Those who study and work to prevent suicide have long known that suicide deaths come in clusters. Multiple deaths may occur within a relatively short period in a particular area. When I served as a Local Outreach to Survivors of Suicide (LOSS) team with the Pennington County Sheriff’s Office, there were two distinct types of suicide clusters. The first were clusters where the victims were teens. The Front Porch Coalition was formed, in part, as a response to a cluster of teen suicides. All of the victims went to the same high school, and there were multiple suicides within a short time frame. Some of those who died had known those who had previously died, but some of them had no direct contact with previous victims. We couldn't determine if they shared common causes, as the cause of a suicide death is often obscured. Critical evidence dies with the victim.

What we learned by bringing experts in to advise us and carefully observing the victims and the response of their loved ones is that education and intervention can have a significant impact on reducing teen suicides. We used an international suicide prevention training program, Applied Suicide Intervention Skills Training (ASIST). Exposing teens to a half-day training and giving them opportunities to practice skills through role-play scenarios helped to reduce death by suicide among their peers. We learned to identify natural helpers among the students. Some students were more likely to be approached by teens in distress. Giving those students additional skills helped to reduce the rate of teen suicide.

With teens, the delay of a suicide is often the prevention of a suicide. Teens’ prefrontal cortices are not fully formed, and teens have less impulse control. Interrupting the impulse cycle can be life-saving. However, this knowledge and our efforts were insufficient to prevent additional deaths. Teen suicide rates rose by 62% between 2007 and 2021. By 2022, suicide was the second leading cause of death for individuals aged 10 - 14 years in the United States. One survey found that nearly a quarter of teens have seriously considered attempting suicide, and 10% had made at least one serious attempt in the previous year.

There are many factors in the rise of teen suicides. Some are shared with other countries. Mental health conditions, substance use, family factors, and bullying occur in countries around the world. LGBTQ+ youth are at higher risk for suicide attempts and ideation. That risk is lower in communities where there is increased visibility and acceptance of LGBTQ+ persons. The overwhelming distinction in youth suicide in the United States, however, is access to means. United States youth have easier access to firearms than youth in other countries. Access to lethal means increased risk.

The second type of suicide cluster that we observed was a cluster among late middle-aged and early retirement men. The likelihood of suicide increased when financial stress was part of the scenario. Men who had suffered financial setbacks later in their careers were more likely to die by suicide. The overwhelming majority of adult male suicides involved firearms. Access to and training in the use of firearms is common among US males. Around 185 active duty law enforcement officers die by suicide each year in the US. Suicide rates are also high among active duty military personnel.

Finding methods for the prevention of suicide among adult males has proven to be a considerable challenge. Although ASIST training can help, it is still not common among adult males who resist such training when offered. There is also the problem of the challenge of obtaining reliable data on death by suicide. Suicide among adults is underreported. Deaths by suicide are often recorded as accidents. Investigators frequently cannot make a judgment of whether death with a hunting weapon was suicide or an accident. A similar challenge applies to drug overdose deaths. There are many cases where it is not possible to tell if the overdose was accidental or intentional.

In South Dakota, where I served, the rate of death by suicide in all age groups is roughly twice the national rate. Death by suicide is more common in rural and isolated areas. This may be due to a lack of mental health services in rural areas.

Although I no longer serve as a suicide first responder, paying attention to deaths by suicide and looking for clusters has become second nature for me. When I become aware of a suicide death, I look for factors that might connect that death with others. The records of the time when I served were all kept by official agencies. I have not retained sensitive information, so I cannot make formal comparisons. Still, I do have a general sense of trends in our community and country based on news stories and other public information I read.

It seems to me that one distinction between clusters of teen deaths and those among older males is that teens often have little experience with death and grief. It looks as if there are cases where the teen isn’t fully aware of the finality of death. I noticed a big difference between reservation youth and upper-middle-class white youth in South Dakota. Reservation teens have attended many funerals and have had a lot of exposure to death. In contrast, some of the white youth we served had never attended a funeral at all. Few had experienced the death of a loved one. Teens are exploring and learning about many things, and death is one of the learnings that comes from experience as much as from theoretical learning.

I frequently ponder a line from the 90th Psalm: “So teach us to count our days that we may gain a wise heart” (Psalm 90:12). Wisdom comes, at least in part, from understanding that our time on earth is limited. We all will one day die. Awareness of that reality is part of gaining the wisdom to treasure our time.

I still often wear a sweatshirt that I received for my service with the LOSS team. The back says, “Suicide Prevention Awareness: supporting the fighters, admiring the survivors, honoring the taken and. . . never giving up hope.” May I gain and share the wisdom of never giving up hope in each relationship I share.