OGDEN — As a survivor of a suicide attempt, Itzel Ramirez says she is acutely aware of the pressures her peers frequently encounter — feeling rejected, being harassed or bullied at school, family problems at home, or expectations of perfection, just to name a few.
Ramirez, a Mound Fort Junior High School student, is now an advocate of suicide prevention and has a message of hope for any teenager questioning whether their life is worth keeping.
"If you can't see something good about yourself, get up, look in the mirror," Ramirez said. "Look a little closer, a little longer."
Ramirez is one of several students at junior high and high schools throughout the Ogden School District who belong to a HOPE Squad — teams of students trained to recognize suicide warning signs and identified as someone their peers can come to if they or a friend are struggling.
The district and NU HOPE, an educational nonprofit organization funded by the McKay-Dee Hospital Foundation, joined forces to conduct a town hall meeting Monday night at Ogden High School, exploring the issue of suicide with parents, students and other members of the community.
The training focused on how and why to talk to someone who may be considering harming themselves and where to connect them with help.
"Kids open up mostly to other kids," said Jody Hansen, Ogden School District's lead counselor, explaining the idea driving the district's HOPE Squads. "Even more so than to parents and to teachers."
Shauna Morgan, a suicide prevention educator for NU HOPE, presented at the town hall meeting about a basic, go-to strategy for teenagers to help their friends who are struggling with depression or suicidal thoughts. The strategy is called QPR: question, persuade and refer.
Students are instructed to ask their friend about whether they are thinking about killing themselves. Then, they are to persuade their friend that they are valued and that their situation will get better, Morgan said. The very most important part of the process, though, is referring their friend to a professional counselor or medical expert who can help, she added.
According to the Utah Department of Health, suicide rates in Weber County have matched or exceeded state rates almost every year from 2005 to 2014.
A Community Health Assessment published by the Weber-Morgan Health Department last year identified suicide as "a significant indicator of poor mental health in the community." It is the leading cause of death in the state for Utahns ages 10 to 17, according to the report.
Suicide in Utah
Preliminary reports have identified 156 deaths across Utah as suicides so far this year, according to the state health department.
For Utah Medical Examiner Todd Grey, that's just the beginning of what he estimates could end up being more than 600 suicide deaths by the end of 2016.
"Horrible. It's been horrible," Grey responds immediately when asked about suicide deaths so far this year. "That's 1 a day for 90 days. It's just the day in, day out grind of this problem as we see it."
Of those suicides, young people represent a smaller but deeply significant number, Grey said.
Since Grey took over the role as state medical examiner 30 years ago, suicide has been a "steady drumbeat" that has kept pace each year with Utah's growing population. He and his staff strive to maintain the professional detachment that is imperative to their roles, but when it comes to suicide, there are times when the emotion catches up.
On a single day last week, the Utah Medical Examiner's Office processed nine deaths. Seven of those were suicides, Grey said.
"That's when people go, 'Whoa. What's going on out there?'" he said.
Grey hopes conversations like the meeting at Ogden High will show Utahns it is not only OK but necessary to talk about the concerns they have for themselves or others. It's a message he has shared with grieving families he has met through the years, especially for those who have requested, perhaps out of embarrassment or shame, that a loved one's death not be listed as a suicide.
HOPE Squads were first formed in Utah in 2004 as Provo schools combatted suicides year after year.
Greg Hudnall, who was a Provo City School District administrator at the time and went on to establish the Hope4Utah campaign, said peer-to-peer support proved to be a key factor in changing the community's trend. Where an adult considering suicide will likely withdraw from others and keep his or her intentions a secret, young people are more likely to confide in a friend or give an indication on social media that they are struggling.
The suicide rate in the district dropped to zero, and the model has been implemented around the state.
Now, three task forces cover the majority of the state, answering calls on a weekly basis for trainings set to fit all kinds of schedules. Last year in Utah, there were 100 HOPE Squads in place, which generated upward of 500 referrals and medical help for 50 students.
"That's those young people reaching out, watching and talking," Hudnall said.
In addition to the support they offer, the HOPE Squads have also proven to be an example for others. After three students were lost to suicide in 2012, a HOPE Squad was put in place at Pleasant Grove High School, generating more than 60 referrals in its first year, Hudnall said.
The school's principal, Tim Brantley, was stunned to report that fewer than 20 of those referrals came from the squad itself, while the rest were made through friends, teachers and parents, Hudnall said.
Hudnall and Brantley agreed that the stigma of suicide was beginning to fall away, making it possible for honest conversation and requests for help to be shared in a way they never had before.
Hope at Mound Fort Junior High
In its current iteration at Mount Fort Junior High, the HOPE Squad's role is to educate both students and parents, Ramirez said.
When she attempted suicide, she says, "it was really hard for my whole family."
It wasn't until Ramirez physically took her mother to school to show her the kind of harassment some students receive that she felt her family totally understood what she had been going through. Her wish is that HOPE Squads will be able to help students and parents get on the same page before an attempted suicide occurs.
"Hopefully parents will understand more and will meet with (their) child," she said, adding that she wants students to "go to their parents. Don't keep it in."