Carmen Hittle, a lifelong resident of Sublette County, lost four members of her family to suicide. Her former husband took his life, leaving Hittle with six children to raise.

Years after her husband’s suicide, Hittle’s only son and one of her daughters took their own lives. Her husband’s brother also took his life.

“Nobody should have to lose a child to suicide,” Hittle said. “It’s such a shock and you can’t understand why it happened.”

Suicide is a difficult subject for many people to talk about. Suicide can be sudden and unexpected, leaving those left behind with unanswerable questions and feelings of guilt. Stubborn social stigmas about suicide persist to this day.

People struggling with suicide can feel even more isolated living in a rural state where mental health resources can seem far away and the “pull yourself up by the bootstraps” mentality persists.

But Hittle is not afraid to talk about suicide despite the devastation it caused her family. She hopes that by sharing her story, she can start a conversation about suicide and raise awareness about a preventable health crisis that takes too many lives in America.

A national and local crisis

An article published by the international newsmagazine The Economist this November reported that suicide rates around the world are dropping. As conditions improve across the globe, however, suicide rates continue to rise in the United States.

A recent report published by the Centers for Disease Control in November showed an increase of 33 percent in reported suicides between 1999 and 2017. Suicide is now the second leading cause of death for Americans between the ages of 10 and 34.

The Rocky Mountain West has some of the highest suicide rates in the country. According to the CDC, Wyoming had the third highest suicide rate in 2016 – the most current year available.

The availability of firearms in the state poses an added risk. Wyoming had the highest rate of suicide by firearms in the U.S. during the period 2008 to 2014 – a rate more than two times the national average, CDC records show.

The Wyoming Department of Health reports that one person takes their life every two days in the state. Sixty-four percent of these deaths are carried out with firearms.

The report in The Economist stated, “The rise (in suicide rates across America) is largely among middle aged white men” in “areas that were left behind by booms and crushed by busts.”

Melinda Bobo, rector at St. Andrew’s in the Pines Episcopal Church in Pinedale, said that suicide takes the lives of 123 people across the country every day.

But suicide is a “preventable” crisis, said Bobo. “We have techniques in place that we know are effective. It is important to keep the idea alive that suicide is an ongoing issue. We need to talk honestly about it, not hide it.”

Silenced by stigma

Bobo struggled with suicide when she was younger. Her world narrowed into darkness where there seemed to be only one escape – death.

Jackie Downie, a licensed social worker practicing in Pinedale, said that many people who contemplate suicide are in a mindset where intense, overwhelming emotional pain causes them to “put up blinders” to any form of relief other than death.

Social anxiety and stigma around suicide can make those suffering from acute emotional distress feel more isolated.

“Because of the stigma, it was hard for me to reach out,” Bobo said. “It’s hard to find help when no one is talking about it.”

When she was growing up, churches “across the board” considered suicide a “mortal sin.”

But attitudes are changing in religious establishments across the country. The Episcopal Church has embraced suicide awareness and prevention efforts, and is a leader in opening the conversation about a once taboo subject.

Rather than use religion to condemn suicide, Bobo uses her faith as a means of acceptance and recovery.

“Why would a loving God punish you for being in pain?” she said. “There is a passage in Isaiah that says when you’re wounded, God is not going to wound you more. Being flawed and broken is a part of being human, not an unforgivable sin. This is a point of redemption. God knows we’re broken, and God loves us in our brokeness.”

When Hittle was a child, she recalls her family’s absence at a funeral for a close family friend who killed himself, because the social stigma around suicide was so strong in rural Wyoming.

“I hate the words ‘commit suicide,’” Hittle said. “You ‘commit’ a crime, but you take your own life. Never, ever would I pass any judgment from where I’ve been.”

Taking action

Two years ago, a spike in suicides across Sublette County inspired Hittle and Downie to form a volunteer support group called Survivors of Loss by Suicide. The group meets every second Tuesday of the month at 5:30 p.m. in Pinedale’s Episcopal Church.

The group provides a safe, judgment-free environment for anyone who has lost someone to suicide to open up and share their story with people who understand, Downie said.

When people take their lives, the death is particularly devastating for those left behind because suicide is usually unexpected and still carries some stigma, Downie stated.

“Suicide really does affect people for a long time, and recovery usually takes three to five years,” she said.

Family members and friends often ask what Downie called the “big question” – why did the suicide happen. The question doesn’t have an answer, but Downie said that as families search for one, they start to blame themselves, and feel an overwhelming sense of guilt.

The focus of Survivors of Loss by Suicide is to treat this crushing guilt.

“If you’re left behind, you can’t feel guilty,” Hittle said. “It wasn’t your fault. It was the (the victim’s) choice.”

Helping people who are contemplating suicide can start with a simple question, Downie said.

“If you are worried someone close to you is suicidal, ask them,” she said. “This can be very hard, but it gives the person the opportunity to open up and start a conversation.”

Downie said that many people struggling with suicide may initially react with anger to an intervention, but are usually grateful that someone reached out to save their life as they recover.

“There is a myth that people who are suicidal once are always suicidal,” she said, “But that’s not true. Suicide preventions do help.”

One preventative method that has showed promise is called “question, persuade, refer,” or QPR. Bobo is trained in providing QPR to community members and has seen success with the program.

QPR is a form of mental health first aid, what Bobo refers to as “CPR for suicide.” Like other forms of first aid, QPR has distinct steps of care that start with asking the question, “Are you considering suicide?”

People trained to administer QPR learn how to recognize the warning signs of suicide, how to offer hope and where to refer a person for help. QPR trains people to save lives and offer a “constructive response” to someone who is struggling with suicide, Bobo said.

The Episcopal Diocese of Wyoming has teamed up with state and local prevention offices with the goal of training 10 percent of a county’s population to administer QPR.

Anyone over the age of 18 can go through the training process to become an instructor, or “gatekeeper,” who can teach QPR to others, said Trisha Scott, prevention coordinator at Sublette County Public Health. If anyone is interested in becoming an instructor, Scott said to contact her at 307-749-5004.

Bobo and Scott are also members of the local Suicide and Sudden Death Response Team. The team mobilizes the resources of three counselors and two clergy to “give support to individuals and families after death from suicide or a sudden death,” said Scott.

Bobo administers to the spiritual side of the response team. She started a non-denominational service of healing for people struggling with suicide and family members and friends who have lost someone to suicide called the Liturgy for Suicide Prevention and Healing.

“My idea was to provide an opportunity within a faith context to acknowledge the pain of suicide,” Bobo said. “Our goal is to talk about suicide and pray about suicide, not to beat each other up, but to hold each other up in the midst of this pain.”

Because firearms are involved in many suicides in Wyoming, Downie and Bobo urge people to practice safe gun handling methods as a way to save lives.

“We’re talking about something as simple as separating the weapon from the ammunition or having a conversation about holding guns for someone going through a difficult time,” said Bobo.

Downie added that alcohol and drugs also increase the risk of suicide, since they lower impulse control.

Downie said that when all else fails, people can call 911 or a suicide hotline. During her professional career in Pinedale, Downie said that the local sheriff’s office did a good job providing “thoughtful, understanding and helpful” responses to suicide.

High Country Behavioral Health in Sublette County always has a counselor on call to respond to mental health crises. They can be reached at 307-367-2111. There is also a National Suicide Prevention Lifeline that can be reached by calling 1-800-273-TALK or texting “Talk” to 741741.

In the end, Hittle said that part of preventing suicide is to be aware of those around you in your community.

“Be more aware of the people around you,” she said. “Be kinder. If you see someone you think is struggling, whether it’s with getting groceries in a car or dealing with emotional distress, reach out to them. A lot of times if you ask if someone is considering suicide, this opens the door to start recovery.” n