It’s not easy being an adolescent suicidologist in Utah, let alone in the United States.
Suicide deaths reached a record-high in America during 2022 with many rural and western states, including Utah, reporting higher rates than the rest of the country. This issue is not just about the numbers — it’s about the young people and families impacted by the unexpected loss of a loved one when they die by suicide.
Over my 30 years of treating youth suicidality, I’ve experienced this tragedy far too often and felt the heartbreaking ripple effects. It affects not just your immediate circle, but also the greater community. We cannot accept this trend as the growing cultural norm.
Suicide is complex, but also preventable. Access, availability and acceptability of mental health care remain serious barriers for people in rural communities, and youth in Utah are no exception. The leading method of suicide overall is by firearm, and rural youth report having easy access to firearms at twice the rate as their urban peers. Firearm availability has direct effects on suicide rates, which is why secure storage is so important. In a large published study, states with higher rates of gun ownership, several of which were rural and/or in the Rocky Mountain West, experienced higher rates of suicide because of disproportionately higher numbers of firearm suicides. The differences were not accounted for by other factors such as higher rates of attempts or mental health ailments.
Several other suicide trends are worth exploring as we work to address this issue: 1) three-quarters of suicides occur at home; 2) among youth firearm suicides, 80% of those firearms are owned by parents or family members; and 3) when a firearm is used in a suicide attempt, it is fatal 90% of the time. In a moment of acute distress, access to lethal means, or the lack thereof, might be the difference between life and death.
Firearm suicides are at levels not seen since the mid-1990s and firearms were the leading cause of death (suicide and homicide combined) for American youth in 2022. Despite these discouraging facts, the good news is that more than 90% of those who make serious attempts and survive do not die by suicide at a later date.
The most sensible way to reduce suicides in Utah — and nationwide — is to invest in lethal means safety. However, many clinicians are hesitant to talk with their patients about the secure storage of firearms and medications, are skeptical that bringing it up will make any difference and are not adequately trained in lethal means counseling. There are culturally-affirming ways to have these conversations, and doing so can make a difference. These discussions must be empathy-based, respectful of a family’s way of life, collaborative and honest.
One story that sticks out is that of a struggling Utah teenager, whose father felt strongly about keeping his guns in the house as a way to protect his family. Implementing suicide-focused treatment in these settings requires addressing prevalent misconceptions, mainly that hospitalization is the norm and clinicians want all households to be gun-free. The evidence suggests that neither of these approaches is necessary. For this family, the tangible safety plan included storing the father’s firearms more securely, including using a small biometric gun safe for his self-defense firearm instead of keeping it under his pillow.
The work I did with this family was an example of one of the most well-established approaches to lethal means safety, Counseling on Access to Lethal Means (CALM). Practicing CALM involves having honest conversations about practical and non-controversial approaches to preventing suicide, including the voluntary and secure storage of firearms and dangerous medications. CALM also includes disseminating objective information about safely storing guns and medicines – both over-the-counter and prescription.
Utah has invested deeply in practices like CALM. In fact, Utah’s HB 481, which I helped draft alongside state leaders and mental health professionals, was signed into law by Governor Spencer Cox in 2023 and requires K-12 school professionals to share information about safe storage with parents and families whose children are at risk of suicide. This landmark evidence-based legislation was vetted by CALM and is now part of the Suicide Prevention Resource Center’s Best Practices Registry.
Utah is ahead of the rest of the country in suicide prevention after passing sensible legislation that promotes voluntary secure storage of firearms and dangerous medications. However, the hard work is only just beginning. The legislation has opened the door, yet the ultimate goal is to promote behavior change. We need to encourage more Utahns to store all of their firearms and dangerous medications securely as a tangible way to reduce suicide risk among their loved ones.
(Photo courtesy of Kurt Michael) Kurt Michael
Kurt Michael, Ph.D., is senior clinical director at The Jed Foundation (JED), a leading national nonprofit that protects emotional health and prevents suicides for teens and young adults. Dr. Michael is a clinical psychologist who specializes in rural school mental health and adolescent suicidology. He works with schools and communities to evaluate, adopt, and implement suicide prevention and postvention policies and practices as well as working with families to store their firearms and medications more safely to reduce the risk of suicide. Dr. Michael is a retired psychology professor, associate editor of the Journal of Rural Mental Health, frequent contributor to numerous school mental health publications, and enjoys outdoor adventure sports with his family when home in Utah’s Wasatch Mountains.
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