'Together, we're stronger'

The latest numbers paint a grim picture.

The suicide rate in Idaho is 50 percent above the national average. Closer to home, the rate is even higher in Coeur d’Alene.

According to 2018 statistics compiled by the Idaho Department of Health and Welfare, Division of Health, there were nearly 23 deaths per 100,000 population in Idaho in 2017 (the latest year statistics are available). That compares to a national average of about 14 per 100,000.

Statistically, the 2017 suicide rate in Coeur d’Alene works out to 24 deaths per 100,000.

Idaho’s high suicide rate is nothing new. A multi-agency effort spearheaded by Panhandle Health District is confronting the devastating trend as part of a Community Health Improvement Plan (CHIP) initiated in early 2018.

The Community Health Improvement Plan involves more than 30 community partners focused on examining and offering solutions to the social determents to health for access to care, substance abuse and mental health.

“It’s a collaborative approach to assessing, developing, and implementing health improvement projects to address major health issues facing our community and come up with strategies and objectives to address these key health priorities,” said Lora Whalen, Panhandle Health District’s Director.

While the community’s health needs are great on many fronts, health professionals involved in a 2017 Community Health Assessment identified three areas on which to focus:

- Access to health care

- Mental Health/Suicide

- Substance Abuse Prevention (including opioid)

Since CHIP was launched nearly two years ago, Whalen said great strides have been made in these major areas of concern.

“Together, we’re stronger,” Whalen said. “The first thing we have to do is recognize a problem and then combine resources to come up with solutions in a collaborative way.”

Regarding mental health and suicide, Whalen said the Suicide Prevention Action Network (SPAN) of North Idaho has been instrumental in raising awareness, helping at-risk individuals and working with the families who have lost loved ones to suicide.

About 150 people attended the second annual Suicide Prevention Summit Oct. 3 at North Idaho College and more than 600 participated in the Break the Silence 5K walk in Riverstone Park in September to raise awareness about suicide prevention. Both events were sponsored by SPAN.

Collaboration is key

Development of the Community Health Improvement Plan started in 2017 when local health organizations prioritized the most pressing health needs using a Mobilizing for Action through Planning and Partnerships (MAPP) model.

“Working collectively is so important,” Whalen said. “We have a strong group with a lot of different partners — from law enforcement, to schools, to hospitals to crisis centers — working to create awareness of the health concerns facing our community and implementing strategies to address these issues,” Whalen said.

Mike Baker, CEO of Heritage Health, the area’s largest health care provider for the uninsured, said mental health services ranging from suicide to drug addiction represent the largest segment of growth for the organization.

And the need is growing. Overall, the number of Heritage clients has sharply increased in recent years—from about 4,000 some 10 years ago to about 28,500 last year, Baker said.

“Our biggest challenge is finding qualified therapists; there’s a real shortage of mental health care professionals in our community,” he said. “We pretty much hire a therapist every 90 days and we currently have a waiting list of 300 patients for mental health (services).”

More help wanted

The local shortage of providers is not limited to the mental health field, Whalen said. Idaho ranks 49th in the nation for its ratio of active physicians per 100,000 patients, according to the Association of American Medical Colleges.

Whalen said a strong residency program at Kootenai Health designed to attract and retain physicians will help improve access.

The Kootenai Clinic Family Medicine Residency is a three-year program accredited for six residents each year. The program is always full, so it consistently has 18 residents, said program manager Melisa Carper Bell.

“The mission of the residency program is to train family medicine physicians to fill (local) shortages,” she said. Of 18 recent resident graduates, 13 are working in Idaho.

Carper Bell said the residency program recruits on a regional and national level and last year had more than 400 applicants.

Battling addiction

Headway is also being made in combating the epidemic of drug addiction, in particular the skyrocketing abuse of opioids, said Caryl Johnston, director of Northwest Hospital Alliance, an organization that works with hospitals across North Idaho to provide a regional approach to health care.

Johnston said a “huge amount of work” is being done to identify ways to fight the opioid epidemic.

A pain management work group made up of physicians, pharmacists and health care providers within the Northwest Hospital Alliance network is taking a hard look at pain medication prescription practices.

“We’re really looking at the best pathways and best practices for prescribing opioids after surgery or an injury to avoid overprescribing the drug,” she said. “And we’re also looking at alternative methods for pain management.”

With the increase in opioid use, there’s been an increase in overdose-related deaths. Between 2012-16, 44.8 percent of overdose deaths in North Idaho specified an opioid drug on the death certificate, according to statistics provided by Panhandle Health District.

And according to the Opioid Needs Assessment compiled in 2018, Idaho is at a particular high risk of opioid addiction and overdose.

Johnston said a number of practices are being implemented to counter the rising abuse of opioids. These include increasing access to substance abuse resources and advocating additional housing opportunities for people recovering from addiction.

“Substance abuse impacts individuals, families and the community and I’m optimistic with our efforts to address the problem,” Johnston said.

Improving health care access

Whalen said CHIP advocates continue to strategize on improving access to health care in North Idaho.

“Barriers to accessing care can be attributed to individuals’ insurance status, income, geographic proximity to providers, and finding a trusted provider,” she said. “North Idaho faces many challenges with increased health care costs, the Idaho Medicaid gap, and the rural nature of the region.”

Progress is being made on Medicaid access thanks to last year’s voter-approved expansion of the medical assistance program. In 2020, Medicaid will be expanded to Idahoans earning up to 138 percent of the federal poverty level — about $12,500 a year for one person, or about $26,000 for a family of four.

That will go a long way toward improving crucial access to health care for the less fortunate, Whalen said.

More work ahead

While health officials involved with CHIP are pleased with the progress, support and involvement over the past two years, they agree more can be done.

“The Community Health Improvement Plan is an action-oriented, five-year strategic plan,” Whalen said. “This plan was developed by over 30 community partners using a health equity lens and examining the social determents to health for access to care, substance abuse and mental health and we’re on track to continue to see great things happen.”

She added: “I feel great about the way the community has come together to focus on these problems and find solutions. One entity alone can’t do it; we all need to come together.”