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

2. 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.

3. “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

4. 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

5. TSPN Regions and Current Regional Chairs
Sabrina Anderson
Boys and Girls Clubs of Jackson-Madison County
832 Lexington Street
Jackson, TN 38301
(731)
Anne Stamps
Center Director
Cumberland Mountain MHC / Dale Hollow MHC
501 Spruce Street
Livingston, TN
(931) or
Harold Leonard, MA, LPC-MHSP
Cognitive Behavioral Specialists of the Tri-Cities
(423)
Anne Young, MS, CAS
Cornerstone of Recovery
(865)
Christen Thorpe, MS, CRC, CATSM
Pastoral Counseling Centers of Tennessee
(615) , extension 70
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)
Executive Director
Scott Ridgway, MS
(615)
Marion
Bradley
Polk
Memphis/
Shelby County
Area
South Central
Southeast
Waring Porter
Pastor, All Saints Presbyterian Church
(901)
Karyl Chastain Beal, M.Ed, CT
Parents of Suicides/Friends and Families of Suicides
(931)
Eve Nite
Mental Health Cooperative of Chattanooga
(423)

6. 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

7. 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

8. 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 per day
1 person every 13.0 minutes
1 person over the age of 65 every 79 minutes
1 person between ages every 102 minutes
*CDC, 2013

9. 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
Est. number of people hospitalized from self-inflicted injuries increased from 155,000 in 2009 to 224,000 in 2011

10. 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

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

12. Suicide in Tennessee by the Numbers
Every day we lose three people to suicide
One person aged every two days
One person over the age of 65 every three days
One person between the ages every four days

13. 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

14. 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

15. 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

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

17. 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

18. 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 (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

19. 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

20. 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

21. 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.

22. 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

23. Applying Primary Prevention Principles to Suicide Prevention

24. Proven Primary Prevention Strategies
Strategy 1—Promote National Suicide Prevention Lifeline ( 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

25. 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

26. 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

27. 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

28. 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

29. Columbia Suicide Severity Rating Scale
Excellent Suicide Risk Assessment Tool
Can download various scales
Can get training re: how to administer

30. 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

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

32. 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)

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

34. Resources TSPN website: www.tspn.org
National Suicide Prevention Lifeline:
TALK (8255)
Survivors of Suicide groups listed at