Preventing Suicide in Communities: A Public Health Approach Jerry Reed, PhD, MSW

Suicide Prevention Resource Center

Preventing Suicide in Communities:

A Public Health Approach

Jerry Reed, PhD, MSW

Katherine Wootten, MPH

Sixth World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders

Washington, DC :: 17 November 2010

What We Will Cover

I. Suicide as a public health problem

II. Preventing suicide in local communities

III. Resources for community-based suicide

prevention

I. Suicide as a Public Health Problem

1. Suicide places a significant burden on the

health of the population.

2. There is the presence of known risk factors

that are measurable and preventable.

3. There is public will for suicide to be

addressed.

Strategic Planning for Suicide Prevention Community Core Competencies course, SPRC

Suicide around the World• Suicide (global)1

– Nearly 1,000,000 deaths per year

– 16 suicides per 100,000 people per year

– 60% increase in suicide rates in last 45 years

– 1.8% of the total global burden of disease (1998)

• Suicide attempts, estimates (global)1:

– Up to 20 times more frequent than completed suicide

• Suicide ideation, estimates (United States)2:

– 24% of US population have considered suicide in lifetime

1: WHO http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ 2: Linehan and Laffaw, 1982

Suicide Rates by Country (WHO)

Suicide Rates by Gender and Age (WHO)

Impact of Suicide

• Suicide survivors and suicide attempt survivors• Years of potential life lost• Economic cost of suicidal behavior

– Medical expenses of emergency intervention and non-emergency treatment for suicidality

– Lost wages of those completing a suicide

– Lost productivity of the loved ones grieving a suicide

– Lost and/or reduced productivity of people suffering from suicidality

Why Suicide?Social Ecological Model

“The complexity of causes necessarily requires a multifaceted approach to prevention that takes into account cultural context. Cultural factors play a major role in suicidal behavior.”

Public Health Approach

Violence – A global public health problem. World Health Organization. 2002, p. 206. DeLeo, D. Cultural Issues in suicide and old age. Crisis. 1999, 20:53-55.

Public Health Approach

Create Planning Team Obtain “Buy-In”

“…the work of suicide prevention must occur at the community level, where human relationships breathe life into public policy.”1

David Satcher, MD, PhDSixteenth Surgeon General of the US

“Prevention goes beyond changing individuals – it changes cultural norms.”

Murray Levine (1998)

1: USDHHS. (2001). National strategy for suicide prevention. p 2.

II. Preventing Suicide in Local Communities

Community

• Norms of communities empowered for suicide

prevention:

o shared responsibility for the general welfare of

the community and its members

o collective knowledge and ability to confront

situations that threaten the integrity, safety, and

well-being of the community

o positive attitudes towards “help-seeking”

behavior

Model for Action: Necessary Conditions for Prevention

Richmond and Kotelchuck’s Health Policy Model

Atwood K, Colditz GA, Kawachi I. (1997). From public health science to prevention policy: Placing science in its social and political context. American Journal of Public Health, 87(10).

• Sequential steps:

1. Leadership

2. Planning group

3. Organization

4. Resources

5. Strategic planning

6. A plan

7. Evaluation (confirming success)

Achieving Success in Suicide Prevention

1: Leadership, 2: Planning, and3: Organization

“Problems are complex and go beyond the capacity, resources, or

jurisdiction for any single person, program, organization, or sector to change or control.”

Lasker R, Weiss E. 2003. Broadening participation in community problem solving: A multidisciplinary model to support collaborative practice and research. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 80(1):5.

4: Resources

• New line item• Realigning existing resources

– “In kind”

– Networking

• Grants/fundraising• Human resources

– Idea people

– Action people

• Technical assistance, prevention support

4: Resources

“The best and most effective prevention programs are ones that are directed toward using resources which are indigenous to a particular community… external programs generally don’t work as well, as they don’t recognize the values of the culture.”

Sherry Davis Molock, MDiv, PhD

Preventing Suicide: The National Journal, 2(3):9. July 2003.

5: Strategic PlanningMany steps required before choosing programs:• Assess the problem

– Incidence/Prevalence– Demographics– Risk/Protective Factors

• Assess community readiness, resources– What’s in place already?

• Set priorities– Populations, risk/protective factors

• Articulate:– What specific results or changes do we hope to achieve, and

how will those help reduce suicide? 1818

5: Strategic Planning

Selection principles:

• Evidence-based (effective) practices

– Multi-layered

– Achieves desired outcome

• Cost feasibility

• Sustainability

• Political acceptability

• Social will

• Possible unintended consequences

5: Strategic Planning

• Best Practices Registry (BPR) for Suicide Prevention

– A resource for information about best practices that

address specific objectives of the National Strategy for

Suicide Prevention.

– Three sections:

• Section I: Evidence-Based Programs

• Section II: Expert and Consensus Statements

• Section III: Adherence to Standards

7: Evaluation

• Formative Evaluation

• Process Evaluation

• Outcome Evaluation

Project Beginning

Project End

• From SPRC (www.sprc.org)

– Resources related to coalition building, locating and using data, strategic planning, evaluation, and more

– Best Practices Registry (BPR) for Suicide Prevention

– Online library

• Elsewhere

– Univ of Kansas Community Tool Box (http://ctb.ku.edu/en/)

– Prevention Institute (http://preventioninstitute.org/tools.html)

– International Association for Suicide Prevention (IASP) (http://www.iasp.info/)

– World Health Organization (WHO) http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

III. Resources

What We Have Covered

• Suicide as a public health problem

• Preventing suicide in local communities

• Resources for community-based suicide

prevention

Thank you

SPRC, www.sprc.org

info@sprc.org, 00 1 + 1 877 438 7772

Jerry Reed, Director

jreed@edc.org, 00 1 + 202 572 3771

Katie Wootten, Associate Project Director

kwootten@edc.org, 00 1 + 202 572 3722