The 2012 National Strategy for Suicide Prevention: We All Have a Role to Play

The 2012 National Strategy for Suicide Prevention: We All Have a Role to Play

Today s Presenters Jerry Reed, Ph.D., M.S.W. Vice President and Director, Suicide Prevention Resource Center, Center for the Study and Prevention of Injury, Violence, and Suicide, Education Development Center, Inc. Co-lead, National Strategy for Suicide Prevention Revision Task Force, National Action Alliance for Suicide Prevention Janice Petersen, Ph.D., Director, Office of Prevention, and the Prevention and Early Intervention Team Lead for the Community Policy Management Section of the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services President, National Prevention Network Representing NASADAD Michael Hogan, Ph.D., Independent Advisor & consultant, Hogan Health Solutions Former Commissioner, New York State Office of Mental Health Member, National Strategy for Suicide Prevention Revision Task Force, and Co-Lead of the Clinical Care and Intervention Task Force, National Action Alliance for Suicide Prevention Representing NASMHPD Richard McKeon, Ph.D., M.P.H. Suicide Prevention Branch Chief, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services Member and Strategic Direction 3 Lead, National Strategy for Suicide Prevention Revision Task Force, National Action Alliance for Suicide Prevention

Presentation Overview We All Have a Role to Play Jerry Reed Key NSSP Objectives Identified by NASADAD and NASMHPD NASADAD: North Carolina s Response to Suicide Prevention Janice Petersen NASMHPD: Learning About a Systems Approach: The Zero Suicide Concept Michael Hogan SAMHSA: Partners Can Richard McKeon Discussion 3

We All Have a Role To Play Jerry Reed, Ph.D., M.S.W. jreed@edc.org Vice President and Director, Suicide Prevention Resource Center, Center for the Study and Prevention of Injury, Violence, and Suicide, Education Development Center, Inc.; Co-lead, NSSP Revision Task Force, National Action Alliance for Suicide Prevention; Member, Action Alliance EXCOM

e: UN Guidelines for the ntation of national strategies uld establish l or nonbody to be on of suicidal proach

Action Alliance Vision A nation free from the tragic experience of suicide. 6

Action Alliance Mission To advance the NSSP by: Championing suicide prevention as a national priority Catalyzing efforts to implement high-priority objectives of the NSSP Cultivating the resources needed to sustain progress 7

NSSP Dedication 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. 8

Strategic Directions within the National Strategy for Suicide Prevention 9

Strategic Direction 1 Healthy and Empowered Individuals, Families, and Communities GOAL 1. Integrate and coordinate suicide prevention activities across multiple sectors and settings. (5 related objectives) GOAL 2. Implement research-informed communication efforts designed to prevent suicide by changing knowledge, attitudes, and behaviors. (4 related objectives) GOAL 3. Increase knowledge of the factors that offer protection from suicidal behaviors and that promote wellness and recovery. (3 related objectives) 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. (4 related objectives) 10

Strategic Direction 2 Clinical and Community Preventive Services GOAL 5. Develop, implement, and monitor effective programs that promote wellness and prevent suicide and related behaviors. (4 related objectives) GOAL 6. Promote efforts to reduce access to lethal means of suicide among individuals with identified suicide risk. (3 related objectives) GOAL 7. Provide training to community and clinical service providers on the prevention of suicide and related behaviors. (5 related objectives) 11

Strategic Direction 3 Treatment and Support Services GOAL 8. Promote suicide prevention as a core component of health care services. (8 related objectives) GOAL 9. Promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors. (7 related objectives) GOAL 10. Provide care and support to individuals affected by suicide deaths and attempts to promote healing, and implement community strategies to help prevent further suicides. (5 related objectives) 12

Strategic Direction 4 Surveillance, Research, and Evaluation GOAL 11. Increase the timeliness and usefulness of national surveillance systems relevant to suicide prevention, and improve the ability to collect, analyze, and use this information for action. (4 related objectives) GOAL 12. Promote and support research on suicide prevention. (4 related objectives) GOAL 13. Evaluate the impact and effectiveness of suicide prevention interventions and systems, and synthesize and disseminate findings. (4 related objectives) 13

Key Objectives Identified by SG1, Objective 1.2: Establish effective, sustainable, and collaborative suicide prevention programming at the state/territorial, tribal, and local levels. SG1, Objective 3.2: Reduce the prejudice and discrimination associated with suicidal behaviors and mental and substance use disorders. SG1, Objective 3.3: Promote the understanding that recovery from mental and substance use disorders is possible for all. SG2, Objective 7.2: Provide training to mental health and substance abuse providers on the recognition, assessment, and management of at-risk behavior, and the delivery of effective clinical care for people with suicide risk. SG3, Objective 9.5: Adopt and implement policies and procedures to assess suicide risk and intervene to promote safety and reduce suicidal behaviors among patients receiving care for mental health and/or substance use disorders. 14

Key Objectives Identified by SG1, Objective 1.2: Establish effective, sustainable, and collaborative suicide prevention programming at the state/territorial, tribal, and local levels. SG1, Objective 3.3: Promote the understanding that recovery from mental and substance use disorders is possible for all. SG2, Objective 5.1: Strengthen the coordination, implementation, and evaluation of comprehensive state/territorial, tribal, and local suicide prevention programming. SG3, GOAL 8, all objectives: Promote suicide prevention as a core component of health care services, to include promoting "zero suicides" (8.1), continuity of care (8.4), coordinating services (8.7), and developing collaboration (8.8). SG3, Objective 9.5: Adopt and implement policies and procedures to assess suicide risk and intervene to promote safety and reduce suicidal behaviors among patients receiving care for mental health and/or substance use disorders. 15

North Carolina s Response to Suicide Janice Petersen, Ph.D. janice.petersen@dhhs.nc.gov President: National Prevention Network Director, Office of Prevention, Prevention and Early Intervention Team Community Policy Management Section NC Division of MHDDSAS Representing NASADAD

North Carolina s Response to Suicide 17

North Carolina s Response to Suicide Deaths by suicide Nationally, it is estimated that 25-33% of deaths by suicide include some form of substance use. In North Carolina: alcohol and substance use problems are estimated at 26% (2011, NC Violent Death Reporting System) NC trends follow national trends. 18

North Carolina s Response to Suicide Comprehensive preventive approach to addressing risk and protective factors identifies with the IOM model of universal, selective and indicated to describe population groups: Universal: address the entire population with messages and strategies aimed at specific sub-groups (youth, schools, parents) Selective: target subsets of the total population deemed to be at a higher risk (ideations, peer influences) Indicated: targets individuals who are showing early warning signs (attempts, substance use) 19

North Carolina s Response to Suicide North Carolina DHHS System Division of MH/DD/SAS Division of Medical Assistance Division of Public Health Local Management Entities/Managed Care Organizations (LME / MCO) Local Health Departments (LHD) Community Care in North Carolina (CCNC) Integrated primary & behavioral health care settings Partnerships Faith Communities, Tribal Organizations, NC Youth MOVE, National Alliance for Mental Illness/NAMINC, NC Families United, ARC, Autism Society 20

North Carolina s Response to Suicide Current Practices: Block Grants NC Suicide Prevention Lifeline 1-800-273-TALK (8255) 24/7/365 person response, 100 counties >3000 calls triaged monthly, avg. 234 referrals to Mobile Crisis Teams, call follow-up services provided 1 of 6 VA Call Centers in US (June 2012) - >1200 calls monthly LME/MCO Crisis Lines and Mobile Services Text for Teens: NAMI in partnership with LME/MCOs (7 county pilot) 21

North Carolina s Response to Suicide Support: LME/MCO Crisis Lines & Mobile Crisis Services Prevention & Postvention Support Gatekeeper Trainings: Question, Persuade, Refer (QPR) and Applied Suicide Intervention Skills Training (ASIST) Curricula Programs for Schools and Professional Groups Outreach & support consumer, youth & family organizations PSA & Web site: Its Ok To Ask 22

North Carolina s Response to Suicide Support: Training and support through SAMHSA via the Garrett Lee Smith Grant-collaboration with the Division of Public Health Mental Health First Aid Training statewide Public private partnerships: faith, businesses, employee assistance programs, higher education 23

North Carolina s Response to Suicide Key Resources for Suicide Prevention: Surgeon General s Call to Action National Suicide Prevention Lifeline (1-800-873-TALK/8255) Suicide Prevention Resource Center (SPRC) After A Suicide: A Toolkit for Schools Suicide Prevention Took Kit for Rural Primary Care Practices SAMHSA Guidance Documents/Tool Kits National Council for Community Behavioral Healthcare integrated care practices to prevent suicides National Action Alliance for Suicide Prevention 24

North Carolina s Response to Suicide Building Strong Community Support: Healthy Carolinians 2020 Parent Resource Centers Community Collaboratives / Coalitions Social Supports and Social Connectedness Aging & elder care communities Higher Education Collaboratives - NC College/Community Coalitions C-3 25

North Carolina s Response to Suicide Highlight Story: Cherokee Healing and Wellness Coalition, Cherokee NC SAMHSA/CSAP 2012 Prevention Week Community Pilot Award Recipient We work collaboratively to address the loss of culture and traditions that are a result of acculturation, historical trauma, grief and loss which cause many of the social problems that affect the well-being of Native Americans, especially the Eastern Band of Cherokee Indians. Promote several wellness and prevention programs around issues of suicide, celebrate life and promote mental health wellness; and participate in the Forgiveness Journey 26

North Carolina s Response to Suicide 27

Learning About a Systems Approach: The Zero Suicide Concept Michael Hogan, Ph.D. dr.m.hogan@gmail.com Independent Advisor and Consultant, Hogan Health Solutions; former Commissioner, New York State Office of Mental Health; Member, NSSP Revision Task Force, National Action Alliance for Suicide Prevention; Member, Action Alliance EXCOM Representing NASMHPD

The inspirations: Learning About a Systems Approach: The Zero Suicide Concept (NSSP Goal 8, Objectives 3.3, 9.5) U.S. Air Force: We CAN bend the curve. It takes everyone, prepared and ready Henry Ford Health System s Perfect Depression: Why not zero defect behavioral health care? Why not Zero Suicide? 29

Learning About a Systems Approach: The Zero Suicide Concept (NSSP Goal 8, Objectives 3.3, 9.5) The inspirations: Other examples in health care: Zero Cancer 30

Learning About a Systems Approach: The Zero Suicide Concept (NSSP Goal 8, Objectives 3.3, 9.5) The inspirations: New knowledge about suicidality: Diagnosis is not destiny: Survivors survive Tools exist: We can do this o Screening o Provide tools to the entire workforce o Collaborative management and treatment New data: Systematic approaches work The Lancet, While et al. (February 2, 2012). o Systematic mental health change reduced suicide 20%. Central Arizona Collaborative 31

How Do We Begin To Get This Done? 1: Describe It From: Stand-alone training for a few Individual provider actions; suicide care as individual specialty Episodes of crisis Suicide Care in Systems Framework To: Systems & culture change Suicide prevention woven into all aspects of care; part of everyone s job what we have learned about staff readiness) Continuity of care; a collaborative approach with individual, family http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/taskforces/clinicalcareinterventionreport.pdf

How Do We Begin To Get This Done? 2: Build Innovation and Adoption Capacity Innovator Agencies and Systems: Arizona-Maricopa County, Kentucky, New York, Tennessee, Texas, Wisconsin Learning Together: Virtual Learning Community facilitated by SPRC Zero Suicide website (v. 1.0 to be launched soon): Development by the Action Alliance s Clinical Care and Intervention Task Force, SPRC, National Council for Community Behavioral Healthcare, and expert advisers Capacities Very soon: Information, links, motivation Soon: Implementation support; streaming instruction on: workforce assessment, screening, proven interventions for safety, follow-up after acute care, performance improvement 33

Partners Can Richard McKeon, Ph.D., M.P.H. Suicide Prevention Branch Chief, Substance Abuse and Mental Health Services Administration, U.S. Dept. of Health and Human Services; Lead: Strategic Direction 3, NSSP Revision Task Force, National Action Alliance for Suicide Prevention

State, Tribal, Local, and Territorial Governments can Healthy and Empowered Individuals, Families, and Communities Identify a lead agency to coordinate and convene public and private stakeholders, assess needs and resources, and develop and implement a comprehensive strategic suicide prevention plan. Develop and implement an effective communications strategy for promoting mental health and emotional well-being that incorporates traditional and new media. Disseminate recommendations for reporting on suicide to news organizations. The recommendations can be found at http://reportingonsuicide.org. 35

State, Tribal, Local, and Territorial Governments can Clinical and Community Preventive Services Identify groups at risk and work with various stakeholders to implement suicide prevention policies and programs that address the needs of these groups. Sponsor trainings and disseminate information on means restriction to mental health providers, professional associations, and patients and their families. Sponsor medication take-back days and ongoing methods for the disposal of unwanted medications (e.g., secure collection kiosks at police departments or pharmacies). 36

State, Tribal, Local, and Territorial Governments can Treatment and Support Services Disseminate information about the National Suicide Prevention Lifeline and other local or regional crisis lines. Promote the availability of online support services and crisis outreach teams. Develop protocols and improve collaboration among crisis centers, law enforcement, mobile crisis teams, and social services to ensure timely access to care for individuals with suicide risk. 37

State, Tribal, Local, and Territorial Governments can Surveillance, Research, and Evaluation Analyze and identify strategies to increase the efficiency of state-based processes for certifying, amending, and reporting vital records related to suicide deaths. Implement the Centers for Disease Control and Prevention (CDC) s action plan for improving external cause of injury coding. Adopt recommended self-directed violence uniform definitions and data elements developed by CDC and the Department of Veterans Affairs. Improve data linkage across agencies and organizations, including hospitals, psychiatric and other medical institutions, and police departments, to better capture information on suicide attempts. 38

Registrants Key Objectives Katherine Wootten Deal, M.P.H. Deputy Secretary, National Action Alliance for Suicide Prevention, Suicide Prevention Resource Center, Center for the Study and Prevention of Injury, Violence, and Suicide, Education Development Center, Inc.

Key Objectives Identified by Today s Registrants Those already identified by NASADAD & NASMHPD (except 9.5) SG1, Goal 1, all objectives: Integrate and coordinate suicide prevention activities across multiple sectors and settings. SG1, Objective 2.4: Increase knowledge of the warning signs for suicide and of how to connect individuals in crisis with assistance and care. SG1, Goal 3, all objectives: Increase knowledge of the factors that offer protection from suicidal behaviors and that promote wellness and recovery. SG2, Goal 5, all objectives: Develop, implement, and monitor effective programs that promote wellness and prevent suicide and related behaviors. SG3, Objective 9.1: Adopt, disseminate, and implement guidelines for the assessment of suicide risk among persons receiving care in all settings. SG4, Objective 11.3: Improve and expand state/territorial, tribal, and local public health capacity to routinely collect, analyze, report, and use suiciderelated data to implement prevention efforts and inform policy decisions. 40

Discussion