FEATURE: Pillar of Support

By on February 15, 2017

JACKSON HOLE, WY – October 29 was an average day in Teton County dispatch. Calls occasionally lit up the desktop screens of dispatchers Jenn McGrath and Jim Ligori, all to the soundtrack of radio chatter from officers across the county. Then Ligori answered an unforgettable call.

“The caller just rattled off a bunch of numbers. It was bizarre,” McGrath remembered. “Then he said, ‘Tell them I’m sorry, I just can’t do it anymore,’ and hung up.”

From just this brief call, they knew that this man was suicidal, and they had very little time to intervene. The two sprang into action. Ligori worked to get the man back on the line, while McGrath cobbled together every shred of information they had. “We didn’t know if he was in a car, or in a home, we didn’t know if he was in Moran or in Hoback,” she said.

McGrath quickly realized that the caller had given them the phone numbers of loved ones; people who were able to give her more information about who the caller was, and what he planned to do. Clues came together, and soon she was able to set law enforcement on the right path with accurate descriptions of the man and his vehicle. “Amazingly, we were able to do that very, very quickly,” McGrath said.

Eventually, Ligori got the caller back on the phone. “I started just asking him questions,” he said. “We talked about sports and all kinds of things, anything to break up his train of thought.” Soon he had the man’s trust. “We started talking about snowmobiling and hunting. I found his Facebook page that referred to him being a former service member, so I asked him about his service, his hobbies and what he liked to do.”

The dispatchers’ compassion and understanding encouraged the man to reconsider his plan to commit suicide. By the time deputies reached him, he did not resist their intervention.

McGrath’s and Ligori’s quick thinking, gentle demeanor and direct communication saved a life on that fall day. Their work earned them both the Teton County Sheriff’s Office Life-Saving Medal, recognition bestowed on them at a Teton County commissioners meeting last week.

This call isn’t one that McGrath and Ligori will forget anytime soon, and it represents a common scenario in Wyoming.

Beyond celebrated mountain culture and recreation, Western states are exceptional in some much darker capacities. Map out the average suicide rates across the nation, and you can’t miss it: stretching from Arizona to Montana, the “Suicide Belt” highlights a serious issue for Wyoming and its neighbors. Substance abuse rates reflect a similar pattern, especially among young people. There’s no question that Jackson Hole—like other communities across the state—faces formidable challenges when it comes to addressing these complex public health concerns.

The Prevention Management Organization (PMO) of Wyoming—which the Wyoming Legislature is debating substantial budget cuts to right now—leads critical prevention work. Efforts by the Teton County branch, launched in early 2015, have kept its two staff members busy with outreach activities. From influencing local policies to distributing gun locks, connecting with local students to hosting free suicide intervention trainings, prevention specialists Matt Stech and Jacob Richins are on the front lines in Jackson Hole. In a state with the highest suicide rate in the nation, the importance of their work cannot be overstated.

Path to compassion

There’s no singular path to preventing substance abuse or suicide, and PMO Teton County takes as many approaches as possible. “One thing I like about the job is that I might be meeting with the mayor to talk about local alcohol concerns and potential alcohol-related policies, or the chief of police,” Stech said, “then later on the same day, I might be delivering gun locks to a hardware store. I might present to the town council one day, but then be talking to the staff at … the rec center about handing out gun locks the next.”

Even when he’s explaining troubling statistics or tragic stories, stylishly bespectacled Stech exudes compassion and understanding. His tone never so much as flickers into judgment or critique; in fact, he will even bubble into a chuckle at the more lighthearted elements of his work. It’s clear that no matter someone’s struggles or past, he respects them wholeheartedly and wants to support them.

Born into a military family, Stech spent the first years of his life between California and Hawaii before moving to the D.C. area around the age of six. But even in the city, his love for the outdoors never waned. “When I was really little, my dad took me out on little adventures in California. I was exposed to the mountains from a very young age. I have always been drawn to mountains, forests, rivers and wild places.”

As a teenager, when his parents divorced, Stech’s time spent outside became more meaningful. He discovered an interest in fishing, and treasured the trips that he took with his father in a canoe together, traversing rivers along the eastern seaboard.

Later, as a student at the University of Delaware, Stech saw the serious toll substance abuse took on the people closest to him: their grades suffered, they had trouble with the law, and they struggled with addiction. Alongside his peers, Stech’s own substance use escalated from alcohol to more serious drugs. But witnessing the consequences some of his friends faced inspired him to reconsider the path he was on, and how he could help pull others out of damaging cycles. At the time, he didn’t realize that he could combine this important work with his love for the wilderness.

Stech still carried with him a deep appreciation of the wild world, and its power to help young people through challenging times. When he saw an advertisement for a job as a counselor at a wilderness camp for at-risk youth in New Hampshire, he leapt at the opportunity.

For Stech, this job marked the beginning of a career journey that would save lives.

Focused on suicide and substance abuse prevention for more than 20 years, Stech’s work in Jackson Hole began in 1996 when he left the East Coast for a job at Red Top Meadows, a residential treatment facility and therapeutic wilderness program for adolescent boys. During his seven years at Red Top, Stech recalled a young man, an LGBT student, having suicidal thoughts.When he left Red Top and headed to pursue a masters in substance abuse counseling at the University of Wyoming, he had already been involved in a significant amount of LGBT support work, and he realized how interwoven the challenges are.

“I was in Laramie on the tenth anniversary of Matthew Shepard’s murder with LGBT students who wanted support. I had already seen teenage boys from around the state sent to residential treatment who were LGBT and heard their stories about the kinds of things they experienced—physical violence, bullying.” It was through this work and the connections that Stech developed that he became increasingly aware of not only the prevalence of suicide in Wyoming, but also its preventability.

Stech’s co-worker Richins also has compelling reasons for immersing himself in this work. “Just before and during my six years in the Marines, the military was experiencing the highest rates of suicide in decades,” Richins explained. “Beginning in boot camp and every year following, I received training on suicide prevention.  When I was in a leadership position one of my Marines was displaying suicide risk signs, so I did as I had been trained: I asked about suicide, showed that I cared about him and escorted him to professional treatment.” That Marine, Richins explained, recovered and is leading a meaningful life today. “When I saw an opportunity to train other people in a civilian version of the training I received, I applied for the job here.”

Wyoming has all the risk factors

According to the Centers for Disease Control, suicide is the second leading cause of death among Wyomingites aged 15 to 44. However, while suicide numbers are rising nationally—according to CDC, from 1999 to 2014, the suicide rate in the US increased 24 percent—Wyoming’s suicide rates have remained static over the last 15 years.

Though the state’s suicide rate is almost double the national average, the fact that Wyoming’s rates haven’t increased signals prevention efforts here are working.

In 2009, Stech returned to Jackson and began working as a substance abuse counselor at the Jackson Hole Community Counseling Center. Over the years, he has witnessed how people here grapple with suicide. “I worked with individuals on the spectrum from occasional suicidal thoughts to actual attempts,” he said. Though it’s easy to look around a place like Jackson and feel immune to such problems, professionals like Stech assure that’s inaccurate. It happens here.

“Across the board, there are some universal risk factors,” Stech said. “Wyoming has them all.” Stech points to a constellation of factors that he believes contribute to these high numbers. Social isolation, limited availability of mental health services and widespread substance abuse are issues in the vast majority of communities across the state.

When it comes to substance abuse, Stech says that Teton County has it in spades. “Teton County has really significant alcohol issues from a national standpoint and a Wyoming standpoint.” While Jackson Hole’s penchant for over-consuming alcohol spans many age groups, rates of binge drinking among older high school students are the highest in the state. In a PMO survey, 33 percent of valley high school seniors reported binge drinking—defined as consuming five or more alcoholic drinks in a row—the highest rate for that age group in the state; 55 percent of the same students reported consuming alcohol in the past two weeks.

“Adult use drives youth use,” Stech explained. Adults not only drive availability of alcohol, but also model social norms around alcohol use for young adults. And the picture that the adults of Teton County often paint isn’t one of moderation. Half the arrests in the county are DUIs, 87 percent of all arrests are alcohol-related, as are 71 percent of domestic violence arrests. These statistics are higher than the state average. It’s no wonder that 86 percent of the 12th graders surveyed reported attending an event in the last year where they saw drunken adults.

It’s important to note that substance abuse alone does not cause suicide. “The estimation is that 90 percent of people who die by suicide could be or were diagnosed with either a mental health or substance abuse disorder” Stech said. “And often it would be both.”

Lack of affordable, easily available mental health support contributes to the troubling rates of suicide in Wyoming and neighboring states.

Also a potential factor for many locals? The housing crisis. Stech noted the theme during his time as a counselor at the Community Counseling Center. “More and more research is indicating that unstable housing is a serious risk factor for many people’s mental health and substance abuse.” In other words, Jackson Hole is short on homes and long on booze.

“It’s really critical to note that suicide is a complex thing, and doesn’t have one single cause,” Stech said. “But what’s equally important is that suicide is preventable, not inevitable.”

Availability of firearms also increases the risk of suicide in many Wyoming communities, especially for younger people. The Cowboy State has one of the highest rates of gun ownership in the nation, and many households have multiple firearms.

Additionally, new research is exploring the links between altitude and suicide. While the connection is not yet fully understood, it is compelling, Stech said. Researchers mapped out suicide rates in various communities in the Rocky Mountains, and then compared those rates with the town’s altitude. The altitude turned out to be a more predictive factor than any other risk factor that the researchers considered. “From what I’ve seen, it’s very interesting. I’ve been discussing it in our trainings. I think it’s worth sharing,” Stech said. “Hopefully this will give us some new tools for treatment and prevention. I don’t know what yet, but different interventions for communities. That’s my hope. The research sounds pretty strong.”

Pushing dialogue

Suicide is inherently difficult and painful to talk about. But Stech believes it’s important to understand that the ways in which communities discuss—or fail to discuss—suicide can directly contribute to its prevention. And the media has an important role to play.

Breaking down the myth that “it doesn’t happen here” is the first step towards building prevention and protective resources. “It’s actually helpful when stories are able to report suicides and emphasize prevention,” Stech said. What’s less helpful, even dangerous, is sharing too much or sensationalizing suicides.

“Giving details and speculating on an individual’s motives actually creates risk,” he explained. Conjecturing about the situation or causes of someone’s reasons for committing suicide is problematic for multiple reasons. First, such musings tend to oversimplify the factors that lead to suicide. It’s almost never a single cause—a breakup, loss of job or other life event—but rather a combination of risk factors.

Additionally, speculation on motives can create a narrative with which other at-risk people can identify. For example, if the narrative surrounding a suicide focuses too heavily on a specific difficulty in the deceased person’s life, it can increase the risk for suicide in others who are suffering from and identify with that same difficulty.

Sharing too many graphic details can have the same risk-increasing effect in others. Information about the method of suicide or the scene can be dangerous to share, Stech said. Especially in small communities, it can cause what is known as “suicide contagion,” or an emergence of copycat suicides.

The potency of real talk

Myths and stigma swirl around suicide, and often stand in the way of prevention and support for suicidal people. One of the most damaging myths, according to Stech, is that even mentioning suicide will inspire people to harm themselves or create suicide contagion. Actually, the opposite is true. Having the courage and compassion to ask a friend or family member if they are thinking about suicide is one of the best ways to prevent it.

Stech advises pointing out the behaviors or comments you’ve seen in that person—such as increased substance use, giving away treasured possessions or planning self-harm—followed by a blunt question about suicide. Stech says he’s asked the question several hundred times over the course of his career: “I notice x, I notice y, I notice z, and I’m concerned about you. Are you suicidal? Are you thinking about killing yourself?”

But for some, finding the courage to confront someone who might be considering suicide sounds intimidating. Stech, however, has yet to receive an awkward response. “I’ve really never had a negative reaction from someone when I’ve asked them,” Stech noted. He’s found that most people aren’t upset when someone asks the question from a heartfelt and genuine place. Instead, he’s found that most people answer honestly. And if they are considering hurting themselves? The next step is to connect them with the Counseling Center—whose crisis line is open 24 hours a day at 307-733-2046—or the emergency department at St. John’s Medical Center.

Research also shows that asking a suicidal individual about their plans does not make them more likely to follow through on them. In other words, do not be afraid that asking will make someone worse, or somehow plant the idea of self-harm.

The willingness to address suicide honestly is the key theme in the suicide intervention training that PMO Teton County hosts twice a month. “From a suicide prevention perspective, that’s the most important takeaway,” Stech said.

Another troubling myth around suicide is that someone who is suicidal is chronically so. “Most people who become seriously suicidal only do that once,” Stech said. While there are people who are suicidal for extended periods of time, they represent the minority. This is important to understand, according to Stech, because believing that someone is chronically suicidal discourages others from helping them get the care they need. “It’s harmful if those who are trying to help have an attitude of, ‘Well, even if I save them today, they’ll probably just kill themselves tomorrow.’ And we certainly don’t want to be treating anyone like a lost cause.”

Similarly problematic is the tendency to label incomplete suicide attempts as a cry for help. “When someone has a purposeful drug overdose, you’ll sometimes hear even professionals say, ‘It must have been a cry for help since they took all these pills and then they called 911.’ There’s evidence to support that people actually changed their mind. I think it is a disservice to prevention to spread the mythology that it’s a cry for help.”

Stech says when behavior is labeled as attention-seeking, both professionals and others around an individual are less inclined to take that person’s needs and concerns seriously.

Informed interventions

Demolishing harmful mythology and empowering community members are the core goals of PMO Teton County’s outreach and education work. One of the most popular and frequent trainings that it offers is called “QPR”—“Question, Persuade and Refer”—the critical steps to keep in mind when helping someone who is suicidal. The hour-long training is held twice a month, and is free for any community members to attend. Stech is particularly excited when young adults join the trainings, since they have so much potential to influence their peers, as well as the community as they get older. “We love it when teens come in; we get especially excited when young people take the class,” he said. The content is appropriate for anyone age 16 and older.

“I love teaching QPR because I believe in it. Almost everybody walks away having had a positive experience,” Stech said.

So far, the team has trained more than 400 Jackson community members, and the feedback has been overwhelmingly positive. Stech said attendees reported feeling more informed and empowered to intervene should someone they know have a suicide crisis. “That’s one of the most satisfying things for me in the job; when we do that training, to pass on information and to give people confidence, and let them know that if they’re concerned about somebody, they can take action to support that person. Even if that person is in a really bad situation or mindset.”

These trainings, as well as other more in-depth courses aimed at professionals, are potentially on the chopping block with looming budget cuts. A new budget proposed by the Joint Appropriations Committee is poised to be passed by the Legislature and would eliminate $2.1 million from the Wyoming prevention budget. This steep cut—40 percent of the current budget for prevention work—would have serious implications for the PMO Teton County branch. However, a recent change to the budget proposal would restore approximately half of those funds to the program. While the impact of a $1 million cut is still significant, Stech hopes that this recent development will mitigate the fallout, at least a little.

“It’s hard to say exactly what the consequences will be,” Stech said, “but I would anticipate operating budget cuts. That might mean facilitating fewer high-level suicide prevention trainings for clinicians, school staff and law enforcement.” Last year, the organization hosted a two-day training that was attended by school employees, private counselors, law enforcement officers and an array of other local professionals. A significant decrease in funding would likely translate into fewer opportunities like this.

Other outreach that could suffer from cutbacks is PMO Teton County’s work in the schools. Stech has taught QPR training to classes at the Jackson Hole Community School, facilitated mental health conversations with parents and students at the Journeys School, and is returning to Jackson Hole High School to present to seniors. His focus is mental health, substance abuse and suicide awareness. “It’s a great opportunity to educate them a little more about what mental health is, and some key ideas about suicide. We talk a little about risk factors like addiction, too. Just trying to build that bridge; make sure it’s clear that [suicide and substance abuse], unfortunately, go together at times.” Given the rates of alcohol abuse among this demographic, Stech’s presentation is especially important.

Stech and Richins provide trainings to a wide variety of groups by request. “If they’re interested and have five or more people, we can bring the training to them,” Stech said. They have customized training for Community Safety Network, the Jackson Police Department, Community Entry Services, Transportation Safety Administration, Fire/EMS and even Teton County Weed and Pest, among others.

The consequences of budget cuts to PMO may be unknown, but Stech feels hopeful when he considers the static suicide numbers in Wyoming.

Just last week, Stech received a message from someone who took the QPR training:  “I want to let you know that because of your suicide training, I found the courage to reach out to an acquaintance who made suicidal comments on Facebook,” the note read. “Apparently, I was the only one who called, and he has commended me multiple times since. That call made a difference, and it was because of your QPR training. Thank you.” PJH

About Melissa Thomasma

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