Experts began warning of dire consequences soon after the pandemic arrived: Mental health crises would escalate. Suicides would rise.

In Oklahoma, those predictions came true. 

Last year, 883 Oklahomans died by suicide, according to data provided by the state medical examiner’s office. 

That’s nearly a 10% increase over 2019. It’s also the highest number of suicides since at least 2006 — when the agency began publishing the information online — an Oklahoma Watch analysis found. 

The data also shows:

  • Oklahomans who have died by suicide increased 62% since 2006, when there were 544. 
  • Suicides among Black Oklahomans doubled from 2016 to 2020. 
  • Suicide rates are highest in rural Oklahoma where access to care is scarce. 

Restrictions meant to protect people from the COVID-19 infections led to job loss, financial instability and isolation. With families cooped up at home, police and victim advocates say domestic and child abuse intensified. Weddings, graduations and holiday celebrations were canceled or postponed. 

The same for funerals, even as the pandemic’s death toll rose to nearly 620,000 — including 8,902 Oklahomans, according to Monday’s State Health Department report. Without those memorials, many loved ones struggled to find closure and support. 

So, when the Center for Disease Control released preliminary suicide data this spring, some experts were surprised. 

The national suicide rate fell by nearly 6% in 2020, according to the CDC data.

The report does not include details about race, age, gender, geography or other demographics that could explain the unexpected drop. But experts point to increased access to mental health care, financial support for struggling families and lack of opportunity as possible justifications. 

“When air is a threat to your life, there is a tendency to do what needs to be done to keep yourself alive during a crisis,” said Dr. Richard McKeon, who leads suicide prevention efforts at the Substance Abuse and Mental Health Services Administration. “COVID causing that may have had an impact.”

Following the onset of COVID-19, mental health programs began offering telehealth counseling sessions and virtual support groups to accommodate people who were encouraged to stay home, or in some cases, required to quarantine. A federal eviction moratorium and increased unemployment benefits eased or delayed financial stress for some families. Bullying at school and workplace harassment were less rampant with many working or learning remotely. And social media posts and personal stories from athletes and celebrities like Lady Gaga and former First Lady Michelle Obama amplified the importance of mental health care and reduced stigma. 

McKeon, a clinical psychologist who worked in emergency psychiatric services before joining the federal agency in 2003, said a significant number of suicides take place at home. The pandemic forced a spike in remote work and virtual schooling, which created fewer opportunities for self-harm, he said. Like the rest of the country, telehealth expanded in Oklahoma.

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In Oklahoma


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Complicating Factors

Though national and state suicide counts fluctuate — Oklahoma’s suicide rate dropped in 2017 while the U.S. rate increased — the state’s 2020 rate is far above the national average. 

For every 100,000 people in the U.S., 13.5 died by suicide last year, compared to 22.3 Oklahomans per 100,000. 

The state confirmed its first case of COVID-19 in March 2020, and within days, Oklahoma counselors saw an increase in anxiety and depression among their patients. By November, Terri White, who led the State Department of Mental Health before taking over as CEO of the state’s Mental Health Association, told Oklahoma Watch that economic fallout from the pandemic had heightened the risk for mental health and substance abuse disorders, “some of which results in death, like suicide and overdose.”

The pandemic isn’t the only factor in Oklahoma’s high numbers. 

According to the newly-released Census data, 16% of Oklahomans identify as Native American or Native American in addition to another race. And Native Americans have the highest suicide rate of any racial group in the U.S. especially among youth and young adults, according to Suicide Prevention Resource Center reports

Suicide rates also tend to be higher in rural areas where care is further away. More than half of Oklahoma’s 77 counties have fewer than 25,000 residents, according to the latest census data

And the risk of suicide is greater in places with a high prevalence of gun ownership.

According to the National Survey of Children’s Health, Oklahoma kids rank among the most traumatized in the nation. Left untreated, that trauma can lead to severe mental health challenges. And the most recent State of Mental Health in America report ranked Oklahoma among the worst states for the prevalence of mental illness and access to care for adults and kids. 

“Our rates have always been higher,” said Shelby Rowe, program manager at the national Suicide Prevention Resource Center based at the University of Oklahoma Health Sciences Center. “We look at different risk factors, things like our incarceration rates are higher and having a parent incarcerated is a risk factor for suicide for the child. And then being incarcerated is a risk factor, too. So yes, there are things on the public health level that will put us overall at a greater risk.” 

Rural counties had the highest 2020 suicide rates, which experts attribute to fewer treatment providers and increased stigma around seeking help. In counties with small populations, even one suicide can drastically impact the rate. For example, Cimarron County, which has a population of just over 2,000, ranked ninth in the state with one suicide in 2020.

The manner of death remained consistent with previous years. The vast majority died from gunshot wounds, 62%, followed by asphyxia, mostly hangings, which account for 27%. 

Suicides increased in 2020 among Native American, Hispanic and Black Oklahomans. Native American and Hispanic communities also contracted COVID-19 at higher rates, according to State Department of Health data. 

Despite a decrease in the overall national suicide rate, McKeon, who leads the federal government’s prevention efforts, said other states are reporting increased suicide among minority populations, which could signal a national trend. That is one area he will be reviewing closely when the CDC releases its final report.    

Rowe, who led suicide prevention efforts at the State Department of Mental Health before moving to the national resource center, said recent racial tensions could be a factor. 

After a Minneapolis police officer murdered George Floyd, a Black man, in May of 2020, protests spread throughout the country, including Oklahoma. Floyd’s death and the stories of others like Breonna Taylor in Kentucky and Ahmaud Arbery in Georgia fueled tensions and pitted police against members of the communities they’re charged to protect and serve. 

Oklahoma City has the nation’s second-highest rate of police killings, according to a recent study of federal crime data. Tulsa ranks fifth. In Oklahoma City, Black people are killed at more than five times the rate of white people.

Rowe, who is Chickasaw and a suicide attempt survivor, said culture clashes can be traumatizing for people of color. 

Signs Of Hope

The fallout from the pandemic and a recent resurgence of COVID-19 has left many feeling anxious and fearful, especially as another unprecedented school year begins. Uneasiness spreads with the emergence of the more contagious Delta variant, breakthrough cases bring into question the vaccine’s ability to keep us safe and unvaccinated Oklahomans fill hospitals across the state. But Rowe said there is hope. 

Dire predictions and improved awareness of mental health have led to an increase in programs to help. 

Oklahoma’s Department of Education spent $35.7 million in federal pandemic relief funds to increase counselors and mental health support in schools. 

Beginning this school year, all teachers and school staff are required to take suicide prevention training. Lawmakers also passed a bill requiring insurance companies to pay health care practitioners the same amount for telehealth visits as in-person visits, which were previously reimbursed at higher rates. This could entice more counselors to offer online services, expanding care. 

Since the pandemic, the State Department of Mental Health has teamed up with the Owasso nonprofit Eagle Ops in an effort to reduce Oklahoma's veteran suicides, which are among the highest in the nation. Veterans from the nonprofit host firearm safety presentations at gun shows and other shooting events, and encourage other veterans who are struggling with their mental health to give their firearms to a friend from the military or to the nonprofit for safekeeping while they receive the treatment they need.

Despite increased efforts to reach those who are hurting and surprising national results, experts said the repercussions of the pandemic are far from over. 

The trauma caused by the pandemic could take years to manifest, Rowe said. For a child that was abused at home, that pain and anger might grow slowly over time, she said. Others may still be in shock, not yet feeling the emotions that could create future mental health challenges. 

Rowe predicts that trauma prompted by the pandemic will contribute to suicide rates through at least 2025. 

“I wish I had the answers. I think we all wish we had the answers,” Rowe said. “The only Oklahomans who have the answers are no longer with us.”

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