SALT LAKE CITY — Arianne Brown remembers a time when she thought suicide was something that only touched other people.
That was before Nov. 5, 2006, when Brown's older sister, Megan, went down into her parent's basement and committed suicide.
"It's been almost seven years, but it still feels fresh," she said. "You think, 'She knew we loved her and that we cared. Why wasn't that enough? … I know if my sister knew what it was like for us after, she wouldn't have done it."
Suicide impacts Utah families every year and the problem is growing worse. In 2005, the Utah Department of Health reported 350 suicides. Preliminary data from 2012 places that number at 540 for Utah residents and the trend has continued through the first quarter of 2013.
The number comes as no surprise to Utah's Chief Medical Examiner Todd Grey.
"How many days do I have without a suicide? I'm thinking, maybe, zero most days?" Grey said. "I've had days where I've had five deaths downstairs and all of them were suicides."
Suicide was the leading cause of death for Utahns ages one to 44 in 2011, according to the state's public health statistics. For teenagers in Utah, the numbers of suicide attempts are equally startling, totaling about two a day among kids ages 10 to 17, according to health officials.
But that doesn't mean everyone is talking about it.
"That's one of those dirty little secrets that doesn't get waved around, and every family goes through it as if they're alone," Grey said. "It's really sad. If there was a running tally in the paper you could bet by March people would say, 'Why aren't we doing something about this? And by November there would be an awful lot of people screaming that this is unacceptable."
He's the first to say it's a complex issue, made worse by one of its biggest obstacles: Stigma.
"There's certainly a reluctance, at best, to discuss this issue publicly and widely," Grey said. "One of the very common responses I'll get from families is saying, 'You can't call this a suicide.'"
It's a stigma that becomes part of the memory of the suicide victim and with the family members left behind.
"And when you have that kind of reluctance to look at the issue, to admit that it exists, how are you ever going to try and solve this problem?" Grey said.
Losing a sister
Brown said it was difficult to explain that her sister had taken her own life and that the news was often received with more judgment, and less compassion.
"Sometimes, too, you feel self-conscious. What did we do wrong? What's wrong with our family?"
Her sister Megan Einfeldt was quiet, but loyal, a beautiful, educated and talented woman who was a devoted mother to her three children. She was 26 years old when she moved to her parent's home in Utah with her three young children, Brown said.
Her family had noticed a change in Einfeldt before she moved home, but felt something was really wrong when they saw her. She had lost weight and was rarely speaking. She seemed to lack confidence and was almost childish. She questioned herself as a mother and sister.
"You're kind of like, 'OK, snap out of it,'" Brown recalled. You're trying to build them up: 'You are beautiful, you are good, you are all these things.' And they don't believe you."
It never occurred to her that her sister might take her own life. She said it seemed like a worst-case scenario and that she didn't let herself go there.
"You know they're sad, different, that something is going on, but you think they're going to snap out of it," Brown said.
The night before the suicide, Brown talked to Einfeldt on the phone and her sister apologized for things Brown didn't even remember happening. Her brother said he had a similar conversation.
"We didn't put things together that she was trying to make things right, but she didn't need to," Brown said. "She was as perfect as they came."
Greg Hudnall, associate superintendent with Provo School District and executive director of the Utah County Hope Task Force, remembers the phone call he received from police asking him to identify the body of a student believed to have committed suicide. He went and made the identification. Then came the vomiting and then the sobbing. He started to investigate suicide in Utah and decided to organize a lunch to discuss suicide prevention.
He called therapists, law enforcement, medical professionals, community leaders.
"I sent out 40 invitations and 42 people showed up," Hudnall recalled. "They were as concerned as I was, because everyone was being effected by suicide."
In 1999, the HOPE task force was formed. The acronym stands for "Hold on, persuade, empower," but what it represents is a committed group of people who decided suicide would no longer be tolerated in their community.
There are community support groups that meet monthly, an annual suicide conference and suicide prevention walk and peer-to-peer support groups in high schools and middle schools in the Provo School District.
Every teacher is trained in prevention at the beginning of the school year and any student who mentions contemplating suicide and also has access to a method is taken to the hospital.
"It takes a lot of work and a lot of effort and you have to have individuals who become passionate about it," Hudnall said. "We have stayed true to it because we feel so strongly about it. We've made a commitment that we can't lose one more child and we have to do what we can to prevent that."
Between 1999 and 2005, Hudnall said the Provo School District averaged one to two suicides each year. Since 2005, there has not been a single suicide within the school system.
"We still have kids that threaten and still have kids that attempt and we get them immediate help and get them to the hospital," Hudnall said, noting there have been nine hospitalizations during the 2012-2013 school year and 15 to 20 suicide threats.
"We take every suicide threat seriously. We act immediately, contact the family and work with Intermountain Health Care to get them help and support."
He thinks the key to their success so far is the teamwork and partnership among those on the task force and in the community. But it's also the refusal to forget about the constant threat of suicide and commitment to keeping it as a focus.
Hudnall does trainings for Boy Scout leaders, has conducted trainings at LDS Churches and for the Catholic Diocese of Salt Lake City.
"On the one hand, I go to sleep at night worrying about that next child," Hudnall said. "There isn't a day that goes by that I don't get a phone call from someone begging for help. But I'm also so amazed at what we've accomplished."
Spreading the message
Providing information and support on suicide prevention to community coalitions is the goal of Kimberly Myers, who is the program manager of Prevention by Design for the National Alliance on Mental Illness — Utah. She said 90 percent of those who commit suicide have an underlying mental illness and that the data on suicide demanded action.
She is charged with going to local communities and educating them about resources in the area and helping them expand their prevention efforts. She usually starts by showing them the state data on suicide and how that is mirrored in their own communities.
"I would say that when communities sit down and look at the data, they're really surprised," Myers said. "And, for the most part, people aren't aware of how big of an issue it is."
She, like Hudnall, talked about the importance of groups and individuals uniting and working together to tackle the issue. But there is also a responsibility for individuals to educate themselves to know how to help.
"I think that one of the most important things that people need to know and can take with them is that if you are worried about someone or if someone is showing warning signs of suicide, it's OK to talk to them about it," Myers said. "It's OK to ask.
"There's a lot of fear about asking if someone is thinking of taking their own lives, because you don't want to plant ideas, but research shows that talking about it is good and saves lives. We have good crisis lines. Don't be afraid to ask. There's no research that says you're going to hurt anyone by asking."
She stressed the importance of be willing to talk with someone struggling with thoughts of suicide without judgment and with empathy.
"That's a really dark place to be and it's usually not because they want their life to be over, but became they want pain to end," Myers said.
Stopping impulsive acts
Doug Thomas, of the Utah Division of Substance Abuse and Mental Health, said suicide is often an impulsive act, frequently tied to mental health issues that are then aggravated by divorce, health problems, job loss or other factors. It's also something that often takes place in conjunction with drug or alcohol use and is then completed or attempted by those with access to lethal means.
"Usually, people who have suicidal thoughts and suicidal feelings, they’re not permanent," Thomas said. "They feel permanent... but suicide is a permanent solution to a temporary problem.
"We think that if we're strong, we can deal with it on our own, but strong people ask for help when they need help."
He said treatment for thoughts of suicide is effective if help is sought and that suicidal thoughts should be treated the same way any other ailment would be treated. Each individual should take care of their own mental health the way they would their physical health.
"There’s a sense that, 'Well this couldn’t happen to me or my family' and the reality is, we all probably know someone who has either been suicidal or has attempted suicide," Thomas said.
"It’s a delicate topic because we feel strongly about ... the sanctity of life and we want people to pull themselves up by their boot straps, but you wouldn't say that if their blood sugar was low and they had diabetes."
Three resources can help immediately.
The Hope Task Force website, established by Hudnall, lists resources for help at http://hope4utah.com/.
The national suicide prevention lifeline, 1-800 273-TALK (8255) will direct callers to local help.
The Uni Crisis Intervention help line at (801) 587-3000 will connect callers with mental health professionals in Utah 24 hours a day.