As of Thursday, 28 Kootenai County residents had taken their lives this year.

Seventeen males. Eleven females.

All of them were loved by someone. Each left a void in the lives of their families and friends.

Most, if not all, had lost hope.

"I have the privilege every day to walk with individuals who have either thought about suicide or who have attempted suicide," Kootenai Behavioral Health Director Claudia Miewald said Thursday.

"I learn from many of the patients day-in and day-out that come through our doors at Kootenai Health, and one of the threads that I can tell you that I see in individuals is the lack of hope when they first walk in the door, and the lack of hope is one of the big things that has brought them to that place," she said. "People describe it to me in their own words as ‘that very dark place' where they can’t see the forest for the trees, where they’re in so much pain that they don’t know which way to turn."

When they do find their way to a resource like Kootenai Behavioral, Miewald is grateful because that means all hope is not lost.

"We can help make a difference. We can walk with them on their journey to find that light again, to find that hope," she said. "One of the most gratifying things to me is when I have a patient who’s leaving and they high-five our front staff and they say, ‘Thanks for giving me my life back.'"

Miewald opened the Suicide Prevention Summit at North Idaho College, where more than 100 health-care professionals, community leaders and concerned citizens gathered to discuss and learn more about best practices in suicide prevention.

Kim Kane, program manager at the Idaho Department of Health and Welfare, educated attendees on how to adopt a “Zero Suicide” mindset in the health-care setting. Zero Suicide is a systemic approach to reduce suicide rates with the hope of someday ending them.

The seven elements of the Zero Suicide approach are: lead system-wide culture change committed to reducing suicides; train a competent, confident and caring workforce; identify suicide risk; engage at-risk individuals using a suicide-care management plan; treat suicidal thoughts and behaviors using evidence-based treatments; transition individuals through care with warm hand-offs and supportive contacts; and, lastly, improve policies and procedures through continuous quality improvement.

"It is based on the belief that suicide among individuals who access health care are preventable and changing the cultural beliefs around what is doable and what is not," Kane said. "This idea of zero suicide, it is an aspirational goal, but I would ask, if not zero, what number's OK? What's OK if not zero? The difference that the zero mindset makes is those who have adopted the Zero Suicide mindset changed their behavior. They change how they do things, and the difference is how many lives they change."

A number of other suicide-prevention concepts were presented during the nearly four-hour seminar.

An emphasis on coordinated efforts weaved throughout the presentations. The upstream approach for youth encourages preventative measures to be taken early in a child's life. In 2017, one in five Idaho high school students seriously considered suicide, one in 10 made an attempt. Ultimately, one in 8,700 kids took their lives.

"If we really want to move the dial on this, we need to stop kids from becoming suicidal to begin with. Ever," Kane said. "There are programs that have that kind of upstream prevention. Stop them before they become suicidal and help reduce risky behaviors over the lifespan and start at an early age."

Restricting access to lethal means has been an effective means of prevention. More than half of suicide deaths in 2017 were completed with firearms; about 28% of suicide deaths were from suffocation, including hanging. Nearly 14% of suicides involved poisoning.

"It works at the societal level, it also works at the individual level,” Kane said. "Almost anything you can do to separate someone and their idea on how they're going to carry it out makes a difference. Their level of suicidality even goes down if they are further away from their means."

The second North Idaho Suicide Prevention Summit was hosted by NIC, Panhandle Health District, Kootenai Health, Idaho Department of Health and Welfare Behavioral Health Division and the Suicide Prevention Action Network of North Idaho.

NIC President Rick MacLennan said the first summit was held in response to a bad year for suicides in North Idaho. NIC reached out to organizations and schools to help them try to recover.

"The sense I got was that there was a lot of despair in the community," he said. "This is something that can only be addressed through a community-wide effort, to link services and resources.

"The other piece of that is North Idaho College is one of the centers of this community. We do have an ability to convene, and it makes sense for us to convene," he continued. "This issue belongs to everybody."

The National Suicide Prevention Lifeline is 800-273-8255.