Suicide Prevention

1. Suicide Prevention Signs, Symptoms, and Solutions

2. There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest -- comes afterward. These are games; one must first answer. ALBERT CAMUSAn Absurd Reasoning • French author, journalist & philosopher (1913-1960)

3. Mick Jagger, nominated for a Golden Globe for his music in "Hotel Rwanda" arrives with L'Wren Scott for the 62nd Annual Golden Globe Awards on Sunday, Jan. 16, 2005, in Beverly Hills, Calif.(KEVORK DJANSEZIAN/AP) • ANDREW RYAN • The Globe and Mail • Published Friday, Mar. 28 2014, 10:07 AM EDT at http://www.theglobeandmail.com/life/celebrity-news/the-a-list/lwren-scott-leaves-9-million-estate-to-mick-jagger-and-nothing-to-her-siblings/article17716501/ Accessed March 28, 2014.

4. 49-year-old L’Wren Scott was found dead in her Manhattan apartment on March 17. The New York City medical examiner determined that “she killed herself by hanging.” “According to public records, Scott’s personal estate was worth approximately $9 million” ANDREW RYAN The Globe and Mail Published Friday, Mar. 28 2014, 10:07 AM EDT at http://www.theglobeandmail.com/life/celebrity-news/the-a-list/lwren-scott-leaves-9-million-estate-to-mick-jagger-and-nothing-to-her-siblings/article17716501/ Accessed March28, 2014. Beautiful and elite, this celebrity fashion designer’s world crashed The day after Scott’s death, Jagger wrote on his website, “I am still struggling to understand how my lover and best friend could end her life in this tragic way. We spent many years together and had made a great life for ourselves. She had great presence and her talent was much admired, not least by me ... I will never forget her." www.mickjagger.com Accessed April 4, 2014

5. We ask … • How can this happen? • How can someone make a decision against life? • Stunned loved ones wonder what they missed, what they could’ve done, left behind to feel guilt, shame, bewilderment. • American individualism? • Or are communal values the priority?

6. Suicide Blue collar, white collar, rich, poor, homeless Men more than women (women make more attempts) Caucasian and Native Americans (more than African-Americans and Asians) Firearms most commonly used, followed by hangings

8. Suicide affects our community • Causes and reflects immeasurable pain, suffering, and loss to individuals, families, and communities nationwide. • For every suicide more than 30 others attempt suicide annually • Each attempt and death affects countless other individuals. • Family members, friends, coworkers, and others suffer the long-lasting consequences of suicidal behaviors. • SAMSHA 2012 National Strategy Overview at http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/overview.pdf. Accessed April 4, 2014.

9. Cultural and Historical Aspects • Honor/shame • Some religious and cultural traditions sanction suicide (Islamic sects, Hindu widows, Japanese disgrace, Chinese political corruption) Use of insecticides • Western Judeo-Christian culture • Common Era church leaders concerned by high rates of suicide related to martyrdom. St Augustine’s City of God proscription • Romans • initially accepted suicide but later outlawed all manners of reducing the population

10. England and colonial United States • England and colonial U.S. • King Edgar proclaims goods of a person who dies by suicide are forfeited. • Henry de Bracton (13th century jurist) declares suicide a crime • 17th century suicides considered criminal even if there was evidence of mental illness • This history provides the backdrop for our modern perspectives of suicide IOM,2002. Reducing Suicide pp 24-5.

11. Yet over the last millennium the associations still very similar • Serious mental illness • Depression, Schizophrenia, Bipolar Disorder, Personality DO • Alcohol and substance abuse • Medical co-morbidities • Head trauma, neurological d/o, HIV, cancer • Childhood loss • Loss of a loved one • Fear of humiliation • Economic dislocation • Insecurity IOM, 2002. Reducing Suicide p 21

12. Emotional and Economic costs in U.S. Suicide outnumbers homicides by 2:1 now >38,000 per year; >1 person every 15 minutes Suicide outnumbers death from AIDS Suicide outnumbers deaths from war Lost productivity; $11 billion to 25 billion The loss in terms of emotional, spiritual life is beyond calculation Contagion

13. Stigma makes it worse • Suicidal behaviors are often met with silence and shame • Families of suicide victims often experience the same • The stigma of suicide can be a formidable barrier to providing care and support to individuals in crisis and to those who have lost a loved one to suicide. • SAMSHA 2012 at

15. Suicide is a serious public health problem 1958 U.S. Public Health Service first suicide prevention center 1966 Center for Suicide Studies (NIMH) 1980s CDC task force; youth violence 1990s World Health Organization concern 1996 Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies by the UN and WHO 1998 Private/public partnerships respond Federal commitment Healthy People 2010 to reduce rate to 6/100,000 (1/2 current)

16. The 1999 Surgeon Generals Call to Action David Satcher MD Reduce the suicide rate to 6 by 2010 Begin educational efforts for suicide prevention, target mental illness while program being developed Followed by the 2001 National Strategy for Suicide Prevention published by U.S. DHHS and Public Health Service.

17. The Public Health Approach Public health model Define the problem--surveillance Identify causes--risk and protective factor research Develop and test interventions Implement intervention Evaluate effectiveness Effectiveness is difficult to measure; no control, no placebo group, may take decades

18. National Strategy for Suicide Prevention “The National Strategy provides a framework that helps communities to devise their own broad-based empowering strategies for reducing suicides. It employs the public health approach, which has helped the nation effectively address problems as diverse as tuberculosis, heart disease, and unintentional injury.” http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/index.html http://www.samhsa.gov/nssp http://www.actionallianceforsuicideprevention.org/NSSP

19. The Assumption The approach assumes that raising general public awareness about the extent to which suicide is a problem, and about the ways in which it can be prevented, can reduce suicide and suicidal behaviors.

20. The Second Wave is now here The initial 2001 publication was by the National Institute of Mental Health (NIMH) The 2012 National Strategy is a joint effort by the Office of the U.S. Surgeon General and the National Action Alliance for Suicide Prevention (Action Alliance), intended to guide prevention activities the next 10 years.

21. Important achievements the past 10 years • Garrett Lee Smith Memorial Act • Creation of the National Suicide Prevention Lifeline (1-800-273-TALK/8255) • Partnership with the Veterans Crisis Line • Establishment of the Suicide Prevention Resource Center (SPRC) • Clinician trainings, community members, collaboration between public and private sectors.

23. Activity in the field of suicide prevention has grown dramatically since the National Strategy was issued in 2001 • Government agencies at all levels • Schools • Nonprofit organizations • Businesses

24. A Plethora of Organizations are involved! Department of Health and Human Services Centers for Disease Control National Institutes of Health and NIMH Department of Defense Dept of Veterans Affairs

25. A Big push the last 10 years American Foundation for Suicide Prevention Suicide Awareness Voices of Education American Association of Suicidology

26. Social Media is a piece of this cooperation

27. Public/Private organizations are involved now • Action for Alliance • >200 National Leaders • Private organizations and entities • Facebook • Universities of Chicago, Rochester, Calgary • Entertainment Industries Council • Mental Health Association of San Francisco • National Organization of People Against Suicide • Samaritans USA • Suicide Awareness Voices of Education • Jason Foundation • Jed Foundation • Henry Ford used in Sedg Co

29. School-Based Prevention Programs http://www.afsp.org/ SOS Signs of Suicide® Prevention Program (SOS)

30. http://www.mentalhealthscreening.org/programs/youth-prevention-programs/sos/http://www.mentalhealthscreening.org/programs/youth-prevention-programs/sos/ • The SOS High School Program is the only school-based suicide prevention program listed on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices that addresses suicide risk and depression, while reducing suicide attempts. In a randomized control study, the SOS program showed a reduction in self-reported suicide attempts by 40% (BMC Public Health, July 2007).

31. USD 259 Yellow Ribbon • Evaluation of pre/post program surveys • Improvement in knowledge and confidence in engagement in help seeking behaviors • May be especially useful for middle school boys • No harm

32. International Drive International Association for Suicide Prevention http://www.iasp.info/index.php http://www.who.int/en/

33. Spin off policies and programs Access to weapons; Firearms, packaging meds Mental Health programs APA’s Vision for Mental Health System The President’s New Freedom Commission The Interim Report of the President’s New Freedom Committee On Mental Health caution the nation about the impending mental health catastrophe if the attitude of denial and neglect continues unchanged APA Suicide Treatment Guidelines Population based studies/Centers/Youth resiliency

34. The 2012 National Strategy for Suicide Prevention is a joint effort • The Office of the Surgeon General • The National Action Alliance for Suicide Prevention (Action Alliance, NAASP) • 4 strategic directions/13 goals/60 objectives • Creating supportive environments and promoting healthy empowered families and communities • Enhancing clinical and community preventive services • Promoting available and timely treatment and support services • Improve suicide prevention surveillance collection, research, and evaluation SAMHSA 2012 NSSP Overview

35. National Strategy for Suicide Prevention • A Awareness of the problem and risks • Now under Healthy and Empowered Individual, Families, and Communities • I Intervention to solve the problem • Spread against 3 strategic directions • M Methodology to monitor the populations at risk • Expanded to include surveillance and program evaluation

36. Our Duck Pond • State of Kansas Suicide Prevention Task Force asked Sedgwick County members to start a local task force • The Suicide Prevention Task Force became a Coalition in 2009 • A recent local addition of the American Foundation for Suicide Prevention

37. Teachers and school staff School health personnel Clergy Police officers Correctional personnel Supervisors in occupational settings Natural community helpers Hospice and nursing home volunteers Primary health providers Mental healthcare and substance abuse treatment providers Emergency healthcare personnel. 2001, DHHS. NSSP p78 Key gatekeepers

38. I. Define the Problem Surveillance of suicide attempts is fraught with concerns about nomenclature, accuracy in reporting, lack of systematic or mandatory reporting Educated and not so educated guesses. KS counties Definitions lacking-population differences Assisted suicide is a “separate issue”-should not be included in the rate

39. Various agencies utilize different data Death certificates Coroner reports Data may be gathered by county of residence or by site of death Field reporters obtain the personal data and interview the families

40. Suicides are tracked by using a Rate No. of suicides per 100,000 persons Overlaps other injury data (ODs, MVAs) The Rate: Is influenced by economic, spiritual, political factors An indicator of a country’s health, hope, stability, and culture. 10th on the list of U.S. Health Indicators

41. Comparing Suicide Rates Nine of the 10 highest suicide rates worldwide are in Europe. The average suicide rate in Europe is 13.9 • Rates as high as 30.7 in Lithuania (41.9 in 2001; males at 73.8), 21.5 in Hungary (43 in 1999), and 18.5 in Finland and 18.4 in Slovenia. • Russian Federation rate in 1998 was 35.5. http://www.who.int/topics/suicide/en/ 2002, IOM. Reducing Suicide p 35

42. Who Crunches the Numbers? National Suicide Prevention Resource Center CDC utilizes Injury and Violence Data National Violent Death Reporting System Model: National Highway Traffic Safety Administration’s system for motor vehicle deaths

43. National Violent Death Reporting System (NVDRS) Harvard-designed to collect information on homicides and suicides and firearms deaths Based on FARS and the National Violent Injury Statistics System (NVISS) Testing at 10 sites-information from death certificates, coroner/medical examiner reports, police Uniformed Crimes Reports, crime laboratories Expected to allay irregular quality of data available through the coroner system Currently collects data in only 18 states

44. Comparisons

45. Despite efforts at prevention the last 15 years … The suicide rate has actually increased Despite the use of antidepressants and improved healthcare and mental healthcare Despite the economy Despite our rich heritage and freedoms Is this an indication of whether our programs are working or not?

47. Public health program concerns Anti-smoking, cancer screening, AIDs prevention can point to success in lives saved Suicide rate however has increased in the U.S. The risk factors for suicide have a wide distribution, are large in number, have a high prevalence, and inherent challenges that make mounting large scale prevention programs difficult. Societal targets (limiting access to lethal means, improving community detection and treatment) have as yet been unsuccessful in achieving a reduction Baker SP, 2013

48. The Disconnect 1990s—The Decade of the Brain Suicidality has a life apart from mental illness No professional has been able to consistently predict individuals’ suicide Mental health tools have been unproven in terms of affecting suicidality

49. The association of suicide with mental illness … Is a “conundrum” 80-90% of people who commit suicide have “depression” 95% of mentally ill do not suicide (6-15% of depressed patients commit suicide, 7% with alcohol dependence, 4% with schizophrenia) (IOM p394)