Angie Wagenhals recently attended her high school prom and had the time of her life. A few days later, the sophomore from Billings West High School went before her peers to discuss a subject far less sanguine: suicide.
"Suicide is such an unrecognized problem," says Angie. "We're letting kids know that we should bring it out in the open."
The 15-year-old is part of a growing and unusual crusade in the West to curb one of the top killers of American youth.
As a member of the Yellow Ribbon Project, she travels to schools in the region encouraging kids to talk about youth depression. In the process, she may be helping to save a few lives.
Just talking about suicide and despair may be nothing new in America's urban schools, but in remote corners of the Rockies and rural high plains, the subjects are still often taboo.
Yet as the region continues to record the highest suicide rates in the country, pressure is growing to take a closer look at what factors contribute to the problem - and what can be done to stop it.
Challenge on a national scale
Suicide, of course, is hardly just a regional phenomenon. In 1999, US Surgeon General David Satcher said the problem had reached "epidemic proportions" nationwide in some age groups and warranted serious attention as a major public-health issue.
Every day, there are 85 suicides and 2,000 attempts. Dr. Satcher has announced a call to action, the details of which will be outlined later this spring.
"Suicide has extraordinarily painful impacts on society," says Alan Berman, who oversees the American Association of Suicidology in Washington. "When people do it, they leave behind psychological skeletons in the closets of families and communities that persist for years to come."
Nevada has the greatest number of suicides on average, with about 23 for every 100,000 residents per year. Wyoming is third and Montana fourth. Because of this, public and private officials are focusing special attention on eight Western states.
Behind the problem lie several issues that are unique to the West. Some clinicians point to the region's isolation, as well as a self-reliant ethic, and the tendency of people living here to keep to themselves.
There's also a lack of access to mental-health professionals, struggling local economies, and easy access to guns and alcohol. "The truth is, we don't know why the suicide rate is so high in the West, but it is something that we need to confront," Mr. Berman says.
Within the past few years, a handful of teenagers at high schools here in Billings killed themselves, leaving students stunned. Berman says youth suicides draw the most attention, but the highest rates are actually among the elderly.
Not long ago, a prominent psychiatrist in a small Wyoming town committed suicide. "It really shocked the town," says Carol Day, regional mental-health consultant with the Wyoming Department of Health. "Everybody knew who he was, but nobody recognized the danger signs."
As a result, a suicide prevention group formed that has worked aggressively in the community. Statewide, Wyoming recently created its first-ever suicide-prevention task force.
Ms. Day calls Satcher's announcement "a major turning point," but adds, "We're just barely getting starting started with programs that could make a difference."
For every two homicides in America, three people commit suicide. Berman notes there is more firearm use in suicides than homicides, and more adolescents dying by suicides than homicides.
"Yet murders get the press because ... homicide is viewed as something outside that is happening to us collectively," he says. "Suicide is perceived to be something that happens to loners."
No one prescription for suicide prevention exists, but experts are learning more about the risks that can lead to it. Some of the latest insights will be coming out of a new suicide-prevention center that has been set up, appropriately enough, at the University of Nevada, Las Vegas.
Getting people to reconnect
One focus of many community campaigns is to get people to reconnect with those around them. That's a huge challenge in rural corners of the West, where hard economic times in traditional ranching and farming communities have led to depopulation and crisis in many families.
"Typically, parents tell their children they shouldn't talk like that," or ,"those are bad thoughts," and "it will all be better tomorrow," says Douglas Jacobs, who edited a Harvard Medical School guide on suicide intervention.
But most communities can point to recent examples of what happens when the warning signs go unheeded. Dr. Jacobs and a few colleagues have developed a new program called Signs of Suicide, or SOS.
"We need to listen, take those comments seriously, and get help," Jacobs says.
Two years ago, a survey was conducted through the Yellowstone County, Mont., school district that indicated 14 percent of high school students had considered suicide at some point during the past year.
"There are a lot of kids out there hurting," says Leanne Swanson, director of the Mental Health Association in Billings, who helped start the Yellow Ribbon Project in Montana.
At the event in Billings where Angie spoke, a short skit launched the discussion. Students, as well as parents in attendance, were especially interested in better recognizing warning signs.
"Kids our age have have come up to us afterward and thanked us because they recognize the danger signs in their friends, or they've written us a note to let us know they're getting help," says Angie. "What I find most interesting is how the problem was ignored for so long."
(c) Copyright 2001. The Christian Science Monitor