I think that's one of the biggest things, is we are not afraid to talk about it. We don't dwell on it on the darkness that often surrounds suicide, it's more how to be aware of what's going on and how to help people. —Wendy Nelson, Syracuse High School principal
SYRACUSE — In March of last year, on the heels of what then-Syracuse mayor Jamie Nagle described as an "epidemic" of suicides, leaders in this Davis County community banded together with suicide prevention experts to put together a town hall meeting.
One young man, a high school student, walked in and approached one of the tables with resources set up in the hallway at Syracuse High School.
"He said, 'I came today because I'm sad. I don't know where to go for help. I need someone to talk to, because I have been thinking about suicide,'" Nagle recounted, recalling the outreach given to the young man.
"Even if that had failed going forward," she said of the meeting, "we saved a life that day, and it was all worth it."
In 2012, 545 Utahns were lost to suicide. Seventeen of them were in Syracuse. But the community wouldn't stand for it. Leaders enlisted help from an area suicide prevention task force and rallied education, law enforcement, city and health leaders, even students, to make a change.
"To date we have had one suicide in Syracuse since then, which is still one too many, but when you take it from where we were — 17 to 1 — it shows the power of a community coming together," Nagle said.
What can be learned from this community that decided to take charge of something as complex and painful as suicide? And can other communities do the same thing?
"What Syracuse did that worked was, for one, they reached out for help," Kristy Jones, community projects coordinator at McKay-Dee Hospital Center and chair of the Northern Utah HOPE task force, said. "Then everyone followed through and did what they agreed to do, and a lot of them went over and above."
Lance Call, a Syracuse police officer and school resource sergeant at Syracuse High School, said the number of suicides in the town forced its community members to make a decision.
"I think we as a community were shocked into, either we allow this or we do something, and I think the community took the idea finally that we're not going to allow this," Call said. "I think there was a fundamental shift in the community's view after way too many suicides."
Syracuse police had heard of the Northern Utah HOPE — hold on, persuade, empower — task force, which is coordinated through McKay-Dee, and that's where leaders in Syracuse decided to start.
Circle for hope
The Northern Utah HOPE task force was formed seven years ago. McKay-Dee social worker Becky Austad, who also serves on NUHOPE as a teacher and facilitator, said the task force was first implemented in the Ogden area.
"We realized there was a real need for suicide prevention, because a lot of people's lives were being touched and impacted by that," she said. "I've been a social worker going on 20 years in October and suicide has touched my life and touched my family's life, and it kind of sparked an interest in me in getting out more into the community, in getting resources and information, because I felt like my family's life could have been different, outcomes could have been different if information had been shared."
They modeled the NUHOPE task force after that of Greg Hudnall, who was then a Provo School District administrator and now serves as the executive director of HOPE4UTAH. Hudnall has long emphasized the power of communities that tackle suicide through collaboration.
"We call it our circle for hope model, and it's basically three circles that come together: community connections, mental health experts and then the schools," he said. "The key is uniting everybody. The challenge is it takes time and it takes effort."
Since devoting all of his time to suicide prevention since July, Hudnall said HOPE4UTAH has given more than 100 presentations to more than 6,000 people in 65 cities from Brigham City to St. George. The group is often called to communities recently impacted by suicide and offers training, sets up community support systems and develops hope squads in the schools.
The idea is to help everyone recognize the warning signs in people who are struggling, and then get them the help they need. It's made a difference in Provo and now in Syracuse because there is a commitment to sustaining the prevention efforts and a willingness to talk about suicide.
"A lot of entities have a suicide, we come in and fix it, and then a little while later, they don't want to do it anymore because they haven't had another suicide — that's why you keep doing it," Hudnall said.
Focus on schools
Hudnall said he has always emphasized schools, because it can be a difficult place where adolescents struggle with identity, bullying and feelings of isolation. One particularly successful program is the in-school "hope squads" comprising students identified by other students as those who they can go to for help.
Wendy Nelson, principal at Syracuse High School, said she had been asking her own questions about what could be done in Syracuse to save lives. She brought the issue up in community council meetings and became involved in NUHOPE's education committee.
After the town hall meeting, the high school launched its hope squad. About a year ago, the school sent a survey to the returning and incoming students asking which students were the best listeners or the most trustworthy.
"They're the people that the students may go to that aren't necessarily the popular kids, but they're the people (the students are) comfortable with," Nelson explained.
The students whose names appeared the most were contacted, as were their parents. Austad and another educator gave a training session, and parents signed off on their child's participation.
There are about 25 students who are active in the hope squad at Syracuse High School, where they undergo training and have monthly meetings. There are also four advisers on the school's staff.
Nelson said there have been many instances in which students have approached hope squad members, advisers and school staff about their own struggles or those of their friends.
Some weeks, she said, students are referred to them on a daily basis, other weeks less so. In all of those instances, the student's parents are contacted and the student either goes home or directly to a doctor, Nelson said.
Currently, six students are in residential treatment programs. In the past two years, school resource officers have transported 10 students to the emergency room for immediate treatment of their struggles.
"The students love to help each other, they really do, and they have a means now and they feel safe and they know that we're going to address it no matter what it is," Nelson said. "In 2012, we had two suicides. We haven't had any completed suicides since."
Austad said the students are the eyes and ears on the ground. One hope squad member overheard two girls in the restroom discussing what to do about a friend who was struggling.
"This hope squad member stepped up in the restroom and said, 'I know what to do. I can help you,'" Austad said. "She took those two friends to a hope squad adviser, and they were able to get the friend some help."
She said most of the hope squad students have expressed gratitude at being able to have the resources to help the people who were already coming to them.
"The hope squad gave them the avenue to be able to help the students they were already helping, but now they have the tools, the skills and the ability to be able to know what to do," Austad said. "Instead of carrying it, instead of worrying about them all the time, they can funnel them and be the gatekeepers in getting them the additional help that they need."
Changing the dialogue
The school's entire staff has been trained in suicide prevention. Davis Behavioral Health also sends a partner to work with students who have been identified as high-risk on a regular basis.
"It's important that we address these issues," Nelson said. "Suicide is ultimately an individual's decision, but if along the way you can provide some support and (help them) to realize that it doesn't have to be the end to everything and there are support mechanisms and people out there who truly do care and want to assist them through the challenges that they're facing.
"My goal is to not have another young life taken when it doesn't need to be."
Like Austad, Nelson said her family had also been touched by suicide. Three people in her family had died by suicide, but the family had never discussed it.
It wasn't until Nelson invited her parents to the town hall meeting that they actually started talking about what had happened. Opening this channel of communication, she said, is part of what is making Syracuse successful in its prevention efforts.
"I think it's the fact that we're having the conversation now," Nelson said. "I think that's one of the biggest things, is we are not afraid to talk about it. We don't dwell on it on the darkness that often surrounds suicide, it's more how to be aware of what's going on and how to help people."
Austad, who teaches suicide prevention at schools in Davis and Weber counties, said she often asks the students how many of them have been impacted by suicide. The majority of their hands go up.
"The next question is, 'And how many of you have been able to share how your life was impacted by that suicide situation?' and no hands go up," Austad said. "I know that suicide impacts so many people, and I feel like breaking down the barriers, breaking down the silence, giving permission for people to have conversations, is really important."
Changing the culture
Nagle said that in less than a year there were two high school students who died by suicide, in addition to a murder-suicide, a couple with children who both attempted, the death of a man in his 30s and another in his 60s, among others. She said at one point it felt like she couldn't go one day without hearing about a suicide or an attempt.
"It just felt like it was an epidemic and we were losing our young kids, and it just became clear that our community was hurting," she said.
It was in late 2012 when she called in the city manager and Syracuse Police Chief and said she knew there had to be resources out there and that they needed to find them. Once the ball was rolling, the community responded.
"We recognized that there were a lot of people that wanted to do something, but nobody knew how to do it or how to organize," Nagle said. "It was amazing that everybody just needed an opportunity to come together, and then it took on a life of its own."
Austad said the rash of suicides in such a short span was a wake-up call for the community.
"People started realizing how their lives were being impacted by what was going on," she said, adding that every piece of the community has to come together to create success. "It's not just an individual's problem or their family's problem, it's a community problem and people are recognizing how big of an issue this is and that we're not going to sit back anymore and start working toward solutions."
Nagle said Northern Utah-based Tanner Clinic and Intermountain Health Care didn't hesitate to come together to help. Rachel Keoppel, marketing specialist at Tanner Clinic, said it participated in a suicide prevention event at Syracuse High School and notified physicians in the Syracuse clinic to be aware of their patients and of the priority of prevention in the city.
It was not the first time the two health providers worked together on an event.
"It's about the people and it's about the community and as far as this was an important event (in the) community, that's what we're here to serve," Keoppel said. "There wasn't any competitive issue. It was, we're both here serving the community and we're both here to participate and to offer our services if we can."
She attributed the progress in Syracuse to its leaders not being afraid to recognize and tackle the problem.
"They weren't afraid to talk about it," Keoppel said. "They saw an issue in their community, and their leadership stepped up to the plate and talked about it and brought a change and the people in their communities who could make a change got involved."
Change didn't happen overnight. Call said police had long relied on mental health professionals or emergency rooms to help those in crisis situations. When students acted out, their parents were called and that was often the end of it. Now, while parents still get called, teachers, administrators and school resource officers are also trained and take additional measures to prevent suicide.
"I think we've done so much better at identifying warning signs and taking it seriously," Call said. "Now we take a very active role in every school, with any type of gestures or comments where before law enforcement's reaction was oftentimes almost a Band-Aid — show up, make sure they were OK for the immediate moment, call parents, the parents would come pick them up and we would walk away and file a police report."
He said there also used to be "stereotypical behavior," where one student harassing another was dismissed as typical teenage behavior that was to be expected from adolescents.
"Today we don't look at it as typical," Call said. "We see the bullying, we see the harassment, and we learned from bad past experiences that those were sometimes the warning signs. We need to give them a resource to get help if they need it."
In Syracuse, they know they can't let up.
"We are losing way too many people, and it's time for that to stop, because there is a ripple effect," Jones said. "When someone takes their life in a suicide it impacts their immediate family, their extended family, their friend group, their community, their church, you name it and on and on and on, there's this ripple like in a pond and they don't realize how many people that they touch."
So much good can be accomplished by just acknowledging that suicide is a real problem that must be addressed.
"I think it's so important that we break down the stigma around suicide and start making it OK to ask for help and to give help. I think that Utah has a great opportunity right now to move forward and try and break down those barriers and make an impact through suicide prevention."
In Syracuse, Nagle said it was important that community leaders took the initiative to bring everyone together and pool the available resources. It wasn't until she asked that she realized how many were ready to respond.
On July 1, there were seven hope squads in schools across the state. Today, there are 55. Hudnall hopes to bring that number to 100 by August.
"With as many districts contacting us, I think we will be there," Hudnall said.
There was prevention-minded legislation passed in the last legislative session and the one before, including a bill that provided for two statewide suicide prevention coordinators.
"I anticipate and project that as the community and as our state has state initiatives for suicide prevention, as we start breaking down the barriers and getting the message out there, I think you are going to see the movement and momentum continue to go," Austad said. "As communities start getting involved and start bringing those elements together, I think were going to see a lot more communities coming together like Syracuse has been."
Where, as Nagle summarizes, "We have come full circle."
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