1. Targeting the Intersection between Substance Use and Suicide: NYS County Initiatives NYS Suicide Prevention Conference Albany, NY September 13, 2016

2. 2 Intersection between Substance Use and Suicide and NSSP Grant Brett Harris, DrPH Suicide Prevention Project Manager NYS Office of Mental Health

3. 3 Presentation Overview Intersection between substance use and suicide Background of SAMHSA National Strategy for Suicide Prevention grant Rationale for targeting Erie and Monroe counties Collaboration with OASAS Article 32 substance use disorder (SUD) treatment clinics Zero Suicide learning collaborative for Article 32 clinics Dutchess County Prevention Initiative Substance use, mental health, and suicide prevention efforts

4. 4 Suicide is Increasing Nationally…

5. 5 Drug Overdose Deaths are also Increasing…

6. 6 Substance Use and Suicide are Interrelated http://store.samhsa.gov/shin/content//SMA16-4935/SMA16-4935.pdf

7. 7 Substance Misuse and Suicide Substance use is the 2 nd most frequent risk factor for suicide Alcohol misuse or dependence increases risk tenfold Injection drug use increases risk fourteen-fold Substance use present at time of death:

8. 8 Also present at time of death Marijuana – 10.2% Cocaine – 4.6% Amphetamines – 3.4% Number of substances used more predictive than types used Alcohol intoxication in 30-40% of attempts 230,000 ED visits from drug-related attempts in 2011 (almost all involving prescription drugs or OTC medications) Substance Misuse and Suicide

9. 9 National Strategy for Suicide Prevention Grant 3-year SAMHSA grant awarded to NYS (2014-17): Targets Erie and Monroe Counties Aims to advance goals 8 and 9 of the National Strategy for Suicide Prevention (NSSP) Goal 8: Promoting suicide prevention as a core component of health care Goal 9: Promoting and implementing effective evidence based assessment and treatments for those at risk NSSP Grant Intervention Safety Planning Structured Follow-up Phone Calls Zero Suicide Learning Collaborative Behavioral Health Treatment Providers Substance Use Disorder Treatment Providers Training Clinical Gatekeeper

10. 10 Suicide in Erie and Monroe Counties ErieMonroeNYS Number of Suicides, 2014114601,700 Number of Suicides, 2012-142891895,082 3-Year Suicide Rate (per 100,000), 2012-14*10.18.1 Number of Suicides, ages 25-64, 201490471,215 Number of Suicides, ages 25-64, 2012-142151473,617 3-Year Suicide Death Rate (per 100,000), ages 25- 64, 2012-14 15.012.311.2 Largest burden of suicide in NYS outside of NYC and Long Island Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 6, 2016.

11. 11 Drug Overdose Deaths in Erie and Monroe Counties ErieMonroeNYS Number of Drug Overdose Deaths, 2014128971,937 Number of Drug Overdose Deaths, 2012-143162315,525 3-Year Drug Overdose Death Rate (per 100,000), 2012-14 11.610.29.1 Number of Drug Overdose Deaths, ages 25-64, 2014102851,640 Number of Drug Overdose Deaths, ages 25-64, 2012-14 2681944,701 3-Year Suicide Death Rate (per 100,000), ages 25- 64, 2012-14 19.116.814.9 Largest burden of death by drug overdose in NYS outside of NYC and LI Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 6, 2016.

12. 12 Alcohol Statistics from Erie and Monroe Counties ErieMonroeNYS Alcohol-Related Motor Vehicle Injuries and Deaths, 2011-13 1,2031,05119,525 Alcohol-Related Motor Vehicle Injuries and Death Rate (per 100,000), 2011-13 43.646.933.3 Adult Binge Drinking Rate (per 10,000), 2013-1419.718.717.7 Adult Binge Drinking, 2012*21.9%18.5%23.0% Source: New York State Department of Health, New York State Community Health Indicator Reports – Tobacco, Alcohol, and Other Substance Abuse Indicators. Accessed at https://www.health.ny.gov/statistics/chac/indicators/sub.htm on September 6, 2016. *Institute for Health Metrics and Evaluation (IHME) US County Profile. Accessed at http://www.healthdata.org/us-county-profiles on September 6, 2016.

13. 13 Finishing up Article 31 learning collaborative Reached out to OASAS to describe our interest in adapting the Article 31 learning collaborative for outpatient SUD treatment clinics to reach substance misusing population Agreed to partner on initiative, plan an informational session for interested clinic administrators, and begin the learning collaborative in the spring of 2016 OASAS Lead – Brenda Bannon Planning the Learning Collaborative

14. 14 New York State Office of Alcoholism and Substance Abuse Services (OASAS) Brenda Bannon Addictions Program Specialist NYS Office of Alcoholism and Substance Abuse Services

15. 15 OASAS Overview OASAS oversees one of the nation’s largest substance use disorder services systems Nearly 1,600 prevention, treatment and recovery programs that assist approximately 240,000 individuals every year Mission – To improve the lives of all New Yorkers by leading a comprehensive premier system of addiction services for prevention, treatment, and recovery.

16. 16 OASAS plans, develops and regulates the state’s system of substance use disorder (SUD) and gambling treatment agencies Direct operation of 12 Addiction Treatment Centers which provide inpatient rehabilitation services to about 8,000 persons per year Inspection and monitoring of the nearly 1,000 SUD programs to ensure quality of care and compliance with state and national standards Substance Use Disorder (SUD) and Gambling Treatment Services

17. 17 Withdrawal & Stabilization Services Inpatient Rehabilitation Residential Services Outpatient and Opioid Treatment Services Integrated Outpatient Services Specialized Services Problem Gambling Services SUD Treatment Services

18. 18 Individuals in SUD treatment programs are at higher risk for suicide Suicide risk is an intimidating subject Some agencies have specific protocols while others are more loosely defined Use Modified Mini which has a suicide question but staff have trouble when they identify risk Do not feel confident addressing suicidality Suicide Risk in OASAS Substance Use Disorder Treatment Programs

19. 19 Suicide-safer care for outpatient treatment programs Over 192,000 admissions to SUD outpatient treatment services statewide in the last 12 months 11,148 in Erie County 11,737 in Monroe County Learning Collaborative - Focus on Outpatient Treatment Services

20. 20 OMH and OASAS Workforce Survey results Christa D. Labouliere, PhD Suicide Prevention Specialist & Research Administrator Suicide Prevention-Training, Implementation, and Evaluation (SP-TIE) program, of the Center for Practice Innovations (CPI) at the New York State Psychiatric Institute, Columbia University

21. 21 Barriers to Suicide-Safer Care in NYS: 2014 OMH Clinician Survey (N=1585) 20% of clinicians were uncomfortable asking about suicide 12% would not bring up suicide even if the client’s record or actions suggested the client was at elevated risk 64% had little specialized suicide-specific intervention training 33% felt they had insufficient training to assist their suicidal clients 43% did not feel confident in their ability to manage client suicidality 50% reported a need for more training in risk assessment and suicide-specific treatments Only 30% of clinics had established systematic protocols for identifying, treating, or monitoring clients at elevated risk Of those who died by suicide in NYS from 2012-14, 68% received outpatient care within 6mo of their death and 49% within 30 days

22. 22 Barriers to Suicide-Safer Care in NYS: 2016 OASAS Clinician Survey (N=116) 12% of clinicians were uncomfortable asking about suicide 24% would not bring up suicide even if the client’s record or actions suggested the client was at elevated risk 61% had received some suicide-specific training 32% had received no training at all 70% participated in a brief training (<1-2 hours) 52% felt they had insufficient training to assist their suicidal clients 40% did not feel confident in their ability to manage client suicidality 52% reported a need for more training in risk assessment and suicide-specific treatments Very few clinics have systematic protocols for identifying, treating, or monitoring clients at elevated risk

23. 23 Learning Collaborative is an opportunity to address these issues Evidence-based tools and protocols for suicide-safer care Adapting suicide-safer care for the unique settings of SUD treatment programs Saving lives Suicide Risk in Substance Use Disorder Treatment Settings

24. 24 OASAS Outpatient Substance Use Disorder Treatment Clinic Learning Collaborative

25. 25 Goals of the Learning Collaborative Develop Learning Collaborative with motivated early adopters in outpatient substance use disorder treatment clinics Engage OASAS/OMH leadership in culture change and policy development to assist clinicians with implementation of best practices tailored to OASAS settings Collaboratively design how Zero Suicide methods can best be implemented to address needs of SUD treatment clinics Identify suicide prevention knowledge and skills gaps Support staff by targeting knowledge and skills gaps with training (commensurate with role/experience) Provide assistance with resource development, creating connections between agencies/organizations, and systematic quality improvement

26. 26 Zero Suicide Aspirational model Goal: To reduce the number of suicides in NYS to ZERO System-wide approach that addresses public awareness, detection, triage, treatment, and follow-up monitoring Provides standardized guidelines for creating comprehensive and effective suicide prevention programs Now being implemented in many OMH settings and spreading to primary care, hospitals, and OASAS

27. 27 Seven Key Dimensions 1.LEAD: Create organizational culture change about suicide prevention 2.TRAIN: Develop a suicide prevention competent workforce 3.IDENTIFY: Screening and assessment of suicide risk 4.ENGAGE: Ensuring pathways to care 5.TREAT: Using effective evidence-based best practices 6.TRANSITION: Continuing contact and follow-up 7.IMPROVE: Data-driven quality improvement

28. 28 Learning Collaborative First in the nation to implement the Zero Suicide model in substance use disorder treatment settings Began in June 2016 and will last for 1 year 1½ hour interactive webinars every month Forum for open discussion, information sharing / learning from each other, and access to training resources from SP- TIE/OMH-SPO Tailor learning collaborative to needs of participants/SUD treatment Hope to develop a statewide strategy for training SUD treatment providers in suicide prevention and disseminate lessons learned to a nationwide audience

29. 29 Brett Harris DrPH, OMH Suicide Prevention Project Manager Christa Labouliere PhD, SP-TIE Suicide Prevention Specialist Brenda Bannon, OASAS Addictions Program Specialist Jillian King, NSSP grant coordinator Jay Carruthers MD, Director, OMH Suicide Prevention Office One clinical supervisor and one upper-level administrator from: 1.RRH Rochester General Hospital CD Services 2.Rochester Regional Health 3.Lake Shore Behavioral Health, Inc. 4.Spectrum 5.Huther Doyle 6.Catholic Charities of Western NY 7.Chatauqua County Learning Collaborative Team

30. 30 Brett Harris, DrPH – brett.harris@omh.ny.gov Brenda Bannon – brenda.bannon@oasas.ny.gov Christa Labouliere, PhD – labouli@nyspi.columbia.edu Questions? Contact Information