The recent suicide of a Sonora High School student left many students and community members wondering what they could have done to prevent it.
Fortunately, there are ways to reduce the number of similar tragedies in the future, public health officials say. Community outreach efforts are ongoing in the Mother Lode to connect people with mental health treatment and train ordinary citizens to intervene.
"The trick is, No. 1, to identify those at risk, because they're going to do their best to obscure that risk," said Dr. Todd Stolp, Tuolumne County's public health officer. "We don't want them to fear that stigma."
Stolp said suicides usually don't have any single cause or motivator.
"There's virtually never any one thing," he said. "Any individual case always has multiple complex factors contributing to the situation. Teasing out those factors is one of the difficulties."
Suicide rates tend to be higher in rural areas, and the pattern holds true in Tuolumne and Calaveras counties. However, Stolp cautioned that the relatively small number of deaths means the rates fluctuate widely from year to year.
Tuolumne County had 11 suicide deaths in 2007, eight in 2008 and 17 in 2009, the last year with publicly available counts through the California Department of Health Care Service's Suicide Prevention Program.
That translated into a suicide rate of about 14 deaths for every 100,000 people in 2008 and 29 deaths per 100,000 the next year, compared with California's rate of 9.7 suicides per 100,000.
In both 2008 and 2009, Calaveras County's rate was about 17 suicide deaths per 100,000.
Tuolumne County's suicide rates have been lower the past few years than they were in 2009. Data for 2002 through 2010 suggests an overall downward trend in Tuolumne County suicide rates, while the state's has risen, Stolp said.
He co-authored a study of suicide rates in 2009 that found a connection between higher rates in rural counties and the greater availability of firearms, among other factors.
"One of the problems we have in these rural counties is that most suicides are by gun," said Brock Kolby, supervisor for adult care at the Calaveras County Behavioral Health Department. "So one of the things we're doing is getting gun locks for people to use."
Many suicides are impulsive decisions, possibly made only five minutes before the act is carried out. Postponement using simple barriers can make all the difference, Stolp said.
Suicide crosses cultural and economic lines, with an important factor being the person's beliefs and perceptions about their own circumstances.
Even a wealthier person whose income suddenly drops may be at risk for depression and suicidal thinking, according to Stolp.
The good news is that there are effective treatments for depression, anxiety and suicidal thoughts, including counseling.
"They're effective and known to be effective in preventing future suicides," Stolp said. "That's why it's so critical to convey that message of hope."
Both Tuolumne and Calaveras counties have tried to spread the message in recent years.
Calaveras County has a suicide prevention collaborative that meets once every few months to discuss prevention strategies.
"It's going to be a community effort to try to solve this problem," Kolby said. "Basically, Behavioral Health tries to take a leadership role."
He pointed out peer counseling programs in Tuolumne and Calaveras counties that send trained volunteers to visit with senior citizens, who have higher suicide rates than other groups.
A new text messaging service for those in crisis is aimed primarily at young adults, who, along with the elderly, are least likely to use traditional mental health services like counseling.
Tuolumne County's Suicide Prevention Task Force, which has several dozen members and is coordinated by the Amador-Tuolumne Community Action Agency, came together in 2007 after a spike in local suicides caused concern. It held its fourth annual summit last month.
One result of the collaboration is a set of programs that train community members on how to spot someone at risk and intervene.
The increased outreach has already helped individuals in crisis and may have contributed to the lower suicide rate in Tuolumne County in recent years, Stolp said.
This year, the task force's focus is shifting to a program called "safeTALK." SafeTALK training sessions, which are three and a half hours long, prepare anyone to identify those at risk for suicidal thoughts and connect them to the right resources.
Often, the trickiest part is being comfortable with asking someone if they're considering suicide, said Bob White, director of the ATCAA's YES Partnership. The YES Partnership was established in 1986 in response to an increase in local teen suicides.
Stolp and Kolby both pointed out that asking the question doesn't prompt people to consider suicide if they aren't already.
"When you ask about it in a clear way, it usually makes them relieved that someone cares," Kolby said.
Tuolumne County's first safeTALK training session will take place from 9 a.m. to 12:30 p.m. Aug. 22 in Room 217 of the Tuolumne County Office of Education.
A second program, called ASIST for "Applied Suicide Intervention Skills Training," lasts two days and is scheduled for June 24 and 25.
The ASIST program goes a step further by teaching community members how to intervene directly - identifying reasons a person wants to commit suicide, helping them identify reasons to live and creating a safety plan.
Both ASIST and safeTALK are free and open to residents of both Tuolumne and Calaveras counties. ASIST is designed for ages 16 and up, and safeTalk is geared to ages 15 and up.
Research has proven the programs effective, White said.
"One of the things that they've said is that really most people don't want to commit suicide," he said. "Most people want to live, but they needs some help kind of moving through this crisis."
To sign up for either program, contact Martha Golay at the Amador-Tuolumne Community Action Agency at 533-1397, ext. 274.