If there was ever a time—and advocates argue there’s always a time—to talk about suicide, it’s September 2020: Suicide Prevention Month in a year that’s swept intense challenges along with isolation into scores of people’s lives.
In Colorado, suicide claims the most lives among individuals ages 10 to 24. It’s a particularly salient topic as young people enter a very different school year, take up responsibilities and lose some autonomies, and continue the struggle for equity while carrying trauma or facing challenging social and political systems. According to a 2016 CDC report, the latter disproportionately affects youth of color, lower economic status, and LBGTQ+.
Calls to a suicide-prevention line at the Trevor Project, a national organization focusing on LGBTQ+ youth and addressing racial disparities, are reported to increase immediately following police brutality against Black people. Overall calls to the Colorado Crisis Services line jumped about 6,400 this March than last year, showing increased distress during the pandemic.
Suicide screening in medical offices across the state is getting another look with a budding organization called Partners for Children’s Mental Health (PCMH). Up to 45 percent of individuals of all ages who die by suicide have seen a primary care provider within a month before their passing, says PCMH training associate Anne Jackson. This led the group, in consultation with Zero Suicide and others, to develop a Youth Suicide Prevention in Primary Care initiative. Launched in June, the initiative has begun training providers in four metro area primary care offices on suicide screening and care planning.
“We thought clinics might be less in a place where they could absorb a new initiative, but the feedback we got was, ‘No, we need this now more than ever,’” says Jackson. “Some of the feedback we’ve heard is that providers feel fairly comfortable administering a screening or even an assessment… and they’re used to working with families around complex issues. They haven’t really been provided support or tools for the, ‘What now?’”
Instead of perhaps seeing an emergency room as the only next available resource from the primary care office, PCMH hopes to equip providers with the right assessment tools and connections in the community to best meet the needs of a patient, which can vary in levels of risk. Making referral and follow-up a more seamless piece of the provider’s assessment is key for continuity of care, says Jackson. She would like to see more direct communication than handing a patient a list of behavioral health centers in the area.
PCMH plans to onboard more clinics starting in late fall, with the goal of universal screening in primary care. PCMH advocates for private and Medicaid reimbursement incentives to help this scaling up across the state. The partnership has also involved more than 600 community stakeholders from across the state to develop strategic plans including mapping and potentially reorganizing the way youth mental health services are funded and delivered to get a clearer picture of need and opportunity. PCMH also offers the Question Persuade Refer (QPR) prevention training to anyone in the community, now provided online and for free at pcmh.org/training.
“What we’re working to do is this shared accountability and shared responsiveness,” says Jackson. “We’re hoping to equip people with the bare minimum of skills to be able to ask the question, create space, and then be able to support safety in the moment and then pass along to someone who can support them in the long run.”
Jason Williams, operations director for the Pediatric Mental Health Institute at Children’s Hospital Colorado, recommends everyone use the direct and even-handed way clinicians screen. Though it can be tempting to hedge, qualify, or show distress while bringing up suicide, any frontloading or perceived judment could discourage honest disclosure. Normalizing the conversation, reducing stigma, and showing clear and tangible support early on is the way to go, according to Williams.
The solemn handing out of yellow ribbons, hotline numbers, and tragedy stories from grieving parents is giving way to more strengths-based and peer-led methods in schools, says Nate Thompson, Director of Social, Emotional, & Behavior Services at Littleton Public Schools (LPS).
Sources of Strength, a suicide prevention project channeled through middle and upper grade social networks, is used in LPS, JeffCo, Douglas County, and Boulder Valley school districts. The model encourages young individuals to identify their protective factors or supports to lean on when they encounter challenges, shifting the conversation away from what Thompson calls “drama trauma,” which can glamorize and perpetuate suicide. Arapahoe High School, which lost eight students to suicide between 2013 and 2019, implements the program through a large group of peer leaders who work on messaging campaigns. They’re working on expanding the group to make sure leaders from all corners of the student body are involved, and parents understand the program’s language to use at home.
Additionally, programs funded by the LPS Foundation have helped elementary students learn emotional regulation skills and have connected individuals to therapy using either a family’s insurance or covering costs directly from the Foundation’s funds, a “life-changing” service, says Thompson. School-based clinics, like those at Aurora and Denver Public Schools, give students access to more affordable and extensive mental health care, says Monica Morris, a school-based therapist at DPS’s Lincoln High School.
Expectations for student performance and participation are going to need an adjustment, said Omar Eltayeb of DSST: Montview High during a student panel discussion on August 13, because schoolwork may be below personal, family, and social issues on kids’ priority lists.
“I think [extra consciousness] could make the students feel more motivated and like, ‘Oh, the teacher is there for me, let me be there for them.’,” Eltayeb says.
Even with extra measures in place this year, like LPS’s screener survey sent to students in fourth grade and up, schools can’t do suicide prevention alone, says Thompson. Parents, nonprofits, faith communities, and others must be engaged.
Find community in action
The American Foundation for Suicide Prevention Colorado chapter will host Out of Darkness community experiences across the state, featuring photo/video storytelling, fundraising, and community resources. Find more information about your local event:
- Fort Collins (September 12-30)
- Denver Metro (September 27, noon-4pm)
- Fremont County (September 12-30)
- Gunnison (September 12-30)
- Northeast Colorado (September 12-30)
- Southwest Colorado (September 12-30)
- Western Slope (September 12-30)
The Center for African American Health offers a Youth Civic Engagement Program as well as a Mental Health First Aid course for youth and adults.
The Center on Colfax’s Rainbow Alley youth programs include a Youth Check-In for LGBTQIA+ youth to create community and take care. They’re meeting online every Tuesday through Friday.
The Denver Indian Health and Family Services Integrated Behavioral Health Programming provides private counseling for ages eight and up along with traditional education and healing groups.
Mental Health Center of Denver (MHCD) provides Mental Health First Aid classes for adults, those assisting youth, and special classes delivered in Spanish and American Sign Language.
MHCD, along with individual and family-centered therapy, conducts youth groups:
- Emerson Street for Teens and Young Adults: Art kits, cooking classes, and employment and education support helps youthI’m ages 15 to 26, including those at the Urban Peak homeless resource center.
- Voz y Corazon: Denver and Aurora youth, ages 10 to 24, can link up with a mentoring group and ease the burdens of isolation or extra responsibilities through art, community, and suicide prevention trainings. It’s especially helpful for Latina youth, says coordinator MichelleTijerina. The program plans on collaborating with other organizations to expand youth outreach during this time.
- Skyline Academy Intensive Day Treatment Program: General education and mental health services are intertwined in this five days per week, seven hours per day separate school setting. The program is an Approved Facility School through the Colorado Department of Education and licensed by the Colorado Department of Human Services as a Day Treatment program.
Know the warning signs and risk factors for suicide
- Changes in eating and sleeping or substance use
- Prolonged agitation
- Expressing hopelessness
- Previous attempts, notes, and current plans
- Isolation and aloneness
- Mental illness including depression, conduct disorders, and substance abuse
- Family stress or dysfunction
- Environmental risks, including presence of a firearm or opioids in the home
For immediate help, contact:
- Safe2Tell Colorado online or at 877-542-7233 for an anonymous tip line to report any kind of threat, including suicide.
- The Colorado Crisis & Support Line at 1-844-493-TALK (8255) to connect with a trained counselor in the area.
- The TrevorLifeline at 866-488-7386. Texting, IM, and social media support available.