Suicide Prevention and System Integration - PowerPoint Presentation

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Suicide Prevention and System Integration

Jeff Coady, Psy.D. Region V AdministratorSAMHSA/DHHS

Midwest Injury Prevention Alliance 2014 Summit

October 27, 2014 Chicago, ILSlide3

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 diverse as the U.S. Air Force and the Henry Ford Health System have also shown reductions.Slide4

Suicide Prevention Requires

A comprehensive, sustained, data-driven strategy.A comprehensive approach must contain an active, effective community component, as well as an active, effective clinical systems approach.Community systems must include workplaces, schools, faith-based organizations, justice systems, as well as all health care systems.Slide5

HHS Region V

Suicide rate per 100,000 in 2011

National Center for Injury Prevention and Control

WISQARS, NVSS 2011

12.41

9.26

13.55

12.36

12.77

12.16Slide6

Suicide: Data and Disparities

Suicides

4 males : 1 female

Highest risk: elderly white males (85+)

Largest numbers: middle-aged (40-60) males at 2x’s baseline rate of other Americans and working-aged males (20-64) = 60 percent of suicides

Higher risk: young and middle-aged AI/AN

Suicide attempts

Female > male

Rates peak in adolescence and decline with age

Higher risk: LGBT youth and young LatinasSlide7

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 attemptsSlide8

Connection between Substance Abuse and Suicidality

Suicide is the leading cause of death among people with substance use disorders (SUDs).Compared with the general population, people treated for alcohol abuse or dependence are at about a 10x greater risk for suicide. (Wilcox, et al., 2004)Those who inject drugs are at about a 14x greater risk for suicide. (Wilcox, et al., 2004)

The number of substances used seems more predictive of suicide than the types. (SAMHSA, 2008)Slide9

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.Slide10

Integrative Care and Suicide

Public HealthPrimary Care

Community Based OrganizationsSlide11

HOMICIDE

MVAs & Accidental Poisoning

Suicide

Accumulating Risk

Emerging Behavioral Problems &

Mental Health Disturbances

School Difficulties

Alcohol and Substance Misuse

Legal System Involvements

Emergency Room Visits

Mental Health & Chemical Dependency Treatment Contacts

Common Risk Factors for Premature Death

Disruptive Family Factors

Disadvantaged Economic & Social Factors

Indicated & Clinical

Selective

& Indicated

Universal &

Selective

Prevention & Intervention

Opportunities Slide12

Shared Risk and Contributing Factors

Family history of suicide or child abuseHistory of mental (especially mood) disordersHistory of or family history of addictionImpulsivenessFeelings of isolationBarriers to behavioral health treatment

Relational, social, work, or financial losses

Physical illness/Chronic pain

Access to lethal means

DelinquencySlide13

Shared Protective Factors

Social supportConnectedness to community and institutionsCoping/problem solving skillsParental involvementTrusting relationship with counselor, physician, or other service providerEmploymentReligious attendance and/or belief in religious teachings against suicideSlide14

CHILDHOOD

ADOLESCENCE

ADULTHOOD

Peer Violence

Suicidal Behavior

Child Maltreatment:

physical, sexual, emotional, neglect

Dating Violence

Sexual Violence

Intimate Partner Violence

Source: Centers for Disease Control and Prevention, Division of Violence Prevention

Different Forms of ViolenceSlide15

Adverse Childhood Experiences (ACEs)

As ACEs “score” goes up, so does risk for…

Risky Behaviors

Physical Inactivity, Smoking, Drug/Alcohol Abuse, Early Sexual Activity

Chronic Disease

Obesity, COPD, Asthma, Diabetes, Liver Disease, Heart Disease

Other Health Outcomes

Teen Pregnancy, STDs, Miscarriage, Depression, Suicide Attempts, Early Death, Job Problems/Lost Time from Work, Perpetration of IPV

Source: Centers for Disease Control and Prevention, Adverse Childhood Experiences Study. Available at:

http://www.cdc.gov/violenceprevention/acestudy/ Slide16

How Do ACEs Affect Our Lives?

Source: CDC, Adverse Childhood Experiences Study. Available at:

http://www.cdc.gov/violenceprevention/acestudy

/

ACEs Can Have Lasting Effects on Behavior & Health (Infographic)Slide17

Connecting the Dots: Why Focus on Shared Risk and Protective Factors?

Prevent multiple forms of violence simultaneouslyDevelop new partnerships

Leverage resources/funding streams

Consider a larger pool of strategies

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.Slide18

Societal Risk Factors

CM

TDV

IPV

SV

YV

Bullying

Suicide

Elder Abuse

Norms supporting aggression*

X

X

X

X

X

X

Media Violence

X

X

X

X

Societal income inequality

X

X

X

X

Weak health, educational, economic, and social policies/laws

X

X

X

X

Harmful gender norms*

X

X

X

X

X

X

*

Norms are generally measured at the individual level

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)Slide19

Neighborhood Risk Factors

CM

TDV

IPV

SV

YV

Bullying

Suicide

Elder Abuse

Neighborhood poverty

X

X

X

X

X

High alcohol outlet density

X

X

X

X

Community Violence

X

X

X

X

Lack of economic opportunities

X

X

X

X

X

Low Neighborhood Support/ Cohesion*

X

X

X

X

X

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

*

Neighborhood support/cohesion typically measured at the individual levelSlide20

Neighborhood Protective Factors

CM

TDV

IPV

SV

YV

Bullying

Suicide

Elder Abuse

Coordination of services among community agencies

X

X

X

X

Access to mental health and substance abuse services

X

X

Community support and connectedness*

X

X

X

X

X

X

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

*

Community support and connectedness typically measured at the individual levelSlide21

CM

TDV

IPV

SV

YV

Bullying

Suicide

Elder Abuse

Social isolation

X

X

X

X

X

X

X

Poor parent-child relationships

X

X

X

X

X

X

X

Family conflict

X

X

X

X

X

X

Economic stress

X

X

X

X

X

Association w/ delinquent peers

X

X

X

X

X

Gang involvement

X

X

X

X

NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

Relationship Level Risk FactorsSlide22

CM

TDV

IPV

SV

YV

Bullying

Suicide

Elder Abuse

Family support/ connectedness

X

X

X

X

X

X

Connection to a caring adult

X

X

X

Association w/ prosocial peers

X

X

X

Connection/ commitment to school

X

X

X

X

X

Skills solving problems non-violently

X

X

X

X

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

Relationship/Individual Level Protective FactorsSlide23

CM

TDV

IPV

SV

YV

Bullying

Suicide

Elder Abuse

Low education

X

X

X

X

X

X

Lack of nonviolent problem-solving skills

X

X

X

X

X

X

X

X

Poor behavior/ impulse control

X

X

X

X

X

X

Violent victimization

X

X

X

X

X

X

X

X

Witnessing violence

X

X

X

X

X

X

X

Mental Health Problems

X

X

X

X

X

X

Substance use

X

X

X

X

X

X

X

X

NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

Individual Level Risk FactorsSlide24

Survivors of one form of violence are more likely* to be victims of other forms of violence

Youth who report attempting suicide: are approximately five times more likely to have been in a physical fight in the last year

Children who have been bullied:

are at greater odds for becoming

involved in physical violence (e.g. weapon carrying, physical fighting)

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014).

Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence

. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

*Likelihood refers to the probability of re-victimization as compared to non-victims. It never means always

.Slide25

Examples of Potential Strategies for Addressing Multiple Forms of Violence

Community/Societal levelNorms change strategies

Strategies/activities that enhance

community support & connectedness

Coordinated services

Relationship level

Strategies that support families under stress

Strategies that connect youth with supportive adults, pro-social peers, and their schools

Individual level

Strategies that build youth and families’ skills in solving problems non-violentlySubstance abuse prevention strategiesSource: Wilkins, N., Tsao

, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.Slide26

Referrals and Resources

National Suicide Prevention Lifeline1-800-273-8255 (TALK)www.suicidepreventionlifeline.org

SAMHSA Treatment Helpline

1-800-662-HELP (4357)

http://findtreatment.samhsa.gov/-

Suicide Prevention Resource Center

www.sprc.orgSlide27

Questions?

Contact:SAMHSA Region V CAPT Jeffrey A. Coady, Psy.D 233 North Michigan Avenue, Suite 200 Chicago, IL 60601

Jeffrey.coady@samhsa.hhs.gov