Research Examines 'Deaths Of Despair' In Montana
Research into nearly 200,000 Montana death records from the last two decades has put hard numbers to anecdotes about suicides and drug- and alcohol-related deaths during the pandemic.
The report, by University of Montana School of Journalism Professor Lee Banville, is published on the American Communities Project’s website and shows that death rates significantly increased in 2020 in communities categorized as "Graying America," "Native American Lands" and "Working Class Country."
Banville spoke with MTPR’s Freddy Monares about what he found.
Freddy Monares Your report analyzed 197,000 death reports obtained from Montana's Department of Public Health and Human Services from 2000 through the end of 2020. This gave you historical context when looking at so-called "deaths of despair" during the pandemic. First off, what are deaths of despair and why are they called that?
Lee Banville So this was a concept developed by some economists at Princeton to kind of look at the health of a community. And so that what they did was they said, if we look at suicides, drug overdoses and alcohol-related deaths — like poisoning or cirrhosis of the liver — that you see that these are deaths that are avoidable, but oftentimes gauge how a community is doing. Are they struggling? Are people depressed? Are people, you know, coping through the use of, you know, sort of self-medication? And so it's a way to kind of look at how is a community sort of faring.
Monares Where are these deaths happening?
Banville So obviously they happen everywhere, and what we found is when you took all of the statistics together, 2020 wasn't radically different than 2019 — they were actually down a tiny bit.
But when you look at the individual types of deaths, we saw a steep drop in drug overdoses. We saw a slight dip — very slight dip — in suicide rates. And then we saw a real spike in alcohol-related deaths. But even there, we saw different parts of the state faring very differently and suffering from these deaths in very different ways.
Monares Was there anything that surprised you in your reporting on this topic?
Banville Yeah. I think, you know, I mean, the alcohol-related deaths were really jarring. You know, you think of alcohol-related deaths as something that takes a long time. But what struck me was clearly that can happen much more quickly, it can be much more deadly and, in large parts of the state, alcohol deaths really spike.
Monares Were there any silver linings, declines in these types of deaths in these communities or across Montana?
Banville You know, we did see some really positive, positive news in terms of drug overdoses and suicide rates in certain parts of the state.
So drug overdoses in Native American counties dropped by 50%. And this was a five year average, right — so we took an average of five years and then we looked at 2020. And so it was 50% below the five-year average and that's fantastic.
In suicide rates, we actually saw college communities like Bozeman or Missoula see a pretty significant drop. We saw rural communities, particularly in Eastern Montana, were down kind of across the board. They actually fared quite well from deaths of despair, but got kind of hammered with COVID.
Monares Experts you cited in your reporting attribute some of that success to health care and government policies. Were there any specific pieces of health care policies they saw as most crucial during the pandemic?
Banville Yeah. This was this was an interesting part of the reporting because you're not going to be able to yet say this equaled that, right? So but this drop in suicide rates, or stability and suicide rates in other parts of the state, sort of made us ask, well, has something changed? And we found that something had changed, and that was there had been an explosive growth in telehealth.
Places that had either never done telehealth or had very little telehealth, suddenly doing thousands of visits, in particular for mental health and behavioral health issues. Which I think, you know, we can't say that's why this drop happened in suicide rates in certain areas. But I think what it does say is, you know, it certainly was a contributing factor to helping people weather this storm.
Monares Are there any implications for telehealth if and when coronavirus numbers get under control?
Banville So I talked to some people about that, both at the Montana Healthcare Foundation and elsewhere, and they definitely pointed to that, you know, a lot of this will go back to the way it used to be.
But just this week, we saw, you know, the governor signed a bill that allowed — that sort of implemented some of the changes that had been happening for telehealth to continue, to promote telehealth. And so I think what I've heard from people is that some of these resources are going to stay in the sort of telehealth space.
Monares What did experts say the role of Medicaid expansion had during the pandemic? That's a state and federal program that provides health coverage for low income adults.
In particular, the health care foundations that sort of research this, these groups both pointed to Medicaid sort of stepping, in particular when, you know, I mean, some 17% of the state filed for unemployment during the pandemic.
But also, Medicaid expansion has allowed rural hospitals and rural clinics to kind of stay open even before that, because they had a more reliable source of income because they had more insured patients.
And I think the last aspect is, you know, there's been a big pilot project in Montana to introduce something called "behavioral health screening." All of that, taken together, allowed Medicaid to sort of serve as a really important safety net during this last sort of, you know, 12-month period.
Monares Montana's Medicaid expansion policy — it's set to expire if not renewed by lawmakers in 2025. It's been controversial in the past. Have you seen political support or opposition to the program change because of the pandemic?
Banville It seems like, at least right now, there isn't a huge political appetite to blow the program up or make it really stringent to get into, because I think, you know, these last, you know, 16 months have been a real sort of testament to what might happen if there wasn't sort of support for, you know, lower income, more rural communities, more rural health care. We probably would have had a very different scenario in Montana last year and this year.
Monares What's the use of knowing this information, and what should we take away with this?
Banville One thing is to move away from anecdotes.
We heard lots of anecdotes about what was happening during the pandemic, and it's always challenging to get really good data to make decisions about.
But Montana is going to make decisions about telehealth, about Medicaid expansion. And those decisions really at the end of the day ought to be made on not anecdotes, but data.
Those stories are tragic, and when we talk about death, people are moved by them. But we also want to make policies that are informed by the reality of the whole complicated world of Montana.
My hope is that by starting to talk about data-based reality of what happened, we can start to have a conversation of, OK, well, what role did Medicaid expansion play? What role did telehealth play and what role should it play in health care moving forward?
And so, you know, understanding what worked and what didn't work, and where there were pain points and where it really, truly did help people and save lives, I think is an important part of that conversation.
Monares Lee Banville is a professor at the University of Montana School of Journalism who looked into what happened to deaths of despair during the pandemic. Thanks for joining us Lee.
Banville Yeah, thanks for having me.