By Susan Keys

Suicide is a critical public health problem facing the nation and the state of Oregon.

Among all states, Oregon has the ninth highest rate of suicide, and with the age-adjusted rate of 17.1 deaths by suicide per 100,000, its rate is 41 percent higher than the national average.

Although rates increase with age, suicide is the second leading cause of death among our state’s youth. The recent death of a young person from Bend High School brings the pain of such tragic losses all too close to home. Many of us have probably been asking ourselves why has this happened? How could this happen here in our community? What are we missing? What could we have done differently?

There are no easy answers to these questions. Suicide by its very nature is complex and its prevention requires a multifaceted approach that involves a wide array of prevention and treatment strategies.

As part of the 77th Oregon Legislative Assembly, Rep. Sara Gelser introduced House Bill 4124, which she hopes will help stem the tide of youth suicide in Oregon. Her bill asks that greater focus be given to “developing strategies for intervention with suicidal, depressed, and at risk youth.” Providing greater emphasis to the treatment side of the suicide prevention equation is a critical component of a comprehensive plan for suicide prevention. In Deschutes County, the county’s Suicide Prevention Advisory Council has recognized the importance of treatment, making training in evidence-based treatment practices for clinicians working with suicidal patients a priority in the county’s suicide prevention plan.

Treating only those with identified needs as the state’s principal prevention strategy, however, falls short of what is required for a comprehensive plan. Primary prevention, aimed at reducing the risk of suicide for those not yet in crisis, is also a critical component.

Supported by funding under the Garrett Lee Smith Memorial Act, Oregon created a plan for youth suicide prevention that emphasizes 15 primary prevention strategies, including developing public education campaigns to increase knowledge of suicide and promote help-seeking; training for members of the community and students in how to identify those at risk of suicide and refer services; educating media to reduce suicide contagion; and skill building for youth and family members.

Gelser is working hard to assure that the state’s strides on the prevention side of suicide will not fall by the wayside as the Addictions Mental Health Division responds to its new charge under HB 4124 of developing strategies for intervention and treatment for those already identified as suicidal. To this end, Gelser has asked that funding be made available for two youth suicide prevention positions — one to remain under public health staff to lead primary prevention efforts and one within Addictions and Mental Health Services to lead the expanded mandate of tertiary prevention.

As the former branch chief for prevention initiatives at the Substance Abuse and Mental Health Services Administration, a division of the federal Department of Health and Human Services, I provided oversight for the initial development of the Garrett Lee Smith Memorial Act suicide prevention program that has awarded funds to states, tribes and college campuses. Recognizing the importance of a comprehensive approach to suicide prevention, the federal mandate was clear — funds awarded to states and tribes were to be expended for prevention programs, such as those mentioned above, and direct services, including treatment for those identified as suicidal. As a community, as a state, as a nation, we will never get ahead of the problem of suicide if our only approach is treatment for those identified as suicidal or prevention aimed at those who are not yet in crisis. We must commit to robust prevention programs and to providing direct services to those in need. It is not a question of one or the other. We need both.

Fortunately for Oregon, Gelser understands this.

— Susan Keys is an associate professor and senior researcher at Oregon State University-Cascades Campus and vice chairwoman of the Deschutes County Public Health Advisory Board.