Despite a decade of work and millions in funding, the number of suicides in Alaska has not decreased over the past 10 years, concludes a report released this week by the Statewide Suicide Prevention Council.
In 2009, 140 Alaskans took their own lives.
"What you will learn from our report is both inspiring and disappointing," said William Martin, chair of the council, in a letter accompanying the report.
The state founded the Suicide Prevention Council in 2001 to advise the Legislature on the "on-going epidemic of suicide" - in 2000 there were 21.2 suicides for every 100,000 Alaskans, or 135 lives lost. Rural Alaskans suffered a rate three times higher than those in urban populations.
Not much has changed since then. In 2009, about 20 Alaskans committed suicide for every 100,000 people in the state.
The southwest and northern parts of Alaska had a suicide rate three times higher than the statewide rate - about 60 suicides for every 100,000 people.
The grim numbers come despite "substantial efforts by communities and organizations statewide," Martin said. Since 2001, the State of Alaska has spent over $10 million on suicide prevention, with a sharp increase in funding in 2009.
Still, Martin said there was reason to hope - even if progress wasn't apparent from the numbers.
"Years ago, no one talked about suicide. There was stigma and fear. Now, even though there is still stigma and there is still fear, people are showing greater courage and speaking out," Martin said.
To view the full report, visit the Statewide Suicide Prevention Council homepage.
Race, age and region
Suicide rates among Alaska Native peoples are higher than for any other ethnicity in the state, and are the highest of any ethnicity in the country.
In 2009, about two Alaska Natives committed suicide for each Caucasian suicide. This has remained consistent over the span of years - in general, Alaska Native individuals are twice as likely to commit suicide as individuals of other ethnicities.
However, the report cautions that ethnicity is just one side of the story. While the rates of Alaska Native suicide are higher, 89 Caucasian Alaskans and 44 Alaska Natives committed suicide in 2009. Since 2001, over twice as many Caucasian Alaskans have committed suicide as Alaska Natives.
"What this tells us is that suicide is not confined to one ethnic group. Suicide is an Alaskan problem," the report concludes.
Young people, ages 15-24, and especially young men, continue to be at high risk for suicide. The suicide rate for men age 15-24 is 56.1 for 100,000 people, for young women it is 16.6 for 100,000 people.
For Alaska Natives, the rate for this age group is 141.6 for every 100,000 among young men and 50.3 for every 100,000 among young women.
Between 2000 and 2008, 4.26 percent of all deaths in Alaska were due to suicide.
For that same period, in the Wade Hampton Census Area (which includes Hooper Bay, Emmonak, Chevak, Scammon Bay, Mountain Village, Nunam Iqua, and nine other villages), 14 percent of all deaths were due to suicide. In the Northwest Arctic Borough, which includes Kotzebue, 13.54 percent of all deaths were due to suicide. In Anchorage, suicide accounted for 3.49 percent of all deaths.
Substance abuse, unemployment and education
While the report states drugs and alcohol are not a cause of suicide, it found substance abuse to be a factor.
According to the Alaska medical examiner's office, evidence of alcohol and/or drug use was involved in the majority of autopsies resulting from suicide. The Alaska Psychiatric Institute reports that alcohol and drugs were involved in 48.44 percent of all admissions to the state psychiatric hospital.
In 2005, the Alaska Trauma Registry published a review of suicide hospitalizations for 2001-2002 showing that 77 percent of hospital visits resulting from suicide attempts (or other self-harm) involved an overdose on medications.
Joblessness can add stress to any household, but while the report noted a weak correlation between unemployment and suicide, authors found no clear connection between an increase in the unemployment rate and an increase in the suicide rate. In fact, there were periods of time when suicide rates fell in regions experiencing increased unemployment.
In the realm of education, Alaska students enrolled in "alternative" high schools (which often serve students at risk of failing academically) presented a much higher incidence of suicide attempts than found amongst students nationally.
Steps forward
In Alaska there are many people working on suicide prevention - including the State of Alaska, the tribal health system, the federal government, local communities and others.
But for years there was little effort to link these programs together. Last January, more than 60 individuals, representing agencies and communities across the state, gathered for the first time at the Alaska Suicide Prevention Summit in Anchorage.
Some issues identified were a lack of survivor support groups, social stigma and taboos over discussing suicide and a lack of communication between various programs.
As a step toward filling gaps in care, the Alaska Mental Health Board developed an online web portal for suicide prevention at stopsuicidealaska.org. Alaska's statewide suicide hotline - called Careline - was also identified as a strength. In 99 percent of calls, Careline counselors provided effective interventions to keep the callers safe until they could access services they needed. In cases so acute that the caller is at risk of death, Careline engaged local emergency services to intervene.
Careline is available seven days a week, 24 hours a day at 800-273-8255.
The report states that the Suicide Prevention Council deliberately avoided coming to conclusions or providing answers in looking back at the past 10 years.
Instead, "We hope that this annual report starts conversations - in the Legislature, in classrooms, in assembly chambers, in doctors' offices, and in living rooms," the authors write.
Members of the public are invited to share suggestions for future efforts - an upcoming statewide suicide prevention plan will include recommendations and strategies for moving forward.