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

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.

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.

Suicide Rates, Children Ages 10-17US and Nebraska, 1997-2007

0

2

4

6

8

10

12

14

16

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

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Nebraska (3-year averages) US (annual rates)

Nebraska rates are three year averages; 2006 & 2007 values are provisional. The 95% confidence intervals around each point are also show n. Nebraska rates are signif icantly higher than US rates for 1999, and 2002-2005 (confidence intervals do not overlap). Source: Centers for Disease Control and Prevention.

Suicide death rates by age and gender, Nebraskaresidents, 2004-2008 (n=881)

1.6

19.517.4

21.3

24

19.1 19.8

25.7

17.1

0.9

3.7 3.3

7.1 6.9

4.22.3

3.3

*0

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

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Males

Females

Source: NHHSS Vital Statistics 2004-2008

Evidence-based =› 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

SocietyCommunit

yIndividu

alRelationship

Among all 18-24 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]

Among all 18-24 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]

Suicide is an outcome that requiresseveral things to go wrong all at onceSuicide is an outcome that requiresseveral things to go wrong all at once

BiologicalFactors

FamilialRisk

SerotonergicFunction

NeurochemicalRegulators

Demographics

Pathophysiology

ImmediateTriggers

Access To Weapons

SevereDefeat

MajorLoss

WorseningPrognosis

ProximalFactors

Hopelessness

Intoxication

ImpulsivenessAggressiveness

NegativeExpectancy

Severe Chronic Pain

PredisposingFactors

Major PsychiatricSyndromes

SubstanceUse/Abuse

PersonalityProfile

AbuseSyndromes

Severe Medical/Neurological Illness

Public HumiliationShame

Detecting potential risk Assessing risk Managing suicidality

Safety planning

Crisis support planning

Patient tracking

MH Treatment

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.

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.

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

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.

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.

Twenty-four competencies and their sub-competencies fall into seven broad categories

Core competencies related to specific treatment interventions have not been developed.

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

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

› 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

› 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

› 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.

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

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