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Suicide Prevention in Health Care Settings & Communities NAMI-NC Conference: Connecting Two Worlds: The Journey to Wellness Integrating Physical and Behavioral.

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Presentation on theme: "Suicide Prevention in Health Care Settings & Communities NAMI-NC Conference: Connecting Two Worlds: The Journey to Wellness Integrating Physical and Behavioral."— Presentation transcript:

1 Suicide Prevention in Health Care Settings & Communities NAMI-NC Conference: Connecting Two Worlds: The Journey to Wellness Integrating Physical and Behavioral Health Care October 18, 2014 Jane Ann Miller, MPH, NC Division of Public Health Susan E. Robinson, M.Ed., NC Division of MHDDSAS

2 Dedication To those:  who have lost their lives by suicide,  who struggle with thoughts of suicide,  who have made an attempt on their lives,  caring for someone who struggles,  left behind after a death by suicide,  in recovery, and To all those who work tirelessly to prevent suicide and suicide attempts in our nation. We believe that we can and we will make a difference.

3 Common Understanding Suicide is best understood as a very complex human behavior, with no single determining cause. Suicide is a cause of death. Suicide is preventable. Future deaths are avoidable. Impacts lives Intervention and support is effective

4 Goals for today: Understand data supporting prevention Learn about suicide prevention programs Gain knowledge about state & national resources

5 Suicide and Self-Inflicted Injury in North Carolina

6 Data Sources: Suicide and Self-Inflicted Injury North Carolina Violent Death Reporting System (NC-VDRS) Death Certificate Law Enforcement Reports Medical Examiner Hospital Discharge Emergency Department Admissions NC-DETECT

7 Suicide Deaths, Hospitalizations and ED visits Rate of Suicides ( ), Self-Inflicted Injury Hospitalizations ( ) and Self-Inflicted Injury ED Visits ( ) for Ages 10 or Older in North Carolina by Gender

8 Suicide Deaths, Hospitalizations and ED visits Rate of Suicides ( ), Self-Inflicted Injury Hospitalizations ( ) and Self-Inflicted Injury ED Visits ( ) for Ages 10 or Older in North Carolina by Age

9 Suicide Deaths, Hospitalizations and ED visits Male Rate of Suicides ( ), Self-Inflicted Injury Hospitalizations ( ) and Self-Inflicted Injury ED Visits ( ) for Ages 10 or Older in North Carolina by Age

10 Suicide Deaths, Hospitalizations and ED visits Female Rate of Suicides ( ), Self-Inflicted Injury Hospitalizations ( ) and Self-Inflicted Injury ED Visits ( ) for Ages 10 or Older in North Carolina by Age

11 Map of Suicide Rates for Age 10 or Older by North Carolina County of Residence ( )

12 Map of Self-inflicted Injury Hospitalization Rates for Age 10 or Older by North Carolina County of Residence ( )

13 Map of Self-inflicted Injury ED Visit Rates for Age 10 or Older by North Carolina County of Residence ( )

14 Hospitalization and ED post-discharge risk

15 From Inpatient Settings 55% of post-inpatient discharge suicides die within first week (Brinkley et al. 2013) From ED’s Experience and research indicate people are still at risk after discharge particularly in the following 30 days. Over 1/3 re-attempt or die by suicide within 18 months post discharge (Beautrais, 2003) Studies suggest 50% -70% of suicide attempters fail to attend treatment post-discharge

16 Hospital Evidence Based Suicide Prevention Programs Emergency Room Intervention for Adolescent Females Emergency Department Means Restriction Education target age 6-19 year olds Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) target age 55+ Programs cross listed in the Suicide Prevention Resource Center’s (SPRC) Best Practices Registry and the National Registry of Evidence-based Programs and Practices (NREPP)

17 Hospital Suicide Prevention Programs/ Adherence to Standards "Is Your Patient Suicidal?" Emergency Department Poster and Clinical Guide clinical-guide At-Risk in the ED one hour simulation training with avatars Question, Persuade, Refer (QPR) for Nurses 3-6 hour on-line training Recognizing and Responding to Suicide Risk in Primary Care One hour training rrsr%E2%80%94pc Suicide Prevention Toolkit for Rural Primary Care

18 Approaches to Engage Discharged Patients Follow-up calls, s, postcards, texts Mobile Apps o ReliefLink: monitor mood, suicidal thoughts, medication and appointment reminders, safety plan, link to crisis services o MY3: three personal support contacts, direct connection to the National Lifeline o mypsych o reachz

19 Crisis Services Continuum Prevention Early Intervention Response Stabilization Mobile Crisis Team CIT Partnership EMS Partnership 24/7 Crisis Walk-In Clinic Hospital Emergency Dept. Non-Hospital 23 hour Observation Facility Based Crisis Non-hospital Detox Hospital Units Community (including 3-way beds) State Psychiatric & ADATC LME/MCO Care Coordination Critical Time Intervention Transition Supports Psychiatric Advance Directives WRAP Person Centered Crisis Planning Family & Community Support Peer Support & Respite Services Same Day Access Program Outpatient Provider LME-MCO Access Center Primary Care Physician MH First Aid

20 The Crisis Solutions Coalition Priorities Fund, define, and monitor 24/7 Walk-in Crisis Centers as alternatives to divert unnecessary ED visits AND as jail diversion sites for CIT officers Provide training and support for all involved system partners – 911 responders, EDs, Providers, Consumers and Families Re-work Mobile Crisis Teams Fund the WHOLE service continuum -- Peer Support, Case management, Jail in-reach, EMS diversion, etc. More inpatient beds are needed Utilize our collective data Treat the whole person – integrated care Emergency Departments should still have a role and be prepared to do so Focus on prevention strategies like Psychiatric Advance Directives and MH First Aid

21 The Crisis Solutions Initiative … building a crisis services continuum to match a continuum of crisis intervention needs For more info: Crystal Farrow Crisis Solutions Initiative Project Manager NC DIVISION OF MH/DD/SAS

22 Prevention in North Carolina For each of us as individuals –  NC Suicide Prevention Lifeline  Its Ok To Ask” & chat lines  Text for Teens: NAMI in partnership with MCOs (7 county pilot)  NC Youth MOVE, NAMI on Campus, Family to Family & Peer Supports  Evidenced based and informed services and supports  Preventive health care For family members –  LME/MCO Crisis Lines & Mobile Crisis Services  Support Groups: Prevention & Postvention  Outreach & support – consumer, youth & family organizations  Web sites: LME/MCO, state and national resources  Evidenced based and informed services and supports

23 Prevention in North Carolina For communities at large –  Gatekeeper Trainings  Learn signs & symptoms & ways to get help needed  Curricula Programs for Schools and Professional Groups Training and Support through SAMHSA: Garrett Lee Smith Mental Health First Aid Training Parents and Teachers as Allies  Prevention Coalitions and Community Collaboratives  Parent Resource Centers  Positive Parenting Programs  Pro-social youth activities & leadership development  Supports for those touched by suicide  Trauma informed community engagement – “it takes a village”  Outreach to high risk groups – e.g. military, veterans & Guard  Public – private partnerships – faith, businesses, EAPs, SROs, CITs, higher education

24 National & State Plans Everyone has a role in preventing suicides. – promote wellness – increase protective factors – reduce risk – promote effective treatment and recovery. DHHS – public health and behavioral health work together Promote public dialogue, counter shame, prejudice, and silence; Build public support for suicide prevention – policies & systems; Address needs of vulnerable groups – culture & disparities; Coordinate and integrate health and behavioral health - continuity of care; Reduce access to lethal means among individuals with identified suicide risks; and Apply the most up-to-date knowledge base for suicide prevention.

25 NSSP & State Plan Strategic Directions 1. Create supportive safe environments that promote healthy & empowered individuals, families, and communities 2. Enhance clinical and community preventive services 3. Promote availability of timely treatment & support services 4. Improve suicide prevention surveillance collection, research, & evaluation

26 DMHDDSAS works with other state and local agencies to provide prevention, crisis intervention, treatment, recovery support and other services to people who are most at risk for, contemplating suicide or who have attempted suicide, and to their families.

27 National Prevention Strategy

28 Community Wellness, Prevention and Health Integration Wellness is: * More than being free from illness or disease. * An active process of change and growth. * Awareness of and making choices toward healthy and fulfilling life. Wellness domains interrelate with another: EmotionalSocialEnvironmental Physical SpiritualIntellectualOccupational

29 ZeroSuicide ention.org/

30 National Action Alliance for Suicide Prevention Partnership of private and public organizations to enhance the goals set forth by the National Strategy for Suicide Prevention (2012) One of their focuses GOAL 8: Promote suicide prevention as a core component of health care services to include promoting “zero suicides” What is ZERO SUICIDE? Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems. Its core proposition is that suicide deaths for people under care are preventable and that the bold goal of zero suicides among persons receiving care is an aspirational challenge that health systems should accept

31 Zero Suicide Step: Ensuring Every Person Has a Pathway to Care Standardized suicide screening of all members enrolled in active behavioral healthcare services. Formal assessment by a qualified health or medical provider for anyone screening positive for suicide risk. Stratification of the risk, as indicated by the assessment, into low, medium or high risk. Engagement of the patient or client in best-practice interventions geared to risk level. Follow-up contact from provider or caregiver. Step: Continuing Contact After Care After a visit to a behavioral health outpatient setting or primary care, for anyone at risk. Between services for those with scheduled care and to engage those not actively engaged in care. After discharge from acute care settings

32 Prevention Partners in NC The Jason Foundation QUESTIONS? NC State UNC Duke Go Heels! North Carolina

33 Key Resources: American Association of Suicidology American Foundation for Suicide Prevention Center for Disease Control: SuicideSuicide Center for Disease Control: Youth Risk Behavioral Surveillance SystemYouth Risk Behavioral Surveillance System Jason Foundation The Jed Foundation NAMI (National Alliance on Mental Illness) National Council for Suicide Prevention National Strategy for Suicide Prevention (PDF) Samaritans USA Suicide Awareness Voices of Education (SAVE) Tennessee Suicide Prevention Network Yellow Ribbon Suicide Prevention Program

34 Resources For additional information about the National Strategy for Suicide Prevention (NSSP), visit: ts/national-strategy-suicide- prevention/index.html ts/national-strategy-suicide- prevention/index.html n.org/NSSP n.org/NSSP

35 SAMHSA Resources - Suicide Prevention Providers: 4793/SMA pdf 4793/SMA pdf Administrators: for-Administrators-Based-on-TIP-50/SMA for-Administrators-Based-on-TIP-50/SMA High schools: (tool kit) 4669/SMA pdf 4669/SMA pdf

36 Thank you for taking the next step… For more information: NC DMHDDSAS NC DPH


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