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HILLSBORO, Oregon – On the wall of Kimberly Repp's office is a sign in Latin: Hic locus is ubi mors gaudet succurrere vitae. It's a place where the dead love to help the living.
For forensic scientists, it's a mission. Their job is to investigate deaths and learn from them for the benefit of all. Repp, however, is not a medical examiner; she is a PhD student microbiologist. And as an epidemiologist from Washington County, she was most used to studying infectious diseases such as influenza or norovirus outbreaks among the living.
But in 2012, the county authorities asked him to look into suicide. This demand has led to the world of death investigations and also seems to have led to something remarkable: in this suburban county of 600,000 located just west of Portland, the suicide rate is down . This is remarkable because national suicide rates have increased despite decades of efforts to reverse this deadly trend.
Although many factors contribute to suicide, local officials believe that they have successfully countered this problem by taking the initiative of Repp to use data – very localized data that any jurisdiction could collect. Repp's mission is now to help others learn to collect and use them.
The state of New York has just started testing a system like its own. Humboldt County, California, is implementing it. She has received inquiries from Utah and Kentucky. Colorado, meanwhile, uses its own brand of data collection to try to achieve the same type of turnaround.
After the death investigators
In 2012, when Repp reviewed the available data (mainly statistics provided periodically to the Federal Centers for Disease Control and Prevention), it found that suicide was a big problem and that rates were higher among white men. aged. But beyond that, the data did not offer much advice. In addition, he took two years late.
She went back to her bosses. "I can tell you who has the highest suicide rate, but I can not tell you what to do about it," she recalls. "It's too wide."
She turned to the investigators of the County Medical Examiner. They collect information at each unnatural death scene to determine the cause (eg drowning or gunshot) and a way (homicide, suicide, accident). It is an important but sinister work that tends to attract unusual personalities.
Repp had the courage to report to one of the investigators, Charles Lovato. "I said," Hello, I'm calling Kim and I hoped to be able to investigate death with you. And he said, "You are that nutch who is investigating an outbreak, is not it? like, & # 39; You are the crazy who makes death investigations. & # 39; "
The gambit has worked. Repp accompanied Lovato during his sinister rounds for more than a year. "Nothing can prepare you for what you will see," she says. "That gave me a very good dose of respect for what they do."
She studied the questions Lovato had asked friends and family of the deceased. She watched how he recorded what he saw on the scene. It also found that much of the data to determine the cause and mode of death never appeared in reports that state and federal authorities use to track suicides. It was a missed opportunity.
On the wall of the Washington County epidemiologist, Kimberly Repp, figures a sign in Latin: Hic locus is ubi mors gaudet succurrere vitae. It's a place where the dead love to help the living.
Collecting data on the dead to save lives
Repp worked with Lovato and his colleagues to develop a new data collection tool that allowed investigators to easily record all of these details in a checklist. This included not only the age and cause of death, but also yes / no questions on items such as evidence of alcohol abuse, history of interpersonal violence, health, job losses, etc.
In addition, the county has created a procedure, called the suicide mortality review, to examine these deaths more closely. The review inspires reviews of infant mortality, a concept now mandatory since the 1970s. After getting the green light from family members, key government and community representatives meet to investigate on individual suicides for the purpose of prevention. The review group could include health organizations to look for recent visits to the doctor; veterans organizations to check service records; forces of order; leaders of the faith; pain clinic managers; and mental health support groups.
The idea, according to Repp, is not to point fingers. System-level interventions that could prevent similar deaths should be sought.
"We were able to identify points of contact in our community that we had never seen before," said Repp.
For example, the data revealed a surprising number of suicides in hotels and motels. He also showed that a number of people who had committed suicide had been deported, seized or had been the subject of a medical visit a few weeks or days after their deaths. He revealed that people in crisis routinely gave their pets to the animal shelter.
But what to do with this information? Experts have long believed that suicide is preventable, and there are evidence-based programs to train people to identify, respond to, and guide people in crisis. This is where Debra Darmata, suicide prevention coordinator in Washington County, comes in. Darmata is responsible for managing these training programs, which she described as CPR, but for mental health.
Training is usually offered to people such as counselors, educators or pastors. But with the new data, the county realized that there were missing people who may have been the last to see the deceased alive. They began offering training to office and motel housekeepers, shelter workers, pain clinic staff and more.
This is a relatively simple process: participants learn to recognize the signs of distress. Then they learn to ask a person if they are in crisis. If so, the role of the participants is not to make the person feel better, to provide advice, or anything like that. This is calling a crisis line and the experts will take over.
Since 2014, according to Darmata, more than 4,000 county residents have received suicide prevention training.
"I have been working in suicide prevention for 11 years," said Darmata, "and I have never seen anything like it."
The sheriff's office has started sending a deputy from his mental health crisis team during deportations. On the eviction documents, they added the crisis line number and information about a county-wide mental health walk-in clinic. Local health care organizations have also put in place new procedures to examine cases of patient suicides.
From 2012 to 2018, the suicide rate in Washington County decreased by 40%, according to preliminary data. Admittedly, 68 people committed suicide here last year. Therefore, preventing a small number of cases can significantly lower the rate.
Take the idea elsewhere
Repp warns that the results can not be generalized. What is true in the suburbs of Portland may not be in rural Nebraska, the city of San Francisco or even in the suburbs of New Jersey. Each community needs to examine its own data.
Nevertheless, Jay Carruthers, who heads the Office of Suicide Prevention in New York, understood the potential. "To be able to close the loop and connect [the data] to prevention? It's beauty, "he said. This year, the state begins testing a similar system in several counties.
In Humboldt County, northern California, Public Health Officer Dana Murguía had been frustrated for some time by the fact that local prevention plans were not going to erode. "I said, 'We do not need another plan. We need an operations manual. That's what Dr. Repp told us.
Humboldt began using a similar checklist in Washington County this year and county officials identified several unexpected contact points, including public parks and motels where people committed suicide. Now these sad facts can become action plans.
In Colorado, a different effort to reduce the number of suicides also began with a thorough analysis of the data. There, they realized that while youth suicide has been a concern, the largest number is among older men. They not only designed equipment specifically for men in crisis, but also created equipment for specialized groups, such as veterans, farmers and construction workers.
"What was unexpected for me was the ability of this data to allow so many different people to change things," said Repp – including Lovato and the other death investigators. "To know that they preserve life is really powerful."
IF YOU NEED HELP
If you or anyone around you think of suicide, call the National Suicide Prevention Line at 1-800-273-8255 or use Lifeline Online Chat, both available 24/7. .
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