CHEYENNE – In 2019, 170 people in Wyoming died by suicide. With a rate of 29.4 suicide deaths per 100,000 people, it had the most of any U.S. state – and double the national average, according to the Wyoming Department of Health’s Injury and Violence Prevention Program.
Suicide is the second-leading cause of death for Wyomingites between the ages of 10 and 44, and the seventh-leading cause of death in the state overall.
“If you ask (people in the community), have you or someone you know been impacted by suicide, every hand in the room goes up,” said Brittany Wardle, Community Prevention project director for Cheyenne Regional Medical Center.
But people like Wardle and her colleagues aren’t standing idly by. After hearing about the concept of suicide fatality review teams – especially the work of Dr. Kimberly Repp, an epidemiologist in Washington County, Oregon, and a team in Humboldt County, California – Wardle and her colleagues became interested in doing something similar in Laramie County.
Wardle said Repp’s team saw a 40% drop in suicides over several years.
“We thought, you know, that sounds too good to be true, but it sounds like it’s going to be worth our time, as well,” she said.
Wardle and her colleagues proposed a similar program to the county’s Behavioral Health Action Team, which is focused on substance use and suicide prevention.
The answer, Wardle said, was a resounding yes.
The goal of the Laramie County Suicide Fatality Review Team is to prevent suicides by learning more about the circumstances leading to these deaths in the county, as well as finding and fixing gaps in the county’s existing system of suicide prevention services. About 15 to 20 agencies are represented on the review team, including CRMC’s Behavioral Health Services, law enforcement, the Wyoming Department of Family Services, Youth Alternatives and suicide prevention nonprofit Grace for 2 Brothers.
Three months following a suicide death, the review team sends a letter to families, asking if they’d feel comfortable with having their loved one’s case examined by the team. Families can then give the team permission to access their loved one’s records.
“We want to make sure that, as much as we can, we learn from the deaths that have happened – what we could be doing better to prevent them,” Wardle said.
The team conducted two reviews in July and has two more reviews planned for October. Wardle said they were advised by Repp to limit the number of cases they reviewed, so the current plan is to look at two to three each quarter.
“So, we’re asking questions like: Was there a loss in communication or some kind of coordination of service that led to this lapse? Are there opportunities where we can influence policies or programs that are addressing risk and protective factors?” Wardle said.
For example, it’s important for coordinating agencies to communicate with one another to make sure that someone referred for a follow-up appointment after a suicide attempt shows up, or to make sure a person is offered mental health care after receiving a terminal cancer diagnosis or while dealing with a chronic health condition.
When a person’s loved one or someone they know dies by suicide, that person is at increased risk of dying by suicide themselves. Wardle suggested training funeral home staff to look out for signs that a person may be contemplating taking their own life, and taking steps to prevent that.
In several cases in Washington County, Oregon, the review team found that individuals would drop off a pet at an animal shelter before dying by suicide to ensure the pet would be cared for. In this case, it was a matter of training animal shelter employees to ask certain questions when individuals surrender their pets.
The Laramie County team also gathers information about the person’s circumstances prior to their death, such as family or financial issues, mental illness diagnoses or previous suicide attempts, Laramie County Coroner Rebecca Reid said.
All of the information specific to each individual is kept confidential, and even the families have to sign a confidentiality form, Reid said.
So far, families have been interested in cooperating with the program.
“The one question the families always have for us is ‘Why?’” Reid said. “And, you know, if there’s a way that we can give them a why, then they’re all for it.”
Though she knows it’s optimistic, Wardle said the group’s mission is to achieve zero suicides in Laramie County.
“I think (the review team) really gives us a chance to use our local data, our local information to say, in Laramie County, this is what risk has looked like and this is how we can work on protecting those in our community from experiencing a death by suicide,” she said.