Every year Montanans commit suicide at a rate of 20 per 100,000 people, making Montana one of the top three states for suicide. We really don't know the reasons why.

In Missoula County, there were 29 suicides in 2008

(275 percent higher than the national average, according to the Missoula Suicide Prevention Network). This rate and other factors led the surgeon general in 1999 to declare suicide a public health issue.

Yet suicide is preventable. Most suicidal individuals want desperately to live, but they are unable to see other solutions to their problems. They develop tunnel vision and think suicide is the only answer. Suicidal thoughts tend to come and go, so it is important to reach out and offer realistic hope to the suicidal person. Most individuals give warning signs indicating they may be thinking of killing themselves. Recognize the signs and know how to respond to someone, and you may be able to prevent a suicide.

The warning signs that a person may be suicidal include:

• Sadness

• Anxiety, feelings of guilt

• Hopelessness, helplessness

• Change in eating or sleeping patterns

• Withdrawing from friends and family, or usual activities

• Loss of interest in work, school, hobbies, etc.

• Increased drug or alcohol use

• Anger

• Excessive irritability

• Excessive impulsivity

• Making arrangements or setting one's life in order

• Preoccupation with death, in writing or talking

Adolescents may also have a drop in school performance, withdrawal from social usual activities, loss of interest in self care, increased anger or irritability, excessive writing or artistic expression of death.

Emergency warning signs that may require more immediate response include:

• Talking openly about suicide

• Talking indirectly about wanting to die or "end it all"

• Taking unnecessary risks

• Giving away personal possessions

• Becoming suddenly calmer

• Becoming increasingly self-critical

If an individual has any of the following issues, he or she is at a higher risk for suicide, according to the National Institute of Mental Health:

• Depression or another mental illness

• Substance abuse

• Prior attempt

• Family history of suicide

• Violence in the home

• Firearms in the home

If you or someone you know has these signs, get help. Ask the person if they are feeling like killing themselves. Just mentioning "suicide" will not make someone suicidal, but it may help them feel understood and hopeful. Stay with the person, remove anything he or she has access to that could be used to self-harm. Seek professional help for the person.

If a person tries to attempt suicide, call 9-1-1. Let the medical providers know what has occurred to give them all the information possible.

If you are an adolescent and you think someone you know is suicidal, contact an adult. If the first adult you talk to does not help, find another adult. Do not take on the burden of helping this person by yourself.

What else can you do? Become involved in suicide prevention. Attend a class and learn more about the warning signs of suicide and what other things you can do to help prevent it. Participate in community activities to develop suicide prevention awareness. Learn about mental illness and treatment. We can change the stigma our society places on mental illnesses by understanding more about it.

The national suicide prevention lifeline number is 1-800-273-TALK (8255). This number provides a trained individual to talk to in times of suicidal crisis.

Our local resource is the Missoula County Suicide Prevention Network at 258-3881.

To learn more, check out online resources under suicide prevention, including the American Foundation for Suicide Prevention, National Mental Health Information Center, National Alliance on Mental Illness, the Suicide Prevention Action Network, Suicide Prevention Lifeline, and Suicide Prevention Resource Center.

Sue Honsky is certified in psychiatric and mental health nursing. She is the neurobehavioral medicine clinical nurse manager at St. Patrick Hospital and Health Sciences Center.