Each year in the United States, over 400,000* new mothers suffer from postpartum depression (PPD)

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1 KBHC has partnered with Family Mental Health Foundation and Community Crisis Services, Inc. to develop the Postpartum Depression Moms Project. The goal is to make screening new mothers for postpartum depression a routine part of prenatal and postnatal care, and provide guidance to treatment and support. Each year in the United States, over 400,000* new mothers suffer from postpartum depression (PPD) For further information and PPD resources, call PPD-MOMS ( ) or visit *estimated Coming Next Month: Building Suicide Prevention Partnerships: 2-1-1, 9-1-1, and Local Law Enforcement 201 North 23rd Street, Suite 100 Purcellville,VA Non-Profit Organization N o n - P r o fi t U. S. Po s t a g e PA I D K B H C

2 O c t o b e r PREVENTING SUICIDE T h e N a t i o n a l J o u r n a l v o l u m e t w o n u m b e r f i v e The mentally ill need no longer be alien to our aff e c t i o n s or beyond the help of our communities. President John F. Kennedy remarks upon signing bill for the construction of mental retardation facilities and community mental health centers October 31, 1963

3 e t t r L e t t e r s About a year or so ago, I called SUICIDE and a wonderful lady talked to me while informing my parents of my relapse. I received the medical treatment I needed, and my family and I are very grateful for your hard work and selfless contribution to my life. Thank you...i'm trying to type this quickly because it makes me emotional to think back to that time. I want you to know that you've saved this little girl from herself and her illness. Anonymous As Director, Crisis & Referral Services for Centerstone, I am proud to announce our recent certification by the American Association of Suicidology (AAS). In addition, Centerstone also joined the National Hopeline Network SUICIDE (NHN) in order to take calls from our geographic region in middle Tennessee. I would like to take this opportunity to encourage other agencies in Tennessee to join us in this network in an effort to show community mental health centers nationwide that we care, and that through this network, we can make a significant impact upon the citizens of our communities during their times of crisis. The certification process required by AAS was relatively smooth, and due to the requirements already placed upon Triage Services by AdvoCare, it was nearly effortless. In general, it took us approximately ten hours to prepare and gather documents for the certification process, and the site visit lasted a little less than two days. All costs related to the AAS certification process, as well the telephony costs associated with the National Hopeline Network, were paid for by a grant from SAMHSA that is administered jointly by AAS and NHN. As a member of the NHN, Centerstone has joined a nationwide network of over 100 crisis centers responding to persons in crisis. If you would like more information regarding Centerstone's experience with this process, please feel free to contact me at , or If you have any questions regarding Tennessee's experience with this program, please contact Scott Ridgway, Tennessee's Co-Coordinator for Suicide Prevention at For certification information, please contact Lee Judy (AAS) at or David Celebrezze (NHN) at Sincerely, Lawrence A. Edwards, Ph.D., CTS Director, Crisis & Referral Services BREAKING NEWS: The Substance Abuse and Mental Health Services Administration (SAMHSA) has selected the SOS High School Suicide Prevention Program for SAMHSA s National R e g i s t ry of Effe c t i ve Programs (NREP). After a rigorous review by a panel of independent e x p e r t s, SOS was designated a "promising progra m, " thus becoming the only suicide p r e vention program that has qualified for NREP. Read more in the November issue of P r e venting Suicide. The Suicide Prevention Resource Center (SPRC) has unveiled its newly - r e d e s i g n e d, web site visit the excellent, c o n t e n t - rich site at www. s p r c. o rg. The National Hopeline Netwo rk reserves the right to accept or reject all editorial and adve rtising materi a l. E d i t o rial submissions must be accompanied by a self-addressed, stamped return enve l o p e.the National Hopeline N e t wo rk assumes no responsibility for return of unsolicited manu s c ripts or art. No part of this publication may be reprinted without the written permission of the National Hopeline Netwo rk. Copy right 2003, N a t i o n a l Hopeline Netwo rk. All rights reserve d. c o n t e n t Table of Contents In Eve ry Issue L e t t e rs 1 The SUICIDE Hotline 5 Happenings in Suicide Preve n t i o n 1 0 C l a s s i fi e d 1 1 Calendar of Upcoming Suicide Prevention/Mental Health Conferences and Eve n t s 12 Fe a t u re s E d i t o r s Message: M u r d e r-suicide in the Wo rk p l a c e 2 O p i n i o n / E d i t o ri a l : P r e s i d e n t s New Freedom Commission on Mental Health 3 Celebrating the 40th A n n i ve r s a ry of the C o m mu n i t y Mental Health Centers A c t 6 Fro n t l i n e: F rank Campbell Discusses The LOSS Te a m: Suicide Surv i vo rs as F i rst Responders 4 PPD Moms Project Back Cove r About this c ove r: Created by : Lisa Nelson Wa rn e r I m a g e : John F. K e n n e d y L i b ra ry Preventing Suicide, The National Journal, devotes space to letters from its readers. The journal requests that letters be addressed To the Editor, include a home address or telephone number and not exceed 250 words. Let us know what you think about our new publication. Letters may be sent by mail to 201 North Tw e n t y - t h i rd Stre e t, Suite 100, P u r c e l l v i l l e, VA 20132, or by to The journal reserves the right to edit letters to meet its style and length requirements. P R E V E N T I N G SU I C I D E O cto ber

4 e s s a g e f rom the editor Murder-Suicide in the Workplace Paul Quinnett, Ph.D. The euphemism and slang of the so-called d i s g ru n t l e d e m p l o ye e who goes postal does nothing to enlighten the p u bl i c s understanding of the u n d e rlying mental conditions and disordered thinking of those who kill others and then themselves. I t s happened again and again and again in just the past few months. The headlines are pretty much the same: Americans killed by fellow employees at their workplace, followed by the suicide of the perpetrator. Does anyone see a pattern? We who study self-destruction for a living know that homicide is sometimes followed by suicide. The fact that innocents are killed before a final act of selfd e s t ruction only adds to our sense of confusion and helplessness in these seemingly senseless tragedies. Yet we also know that no suicide is without purpose or meaning. A brief review of the basics may be helpful. First, only the utterly hopeless kill themselves. The majority of suicidal people a re suffering from serious untreated psychiatric illnesses, illnesses that can be reasonably detected, diagnosed and treated. The euphemism and slang of the socalled disgruntled employee who goes postal does nothing to enlighten the p u b l i c s understanding of the underlying mental conditions and disord e re d thinking of those who kill others and then themselves. Second, it is important to understand that the homicidal person s decision to die by their own hand (or in a hail of police gunfire) is typically made well before any shooting begins. Since you cannot arrest, humiliate or punish a dead man, these acts are not indiscriminate, impulsive or random, but rather planned and p remeditated. These acts are almost always preceded by observable warning signs. It follows that at least some of these murd e r-suicides are preventable. T h i rd, to carry out a murd e r-suicide, the perpetrator must answer several questions before initiating the plan. These include why, who, with what and where? The m o t i v e (unendurable psychological pain and perceived injustice by others), m e t h o d ( f i re a rms appear to be the first choice) and o p p o rt u n i t y (workplace) are at once understandable and knowable. Just as solving a Murder She Wrote whodone-it episode, answering these few questions solves the mystery. What can we do? Leading American companies have embraced physical wellness and employee assistance programs to help sustain the health and well-being of their human capital as a cost-effective strategy to achieve corporate goals. But has enough been done to a g g ressively market mental wellness programs to employees? Has suff i c i e n t emphasis been placed on building up psychological strengths and resilience, and in teaching conflict resolution skills? Have we developed a corporate culture in which help seeking is completely de-stigmatized? Just as schools are the venue for youth suicide prevention eff o rts, the re c e n t University of Rochester national consensus conference on suicide by men in their middle years confirmed that we should consider the workplace as a potential venue for suicide and violence prevention training for working adults. Financial reasons alone should compel us to act. While definitive studies on the cost of suicide and violence in workplace are incomplete, the Institute of Medicine s recently published Reducing Suicide: A National Imperative calculated the economic cost of suicide to society at $11.8 billion (in 1998 dollars). These costs a re shared by us all, and especially by employers. Q u e s t i o n : If we could prevent suicide, could we also prevent some homicides, both in the workplace and in the home? The answer is yes. Accord i n g to U.S. Air Force data, successful suicide prevention programs also re d u c e other kinds of violence (Air Force Suicide Prevention Pro g r a m, we do better? Yes, with the help of business leaders willing to open their doors to suicide prevention awareness and employee training, I believe suicide and workplace violence prevention efforts can quickly move forward. Pogo said, There is no problem too big you can t run away from it. Well, America, it s time to stop running, turn around, and face this one. n 2 P R E V E N T I N G SU I C I D E O cto ber 20 03

5 Call for Action Against Suicide: The President s New Freedom Commission on Mental Health Charles G. Curie, M.A., A.C.S.W. Administrator, Substance Abuse and Mental Health Services Administration (SAMHSA) U.S. Department of Health and Human Services After a year of study, and after reviewing research and testimony, on July 22, 2003, the President s New Freedom Commission on Mental Health released its final report. The commissioners found that recovery from mental illness is now a real possibility and that the promise of the President s New Freedom Initiative - a life in the community for everyone - can be realized. However, they cautioned that achieving that goal would take a wholesale transformation of the nation s approach to mental health care. U.S. D e p a rtment of Health and Human Services (HHS) Secretary Tommy Thompson assigned the Substance Abuse and Mental Health Services Administration (SAMHSA) to lead the Administration s response to the Commission s challenge. A critical part of that transformation, and a specific Commission recommendation, is swift action to address suicide - the leading cause of violent death worldwide, outranking both homicide and war. Suicide rates among the nation s teens have tripled since the 1950s. Critically, the vast majority of people of all ages who end their lives by suicide have a mental illness too often undiagnosed and untreated. In America, too often suicide is the tragic failure of the patchwork mental health care system that does not always provide the best possible services, which consequently hinders the possibility of recovery. The National Strategy for Suicide Prevention is both a blueprint and framework for action to guide creation of partnerships spanning the national, state and local levels to develop and implement an array of services and programs to combat suicide. The National Strategy aims to prevent premature deaths due to suicide, reduce rates of other suicidal behaviors, reduce harmful aftereffects associated with suicidal behaviors, and promote opportunities and settings to enhance resilience, re s o u rcefulness, and interconnectedness (USPHS, 2001). One of the first recommendations of the Commission was to prompt adoption and implementation of the National Strategy. SAMHSA has led the efforts to implement the National Strategy through various funded programs. In 2001, a $7.55 million grant was awarded jointly to the Kristin Brooks Hope Center and the American Association of Suicidology to certify, evaluate and link crisis centers operating suicide prevention hotlines under the National Hopeline Network SUICIDE ( ). The funding from that grant also financially supports the publication of Preventing Suicide: The National Journal. Last fall, we awarded a three-year, $7.5 million grant to create the National Suicide Prevention Technical Resource Center (SPRC). The Center is dedicated exclusively to suicide prevention and serves as a central resource for states and communities seeking to build capacity to implement and evaluate suicide prevention programs. The Center provides technical assistance to stakeholders, serves as a clearinghouse for best practices, promotes evaluation of suicide prevention programs, gathers and assembles suicide information used by states, and supports local and regional training. SAMHSA maintains a web site (www.mentalhealth.org/suicideprevention) dedicated to the National Strategy and suicide prevention, which offers the public facts about suicide, details of federal, state and private suicide prevention activities, re s o u rces for practitioners and researchers, and funding opportunities. At the same time, the Commission also urged the creation of a national-level public-private partnership to advance the goals and objectives of the National Strategy for Suicide Prevention. That effort is already underway. With SAMHSA s engagement and support, work has begun to develop an Action Alliance - a collaborative entity designed to foster the very same partnerships the National Strategy and the President s Commission envisioned. The process for designing a public/private collaborative will involve identifying leadership from all sectors (e.g., national, state, local and tribal governments, foundations, n o n - p rofits, education, mental health, etc.); securing funding from multiple sources; and promoting maximum public, private and foundation participation. The public/private collaborative is expected to be operational by 2004, with a 10-year agenda to accomplish the National S t r a t e g y s goals. The value of suicide pre v e n t i o n organizations that span the public and private sectors cannot be underestimated. While we re learning about risk factors for suicide and ways to identify and treat underlying triggers for suicide, we must take what we ve learned to communities nationwide to reach all Americans wherever they live and whoever they are. We must identify, evaluate and promote community-based suicide pre v e n t i o n programs that work systems of services in which every door can be the right door to help. As the SAMHSA-sponsored programs gain strength and focus, they will serve as the nexus - the central place - from which the funding, information and training, and ultimately, the responsibility for implementing the National Strategy will emanate. In this way, these projects will help place national focus on suicide prevention as a key public health issue. These programs that partner public and private sector will enable far greater national achievements in suicide prevention, greater than what may be achieved on an individual organizational level. While current efforts to reduce the loss of life to suicide have been successful, we need to expand existing collaborations and work better and faster. At the national continued on page 12, Call for Action Á PR E V E N T I N G SU I C I D E Octo ber

6 //////// F ro n t l i n e Suicide Surv i vors as First Responders: The LOSS Te a m Frank R. Campbell, Ph.D., LCSW Executive Director Baton Rouge Crisis Intervention Center, Inc. The Crisis Center Foundation D r. Edwin Shneidman suggested the concept of postvention as prevention for the next generation in the p reface to Al Cain s publication, S u rvivors of Suicide, f i r s t published in That concept of postvention as p revention has governed my work with survivors of suicide since It has been my personal goal to i n t e rrupt the multi-generational impact of risk that s u rvivors are often re p o rted to have as a legacy of suicide. In Memphis, Tennessee, my presidential address to the AAS conference (Campbell, 1997) was a challenge to those attending to consider implementing an active postvention model (APM) in their communities. Too many surv i v o r s would seek support to cope with their loss if they knew help was available. Most re f e rrals for survivors of suicide g roups come from physicians or nurses (Rubey and McIntosh, 1995) who share the information when the death is pronounced in a hospital. Unfortunately for many, a hospital is never involved, there f o re eliminating a prime re f e rral re s o u rce for survivors. Even when re s o u rces are available in communities, the length of time between the death and the survivor seeking help is too long, due p a rtially to the lack of knowledge of the re s o u rces by the s u rvivors and by gatekeepers. In the review of the h u n d reds who have sought assistance from the Baton Rouge Crisis Intervention Center (BRCIC), the average length of time between death and seeking assessment is 4.5 years (Campbell, 2003). That time delay allows maladaptive coping and compromised activities of daily living (eating, sleeping, work, etc.) to occur. I envisioned an active model of postvention made up of a team of trained survivors who would go to the scenes of suicides to disseminate information about re s o u rces and be the installation of hope for the newly bereaved. The p r i m a ry goal of the APM is to let survivors of suicide know that re s o u rces exist as soon as possible following the death. To accomplish that goal, I re c ruited a team of twelve volunteers in November, 1997 (four staff and eight suicide s u rvivors). They received survivor visitor training with Iris Bolton (The Link Counseling Center in Atlanta) and then continued to attend monthly training sessions to enhance attending skills and to develop protocols for going to the scenes of suicides. The group was named the LOSS Te a m (Local Outreach to Suicide Survivors.) It was after a year of training that the new coro n e r, Dr. Louis Cataldie, invited us to become first responders to suicides in our parish ( c o u n t y ). In the area we serve, there is a suicide about every eight days (Campbell and Lester, 1996). The frequency of suicide quickly provided the team opportunities to demonstrate our effectiveness at the scenes. The team has now contributed their services to more than 100 suicides. New members have been trained, and the organization is m o re highly developed than anyone could have imagined. A full time staff member from the BRCIC coordinates the LOSS Team in addition to overseeing our extensive s u rvivors program and doing suicide prevention training t h roughout Louisiana. That staff member is a survivor who speaks with passion and determination on the issues that s u rround suicide. Interested parties in other communities have received training related to the active postvention model and each week others wanting to start a LOSS team in their communities contact our agency. Our re s e a rch has shown that survivors who receive the Active Postvention Model (APM) ask for assistance fro m our agency on average within 39 days as compared to those using the passive model, who seek assistance on average in 4.5 years. The annual number of survivors who received services from the LOSS Team is ten times gre a t e r (300 versus 30) than when the passive model was our p r i m a ry approach to postvention. Even though the ratio of six survivors (assumed to be next of kin) to each suicide continues to be expressed in the literature, our re s e a rc h indicates at least twenty-four relationships to the deceased seeking help who have been impacted by suicide, gre a t l y expanding the quantity of survivors assumed to be impacted each year. The LOSS Team has given us much better access to the many suff e rers who have not been included in the traditional six to one ratio. The team has accomplished all this and more! Our re s e a rch has confirmed that in the areas of depre s s i o n, a n x i e t y, and grief, team members are at no greater risk than a control group not participating as first responders. For the first three years, each LOSS Team member completed the Beck Depression Inventory (BDI), the Beck Anxiety I n v e n t o ry (BAI-II), and the Hayes-Jackson Bere a v e m e n t I n v e n t o ry (HJBI) every 60 days, while a comparison gro u p of survivors (not responding to suicides) did the same. The results of those inventories indicated that the LOSS Te a m members had no increased risk due to exposure at the scenes of suicides. Survivor team members re p o rted that the process of helping others at difficult times of discovery and notification allowed them to heal from their own losses in ways they could not have imagined. The next goal of our re s e a rch is to determine if the s u rvivors who sought treatment earlier as a result of the Active Postvention Model (APM) have statistically significant clinical diff e rences compared to those seeking t reatment later from the more traditional or passive model of postvention (PPM). The Baton Rouge Crisis Interv e n t i o n 4 PR E V E N T I N G SU I C I D E Octo ber 200 3

7 Center is seeking funding to do re t rospective and prospective survivor re s e a rc h comparing active and passive models. The center will also continue consulting with other communities to identify survivors who are re a d y, willing and able to be first responders to suicides. Survivors have proven to be important re s o u rc e s at the scenes of suicide, and, although members of the crisis center staff p a rticipate in the LOSS Team, it is the survivor volunteers who provide the majority of coverage for the LOSS Team. Their volunteer involvement contributes greatly to our entire postvention programming, including working as peer facilitators in our weekly survivors group, participating in surv i v o r assessments, being a member of the agency speakers bureau, and mentoring new team members. Since the LOSS Team began responding in 1998, team members have been recognized for the generous contributions to the newly bereaved. Clearly, the team is working on changing the legacy of suicide for survivors. I hope that we can prove that postvention is prevention for the next generation, especially in light of the recent news coverage re g a rding re s e a rch that suggests that a suicide gene may exist. Most studies have failed to compare survivors who received help following their losses and survivors who did not. The upcoming special (scheduled for December, 2003) produced for the Discovery Channel and n a rrated by Marriette Hartley will highlight the stories of several survivors who have been involved with the Baton Rouge Crisis Intervention Center, as well as f e a t u re our LOSS Team. This program conveys the reality of seeking help in o rder to reduce future risk of suicide. For more inform a t i o n about the LOSS Team, or to arrange for training or consultation on implementing an Active Postvention Model in your community, visit our website at w w w. b rc i c. o rg, Dr. Campbell at f r a n k c a m p b e l b rc i c. o rg, or call (225) , ext. 12. D r. Campbell serves as Executive Director of the Baton Rouge Crisis Interv e n t i o n C e n t e r, Inc. and the Crisis Center Foundation in Baton Rouge, Louisiana, United Sates of America. He is a past president of the American Association of Suicidology and has d e l i v e red over fifty national and international presentations, published articles, and is c u rrently writing a book on metaphors for healing from sudden and traumatic loss. The Active Postvention Model he developed (The LOSS Team) will be featured in an upcoming documentary for the Discovery Channel to be released worldwide at the end of n R e f e re n c e s : Cain, A.C. (Ed.). (1972). S u rvivors of suicide. Springfield, IL: Charles C. T h o m a s. Campbell, F.R. (2003). An Active Postvention Model, C r i s i s, Vo l u m e 24,No.4,2003 (at pre s s ). Campbell, F.R. (1997). Changing the Legacy of Suicide, Suicide and Life- T h reatening Behavior, 27 (4). Campbell, F.R. & Lester, D. (1996). The temporal distribution of suicides in Baton Rouge, P e rceptual and Motor Skills, 83 (14). R u b e y, C.T., & McIntosh, J.L., Suicide Survivors Groups: Results of a S u rv e y, paper presented at the annual meeting of the American Association of Suicidology, Phoenix, AZ., May h o t l i n e SUICIDE Help is just a phone call away; that s the beauty of the National Hopeline N e t wo rk s easy-to-remember SUICIDE ( ) number. The way we see it, the more certified crisis centers in our network, the more effective our services will be.that s why we re issuing a blanket invitation to crisis centers across the nation to join us, free of charge. The National Hopeline Netwo rk is the n a t i o n s only suicide prevention cri s i s hotline netwo rk linking A m e ri c a n Association of Suicidology (AAS) and C O N TACT USA cert i fied crisis centers under one toll-free nu m b e r. A simple call to our toll-free number puts a person in c risis (or someone close to that pers o n ) in immediate touch with help at the nearest AAS or C O N TAC T U S A c e rt i fied crisis center. The line is staffed 24 h o u rs a day. The fact that your crisis center may not be c e rt i fied is not a probl e m. Free of charg e, we will help you obtain national c e r t i fi c a t i o n, thanks to a three-ye a r Substance A buse Mental Health Serv i c e s A d m i n i s t ration (SAMHSA) gra n t, aw a r d e d j o i n t ly to the A m e rican Association of Suicidology (AAS) and the Kristin Brooks Hope Center. The grant is for the expansion and support of national crisis-center services and subsequent research to evaluate their effectiveness. Even charges for telephone calls received via SUICIDE are paid for by the SAMHSA grant. For more info rmation about joining, contact G. Lee Judy, AAS cert i fi c a t i o n c o o r d i n a t o r, or David Celebrezze, D i r e c t o r of the National Hopeline Netwo rk. L e e can be reached at (202) or ed at o rg, a n d D avid can be reached at (540) , or by at dav i h o p e l i n e. c o m The AAS website is The website for the Kristin Brooks Hope Center is n PR E V E N T I N G SU I C I D E O cto ber

8 "In October we will celebrate the fortieth anniversary of the day the Mental Retardation Facilities and Community Mental Health Centers Construction Act was signed into law by President Kennedy. That legislation brought dignity to the mentally ill by assisting them and enabling them to move out of mental institutions and into their communities. The need today is to strengthen the resources of our communities so that persons living with mental illness can be successful, contributing members of society." Senator Edward Kennedy, D-MA

9 C o m munity Mental Health Centers at the 40-Year Mark: The Quest for Surv i v a l In 1963, when the CMHCs were mandated, part of their organizational requirement was to maintain 24/7 crisis hotline services.today, just over 800 agencies are p a r t of the National Council for Commu n i t y B e h a v i o ral Healthcare (NCCBH). O ver 80% of CMHCs still maintain crisis services today, and most are certified by JCAHO, CARF or CoA.They are still a rich resource that allows people in a psychiatric crisis to receive the help they need when they need it. The community mental health center (CMHC) movement is now 40 years old. Since its inception under the Kennedy administration, CMHCs have undergone a significant shift in treatment focus and revenue sources. Their original mandate to provide compre h e n s i v e, community-based mental health services to all has given way to a focus on treating individuals with serious mental illnesses and addiction disorders. Centers no longer provide only mental health treatment services but have taken on a wide range of programs designed to allow people with the most serious disorders to live in their communities, such as housing and social supports. In order to fully understand the state of community mental health centers today, one must first look at their origins. From the enactment of the Community Mental Health Centers Act of 1963 to the 1981 repeal of its amended version, CMHCs were developed with full federal support. In the beginning, recipients of construction grants were required to provide a comprehensive program of five which began in earnest during the 1960s. CMHCs were expected to treat these patients, who often arrived at the centers with no ability to pay. Meanwhile, patients from third-party payors such as employee health plans failed to materialize. Considering the high level of stigma associated with mental health treatment during those formative years, it is no wonder that patients carrying private insurance would hesitate to seek treatment from a center with clientele newly released from state mental hospitals. As it became clear that CMHCs were not achieving selfsufficiency, policy makers debated the fate of the program. In 1981, President Reagan repealed the Mental Health Systems Act (which Congress had passed only one year earlier), seeking to restructure and realign the nation s mental health system. The repeal brought significant structural and financial changes to community mental health services. The degree of distress that CMHCs experienced as a result of funding reductions during the 1980s depended in large part on how reliant the centers had been on federal funding, and on each state s willingness to support community mental health services by replacing those lost funds. In general, CMHCs responded by maintaining direct services and reducing services to populations without a designated funding source. Services such as consultation, education, prevention and re s e a rch were substantially reduced or eliminated. By 1990, CMHCs served an average of 2,807 persons essential services inpatient; outpatient; part i a l annually. Of the total clients seen, 46 percent had a primary hospitalization; 24-hour crisis; and consultation and education to all residents of designated service areas (catchment areas). For a 20-year span, these centers were to serve individuals regardless of age, race, religion, place of national origin or diagnostic classification. The original intent was that the centers would receive 4.5 years of funding for initial staffing purposes, allowing time for the CMHCs to develop alternate funding sources in order to become self-sufficient. Federally-funded CMHCs were required to provide a reasonable volume of free or reduced cost care, but early planners believed that other revenue sources would bear the operating costs: feefor-service patients; individual and group insurance; other third-party payments; voluntary and private contributions; and state and local aid. There was a federal expectation that this new and expensive undertaking for most communities would require only temporary federal aid. H o w e v e r, there were several serious flaws in expectations and design that did not allow this to happen. One of the most serious and dangerous flaws in the original design was the expectation that CMHCs would serve a substantial number of patients who would be able to pay for their own treatment. However, this ran counter to the consequences of downsizing state psychiatric facilities, diagnosis of serious mental illness. Another 6 percent had a primary diagnosis of substance abuse with mental illness. These populations re q u i red extensive re s o u rces and services and contributed to the shift in focus at CMHCs to the most severely ill within the total client population. Many CMHCs provided a number of specialty programs: 62 percent had programs for children and adolescents; 43 percent had programs for alcohol abusers; 39 percent had programs for drug abusers; 37 percent had programs serving families of persons with serious mental illness; and 22 percent had programs for the homeless. CMHCs, which already faced daunting financial challenges, faced even greater competition for resources. In some states, public officials openly acknowledged that only the strongest community mental health centers would s u rvive and that vulnerable centers should consider consolidating with other providers. Because most centers relied heavily on state revenues, they were largely at the mercy of state-level policy decisions. A large network of community mental health providers had developed since the inception of the CMHC movement 30 years earlier, but large service gaps continued to exist for both adults and children. In many states and localities, lack of a cohesive public continued on page 11, Community Mental Healtth Centers Á P R E V E N T I N G SU I C I D E O ctob er

10 Historic events, pieces of legislation, and various regulations that established community mental health centers (CMHCs) also helped define key concepts of comprehensiveness, continuity of care, accessibility of services, community involvement, and accountability and responsiveness to the community. Following is a brief timeline of these landmark events: The first hospital for the mentally ill in the United States opened in Wi l l i a m s b u rg, Vi rg i n i a Mental illness in the United States received scientific attention given the ingenuity of Dr. Benjamin Rush. He i n t roduced occupational therapy, amusements, and exerc i s e for consumers and saw to it that they had decent, clean q u a rters. For his accomplishments, Dr. Rush is known as the Father of American Psychiatry In 1840, there were only eight asylums for the insane in the U.S. Dorothea Dix s crusading led to the establishment or enlargement of 32 mental hospitals. Also in 1840, the first attempt to measure the extent of mental illness and re t a rdation in the U.S. occurred with the Census of 1840, which included the category insane and idiotic Early in the 20th century, the mental hygiene movement came into being, due largely to the eff o rts of Cliff o rd Beers and his famous book, The Mind that Found Itself The Public Health Service (PHS) established the Narc o t i c s Division, later known as the Division of Mental Hygiene. The Division brought together for the first time the thre a d s of the mental health movement from re s e a rch and t reatment programs to combating drug addiction to the study of the causes, prevalence, and means of pre v e n t i n g and treating nervous and mental disease On July 3, President Truman signed the National Mental Health Act. For the first time in United States history, the act provided a significant amount of funding for psychiatric education and re s e a rch. This act led to the 1949 creation of the National Institute of Mental Health (NIMH) Lithium was discovered to treat and reduce symptoms in mental health consumers diagnosed with a bipolar disord e r D r. Henri Laborit discovers chlorpromazine (Thorazine), which in many cases alleviated symptoms of hallucinations, delusions, agitation and thought disord e r s The Mental Health Study Act of 1955 was authorized by C o n g ress. The commission s final re p o rt, Action for Mental Health, provided the background for President John F. K e n n e d y s special message to Congress on mental health C o n g ress appropriated $12 million for re s e a rch in the clinical and basic aspects of psychopharmacology and the P s y c h o p h a rma cology Service Center was established P resident Kennedy signaled the beginning of the community mental health center movement with a message to Congress on mental illness and mental re t a rdation on F e b ru a ry 5, He proposed a bold new approach to substitute comprehensive community care for custodial institutional care. Congress responded with the passage of the Mental Retardation Facilities and Community Mental Health Center Construction Act, which was signed into law on October 31, The law authorized federal grants for construction of public or nonprofit community mental health centers. Monies were allotted to states on a percentage basis of populations, extent of need, and financial need. Require d s e rvices included the following components: inpatient c a re, outpatient care, partial hospitalization, emerg e n c y c a re, and consultation/education The Community Mental Health Centers (CMHC) Act Amendments of 1965, (P.L ), were enacted and included the following major provisions: construction and s t a ffing grants to centers were extended and facilities that s e rved those with alcohol and substance abuse disord e r s w e re made eligible to receive these grants; grants were p rovided to support the initiation and development of mental health services in poverty-stricken areas; and a new p rogram of grants was established to support furt h e r development of childre n s serv i c e s The National Council of Community Mental Health Centers was founded by a group of CMHCs. In 1997, the Council became the National Council for Community Behavioral Healthcare (www. n c c b h. o rg ) The CMHC Act Amendments of 1975 (P.L ) mandated a more detailed community mental health center definition, emphasizing comprehensiveness and accessibility to all persons re g a rdless of ability to pay, t h rough the creation of a community governing board and quality assurance. Required core services expanded fro m the 1963 levels from 5 to 12, which included the following: s e rvices for children and the elderly; screening, drug abuse, 8 PR E V E N T I N G SU I C I D E O cto ber 2 003

11 alcohol abuse and transitional services, and follow-up care The Mental Health Systems Act (P.L ) re s t ru c t u re d the federal community mental health center program by s t rengthening the linkages between the federal, state, and local governments made by President Jimmy Cart e r s Mental Health Commission The Mental Health Systems Act was repealed. In its place, the Alcohol, Drug Abuse and Mental Health (ADMS) Block Grant was enacted as part of the Omnibus Reconciliation Act of 1981, (P.L ), which was signed into law on August 13, The Omnibus Reconciliation Act was one of the first substantive pieces of legislation of the Reagan era. It forever changed community mental health by stripping CMHCs of their federally qualified status, devolving the p rograms to the states and localities. This would allow for CMHC programs to differ in each of the 50 states The ADMS block grant, the most prominent block grant that applied to CMHCs at the time, decreased federal funding levels by 30 perc e n t By 1985, federal funds through the ADMS block grant d ropped to 11 percent of agency budgets In 1986, Congress passed the State Mental Health Planning Act of 1986, which authorized small grants to states to develop comprehensive mental health plans for persons with serious mental illness C o n g ress amended Medicare by increasing outpatient mental health benefits for the first time since the pro g r a m s enactment in The concept of behavioral health managed care evolved f rom theory to practice. Massachusetts was the first state that utilized a managed care platform re g a rding service of its behavioral healthcare needs Community mental health centers were authorized to p rovide Medicare partial hospitalization serv i c e s The Health Insurance Portability and Accountability Act ( H I PAA) was enacted. The intent of HIPAA was to pro t e c t health insurance coverage for workers and their families upon job change/loss also saw the passage of the first parity law. The law prohibited insurers or plans s e rving 50 or more employees from setting lower annual or lifetime dollar caps on mental health benefits than for other health benefits Social Services Block Grant (SSBG) was cut under the Balanced Budget Act (BBA), from over $2 billion to $1.7 billion in FY S e p t e m b e r, 1998 The National Hopeline Network (www.hopeline.com) was f o rmed, linking suicidal callers to help via SUICIDE ( ). O c t o b e r, 1998 Suicide Prevention Action Network USA (SPAN-USA), in collaboration with the Department of Health and Human S e rvices, convened the first national conference on suicide in Reno, Nevada. The conference brought CDC, HRSA, SAMHSA, NIH, IHS, and PHS together with the private sector to develop a national strategy for suicide prevention. June, 1999 The Clinton White House held a conference on mental health issues that focused on dispelling the myths about mental illness and decrying prejudices against behavioral health consumers. In late 1999, Mental Health: A Report of the Surgeon General was published, which sought to eradicate the stigma surrounding mental health and simultaneously encourage the use of innovative p h a rmaceutical and psychotherapy treatments. In addition, the Surgeon General s Call to Action on Suicide P revention was released in S e p t e m b e r, 1999 The National Council on Suicide Prevention was form e d ( w w w. n c s p. o rg ). June, 2000 C o n g ress passed the LHHS Amendment 4077 to fund c e rtification and networking of suicide crisis hotlines. O c t o b e r, 2000 P resident Clinton signed the Childre n s Health Act (P. L ) into law, which established national standard s that restrict the use of seclusion and restraint in all psychiatric facilities that receive federal funds and in nonmedical community-based facilities for children and youth. The act also mandated that a re p o rt be submitted to C o n g ress on co-occurring disord e r s The National Strategy on Suicide Prevention was re l e a s e d ( w w w. m e n t a l h e a l t h. o rg / s u i c i d e p re v e n t i o n / d e f a u l t. a s p ) G e o rge W. Bush formed the Pre s i d e n t s New Fre e d o m Commission on Mental Health, charging it to focus on the mental health service system and identify barriers to getting serv i c e s. Also in 2002, the Education Development Center (EDC) formed the National Suicide P revention Resource Center (www. s p rc. o rg), funded by a t h ree-year SAMHSA grant. J u l y, 2003 The Pre s i d e n t s New Freedom Commission on Mental Health released its final re p o rt, which can be accessed at w w w. m e n t a l h e a l t h c o m m i s s i o n. g o v. H i s t o ry article and Timeline reprinted (with minor adaptations) c o u rtesy of the National Council for Community Behavioral H e a l t h c a re (NCCBH). For more information on the 40th a n n i v e r s a ry, visit www. n c c b h. o rg. n PR E V E N T I N G SU I C I D E Octo ber

12 appenings IASP / WHO Celebrate First-Ever Wo r l d Suicide Prevention Day The International Association for Suicide Pre v e n t i o n and the World Health Organization celebrated the firstever World Suicide Prevention Day on September 10, In a recent letter, IASP President Dr. Diego De Leo stated, The burden associated with suicide and attempted suicide has risen to the extent that in the year 2000, the World Health Organization (WHO) has identified suicide as a public health priority for the first time since its constitution In 2000, suicide claimed the life of a p p roximately 815,000 persons worldwide, and re p resented 1.3% of the total global burden of disease. In addition to addressing the need for suicide prevention to be put on global and regional health agendas, the o rganization hopes that observing the yearly date will raise a w a reness and encourage global, regional, and local suicide prevention eff o rts. Visit w w w. i a s p o rg o r w w w. w h o. i n t / e n / for more inform a t i o n. Request for Funding A p p l i c a t i o n s : M e n t a l Health of Asian American Wo m e n The Iris Alliance Fund and the National Asian Wo m e n s Heath Organization recently announced the availability of funding for culturally competent programs that work to reduce suicide and depression in Asian American women. With the support of SAMHSA, NAWHO is inviting applications from organizations that have the capacity to p rovide culturally competent education and outre a c h p rograms to address the mental health of Asian American women. The Iris Alliance Fund is pleased to partner with N AWHO in this eff o rt, contributing its knowledge and networks in suicide prevention to help identify innovative p rojects and evaluate promising programs. A Request for Applications is available at www. i r i s f u n d. o rg and at w w w. n a w h o. o rg. Questions or requests for furt h e r i n f o rmation should be directed to m a i i r i s f u n d. o rg. AAS Call for Pap e r s : 36th A n nual Confe re n c e : Working Together to Save Live s Deadline: November 14, Presentations can be submitted online at www. s u i c i d o l o g y. o rg. Paper copies of the call can be requested by i n f s u i c i d o l o g y. o rg o r by calling (202) NIMH Launches Real Men, Real Depre s s i o n P u blic Health Campaign The National Institute of Mental Health (NIMH) recently announced the launch of the first national campaign Real Men, Real Depression - to raise a w a reness that depression is a major public health p roblem affecting an estimated 6 million men annually. R e s e a rch suggests that men die by suicide at four times the rate of women, and the sexes talk diff e rently about d e p ression symptoms. Men may not recognize their i rr i t a b i l i t y, sleep problems, loss of interest in work or hobbies, and withdrawal as signs of depression. This may result in fewer men asking for the help they need. For m o re information on the campaign, call or visit the NIMH web site at w w w. n i m h. n i h. g o v. Indian Health Service Convenes to A dd re s s S i g n i f i c a n t, D e a d ly Pro bl e m The Indian Health Service (IHS) announced a major national initiative to address suicide among American Indian and Alaskan Natives at its National Behavioral Health Conference held in Washington, D.C., July 14-17, The multiyear eff o rt will include IHS and other federal agencies; tribes and tribal organizations; re s e a rc h and service organizations; and state and local govern m e n t p rograms. Over the last approximately thirty years, suicide has become a significant, deadly problem among Native Americans and Alaskan Natives across the country. Vi rtually unknown in previous generations, according to data from the Indian Health Serv i c e s Trends in Indian Health (1999), suicide rates for Native populations now range from 1.5 to 3 times the national average. It is the second leading cause of death (behind accidents) for Indian youth aged and is 2.5 times higher than the national average for this age group. It is the fifth leading cause of death overall for males and the seventh leading cause of death for females. Of particular cause for concern, young people aged make up 64% of all suicides and the trending indicates this percentage could rise even h i g h e r. R e s e a rch and programs to reduce Native American suicide have been plagued by their paucity and appro a c h. Solid data and accurate statistical information on suicide and suicidal behavior are very difficult to gather. Diff e r i n g collection systems; difficulties sharing information among p rograms, tribes, states, IHS, as well as other federal agencies; and lack of a national standard re p o rting system have all hampered attempts to more accurately assess the t rue nature and magnitude of the problems. Congru e n t l y, data have indicated that suicide profiles among Native populations differ from those of other ethnic and racial g roups. Programs have been developed for specific communities with varying levels of success, but there has never been a national eff o rt to develop, share, and c o o rdinate them. To address this situation, IHS has undertaken thre e major goals: 1.) Develop a nationally coordinated suicide e ff o rt in Indian Country, 2.) Deploy a national electro n i c suicide surveillance system to more accurately track and c o m p rehensively assess Native suicide, and 3.) Develop m o re appropriate Native re s e a rch and service programs to a d d ress the problem. 1 0 P R E V E N T I N G SU I C I D E Octo ber 200 3

13 happenings A workgroup has been charged with making initial recommendations for the initiative s deployment and solicit membership in a National Advisory Group to guide the multiyear eff o rt. All interested people and programs are encouraged to contact Jon Perez, PhD, Director of Behavioral Health for the Indian Health Service, at j p e re h q e. i h s. g o v for more inform a t i o n. H P P, EPIC and 28 Other Major Organizations Send Letter to Secre t a ry Thompson Opposing Data Mining of Health I n formation by Financial Institutions On September 10, the Health Privacy Project (HPP), the Electronic Privacy Information Center (EPIC), and 28 other health care advocacy, labor, consumer, disability rights, and health care provider groups, sent a letter to Health and Human Services Secretary Tommy Thompson, opposing any changes to the new medical privacy regulation that would give a green light to banks and other financial institutions to access sensitive, personal medical information. HHS officials have stated that they may act soon on this issue. For more information, visit A PA Study: Suicide Attempts in A d u l t s Influence Suicidal Tendencies in Childre n A study published in the August, 2003 American Journ a l of Psychiatry found that children of parents who have attempted suicide and who also have siblings with a history of suicide attempts are at high risk for a suicide attempt at an early age. The study suggests that a strong family history of suicidal behavior was associated with a greater risk of suicidal behavior and earlier age of first suicide attempt in o ffspring, as well as greater impulsive aggression in both p a rents and offspring. For more on the study, visit w w w. p s y c h. o rg / n e w s _ s t a n d / b re n t a j p s u i c i d e p d f. Suicide Rates in Japan Reach Record High The July 25, 2003 edition of USA Today re p o rted that Japanese suicide rates have reached a re c o rd high, following a 3.5% increase in Police speculate that the increase is linked to job losses and bankru p t c i e s. Japan's suicide total is almost 3,000 more than the United States, yet their population is far less than half of the U.S. p o p u l a t i o n. S u rv i vor Web Sites Av a i l a ble for Pa re n t s, Friends and Fa m i l i e s P a rents of Suicides (w w w. p a re n t s o f s u i c i d e. c o m) is an international support group for pare n t s u rvivors; Friends and Families of Suicides (w w w. f r i e n d s a n d f a m i l i e s o f s u i c i d e. c o m) is a similar gro u p for anyone whose life has been affected by suicide. American Self-Help Group Clearinghouse: w w w. s e l f h e l p g ro u p s. o r g This web site maintains a database of curre n t i n f o rmation and contacts for national self-help groups and individuals who need information on starting new networks. TALKING WITH THE CALLER is a manual for paraprofessional counselors. Although it is directed specifically at telephone counselors, the information is also valuable for people working face-to-face with individuals experiencing difficulties. Crisisline volunteers, information and referral staff, youth workers, health service providers, human service volunteers, mental health practitioners, law enforcement officers, and emergency service providers will find this manual useful. The content includes problems requiring immediate intervention, such as potential suicide, accident, abuse, or panic attack, as well as ongoing problems, such as depression, loneliness, anger, substance abuse, mental illness, sexual issues, or relationship difficulties. Counselors are provided with step-by-step guidance in addressing these issues. The clear format makes the manual useful for both training and on-the-spot guidance. This comprehensive resource was prepared by a Cornell University development team in consultation with Suicide Prevention and Crisis Service and mental health professionals. Available through: Sage Publications, 2455 Teller Road, Thousand Oaks, CA 91320, Telephone: (805) , SPCS is a certified member agency of the American Association of Suicidology. c l a s s i f i e ds Preventing Suicide is pleased to offer a new, complimentary Classified section. your listing to e d i t o h o p e l i n e. c o m f o r possible inclusion in a future edition. HELPLINE, (212) , provides 24/7 crisis intervention and emotional support to all New Yorkers. Our staff and volunteers are extensively trained in handling issues of suicide, depression, anxiety, loneliness, domestic violence, relationship issues, etc. We offer up-to-date information and referrals to over 1,000 local and national agencies. Another service offered is our Cheering Program, which provides weekly phone visits to homebound and isolated New Yorkers. A program of the Jewish Board of Family and Children's Services. Please visit us at n P R E V E N T I N G SU I C I D E O cto ber

14 Call for Action, continued from page 3 level, SAMHSA has worked with its colleague agencies in the HHS to create a robust network resource of accurate and up-to-date suicide prevention-related information. Our start is a good one, but to go to the next level we must work better and faster and in partnership with our colleagues at the state and local levels. Our course has been charted and our challenge will be to transform today s mental health care system into one that is both consumer-and family-driven and focused on recovery and resilience. We must continue to identify ways to leverage our resources across all sectors and levels of s e rvice delivery to identify, evaluate and pro m o t e community-based suicide prevention programs that work. We must continue to shatter the discrimination, fear, and stigma that still surround mental illnesses, despite the fact that recovery is possible. Finally, we must recognize that it takes the work of all of us if we are to achieve our shared goal of ending the tragedy of suicide. n Community Mental Health Centers, continued from page 7 health policy threatened the very safety net on which people with serious mental illness depended. Those who fell through the treatment gaps wound up in a revolving-door cycle that led from acute hospitalization to homelessness to arrest. In many parts of the country, jails and prisons became de facto psychiatric institutions. Services that could have kept these clients in the community, namely affordable housing and other social supports, were hard to come by. These problems continue to persist into the 21st century. Despite economic boom times in the 1990s, the decade proved tough for most CMHCs and for community mental health systems in general. With that in mind, it s difficult to see how the new century could bring anything but more financial challenges to CMHCs. As dire as the problems facing CMHCs are, the situation is reversible. An effective community-based system requires careful deliberation by local, state and federal officials to devise effective policies and to find the resources necessary to support them. CMHC participation in integrated care is essential for systems hoping to provide the most effective care with finite resources. CMHCs overall have shown remarkable resilience in their 40-year history. Emerging from a program hampered by flawed expectations and design, they have grown to become an essential piece of the healthcare system, many times offering the last chance for care for some of the nation s most vulnerable populations. This has been achieved through sheer will power, commitment and vision. But those resources are finite as well. The CMHCs original mandate to provide comprehensive, community-based mental health services is more critical now than ever. And yet many of these centers find themselves on the precipice of extinction. Their fate lies in the hands of federal and state policy makers. So does the well-being of millions of Americans who rely on the safety net that CMHCs provide. We invite readers to contribute suicide prevention events for inclusion in our calendar. Send your submissions to: Please include the official title of the event, its date and a brief description, along with the name of a contact, and a way to reach that person. november 1-2 CME Meeting of the American Society of Clinical Psychopharmacology, New York, NY; for more information, call (212) or visit th Annual Psychiatric and Mental Health Congress, Conference and Exposition, Orlando, FL; coordinated by Continuing Medical Education, Inc.; for more information, visit 7-8 Critical Research Issues in Latino Mental Health, Princeton, NJ; sponsored by the Robert Wood Johnson Medical School: (732) or 8-13 Society for Neuroscience 33rd A n nu a l Meeting, New Orleans, LA; for more information, call (202) or alendar 1 2 PR E V E N T I N G SU I C I D E Octo ber 200 3

15 You are invited to become a s u b s c riber to P r eventing Suicide: T h e National Journ a l. Through September , s u b s c ription costs are cove r e d by a grant as part of the educational awareness component of the SAMHSA suicide prevention initiative. Please complete and return the enclosed card with your name and mailing address to the KBHC Journ a l S u b s c ription Depart m e n t, N o r th 23rd Street, P u r c e l l v i l l e, VA If you prefe r, you may enter your s u b s c ription electronically at s u b s c ri p t i o n h o p e l i n e. c o m. P l e a s e feel free to duplicate this subscri p t i o n fo rm for colleagues and other people interested in preventing suicide. N a m e Mailing A d d r e s s C i t y S t a t e Z i p Telephone Number (with area code) address To help us better serve P r eventing Suicide: The National Journal r e a d e rship and its interests, please complete the fo l l owing info rmation about yo u rs e l f : Place of employ m e n t Job title Are you curr e n t ly invo l ved in the prevention of suicide? yes no If ye s, please give a b rief explanation of your wo rk and how long you have been invo l ved in suicide preve n t i o n : Get Connected 2 IT: Presented by the I n fo rmation Technology Project of the New Jers e y Association of Mental Health Agencies, Inc.; Atlantic City, NJ; for more information, or call (609) , ext National Council for Community Behav i o r a l H e a l t h c a re State Association Meeting, B e t h e d s a, M D ; sponsored by the National Council for Commu n i t y B e h av i o ral Healthcare: w w w. n c c b h. o rg or call (301) B e h av i o r, L i fe s t y l e, and Social Determinants of Health: 131st Annual Meeting and Exhibition of the American Public Health Association; San Francisco, CA; for more information, call (202) or visit Summit 2003: Suicide Prevention and Education Making Strides to Save Lives, Daytona Beach, FL; sponsored by the Suicide Prevention Coalition of Volusia and Flagler Counties and the Florida Suicide P r e vention Coalition. For more info rm a t i o n, v i s i t w w w. f l o ri d a s u i c i d e p r e ve n t i o n. o rg or L eve r aging Te c h n o l ogy to Pre p a re & Perform in a Changing World, New Orleans, LA; sponsored by Open Minds: or Celebrating 50 Years of Psychosomatic M e d i c i n e : Setting Priorities for the New Subspecialty, San Diego (Coronado), CA; sponsored by the Academy of Psychosomatic Medicine: (773) or Association for Advancement of Behavior Therapy (AABT) 37th Annual Convention; Boston, MA; for more information, call (212) or visit Families Deserve the Best: P ro m i s i n g I n t e rventions and Best Practices for Serv i n g Children with Mental Health Needs, Washington, D.C., sponsored by the Federation of Families for Children's Mental Health: 22 Fifth Annual Survivors of Suicide Day. National s u rv i vor events will be linked by satellite and we b broadcasts provided by the A m e rican Foundation fo r Suicide Prevention. For more information on how to participate, call AFSP or visit 22 Suicide Aw a reness Voices of Education (SAVE) 13th Annual Suicide Awareness Memorial; St. Paul, MN; for more information, call SAVE or visit december 3-6 Southeast Confe rence on A dd i c t i ve Disorders (SECAD), Atlanta, GA; sponsored by the National Association of Addiction Treatment Providers: or th Annual Meeting and Symposium of the American Academy of Addiction Psychiatry, New Orleans, LA; for more information, call (913) or visit 7 The Trevor Project 6th Annual "A Cracked X m a s " : Comedy/Musical Show Event and Fundraiser; The Wiltern Theater in Los Angeles, CA; for more information, visit American College of Neuro p s y c h o - p h a r m a c o l ogy (ACNP) A n nual Meeting; C a ri b e Hilton, Puerto Rico; for more information, call (615) n Calendar

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