Students hear warning signs on suicide

Four students at Stone Child College, along with several mental health counsellors and health services workers on Rocky Boy's Indian Reservation, took a one-day course Tuesday on how to assist people experiencing a mental health crisis.

The course, presented by Karl Rosston, a suicide prevention coordinator with the Montana Department of Public Health and Human Service, was the speaker at the eight-hour course which took place in the Stone Child College Conference Room.

Mental Health First Aid, an evidence-based mental health program that uses the principles of traditional first aid, trains people on how to identify and assist those with mental illness or who experience a mental health crisis.

The program, like traditional first aid, educates people in how to effectively help others cope with a situation until professionals can come onto the scene or the episode passes.

Rosston said the community-based model, which is used to train law enforcement in Montana, is especially useful for remote rural areas where access to effective mental health services is often limited.

Touching on mental health crises caused by anxiety, depression, schizophrenia, trauma and substance abuse, the course centered around the program's plan of action, called ALGEE. The components of the program are:

• Assess for risk of suicide or harm • Listen nonjudgmentally

• Give reassurance and information • Encourage appropriate professional help

• Encourage self-help and other support strategies

•Rosston said severe depression can be as debilitating as being a quadriplegic. Mental illnesses, he said, impair people's ability to work, maintain meaningful relationships and carry out daily tasks.

There is a strong correlation, he said, between suicide and mental health. Suicide is often a symptom of a greater mental health issue. This is especially true as it relates to relationships.

Rosston said 70 percent of suicides in Montana are carried out by those who are single, widowed, divorced or separated.

"It's a relationship issue," Rosston said.

He said this is especially true of young people experiencing breakups, spouses who get in a fight or those who are going through a divorce. He said those who contemplate or commit suicide often express a sense of anger and revenge.

The rate of suicide is increasing. In the past 15 years, he said, there has been a 28 percent jump in the number of suicides in the U.S. In 2013, the most recent year for which numbers are available, Rosston said there were 41,149 suicides in the United States, or one on average every 13 minutes.

Montana leads the nation in suicides per capita, with 22.8 per 100,000 people in 2013 compared to the national average of 12.7 per 100,000 people.

Rosston said Montana has been among the top five states with the highest suicide rate for at least the past 35 years. Most of these states are in the Rocky Mountain region. By contrast, he said, those states with the lowest suicide rates are mostly in the East.

"It's not just one factor," Rosston said, in explaining Montana's high number of suicides. "We have a perfect storm in the Rocky Mountain region when it comes to suicide."

There is a host of reasons for this, ranging from environmental factors such as the lack of sunlight and the high altitude that causes metabolic stress due to decreased oxygen over time, to the rugged individualism and stoicism that has come to characterize the West.

This, he said, brings with it a certain stigma around mental illness including depression. Unlike the East, where people have better access to mental health resources and the culture is one in which people are more open about their problems and willing to seek help, the mindset in Montana and many of the more rural isolated states is to suppress rather than address the issues they are battling. This creates a stigma around mental illness and makes people more reluctant to seek help, he said.

"If you think you are a burden, how likely is it that you will seek help," asked Rosston.

Many seek to suppress the pain of mental illness through high alcohol consumption which can increase the negative effects of mental illness. That, combined with the loneliness in a sparsely populated rural state, poverty, easy access to firearms and lack of effective mental health services in rural areas, makes for more suicides.

Those who think someone is at risk of suicide, Rolston said, should do the following:

• Ask the person if they are thinking about suicide: Rarely, do people come out and say it, but they will often use language like "I don't know how much more of this pain I can take" or "everyone would be better off without me."

• Also don't ask this question with dread or dismissiveness. You want an honest response and the person to be as open with you as possible.

• If they say yes, try to get specifics from them. Ask if they have a plan. Try and get as much specifics from them as you can relating to means of suicide, time and place. The more specific they are the greater risk they are at of committing suicide.

• Let the individual know you are concerned and willing to help.

• Don't pass negative judgement: Don't blame them or tell them they are being selfish. Many times those who are at risk of committing suicide view themselves as a burden to their family and think suicide is a way to lift that burden from their family.

• Appear confident when talking to them. Sit up straight and use body language that signifies openness.

Other actions you should take to keep the person safe:

• Call a safety contact number, usually 911. Stay with the person until help arrives.

• Help the person identify past supports, things that have helped them in the past.

• Involve the person in decision making about how they go about calming themselves down and avoiding future episodes. • Call law enforcement if that person has a weapon or is acting aggressively. • Don't leave an actively suicidal person alone.

• Don't use guilt or threats to try and dissuade someone from committing suicide.

• Don't agree to keep the plan a secret. Federal privacy laws do not cover those who want to do harm to themselves or others.

Here are some warning signs that should tip people off that a suicide attempt is possible:

• Threatening to kill or hurt oneself

• Sudden interest in firearms

• Starting to stockpile medications

• Frequently talking, writing about death, dying and suicide

• Feeling hopeless

• Feeling worthless or lacking in purpose

• Giving away items of great personal value

• Acting reckless or engaging in reckless activity

• Feeling trapped

• Increase alcohol use or drug consumption

• Withdrawing from family, friends and society

• Demonstrating rage, anger or the desire for revenge

• Increased agitation

• Demonstrated change in mood