The National Strategy for Suicide Prevention: Everyone Has a Role

Richard McKeon Ph.D.

Can national strategies reduce suicide rates?

• Yes, but it requires a sustained, comprehensive approach in which everyone has a role.

• Implementation of national strategies/ national efforts have led to reductions in England and Taiwan.

• Organizations as different as the U.S. Air Force and the Henry Ford Health System have also shown reductions.

International Efforts

• England—Reduction in suicides in communities that implemented

• Community crisis teams, proactive outreach• Follow-up within 7 days of IPU discharge• Training of clinical staff at least every 3 years• Dual diagnosis policies• Taiwan—Follow-up after suicide attempts led to

63% reduction in suicides.

The Air Force Did It

MH

Henry Ford Health System Also Did It

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Key Issues

• Integrate and coordinate suicide prevention activities across multiple sectors and settings.

• Comprehensive, lifespan approach. • Data-driven efforts to continuously improve. • Both public and private sectors. • Healthcare providers, educators, workplaces,

faith-based entities, and community-based organizations all need to be involved.

Tough Realities

• ~30 percent of deaths by suicide ~30 percent of deaths by suicide involved alcohol intoxication – BAC involved alcohol intoxication – BAC at or above legal limitat or above legal limit

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Tough Realities

2005-2009: 55%↑ in emergency department visits for drug related suicide attempts by men 21 to 34

2005-2009: 49% ↑ in emergency department visits for drug related suicide attempts by women 50+

Every year > 650,000 persons receive treatment in emergency rooms following suicide attempts

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Estimated Number in Population(Number in Thousands)

Past year Suicidal Ideation

(Number in Thousands)

Past Year Suicide Attempt

(Number in Thousands)

Pat year SMI and suicidal ideation

(Number in Thousands)

Past year SMI and Suicide attempt

(Number in Thousands)

Full time Employed (18+)

118,225 3,678 351 1,213 149

Treated in ER for any reason in past year (18+)

57,977 3,839 686 1,686 403

Military Veterans (18+)

24,356 804 74 276 44

Adults (18 +) on Medicaid/CHIP

18,629 1,383 270 644 164

Full time College Students (18+)

14,612 785 108 312 64

Adults (18+) on Probation or Parole

5,581 585 161 285 106

Adults in Substance Use Treatment

2,292 395 106 238 80

Data Source: SAMHSA , Center for Behavioral Health Statistics and Quality, National Survey on Drug use And Health (NSDUH), 2008 and 2009

What if we targeted these groups for suicide prevention programs?

Key Issues

• Goal 7– Provide training to community and clinical service providers on the prevention of suicide and related behaviors.

• Community groups, mental health, and substance abuse providers.

• Recognizing the warning signs for suicide and actions to take in response.

• Train in evidenced-based practices.

Role #Counselor 2,421Social Worker 2,361Physician 416Nurse 1,371Case Manager 3,312Para-professionals 826Certified Peer Staff 479Administrator 2,640Support Staff 3,409

BH Workforce Survey (16 Questions)

3,802

2,507

1,123

6,2921,562

6,816

22,337 Total Responses

Endorsed Don’t Know, Disagree, or Completely Disagree

I have the _________ to engage and assist those who are suicidal. Over 6,000 report a patient has died by suicide (27%).

SMI Suicide Rate vs. General Population

Suicide Prevention as a Core Component of Health Care

• What does it look like?• The clinical workforce is routinely trained in suicide risk assessment,

management, and treatment.• Accrediting and certifying bodies have standards and guidelines

related to suicide prevention.• Continuity of care during high risk transition times is assured.• Deaths by suicide and non-fatal suicide attempts are routinely

monitored and reviewed to help guide suicide prevention efforts.• Continuous quality improvement efforts focused on suicide

prevention are conducted.• VA and Joint Commission have made major efforts.

“For many years suicide prevention has not been informed by people who have been there.

Peers who have experienced the agony and decision-making can provide support that can

be magic.” - Eduardo

VegaMental Health America of San Francisco

National Suicide Prevention Lifeline1-800-273-TALK

• Answered over 800,000 calls in 2012.• 161 local crisis centers—your partners

in suicide prevention.• In response to evaluation findings, created the

Crisis Center Follow-up Grants, developed risk assessment standards, and guidelines for callers at imminent risk.

• Crisis Chat service can be accessed through Lifeline website.

Preventing Suicide: A Toolkit for High Schools

• We now have many resources. We need to utilize them and make them even better.

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To Live to See the Great Day that Dawns17

TIP 50

TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment

• High prevalence of suicidal thoughts and attempts among persons with SA problems who are in treatment.

• TIP 50 helps– SA counselors work with adult clients who may be suicidal– Clinical supervisors and administrators

• Free at: http://store.samhsa.gov/product/SMA09-4381 • Training video: SAMHSA YouTube channel• SPRC Webinar:

http://www.sprc.org/traininginstitute/disc_series/disc_22.asp\