SALT LAKE CITY — A lot of Utahns are assisting with efforts to curtail the state's uniquely high rates of suicide, specifically among teenagers.

But a new report indicates there isn't much data available on whether these many efforts are producing the desired results, as suicide rates in Utah continue to rise and the phenomenon of suicide remains largely misunderstood.

It also points to the fact that Utahns lack access to sufficient mental health care, beginning in elementary school, where the state has one counselor for every 2,333 students.

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"People have to realize that we've got to have engagement across the whole of society on this issue," said Peter Reichard, president at the Utah Foundation, which released its report, "Getting to Tomorrow: Addressing Suicide in Utah and the Mountain States," on Wednesday.

"Whether it is better parenting, having engaged friends, engaged educators and engaged health professionals, help in the criminal justice system, involved employers and policymakers, even the media has a role to play."

Reichard said more research is needed to know out how to properly intervene.

"We have programs in place, we're just not sure they're working," he said, adding that it might also be difficult to determine whether programs or policies are helping. "If they're preventing something, it doesn't happen, so it's hard to know what stopped it."

The Utah Foundation report provides a comprehensive view of what's happening and where it is happening, both in Utah and in a region of mountain states that share uncommonly higher rates of suicide. Some of the highest rates of suicide are in Utah, Arizona, Colorado, Idaho, Montana, New Mexico and Nevada, with all but Arizona falling in the top 10 in 2016.

In Utah, the years 1999 to 2016 (the most recent year for which data are available) saw a "startling increase," according to the report, in its suicide rate, from 15.8 per 100,000 to 24.2. Suicide rates increased among all age groups.

Know the warning signs

The following are warning signs of immediate risk. Call 911 if you or someone you know is experiencing the following:

Threatening to hurt or kill themself or talking of wanting to hurt or kill themself

Looking for ways to kill themself by seeking access to firearms, available pills or other means

Talking or writing about death, dying or suicide when these actions are out of the ordinary

_{Additional Warning Signs:}

Increased substance use

No reason for living, no sense of purpose in life

Anxiety, agitation, unable to sleep or sleeping all the time

Feeling trapped — like there's no way out

Hopelessness

Withdrawal from friends, family and society

Rage, uncontrolled anger, seeking revenge

Acting reckless or engaging in risky activities, seemingly without thinking

Dramatic mood changes

_{Courtesy of the Utah Suicide Prevention Coalition}

The counties with the highest rates include Carbon, Emery, Sevier, Beaver and Duchesne. All five are among higher elevations within the state, whereas, lower elevated counties correlate with lower suicide rates, the research finds.

In addition to elevation, other links to suicide, although "far from absolute," according to the report, include rurality, gun ownership levels, ethnicity and opioid use.

Opioid prescription levels are high in four of the five counties where suicide is highest in Utah, Reichard said. The report also found that suicide deaths are predominantly male and are highest among working age adults.

The report points out that there are 20 suicide crisis hotlines operating across the state, including a statewide affiliate of the National Suicide Prevention Lifeline, or 1-800-273-8255. Various efforts have been made recently by state and federal lawmakers to upgrade and streamline available services, as well as offer help in other ways.

The state has mobilized crisis intervention teams and the SafeUT smartphone app gets an average of 1,206 chats and 616 anonymous tips per month. Despite this, Reichard said, the rate of teen suicide in Utah has quadrupled since 2007, to more than double the national rate.

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While the state requires secondary schools to implement suicide prevention programs, it's up to each school to decide how and which programs to use. Funding for those increased following the 2018 legislative session, to $1,000 per school, according to the report.

Of the suicide prevention laws in Utah, eight are school-based, giving schools and higher education institutions heightened opportunities to promote mental health, though programs vary greatly among institutions, the report says. The remaining 13 laws address a range of different areas such as health care or firearm-related policies.

The Utah Foundation report points out that teachers and student peers specifically play an important role in suicide intervention and prevention.

The report also states that a higher number of teens who commit suicide have contact with the juvenile court system.

The Utah Foundation isn't producing an action plan, but putting information out there for parents, educators, employers and policymakers, among others. The nonpartisan public policy research group wants to inform issues it believes are at the top of Utahns' minds.

"This is what's out there and what ought to be considered," Reichard said. "We need more research to see what works."

The group plans to further research opioid use and mental health access throughout the state, to determine what kind of role they play in the rising number of suicides in Utah.

"The more we know and the more we understand what's happening and where, the more effective our strategies can be," Reichard said. "Addressing suicide requires an all-hands-on-deck effort to improve mental health, from good parenting all the way to ensuring access to highly trained mental health professionals for those who need it."

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