Rural Health Association of Tennessee November 13, 2014 Micky Roberts, MBA

Defining Suicide Suicide: Death caused by self-directed injurious behavior with any intent to die as a result of the behavior. Suicide attempt: A non-fatal self-directed potentially injurious behavior with any intent to die as result of the behavior.  A suicide attempt may or may not result in injury. Prevention: Interventions designed to stop suicidal behavior before it occurs. These interventions involve reducing the factors that put people at risk for suicide and suicidal behaviors.  They also include increasing the factors that protect people or buffer them from being at risk. Postvention: Actions taken after a suicide has occurred largely to help persons affected by the suicide loss, such as family, friends, and co-workers of the deceased.

“Saving Lives in Tennessee” Prevention: Suicide prevention trainings Advocacy/public policy Suicide awareness Intervention Crisis counseling 911 Hospitalization, walk-in centers, CSUs Postvention Support groups Work with media Work with schools and businesses

TSPN’s Advisory Council Governor-appointed Independent and nonpartisan Two-year appointments Consecutive pending reappointment Review and evaluate TSPN activities and objectives through committees Advocate for public policy change on the statewide level regarding suicide prevention Preside over eight regional networks

TSPN Regions and Current Regional Chairs Sabrina Anderson Boys and Girls Clubs of Jackson-Madison County 832 Lexington Street Jackson, TN 38301 (731) 422-2008 sanderson@bgcjmc.org Anne Stamps Center Director Cumberland Mountain MHC / Dale Hollow MHC 501 Spruce Street Livingston, TN 38570-2025 (931) 484-8020 or 823-5678 jstamps@vbhcs.org Harold Leonard, MA, LPC-MHSP Cognitive Behavioral Specialists of the Tri-Cities (423) 245-5608 hleonard@centurylink.net Anne Young, MS, CAS Cornerstone of Recovery (865) 970-0500 anneyoung@cornerstoneofrecovery.com Christen Thorpe, MS, CRC, CATSM Pastoral Counseling Centers of Tennessee (615) 383-2115, extension 70 christen.thorpe@gmail.com Mid-Cumberland Upper Cumberland Rural West East Tennessee Northeast Stewart Robertson Sumner Macon Clay Pickett Montgomery Scott Claiborne Hancock Sullivan Obion Henry Trousdale Fentress Campbell Hawkins Johnson Lake Weakley Jackson Overton Houston Wash- Cheatham Smith Union Grainger ington Carter Davidson Putnam Morgan Hamblen Greene Dickson Dyer Benton Wilson Anderson Gibson Humphreys De Kalb Cumberland Knox Jefferson Unicoi Carroll Williamson White Cocke Lauderdale Crockett Hickman Rutherford Roane Cannon Sevier Van Loudon Blount Haywood Madison Henderson Decatur Perry Maury Warren Buren Tipton Lewis Bedford Bledsoe Rhea Coffee Monroe Chester Marshall Grundy Sequatchie Meigs McMinn Shelby Fayette Moore Hardeman McNairy Hardin Wayne Lawrence Giles Lincoln Franklin Hamilton Advisory Council Chairperson Tim Tatum, MA, LPC-MHSP Pine Ridge Treatment Center (423) 339-4351 tim_tatum@chs.net   Executive Director Scott Ridgway, MS (615) 297-1077 sridgway@tspn.org Marion Bradley Polk Memphis/ Shelby County Area South Central Southeast   Waring Porter Pastor, All Saints Presbyterian Church (901) 233-2175 wporter@allsaintspres.com Karyl Chastain Beal, M.Ed, CT Parents of Suicides/Friends and Families of Suicides (931) 388-9289 karylcb@bellsouth.net Eve Nite Mental Health Cooperative of Chattanooga (423) 697-5952 enite@mhc-tn.org 

TSPN: A Public/Private Partnership Participants (Private) Survivors and attempters Mental health and public health professionals Existing suicide prevention groups (i.e., AFSP, AAS, Jason Foundation, SPRC, Yellow Ribbon) Clergy Journalists

TSPN’s Regional Networks Implement TSPN objectives on the local level Organize regional awareness and educational events Provide assistance in local postvention efforts Promote public policy change locally and statewide Local support for statewide TSPN projects

Suicide in the US, By the Numbers 40,600 deaths in U.S. in 2012 (compared to 34,935 deaths in auto accidents that year)* Average of 110.9 per day 1 person every 13.0 minutes 1 person over the age of 65 every 79 minutes 1 person between ages 10-24 every 102 minutes *CDC, 2013

Brief Suicide Statistics Suicide is the 10th leading cause of death among Americans. Suicide attempts impact a larger population. More individuals survive suicide attempts than die and are in need of medical attention for serious injuries. Suicides doubled homicides from 2008-2010 Est. number of people hospitalized from self-inflicted injuries increased from 155,000 in 2009 to 224,000 in 2011

Suicide in Tennessee by the Numbers 1,017 reported suicide deaths in 2013 Suicide rate at 15.7 per 100,000—highest rate since 2008 National suicide rate for 2012: 12.9 per 100,000 In 2012, Tennessee’s suicide rate ranked 20th in the nation

Suicide in Tennessee by the Numbers 34 confirmed suicide deaths in 2012 within 10-19 year old age group (rate at 5.0 per 100,000) (32)2007-(31)2008-(44)2009-(38)2010-(32)2011 Between 2004-08, suicide rate dropped by 32% (from 45 to 31) Between 2010-11, rate dropped by 28% (from 38 to 32)

Suicide in Tennessee by the Numbers Every day we lose three people to suicide One person aged 45-54 every two days One person over the age of 65 every three days One person between the ages 10-24 every four days

Suicide by the Numbers 2008 2009 2010 2011 2012 2013 Tennessee 965 (15.7) 939 (15.1) 932 (14.7) 938 (14.6) 956 (14.8) 1,017 (15.7) U.S. 36,035 (11.8) 36,909 (12.0) 38,364 (12.4) 39,518 (12.7) 40,600 (12.9) N/A Source: TDOH, 2011; CDC, 2010

Counties with Highest Suicide Rates, 2012 County TSPN Region Rate per 100,000 population Actual number of deaths Smith Upper Cumberland 41.9 8 Cheatham Mid-Cumberland 35.6 14 Giles South Central 31.0 9 Grainger East Tennessee 30.9 7 Stewart 30.1 4 Cannon 28.9 Cumberland 28.1 16 Humphreys 27.4 5 Marshall 25.9 Claiborne 25.2

Counties with Highest Suicide Rates, 2013 County TSPN Region Rate per 100,000 population Actual number of deaths Pickett Upper Cumberland 59.1 13 Lewis South Central 50.2 6 Overton 45.3 10 Hancock Northeast 45.1 3 Stewart Mid-Cumberland 44.9 McNairy 38.3 Perry (tie) 38.1 White (tie) Houston 36.2 Giles 34.8

Leading Methods of Suicide Death in Tennessee, 2013 Source: TDOH, 2014

Current Factors in Play Lingering effects of the Great Recession US suicide rate increased by 4.8% between 2007 and 2010 Tennessee suicide rate went up 15% (13.7 to 15.7) between 2007 and 2008… still elevated Cuts to mental health services From 2009 to 2011, states cut mental health budgets by a combined $4 billion-largest single combined reduction to mental health spending since 1970s (Mental Health America, 2013) Rural areas are hardest-hit by cuts and have greater issues with access to begin with

Current Factors in Play Suicide in midlife on the rise Age-adjusted suicide rate for adults aged 35–64 years in the US increased by 28.4% between 1999-2010 (CDC, 2013) Aging baby boom generation is moving into this demographic This generational cohort has always had a higher suicide since those before or after

Warning Signs of Suicide Talking about suicide, death, and/or no reason to live Preoccupation with death and dying Withdrawal from friends and/or social activities Experience of a recent severe loss (especially a relationship) or the threat of a significant loss Experience or fear of a situation of humiliation of failure Drastic changes in behavior Loss of interest in hobbies, work, school, etc. Preparation for death by making out a will (unexpectedly) and final arrangements Giving away prized possessions Previous history of suicide attempts, as well as violence and/or hostility Unnecessary risks; reckless and/or impulsive behavior Loss of interest in personal appearance Increased use of alcohol and/or drugs General hopelessness Recent experience humiliation or failure Unwillingness to connect with potential helpers

Suicide in Rural Communities Higher suicide rates due to: Fewer mental health/social service resources Community stigma Increased access to lethal means Lack of transportation

The Public Health Approach to Suicide Prevention Define the problem Identify the causes Test interventions Implement interventions Evaluate effectiveness This approach is most likely to produce significant and sustained reductions in suicide. The public health approach to suicide prevention focuses on identifying broader patterns of suicide and suicidal behavior throughout a group or population. An ideal, evidence-based intervention is one that has been evaluated and found to be safe, ethical, and feasible, as well as effective.

Understanding Risk Factors, Protective Factors, and Warning Signs Heart Attack Suicide Examples of Risk Factors (Individual Level) Indicate someone is at a HIGHER RISK of a heart attack or suicide Obesity High LDL cholesterol Physical inactivity Prior suicide attempt Mood disorders Substance abuse Access to lethal means Examples of Protective Factors (Individual level) Indicate that someone is at lower risk for heart attack or suicide Exercise Sound diet High HDL cholesterol Stress management Connectedness Availability of physical and mental health care Coping ability Examples of Warning Signs Indicate that someone is having a heart attack or is seriously considering suicide Chest pain Shortness of breath Cold sweat Nausea Lightheadedness Threatening to hurt or kill oneself Seeking a means to kill oneself Hopelessness Increasing alcohol or drug use Dramatic mood changes

Applying Primary Prevention Principles to Suicide Prevention

Proven Primary Prevention Strategies Strategy 1—Promote National Suicide Prevention Lifeline (1-800-273-TALK) Objective: Promote Lifeline and TSPN.org website as statewide resources for suicide prevention  Activity: Get local media to promote the Lifeline number & TSPN website Distribute resources that include the number (especially TSPN pamphlets and resource directories) Encourage churches and civic groups to promote the Lifeline and TSPN website Add Lifeline to appropriate websites Strategy

Proven Primary Prevention Strategies Strategy 2—Promote Gun Safety Project Objective: Help firearm dealers and firing range owners spot and engage troubled/suicidal customers Activity: Share guidelines with gun store/firing range owners about how to avoid selling or renting a firearm to a suicidal customer Encourage gun stores and firing ranges to display and distribute project materials Educate public about safe firearm use and storage, including temporary removal of guns from premises if someone there may be suicidal

Proven Primary Prevention Strategies Strategy 3—Promotion of suicide prevention curricula in schools Objective: Implement means for educating students and staff about suicide prevention  Activity: Promote mental health programs like Mental Health 101 and I.C. Hope Promote suicide prevention programs like the Jason Foundation’s “Promise for Tomorrow” program Promote adoption of anti-bullying programs with a suicide prevention component College & University

Proven Primary Prevention Strategies Strategy 4—Promote suicide prevention training and assessment Objective: Train general public in suicide prevention, with an emphasis on potential gatekeepers Activity: Promotion of evidence-based training programs like QPR to schools and community groups Promotion of appropriate training programs (e.g., ASIST) to mental health and medical professionals Inclusion of information about suicide prevention training in directories, pamphlets, etc. Objective : Train MHPs and MDs & RNs

Proven Primary Prevention Strategies Strategy 5— Promote support to the survivors of suicide Objective: Connect survivors to sources of support throughout the state Activity: Promotion awareness of and attendance in the survivors of suicide support groups Promotion the development of new survivor of suicide groups. Inclusion of information about support groups in directories, pamphlets, online, etc. Objective : Train MHPs and MDs & RNs

Columbia Suicide Severity Rating Scale Excellent Suicide Risk Assessment Tool http://www.cssrs.columbia.edu/ Can download various scales Can get training re: how to administer

Suicide Prevention Awareness Month Observed every September since 2001 Statewide and local awareness events Statewide and local proclamation project (88 out of 95 counties covered this year; 130 documents) Awareness walks Exhibits at local conferences and other events

TSPN’s Publications Brochures: Survivors of Suicide groups Older adults Youth Midlife Veterans Bullying and suicide Substance abuse and suicide GLBT African-Americans

TSPN’s Publications Church bulletin inserts Regional resource directories TSPN Call to Action (monthly) Status of Suicide in Tennessee (annual) Out of the Shadows (bi-monthly, survivors) can you hear me? (bi-monthly, attempt survivors)

Resources: Telephone, Internet & Apps National Suicide Prevention Lifeline Apps  Internet NSPL  Suicidepreventionlifeline.org TSPN  tspn.org SPRC  sprc.org AAS  suicidology.com TSPN App

Resources TSPN website: www.tspn.org National Suicide Prevention Lifeline: 1-800-273-TALK (8255) Survivors of Suicide groups listed at http://tspn.org/for-survivors-of-suicide