A conversation with Jill Baker, OHA Youth Suicide Prevention coordinator, on how to identify and help someone in crisis

In 2021, the most recent year for which we have data, suicide was the second leading cause of death in Oregon among people under 25.

Oregon began tracking youth suicide data in 1999, when youth suicide rates nationwide had been rising for decades. Between 1950 and 1990, youth suicide rates across the United States tripled, while for the rest of the population it decreased.

Last year, OHA released its Youth Suicide Intervention and Prevention Plan Annual Report. The chart below shows that, since 1999, Oregon’s youth suicide rate has consistently been slightly higher than the national rate. And after peaking in 2018, the number of youth who died by suicide in Oregon dropped 26% (from 129 to 95) over the next three years. Suicide is complex, and while it’s difficult to know for certain why Oregon has seen these recent decreases, we believe that efforts such as requiring schools to have suicide prevention plans and behavioral health providers to undergo suicide prevention training have likely contributed.

We asked a series of questions to OHA Youth Suicide Prevention and Policy Coordinator Jill Baker to better understand youth suicide and what people can do if they believe a friend or loved one may be having thoughts of suicide.

If I suspect a young friend or loved one might be thinking about suicide, what should I do?

JB: You should ask them directly if they’re thinking about suicide. The truth is, asking this question is much more awkward for you than for the other person, and it could save their life. Also, it’s a common myth that asking someone about suicide or talking about suicide will increase suicide risk. It’s actually incredibly protective because even if the answer is “no,” what you’ve done is establish that you’re someone—a parent, a friend—that is safe to talk to if suicide does enter their mind later. When someone who is thinking about suicide shares their fears, those fears are more likely to diminish.

An example of how to ask this question is, “Hey, you’re my friend, and I’ve noticed that you’re drinking a lot more lately and your words are a little bit more dark and twisty than they normally are. Sometimes that means people are thinking about suicide. Are you thinking about suicide?” That’s how I would ask it, but it’s important to use your voice, using words and phrasing that sound like you, based on the relationship you have with that person. Practice ahead of time, and find a way to ask that sounds like you. Otherwise it will get stuck in your throat.

And if the answer is “yes,” you’ve shown that person that you care about them enough to ask, and it will likely be a relief to them not to have to carry that secret around. Then you might say, “Thank you so much for telling me and trusting me with that. It must have been really hard for you. I’ll help you figure out what to do next to get help, I’m here for you.” Again, that’s my voice, but you should practice what feels right for you.

Suicide is a liar, which means that when suicide thoughts enter our brains they are often really good at convincing us of things that just aren’t true. Things like, “Your loved ones would be better off without you” and “There is no way things will get better.” When suicide thoughts are shared with others, out in the open, often those lies are easier to see and debunk. That’s why asking directly about suicide is so powerful – it forces suicide thoughts out of hiding and can take away a big source of their power—secrecy.

I think everybody should take Oregon’s suicide prevention trainings called QPR – Question, Persuade, Refer – which teaches people how to recognize some of the basic warning signs and risk factors, and how to intervene and ask questions. The 90-minute classes are free and virtual.

What are the signs? How can family and friends know if a young person is thinking about suicide?

JB: In a nutshell, look for changes around personality, relationships and risky behavior. It’s tricky, though, because these things change for youth all the time. But for example, if a typically outgoing and positive young person becomes reclusive and negative—or the opposite … if a typically introverted person becomes extroverted and more positive—that could be a sign that they are going through something. Other examples might be if someone starts giving away their things, dramatically changes their sleep patterns, expresses lack of interest in the future, exhibits extreme change in weight or eating habits, is disinterested in personal hygiene or drops out of group activities. Again, pre-teen and teenagers experience drastic changes as a part of their normal development – so the important lesson here is to ask young people directly about suicide if you are noticing changes that concern you.

One of the biggest risk factors for a future suicide attempt is a previous suicide attempt, and the chances of attempting suicide rise with every non-fatal attempt. If someone loses a friend or loved one to suicide, that increases risk as well.

But it’s also a myth that a young person thinking about suicide must have experienced a traumatic event. Life is hard because it’s hard. They don’t have to lose a loved one, fail school or be abused by their parents. Suicide also doesn’t discriminate against wealth or poverty or anything like that.

Loss survivors—people who have lost someone to suicide—often blame themselves for not seeing the signs, because there are always signs. But they shouldn’t, and we cannot judge ourselves yesterday for what we know today. One thing we can do is learn, and this is where the QPR classes can really help.

How big of a factor is depression among youth considering suicide?

JB:  Not everyone who experiences depression has thoughts of suicide. Depression is a common mental illness that is highly treatable for most people. While it’s important to screen for suicide when depression is present, it’s not as common as one might think for someone who experiences depression to also have thoughts of suicide.

Are some youth more at risk of suicide than others?

JB:  We know that LGBTQ2SIA+ youth are at least four times more likely to attempt suicide than their peers who do not share that identity. This has nothing to do with who they are, and the statistical disparity almost disappears when there’s an accepting family member or trusted adult in their lives. So when there’s acceptance within their home or chosen family or school community, LGBTQ2SIA+ youth are no more prone to suicide than other youth. The Trevor Project keeps excellent data on this, nationally.

Like many states, Oregon’s death data gathering has some limitations due to lack of standard questionnaires, reliance on witnesses and contacts of a person who died by suicide, and limitations around race/ethnicity data collection. The other important factor is that suicide deaths are measured in rates of one per 100,000 people, and for some demographic categories there simply aren’t enough total people to have a statistically reliable rate. So, in Oregon, we look at national trends for rates, and we look at the number of suicide deaths in Oregon for local data. Recent legislation in Oregon is designed to make this kind of data collection more inclusive and accurate, and you can learn more about that on our website.

With that in mind, within Oregon’s LGBTQ2SIA+ population, 22 youth died by suicide between 2016 and 2020. Based on the data limitations I’ve mentioned, we think that’s likely an undercount.

We should also note that although Oregon’s overall youth suicide rate dropped by 26% between 2018 and 2021, almost all of that decrease was among White-identified youth. For Black and African American, American Indian, Alaska Native, Asian, Hispanic, and multi-racial young people, suicide deaths between 2018 and 2021 remained similar or increased in Oregon. When we look at national trends, we see that American Indian or Alaska Native youth have a suicide rate about three times higher than White-identified youth. National trends also show that the rate of Black or African American youth suicide increased 36% from 2018-2021. We have work to do!

Another interesting statistic is that male youth are three times more likely to die by suicide than female youth, but female youth are three times more likely to attempt suicide. This has been true for decades, for all ages. That tells a story about methods, that males are more likely to choose more lethal means, such as a firearm. Between 2016 and 2020, 45% of Oregon’s male youth who died by suicide used a firearm, while 19% of female youth used a firearm. This correlates with the much higher number of females who are hospitalized from a suicide attempt.

Can we correlate youth suicide with world events, politics or technology?

JB: Youth suicide can be correlated to some things, but correlation and causation are very different. Suicide is always complex, and it can be dangerous to point to one thing as “the reason” someone dies by suicide. One thing we know to be correlated with suicide are economic issues.

It’s easier to make this correlation for adults, for whom finances play a bigger role, but things like the recession in 2008 … seeing the increase in youth suicides in Oregon after that in 2010 makes sense because often financial stress in adults can affect their children as well. Wellness in adults is connected to wellness in young people.

Interestingly, Oregon did not see an increase in youth suicide during the height of the COVID-19 pandemic like the rest of the nation did, and we believe it’s partly because of Oregon’s commitment to economic supports during the pandemic response. We also had some good legislative investments come through, including for training requirements for providers and requirements for school districts to implement suicide prevention plans. That all happened in 2019, so we might have had a buffer in the works prior to the pandemic.

It may be too early to draw definitive conclusions about youth suicide rates as they relate to the pandemic. Even though youth suicide rates dropped between 2018 and 2021, we do expect 2022 numbers to return to 2020 levels.

Climate change has a strong correlation to feelings of anxiety, anger and hopelessness among youth. OHA’s Climate Change and Youth Mental Health report, published in 2022, details this dynamic and offers strategies for helping youth cope.

Another possible correlation is around technology, but this is also a complex area – use of cell phones and social media can be a source of connection to peers if used appropriately, but overuse or developmentally inappropriate use can increase risk. It’s a topic that parents and caregivers should consider carefully, and maintain open communication with their teenagers about. The U.S. Surgeon General recently released an advisory about this very topic.

We know that access to firearms increases risk for suicide – because suicide attempts with a firearm are incredibly lethal. Recent OHA data show that 37% of eighth graders and 41% of 11th graders in Oregon say they could get a loaded gun in less than a day, while about a quarter (from the same grades) say they could get one in less than 10 minutes. And so, safe storage of firearms is essential to the work of suicide prevention. Firearms should be locked and stored separately from ammunition.

What is your advice for parents or young people who are having trouble finding a therapist?

JB:  We are hearing from families and young people across the state that finding a therapist, particularly a therapist that can provide culturally or linguistically specific services is challenging – given the current workforce shortages. If you are looking for a therapist for a young person in your life, it might be helpful to check with their school and your insurance provider and consider telehealth providers.

Also, I’d say that finding a therapist should be one piece of an overall wellness strategy. For mental wellness, there are often other strategies and places to find help, healing and hope. For youth, a trusted adult is one of the most powerful protective factors against suicide. Anything that increases connection and belonging for a young person is protective. Maintaining healthy and steady sleep patterns is also important, and look for ways to increase movement or physical activity if possible. All of these things contribute to better mental wellness.

And remember, calling or texting 988 is a resource that is available 24/7.

Is there anything else you’d like people to know?

JB:  Yes. Suicidality often comes in waves. For a young person, educators and health care providers often have a hard time understanding that, for example, a kid who was acutely suicidal on Tuesday afternoon, might not be Tuesday evening. That doesn’t mean that their risk has dissipated. It means that the crisis—the wave—went down and that another wave could come. In fact, another wave will likely come, because life is hard. And brains get sick when they’re under distress for a long time. So we need to be really serious about building protective factors into that young person’s life to help them regulate and stay safe when the next wave comes.

The other thing I’ll say is that, regarding the greatest suicide risk being among people 85 and older—the most powerful correlation for them is loneliness and lack of connection. And connection is suicide prevention, for all ages. Human connection and belongingness. Those two things are incredibly protective, and the only thing more powerful than a risk factor is a protective factor. The will to live is strong, and when you can connect a will to live with other humans in your life, that’s incredibly protective against the lies that suicide tells. Because suicide is an excellent liar.

What is true, though, is that help, healing and hope are always possible. Very often, when folks get the right help at the right time, they experience healing. And the cornerstone to suicide prevention is maintaining hope. We need hope to be the anchor.