A Public Health Approach Lynn Mangini, MD Child & Adolescent Psychiatry HH/IOL & CCMC May 20, 2010

Increase Protective Factors: Expand access to services Decrease Risk Factors: Restrict access to lethal means

11 TH LEADING CAUSE OF DEATH IN 2006 THERE WERE MORE THAN 33,000 SUICIDES 1 SUICIDE EVERY 16 MINUTES

ADOLESCENTS 15 TO 19 SUICIDE IS THE THIRD LEADING CAUSE OF DEATH CHILDREN 10 TO 14 SUICIDE IS THE FOURTH LEADING CAUSE OF DEATH Suicide Homicide Accidents Suicide Homicide Cancer Accidents

14% seriously considered suicide 7% attempted suicide at least once 2% made a suicide attempt which required medical attention

 During the year, six NYU students completed suicide.  Two of the students died within a two-month period after jumping off balconies in Bobst Library.  The Bobst Library, the main library on campus, is 12 stories high.  In response, NYU permanently installed Lexan barriers made of transparent plastic around the balconies in Bobst library. (Willner 2010)

 The school also blocked access to certain balconies within the residence halls and installed locks on all the windows, which prevent students from opening the windows more than a few inches.  This was in response to the completed suicide of a freshman at NYU who jumped off the roof of his 15-story dormitory in  It was noted that some NYU students have reacted negatively to these measures. (Willner 2010)

 According to Dr. Lanny Berman, Executive Director of the American Association for Suicidology:  Studies from around the world have shown that building barriers to “jump sites” are effective in preventing suicides. (Willner 2010)

The decision to attempt suicide is often made impulsively Having immediate access to a potential suicide plan, such as a bridge or balcony, Increases the likelihood that a person will complete the suicide attempt

Decrease the likelihood that a person will complete suicide Few seek alternate method to attempt again Suicide barrier blocks access to jump site Impulsive decision to jump off a bridge or balcony

 Design: prospective follow-up study  Goal: educate parents of youth at high risk for suicide about limiting access to lethal means for suicide.  Setting: emergency departments  Lethal means: included firearms, medications (over the counter and prescribed), and alcohol.  Results: family members of at-risk youth who received means restriction counseling were more likely than those not exposed to remove or lock up firearms and medications. (Kruesi 2005)

Their child was at increased risk for suicide and why staff believed so Parents could reduce that risk by limiting access to lethal means Problem-solving about how to limit access to lethal means

Each practice of securing the firearms in the home reduced risk of youth shootings Securing the firearm: keeping locked & unloaded Securing the ammunition: keeping locked & stored away from guns Ingestion of pills is most common method of suicide among adolescents yo However, suicide attempts by firearms are usually fatal, because there is little chance for rescue Firearms were used in over 50% completed suicides in ages yo in % boys: leading method of suicide 29% girls: second leading method of suicide

During routine evaluations ask whether firearms are kept in the home. Discuss with parents the increased risk of adolescent suicide with the presence of firearms. For adolescents at risk of suicide, advise parents to remove guns and ammunition from the house and secure supplies of potentially lethal medications.

 Centers for Disease Control and Prevention (CDC). Suicide: Facts At a Glance Summer 2009 [Online]. (2009). National Center for Injury Prevention and Control, CDC (producer). Available from URL:  Heron, M. (2010) Deaths: Leading causes for National vital statistics reports; vol 58, no 14. Hyattsville, MD: National Center for Health Statistics. Table 1. Deaths, percentage of total deaths, and death rates for the 10 leading causes of death in selected age groups, by race and sex: United States,

 Kruesi, M (03/17/2005). Emergency Department Means Restriction Education. Registry of Evidence-Based Suicide Prevention Programs. w ww.sprc.org/featured_resources/bpr/ebpp_PDF/emer_dept.pdf  Mulkern, V, Raab B, Potter, D (2007) A Rising Tide: Use of Emergency Departments for Mental Heath Care for Connecticut’s Children: Report One: Children Enrolled in Husky A. Child Health and Development Institute. CT: Farmington.  Mulkern, V, Isvan N, Potter, D & Huntington N (2007) A Rising Tide: Use of Emergency Departments for Mental Heath Care for Connecticut’s Children: Report Two: statewide Utilization Child Health and Development Institute. CT: Farmington.  Shain, B & The Committee on Adolescence (2007) Suicide and Suicide Attempts in Adolescents. Pediatrics. 120 (3):  Willner, S (May 4, 2010 – 12:00am). Suicide Prevention at Peer Schools May Guide Cornell. The Cornell Daily Sun.