AILSA CHANG, HOST:
We're going to go now to a region of the country that's been labeled tragically the suicide belt. Suicide rates are high across rural America. In a new poll on rural life conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, more than half of those surveyed said they knew someone personally affected by suicide. But eight rural mountain west states are among the 10 U.S. states with the highest suicide rates. NPR's Kirk Siegler visited one town, Grand Junction, Colo., which is trying to do something about it.
KIRK SIEGLER, BYLINE: At the confluence of the Gunnison and Colorado rivers, Grand Junction sits in a bowl of a valley ringed by tall mountains, desert mesas and red rock cliffs. You can see how someone who is struggling could feel a little trapped here. This is how 17-year-old Victoria Mendoza describes it.
VICTORIA MENDOZA: I know we can't really fix this because it's nature, but the surrounding mountains - I feel like the people in our valley feel like there is only life inside of Grand Junction.
SIEGLER: Mendoza has battled with depression. It runs in her family. The first funeral she ever went to as a little girl was for an uncle who died by suicide. Things got really hard a couple years ago when there was a rash of teen suicides - seven over a school year. One was a student Mendoza knew from being in band together. At another high school, a student killed himself in the parking lot in front of a crowd.
MENDOZA: Honestly, physically kind of felt like there was, like, this cloud around our whole valley. We were just kind of anticipating the next one. And it got to a point where we were just like waiting for the next one.
SIEGLER: Before it became such a public crisis, suicide was stigmatized in this valley. That's long been a problem across the rural West. It's that cowboy stereotype of self-reliance that runs deep.
CATHY EBEL: You know, pick yourself up by your bootstraps mentality.
SIEGLER: Cathy Ebel has worked in the school district for 30 years, most recently helping at-risk kids.
EBEL: I think that we unfortunately think of mental illness instead of mental health.
SIEGLER: And it's a rural area, and there aren't as many resources. Grand Junction does have a small mental health hospital, but it's the only one between Salt Lake City and Denver.
EBEL: I think there's also the issue of access to guns. And I'm not - I mean, that's not a political statement one way or another. We have guns in our home because my boys hunt. But I think that accessibility makes a difference.
SIEGLER: Regardless of the causes, Ebel says that after those teen suicides of 2016 and '17, the school district was forced to act. The old way wasn't working. Victoria Mendoza says at first kids were told not to talk about the suicides or publicly memorialize the victims. The thinking was that there would be copycats or students might not get good advice if they talked to adults who weren't trained. And that was frustrating for Mendoza.
MENDOZA: And it kind of just made a division between all of us because we were all scared to even say anything about it.
SIEGLER: Fast-forward to today, and things appear to be changing. Mendoza, who's now a senior, is one of dozens of peer mentors in the district's new Sources of Strength suicide prevention program. She's trained to be a gatekeeper, to recognize when fellow students could be in trouble. These are not junior psychologists, but the idea is that someone like Mendoza might be more approachable to a kid at first and also that she may be able to recognize someone who is struggling earlier on and connect them to help. A lot of this came from the students who demanded action.
MENDOZA: We realized that we didn't really have any mentors to go to, especially if we personally were affected by the suicides.
SIEGLER: And alongside the mentors, the school district also hired a suicide prevention coordinator to work in the schools full time. Every employee, from teachers to bus drivers, now has to have mandatory suicide prevention training every year. What are the warning signs in kids? How do you respond and talk about mental health? And starting in the sixth grade, all students have to have a similar training. And lately, they're starting even earlier in classrooms with a mental health resiliency curriculum beginning in grade school. At Orchard Mesa Middle School, eighth-grader Lily Lee is in the lunchroom taping note cards to a wall.
LILY LEE: Since we're done with red, we could probably overlap right here.
UNIDENTIFIED PERSON: I don't think we're...
SIEGLER: All the kids in the school had to write positive messages on these cards about what a good friend is or how a friend has helped them through tough times. Lily points up to hers on the crowded wall.
LILY: I wrote supporting them and keeping them positive because I feel like even if they're down, you can, like, help them be positive and just support them through what they're going through so they don't feel like giving up.
SIEGLER: Lily has brown hair in a ponytail. She's wearing a blue Sources of Strength hoodie with the words hope, help, strength displayed in bold, white letters. She too is a peer mentor acting as a role model and talking openly about why it's important to be strong and help others. She says that's what her friends did for her.
LILY: I actually lost my uncle and my dad to suicide, so...
SIEGLER: She says she started speaking out about her family's trauma at school because suicide shouldn't be taboo.
LILY: It's tough to share, but, like, I've shared it a lot, so it's easier. And if it helps other people cope, I don't mind sharing it.
SIEGLER: What's going on in Grand Junction represents a broader shift in thinking in the public health world. The idea is that you go way, quote, "upstream" and try to tackle a problem like suicide by focusing at its earliest roots - in this case, the mental health and well-being of every kid and, for that matter, the entire town. In the schools, people on the front lines sound confident that this is going to work, though it could take years. One person in the community who's watching all of this is Kari Sewell. She had two daughters in a high school here. Six years ago, she lost her husband to suicide.
KARI SEWELL: The idea of having a peer or someone who is supporting you who has been through that experience I think is incredibly valuable because you're traumatized. You don't know which way to turn.
SIEGLER: Sewell's husband grew up here. He was captain of his high school's football team, valedictorian, a pilot in the Gulf War. Later, he was a dad, a competitive bike racer. He was a community leader, seen as a pillar.
SEWELL: Suicide has no boundaries, even in beautiful places with incredibly successful, active, healthy people.
SIEGLER: Sewell says her town and others in the Colorado mountains have come a long way in even just talking about suicide since her husband's death.
SEWELL: Oh, gosh, I guess that's a double-edged sword. I guess it's so common here that there are so many people in the community who are struck by it in one way or another.
SIEGLER: Suicide is most common here among older men like Sewell's husband or Lily Lee's dad and uncle. And this mirrors a national trend. In Grand Junction, there are prevention programs aimed at this demographic, like a project in gun shops. But really, the bulk and focus of a lot of the resources is in the schools. Genevieve Morris is the school district's new suicide prevention coordinator.
GENEVIEVE MORRIS: Why are we focusing on youth? Well, youth have a super powerful voice. They have the most powerful voice, research tells us, when it comes to creating social movements and changing social norms and changing the things that need to change.
SIEGLER: Kids are catalysts to change, Morris says. You start there, and hopefully, the community will follow. Kirk Siegler, NPR News, Grand Junction, Colo.
(SOUNDBITE OF BRUNO BAVOTA'S "IF ONLY MY HEART WERE WIDE LIKE THE SEA")