1. Assessing and Managing Suicide Risk
ATAP WEBINAR
May 20, 2011

2. Nebraska Youth Suicide Prevention Initiative
Background
Began in 2009 with the receipt of the Garret Lee Smith grant through SAMHSA
Nebraska Suicide Prevention Coalition
Evidence based programming
Question Persuade Refer - Gatekeepers
Assessing and Managing Suicide Risk - Clinicians

3. Acknowledgement
The Suicide Prevention Resource Center is a funded project of SAMHSA), U.S. Department of Health and Human Services (HHS).
Promoting a mental health workforce that is better qualified to practice culturally competent mental health care based on evidence-based practices is one of the commitments of SAMHSA and a key to fully implementing the National Strategy for Suicide Prevention.

4. Nebraska Data
Suicide is the third leading cause of death in young people between the ages of 15 and 24.
Every 16 minutes a suicide occurs in the U.S.
An average of one young person (ages 15-24) dies every 2.08 hours.
No less than six other people are intimately affected by those losses.
Children who have lost a loved one to suicide are more likely to die by suicide themselves.

6. Suicide death rates by age and gender, Nebraska
residents, (n=881)
1.6
19.5
17.4
21.3 24
19.1
19.8
25.7
17.1
0.9
3.7
3.3
7.1
6.9
4.2
2.3 * 5 10 15 20 25 30
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age group
Deaths per 100,000 population
Males
Females
Source: NHHSS Vital Statistics

7. What does “Evidence-Based” mean?
Has demonstrated a causal link between program and outcome through rigorous evaluation methodology
Achieves desired outcome
Accurate to say “effective”
Current research and expertise 
Help create an “evidence-base” for our work

9. Strategic Planning Process
1. Describe the problem & its context
2. Identify priority problems & long-range goals
3. Consult the science; identify strategies
4. Select or develop interventions
5. Develop an evaluation plan
6. Create an action plan
7. Implement, evaluate, & improve interventions

10. Which of these suicide prevention practices are going on in your local area? Select all that apply. N = 152

11. Understanding Risk Factors
Community
Individual
Society
Relationship

12. What is the greatest precipitating factor among youth suicide?
Among all year olds who died by suicide:
Almost 50% were due to intimate partner problems
Other reasons included:
legal/criminal (20%),
financial (12%),
relationship problem with friend or family (13%)
Important to attend to youth who have had a recent life event (relationship problem), who are depressed, and a tendency towards impulsiveness, especially within 2 weeks of life event
[Source: Harvard NVISS Pilot 2001]

13. What do we know about impulsiveness of youth suicide?
Among all year olds who died by suicide:
1 in 5 occurred on the same day as an acute life crisis
1 in 4 occurred within 2 weeks
Approx. 46% occurred either on the same day or within 2 weeks of a life crisis
Important because impulsiveness of suicide
Crucial to provide immediate help
Develop means for students in crisis to cope, provide safe haven, ensure support system in place
[Source: Harvard NVISS Pilot 2001]

14. Suicide is an outcome that requires
several things to go wrong all at once
Biological
Factors
Predisposing
Factors
Proximal
Factors
Immediate
Triggers
Familial
Risk
Major Psychiatric
Syndromes
Hopelessness
Public Humiliation
Shame
Serotonergic
Function
Substance
Use/Abuse
Access To
Weapons
Intoxication
Neurochemical
Regulators
Personality
Profile
Impulsiveness
Aggressiveness
Severe
Defeat
Every suicide is different; every suicide has its own story.
2. This slide describes one convenient way of organizing the chapters of every story. For example, Fred, an 80 year old white male; his father committed suicide (i.e., biological factors). At the present time, Fred has major depression (i.e., predisposing factor); Fred starts drinking (i.e., proximal factor). Fred’s wife is caught having an affair with Fred’s best friend; Fred has access to a firearm (i.e., immediate triggers)—one story.
3. Jane is the high school senior with bipolar disorder who has told everyone she is going to Princeton. When she doesn’t get accepted, Jane feels publicly humiliated; she impulsively jumps from a parking structure—another story.
4. There are countless such stories.
5. The goal of suicide assessment is to “read” all the chapter’s and intervene before the last, and final, chapter is written.
Abuse
Syndromes
Negative
Expectancy
Major
Loss
Demographics
Severe
Chronic Pain
Severe Medical/
Neurological Illness
Worsening
Prognosis
Pathophysiology

15. Clinical Chain in Suicide Prevention
Detecting potential risk
Assessing risk
Managing suicidality
Safety planning
Crisis support planning
Patient tracking
MH Treatment

16. Do Professionals Really Need More Training?
Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals
Do Professionals Really Need More Training?
Behavioral health professionals have a crucial role in preventing suicides.
A number of studies report that a substantial proportion of people who died by suicide had either been in treatment or had some recent contact with a mental health professional.
Many previously diagnosed with a psychiatric illness at the time of death
Additionally, hundreds of thousands of people show up in hospital emergency departments each year for treatment after a suicide attempt.

17. Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals
Clients' suicidal behaviors are a reality for mental health therapists and the source of significant distress for them.
Mental health professionals are "not adequately trained to provide proper assessment, treatment, and management of suicidal patients."²
Professionals have been calling for increased formal training in this area for decades.

18. Curriculum Development
In 2004, SPRC contracted with the American Association of Suicidology (AAS) to validate the need for competency-based curricula
collect available curricular materials,
develop curricula modules in the areas of assessment and management.
develop a one-day curriculum

19. Core Competencies
Competencies encompass clusters of knowledge, skills, abilities, and attitudes or perceptions required for people to be successful in their work.
In this case, core competencies refer to the clinical evaluation, formulation of risk, treatment planning, and management of individuals at risk for suicide to protect their lives and promote their well-being.

20. Core Competencies
The following set of core competencies, based on current empirical evidence and expert opinion, provides a common framework for learning about and gaining skill in working with individuals at risk for suicide. They are not intended to be construed or to serve as a standard of care.

21. Core Competencies
Twenty-four competencies and their sub-competencies fall into seven broad categories
Core competencies related to specific treatment interventions have not been developed.

22. Core Competencies Literature review
Collection of core competencies and rubrics for measuring core competencies from related fields
Collection of instructional materials
Creation of a Task Force to review the collected information; develop training, recommend reference material and instructional strategies;
Pilot testing the curriculum and making necessary revisions

23. Learning Objectives
Become familiar with core competencies that enable mental health therapists to assess and work more effectively with individuals at risk for suicide
Define terms related to suicidality
Become familiar with suicide-related statistics
Identify major risk and protective factors
Understand the phenomenology of suicide

24. Increase knowledge in the following core competencies:
Manage one's own reactions to suicide
Reconcile the difference (and potential conflict) between the clinician's goal to prevent suicide and the client's goal to eliminate psychological pain via suicidal behavior
Maintain a collaborative, non-adversarial stance
Elicit suicide ideation, behavior, and plans
Make a clinical judgment of the risk that a client will attempt or complete suicide in the short and long term

25. Increase knowledge in the following core competencies
Collaboratively develop an emergency plan
Develop a written treatment and services plan that addresses the client's immediate, acute, and continuing suicide ideation and risk for suicide behavior
Develop policies and procedures for following clients closely, including taking reasonable steps to be proactive
Follow principles of crisis management

26. Experience a shift in perspective in working with individuals at risk for suicide.
Expect participants to experience changes in perceptions of working with suicidal clients.
For example, increased willingness, confidence, or clarity in working with individuals at risk for suicide.
Identify changes to make in practice specific to the assessment and management of individuals at risk for suicide.

27. Core Competencies Attitudes and Approach
Manage one's own reactions to suicide
Reconcile the goal to prevent suicide and the goal to eliminate psychological pain via suicidal behavior
Maintaining non-adversarial stance
Realistically assess one's ability care for a suicidal client

28. Core Competencies Understanding Suicide
Identify basic terms related to suicide
Become familiar with suicide-related data
Describe the phenomenology of suicide
Understanding of risk and protective factors

29. QUESTIONS???