A state audit released in December found that of 80 organizations receiving federal and state suicide prevention funds, about a quarter failed to meet performance expectations, even as suicides among youths again rose to alarming levels.
The audit also concluded that it’s difficult to determine the efficacy of suicide prevention efforts.
The report comes as preliminary 2020 tallies from the El Paso County Coroner’s Office show the number of youths under age 18 who died by suicide last year tied the county’s record high of 2016, reversing what since had been a downward trend.
“COVID-19 has been an incredibly unprecedented external factor,” said Meghan Haynes, teen suicide prevention planner for El Paso County Public Health. “We are aware of the need to take a close look at our prevention efforts and enhance those to respond to our community’s needs.”
The state’s Office of Suicide Prevention and the Suicide Prevention Commission at the Department of Public Health and Environment have developed sound processes for prioritizing suicide prevention work statewide, according to the report from the Office of the State Auditor.
The office, however, needs to ensure that it “receives full value and benefit from its investment of limited resources.”
Of the $3.7 million the office doled out between July 2016 and June 2019 for 11 suicide prevention activities, an estimated $301,000 — or 8% — was spent on programs that “did not meet all of the performance expectations in the written agreements,” according to the audit.
Using the word “aspirations” instead of “requirements” may have contributed to the problem, according to a response from state officials, who agreed to improve their contract and grant agreements.
“I think it is more than commendable that the Office of Suicide Prevention would receive only one recommendation — being sure that the grantees follow through with their contract agreements,” said Shannon Harrison, a licensed clinical social worker in Colorado Springs and a board member of the Suicide Prevention Coalition of Colorado. The nonprofit organization focuses on suicide prevention and intervention.
“Given the office’s painfully small budget and understaffing, I believe that what they are accomplishing is remarkable,” Harrison said.
The state office coordinates suicide prevention strategies, and, in 2014, Colorado lawmakers established the commission to advise the office and provide recommendations.
State and federal funding increases boosted office spending from $600,000 in fiscal year 2017 to $2.9 million in fiscal year 2020, according to the audit.
Money pays for training for community professionals, programs in schools, additional staff for suicide prevention, events such as communitywide seminars and awareness campaigns.
Funding agreements with government and nonprofit groups are intended to focus on high-risk populations and severely impacted areas of the state, such as El Paso County, expand recognition of warning signs and risks for suicide and strengthen protective factors.
The goal: reduce the suicide rate in Colorado, which in 2019 continued to rank among the top 10 highest in the nation.
COVID's 'brutal' effect on suicide
Statewide numbers of deaths by suicide are not yet in for 2020.
In 2019, 1,287 Coloradans died by suicide, putting the state’s rate at 21.6 suicide deaths per 100,000 people. That was up from 19.5 in 2015.
In El Paso County, 177 residents died by suicide last year, according to preliminary totals from El Paso County Coroner Leon Kelly. The number in 2019 was 180, a record high for the county, he said. El Paso County also led the state in deaths by suicide.
In 2018, El Paso County had 152 suicide deaths.
Teller County had 16 suicides in 2020, said Coroner Kayla Daugherty, up from nine in 2019 and 12 in 2018.
Daugherty told The Gazette in June, when 10 deaths by suicide had already eclipsed the previous year's total, that her county was experiencing a suicide epidemic before the pandemic even started.
The number of youth suicides in Teller County remained at one in 2020, the same as 2019, she said.
Teen suicide deaths increased sharply in El Paso County in 2020, with 15 teens ages 17 and under completing suicide last year, compared with nine in 2019 and seven in 2018, Kelly said.
In 2016, when adolescent suicides hit a historic high of 15, the community responded with a host of prevention programs in schools and other steps, such as social media drives, to let people know about what to look for and how to get help.
Of the teen deaths in El Paso County last year, Kelly said 13 occurred during the COVID-19 window, which began March 16 and ran through December. In 2019, six teens died by suicide in that same period.
COVID-19 not only has kept kids separated from their peers, but it's also changed the structure of the education system and related activities, such as sports and clubs, and support systems such as hanging out with friends, mental health experts have said.
The number of adults who died by suicide during the time of the pandemic in 2020 was 146 in El Paso County — just one more than in 2019 number during that time frame, according to the county coroner.
“Through death investigations, we have identified 18 deaths where the COVID-19 pandemic was expressed in some way as to a contributing factor, such as grief associated with the death of a loved one to COVID, health stress or economic stress,” Kelly said.
Harrison thinks it will take years and much research before COVID’s “brutal” effects on mental health and suicide will be understood.
“How could any state plan ahead for the isolation, despair and destruction that accompany this awful virus?” she said.
Prevention 'turned on its head'
The numbers don't show the whole picture, though. As the audit states, “measuring the impact of these investments (in suicide prevention) is difficult for a variety of reasons.”
Factors involved in whether someone is at risk for suicide include mental health status, financial stability, access to health care, family health history, domestic violence, isolation, lack of social support and the availability of lethal means, such as guns or pills.
Activities the state Office of Suicide Prevention funds typically cover one or two of the risk factors, which makes it hard to correlate changes in the suicide rate with specific measures, the audit says.
Other points that make the success of programs tough to gauge include smaller contracts under $40,000 not being evaluated as intensely as larger ones, the fact that data is lagging, misclassifying deaths and assessing whether a suicide was actually prevented.
The number of completed suicides identified can be unreliable, said Harrison, an accredited psychological autopsy investigator.
“Suicides could be misreported as accidental deaths, or not reported at all,” she said.
Also, with the added stress, anxiety and financial burdens of the pandemic, “suicide rates may not be reflective of how well the office is carrying out the state’s strategy,” according to the audit.
“Suicide prevention anywhere has been turned on its head, by the outrageous effects of COVID,” Harrison said.
And, “It’s going to take time to see the impacts and shore up our prevention,” said the county health department’s Haynes.
Protective factors known to work best for teens include social connectedness — relationships with family, friends and other supportive adults — along with access to responsive care, knowledge of what resources are available and overcoming the stigma associated with mental health, Haynes said.
“None of these things by themselves are going to solve the issue,” said Kelsey Leba, youth health and development planner for El Paso County Public Health.
“It takes a community approach,” she said. “It’s hard to say there’s one thing to solving the problem of youth suicide. It’s critical we do all of those things and work collaboratively as a community.”
A 90-member, countywide youth suicide prevention work group and a child mortality review team will assess the pandemic’s level of impact on suicide and adjust a community action plan for this year, Leba said.