Milestones and Priorities in Suicide Prevention

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1 EVIDENCE BASED SUICIDE PREVENTION: ZERO SUICIDE IN HEALTHCARE New Hampshire Behavioral Health Summit December, 2015 Mike Hogan, Ph.D.

2 Milestones and Priorities in Suicide Prevention USAF successes: 1990 s Dr. Satcher s leadership Mental Health: A Report of the Surgeon General (1999) National Strategy for Suicide Prevention (2001) President s New Freedom Commission on Mental Health (2003) Recommendation 1: Advance a national strategy for suicide prevention a national public-private partnership to advance the NSSP National Action Alliance on Suicide Prevention (2010) 2

3 3 A New Perspective: Improve Suicide CARE: Action Alliance Clinical Care and Intervention Task Force Report Access at:

4 Why? Suicide in Health Care Settings is a Problem 4 45% of people who died by suicide had contact with primary care providers in the month before death. Among older adults, it s 78%. 19% of people who died by suicide had contact with mental health services in the month before death. About 1/3 were receiving mental health care South Carolina: 10% of people who died by suicide were seen in an emergency department in the two months before death.

5 And Suicide in Mental Health Care is a Problem 5 Ohio: Between , 20.2% of people who died from suicide were seen in the public behavioral health system within 2 years of death. Kentucky: 24%+ of people who died by suicide received community BH services in the prior year for 5 consecutive years Vermont: In 2013, 20.4% of the people who died from suicide received care from state-funded mental health or substance abuse treatment agencies within 1 year of death.

6 What s Missing? 6 Suicide Prevention not yet a core mission except in crisis, inpatient Training. Studies show that most mental health clinicians (and primary care physicians and nurses) are not competent in assessing suicide risk; they are not trained in graduate and nursing schools on how to elicit suicidal thinking and behaviors. Leaders in community mental health centers assume staff was properly trained in suicide prevention by their graduate training consequently the centers don t provide solid training to staff in most cases. Skip Simpson, Esq. Tools to fill the gaps in mission, training, care Until now

7 7WITHOUT IMPROVED SUICIDE CARE, PEOPLE SLIP THROUGH GAPS * Ask? Safety Plan? Reduce Lethal Means? Treat? Stay In Close Contact?

8 8

9 9 THE TOOLS OF ZERO SUICIDE FILL THE GAPS

10 10 THE TOOLS OF ZERO SUICIDE FILL THE GAPS

11 11THE TOOLS OF ZERO SUICIDE FILL THE GAPS

12 12THE TOOLS OF ZERO SUICIDE FILL THE GAPS

13 13 THE TOOLS OF ZERO SUICIDE FILL THE GAPS

14 14THE TOOLS OF ZERO SUICIDE FILL THE GAPS

15 15THE TOOLS OF ZERO SUICIDE FILL THE GAPS

16 16THE TOOLS OF ZERO SUICIDE FILL THE GAPS

17 17THE TOOLS OF ZERO SUICIDE FILL THE GAPS

18 18THE TOOLS OF ZERO SUICIDE FILL THE GAPS

19 19THE TOOLS OF ZERO SUICIDE FILL THE GAPS

20 20THE TOOLS OF ZERO SUICIDE FILL THE GAPS

21 What is Different in Suicide Safe Care? 21 Making suicide prevention a core responsibility of health care Applying new knowledge about suicide and treating it directly A systematic clinical approach in health systems, not heroic efforts of crisis staff and individual clinicians. System-wide approaches work to prevent suicide: United States Air Force Suicide Prevention Program UK (While et al., 2009) Henry Ford Health System

22 The Prototype for Zero Suicide: HFHS Launch: Perfect Depression Care Suicide Deaths/100k HMO Members

23 23 Elements of Zero Suicide Essential Support Elements Clinical Elements

24 Clinical Care TF: Shifts in Perspective FROM: SOMEONE ELSE S JOB STAFF PESSIMISM AND WITHDRAWAL ONLY A FEW EXPERTS KNOW WHAT TO DO TRAINING AND OTHER SINGLE "SOLUTIONS" EPISODES OF CRISIS WE DON T KNOW WHAT WORKS To: A fundamental responsibility of health care organizations Rational optimism, and engagement A shared commitment with tools and supports A comprehensive approach to a chronic health condition Continuity of caring We have potent, evidence-based tools. They re feasible. They work

25 Early ZS Innovators are Seeing Results: Centerstone 25

26 Zero Suicide/Suicide Safe Care is 26 A framework for suicide care in behavioral health and healthcare systems. An ESSENTIAL compliment to community prevention strategies: suicidal people need Safe Care and the current system doesn t provide it Now embedded in the National Strategy for Suicide Prevention. A set of best practices and tools at

27 2012 National Strategy for Suicide Prevention: GOALS AND OBJECTIVES FOR ACTION A report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention GOAL 8: Promote suicide prevention as a core component of health care services.

28 28 Spread/Adoption of Zero Suicide ZS Dissemination: Feasibility demonstrated in real world care settings Toolkit built, available on-line and free at Implementation underway in?? 200 settings; State leadership: TX, OK, WI, KY, UT, NY; Breakthrough Series with states, partners

29 Resources Are At: 29

30 Resources are behind each button for that topic 30

31 31 Spread/Adoption of Zero Suicide ZS Dissemination: Implementation underway in?? 200 settings; State leadership: TX, OK, WI, KY, UT, NY; Breakthrough Series with states, partners International Declaration: 12 countries at Atlanta meeting 9/15; implementation in Netherlands, Canada Other national efforts (US) NIMH: Research Prioritization report, MHN study SAMHSA: State grants, GLS focus Accreditors: New COA standards. Pending TJC Alert CDC surveillance efforts, NVDRS Colorado project: Comprehensive, statewide effort Is this enough to save lives?

32 Zero Suicide: A Movement and a Mission 32

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