The issue is particularly challenging for youth who live in rural communities, where lethal means for suicide, such as prescription or over-the-counter medications and firearms, are often perceived as more readily available than they are elsewhere. Indeed, a large published study supports that perception, finding that in states with higher rates of gun ownership—several of which were rural and/or in the Rocky Mountain West—disproportionately high numbers of firearm suicides drove higher overall suicide rates. The differences were not accounted for by other factors such as higher rates of suicide attempts or mental health ailments.
Therefore, a proven way to reduce suicides in rural areas and elsewhere is to invest more deeply in the science and practice of lethal means safety—limiting access to the means to harm oneself. Counseling on Access to Lethal Means (CALM), the oldest and most well-established lethal means safety intervention, has been vetted fully and is listed on the Suicide Prevention Resource Center’s Best Practices Registry. CALM is a practical intervention to increase the time and distance between individuals at risk of suicide and the most common and lethal methods of suicide. The intervention involves having honest conversations with individuals, families, schools, systems of care, and other organizations about practical and non-controversial approaches to preventing suicide, including the voluntary and safe storage of firearms and dangerous medications. Most relevant for schools, CALM includes the dissemination of objective information about safely storing guns and medicines.
Even though lethal means safety approaches make sense, there is still a significant and problematic gap in practice across the country. Many mental health professionals are hesitant to talk directly with their clients and patients about substance misuse and firearms, are skeptical that bringing it up will make any difference, and are not adequately trained or practiced in talking about the safe storage of dangerous medications and firearms with their patients and families. The issue is urgent, especially since the suicide rates in the U.S. appear to be moving in the wrong direction.
For more information and resources to support suicide prevention, visit The Jed Foundation's website.