1. A Community Approach to Suicide Prevention Presented By: Karen M Marshall

2. About the American Association of Suicidology AAS is a membership organization for all those involved in suicide prevention and intervention, or touched by suicide. AAS is a leader in the advancement of scientific and programmatic efforts in suicide prevention through research, education and training, the development of standards and resources, and survivor support services. AAS is a membership organization for all those involved in suicide prevention and intervention, or touched by suicide. AAS is a leader in the advancement of scientific and programmatic efforts in suicide prevention through research, education and training, the development of standards and resources, and survivor support services.

3. Why I’m Here AAS and Rail Suicide Prevention AAS and Rail Suicide Prevention Background in print and broadcast media Background in print and broadcast media –Meeting with media today 20 years of experience in prevention, intervention and post-vention 20 years of experience in prevention, intervention and post-vention

4. National Rail Suicide Prevention Research Project Funded by the Federal Railroad Administration Funded by the Federal Railroad Administration In its fourth year In its fourth year –Prevalence assessment –Causal Analysis –Plan, pilot-test and evaluate prevention measures

5. My Journey …

6. On the Agenda for Today A snapshot of suicide in the United States A snapshot of suicide in the United States What is known about suicide clusters What is known about suicide clusters A community-based approach A community-based approach Resources Resources Wrap-up and questions Wrap-up and questions

7. Depression and Suicide Major Public Health Risks* Relevant Facts: More than 33,000 suicide deaths annually More than 33,000 suicide deaths annually Twice as many suicides as deaths from HIV/AIDS Twice as many suicides as deaths from HIV/AIDS Nearly twice as many as homicides Nearly twice as many as homicides Estimated 750,000 non-fatal attempts, many requiring medical intervention; many resulting in lifelong health problems or permanent disability Estimated 750,000 non-fatal attempts, many requiring medical intervention; many resulting in lifelong health problems or permanent disability *Former US Surgeon General Dr. David Satcher

8. Depression and Suicide Major Public Health Risks* Analogy: Analogy: –Passenger Jet

9. Relevant Facts: Third leading cause of death among Third leading cause of death among 15-24 year olds Second leading cause of death for college- age young people Second leading cause of death for college- age young people The Good News is …

10. Relevant Facts White males over age 65 have the highest rate of suicide White males over age 65 have the highest rate of suicide Two-thirds of suicide deaths are among the workforce, those ages 25 - 59 Two-thirds of suicide deaths are among the workforce, those ages 25 - 59

11. Relevant Facts Men end their lives four times more often than women Men end their lives four times more often than women Women attempt suicide four times more often than men Women attempt suicide four times more often than men Firearms account for more than two-thirds of all suicide deaths Firearms account for more than two-thirds of all suicide deaths 90 percent of all suicide deaths are linked to a diagnosable, treatable brain illness 90 percent of all suicide deaths are linked to a diagnosable, treatable brain illness

12. What is Known About Clusters Madelyn Gould’s study Madelyn Gould’s study Community Responses Community Responses Possible interventions Possible interventions

14. Interventions Knowledge Knowledge –Psychological Autopsies –Emergency Room records –Screening Gatekeeper Training Gatekeeper Training Treatment Treatment –Accessible, appropriate –Safety planning upon discharge Means restriction Means restriction Honor the stress and pain Honor the stress and pain

15. Risk of Cycle Acceleration with Aging in Untreated Illness Pine et al, AJP, 1998 Slides courtesy of University of Michigan Depression Center

17. The Good and the Bad Study of 53 clusters to be published Study of 53 clusters to be published Communities remain vulnerable Communities remain vulnerable

18. Your Suicide Prevention Future It is important that your Safety Net remains strong and sustainable It is important that your Safety Net remains strong and sustainable Leadership Leadership Gatekeeper Training Gatekeeper Training School Accreditation Program School Accreditation Program Training for Health Professionals Training for Health Professionals Means Restriction Means Restriction Good Post-vention Good Post-vention

20. Community-Based Suicide Prevention A shining example – the U.S. Air Force A shining example – the U.S. Air Force

21. USAF Program Elements General suicide awareness and prevention training - annual General suicide awareness and prevention training - annual Special training for Special training for –Key gatekeepers –Service providers Policies to improve access to key services Policies to improve access to key services Communications (social marketing) campaign Communications (social marketing) campaign –De-stigmatize EARLY help-seeking –Promote social support – “caring community” Screening for mental health problems Screening for mental health problems Improved coordination of social services Improved coordination of social services –Focus on strengthening life/coping skills

22. Suicide Among Airmen

23. Comparison of the effects of risk for suicide and related adverse outcomes in the USAF population prior to implementation of the program (1990-1996) and after implementation (1996-2002). Outcome Relative Risk (RR) and 95% CI Risk Reduction (1-RR) Excess Risk (RR-1) Suicide.67 [.5702,.8017]  33% -- -- Homicide.48 [.3260,.7357]  51% Accidental Death.82 [.7328,.9311]  18% -- Severe Family Violence.46 [.4335,.5090]  54% -- Moderate Family Violence.70 [.6900,.7272]  30% -- Mild Family Violence 1.18 [1.1636, 1.2040] --  18% Results

24. The result of a complex mix of biological, emotional, physical and circumstantial conditions. And, it is preventable Suicide is…

25. What has delayed suicide prevention? Myths Myths Stigma Stigma Belief that no one can stop a person who plans to die by suicide Belief that no one can stop a person who plans to die by suicide Suicide Prevention is Everybody’s Business!

26. What Is Suicide Prevention? A Public Health Approach –Ranges from general education and awareness –To research –To treatment of individuals

27. Warning Signs of Acute Suicide Risk* *Developed by AAS with an international task force

28. Warning Signs of Acute Risk Threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself; and/or Threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself; and/or Looking for ways to harm or kill him/herself (seeking access to firearms, quantities of pills, or other means; and/or Looking for ways to harm or kill him/herself (seeking access to firearms, quantities of pills, or other means; and/or Talking or writing about death, dying or suicide when these actions are out of the ordinary. Talking or writing about death, dying or suicide when these actions are out of the ordinary.

29. What to Do? Take all signs seriously – never think that suicide can’t happen to someone you know Take all signs seriously – never think that suicide can’t happen to someone you know Stay with the person. If you can’t, find someone who can. Stay with the person. If you can’t, find someone who can. Involve others – friends, trusted adults, mental health professionals, family or someone of faith if appropriate Involve others – friends, trusted adults, mental health professionals, family or someone of faith if appropriate Get the person to additional help as soon as possible Get the person to additional help as soon as possible

30. To Call for Help The National Suicide Prevention Lifeline: 1 – 800- 273 –TALK (8255) If there is imminent threat, call 911

31. Other Resources In California: In California: –The Suicide Prevention Task Force –Crisis Centers –Community Mental Health Centers Nationally Nationally AASAFSP National Suicide Prevention Lifeline SPRCNational Council for Suicide Prevention AAS’s Annual Conference

32. Contact Information Karen M Marshall Karen M Marshall American Association of Suicidology 5221 Wisconsin Ave., NW Washington DC 20015 202-237-2280 KMarshall@suicidology.org www.suicidology.org