The National Strategy for Suicide Prevention: Everyone Has a Role Richard McKeon Ph.D.

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

International Efforts England—Reduction in suicides in communities that implemented Community crisis teams, proactive outreach Follow-up within 7 days of IPU discharge Training of clinical staff at least every 3 years Dual diagnosis policies Taiwan—Follow-up after suicide attempts led to 63% reduction in suicides.

The Air Force Did It MH

Henry Ford Health System Also Did It MH

Key Issues Integrate and coordinate suicide prevention activities across multiple sectors and settings. Comprehensive, lifespan approach. Data-driven efforts to continuously improve. Both public and private sectors. Healthcare providers, educators, workplaces, faith-based entities, and community-based organizations all need to be involved.

Tough Realities ~30 percent of deaths by suicide involved alcohol intoxication – BAC at or above legal limit ~30 percent of deaths by suicide involved alcohol intoxication – BAC at or above legal limit 8

Tough Realities : 55%↑ in emergency department visits for drug related suicide attempts by men 21 to : 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 attempts 9

Estimated Number in Population (Number in Thousands) Past year Suicidal Ideation (Number in Thousands) Past Year Suicide Attempt (Number in Thousands) Pat year SMI and suicidal ideation (Number in Thousands) Past year SMI and Suicide attempt (Number in Thousands) Full time Employed (18+) 118,2253, , Treated in ER for any reason in past year (18+) 57,9773, , Military Veterans (18+) 24, Adults (18 +) on Medicaid/CHIP 18,6291, Full time College Students (18+) 14, Adults (18+) on Probation or Parole 5, Adults in Substance Use Treatment 2, Data Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug use And Health (NSDUH), 2008 and 2009 What if we targeted these groups for suicide prevention programs?

Key Issues Goal 7– Provide training to community and clinical service providers on the prevention of suicide and related behaviors. Community groups, mental health, and substance abuse providers. Recognizing the warning signs for suicide and actions to take in response. Train in evidenced-based practices.

Role# Counselor2,421 Social Worker2,361 Physician416 Nurse1,371 Case Manager3,312 Para-professionals826 Certified Peer Staff479 Administrator2,640 Support Staff3,409 BH Workforce Survey (16 Questions) 3,802 2,507 1,123 6,292 1,562 6,816 22,337 Total Responses Skills 39% Training 44% Supports 30% One/Three 53% Endorsed Don’t Know, Disagree, or Completely Disagree I have the _________ to engage and assist those who are suicidal. 3,314 / 15% Once 2,792 / 13% More than once Over 6,000 report a patient has died by suicide (27%). SMI Suicide Rate vs. General Population

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. VA and Joint Commission have made major efforts.

“For many years suicide prevention has not been informed by people who have been there. Peers who have experienced the agony and decision- making can provide support that can be magic.” - Eduardo Vega Mental Health America of San Francisco

National Suicide Prevention Lifeline TALK Answered over 800,000 calls in local crisis centers—your partners in suicide prevention. In response to evaluation findings, created the Crisis Center Follow-up Grants, developed risk assessment standards, and guidelines for callers at imminent risk. Crisis Chat service can be accessed through Lifeline website.

Preventing Suicide: A Toolkit for High Schools We now have many resources. We need to utilize them and make them even better. 16

To Live to See the Great Day that Dawns 17

TIP 50 TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment High prevalence of suicidal thoughts and attempts among persons with SA problems who are in treatment. TIP 50 helps – SA counselors work with adult clients who may be suicidal – Clinical supervisors and administrators Free at: Training video: SAMHSA YouTube channel SPRC Webinar: