1. 1 Youth Suicide Prevention in Nevada A Program of the Nevada Office of Suicide Prevention Suicide Prevention

2. 2 Suicide Prevention in Nevada 2003 Suicide prevention legislation (SB49, SB36, SCR 3, 4, & 5) adopted in Nevada 2005 Nevada Coalition for Suicide Prevention established; State of Nevada receives Cohort 1 Garrett Lee Smith grant $1.2 million; 2005 Nevada Office of Suicide Prevention established; 2007 Nevada Suicide Prevention Plan released; 2008-2011 Three Garrett Lee Smith Awards come to Nevada (ITCN/IHBN, OSP and Pyramid Lake Paiute Tribe; 4 MSPI grants awarded to NV tribes; 2009 State of Nevada awarded Garrett Lee Smith grant for $1.5 million, funding ended June 2013; 2013 Fund for a Healthy Nevada funds office and two state positions added;

3. Reducing Access to Lethal Means Progress of Nevada’s program Child Fatality Review Awareness Grant Bringing the program to gun stores and shooting ranges Bringing the program to the public through gun shows in Nevada 3

4. 4 Facts You Need to Know About Suicide Used with permission from the Maine Resource Book for Gatekeepers 1. Talking about suicide will not cause a person to kill themselves. 2. Few suicides happen without warning. 3. There is no “suicide type.” 4. Suicidal people can help themselves. 5. Suicide “secrets” and/or “notes” must be shared

5. 5 Facts You Need to Know About Suicide Used with permission from the Maine Resource Book for Gatekeepers 6. Depression, anxiety, mood disorders, substance abuse and conduct disorders are the most common factors found in suicidal individuals. 7. Suicide is preventable. 8. Youth most commonly share their thoughts, problems, and feelings with other youth. 9. Suicide is not painless…not an “easy way out.”

6. 6 Facts You Need to Know About Suicide Used with permission from the Maine Resource Book for Gatekeepers 10. People who show marked and sudden improvement after a suicide attempt or depressive period may be in great danger. 11. People who talk about suicide may very well attempt or complete suicide. 12. Suicide is not inherited. 13. Suicidal behavior is not just a way to get attention

7. 7 Facts You Need to Know About Suicide Used with permission from the Maine Resource Book for Gatekeepers 14. There is strong evidence that sexual minority individuals are more likely than their peers to think about and attempt suicide. 15. Any concerned, caring friend can be a “gatekeeper” and may very well make the difference between life and death. 16. Not every death is preventable.

8. 8 Suicide in the U.S. Over 38,600 suicide deaths in 2010 Firearms used in about five of every ten suicides 3.7 male deaths for every female death Suicide claims a life every 14 minutes Source: AFSP, USA Suicide: 2010 Official Final Data

9. Suicide Death Rates by State 2009 Source: National Vital Statistics Reports (Released Winter 2012) (1) Montana (2) Alaska (3) Wyoming (4) Idaho (5) Nevada

10. 10 Suicide Rates in Nevada and the US --1999-2010 Source: Centers for Disease Control and Prevention and NV Office of Health Statistics and Surveillance

11. 11 Suicide in Nevada 4 th highest rate in the nation 6 th leading cause of death, 2 nd for youth Elderly rates exceed national average More suicides than homicides, motor vehicle accidents, or AIDS Source: AFSP, USA Suicide: 2010 Official Final Data, Nevada Bureau of Health Planning and Statistics

12. Leading Causes of Death, Nevada Source: CDC WISQAR, 2014 http://www.cdc.gov/injury/wisqars/index.html http://www.cdc.gov/injury/wisqars/index.html NV Suicide Rate: 19/100,000 (vs. 11 for US) Ages 15-24 : NV 16.1 vs. US 9.8

13. 13 Youth Risk Behavior Survey

14. 14 Risk factors Certain mental disorders: Depression Bipolar Disorder Anxiety Disorders Schizophrenia Conduct Disorder (in youth) Psychotic Disorders Impulsivity and aggression, related to a mental health diagnosis American Foundation for Suicide Prevention, 2013

15. 15 Risk factors Alcohol or substance dependence or abuse Problem gambling Previous suicide attempt(s) Family history of attempted or completed suicide Serious medical condition or pain American Foundation for Suicide Prevention, 2013 National Council on Problem Gambling

16. 16 Risk factors A highly stressful life event such as losing someone close, financial loss, or trouble with the law Prolonged stress due to adversities such as unemployment, serious relationship conflict, harassment or bullying Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide (contagion) Access to lethal methods of suicide during a time of increased risk American Foundation for Suicide Prevention, 2013

17. 17 Protective factors Receiving effective mental health care The skills and abilities to solve problems Connectedness – positive connections with family, peers, community and social institutions that foster resilience American Foundation for Suicide Prevention, 2013

18. 18 Warning Signs for Suicide Adolescents Volatile mood swings Evidence of unhealthy relationship Sudden deterioration in personal appearance Self-mutilation Fixation with death or violence Eating disorders Gender identity issues Depression Source: Suicide Prevention Resource Center website www.sprc.orgwww.sprc.org

19.  Access to lethal means

22. Self-Harm Case Fatality Rates Firearms Cutting & Poisoning 85-90% fatal 15% nonfatal, ED-treated 1-2% fatal 98% nonfatal, ED-treated Source: CDC WISQARS

23. Self-Harm Case Fatality Rates Firearms Cutting & Poisoning 85-90% fatal 15% nonfatal, ED-treated 1-2% fatal 98% nonfatal, ED-treated Source: CDC WISQARS

24. Nonfatal InpatientSuicide Methods of Self-Harm, Nevada Source: CDC WISQARS www.cdc.gov/ncipc/wisqars (2007 suicides) and State of Nevada Health Division (2006 hospitalizations)www.cdc.gov/ncipc/wisqars Poison 85% Poison 23% Firearm 57% Suffoca- tion 14% Sharp 8% Other 4% Jump 2% Sharp 2% Other 2% Suffocation 2% Firearm 1%

25. Another 47% said under an hour. Only 13% said one day or more.

27. Means Matter People who attempt suicide are often ambivalent. Some are acting impulsively during a short-term crisis period. If a highly lethal method is unavailable and an attempter substitutes a less lethal method, the odds are increased that the attempt will be nonfatal. 90% or more of those making nonfatal attempts will not go on to die by suicide

34. What Providers? School psychologists Truant officer, coach, teacher, principal, nurse Pediatricians ED clinicians Defense attorneys Police Social workers Rehab clinician Employee assistance projects Divorce attorneys, marriage counselors Clergy Etc.

35. Training New Hampshire’s CALM training (Counseling on Access to Lethal Means) – offers trainings and train-the-trainer sessions; on SPRC’s evidence- based registry CALM-Online – coming soon to SPRC’s free online training website Kruesi Emergency Dept. Training – on SPRC’s evidence-based registry

37. Building It Into the System Emergency Dept. Social Worker

38. Building It Into the System Emergency Dept. Social Worker State Social Work Association Hospital Administration State Hospital Association Graduate School Change policies & information systems

40. Lethal Means Program in Nevada 2013, Teamed with Rhode Island, Suicide Proofing Your Home Brochure Feb 13, State Suicide Prevention Coordinator asked me to look into New Hampshire's Program May 13, went to our first Gun Show in Las Vegas Aug 13, Received $9,000 Grant to purchase Posters, Brochures, Gun Locks, and DVDs to distribute Dec 13, Teamed with the Nevada Firearms Coalition Apr 14, Finalizing materials for distribution 40

41. Going into Gun Stores and Shooting Ranges Offering Materials for their use and being able to provide them on a DVD for printing or viewing Safety and Security Brochures Videos for viewing by staff Tips for Gun Shops and Shooting Ranges Offering Trainings safeTALK and ASIST trainings from LivingWorks 41

42. Talking to the public through gun shows in Nevada How to get them engaged in the topic of suicide prevention #1, Anti-Suicide, Pro-Firearm, Safety and Security The Nevada Coalition for Suicide Prevention raffles off a Handgun Safe at each show Showing different ways to secure firearms helps to start the conversation From the grant funds we give away locks for securing firearms 42

43. Talking to the public through gun shows in Nevada Building a Relationship with the Gun Show Promoters Consistent message, Anti-Suicide, Pro-Gun, Safety and Security Work with your non-profit organization to enable the promoter to provide the table space at no cost Being Flexible when free tables are not available and also when extra space is available 43

44. Talking to the public through gun shows in Nevada What to expect from the public when you are there Taboo subject, many people will not talk about Suicide Some will just walk on by Some will just look at the materials on the tables and not talk about suicide prevention 44

45. Talking to the public through gun shows in Nevada Nevada's Most Successful Show Reno 22/23 March 14 463 people looked at materials or stopped and engaged in conversation during the 2 day show 200 raffle tickets were purchased 19 locks were given away to individuals for a specific gun in their home 45

46. Lethal Means Counseling Approach LAST TWO MONTHS - How often in the past couple of months have you felt like you didn’t want to live? Tell me about the times it was the worst. Did you want to kill yourself? EVER ATTEMPTED - Have you ever attempted suicide in your life? TODAY - What about today? Are you thinking about killing yourself? IF AT RISK, ask about access to firearms, regardless of whether any plans are mentioned. IF AT RISK, ask about plans & access to methods mentioned.

47. Lethal Means Counseling Approach Firearm assessment: Ask about all homes the youth spends time in (e.g. joint custody, grandparents living next door) Ask the father/male figure, not just the mother (females often don’t know about the guns at home) Ask the youth Make a plan Best option is to get the guns out of the house until situation improves Police may be able to store them Or ask a friend or relative Second best option is to unload and securely lock all guns See www.lokitup.org for locking optionswww.lokitup.org Hiding guns is not recommended; kids often know where to look

48. 48 Washoe County Resources Northern Nevada Child and Adolescent Services 775-688-1600 Renown 775-982-5318 West Hills 775-323-0478 ReStart 775-324-2622 Information and Referral (social services) 2-1-1 Washoe County Social Services 775-785-8600 NV Aging and Disability Services Division 775-688-2964 Crisis Call Center 775-784-8090 Mojave Adult, Child and Family Services 775-324-3300 Northern NV Adult Mental Health Services 775-688-2001

49. 49 Clark County Resources Southern NV Adult Mental Health Services 702-486-6000 University Medical Center 702-383-2000 Spring Mountain Treatment Center 702-873-2400 Montevista Hospital 702-364-1111 Information and Referral (social services) 2-1-1 Clark County Social Services 702-455-4270 State of NV Aging and Disability Services Division 702-486-3545 Community Counseling Center 702-369-8700 Bridge Counseling Center 702-4746450

50. 50 Family and friends Nurse Pastor Psychiatrist Psychologist Therapist How to Help Primary Care Physician Mental Health Facility Hospital Emergency Room Social Worker YOU

51. 51 Suicide Prevention Training & Outreach Facilitator Janett Massolo 445 Apple Street, Ste. 104 Reno, NV 89502 Phone: (775) 688-2964 ext. 261 E-mail: jmassolo@dhhs.nv.gov Youth Suicide Prevention Assistant Brandi McConnell 3811 W. Charleston Bl. Suite 210 Las Vegas, NV 89102 Phone: (702) 486-8225 E-mail: bmmcconnell@health.nv.gov Suicide Prevention Coordinator Misty Vaughan Allen, MA 445 Apple Street, Ste. 104 Reno, NV 89502 Phone: (775) 443-7843 E-mail: mvallen@dhhs.nv.gov Suicide Prevention Training & Outreach Facilitator Richard Egan 3811 W. Charleston Bl. Suite 210 Las Vegas, NV 89102 Phone: (702) 486-8225 E-mail: regan@health.nv.gov