This article is from Kaiser Health News,\u00a0a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. HILLSBORO, Oregon \u2014 On Kimberly Repp\u2019s office wall is a sign in Latin: Hic locus est ubi mors gaudet succurrere vitae. This is a place where the dead delight in helping the living. For medical examiners, it\u2019s a mission. Their job is to investigate deaths and learn from them, for the benefit of us all. Repp, however, isn\u2019t a medical examiner; she\u2019s a Ph.D. microbiologist. And as the Washington County epidemiologist, she was most accustomed to studying infectious diseases like flu or norovirus outbreaks among the living. But in 2012 she was asked by county officials to look at suicide. The request led her into the world of death investigations, and also appears to have led to something remarkable: In this suburban county of 600,000 just west of Portland, the suicide rate now is going down. It\u2019s remarkable because national suicide rates have risen despite decades-long efforts to reverse the deadly trend. While many factors contribute to suicide, officials here believe they\u2019ve chipped away at this problem through Repp\u2019s initiative to use data \u2014 very localized data that any jurisdiction could collect. Now Repp\u2019s mission is to help others learn how to gather and use it. New York state has just begun testing a system like hers. Humboldt County, California, is implementing it. She\u2019s gotten inquiries from Utah and Kentucky. Colorado, meanwhile, is using its own brand of data collection to try to achieve the same kind of turnaround. Following the death investigators Back in 2012, when Repp looked at the available data \u2014 mostly statistics reported periodically to the federal Centers for Disease Control and Prevention \u2014 she could see that suicide was a big problem and that rates were highest among older white men. But, beyond that, the data didn\u2019t offer a lot of guidance. Plus, it lagged two years behind. She returned to her bosses. \u201cI can tell you who has the highest suicide rate, but I can\u2019t tell you what to do about it,\u201d she recalled telling them. \u201cIt\u2019s too broad.\u201d So she turned to the county medical examiner\u2019s death investigators. They gather information at every unnatural death scene to determine the cause (say, drowning or gunshot) and manner (homicide, suicide, accident). It\u2019s an important job, but a grim one, and it tends to attract unusual personalities. Repp mustered the courage to introduce herself to one of the investigators, Charles Lovato. \u201cI said, \u2018Hi, my name is Kim and I was hoping to go on a death investigation with you.\u2019 And he\u2019s like, \u2018You\u2019re that weirdo that does outbreak investigations, aren\u2019t you?\u2019 And I\u2019m like, \u2018You\u2019re the weirdo that does death investigations.\u2019\u201d The gambit worked. Repp accompanied Lovato on his grim rounds for more than a year. \u201cNothing can prepare you for what you\u2019re going to see,\u201d she said. \u201cIt gave me a very healthy dose of respect for what they do.\u201d She studied the questions Lovato asked friends and family of the deceased. She watched how he recorded what he saw at the scene. And she saw how a lot of data that helped determine the cause and manner of death never made it into the reports that state and federal authorities use to track suicides. It was a missed opportunity. Collecting data on the dead to save lives Repp worked with Lovato and his colleagues to develop a new data collection tool through which investigators could easily record all those details in a checklist. It included not only age and cause of death, but also yes\/no questions on things like evidence of alcohol abuse, history of interpersonal violence, health crises, job losses and so on. In addition, the county created a procedure, called a suicide fatality review, to look more closely at these deaths. The review is modeled on child fatality reviews, a now-mandatory concept that dates to the 1970s. After getting the OK from family members, key government and community representatives meet to investigate individual suicides with an eye toward prevention. The review group might include health care organizations to look for recent visits to the doctor; veterans\u2019 organizations to check service records; law enforcement; faith leaders; pain clinic managers; and mental health support groups. The idea, Repp said, isn\u2019t to point fingers. It\u2019s to look for system-level interventions that might prevent similar deaths.\u00a0\u201cWe were able to identify touchpoints in our community that we had not seen before,\u201d Repp said. For example, data revealed a surprising number of suicides at hotels and motels. It also showed a number of those who killed themselves had experienced eviction or foreclosure or had a medical visit within weeks or days of their death. It revealed that people in crisis regularly turn their pets over to the animal shelter. But what to do with that information? Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That\u2019s where Debra Darmata, Washington County\u2019s suicide prevention coordinator, comes in. Part of Darmata\u2019s job involves running these training programs, which she described as like CPR but for mental health. The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more. It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants\u2019 role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there. Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention. \u201cI\u2019ve worked in suicide prevention for 11 years,\u201d Darmata said, \u201cand I\u2019ve never seen anything like it.\u201d The sheriff\u2019s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too. From 2012 to 2018, Washington County\u2019s suicide rate decreased by 40%, preliminary data shows. To be sure, though, 68 people died by suicide here last year, so preventing even a handful of cases can lower the rate quite a bit. Taking the idea elsewhere Repp cautions that the findings can\u2019t be generalized. What\u2019s true in suburban Portland may not be true in rural Nebraska or the city of San Francisco or even suburban New Jersey, for that matter. Every community needs to look at its own data. Still, Jay Carruthers, who runs New York\u2019s Office of Suicide Prevention, saw the potential. \u201cTo be able to close the loop and connect to prevention? That\u2019s the beauty,\u201d he said. This year, the state is beginning to test a similar system in several counties. In Northern California\u2019s Humboldt County, public health manager Dana Murgu\u00eda had been frustrated for some time that local prevention plans weren\u2019t making a dent. \u201cI said, \u2018We don\u2019t need another plan. We need an operations manual.\u2019 That\u2019s what I feel Dr. Repp has given us.\u201d Humboldt began using a Washington County-style checklist this year, and county officials have identified several unexpected touchpoints, including public parks and motels where people have died by suicide. Now, those sad facts can become action plans. In Colorado, a different effort to reduce suicides also began with extensive data analysis. There, they realized that while youth suicide has understandably been a focus, the biggest numbers are among older men. They\u2019ve not only crafted materials specifically for men in crisis, but they\u2019ve also created materials for specialized groups, such as veterans, farmers and construction workers. \u201cWhat was unexpected to me was how empowering these data would be to so many different people to make change,\u201d Repp said \u2014 including Lovato and the other death investigators. \u201cTo know that they\u2019re actually keeping the living alive is really powerful.\u201d If you need help If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Chat, both available 24 hours a day, seven days a week.