WALLA WALLA - Walla Walla County Coroner Richard Greenwood, along with Deputy Coroner Allison Barnett, hardly knew where to turn.
It was the end of January and the five suicides they'd officially attended had already reached the total for all of 2010.
Both were new to the office and had no idea what could be done to stop the number from climbing higher.
"I was sitting there keeping score," Greenwood recalled.
The duo decided they were tired of being reactive. Proactive efforts - and in a hurry - were called for.
By early February, the coroner found himself heading a couple of hastily assembled roundtable discussions with area professionals, county officials, residents and clergy.
Together, the group discovered a need for the community to have a conversation about a crisis that claimed more than 34,000 American lives last year, 865 of those in Washington state.
Washington ranks 23rd in the nation for the number of suicides per capita, just below Mississippi and just above Wisconsin, according to the American Foundation for Suicide Prevention.
Walla Walla County residents have historically struggled with suicidal behavior, said Harvey Crowder, administrator for Walla Walla County Public Health Department.
"Our attempted suicide rate is 50 percent higher than the rest of the state. The success rate is about the same."
In the past dozen years, including data available for 2011, 100 people in this county are known to have died by suicide.
Suicide is everyone's problem
For many, the numbers are surprising, even shocking. She was wary of many things when taking on the job of deputy coroner, Barnett said. "But I had no idea suicide would be one of them. I was blindsided - totally unprepared for it. And we've been slammed with it."
Education about suicide has been sporadic. Take fire prevention, Greenwood told those gathered at what would become the first of two stakeholder meetings. "They have done a great job. The message never stops. It seems like with suicide, once it's over, awareness stops. Prevention efforts stop."
Suicide impacts every sector of society, as evidenced by incidents in Walla Walla. While public perception may be that these deaths occur with distraught teenagers and young adults, recent deaths have been "all over the board. Different ages, different socioeconomics, different methods, different education," said Patty Courson, director of the county's emergency medical services. "Typically, a spike is in a certain group."
Suicide, added longtime therapist Richard Garcia, "has been with us for a long, long time. One of the primary causes is a sense of not belonging in a community."
He is concerned with limited accessibility to mental health services, here and everywhere, Garcia explained. That, coupled with traumatized men and women returning from war is bad news for everyone, he said.
None of the five January suicides matched up perfectly in method of death. Two victims had copious amounts of prescription drugs in their systems, and three had consumed alcohol, Greenwood said.
The commonality, then, must be found in a community response now, the group agreed.
But how, and where to start? That was everyone's question.
How can Walla Walla respond?
It begins with the care providers, believes Skip Pritchard, an associate pastor at College Place Presbyterian Church. Educators, health-care workers, clergy and social-service agencies must unite, he said. "How can we lock arms and work together?"
Dealing with suicide in the Walla Walla Valley needs to be multi-faceted. Prevention has to be uppermost, but care for the surviving family is also a high priority.
Presently, "there is a paucity of support," noted John Paulson, whose adult son died by suicide last summer. "No one is truly going to hold your hand."
To attend a survivor's support group, he would have to travel to Tri-Cities, Paulson added. "That's a long way to drive while thinking about the death of your son."
Professionals who respond to suicide scenes must also be supported, Courson said. Her paramedics and emergency medical technicians attend many near- and successful suicides. Those have a ripple-out effect on everyone, she emphasized.
In many cases of suicide, it comes down to a lack of preventative care, explained Tracee Anderson. She has been on the counseling staff at Whitman College since 1991 and conducts workshops, as well as assists with staff training in mental health matters.
Depression, often chronic and sometime situational, is frequently identified as the underlying factor behind suicide and suicide attempts. The majority of youths who attempt suicide have a diagnosable mental illness, she said.
No one should ever try to simplify the causes of suicide, Anderson said. "It's a plethora of complicated issues ... one thing we do know is that treatment for mental health issues works. Eighty to 90 percent who succeed in killing themselves were not hooked up with a treatment provider. And there are other options besides a therapist you pay. All kinds of options."
One option severely curtailed in Walla Walla is the Department of Human Services, said Executive Director Daryl Daugs. Services are hobbled by diminished federal and state funding, which has been on the downturn nationally since 1980.
"In Walla Walla County, we just had a 25 percent cut in funding for mental health services," Daugs said. "That's between October and now and we didn't have enough to around in October."
In the meantime, the 24-hour crisis services at DHS have seen a significant uptick in demand, Daugs added. "Our crisis team is one of the best in the state."
Yet there is a deficit of psychiatric help everywhere, he noted. "And it gets worse in rural areas."
There is a suicide "snowball effect" happening here, Daugs told those at the table, "all over the county. And it feels like we are more reluctant to talk about this publicly."
While there is very little anyone at the meeting can do about the economy and state funding problems, "we can as a community, come together and have a conversation," he said.
‘C' is for compassion, care and communication
Stigma, fear and misconceptions about suicide often keep those discussions from happening, Pritchard said. "What is it about us here? A more than 100 percent increase in crisis hours in the past two years ... we're the problem as the adult community. Are we willing to say there are no sacred cows on the table? What is our plan?"
Education opportunities in schools, churches, at civic groups and in social-service agencies are vital to the awareness movement, the group agreed. Knowing the signs of suicidal thoughts in others, getting information to families, strengthening local mental health services and a public campaign all make sense, they said.
Too often people are afraid. Afraid to talk to someone about suicide for fear of "putting the idea in their head." Afraid to talk to grieving families, afraid to believe it can happen to this group of people or that one.
"As a culture, we need to build connections," Paulson said. "Throw out the stereotype of who is suicidal. My son was intelligent, a chess master, had a beautiful wife and millions of friends."
Suicide must come out of the closet, even if all the answers are not yet there, Courson said. "We have to eat that elephant one bite at a time."
Support for the survivors must also take several steps forward. The stigma of suicide has to be erased through education and compassion, the stakeholders emphasized.
"What causes that stigma?" asked Peggy Litzenberger, attending the forum as a concerned resident. She has lost a family member to suicide and watched another make three attempts, she said.
Ultimately, it is a death, Litzenberger pointed out. "Why do we run to some tragic deaths and not others? Have we made it evil? We're sitting here making (survivors) villains."
To not talk about those deaths invalidates the survivors, risking not allowing them to grieve in a healthy way, Pritchard agreed. "Families are not allowed to be honest about it. They are not allowed to go to the depth of the grief you need to."
Such folks are already struggling with misplaced guilt and questioning themselves, he expounded. "Part of the reason people have a hard time with suicide (in others) is they personalize it."
Limited understanding from others can be as hard as the loss of the loved one. "If you don't have a community that will stand beside you, what is your rock?" Paulson asked his partners at the table.
"We cannot hesitate to move forward," he added. "We can stand and look into Canaan ... or we can cross over into it."