In Our Faces: Lessons from the Billings Gazette suicide series

I had the privilege of speaking to the Advisory Board for the California Endowment Health Journalism Fellowships this week. I addressed the effort to bring the Just One Breath series to readers and the impact of that project. But I had a very tough act to follow.

The first speaker was Cindy Uken from the Billings Gazette.

Uken has a demeanor that is as genuine, warm and open hearted. She will tell you -- as she told the audience -- that she is not a gifted public speaker, but she is wrong. Her delivery had everyone in the room completely captivated. And only a portion of the reason for that was the topic.

Uken has been writing about suicides in Montana for the past year. Initially funded by a National Health Journalism Fellowship, Uken’s work so impressed the Gazette and its readers throughout the state that she has continued to be supported by the paper and its owner – Lee Enterprises – for dozens of stories under the banner State of Despair that have examined Montana’s high suicide rates and the possible ways to change those trends.

See Also: Montana's Struggle With the Highest Suicide Rate in the Nation

There are many lessons here for reporters wanting to take on similar projects. I picked those that resonated the most with me.  

Don’t discount the obvious. Uken did not set out to report on suicide. When she first applied for a fellowship with the California Endowment Health Journalism Fellowships, she suggested that she pursue the low number of psychiatrists in Montana and the impact that has on the state. Her project advisor, Kate Long, told her to narrow her focus even further.

“Montana has the highest suicide rate in the country, and Kate thought I should focus on that,” Uken said. “I thought, ‘How do you do a project on something that everyone already knows.’”

She then proceeded to provide an answer week after week in the pages of the Gazette. Yes, people knew that suicide rates were high but that’s precisely what made the topic so ripe for deeper examination and created a wealth of sources for Uken to tap. Just as the Reporting on Health Collaborative was able to reintroduce valley fever to readers who likely had experienced the disease or had nurtured a loved one who had suffered from it, Uken was able to both learn from the experiences of her audience and share new insights.

“This is a problem that is in our faces,” Uken told the crowd.

Upend assumptions. When people think of suicide they often think of confused teen-agers or young adults making a terrible decision based on the emotion of the moment. Uken assumed when she started reporting that she would find most suicides had been happening in that 15 to 25 bracket. But she kept reporting. And what she found out was that suicides were happening in the highest numbers at the other end of the age scale.

“While they seem like the least likely candidates, the elderly are killing themselves with greater regularity than any other age group in Montana,” she wrote. “That’s also true across the country, eroding the myth that teens run the highest risk of suicide. Even though in 2010 the elderly, those 65 and older, made up 13 percent of the country’s population, they accounted for nearly 15.6 percent of all suicides, according to the American Association of Suicidology.”

Keep your name in the game. When journalists from small newspapers see a project like Uken’s, they often wrongly assume that she dropped out of sight for months, leaving the health beat to some unlucky courts reporter or schools reporter to pick up the slack. I asked Uken what was the longest stretch during her reporting on suicide that her byline did not appear in the Gazette. Her answer? Two weeks. She still wrote day-of-news news. She still wrote weekend feature pieces. She’s living proof that you can do the big projects and still feed the daily beast. She even left the meeting room after her talk to go write a story!

Keep going back. Uken had intended to make a story about American Indians killing themselves at higher rates one of the first in her series. But a non-Indian reporter can’t expect to walk onto a reservation and gain acceptance on the first visit. I covered the Yakama Indian Nation for several years, and, even after dozens of stories, it wasn’t until right before I left that I felt I had secured a measure of trust among tribal leaders.

Uken started by going right to Gordon Belcourt, executive director of the Montana-Wyoming Tribal Leaders Council, very early in her reporting. “I went there to talk, to have a conversation, not to ask questions,” Uken said. “And I kept going back month after month.”

Her story, “Suicide does not discriminate in Indian Country,” was one of the best in the series. Instead of running first, it ran last, five months after the first piece.

“Earlier this year, an 8-year-old girl on the Fort Peck Indian Reservation tried to hang herself in her bathroom. Another 8-year-old spoke openly about killing herself. And a 9-year-old planned to kill herself by taking her parents’ medications. Each of these attempts was caught in time. But, a staggering number are successful,” she wrote. “In fact, Montana Native Americans have the highest rate of suicide in a state that has the highest rate in the nation. All the factors that contribute to Montana's alarming number of suicides -- high rates of alcohol use and gun ownership, insufficient mental health care, rural isolation and joblessness -- are compounded on the state's Indian reservations.”

Find solutions. Perhaps the strongest piece in a very strong series was the one Uken wrote about Miles City.

“It has been more than four years since the last youth suicide in the Miles City public school system,” she wrote. “It was Aug. 25, 2008. The student was 14-year-old Nicole McFarland. Scott Rapson is on a mission to ensure that she was the last. The part-time high school counselor knows that statistically it will be improbable to sustain that. At a rate of 26 suicides per 100,000 people, Custer County has the second-highest suicide rate in the state, behind Deer Lodge. That is more than twice the national average.”

The story provided specific, replicable information that could be actually used as a blueprint for similar schools wanting to take action and, more broadly, for communities troubled by the high number of suicides. Throughout the series, Uken brought this type of information into her series. She even wrote about the focus of her original proposal: the low number of psychiatrists in the state. That’s the reason Montanans and those outside Montana have responded so powerfully. When Montana’s governor signed a law creating a suicide review team in May 2013, he called Uken personally to tell her he signed it.

More from this series:

VIDEO: High rate of suicide casts shadow over Indian country

Learning to Talk About Suicide

'I didn't think he would do it,' mother says