1. MCW Seminar Series Prevention of Suicide and Other Violence Shel Gross, MPA Mental Health America of Wisconsin April 13, 2015

2. Overview Suicide Data Zero Suicide: Changing the Paradigm Reducing Gun Violence

3. Data: Wisconsin Deaths, 2012 Suicides: 734 Homicides: 185 –10 th leading cause of death –2 nd leading cause for those 15-24 and 25-44.

4. Data: Burden of Suicide 4 th leading cause of YPLL 2007-2011, for self-inflicted injury: –$369 m. in inpatient cost –$22.6m. in ER costs

5. Data: Burden of Suicide Highest Suicide Rates: –Men 45-54 y/o –White –Less than a high school degree –Divorced –Veterans –Northern and Western Regions

6. Data: Burden of Suicide Ideation/Self Injury Rates among HS youth: –Racial and ethnic minorities –LGB teens.

7. Data: Circumstances

8. Clinical Training Percentage of individuals who reported receiving didactic training on suicide prevention in their graduate programs: Psychology: 50% Social Work: 25% And most deemed it limited or inadequate. Few licensing bodies require CE for suicide risk and management.

9. Perfect Depression Care Henry Ford Health Systems: –Assigned all patients to suicide risk level –Defined interventions for each risk level –Trained all therapists in CBT –Means restriction protocols

10. Perfect Depression Care About 200,000 covered lives. Expected suicide rate in population: –12 per 100,000; general population –230/100,00 expected in MH clinic pop. First four years –Reduced from 89 to 22 per 100,000 Next two and a half years…

11. Perfect Depression Care Suicides

12. HFHS is Not Alone Air Force Suicide Prevention Initiative Suicides dropped by 1/3 over six years. Maricopa Suicide Deterrent System Project 38% reduction among SMI All three programs demonstrate the ability to dramatically reduce suicide in a “boundaried” population.

13. What is Zero Suicide? Culture Shift Over the decades, there have been many instances where individual mental health clinicians have made heroic efforts to save lives, but systems of care have done very little. Dr. Richard McKeon Suicide Branch Chief SAMHSA

14. What is Zero Suicide? Practices not a Program Program Set of Practices Screening Assessment Workforce Training Cont- inuity of care

15. Tool Kit Zero Suicide Tool Kit A compilation of advice, resources, and tools from several groundbreaking initiatives and from the Clinical Care and Intervention Task Force of the National Action Alliance for Suicide Prevention.

16. Tool Kit Organized into 6 Sections: Zero Suicide Culture Pathway to Care Competent Workforce Suicide Risk Level Evidence-based Care (EBPs) Continuity of Contact

17. What Can I Do Right Now? Re-examine beliefs about suicide prevention –Zero Suicide Culture Do an organizational self-assessment –On the Zero Suicide website Increase clinician competency –See handout Start the conversation

18. Data: Firearm Violence 483—WI firearm deaths in 2012 72% are suicides –Nationally, 60% of firearm deaths are suicides.

19. Data: Firearm Violence The large majority of persons with mental illness are never violent. Most violence towards others (95-97%) is not attributable to mental illness. At certain times, such as the period surrounding a psychiatric hospitalization or first episode of psychosis, small subgroups of persons with serious mental illness are at elevated risk of violence.

20. Expand Firearm Prohibitions Individuals convicted of violent misdemeanor crimes. Respondents to temporary domestic violence restraining orders. Individuals convicted of multiple DWI/DUI offenses in a five year period. Individuals convicted of multiple drug-related misdemeanor crimes in a five year period.

21. Gun Violence Restraining Orders Develop a mechanism to allow law enforcement officers to remove firearms when they identify someone who poses a threat to themselves or others. The mechanism should allow for removal without a warrant in the case of immediate threat and removal with a warrant in the case of a credible but not immediate threat to self or others.

22. Resources Wisconsin Deaths, 2012, WI Dept. of Health Services. https://www.dhs.wisconsin.gov/publications/p4/p45368-12.pdf https://www.dhs.wisconsin.gov/publications/p4/p45368-12.pdf Burden of Suicide in Wisconsin: 2007-2011; WI Dept. of Health Services, Medical College of WI, Mental Health America of WI; 2014; https://www.dhs.wisconsin.gov/publications/p0/p00648-2014.pdf https://www.dhs.wisconsin.gov/publications/p0/p00648-2014.pdf Suicide Care in Systems Framework: National Action Alliance for Suicide Prevention, Clinical Care and interevention Task Force report: http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicid eprevention.org/files/taskforces/ClinicalCareInterventionReport.pdf

23. Resources Preventing Suicide through Improved Training in Suicide Risk Assessment and Care: An American Association of Suicidology Task Force Addressing Serious Gaps in U.S. Mental Health Training; Schmitz, W. M., Jr., et. al., Suicide and Life Threatening Behavior, 2012 Zero Suicide Toolkit:www.zerosuicide.org/zero-suicide-tool-kitwww.zerosuicide.org/zero-suicide-tool-kit Mental illness and reduction of gun violence and suicide: Bringing epidemiological research to policy. Swanson J, McGinty EE, Fazel S, Mays V (2014). Annals of Epidemiology, In Press. http://www.annalsofepidemiology.org/article/S1047-2797(14)00147- 1/fulltext http://www.annalsofepidemiology.org/article/S1047-2797(14)00147- 1/fulltext

24. Resources Center for Gun Policy and Research; Johns Hopkins Bloomberg School of Public Health: http://www.jhsph.edu/research/centers-and- institutes/johns-hopkins-center-for-gun-policy-and- research/publications/http://www.jhsph.edu/research/centers-and- institutes/johns-hopkins-center-for-gun-policy-and- research/publications/

25. Contact Mental Health America of Wisconsin Shel Gross Ph: 608-250-4368 Email: shelgross@tds.netshelgross@tds.net