From Plan to Action: New York State Suicide Prevention in 2017

Transcription

1 From Plan to Action: New York State Suicide Prevention in 2017 Jay Carruthers, MD Director, OMH Suicide Prevention Office NYS Suicide Prevention Conference September 18-19, 2017 Albany Hilton

2 3 Suicide: An Enormous Public Health Problem 20% 10% 0% -10% -20% -30% -40% Percent Change in Age-Adjusted Death Rates since 2003 by Cause of Death, Suicide Heart disease Cancer Stroke All-cause From 1999 through 2014, the age-adjusted suicide rate in the United States increased 24%, from 10.5 to 13.0 per 100,000 population NCHS Data Brief No. 241, April 2016 Center for Disease Control and Prevention

3 4 Integrated Suicide Prevention in NYS CLINICAL APPROACHES

4 Zero Suicide Community Interventions Surveillance & QI Data 5

5 6 The Zero Suicide Model

6 Bedrock Principles of the Zero Suicide Model Most suicide deaths are among people in care or recently seen in healthcare. Suicide prevention must become a core responsibility of health care organizations and systems. We have new knowledge about detecting and treating suicidality. Very little of it is commonly used. The gap between what we know and what we do can be fatal. We must apply new knowledge. Preventing suicide deaths in health care requires a systematic clinical approach, not the heroic efforts of crisis staff and individual clinicians. We have work to do. Slide provided by Mike Hogan, PhD 7

7 8 Zero Suicide

8 THE TOOLS OF ZERO SUICIDE FILL THE GAPS EDC All rights reserved.

9 10 Zero Suicide: Early Evidence It Works Centerstone Behavioral Health System

10 11 Zero Suicide s Evolution in New York State

11 12 NYS Zero Suicide Implementation Medical-Surgical Primary Care ERs Behavioral Health

12 13 Leveraging Existing NYS Data Sets NIMRS PSYCKES/Medicaid SPARCS Vital Statistics

13 14 NYS Surveillance Patterns: OMH NIMRS Most (~75%) NYS suicide deaths in public mental health care are among community care clients Of 17% classified as inpatient related, vast majority (85%) were within 30 days of discharge *From , among Medicaid recipients that had an OMH (NIMRS) reported suicide death, claims w/in 30 days of death showed: nearly half, 47% (N=61) received outpatient mental health services 11% received Psychiatric ER or Medical ER services; and 5% Psychiatric Inpatient services Among those receiving outpatient MH services w/in 30 days prior to death: most were receiving care in clinics (56%) 6 month look back period prior to death showed: median number of visits was 8 Mode was 3 visits *Source: NIMRS and Medicaid OMH crosswalk analysis; Dual eligibles excluded from analysis

14 15 OMH Outpatient Clinics: Suicide Count by Duration of Care NIMRS Q Q DURATION OF CARE Total Count Percent of Total Under 1 Year % 1-2 Years 49 19% 3-4 Years 22 8% More than 5 Years 41 16% Grand Total % SUICIDES WITHIN 1 Year of Care SUICIDES INVOLVING CLIENTS WITH A Total Count Percent of Total DURATION OF CARE UNDER 1 YEAR Within 1 First Week of Admission 14 9% 1 to 2 Weeks 7 5% 2 to 3 Weeks 15 10% 1 to 3 Months 46 30% 3 to 6 Months 29 19% 6 to 9 Months 21 14% 9 Months to 1 Year 20 13% Grand Total % Among suicides in the first year, nearly 25% in care for 3 weeks; over ½ 3 months!

15 16 NIMRS NYS Surveillance Patterns: Take Home Messages OMH surveillance data suggests the greatest burden of suicidal patients falls on outpatient mental health providers, especially clinics High proportion of suicides among those receiving clinic care occur early in the course of treatment Must be ready from day 1! 16

16 17 Outpatient Clinic Suicide Prevention CQI Project Building Zero Suicide into the project architecture: Systematic personalized screening for increased detection Sound suicide risk assessment to guide treatment & engagement (planning and prevention, not prediction) Zero Suicide High Risk Suicide Care Management Plan/Pathway Safety Plan with means restriction Increased engagement and monitoring Individualized plan that targets drivers Workforce training provided by Learning Collaborative to support culture change Monthly performance metrics for CQI throughout Project launch in Oct. 2017: 170 mental health clinics!

17 18 Leveraging Existing NYS Data Sets NIMRS PSYCKES/Medicaid SPARCS Vital Statistics

18 19 NYS Surveillance Patterns: All Payer SPARCS NYS Suicide Deaths in PRELIMINARY ANALYSIS*** ED or Inpatient discharge w/in 30 Days of Death ED or Inpatient discharge w/in 7 Days of Death 3, (29%) 735 (21%) *SPARCS 2017 analysis from Vital Statistics suicide deaths cross walk

19 SPARCS NYS Surveillance Patterns: Take Home Messages 20 A significant portion of suicides in NYS (1:5?) take place within 7 days of a hospital or ER discharge Improvements in transitional care are critical 20

20 21 Targeting High Risk Transitions NYS National Strategy for Suicide Prevention (NSSP) grant: 3 year ( ) $1.4 M SAMHSA grant Monroe and Erie County catchment area Safety Plans (Brown, Stanley) and Follow-up calls for those at elevated risk being discharged from inpatient psych or CPEPs Inpatient Psychiatric Unit Pilot More aggressive preventive engagement prior to discharge and closer monitoring 21

21 How do we save the most lives? LOW RISK< MODERATE RISK >HIGH RISK

22 23 (Non-Clinical)Community Interventions

23 24 School-based prevention Pat Breux - State Coordinator of School and Youth Initiatives PreventSuicideNY.org

24 2B Suicide Safer Schools Sources of Strength Universal intervention influencing social norms 22 schools 202 School Professionals 404 Student Peer Leaders Creating Suicide Safety in School Comprehensive prevention framework for school planning 175 schools 562 participant 20 workshops Suicide Safety for Teachers Awareness training for teachers and staff 177 trainers 400 teachers trained Lifelines Postvention Crisis Team training improves readiness to support school safety and recovery after a suicide death. School Mental Health Consultant Project Partnership of SPCNY with NYC Office of School Health. 10 hours of training 112 SMHC and supervisors

25 Sources of Strength 26 Developed by Mark LoMurray ( ) Suicide prevention by adolescent Peer Leaders w/ adult mentors National Field Project Award APHA (2005) Testing/program refinement w/ U Rochester began 2006 Increases youth-adult connections, help-seeking acceptance across school populations First Peer Leader program to change school-wide risk-protective factors associated with reduced suicide in RCT w/ 18 schools (Wyman et al 2010, AJPH); NREPP 2012 Slide provided by Peter Wyman, PhD, Univ. Rochester

26 Illustrative High School Social Network w/ Sources of Strength: Clustering of High Risk Students on Periphery 27 Attempt Ideation Node size: local network density Shading: suicide homophily Slide provided by Peter Wyman, PhD, Univ Rochester

27 28 Community Coalitions Garra Lloyd-Lester, Assoc. Director, SPCNY PreventSuicideNY.org

28 Community Highlights: Coalition Expansion 29 Expanded number of existing community coalitions in our state from 43 to 53 which provides coverage to 57 counties all but NYC!

29 30 Community Highlights: Coalition Strengthening Coalition Academy technical assistance to strengthen, bring some standardization and more rigor to coalitions; 6 step structured Strategic Planning process to inform and instruct coalition planning activities Topics covered: Mission statement, maximizing participation, governance, Sustainability Using data Academy results: Broadened participation, including but not limited to: law enforcement, local health departments, VA Suicide Prevention coordinators, medical examiners Increased local infrastructure, capacity and sustainability to support implementation of the State plan at the local level

30 31 Community Highlights: Community-led Postvention Response Based on literature review, expert interviews, and identified best practices, developed and disseminated a Pillars of Postvention technical assistance package 25 coalitions participating in structured process: Understand best practices of postvention Develop or enhance a coordinated local postvention response End product: a coordinated process using a standard framework of best practices while balancing local conditions and circumstances for participating coalition communities

31 32 Acknowledgments: Suicide Prevention is a team endeavor Sigrid Pechenik Brett Harris Alexi Saldamando Jillian King Silvia Giliotti Suicide Prevention Office Center for Practice Innovations: Barbara Stanley Beth Brodsky Christa Labouliere Cory Cunningham Suicide Prevention Center of NY: Garra Lloyd-Lester Pat Breux Samantha Ley NYS Suicide Prevention Council & Commissioner Dr. Ann Sullivan Molly Finnerty Anni Kramer Prabu Vassan Emily Leckman-Westin & Many others.. 32

32 33 Thank you for your time! 33