The state is rolling out information intended to equip Missourians with the tools they need to act in suicidal crises as rates outpace national averages.
The Governor's Challenge to Prevent Suicide among Service Members, Veterans and their Families launched a public training video titled "The Safety Plan" on Oct. 4, detailing steps Missourians can take to support veterans or anyone else struggling with a suicidal crisis.
Safety plans are brief interventions that involve custom coping strategies and resources that can be used if someone is experiencing self-harm or suicidal thoughts. They're ultimately designed to distract from stressors and get the suicidal individual to professional care.
"While suicide is one of the leading causes of death in Missouri, it is preventable," Gov. Mike Parson said at the top of the video. "Support a friend, family member or loved one who received care for suicidal thoughts or surviving an attempt."
With slightly more than 18 people per 100,000 dying from suicide, Missouri is tied for the 14th highest suicide rate in the country, according to the Centers for Disease Control and Prevention statistics. The state had 1,125 suicide deaths in 2020.
Wyoming, with 182 deaths in 2020, leads the country with a suicide rate of 30.5 per 100,000, according to the CDC.
Missouri's suicide rate is higher than its homicide rate -- 14 per 100,000 -- but less than the state's drug overdose death rate at 32.1 per 100,000, its firearm injury death rate at 23.9 per 100,000 and its COVID-19 death rate at 104.4 per 100,000, according to the CDC.
But veterans commit suicide at a 57.3 percent higher rate than the general population in the U.S., according to the 2022 National Veteran Suicide Prevention Report from the U.S. Department of Veterans Affairs.
There were 6,146 veteran suicides throughout the country in 2020, putting the rate at 31.7 deaths for every 100,000 veterans, or 16.8 veteran suicides per day. The 2020 figures are a 9.7 percent decrease from a peak veteran suicide rate in 2018. With 38,152 recorded suicide deaths in 2020, the country's non-veteran population has a suicide rate of 16.1 per 100,000.
According to the report, suicide is the 13th leading cause of death among veterans, with the first two leading causes being heart disease and cancer. Among veterans under the age of 45, however, suicide is the second leading cause of death behind accidental injuries.
Missouri's largely rural landscape could be a factor in higher suicide rates.
According to the VA report, veteran suicide rates were elevated for residents of rural areas at 44.9 per 100,000, compared to the general veteran rate of 31.7 per 100,000.
The suicide rate for veterans in Missouri is higher than the national rate and hasn't followed the same downward trend during the past two years, the News Tribune reported in April. It's stayed steady at around 43 suicides per 100,000 Missouri veterans.
The Governor's Challenge to Prevent Suicide Among Service Members, Veterans and their Families -- a national initiative from the Substance Abuse and Mental Health Services Administration under the U.S. Department of Health and Senior Services -- is one effort seeking to lower the numbers.
Fifty-two states and territories are taking part in the Governor's Challenge, which uses a public health approach to develop and implement statewide suicide prevention best practices.
Missouri joined the Governor's Challenge in 2021. The state's team consists of representatives from the Governor's Office, Department of Mental Health, Department of Higher Education & Workforce Development, Department of Social Services, Missouri Veterans Commission, Office of State Courts Administrators, Missouri National Guard, Department of Corrections, American Legion-Missouri, Compass Health Network, Missouri AgrAbility, Missouri Behavioral Health Council, Missouri Institute of Mental Health-Safer Homes Collaborative, U.S. Department of Veterans Affairs and the American Foundation for Suicide Prevention.
Parson said the safety plan video, one of the first products from the state's governor's challenge group, gives Missourians the tools they need to help decrease the risk of suicidal behavior and prevent suicide.
The nearly seven-minute video encourages people to recognize the warning signs of suicide, ask important questions of the suicidal person and help them get to a mental health center or hospital for care.
Treatment usually involves creating a clinician-approved safety plan -- a set of coping strategies and resources to decrease the risk of suicidal behavior.
Suicidal crises are time-limited, the video states, so employing a custom safety plan can help get someone through a crisis without them acting on suicidal thoughts.
Safety plans start with a list of signs the individual may be in crisis, such as experiencing feelings of worthlessness, helplessness or depression, or not bathing or eating regularly. They should be totally custom to the individual and what they experience during crises.
The second part of safety plans involve actions the individual can take alone to distract from suicidal thoughts, such as listening to specific music or engaging in hobbies.
People and social settings can also provide distraction, according to the video. Listing people or groups who can provide a healthy environment to distract from stressors putting the suicidal person at increased risk is part of creating a safety plan.
"Find whatever healthy setting that can help them feel connected and not alone," the video states. "There are some activities that should be avoided, like drinking alcohol, using firearms or other dangerous activities since these can increase risk during a suicidal crisis."
When distractions aren't enough, the video encourages friends, family and loved ones of the person experiencing suicidal thoughts to reach out, stay calm and offer to be there.
They're also encouraged to be prepared to call the 988 suicide and crisis lifeline (veterans can press 1 to talk to another veteran) and take the individual in crisis to the nearest behavioral health crisis center or emergency department, not leaving them alone until they receive clinical care. When creating a safety plan, clinicians should help the individual with suicidal behavior identify professionals and resources they can call at any point for help.
"Remember, they are reaching out because they are in suicidal crisis," the video states. "It's okay for you to take the lead on connecting them to care."
The final step of a safety plan is to create a safe environment by limiting access to lethal means.
The video is intended to complement existing suicide prevention training organizations may offer, according to a news release from the Missouri Department of Higher Education and Workforce Development.
A bill before the Missouri General Assembly last session would have tasked the Missouri Veterans Commission with expanding suicide prevention efforts, but it didn't pass. The bill's sponsor, Rep. Dave Griffith, R-Jefferson City, said addressing veteran suicide will be a priority next session if he's re-elected in November.