The suicide rate in Montana is more than twice the national average, that’s according to the latest update from the Centers for Disease Control and Prevention. Among the counties with the highest suicide rate in Montana is Butte/Silver Bow. Karen Sullivan is the Health Officer for Butte Silver Bow. MTPR's Beau Baker spoke with Sullivan about why suicide rates are so high in Montana.
Beau Baker: Were you surprised at this new report?
Karen Sullivan: I was not. You know, for the past many, many decades Montana has been at the forefront, unfortunately, of this particular statistic. We’ve been in the top five per capita for suicide rate per capita for years. Gettting to this rate didn’t happened overnight and rectifying our high suicide rate will not be accomplished overnight. We got years of work ahead.
BB: What are some of the contributing factors to our state’s high suicide rate?
KS: Well, mental health issues continue to be at play, often times. That’s true nationally and in Montana, but the surprising thing out of the CDC report was that a high percentage of people now without a diagnosed mental illness are dying by suicide. We know that, in particular, depression is an issue, trouble in relationships are at issue, finances are often at the root of what we’re finding and we know that substance abuse is also a contributing factor as well.
BB: Does Montana’s sparse, rural population figure into this puzzle as well, is that part of this picture of suicide?
KS: It is indeed. We are highly rural in Montana and that can lead to geographic isolation, that can also lead to an inability or trouble accessing services like mental health. I find it highly ironic right now that we’re number one per capita in suicide rate in Montana and we have just been the target of budget cuts related to mental health and developmental disabilities and how people are getting case managed. That funding largely went away. And so at the same time that we’re number one in the country in regard to this awful statistic, the rug is being pulled under from many agencies. Let me give you an example of a mentally ill person who is having trouble with his or her Medicaid. As you might expect, Medicaid is a complicated array of rules and regulations and paperwork. A case manager used to be at the side of that mentally ill person to assist with something like that. Is that mentally ill person keeping his medical appointment or his mental health appointment? Is that individual getting into the dentist? Is there food in the house? Do groceries need to be purchased? Case managers were really partners in that, and a lot of that has really gone away. That is the reality of the state budget cuts. And we’ve talked about how those cuts have really resulted in communities like Missoula, like Billings, like Butte, picking up the slack and trying to figure out how to take care of people without the funding and personnel that were cut.
BB: When you look at the numbers by county, Silver Bow has one of the highest rates at 20.6 per 100,000 people. That’s from 1995 to 2014. In raw numbers, that about 145 people over 20 years. Why do you think your county has among the highest suicide rates in the state?
KS: We talk about that tough guy nature of Butte, there are even t-shirts that you can buy today that carry the moniker “Butte tough.” It really conveys this kind of pull-yourself-up-by-the-bootstraps attitude and Butte is tough. If there’s a resilient town, Butte would be it. But the dark side of that is that we can be afraid to seek help when we need it, particularly help for a mental illness. You know that cowboy-up mentality, if you’re contemplating suicide it means you’re weak. We’re a mile high city. Altitude has been posited as a possible cause. We have a higher rate of homes in Butte, even higher than other communities in Montana, homes with firearms in them.
BB: From 2014 to 2016, 63 percent of all suicides in Montana were carried out with a firearm. How do you address guns as an element to this suicide issue without rubbing that sort of rugged individualism that western cultural values you kind of touched on, the wrong way? Is there a good way to address this?
KS: We knew that if we got into a gun control debate within our work, that our work would take a back seat, and so we opted not to talk the control of firearms at all. The reality of our culture is one in which people recreate with firearms and they feed their families that way. And we honor that heritage and we respect it. What we’ve talked to people about is locking their guns away. And so, more than 2,000 residents who could not lock their guns away - they didn’t have a gun safe, they didn’t have a garage to hide guns away - we provided the gun lock. We also knew that with the gun locks, that if a person was contemplating dying by suicide with a firearm, that we could delay that impulse by having that lock on the gun. You know, even 5 minutes of delay might prevent suicide.
BB: Another aspect of the CDC report that really struck me is the suicide rate for women in Montana has more than doubled since 1999, it’s climbing much more dramatically for them than males in the state. Do have any idea what is going on there? Why such a significant jump for women?
KS: You know, I don’t. In Butte we know that we have a higher percentage of children living in single parent homes, and we know that most of those single parent homes are headed by a female. And that’s tough work. We know that more and more pressure is being put on women to work full time and maintain a household, it’s tough; but it’s all anecdotal. You know being a woman, a wife, a mother a feminist I’d have my theories and I certainly have empathy and sympathy for that, but no evidence or science quite yet to theorize what might be in play there.
BB: And Karen, what would you like to see change in Silver Bow county and in Montana in general to address this problem?
KS: I think our overall goal in the coming years will be not only to prevent suicide, but to ensure people have the services that they need for health care and mental health and that we have a collective empathy for what people are literally going through. When you’re worried about someone that may be suicidal, that you don’t leave that individual’s side, that you talk to them about their value, that they’re important in our life, that we aid them in getting them the help they need. I know that I’ve come to a personal and professional conclusion that we can all work very hard, we can love very much, but we can lose so greatly. And suicide is this maddening thing that is brutally wrenching, and in the end, is an act that is quite simply final. It’s so sad. And in Montana we have a real problem and I hope that we can collectively work as a state, convince our policy makers that cutting funding in these areas is the absolute last thing that we as a people want to do, and love each other.
BB: Karen Sullivan of Butte/Silver Bow Health Department, thank you so much for talking with me today.
KS: Thank you Beau and I appreciate your interest.