Bella Nyman has struggled with her mental health since age 7, when she was diagnosed with bipolar disorder and anxiety.
Nyman said she was afraid to tell her parents she had thoughts of suicide. Looking back, a mental health screening might have helped her to stop hiding her struggles from adults and peers, she said.
“Hard things don’t get better if we don’t talk about them,” Nyman said.
Today, Nyman works with the Rural Behavioral Health Institute, a Livingston, Montana-based organization that aims to reduce youth suicides by improving mental health care in rural places. She recently testified for a bill that has been twice rejected this legislative session by the Montana House to use state money to fund free mental health screenings in schools, like those that Rural Behavioral Health Institute provides.
Montana, which perennially has one of the highest suicide rates in the nation, also has a youth suicide rate twice the national average, according to a study released last year by the state Department of Public Health and Human Services. The covid-19 pandemic and the isolation it caused increased many of the risks associated with suicide, experts said.
One in 5 students will develop a significant mental health problem during their school years, and roughly 7 in 10 students who need mental health treatment will not get appropriate care, according to the Substance Abuse and Mental Health Services Administration. Screening for behavioral and mental health issues has become more prevalent in schools and can help identify students at risk or in need of intervention, according to SAMHSA.
But lawmakers in the state House of Representatives rejected the school screening measure, House Bill 252, sponsored by Democratic Rep. Jonathan Karlen, saying the state already has a suicide prevention program and a statewide coordinator.
During a Feb. 2 House floor debate on a separate bill on suicide prevention, Republican Rep. Bob Keenan said suicide prevention has developed into an industry with no results to show for it.
“We’re still here talking about it, and the numbers continue to go up,” Keenan said.
On Feb. 15, Republican Gov. Greg Gianforte announced a $2.1 million grant to the Rural Behavioral Health Institute to essentially fund what HB 252 proposed — free optional mental health and substance abuse screenings for all schools statewide and same-day care for students flagged as being at high risk for suicide. The money will come from the Governor’s Emergency Education Relief Grant program, which is funded by federal covid relief aid — and can be spent without legislative approval.
Keenan said he supports the governor’s plan. However, he said, he still thinks the state has spent too much money on suicide prevention and would like to see more community-based peer-support programs.
The health department report showed the state’s highest rate of suicide between 2011 and 2020 was among Native Americans — 32 people out of 100,000 — though Native Americans make up only 6% of the state’s population. National data released by the Centers for Disease Control and Prevention in 2021 showed that 16% of Native American and Alaska Native high schoolers had attempted suicide over the prior year.
Tribal leaders on rural reservations, such as Fort Peck in northeastern Montana, worried the pandemic would lead to a spike in child suicide deaths.
Other data from the CDC that the Rural Behavioral Health Institute shared with lawmakers last year shows that suicide is the second-leading cause of death for people ages 10 to 44 in Montana. Most recently, eight teenagers died by suicide over a span of 16 months in northwestern Montana’s Flathead Valley.
The initiative announced by Gianforte would build on a pilot project by the Rural Behavioral Health Institute called Screening Linked to Care, which screened more than 1,000 students in 10 Montana schools from 2020 to 2022. Janet Lindow, executive director of the institute, said screenings are a key component in identifying students who may be at risk of dying by suicide.
“This is a way to find those kids who are basically suffering in silence,” Lindow said.
At least one student who was on nobody’s radar has been identified as needing help in each school where the program has operated, she said.
Shawna Hite-Jones, a suicide prevention specialist with the Suicide Prevention Resource Center at the University of Oklahoma, said it’s important to use screenings as part of a comprehensive approach that includes training teachers to recognize suicide risk, teaching students about healthy coping strategies, following up with at-risk students, and making sure students can connect with their peers and trusted adults.
“Screenings are a tool that can be helpful for schools if they have the capacity and relationships with mental health providers to make them useful,” Hite-Jones said.
CDC data shows suicide rates have been increasing over the past decade. The covid pandemic exacerbated many of the risk factors for suicide, like social isolation, financial insecurity, or lacking a trusted support group, Hite-Jones said. The pandemic also prompted new discussions around mental health and suicide, she said.
Jennifer Preble advocates for suicide prevention education and legislation with the Montana Chapter of the American Foundation for Suicide Prevention. Because suicide is complex, she said, it’s important to look at the bigger picture.
“There’s no one reason for suicide, and there’s also no one solution for suicide,” Preble said.
Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.