H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment

1

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director

Center for Substance Abuse TreatmentSubstance Abuse Mental Health Services

AdministrationU.S. Department of Health & Human Services

““Co-occurring Substance Abuse Co-occurring Substance Abuse and Mental Disorders & Suicide”and Mental Disorders & Suicide”

October 29, 2008Mandan, ND

North Dakota Conference on Injury Prevention & Control

North Dakota Conference on Injury Prevention & Control

22

President George W. Bush

May 2001

“…above all, our efforts rest on an unwavering

commitment to stop drug use. Acceptance of drug

use is simply not an option...”

3

Substance Abuse and Mental Health Substance Abuse and Mental Health Services Administration/CSATServices Administration/CSAT

Substance Abuse and Mental Health Substance Abuse and Mental Health Services Administration/CSATServices Administration/CSAT

SAMHSA’s Mission: • To build resilience and facilitate recovery for

people with or at risk for substance abuse and mental illness.

Center for Substance Abuse Treatment (CSAT) Mission:

• To improve the health of the nation by bringing effective alcohol and drug treatment to every community.

4

SAMHSA Matrix of PrioritiesSAMHSA Matrix of Priorities

• Suicide prevention and Co-occurring Disorders are two of SAMHSA’s priorities.

5

The Issue…The Issue…The Issue…The Issue…

• Every 18 minutes another life is lost to suicide – totaling more than 32,000 Americans each year.– That equals 89 suicides each day or 1 suicide

every 16 minutes.

• In 2006, 162,359 people were hospitalized due to self-inflicted injury.

• Suicide is now the 11th leading cause of death in Americans.

• Many who attempt suicide never seek professional care.

Source: National Strategy for Suicide Prevention web site & CDC

6

U.S. Suicide Rate is UpU.S. Suicide Rate is Up

• According to a new study, the U.S. suicide rate rose to 11 per 100,000 people in 2005 – an increase of almost 5% since 1999.

• The greatest impact was attributable to a nearly 16% jump in suicides among people aged 40 to 64. Within that age group, from 1999 to 2005:– Suicides for whites rose 17%.

• The rate for middle-aged white men rose 16%.• For middle-aged white women, the rate rose 19%.

– The suicide rate for middle-aged African Americans rose 7%

Source: Baker, S.A. et al (in press) Mid-life suicide: An increasing problem in U.S. whites. 1999-2005, American Journal of Preventive Medicine

7

Possible Influencers in Rate IncreasePossible Influencers in Rate IncreasePossible Influencers in Rate IncreasePossible Influencers in Rate Increase

• Although the reason for the increase is not clear, one possibility is a tie to a concurrent increase in abuse of prescription pain pills – such as OxyContin.

• Another explanation might be the drop in hormone replacement therapy due to health risks, since women who gave up the drugs might be more susceptible to depression.


8

Trends in U.S. Suicide Mortality by Trends in U.S. Suicide Mortality by MethodMethod


10. 84

5. 62

2. 42

1. 930

2

4

6

8

10

12

14

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Age

-adj

uste

d m

orta

lity

/100

,000

total firearm suffocation poisoning


9

• Suicide by firearm, hanging/suffocation, and poisoning together comprise 92% of all suicides.

• In 2005, suicide by firearm comprised 52% of all suicides.

• Hanging/suffocation accounting for 22% of all suicides in 2005, and

• Poisoning accounted for 18%.




10

Trends in U.S. Suicide Mortality by RaceTrends in U.S. Suicide Mortality by RaceTrends in U.S. Suicide Mortality by RaceTrends in U.S. Suicide Mortality by Race

0

2

4

6

8

10

12

14

16

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Ag

e-ad

just

ed m

ort

alit

y /1

00,0

00

White Black Native American Asian


11

North Dakota Suicide Rates by RaceNorth Dakota Suicide Rates by Race

12.9

50

0

10

20

30

40

50

60

De

ath

s p

er

10

0,0

00

Po

pu

lati

on

ND White ND American Indian

Source: North Dakota Department of Health

12

Suicide Rates among Native Suicide Rates among Native Americans/Alaska NativesAmericans/Alaska Natives

Suicide Rates among Native Suicide Rates among Native Americans/Alaska NativesAmericans/Alaska Natives

• Among Native Americans/Alaska Natives ages 15-34 years, suicide is the 2nd leading cause of death

– at 21.7 per 100,000 it is 2.2 times higher than the national average.

• Young Native American women have suicide rates that are 2 to 3 times higher than for females in the general population.

CDC 2005

13

NationalNational Suicide Mortality Rates by Suicide Mortality Rates by Gender: 1950-2004Gender: 1950-2004

NationalNational Suicide Mortality Rates by Suicide Mortality Rates by Gender: 1950-2004Gender: 1950-2004

21.2

20.0 19.8 19.921.5 17.7 18.0

18.0

5.6 5.67.4

5.7 4.8 4 4.2 4.5

0

5

10

15

20

25

1950 1960 1970 1980 1990 2000 2003 2004

Year

Ra

te P

er

10

0,0

00

Male Female

Source: National Center for Health Statistics, 2007

• Suicide is the 8th leading cause of death for men of all ages and the 17th leading cause of death for women (CDC 2005)

14

North DakotaNorth Dakota Suicide Mortality Rates by Suicide Mortality Rates by Gender: 1999 - 2007Gender: 1999 - 2007

North DakotaNorth Dakota Suicide Mortality Rates by Suicide Mortality Rates by Gender: 1999 - 2007Gender: 1999 - 2007

18

19.9 20.7 21.122.4

23.325.6

3.53.44.15.144.5

3.3

0

5

10

15

20

25

30

1999-20012000-2002

2001-20032002-2004

2003-20052004-2006

2005-2007

Su

icid

e D

ea

th R

ate

s b

y 1

00

,00

0

ND Male ND Female

Source: North Dakota Department of Health

15

Gender Disparities in Suicide RatesGender Disparities in Suicide RatesGender Disparities in Suicide RatesGender Disparities in Suicide Rates

• Males represent 79.4% of all U.S. suicides.

• However, during their lifetime, women attempt suicide about 2 to 3 times as often as men.

• Among males, adults ages 75 and older have the highest rate of suicide (37.97 per 100,000).

• Among females, those in their 40s and 50s have the highest suicide rate (7.53 per 100,000).

• Firearms are the most commonly used method of suicide among men, while poisoning is the most common among women.

Source: CDC 2005

16

Co-occurring Disorders & SuicidalityCo-occurring Disorders & SuicidalityCo-occurring Disorders & SuicidalityCo-occurring Disorders & Suicidality

• Research shows that most people who commit suicide have a diagnosable mental or substance use disorder or both, and that the majority of them have depressive illness.

• Studies also indicate that the most promising way to prevent suicide and suicidal behavior is through the early recognition and treatment of substance abuse and mental illnesses. This is especially true of clients who have serious depression (U.S. Public Health Service 1999).

Source: Treatment Improvement Protocol 42

17

Call to ActionCall to ActionCall to ActionCall to Action

• Surgeon General issued “Call to Action to Prevent Suicide” (1999)– First step toward adoption of a National Strategy

on Suicide Prevention and the acknowledgement of suicide as a public health issue.

– Called for the implementation of strategies to reduce the stigma associated with suicidal behavior, mental illnesses and substance abuse disorders.

– Recommended that health care providers be trained to better recognize and either refer or treat depression, substance abuse, and major mental illnesses associated with suicide risk.

18

Definition:Definition:Co-Occurring DisordersCo-Occurring Disorders

Definition:Definition:Co-Occurring DisordersCo-Occurring Disorders

• Clients said to have co-occurring disorders have one or more mental disorders as well as one or more disorders relating to the use of alcohol and/or other drugs.

• A diagnosis of a co-occurring disorder (COD) occurs when at least one disorder of each type can be established independently of the other and is not simply a cluster of symptoms resulting from a single disorder.

19

Consequences of Co-occurring Consequences of Co-occurring DisordersDisorders

Consequences of Co-occurring Consequences of Co-occurring DisordersDisorders

• Increased vulnerability to relapse and re-hospitalization

• More psychotic symptoms

• Inability to manage finances

• Housing instability and homelessness

• Noncompliance with medications and treatment

• Increased vulnerability to HIV infection and hepatitis

20

Consequences of Co-occurring Consequences of Co-occurring Disorders (continued)Disorders (continued)

Consequences of Co-occurring Consequences of Co-occurring Disorders (continued)Disorders (continued)

• Lower satisfaction with familial relationships

• Increased family burden

• Violence

• Incarceration

• Higher service utilization and costs

• Increased depression and “suicidality” (the Increased depression and “suicidality” (the composite of suicidal behaviors)composite of suicidal behaviors)

21

Serious Psychological Distress (SPD) & Serious Psychological Distress (SPD) & Drug UseDrug Use

Serious Psychological Distress (SPD) & Serious Psychological Distress (SPD) & Drug UseDrug Use

28.0%

42.1%

32.2%

10.9%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Past Year Illicit DrugUse

Past MonthCigarette Use

Binge AlcoholDuring Past Month

Heavy Alcohol Usein Past Year

Percent of Persons 18 or older

With SPD Wihout SPD

Source: NSDUH 2007

22

Substance Abuse & SuicideSubstance Abuse & Suicide

• As many as 27% of all deaths of people who abuse alcohol are caused by suicide, with the lifetime risk for suicide among people who abuse alcohol estimated to be 15%.

• According to SAMHSA’s Drug Abuse Warning Network (DAWN), in 2005 over 132,500 visits to emergency rooms were for alcohol or drug-related suicide attempts.– The most frequently identified substance was alcohol

– found in 1/3 of those tested.

– Illicit drugs were involved in approximately 19% of the ED visits for drug-related suicide attempts.


23

Substance Abuse & SuicideSubstance Abuse & SuicideSubstance Abuse & SuicideSubstance Abuse & Suicide

• Alcohol and drug abuse are second only to depression and other mood disorders as the most frequent risk factors for suicide.

• The association between alcohol use and suicide also may relate to the capacity of alcohol to remove inhibitions, leading to poor judgment, mood instability, and impulsiveness.

• Substance intoxication is associated with increased violence, both toward others and self.


24

Substance Dependence or Abuse among Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Adults Aged 18 or Older, by Major Depressive

Episode (MDE) in the Past Year: 2007Episode (MDE) in the Past Year: 2007

Substance Dependence or Abuse among Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Adults Aged 18 or Older, by Major Depressive

Episode (MDE) in the Past Year: 2007Episode (MDE) in the Past Year: 2007

21.5

8.2 8.8

2.1

17.0

7.0

0

5

10

15

20

25

% D

ep

en

de

nt

on

or

Ab

us

ing

S

ub

sta

nc

e

Drug or AlcoholDependence or Abuse

Drug Dependence orAbuse

Alcohol Dependence orAbuse

Had Major Depressive Episode in the Past Year

Did Not Have major Depressive Episode in the Past Year

Source: SAMHSA NSDUH 2007

25

Treatment Data: General PopulationTreatment Data: General Population2007 National Survey on Drug Use and Health

Treatment Data: General PopulationTreatment Data: General Population2007 National Survey on Drug Use and Health

Of the 5.4 million adults with both serious psychological distress (SPD) and a substance use disorder:

2.80%

10.40%

33.30%

53.50%

Treatment for MentalHealth Problems Only

Treatment for BothMental Health &Substance UseProblems

Treatment forSubstance UseProblems Only

No Treatment

Source: NSDUH 2007

26

Suicide & Major Depressive Episodes Suicide & Major Depressive Episodes (MDE)(MDE)

Suicide & Major Depressive Episodes Suicide & Major Depressive Episodes (MDE)(MDE)

• Among adults (18 and older) who experienced a past year MDE – during their worst or most recent episode -- 56.3% thought it would be better if they were dead.– 40.3% thought about committing suicide,– 14.5% made a suicide plan, and– 10.4% made a suicide attempt.

• There were no significant differences between males & females who thought it would be better if they were dead.– However, males were more likely than females to

actually consider committing suicide (45.5% vs. 37.6%)

Source: SAMHSA Office of Applied Studies, 2006

27

Suicidal Thoughts & Past Year MDESuicidal Thoughts & Past Year MDESuicidal Thoughts & Past Year MDESuicidal Thoughts & Past Year MDE

64.3%

52.6%

62.8%

46.8%

57.5%

41.9%

56.5%

40.6%

46.2%

27.1%

0%

10%

20%

30%

40%

50%

60%

70%

% R

ep

ort

ing

Su

icid

e P

lan

s &

Att

em

pts

18-20 21-24 25-34 35-54 55 or Older

Age

Thought Better if Dead Thought About Committing Suicide

Adults aged 18 or older with a Past Year MDE

Source: NSDUH 2004 & 2005

28

Suicidal Thoughts/Attempts, MDE & Past Suicidal Thoughts/Attempts, MDE & Past Month Month Binge Alcohol UseBinge Alcohol Use

Suicidal Thoughts/Attempts, MDE & Past Suicidal Thoughts/Attempts, MDE & Past Month Month Binge Alcohol UseBinge Alcohol Use

61.8%

13.7%

57.1%

9.1%

0%

10%

20%

30%

40%

50%

60%

70%

% R

ep

ort

ing

Su

icid

e T

ho

ug

hts

& A

tte

mp

ts

Past Month Binge Alcohol Use No Past Month Binge Alcohol Use



Past Year Suicidal Thoughts Past Year Suicide Attempt

29

Suicidal Thoughts/Attempts, MDE & Past Suicidal Thoughts/Attempts, MDE & Past Month Month Illicit Drug UseIllicit Drug Use

Suicidal Thoughts/Attempts, MDE & Past Suicidal Thoughts/Attempts, MDE & Past Month Month Illicit Drug UseIllicit Drug Use

67.0%

19.0%

56.9%

8.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

% R

ep

ort

ing

Su

icid

e T

ho

ug

hts

& A

tte

mp

ts

Past Month Illicit Drug Use No Past Month Illicit Drug use



Past Year Suicidal Thoughts Past Year Suicide Attempt

30

Mental Health and Co-Occurring Illness Among Veterans

Mental Health and Co-Occurring Illness Among Veterans

• From 2004 to 2006, 395,000 veterans had co-occurring serious psychological distress (SPD) and substance use disorder (SUD)

• Veterans aged 18 to 25 have the highest rate of SPD and SUD at 8.4%, with veterans 55 or older having the lowest rate at 0.7%.

The NSDUH Report, November 1, 2007

31

Prevalence of Serious Psychological Distress (SPD), Prevalence of Serious Psychological Distress (SPD), Substance Use Disorder (SUD), and Co-Occurring Substance Use Disorder (SUD), and Co-Occurring

SPD and SUD in the Past Year among Veterans: 2004 SPD and SUD in the Past Year among Veterans: 2004 to 2006to 2006

Prevalence of Serious Psychological Distress (SPD), Prevalence of Serious Psychological Distress (SPD), Substance Use Disorder (SUD), and Co-Occurring Substance Use Disorder (SUD), and Co-Occurring

SPD and SUD in the Past Year among Veterans: 2004 SPD and SUD in the Past Year among Veterans: 2004 to 2006to 2006

7.0% 7.1%

1.5%

0%

1%

2%

3%

4%

5%

6%

7%

8%

SPD SUD Co-Occuring SPD& SUD

Source: The NSDUH Report, November 1, 2007

32

Mental Health and Co-Occurring Illness Mental Health and Co-Occurring Illness Among VeteransAmong Veterans

Mental Health and Co-Occurring Illness Mental Health and Co-Occurring Illness Among VeteransAmong Veterans

• A NSDUH study found no significant difference in co-occurring disorders among male and female veterans (1.5% vs. 2.0% respectively.)

• Veterans with family incomes of less than $20,000 per year were more likely to have had co-occurring SPD & SUD in the past year than veterans with higher family incomes.1

• According to the Department of Veterans Affairs, 18% of the veterans recently back from tours of duty are unemployed. Of those employed since leaving the military, 25 percent earn less than $21,840 a year.

1 The NSDUH Report, November 1, 2007

33

Prevalence of Serious Psychological Distress (SPD), Prevalence of Serious Psychological Distress (SPD), Substance Use Disorder (SUD), and Co-Occurring Substance Use Disorder (SUD), and Co-Occurring SPD and SUD in the Past Year among Veterans, by SPD and SUD in the Past Year among Veterans, by

Family Income: 2004 to 2006Family Income: 2004 to 2006

Prevalence of Serious Psychological Distress (SPD), Prevalence of Serious Psychological Distress (SPD), Substance Use Disorder (SUD), and Co-Occurring Substance Use Disorder (SUD), and Co-Occurring SPD and SUD in the Past Year among Veterans, by SPD and SUD in the Past Year among Veterans, by

Family Income: 2004 to 2006Family Income: 2004 to 2006

15.1%

10.8%

4.1%

0.7%1.4%

6.6%6.9%6.3%

5.9%

1.2%

6.7%

4.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

SPD SUD Co-OccurringSPD & SUD

Less Than $20,000

$20,000-$49,999

$50,000-$74,999

$75,000 or More

Source: The NSDUH Report, November 1, 2007

3434

Prevalence of Reporting a Mental Health Prevalence of Reporting a Mental Health Problem Among Returning VeteransProblem Among Returning Veterans

• The prevalence of reporting a mental health problem was 19.1% among veterans returning from Iraq, compared with 11.3% after returning from Afghanistan, and 8.5% after returning from other locations.

• 35% of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were

diagnosed with a mental health problem.

• More than 50% of those referred for a mental health reason were documented to receive follow-up care.

Hoge, C. W., et al., JAMA, 3/1/06

35

Veterans and SuicideVeterans and Suicide

• Between 2002 and 2005, 144 out of 490,346 separated OEF/OIF service members committed suicide, for an overall rate of 21.9 per 100,000.

• Among veterans receiving care from the Department of Veterans Affairs (VA) who died from suicide, almost 60% of those under age 65 had a mental health or substance abuse diagnosis on their medical records.

• Those veterans who are wounded in combat are at higher risk of suicide.

Source: VA Testimony of The Honorable James B. Peake, M.D. before Congress on May 6, 2008 - Congressional and Legislative Affairs

3636

Unique Characteristics of Returning Unique Characteristics of Returning VeteransVeterans

Unique Characteristics of Returning Unique Characteristics of Returning VeteransVeterans

Returning veterans may be different from others in public substance abuse and mental health treatment:

• They are generally younger, with a shorter history of substance abuse.

• They have been used to a very structured, controlled environment

• National Guard and Reservists, in particular, might feel split between who they were before seeing combat, and who they are now, i.e., citizen-soldier.

• The military culture is shared across ethnic and racial populations, but also has ethnic/racial tensions.

3737

Key Questions for Community Providers Key Questions for Community Providers to Considerto Consider

Key Questions for Community Providers Key Questions for Community Providers to Considerto Consider

• Counselors should routinely assess clients for histories of traumatic events and for the diagnosis of PTSD

• Counselors should ask both male and female clients about military experiences

• Counselors should ask if their clients or family members are part of the military and/or combat veterans family network.

3838

SAMHSA Priority PopulationSAMHSA Priority PopulationSAMHSA Priority PopulationSAMHSA Priority Population

• SAMHSA recently established returning veterans and their families as one of SAMHSA’s priority populations.

• This means that, beginning in FY 2008, this population is included in all relevant announcements of grant availability, and

• Applicants for SAMHSA grants will be strongly encouraged to address veterans’ issues.

• The returning veterans and families population is now one of the SAMHSA Matrix program areas, assuring continuing attention throughout SAMHSA’s major, ongoing programs.

39

A Public Health Approach to Suicide Prevention & Treatment

A Public Health Approach to Suicide Prevention & Treatment

• A public health approach is population-based that focuses on the full range of the health-illness continuum:– Promotion of health through the prevention of

illness and disability– Treatment and rehabilitation of those affected

• Prevention and treatment are both important.– While focusing treatment and care on the

needs of the individual, a public health model also supports development of preventive interventions for the entire population.

Source: Substance Abuse and Suicide Prevention: Evidence & Implications, White Paper (in press), DHHS, SAMHSA, 2008

40

Working Upstream and DownstreamWorking Upstream and Downstream

• A public health approach focuses on prevention as well as illness.

• Providers keep “rescuing drowning individuals” downstream,

• But, they also need to move “upstream” to keep people from falling into the river in the first place.

• The emphasis is on connections rather than a stovepipe approach to services.


41

• A public health approach follows an ordered, continuous set of steps to promote health and prevent illness:– Identify the problem– Identify risk and protective factors

• Risk factors include extreme economic deprivation, academic failure, peer rejection, family conflict

• Protective factors include strong family bonds and social skills, opportunities for success, and community involvement

– Develop, implement and test interventions– Ensure widespread adoption of evidence-based

practices

A Public Health Approach to Suicide A Public Health Approach to Suicide Prevention & TreatmentPrevention & Treatment

A Public Health Approach to Suicide A Public Health Approach to Suicide Prevention & TreatmentPrevention & Treatment


42

Public Health Approach ValuesPublic Health Approach Values

A public health approach values:• Preventive care that can identify and act on risks

for suicide early, including attention to both substance abuse and mental disorders.

• Primary care practitioners and behavioral health care providers who look beyond their individual disciplines.

• Connections between the scientific community and the broader public – and between the behavioral health service community and consumers.


43

Role of Primary Care ProvidersRole of Primary Care Providers

• According to the Institute of Medicine, a majority of people who die by suicide visited a health care provider within a year of their deaths.

• 40% had seen a clinician within a month.• A study of suicides of elderly patients indicated

that 18% saw their primary care provider on the same day as their suicide. (Loebel 2005)

• Primary care providers need to be vigilant in screening for suicide risk.


44

SAMHSA’s National Suicide SAMHSA’s National Suicide Prevention Initiative (NSPI)Prevention Initiative (NSPI) SAMHSA’s National Suicide SAMHSA’s National Suicide Prevention Initiative (NSPI)Prevention Initiative (NSPI)

Center for Mental Health ServicesKathryn A. Power, Director

45

National Suicide Prevention Initiative National Suicide Prevention Initiative (NSPI)(NSPI)

National Suicide Prevention Initiative National Suicide Prevention Initiative (NSPI)(NSPI)

SAMHSA suicide prevention programs currently are underway under NSPI:

• National Suicide Prevention Lifeline

• Suicide Prevention Resource Center (SPRC)

• National Strategy for Suicide Prevention (NSSP)

46

National Suicide Prevention LifelineNational Suicide Prevention LifelineNational Suicide Prevention LifelineNational Suicide Prevention Lifeline

• The SAMHSA-funded National Suicide Prevention Lifeline has become the nation’s leading source of immediate help for those dealing with suicide-related issues.

• It offers a 24/7 toll-free suicide prevention service at 1-800-273-TALK (8255)

• The Lifeline receives an average of 43,000 calls a month from people seeking help for themselves or someone else.

• Callers are routed to the closest in a network of 135 local emergency, mental health, and social services resources.

• Web site: http://www.suicidepreventionlifeline.org/

4747

National Suicide Prevention LifelineNational Suicide Prevention Lifelinefor Veteransfor Veterans

National Suicide Prevention LifelineNational Suicide Prevention Lifelinefor Veteransfor Veterans

• In July 2007, SAMHSA, in collaboration with the U.S. Department of Veterans Affairs, modified its toll-free National Suicide Prevention Lifeline.

– A new prompt offers the option of pressing #1 and connecting directly to a special VA suicide crisis line, located in Canandaigua, NY, and staffed by mental health professionals, who can refer callers to more than 150 Suicide Prevention Coordinators at local VA Medical Centers across the country.

• Over 22,000 calls have come into the Lifeline during Over 22,000 calls have come into the Lifeline during its first year from veterans and those seeking help its first year from veterans and those seeking help for veterans who are family members or friends.for veterans who are family members or friends.

48

Lifeline Efforts to Reach Young PeopleLifeline Efforts to Reach Young PeopleLifeline Efforts to Reach Young PeopleLifeline Efforts to Reach Young People

• Recently the National Suicide Prevention Lifeline arranged to establish sites within the MySpace, Facebook and YouTube social networks.

• Also, users who mention “suicide” in their postings to Help.com receive an automatic response from Lifeline – urging them to call 1-800-273-TALK.

49

Lifeline GalleryLifeline GalleryLifeline GalleryLifeline Gallery

• The online Lifeline Gallery: Stories of Hope and Recovery is an interactive web site designed to raise awareness about the effects of suicide.

• Animated avatars allow survivors of people who have died through suicide, suicide attempt survivors, and those in the suicide prevention field to share messages of hope and recovery.

• Web site: www.lifeline-gallery.org

50

National Suicide Prevention Lifeline – National Suicide Prevention Lifeline – North DakotaNorth Dakota

National Suicide Prevention Lifeline – National Suicide Prevention Lifeline – North DakotaNorth Dakota

• North Dakota National Suicide Prevention Lifeline centers received 756 calls during the past 12 full months.

• Calls were handled by North Dakota’s two Lifeline centers:– FirstLINK HotLINE – Fargo, ND– Mental Health America of North Dakota –

Bismark, ND

51

Suicide Prevention Resource Center Suicide Prevention Resource Center (SPRC)(SPRC)

Suicide Prevention Resource Center Suicide Prevention Resource Center (SPRC)(SPRC)

• Established in 2002, SPRC is the first federally-funded center of its kind.

• SPRC provides states, government agencies, private organizations, colleges and universities, and suicide survivor and mental health consumer groups with– Prevention support designed to help states and

communities increase their capacity to prevent suicide, and to inform the work of researchers and suicide prevention professionals with a registry of best practices for suicide prevention.

– Information support, including an extensive library and website, literature searches and a variety of resource materials.

– Web site: http://www.sprc.org/

52

National Strategy for Suicide Prevention National Strategy for Suicide Prevention (NSSP)(NSSP)

National Strategy for Suicide Prevention National Strategy for Suicide Prevention (NSSP)(NSSP)

• NSSP is a collaborative effort between SAMHSA, the Centers for Disease Control (CDC), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and Indian Health Service (HIS).

• It contains links to resources that deal with understanding and preventing suicide and Federal plans for reducing suicide in this country.

• Web site: http://mentalhealth.samhsa.gov/suicideprevention/

53

SAMHSA Grants for Suicide PreventionSAMHSA Grants for Suicide PreventionSAMHSA Grants for Suicide PreventionSAMHSA Grants for Suicide Prevention

• In FY2008, SAMHSA provided $48.6 Million in funding to improve public and professional awareness of suicide and promote prevention.

• SAMHSA funds are support the following programs/initiatives:– Garrett Lee Smith Suicide Prevention Activities in

States and Colleges,– Garrett Lee Smith Suicide Prevention Resource

Center,– The National Suicide Prevention Lifeline, and– American Indian/Alaska Native Suicide Prevention

Initiative

54

SAMHSA 2008 Suicide Prevention SAMHSA 2008 Suicide Prevention GrantsGrants


• Campus Suicide Grants– Assists colleges and universities to prevent suicide

attempts and completions and to enhance services for students with mental and behavioral health problems, such as depression and substance abuse, which put them at risk for suicide and suicide attempts.

– In September, SAMHSA announced 17 new grant awards, totaling approximately $4.5 Million over 3 years.

• North Dakota Grantee: University of North Dakota – The American Indian Suicide Prevention Program– Two-phase program that develops a circle of care

model for suicide prevention and then applies the model to tribal colleges in North Dakota.

55

FY 2009 Campus Suicide Prevention Grants

FY 2009 Campus Suicide Prevention Grants

Award Information:• Application Deadline: November 25, 2008Application Deadline: November 25, 2008• Funding Mechanism: Grant• Anticipated Total Available Funding: $2.1 Million • Anticipated Number of Awards: 21• Anticipated Award Amount: Up to 100,000 per year• Length of Project Period: Up to 3 years • For more information & application: http://www.grants.gov/ Eligibility:• Limited to institutions of higher education. • Applicants from both public and private institutions may apply,

including State universities, private four-year colleges and universities (including those with religious affiliations), Minority Serving Institutions of higher learning, and community colleges.

56



• State/Tribal Youth Suicide Prevention Grants

– Supports 31 States and 7 tribes/tribal organizations in developing and implementing statewide or tribal youth suicide prevention and early intervention strategies, grounded in public/private collaboration.

• North Dakota Grantees received a total of $800,000 in FY 2007

– North Dakota State Department of Health

– Standing Rock Sioux Tribe

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Garrett Lee Smith Youth Suicide Prevention Garrett Lee Smith Youth Suicide Prevention and Early Intervention Programand Early Intervention Program

Cross-Site EvaluationCross-Site Evaluation



Training:

• 153,184 professionals and community members have been trained through GLS-supported activities including:

– College and University Students – Parents, Foster Parents and other caregivers – Teachers, College and University Faculty and Staff

(3,930)– Direct Mental Health Service Providers – Child Welfare Staff– Primary Care Providers – Clergy and Religious Educators

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Connecting Youth with Services • 13,618 Youth have been screened through GLS-

supported activities• 2,851 Youth screened positive for suicide risk and 95%

of those youth were referred for additional services, including:– Mental health assessment – Tutoring/academic counseling– Crisis hotline– Psychiatric hospitalization– Emergency room or mobile crisis units– Substance use assessment or treatment

[

*Youth are often referred to more than one service





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• Within 3 months, nearly 90% of youth identified through screening and referred for mental health services made contact with a provider, receiving:

[

6%

3%14%

6%

71%

.4%Mental HealthAssessmentSubstance Use Services

Family Therapy

Individual Therapy

Group Therapy

Other Mental HealthServices





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Increasing Awareness on College Campuses

• Approximately 74% of students surveyed on grantee campuses are aware of at least one place to refer a suicidal peer, such as university counseling centers, specific counselors or faculty, and 1–800–273–TALK.

• Students who had been exposed to suicide prevention materials demonstrated greater awareness of suicide risk and prevention

• Faculty who had participated in suicide prevention activities were significantly more aware of suicide risk and prevention





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SAMHSA Co-Occurring SAMHSA Co-Occurring WorkgroupWorkgroup

SAMHSA Co-Occurring SAMHSA Co-Occurring WorkgroupWorkgroup

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SAMHSA’s Co-occurring Center for SAMHSA’s Co-occurring Center for Excellence (COCE)Excellence (COCE)

SAMHSA’s Co-occurring Center for SAMHSA’s Co-occurring Center for Excellence (COCE)Excellence (COCE)

• SAMHSA’s COCE is administered by the Center for Substance Abuse Treatment (CSAT) and the Center for Mental Health Services (CMHS).

• COCE provides technical assistance, training, products, and resources to support the dissemination and adoption of best practices in systems & programs that serve persons with co-occurring disorders.

• Web site: http://coce.samhsa.gov

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COCE Technical AssistanceCOCE Technical AssistanceCOCE Technical AssistanceCOCE Technical Assistance

• COCE technical assistance and cross-training is available to States, cities, counties, tribes and tribal organizations, community-based providers, educational establishments, criminal justice related entities, and other social and public health providers.

• Technical Assistance opportunities include:– Screening & Assessment– Treatment Planning and Approach– Evidence & Consensus Based Practices– Workforce Development– Services Integration– Systems Change

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COCE TrainingCOCE TrainingCOCE TrainingCOCE Training

• COCE’s training task consists of two main goals:

– Development of training modules on co-occurring topics, and

– Identification and provision of training for persons who will provide this training for those in need.

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TIP 42: Substance Abuse Treatment for TIP 42: Substance Abuse Treatment for Persons with Co-occurring DisordersPersons with Co-occurring Disorders

TIP 42: Substance Abuse Treatment for TIP 42: Substance Abuse Treatment for Persons with Co-occurring DisordersPersons with Co-occurring Disorders

• Treatment Improvement Protocol (TIP) 42 provides information about the field of co-occurring substance use and mental disorders, and captures the state of the art in the treatment of people with co-occurring disorders.

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Case Study for DiscussionCase Study for Discussion

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Case Study: Counseling a Substance Case Study: Counseling a Substance Abuse Client who is SuicidalAbuse Client who is Suicidal


The Situation:• Beth M., an American Indian woman, comes to the

substance abuse treatment center complaining that drinking too much causes problems for her.

• She has tried to stop drinking before but always relapses.

• The counselor finds that she is not sleeping, has been eating poorly, and has been calling in sick to work.

• She spends much of the day crying and thinking of how alcohol, which has cost her latest significant relationship, has ruined her life.


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The Situation (cont’d):

• She also has been taking painkillers for a recurring back problem, which has added to her problems.

• The counselor tells her about a group therapy opportunity at the center that seems right for her, tells her how to register, and makes arrangements for some individual counseling to set her on the right path.

• The counselor also tells her she has done the right thing by coming in for help and gives her encouragement about her ability to stop drinking.


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The Situation (cont’d):

• Beth M. does not arrive for her next appointment, and when the counselor calls home, he learns from her roommate that Beth made an attempt on her life after leaving the substance abuse treatment center.

• She took an overdose of opioids and is recovering in the hospital.

• The emergency room staff found that Beth M. was under the influence of alcohol when she took the opioids.


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Discussion:

• Although Beth M. provided information that showed she was depressed, the counselor did not explore the possibility of suicidal thinking.

• Counselors always should ask if the client has been thinking of suicide, whether or not the client mentions depression.

• An American Indian client, in particular, may not answer a very direct question, or may hint at something darker without mentioning it directly.

• Interpreting the client's response requires sensitivity on the part of the counselor.


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Discussion (cont’d):

• It is important to realize that such questions do not increase the likelihood of suicide.

• Clients who, in fact, are contemplating suicide are more likely to feel relieved that the subject has now been brought into the light and can be addressed with help from someone who cares.

• It is important to note that the client reports taking alcohol and pain medications.

• Alcohol impairs judgment and, like pain medications, depresses brain and body functions. The combination of substances increases the risk of suicide or accidental overdose.


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SAMHSA/CSAT InformationSAMHSA/CSAT InformationSAMHSA/CSAT InformationSAMHSA/CSAT Information

• SAMHSA web site: www.samhsa.gov• National Strategy for Suicide Prevention web site:

http://mentalhealth.samhsa.gov/suicideprevention/

• Suicide Prevention Resource Center web site: http://www.sprc.org/

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

• For information regarding grants & application: http://www.grants.gov/

• SHIN 1-800-729-6686 for publication ordering or information on funding opportunities SHIN TDD Line: 1-800-487-4889

• 1-800-662-HELP – SAMHSA’s National Helpline (average # of sub abuse tx calls per mo.- 24,000)

Documents

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment