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With a teen suicide rate amongst the highest in the country, Montana is using extension agents to help teens deal with mental health issues.

The program, Youth Aware of Mental Health (Y.A.M.), uses extension agents to help teens learn to talk about their mental health and practice coping mechanisms.

Kelley Edwards, program manager for Y.A.M. at the Center for Research on Rural Education, said the program originated in Sweden. In 2015, it was tested in a few schools in Montana before being rolled out to more schools over the past five years.

“We've had the distinction of being in the top five (states) for all suicides of all ages, basically throughout the last 30 years since they began measuring suicide,” Edwards said. “It’s been an issue for a really long time.”

According to the National Vital Statistics Report, Montana is ranked third nationally for its suicide rate, with 289 suicides or 27 per 100,000 people. Between 2009 and 2018, the youth suicide rate was 11 suicides per 100,000 teens, more than double the national rate of 4.56 per 100,000. According to the Youth Risk Behavior Survey in 2019, 10% of all Montana students in grades 9 through 12 had made a suicide attempt in the previous 12 months, and 15.6% of the 7th and 8th graders had. For American Indian students, 15.4% had attempted suicide one or more times in the past year.

The reasons behind the high suicide rates are varied, she said.

“If you kind of look up the Rocky Mountain front, many of those states are unfortunately always in the top five (for suicide rates) Wyoming, Nevada, Alaska, Montana,” she said. “Is it an elevation issue? Is it a vitamin D deficiency? Is it a lack of resources? In Montana, is it because it's socially isolated?... We also think that there may be some stigma of that kind of Wild West, pull yourself up by your bootstraps mentality that can still be present, and then sadly, the access to lethal means. We have a lot of firearms in Montana.”

Lack of resources is a problem, like any rural area, she said.

“For example, I grew up in a town with 200 people and… the closest psychiatrist would have been three hours away,” she said. “Let’s say you live in a place in eastern Montana, you might be driving six hours for mental health care if you were in a crisis.”

That’s one of the things that excites her about the Y.A.M. program, she said, because it gets help identifying and discussing mental health to young people where they live.

The program typically targets ninth graders in their physical education classes. Two extension agents will meet with the students five times. The first session, said Brenda Richey, a Y.A.M. instructor in Lake County, Montana, involves talking about what mental health is.

“I'm not there to teach and to stand at the blackboard… and say ‘monkey see, monkey do,’” Richey said. “We have one presentation where I go through my work and I teach the question ‘What is mental health?’… Our program is about recognizing and understanding that as important in our life as our physical health is, our mental health is and will be, in my opinion, equal to or more important than physical health.”

The instructors talk to the kids about the difference between being nervous and being anxious and the difference between being sad and being depressed. They also discuss how sleeping all the time, not having any energy, and isolating oneself from friends and family may be signs of depression, not just teen angst.

Other classes, each at least three days apart, help students explore their emotions and responses to external stresses. Through role-play, open discussion, and other methods, the exercises help students slow down, think through a situation, and process possible results of different actions.

“The whole purpose is that you get to practice in a fun and non-threatening way somewhat difficult situations that they may be faced with,” she said.

Edwards credits Sandra Bailey, professor emeritus, with Montana State University Extension, for researching the program and bringing it to Montana.

Bailey said something had to be done to tackle the youth suicide rate. Research into the program found it to be a good fit for the state.

Using extension agents added a level of trust to the program, she said.

“Extension agents are typically well known and respected in their counties,” she said. “They develop strong ties to communities and for many, their interest in reducing suicides and suicide attempts brought great interest to this program.”

Richey said the program seems to be having some positive results. According to a recent report, while incidents of depression went up last year from 36% of students reporting incidents of depression to 41% of students, there was not a parallel increase in the rate of teens reporting that they seriously considered suicide, having a plan to commit suicide, or attempting suicide.

For Richey though, the bigger results are the comments she’s received on anonymous surveys of participants. “One student wrote ‘I didn’t know it was okay to feel this way.’ I just sat there and I will admit I get teary-eyed every time I think about it, but for that youth… someone finally said something in a way that they understood that it was OK to have challenging moments,… and that it’s normal to have negative emotions and to have bad days and good days, physically and emotionally.”

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