Addressing cultural issues 
that increase the risk of suicide

During rallies held by students who survived the high school shooting in Parkland, Fla., there has been one frequent attendee. The owner of an online gun marketplace based in Utah has taken the company's armored vehicle on the road to hold countless counterprotests throughout the country.

As students and their advocates ask for stricter gun laws, the company is promoting gun owners' constitutional right to bear arms, said the owner.

That culture, however, also appears to be related to Utah's growing suicide rate. Over less than a decade, the Western state went from the 10th-highest suicide rate at 15.4 deaths for every 100,000 people in 2005 to being ranked fifth-highest by 2014, where it remained in 2015 and 2016.

Suicide is currently the state's eighth leading cause of death, resulting in 654 deaths in 2017, according to preliminary figures from the Utah Department of Health.

Firearms were used in at least half of all suicides in the state, according to a 2014 report by the National Violent Death Reporting System, the most current year recorded.

The potential of Utah's gun culture making it easier for firearms to be placed in the hands of those struggling with depression or suicidal thoughts is what Salt Lake City-based Intermountain Healthcare is addressing in a new initiative to stop the state's rising suicide rate.

Earlier this month, Intermountain launched Zero Suicide, a collaboration between the system, the state's health department and community groups. The program not only expands access to behavioral healthcare services by continuing to task primary-care physicians with screening for depression and anxiety, but it helps clinicians better address firearm safety and proper storage of firearms.

Intermountain, a not-for-profit system of 22 hospitals, 170 clinics, a medical group and health plan, began prioritizing suicide in recent years as the state's suicide rate rose. Utah had the country's third-highest percentage increase—46.5%—in suicide deaths between 1999 and 2016, according to the Centers for Disease Control and Prevention. That's almost double the growth nationally in the same period.

It's the use of firearms that allows residents in Utah to succeed in killing themselves at a greater rate than those contemplating the act in other states, said Lisa Nichols, Intermountain's community health executive director. While 1 in every 25 suicide attempts in the U.S. results in death, in Utah, it's 1 in every 14, according to the American Foundation for Suicide Prevention.

“Deaths by suicide have a high correlation with states having high gun ownership,” Nichols said. “Attempts with guns are almost always fatal.”

This isn't the health system's first project directly addressing suicide in novel ways. For example, in 2013 an Intermountain hospital co-hosted a town hall to help educate residents of a small Utah city on the signs and symptoms of suicide risk and how they can help. The town experienced 17 suicides over the course of a year.

Intermountain hopes Zero Suicide will lead to just that in the ambitious timeline of five years. The system will track progress clinically, by increasing the number of patients who get screened for behavioral health needs throughout all clinical-care units, not just primary-care or emergency visits.

Other metrics will include increasing the number of patients who see a behavioral health specialist within seven days after asking for treatment—something that could be a challenge given the shortage of such professionals across the country.

Intermountain is also working to increase the number of programs in each community designed to help patients at risk identify warning signs indicating that they should seek help.

Nichols hopes to include partnerships with other health systems throughout the state to further diminish gaps in access to care.

“This is no longer just a behavioral health problem—this is a public health crisis,” said Dr. Mark Foote, Intermountain's senior medical director of behavioral health. “We need to engage our entire system and our communities in combating this horrible problem.”