Over the last five years, Larimer County in northern Colorado has seen what appears to be a steady, sustained drop in its suicide rate -- a potentially significant breakthrough in a state that consistently ranks in the top 10 nationally for its high rate.
How the county got there was a decade-long affair in which local officials, nonprofits, private businesses and law enforcement rallied around suicide prevention, Larimer County advocates said. Their efforts were bolstered by state and federal grants and a voter-approved dedicated sales tax that pumped millions of dollars into varying initiatives.
The combined push there has included community training, economic support, and sustained investment in suicide prevention organizations.
As a result, Larimer County stands alone among large Colorado counties in seeing a continuous year-over-year decrease in suicide rates between 2019 and 2023.
"What Larimer is exemplifying, and what we were hoping to see, is that implementing all the best practices at once -- for all communities -- is the best strategy to reduce the impact of suicide," Lena Heilmann, the director of the state Office of Suicide Prevention, said in an interview.
In 2019, Larimer County had one of the highest rates of suicide deaths per capita in Colorado, about 23 per 100,000 residents, among counties with a population of at least 100,000. That about matched the statewide rate.
But unlike the state as a whole, the rate since then has slowly ticked down, to about 21.2 deaths by suicide per 100,000 people in both 2021 and 2022 and then to 16.5 in 2023 -- a total drop of about 28% over the time span.
In terms of individual lives, that equated to 20 fewer deaths by suicide in Larimer County in 2023 compared to 2019.
The statewide suicide rate in that time has hovered at about 22 deaths per 100,000 people, with an uptick in 2021 to just under 24. Denver likewise remained about flat, at 22 per 100,000 people, in that time. Jefferson County averaged 21 deaths by suicide per 100,000, including a swing from about 18 in 2019 to nearly 27 in 2021.
Rates are always at risk of fluctuating, but a sustained drop represents a clear success. Advocates say Larimer County's decreases also highlight that there's no single tool local agencies can leverage on its own to fight a public health crisis as complex as suicide.
One local official says the success has come from anti-suicide efforts there being truly communitywide.
"If I look at what we identify as pieces that have contributed to the success in Larimer County, it's that ongoing community dialogue about behavioral health across the continuum, from crisis through wellbeing and recovery," said Amy Martonis, the Larimer County behavioral health director. "That is, the shared commitment for this to be a community issue. It's not an individual issue or a family issue to be solved."
In late 2015, two 11-year-olds in Fort Collins, the county's largest city, died by suicide within a week of each other. The tragedies shattered hearts across the city and underscored the importance of fighting the public health crisis that has long plagued the Mountain West.
The community formed the Imagine Zero coalition. The coalition worked to weave together disconnected anti-suicide efforts, and in turn they "flourished," said Rachel Olsen-Towlen, deputy director of the Alliance for Suicide Prevention of Larimer County, in an interview.
Local advocates also built support for a dedicated sales tax to support behavioral health services and suicide prevention. The quarter-percent tax, equal to 25 cents on every $100 spent, passed in 2018. The tax revenue has led to more than $14 million in local community grants and the opening last year of the Longview Campus, which has 24/7 behavioral health urgent care among its services.
That influx of money coincided with another major effort as part of the Colorado-National Collaborative for Suicide Prevention. The program includes $900,000 in grants, spread across counties with high rates of suicide, from the Centers for Disease Control and Prevention.
The federal grant has made up a third of the budget for the local Alliance for Suicide Prevention. That grant expires next year, and officials aren't sure if they can expect more. The grant was billed as funding a pilot program to see which strategies might work to reduce suicide rates.
The numbers bear out the effort's success, and now the alliance is looking to shore up financial support and avoid any sudden funding gaps.
Kimberly Moeller, executive director of the alliance, expressed concern but said the group was hopeful.
"We believe that people are generous," she said. "We believe that our community is invested. We believe that this state is invested, and we are cautiously optimistic that this funding will continue to come."
The alliance isn't a direct services provider in the way the Longview Campus is. It's more focused on acting quickly and filling in where needs arise, such as community training, awareness campaigns and connecting providers with those who need help.
A big part of the success was simply investing in the staff that made these efforts possible, Moeller and Olsen-Towlen said. Low pay and trying work conditions lead to turnover, which in turn leads to frayed relationships that need to be rebuilt whenever a new person is hired. Breaking that cycle means that staff members stay around long enough to build programs and adapt them to changing needs, without starting fresh at every new development.
The broad-based strategy means there's no specific program or effort that officials in Larimer County can point to for other communities to emulate. The makeup of every community and county is too distinct.
"I wish there was a cookie-cutter situation where we could say, 'Here is our plan, here's exactly how we did it' -- and go and implement this into another community," Olsen-Towlen said. "I don't really think that (our success is) exactly there. But part of what has made us successful is that we are a very small, nimble nonprofit."
Larimer County is among 15 Colorado counties that have participated in the Colorado-National Collaborative. Most others are smaller and rural, making per-capita trends more subject to large fluctuations. In the larger participating counties -- El Paso, Jefferson, Pueblo and Mesa -- the suicide rates also fluctuated up and down.
Larimer also wasn't the only community in Colorado to pass a dedicated sales tax for behavioral health needs, the umbrella term for substance use and mental issue issues, in recent years. Denver voters approved a similar tax in 2018, and its suicide rate has remained relatively flat, at about 22 deaths per 100,000 people, since 2019.
A recent investigation by Colorado Public Radio found Denver's grant money, which has gone to service providers to address a variety of purposes, was subject to questionable oversight.
Heilmann, from the state Office of Suicide Prevention, highlighted Larimer County's and the alliance's focus on community training to recognize suicidal despair, the fighting of isolation and connecting people with economic support as particularly effective. Advocates have worked with schools, businesses and the wider health care community to launch suicide prevention initiatives and trainings.
The results have caught the eye of federal partners, Heilman said, as well as the state.
One of the most visible pieces of Larimer's commitment has been the Longview Campus for behavioral health services. In its first year, it served more than 6,000 people across the behavioral health spectrum. Its services include medicated withdrawals for substance use disorders and other crisis care.
Dr. Lesley Brooks, the executive director and medical director at Longview, noted it was too new to play a direct role in suicide rates yet, but she underlined its importance both as a symbol of the community taking action and producing tangible results in people's lives.
Many of the people it has served since opening might have found care elsewhere, she said, but some also likely would have stayed home and suffered in silence.
Larimer County's broader suicide prevention efforts and its long-term push show a recognition that "the cavalry isn't coming to save us," she said.
That's the lesson she hopes other communities take from its promising results: Community advocates, including those in law enforcement, schools, local governments and private businesses, need to rally together to identify the gaps and how to fill them.
That doesn't necessarily mean new taxes, either, she said.
"We really did, across sectors, have people who said, 'OK, let's figure this out,' " Brooks said. "That's my message to other communities: You have those champions. You don't have to pass ballot initiatives."
None of the officials downplayed the role of money in helping Larimer County bend down the curve of suicide rates, but they also said it's not the central piece.
"This is really a county that is demonstrating this comprehensive approach is working," Heilmann said. "We're on the right track on understanding how to implement this comprehensive approach, tailored to local communities, to see the biggest decrease that we can."