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Boone County has recently organized the Boone County Suicide and Overdose Fatality Review Team and Boone County Coroner Justin Sparks explained the team’s purpose in detail.
Why Suicide and Overdose Fatality Review?
Even prior to the pandemic that began in 2020, death rates for suicide have continued to rise both nationally and in Indiana, despite efforts to curtail these trends. Based on recent data provided by the Indiana Department of Health (2018), suicide is a top 10 leading cause of death in Indiana for people aged 10–64 years and is the 11th overall leading cause of death for all ages. While each suicide death or attempt is different, there are ways to address the multiple factors involved. Suicide prevention efforts must utilize different strategies, require a wide range of partners, coordinate community response language and draw on a diverse set of resources and tools.
Suicides occurred at twice the rate of homicides. In Indiana, based on 2018 data, suicide is the 11th leading cause of death among all age groups. Death due to suicide is most prevalent in younger age groups, 10 to 54 years, where suicide ranks among the top 5 causes of death. According to IDOH Vital Records data, between 2015 and 2018 there have been 4,177 deaths by suicide in Indiana. This equates to around three deaths a day in the state of Indiana alone.
Vital records, such as death certificates, are important for tracking quantitative data; however, numbers are not enough. The context surrounding that death is essential to learn how to help prevent that type of death from happening again. Fatality Review teams meet this need by providing the information about the who, what, where, when, how and why.
Expanding the Mission to Save Lives
Sparks takes his duties as coroner seriously, and as a parent himself, dealing with child suicides is devastating to everyone involved but especially for the child’s loved ones he/she has left behind with more questions than answers. Sparks has been collaborating with the Indiana Child Fatality Review (CFR) Program to not only find answers to these questions but to help prevent them from having to be asked.
On July 1, 2013, a new Indiana law (IC 16-49) went into effect, requiring child fatality review teams in each county with coordination and support for these teams to be provided by the IDOH.
The county prosecuting attorney in each county is required by this new legislation to establish a Child Fatality Committee whose membership includes the prosecuting attorney or their representative, the county coroner or deputy coroner and representatives from the local health department, Department of Child Services and law enforcement. The Child Fatality Committee is responsible for selecting members to serve on the Local Child Fatality Review Team and determining whether to establish a county child fatality review team or enter into an agreement with another county or counties to form a regional child fatality review team.
Each local child fatality review team will be made up of a coroner/deputy coroner, pathologist, pediatrician or family practice physician and local representatives from law enforcement, the local health department, DCS, emergency medical services, a school district within the region, fire responders, the prosecuting attorney’s office and the mental-health community. The teams are required to review all deaths of children under the age of 18 that are sudden, unexpected or unexplained, all deaths that are assessed by DCS and all deaths that are determined to be the result of homicide, suicide, accident or are undetermined.
To determine which cases meet the criteria for review, the local teams will examine death certificates provided to the team by the local health officer in each county. The local teams will provide the aggregate data collected from their reviews to the Statewide Child Fatality Review Committee. The statewide committee will then endeavor to classify the details of these deaths, identify trends and inform efforts to implement effective statewide strategies designed to prevent injuries, disability and death for our children. By working together to understand the circumstances involved in a child’s death, we can make Indiana a healthier and safer place for our children.
“Enabled through state statute, we’re [stakeholders] are able to share information on these cases,” Sparks said. “We can construct these kids’ lives from birth until death and see what was going on in their lives. We’re working at how we can do things better and how we can prevent kid cases [of suicide] from happening again.”
New for Boone County is an adapted model of CFR that focuses on the county’s adult suicides and overdoses.
“I’ve been working on this since my first week in office,” Sparks explained. “The Suicide and Overdose Fatality Review Team is the same concept as CFR. The IDOH is kind of the parent agency. I am very cautious about my approach—the last thing I want to do is essentially exploit these people’s tragedies. I have addressed these issues before the justice center project took center stage, and I’m going to continue to address these [issues] after the justice center project. It’s about doing the right thing for Boone County residents and families.”
Sparks explained his role as coroner in cases involving suicide—at any age—and overdoses that occur within Boone County.
“We [coroners] have to come up with scientific facts/statements and determine whether [an unexpected] death is a suicide or an accident,” Sparks stated. “It literally takes a scene investigation, interviews from family members, an autopsy, toxicology results, and I subpoena for medical records. My decision making is like the scales of justice to the point that—based on the evidence—I have to tip the scale towards an accident or suicide, and I can’t be wrong. I have to make that determination based on facts, and so the job is very complex.”
A Disturbing Upward Trend
In addition to the pandemic ripple effects that have deeply affected the adults and children throughout our state and nation, Boone County has seen exponential growth over the last few years, and along with a growing population comes the increase of substance abuse disorders and behavioral health issues in both child and adult demographics.
“I had two cases involving kids—14-year-olds—in 2021 who took their own lives,” Sparks said. “Neither of these kids had fallen through the cracks. Both kids were actively engaged with counselors. Their parents had seen warning signs. So, everyone was doing absolutely everything right in those situations. It’s easy to say, ‘Those were tragedies,’ but I can’t just say that. I have to figure out what happened. I’m trying to understand what we are missing. We’ve got some real issues that we’ve got to address in our community. I don’t think we’re different than every other community in the state right now. But we better confront this right now. My office saw a 35% increase in caseload from 2019–2020. We’ve got a lot of resources that exist in Boone County, and I’m working on networking and bringing them together.”
Sparks is looking at targeted education to address the rise in suicide and overdose fatalities. The review teams he participates on adds another layer of investigation and information that will help him discover root causes and help devise even more preventative measures when it comes to suicide and overdoses. “I can’t change the nature of the work that I have to do, but I can stand up and tell everybody that I can get in front of, ‘Here are the problems, and here are the things we can do to work on them,’” Sparks said. “I spoke in a commissioners’ meeting and said, ‘I will never be able to fill this room up with people whose lives I’ve saved, but what I can do is start changing the tide.’ I can start destigmatizing or ‘normalizing’ what is happening.”