Editor’s note: This article discusses suicide and suicide prevention. If you or someone you know is in crisis, contact your physician, go to the local emergency room or call or text Colorado Crisis Services at 844-493-8255 or text TALK to 38255, which provides free, confidential support 24/7.

One hour can make a life-or-death difference for someone in the community.

One hour is the common amount of time that a person who has made the ultimate decision to take his or her life lives before actually completing that action.

One hour is the approximate amount of time that a community member can devote to completing a basic suicide prevention online or in-person class, offered free through the local nonprofit REPS — Reaching Everyone Preventing Suicide.

Within the past two months in Routt and Moffat counties, two more individuals died by suicide, one man in each county. Both individuals were adult males who died by firearm, which is an all too common and accessible means in rural Northwest Colorado, local suicide experts say.

According to the Colorado Department of Public Health and Environment, the agency’s online suicide database reports 59 suicides from 2010 through 2020 of Routt County residents, with 44 Moffat County residents during the same time frame.

Educators stress that suicide is preventable through comprehensive community efforts.

“If you can save someone’s life, an hour of training seems like nothing,” said Mindy Marriott, executive director of REPS, which provides services in Routt and Moffat counties. “We’ve had too much loss in this community to not take it seriously and make it a priority.”

The team of volunteers at REPS works together with local first responders, co-responders, mental health counselors and health care professionals to reach individuals in the Yampa Valley experiencing suicidal crisis much sooner than one hour, Marriott said. But oftentimes, a family member, neighbor, friend, boss or co-worker can be there for the person first.

“Suicide prevention is everyone’s business, because it’s going to take every single person in the community to make it a priority so we don’t have another loss,” Marriott said. “We want everyone in the community to be well educated and trained to recognize when someone is struggling and how to connect them to resources. Our trainings will empower people to have that confidence.”

Prevention techniques

Molly Lotz, a licensed clinical social worker and crisis support counselor at UCHealth Yampa Valley Medical Center in Steamboat Springs, offered an easy and tangible suggestion. Residents can enter numbers for suicide crisis support services in their phone contacts to have at their fingertips if or when the need arises. Those numbers for assistance include: local REPS at 970-846-8182, statewide Colorado Crisis Services at 844-493-8255 or National Suicide Prevention Lifeline at 800-273-TALK (8255).

Lotz said individuals who have experienced feelings of suicide ideation, or thoughts that can come and go on a scale of 0 to 10, should have a suicide crisis number listed in their phones and also practice calling the number in advance. Individuals can call and say, “I’m not in crisis now, but I have been encouraged to practice.”

“That likely will increase the likelihood those services will be used,” Lotz said.

Marriott advises community members that any suicide statement should be taken seriously.

“Every single statement, comment, we take it very seriously,” Marriott said. “We don’t encourage anyone to brush off someone talking about suicide. It’s better to be safe than sorry.”

Even if a community member has not participated in suicide training yet, the National Institute of Mental Health and other organizations educate about five action steps at NIMH.NIH.gov/health/topics/suicide-prevention for helping someone in emotional pain or considering suicide.

• Ask: “Are you thinking about killing yourself?” It’s not an easy question, but studies show asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.

• Keep them safe: Reducing a suicidal person’s access to highly lethal items or places is important. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.

• Be there: Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.

• Help them connect: Community members can help a person in crisis make a connection with a trusted individual, such as a family member, friend, spiritual adviser or mental health professional.

• Stay connected: Staying in touch after a crisis or after being discharged from care can make a difference. Studies show the number of suicide deaths goes down when someone follows up with the at-risk person.

Lotz explained some conversations taught in training are called QPR, or question, persuade, refer. Lotz often uses such questions as, “I need to know, right now, are you actively making a plan or concerned about your safety?” Or, “Sometimes when people have experienced a type of loss like yours, they get kind of get depressed or down and think about killing themselves. Do you ever feel like that?”

Lotz said when people are actively suicidal, unfortunately, they may want to isolate themselves more. She said community members should “lay eyes” on someone in crisis and see what level of help or intervention he or she needs.

Next, the community member can say, “Thank you for telling me. I’m going to stay with you, and we’re going to figure this out together.”

After questioning, the next step in QPR is persuading a person in crisis that they do need help. Lotz said community members can say, “I feel like we probably need to get you some help. Are you OK if we sit and call the Colorado crisis line together to get an expert on the line?

The respond step of QPR could include the statement, “I’ll stay with you while we have this conversation.”

If the person is not actively making a plan to die by suicide, Lotz said then a friend might ask, “Have you talked to your therapist lately?” or “Who have you connected with lately?”

REPS will be offering a communitywide QPR training as part of the Steamboat Pilot & Today’s Longevity Project event Sept. 22 at Colorado Mountain College Steamboat Springs.

Community services

Yampa Valley Medical Center employs four licensed clinical social workers within its case management department, and the local hospital has a crisis team that offers 24/7 support from social workers and registered nurses who have received special training in crisis support, said Lindsey Reznicek, YVMC communications specialist. Lotz, a member of the care team, said if a person has either suicide ideation or has made an attempt at suicide, the person may come to the hospital alone or with a friend, family member, community partner or first responder.

In 2019, 37 people were seen in the YVMC Emergency Department with the primary diagnosis of suicidal ideation, and 16 additional people had suicidal ideation as a secondary diagnosis. In 2020, those numbers were 52 for primary plus 21 for secondary diagnosis, Reznicek said.

The person in crisis might spend time in a secure, safe and observed behavioral health room in the Emergency Department, where an evaluator conducts a deep dive to understand the catalysts of why the person came to the hospital in crisis that day. Sometimes, the person might need a higher level of care, such as a transfer to another facility, or depending on the individual’s situation, the person may be discharged with a detailed home safety plan, Lotz said.

Part of that plan includes making connections for assistance, free counseling sessions and links to other community resources through REPS, whose suicide prevention advocates are trained peer volunteers who visit the person within a day. Or individuals may be connected with Rocky Mountain Crisis Partners, which is a statewide, 24/7, community-based system of crisis intervention services for people experiencing mental health or substance abuse crises to be assessed, safely and effectively stabilized, and efficiently linked to appropriate follow-up care and services.

“When we decide to send them home, we enlist a whole support system as much as we can — friends, neighbors, family, mental health therapists,” Lotz said.

REPS also provides loss assistance teams of volunteers who reach out and support dozens of community members each month as a result of suicide loss. People touched by suicide are part of a “ripple effect.” Experts say when someone dies by suicide, the people impacted most dramatically are those closest to the person who died, but the ripples spread out to others, too.

Earlier this year, YVMC officials started a local Zero Suicide initiative to raise awareness and comfort levels for all local medical profession employees to be able to ask patients if they may be in need of mental health assistance.

“Eighty-three percent of people who die by suicide have seen a health care provider within one year prior to death,” Lotz explained. “We also want to support employees who may be finding themselves on the suicide spectrum.”

Tackling local trends

Local experts say the threat of suicide can triple during the shoulder seasons in resort towns like Steamboat Springs. Marriott said suicide crisis situations are more predominant in March and April and again in October and November.

Seasonal workers or residents in a tourist-oriented town may be engaged and distracted in an active and social lifestyle during the busy seasons, but during the slower shoulder seasons, they may experience an increase in preexisting personal concerns and may face additional stressors of trying to find a new job or housing, Lotz said.

“We notice an increase in suicidal ideation and intensity during those times,” Lotz said. “People live the dream of a mountain town lifestyle, and when that is done by the end of the ski season, feelings are back or easily accessed. It’s more of a challenge.”

The suicide rate in Colorado is among the 10 highest in the U.S., according to the state Office of Suicide Prevention at the Colorado Department of Public Health and Environment. In 2019, 1,306 Colorado residents died by suicide and 1,294 in 2020.

All of the individuals who died by suicide to date in 2021 in Routt and Moffat counties have been males who died by firearm, Marriott said, noting that segment of population is a “really hard demographic to reach.”

“Unfortunately, we don’t get a chance to see a lot of the people who die by firearm,” Lotz said. “Once someone makes that decision by firearm, the window of intervention is so small, and the impact of that method is very lethal.”

REPS participates in the Colorado Gun Shop Project, a program that encourages local gun owners to be “their brother’s keeper” and protect other gun owners struggling with mental illness by keeping firearms out of reach. REPS collaborates with local gun sellers, gun clubs and gun safety training programs to spread the message of gun safety as related to mental illness.

In addition to focusing on men ages 40 to 65, another priority for REPS is suicide prevention education for youth ages elementary through college. Marriott cited an example of an 8-year-old who visited the local hospital last year due to suicidal thoughts.

“We have elementary school kids in our ER with suicide ideation,” Marriott said. “They are struggling and suffering enough that they don’t want to be alive. Studies show this generation of kids growing up is the hardest by far yet in history in terms of everything they are being faced with, constant social pressures, constant need to achieve and succeed. A lot of middle and high school students are hit with this every day, constantly having to perform and perform at your best, toxic positivity, good vibes only, no bad days.”

Volunteers needed

As a volunteer coalition of community members, REPS continues to grow its programming and always needs more volunteers, including volunteers who do not interact directly with clients in crisis, noted REPS board member Jenny Corrigan. More information is available at SteamboatSuicidePrevention.com.

Nonprofit REPS has trained thousands of local individuals and dozens of community organizations and groups in suicide prevention for free since it started in 2004, including trainings in local middle and high schools several times per year.

“The more people who understand what suicide ideation looks like, the better we are as a community to handle, deal with and support folks and relatives going through this super difficult time,” Corrigan said. “The more people who can understand the importance of this work and what it means to be suicidal … the healthier the community is all around.”

REPS director Marriott said each suicide can affect hundreds of people.

“Each suicide in the community is one too many. It’s suffering and pain that we don’t want,” Marriott said. “For REPS, we just want everyone in the community to know that we are here, and they are not alone. There are resources to help them.”

Visit SteamboatSuicidePrevention.com for more information about REPS and how to volunteer.

To reach Suzie Romig, call 970-871-4205 or email sromig@SteamboatPilot.com.