Are We Making a Difference? The Changing Landscape of Suicide Prevention

Transcription

1 Are We Making a Difference? The Changing Landscape of Suicide Prevention James Wright, LCPC Public Health Advisor Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services 2018 Vermont Suicide Prevention Symposium

2 Overview The Problem is Bigger than We Think National Public/Private Suicide Prevention Initiatives SAMHSA Suicide Prevention Opportunities and Activities What Works and What Doesn't

3 Its Time to Change Over the decades, individual (mental health) clinicians have made heroic efforts to save lives but system of care have done very little Dr. Richard McKeon

4 The Problem Suicide continues to increase- US 45,000, Worldwide 800, th leading cause of death, 2 nd for youth and young adults Vermont s 18.9 suicide rate ranks 11 th in the nation Over 80% of people who die by suicide had recent health care visits 45% a primary care visit month prior 19% a mental health visit month prior 10% a ED visit within last 60 days Highest risk (44X) is AFTER psych hospitalizations

5 What is Needed If we wait for suicidal people to show up in the offices of psychiatrists and psychologists we wont change this tragic trend. Approaches that have been successful have utilized a comprehensive, multi-sector approach. Implementation of activities such as Sentinel Event Alert 56 from Joint Commission Calls for comprehensive suicide prevention approach within healthcare systems

6 More evidence of effective care Ensure responsibility during continuity of care and in between treatments and appointments. Action Alliance NSSP Implementation Task Force found more suicide prevention activity than ever before. Lets review some National Initiatives. Take out your phones

7 National Initiatives National Action Alliance for Suicide Prevention The nation s public-private partnership for suicide prevention Active engagement with more than 250 organizations Worked completed through Action Alliance Ex-Committee and 16 Task Forces Mission: Champion suicide prevention as a national priority Catalyze efforts to implement high-priority objectives from the National Strategy for Suicide Prevention Cultivate the resources needed to sustain progress Goal: reduce annual suicide rate 20 percent by

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9 Action alliance committed to advancing the National Strategy for Suicide Prevention The 2012 National Strategy for Suicide Prevention (NSSP) was co-released by the Action Alliance and the U.S. Surgeon General 13 Goals and 60 objectives Many states mirror their state plan from the NSSP ational-strategy-suicide-prevention/index.html

10 Action Alliance Priorities

11 Action Alliance Priorities Transforming Health Systems NSSP GOAL 8. Promote suicide prevention as a core component of health care services. NSSP Goal 9. Promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors. Transforming Communities NSSP GOAL 1. Integrate and coordinate suicide prevention activities across multiple sectors and settings. Framework for Successful Messaging (Suicidepreventionmessaging.org) Changing the Conversation NSSP GOAL 4. Promote responsible media reporting of suicide, accurate portrayals of suicide and mental illnesses in the entertainment industry, and the safety of online content related to suicide.

12 Zero Suicide The Zero Suicide framework is defined by a system wide, organizational commitment to safer suicide care in health and behavioral health care systems. This commitment is: To patient safety, the most fundamental responsibility of health care To the safety and support of clinical staff, who do the demanding work of treating and supporting suicidal patients Fix the fragmented and sometimes distracted health care system sections where individuals fall through the cracks Go to Includes Zero Suicide Toolkit, community discussions, technical assistance and additional links to other outside resources that can impact zero suicide implementation

13 Seven Elements of Zero Suicide Lead system-wide culture change committed to reducing suicides Train a competent, confident, and caring workforce Identify patients with suicide risk via comprehensive screenings Engage all individuals at-risk of suicide using a suicide care management plan Treat suicidal thoughts and behaviors using evidence-based treatments Improve policies and procedures through continuous quality improvement

14 Zero Suicide Could be perfect for Vermont s size There are 14 non-profit hospitals and network of healthcare systems spread throughout Vermont including: 8 small critical access hospitals (CAHs) 5 mid-size rural hospitals 2 academic medical centers a Veterans Administration hospital 5 designated psychiatric inpatient facilities

15 Crisis Now: Transforming Services Is Within Our Reach Document released from Crisis Services Task Force from the Action Alliance Recommendations: Comprehensive Crisis Care to include regional/statewide call centers coordinating in real time, 24/7 MCOT, respite and residential stabilization programs, core crisis care principles and practices and recovery oriented, including use of peers, zero suicide approach and trauma-informed care

16 Goal of Crisis Now Transformation Never lose the individual while in care Maintain contact and verify when an individual receives care from another provider Systematically transform crisis services nationwide to a comprehensive standard of behavioral healthcare crisis services that reduce the amount of utilization on law enforcement and hospital based systems Suicide Prevention is a Core Priority throughout Crisis Now

17 New Website for Crisis Now Includes rating system for current crisis services Recommendations from Crisis Now document Examples of Innovative and comprehensive models Cost savings and impact examples of law enforcement, inpatient hospitalization, state funded services and reduction of psychiatric boarding

18 21 st Century Cures Act SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS IN GENERAL. The Secretary shall award competitive grants to (1) State and local governments and Indian tribes and tribal organizations, to enhance community-based crisis response systems; (2) States to develop, maintain, or enhance a database of beds at inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential substance use disorder treatment facilities, for adults with a serious mental illness, children with a serious emotional disturbance, or individuals with a substance use disorder.

19 19 Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) 21st Century Cures Act required establishment of a Public/Federal partnership to review current programs/practices within the federal government and encourage more collaboration between agencies SAMHSA will lead these efforts over the next 4 years Collaboration with HUD, DOL, DOE, CMS, DoD/VA, SSA and others December 2017 Report to Congress with 45 recommendations: Federal collaboration, treatment issues: access/engagement/ebp, justice diversion/services, community recovery services, finance models Five Implementation workgroups report to coordinating council- Data, Access, Treatment and Recovery, Justice and Financing Purpose to keep federal government focused on SMI needs

20 20 From the ISMICC Approximately 5-20 percent of people with SMI die by suicide. The highest risk follows discharge from an emergency department or inpatient hospitalization. Effective strategies that reduce risk during the post-discharge period include: Systematized safety planning prior to discharge, Follow-up outreach (phone, text, home visits), and Suicide-specific psychotherapies (e.g., cognitive therapy for suicide prevention, dialectical behavior therapy). Knowledge about detecting and treating suicidality (i.e., selective prevention) is not routinely employed in health care systems.

21 21 ISMICC Plan to Address SMI Address SMI prevention potential Increase access to treatment: Increase treatment capacity Innovative approaches Healthcare practitioner education Reduce suicide Training and technical assistance to communities Justice intervention programs for those with mental health issues Enforce parity laws/work with insurers on best approaches Items coming out of ISMICC shaping current and future grant opportunities

22 SAMHSA- Who Are We and What Do We Do? How Big Are We? Centers for Disease Control and Prevention NASA Department of Veterans Affairs SAMHSA Leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

23 Suicide Prevention Programs Garrett Lee Smith State and Tribal Suicide Prevention Grant Program Garrett Lee Smith Campus Suicide Prevention Grant Program National Strategy for Suicide Prevention National Suicide Prevention Lifeline Crisis Center Follow-up Grant Program Suicide Prevention Resource Center Native Connections Zero Suicide

24 Garrett Lee Smith Youth Suicide Prevention The purpose of this program is to support states and tribes in developing and implementing statewide or tribal youth (age 10-24) suicide prevention and early intervention strategies. The programs include collaboration among youth-serving institutions and agencies and should include schools, educational institutions, juvenile justice systems, foster care systems, substance abuse and mental health programs, and other child and youth supporting organizations; these efforts should include both a strong community component and a strong health system component. The ultimate goal of this program is to reduce suicide deaths and non-fatal suicide attempts. Heightened efforts have been placed on ensuring care transitions and data surveillance. Goals are accomplished through a number of activities- some, but not all of which, are gatekeeper trainings, screening programs, coalition and task force building, outreach and awareness campaigns and direct services. Most states focus on middle and high school training, with recent increases in primary care and emergency department collaborations. States currently receive $3.7 million over 5 years. Started in 2005, all states have received GLS funding.

25 GLS Campus Suicide Prevention The purpose of this program is to develop a comprehensive, collaborative, well-coordinated, and evidence-based approach to enhance mental health services for all college students. Required activities are: Create a network infrastructure to link the institution of higher education with appropriately trained behavioral healthcare providers; Train students, faculty and staff to respond effectively to college students with mental and substance use disorders; Administer voluntary mental and substance use disorder screenings and assessments; Provide outreach service to inform and notify college students about available mental and substance use disorder services. Details One time 3 year award up to $102, grants to 232 institutions of higher education awarded since

26 National Strategy for Suicide Prevention Grants Current funding 5 grants at $470,000 a year for 3 years. Population of focus is adults age 25 and older. New cohort released in FY2018. States awarded were Utah, Massachusetts, Florida, Maine and Tennessee. Advance Goals 8 & 9 of the NSSP Goal 8: Promote suicide prevention as a core component of health care services. Goal 9: Promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors. Work across state departments and systems to implement comprehensive suicide prevention Should include agencies responsible for Medicaid; health, mental health, and substance abuse; justice; corrections; labor; veterans affairs; National Guard; health plans and managed health and behavioral health organizations; other appropriate groups as relevant for your state.

27 Suicide Prevention Resource Center The Nation s first and only Federally funded suicide prevention resource center SAMHSA-funded resource center devoted to advancing the National Strategy Information on suicide prevention activities in every state (state plans, coordinators) Provides technical assistance on programs and activities for both grantees and non-grantees Clinical training for MH professionals Free on-line and webinar trainings Weekly newsletter- SPARK (Sign up!!) Zero Suicide lead

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29 National Suicide Prevention Lifeline The Lifeline is a telephone network comprised of 160 independent crisis centers across the country dedicated to preventing suicide. By dialing TALK, people in emotional distress or suicidal crisis have 24/7 access to trained workers who can offer support, empathy and refer callers to additional crisis services, if needed. Using innovative technology, callers are routed to their nearest crisis center, helping to ensure as best as possible that they receive culturally-relevant support and information about local community services. Since its launch in 2005, the Lifeline has seen a steady increase in call volume and answers more than 200,000 calls per month and has taken more than TWELVE MILLION calls to date.

30 Lifeline Continued 160 local crisis centers Regional Back up capacity Collaborates with Veterans Administration for Press 1 option Answered over 2 million calls in CY2017 In response to Lifeline evaluation findings, created the Crisis Center Follow-up Grants (36 crisis center grantees funded to-date) Chat services added 24/7 Feb 2014 Spanish sub-network Linked by calling TALK (8255) or SUICIDE Follow-up grants, risk assessment standards, and imminent risk guidelines were all a result of the Lifeline evaluation findings. (research-to-practice in action)

31 31 Lifeline in Vermont Currently one center in Vermont that participates in the Lifeline under limited hours In-state answer rate: total calls in Vermont- 1, were answered in state giving Vermont a 1% in-state answer rate which is the lowest in the country besides Wyoming. Remainder abandoned or answered out of state. 27% increase in call volume from had 9% answer rate and 2015 a 5% answer rate. Two important things to be aware of: Those who, on average, are answered in-state are answered twice as fast as those that role to backup centers. Also experience less abandoned calls. SAMHSA has implemented requirements to include plans to reach 70% minimum in-state answer rates in current and future SP grant cycles.

32 32 State and Crisis Center Collaboration Since including Lifeline in-state answer response (70%) in grant programs, many states have increased focus and support for the Lifeline Rhode Island Governor inclusion of Lifeline support and the Dept. of Behavioral Health has developed a new one stop, no wrong door center that is combining the opioid treatment line and the Lifeline responsibilities in one call center Arkansas creation of the Arkansas Lifeline Call Center- went live 12/11/17 Collaborations in Oklahoma with Heartline crisis center and NSSP grant for follow-up Centerstone of Tennessee receiving Follow-up grant, partnering on NSSP and GLS programming for enhanced follow-up Enhanced discussions and plans for high roll-over volume to backup network And many more

33 National Hotline Improvement Act Introduced by Sen. Orrin Hatch and Rep. Chris Stewart of Utah in May 2017 Aims to designate a new national 3-digit dialing code (N-1-1) for a national mental health crisis and suicide prevention hotline: Recommend best 3-digit number for a crisis hotline Examine efficacy of current Lifeline and VCL and recommend improvements Perform a cost-benefit analysis of using a three-digit code

34 Zero Suicide FY2018 Zero Suicide Grants New adult suicide prevention grant program from Cures Act States, Tribes and health/behavioral healthcare systems Goal to completely embed ZS in health and behavioral healthcare systems $7.9 million for 5 years

35 35 Using Social Media and Emerging Technologies to Engage 2 ways- information dissemination vs. user generated content Pros vs cons example Barriers to Address: Transitioning to new technologies takes patience, time and courage. Not an overnight process, even with app download! Challenges historical ways of organizational thinking and current processes/structures in place. In rural areas, the lack of technology infrastructure, such as having needed bandwidth for operations of telehealth, many times limits full, successful implementation. Important for suicide prevention work.

36 36 SAMHSA has invested in several initiatives specifically aimed at increasing behavioral health service utilization nationwide through the use of technology Mobile App Development National Suicide Prevention Lifeline- chat and social media Partnerships with social media- Facebook and others

37 37 Apps Content The "Talk. They Hear You." (TTHY) app: interactive game Centerstone of Tennessee Relief Link KnowBullying BH Disaster Response App Texas Lifeline

38 38 What Does This Mean For Suicide surveillance, research, and prevention Surveillance: used to identify, track and connect Research: short-term outcomes easier to identify than long-term impact Prevention: Rates for suicide continue to rise. Social media and app utilization allows for another avenue to reach individuals both before and during suicidal crisis. Little is know regarding impact of app and social media engagement in suicide prevention. How will you know if you are effective? Major gaps- but opportunities exist.

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40 The Garrett Lee Smith (GLS) Suicide Prevention National Outcomes Evaluation is supported through contract no. HHSS I/HHSS T (reference no ) awarded to ICF International by the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS). THE IMPACT OF GLS SUICIDE PREVENTION PROGRAM ON YOUTH SUICIDAL BEHAVIOR Lucas Godoy Garraza (ICF International); Christine Walrath (ICF International); David Goldston (Duke CSSPI); Hailey Reid (ICF International), Richard McKeon (SAMHSA)

41 GLS Evaluation Findings Results suggest there is an important reduction on youth suicide and attempts following the implementation of GLS. More than 400 deaths were avoided between More than 100,000 attempts among youth were avoided during approximately the same period.

42 Zero Suicide With a focus on suicide care using such rigorous quality improvement processes, Henry Ford Health System demonstrated stunning results a 75 percent reduction in the suicide rate among their health plan members (Coffey 2007) Centerstone, one of the nation s largest not-for-profit CMHCs, saw a reduction in suicide deaths from a baseline of 35 per 100,000 to 13 per 100,000 after implementing Zero Suicide for 3 years Educational Development Center is currently working on a collection of recent impact examples from healthcare organizations around the United States

43 There is Hope Reaching new people- Through the chat program Lifeline has significantly increased the reach to young people. Evaluation indicates that 44% of those that reach out via chat are under the age of 20 (75% are under 29) They are also a high risk group with 53% entering the chat reporting current suicidal thoughts (and an additional 27% with suicidal thoughts in the "recent past") From previous evaluation: Follow-Up works- 80% individuals reported crisis center follow-up played a role in keeping them alive

44 A Challenge to Everyone Identify what you are doing Identify what you need- as an individual, organization, community and a state Challenge systems to change and support SP efforts- including me Modify your programs as national/state/community suicide prevention evolves Identify and track all those in suicidal crisis- know where they are, how they are doing and how your program is impacting their lives

45 Preventing Suicide Is Everyone s Business To those who have lost their lives by suicide, To those who struggle with thoughts of suicide, To those who have made an attempt on their lives, To those caring for someone who struggles, To those left behind after a death by suicide, To those in recovery, and To all those who work tirelessly to prevent suicide and suicide attempts in our nation. We believe that we can and we will make a difference. Dedication from the 2012 National Strategy for Suicide Prevention

46 46 Thank you. SAMHSA s mission is to reduce the impact of substance abuse and mental illness on America s communities. James Wright, LCPC James.wright@samhsa.hhs.gov SAMHSA-7 ( ) (TDD)