SUICIDE PREVENTION, SCREENING, ASSESSMENT AND SAFETY PLANNING NANCY KIRKPATRICK, YOUTH SUICIDE PREVENTION PROGRAM COORDINATOR AND FRANCISCO CHAVEZ, BEHAVIORAL HEALTH CONSULTANT NM DEPARTMENT OF HEALTH OFFICE OF SCHOOL AND ADOLESCENT HEALTH

SUICIDE IS THE 10 TH LEADING CAUSE OF DEATH IN US SECOND LEADING CAUSE OF DEATH FOR YEAR OLDS Y/O NA MALES TIMES HIGHER THAN NATIONAL AVERAGE Y/O WHITE MALES FASTEST RISING RATE IN NM, 53% OF ALL SUICIDES WERE BY FIREARMS (2013)

DATA: THE SCOPE OF THE PROBLEM Top 5 states for Suicide rates in US Montana 24.5 Alaska 22.7 New Mexico 21.5 Wyoming 20.5 Colorado 20.2 (US RATE American Association of Suicidology)

RISK FACTORS FOR NEW MEXICO:  Rural – Frontier  Access to care  High gun ownership  Poverty  High rates of drug/alcohol use and abuse  High military population  High Veterans population PERSONAL RISK FACTORS:  Relationships  Alcohol/Drug use and abuse  Mental illness  Financial problems  Access to lethal means  Previous attempt  School Failure  Legal problems (JJ)/CYFD

WARNING SIGNS - FACTS  Feelings – helplessness, hopelessness, guilt, shame, self hate, worthlessness, sadness, anxiety  Actions – writing, drawing or talking about death, alcohol/drug use or abuse, aggression, recklessness  Changes – personality, behaviors, sleeping, eating, disinterest in friends, personal appearance, or activities  Threats – statements, making plans to die, self-injury, attempt  Situations – trouble at school, legal trouble, feeling overwhelmed, recent losses

PROTECTIVE FACTORS  Having an adult other than a parent in their life who cares about them  Responsibility to others  Supportive family – friends  Engaged in school/community  Someone who cares about their school work  Connectedness - Belonging

ORGANIZATIONAL POLICIES AND PROCEDURES Make sure your school has policies and guidelines around suicide ideation/attempts/completions and postvention Make sure everyone is trained: Everyone in your school needs to know the Who, What, When, Why, and How After everyone is trained, PRACTICE (just like a fire drill!) Document – everything!

ZERO SUICIDE INITIATIVE Explicit commitment to reduce suicide deaths Develop a confident, competent, and caring workforce Identify every person, every time, for suicide risk Engage clients in a Safety Management Plan Treat suicidal thought and behaviors directly Follow patients through every transition in care Apply data-driven quality improvement

ZERO SUICIDE INITIATIVE Explicit commitment to reduce suicide deaths Develop a confident, competent, and caring workforce Identify every person, every time, for suicide risk Engage clients in a Safety Management Plan Treat suicidal thought and behaviors directly Follow patients through every transition in care Apply data-driven quality improvement

COMMUNITY RELATIONSHIP WITH BEHAVIORAL HEALTH REFERRAL SOURCES Building authentic relationships with referral/community resources is vital Increase familial resiliency though relationships with: youth serving organizations, YMCA, after school programs, family support programs, CYFD, faith-based organizations

C-SSRS COLUMBIA SUICIDE SEVERITY RATING SCALE Developed in the context of a national effort to meet the need for a scale to better identify people at risk Many schools, police departments and other first responders throughout the United States have implemented the C-SSRS as a tool for everyday use You don't need to have any mental health training to administer it Using the same assessment instrument - the C-SSRS - across settings will allow for quick and efficient communication (Speak the Same Language)

C-SSRS USING THE SCALE There are several versions of the C-SSRS The “Full Version,” which still takes just a few minutes - assess severity of ideation as well as intensity of suicidal ideation. The “Screening Version” is an even shorter version that can be used by first responders Consisting of 3 to 6 questions assesses severity of the ideation and behaviors You don't have to ask any or all questions, just the amount that you need Integrate information given by collateral sources family, caregivers

Suicidal Ideation Intensity Suicidal Behavior Actual Attempt Interrupted Attempt Aborted Attempt Preparatory Behavior Lethality Assessment of Suicidal Risk Using C-SSRS This module will describe: How the C-SSRS is structured How to administer it This illustration gives an overview of the types of thoughts and behaviors you will assess with the C-SSRS.

Low Risk # 1- Have you wished you were dead or wished you could go to sleep & not wake up? Low Risk Low Risk #2- Have you actually had any thoughts of killing yourself? Low Risk Moderate Risk #3- Have you been thinking of how you might kill yourself? Moderate Risk High Risk #4- Have you had these thoughts & had some intention of acting on them? High Risk High Risk #5- Have you started to work out the details of how to kill yourself? Do you intend to carry out this plan? High Risk High Risk #6- Have you ever done anything, started to do anything, or prepared to do anything to end your life? High Risk C-SSRS Questions

WHEN TO REFER FOR FURTHER PSYCHIATRIC EVALUATION OR MORE INTENSIVE TREATMENT? Ideation: 4 or 5 in the past month Behaviors: any behavior in the past 3 months Risk doubles from 3 to 4

OTHER SUICIDAL BEHAVIORS QUESTION 6: HAVE YOU EVER DONE ANYTHING, STARTED TO DO ANYTHING, OR PREPARED TO DO ANYTHING TO END YOUR LIFE? Interrupted Attempt: Person takes steps to end their life, but someone or something stops them Aborted Attempt: Person takes steps to end their life, but they stop themselves Preparatory Behavior: Any other behavior with suicidal intent, such as collecting or buying pills, purchasing a gun, writing a will or suicide note

LET’S PRACTICE You have a C-SSRS Screening Version in your packet Turn to your neighbor and practice asking the questions Remember if 1 and 2 are NO you can move to question 6

QUESTIONS RESOURCES ARE IN YOUR PACKET

Office of School and Adolescent Health 300 San Mateo Blvd NE Suite 902 Albuquerque, NM Nancy Kirkpatrick Francisco Chavez