Wyoming, A leader in loss
LANDER — Wyoming’s suicide rate may be down this year. But what does that actually mean for mental health in the Cowboy State?
Of three states that frequently lead the nation in suicide rates – Wyoming, Montana and Alaska – Wyoming’s suicide rate has long been the highest. The suicide rates in all three states may have fallen this year; in 2021, per the Center for Disease Control and Prevention’s website, Wyoming stood at 190 suicides total or 32.3 suicide deaths per 100,000 people, Montana at 32 per 100,000 people, and Alaska at 30.8 per 100,000 people.
Based on preliminary reporting, Wyoming had 155 suicides in 2022, closer to 26.8 suicide deaths per 100,000 people. This is still more than triple the 2021 figures for the state with the lowest suicide rate, New Jersey (7.1 deaths per 100,000 people).
“We have been in an upward growth trajectory for the last eight to nine years,” Wyoming Association of Mental Health and Substance Abuse Centers Executive Director Andi Summerville said. “Last year may have been the first year that we saw a flattening.”
This preliminary reporting data could change; in Wyoming, suicide numbers are based almost entirely on reports from county coroners, which take time for the state to collect.
“We lack mental health data collection in Wyoming to start with,” Summerville remarked. “There’s an indication that we might have dropped out of the number one spot … The early numbers certainly look that way and the numbers support it, but that may change.”
Montana and Alaska may have faired worse, this year, but suicide numbers are notoriously difficult to report accurately – and Wyoming’s numbers have a tendency to fluctuate.
“Given our state’s small population numbers, this percentage could fluctuate significantly from year to year. In fact, it has done so previously,” explained Wyoming Department of Health Public Information Officer Kim Deti. “While we certainly hope early indications that our suicide rate may be flattening instead of continuing the linear increase over time we had been seeing, it really is too soon to tell if that will be the case.”
According to Deti, since 2016, Wyoming’s suicide rate has seen fluctuations as large as a 23.2% increase in 2019, and between 2016 and 2022 fluctuated either up or down by an average of about 10.6% per year. This year’s potential 8.3% decrease is well within that average range.
In layman’s terms, what all these numbers add up to is that Wyoming may no longer have the highest suicide rate in the country – but this isn’t set in stone, the state likely still ranks amongst the top three even if it’s no longer the worst, and the factors that have led to such a high suicide rate likely still persist.
“There are very prominent members of our community who have taken their lives,” commented Wyoming State Senator Cale Case. “When more things happen to you than you can deal with, suicide becomes an option.”
Risk factors
Suicide is something that can impact anyone, from any background – but statistically, not all demographics are at the same risk of suicide.
“The group at the highest risk are men who are between 45 and 60 years old,” Summerville explained.
According to the CDC, other groups at comparatively higher risk of suicide include veterans, Native Americans, people who work in mining and oil and gas extraction, people with disabilities, people who live in rural areas and gender and sexual minorities.
Wyoming is one of the most rural areas of the United States, with relatively high veteran and Native American populations, many people who are employed in industries associated with higher suicide risk and a political landscape that isn’t always welcoming to LGBTQ+ individuals.
“There was a time when there was an astounding number of young Native youth who took their own lives,” Case recalled.
Access to health care is also a major issue in Wyoming; between the state’s high health care costs and its remote, rural nature, health care can be difficult to find and at times even harder to afford.
“If it’s a choice between buying food and going to see a therapist, they’re not going to see a therapist,” Summerville pointed out.
In Wyoming, every county has a community mental health center that serves everyone regardless of their ability to pay; the state has several hospitals with psychiatric departments and psychiatric beds; telehealth access has been a focus for a long time, and the state has been working to make sure that primary health care providers have the resources to be able to offer what Summerville described as “a kind of front door approach.”
The state additionally put funding toward the creation of a Wyoming-based 988 suicide and mental health crisis call center in 2022, although earlier this year the state legislature voted not to create a trust which would permanently fund this center.
These solutions are imperfect; Fremont County’s community mental health center, Fremont Counseling, for example, is a single entity serving an area roughly the size of the state of Vermont. People who are unable to travel to Lander or Riverton for its free treatment and who can’t afford other options are left with few avenues available to them if they are hoping to seek treatment before it becomes a crisis. While 988 is a free service that anyone can access and it can go a long way toward helping people who are in crisis, it is not a replacement for people who need longer-term treatment.
Access to lethal means such as firearms is also a major risk factor.
“Of the 155 suicides recorded among Wyoming residents in 2022 … more than 70% of Wyoming resident suicides involved firearms,” Deti said.
Additionally, in Wyoming as in other states, there may be cultural barriers preventing people from seeking help.
There have historically been strong stigmas around mental health, which can be exacerbated by the social realities of living in a small town – in a town of 50 people, Summerville pointed out, everyone will know whose car is parked outside the psychiatrist’s office. That may prevent those who feel ashamed of their struggles or of seeking treatment from going to the doctor’s office. Both Summerville and Case pointed to the state’s 988 call center as something that can help mitigate this factor.
“They don’t call it frivolously, they call it because they need to call somebody, and we need to have somebody there,” Case said. The anonymity of a suicide prevention call line means people may feel more comfortable picking up the phone than they would going to a doctor’s office.
Wyoming is unique
Wyoming is in the midst of a mental health crisis: Access to mental health care is low here, the state’s suicide rates are high and substance abuse among its youth is on the rise. Around the world, the isolation and stressors associated with COVID prompted an increase in mental health issues in general. Summerville explained that anxiety and depression in particular rose in response to COVID, both of which are associated with increased suicide risk.
Fremont County has a high suicide rate even for Wyoming.
“Fremont County is our highest-need county in the state,” Summerville explained. “There’s a lot of need that comes from your county.”
According to data presented by Lander Police Chief Scott Peters to the city council on September 26, so far in 2023 the Lander Police Department alone has responded to three suicide attempts and 21 suicide threats (verbal or non-verbal indications that someone is at risk of suicide).
The unique factors impacting Wyoming mean that it can be difficult to take solutions that have worked in other states and apply them here. Out of necessity, Summerville said, “Wyoming is on the cutting edge of mental health care,” especially when it comes to things like telehealth – which Wyoming was utilizing long before it became common during COVID.
“One of the things that they have that we just don’t is economy of scale … If you can make it work in Wyoming, then you can duplicate it anywhere.”
One solution Wyoming is looking into is mental health diversions for people who have been arrested and are dealing with mental health issues, so those people can receive medical treatment first.
Summerville noted that since law enforcement is often called on to deal with mental health crises even in non-criminal scenarios in Wyoming, this can put a major strain on local law enforcement offices, is expensive for the state and can be traumatic for both the person in crisis and their friends and family members. Being able to divert people from law enforcement to medical treatment can help reduce this strain on law enforcement and increase access to mental health care.
Another important factor that may already be contributing to helping lower Wyoming’s suicide rate is 988.
“I feel that Wyoming is so unique that it’s very important to have someone from Wyoming on the line [when people call 988],” Case commented. “We have to be at the end of that telephone line – and it has to be somebody from Wyoming.”
Earlier this year, the state legislature voted not to permanently fund the 988 call centers – which Summerville said is a major source of concern.
Like other safety precautions and preventive measures, suicide prevention can be unfortunately prone to survivorship bias. As the saying goes, you can’t prove a negative, and it is difficult to show the number of people who didn’t die by suicide because of access to something like a call line. However, since the Wyoming call center opened the national 988 call line has seen a 60% increase in the number of calls from Wyoming phone numbers, Summerville said.
“It is one of the resources that we are concerned about losing,” she noted. “When you find something that works, we want to make sure that we keep using that.”
As of right now, funding for 988 call centers could last through early 2025 at the very latest, Summerville explained. Case said that while he plans to continue advocating for permanent funding, he also doesn’t believe that temporary funding is any cause for concern.
“Temporary funding isn’t always a bad thing,” he remarked. “I don’t see why it wouldn’t be funded going forward.”
Signs of suicide
According to the National Institute of Mental Health, warning signs of suicide include talking about wanting to die or feeling like a burden, withdrawing from friends, giving away important items, making a will, taking dangerous risks, extreme mood swings, eating or sleeping more or less, and using drugs and alcohol.
If you think someone you know may be at risk of suicide, call or text 988, chat with someone online at 988lifeline.org or text “HELLO” to 741741.
“We believe it is too soon to tell if a decline in Wyoming resident suicides will continue,” Deti noted.
Only time will tell if Wyoming’s suicide rate will continue to flatten or go down, or if this year’s potentially lower numbers are just another one of the state’s common fluctuations.
This story was published on October 2, 2023.