Paul Quinnett, Ph.D.QPR Institute

U of Washington School of Medicine

“Suicide is our most preventable form of death.”

David Satcher, MD

Politically active survivors of the death by suicide of a family member

Congressional appeal – house/senate resolutions

Senator Harry Reid (D – Nevada) Senator Gordon Smith (R – Oregon) 2001 first national meeting – NSSP 2001 IOM report: Reducing Suicide: A National

Imperative

AAS AFSP SPRC NIMH CDC SAMSHA – SPRC/AFSP BPR National Action Alliance for Suicide

Preventionhttp://actionallianceforsuicideprevention.org

Championing suicide prevention as a national priority

Catalyzing efforts to implement high-priority objectives of the NSSP

Cultivating the resources needed to sustain progress

National Strategy 2012 Revision (done)

Research PrioritizationResearch Prioritization: Reduce suicide by 20% in five years or 50% in 10 years.

Clinical Care and Intervention: Released a task force report, Suicide Care in Systems Framework, laying out recommendations for national leaders, health and behavioral health providers, and health plans.

- Chaired by the Honorable John McHugh, Secretary of the Army, and the Honorable Gordon H. Smith, President and CEO of the National Association of Broadcasters

- 200 organizations participated- Chaired by Surgeon General Regina M.

Benjamin and SPRC Director Jerry Reed

Public-private all the way……..

- Foster positive public dialogue, counter shame, prejudice, and silence; and build public support for suicide prevention

- Address the needs of vulnerable groups, be tailored to the cultural and situational contexts in which they are offered, and seek to eliminate disparities

Be coordinated and integrated with existing efforts addressing health and behavioral health and ensure continuity of care

Promote changes in systems, policies, and environments that will support and facilitate the prevention of suicide and related problems

Bring together public health and behavioral health

Promote efforts to reduce access to lethal means among individuals with identified suicide risks

Apply the most up-to-date knowledge base for suicide prevention.

1. Create supportive environments that promote healthy and empowered individuals, families, and communities (4 goals, 16 objectives)

2. Enhance clinical and community preventive services (3 goals, 12 objectives)

3. Promote the availability of timely treatment

and support services (3 goals, 20 objectives);

4. Improve suicide prevention surveillancecollection, research, and evaluation (3 goals, 12 objectives).

AFSP/SPRC Best Practices Registry NREPP Role of BPR in emerging state healthcare law

Implications for practice from the National Violent Death Surveillance System (NVDRS)

Example:- 41% adult suicides occur while in active care

of a health professional (49% in Dane CO.)- 23 EMS professionals in CO over 4 years

An increased understanding of the link between suicide and other health issues

New knowledge on groups at increased risk

Evidence of the effectiveness of suicide prevention interventions

Increased recognition of the value of comprehensive and coordinated prevention efforts

Objective: Encourage health care providers and health

and safety officials caring for individuals with suicide risk to routinely assess for the presence of, or access to, lethal means as part of their patient safety plans, and to educate those individuals and their support networks about actions to reduce risk.

GOAL:

Encourage the training of community and clinical service providers on the prevention of suicidal self-directed violence, including training on how to address the needs of those affected or bereaved by suicide deaths and attempts (postvention services)

Objective:

Deliver training on suicide prevention to community groups that have a role in the prevention of suicidal self-directed violence and related behaviors

Objective: Develop core education and training

guidelines for the recognition, assessment, and team-based management of at-risk behavior, and the delivery of effective clinical care for people with suicide risk.

Objective:

Promote the adoption of “zero suicides” as an aspirational goal by health care and community support systems that provide services and support to defined patient populations.

GOAL: Develop and promote effective clinical and

professional practices for assessing and treating those identified as being at risk for suicidal self-directed violence.

The 2001 NSSP strategy started the ball rolling

The suicide deaths of soldiers and veterans have ramped up interest and motivation

Professional member organizations, universities, and training institutions did not heed the recommendations of the IOM or NSSP

The suicide prevention community is growing and building political force for change

It is strongly believed by the SP community that stigma and taboo have contributed to the training deficit in suicide prevention education at the professional level…. And that such training could enhance consumer safety and prevent suicide…

Would improved specific knowledge and skill in the “assessment, treatment, and management” of consumers detected to be at elevated risk of suicide reduce morbidity and mortality among behavioral health service customers?

Answer: ???? - We shall see…

Chart entry from PCP visit with 18-year-old single Hispanic female. “Complains of headache and stomach distress. Drank some poison last week….” (provided medicines for headache, etc.)

Two days later this young woman was dead of an overdose…

No SRA, no referral for a workup by a MHP, even though one was in the building…

Washington state legislature drafted and passed Engrossed Substitute House Bill No. 2366 – “An act relating to requiring certain health professionals to complete education in Suicide assessment, treatment, and management.”

House vote: 92 to 5Senate vote: 100%

Matt Adler dies by suicide Jenn Stuber obtains provider’s record Begins review – support by U of WA School of Social

Work Champion: Rep. Tina Orwall – SW with experience

with suicidal consumers Review of literature undertaken/BPR review Agenda: inadequate training costs lives Stakeholder meetings begin – ownership of failure

to train A gathering of expert eaglets (AAS/AFSP support) A bill is drafted Atmosphere: Legislative session where both sides

wanted to get a least ‘something passed.’

All licensed mental health providers to:- Complete a training program in suicide

assessment, treatment, and management every six years

- Clarifies that training programs in suicide assessment, treatment, and management must include the following elements: Suicide assessment, including screening and referral, suicide treatment, and suicide management.

Availability of BPR training options (more than one)

Consensus expert opinion published paper (read from paper in testimony – you have a copy)

Capacity to train an entire workforce – online availability (cost shift to providers)

Allows a disciplining authority to approve training programs that do not include all of the elements if the excluded elements are inappropriate for the profession in question based on the profession's scope of practice.

Requires training that includes only screening and referral to be at least three hours in length. Requires all other training to be at least six hours in length.

Rules are in process Implementation on schedule Staff will be impacted by license, age, renewal Physicians and nurses working to adopt/adapt DOH evaluation on training status report out

in July Other states “all in” KY+ WA is ahead of the curve….. FOREFRONT

organization launched

- Detection- Assessment- Treatment – (limited)- CBT – DBT – Lithium – Clozapine - Follow Up (caring letters/emails) – see complete list of NREPP programs (17 only)- Management of risk over time… good data on continuity as a best practice…

Suicide risk continues to go undetected Assessment failures account for 70% of “medical

errors” associated with patient suicide Lack of specific training Lack of specific knowledge Lack of supporting policies & payments Reliance on junk science, e.g., no-suicide

contracts Wrong beliefs, e.g., If they really want to kill

themselves you can’t stop them. CEO, “Patient suicides is the ‘cost of business.’”

The public is being taught that suicide is “preventable.” (SPAN USA Survey)

If so, then, “How come my brother killed himself after seeing one of your therapists?”

SP training is needed to maintain the public’s trust in our competence…

Millions need to be trained – few subject matter experts, fewer trainers…

How can national policy vision be translated into practice settings?

What questions do you (providers) have about current research/evidence re: suicide prevention?

What challenges/barriers do you experience in practice settings?

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Office phone: 509-235-8823 Institute phone: 1-888-726-7926 Email: pquinnett@mindspring.com Website: www.qprinstitute.com