Speaker’s Task Force on Suicide Prevention

1. Speaker’s Task Force on Suicide Prevention May 20th, 2019

2. Welcome to the Coulee Region!

3. Speakers task force on Suicide Prevention Donna Christianson, Crisis Program administrator Emily McGonigle, CCs supervisor

4. Integrated Support & Recovery Services ~What Services are There? Crisis – Mental Health Intake Outpatient MH/SA Clinic Quality Assurance, Residential & Support Services Children With Special Needs Long Term Case Management

5. Crisis program impact • Reducing psychiatric hospitalizations • Reducing inpatient length of stay • Increase crisis planning • Prevent future crisis situations • Linkage to community resources • Coordination with community partners

6. Immediate safety: 784-help • Rapid mobile response • Assessment • Collateral Contacts • De-escalation • Safety Planning • Resolution

7. Safety Planning: • Mitigating Risk • Removing the access to means (firearms are the #1 means for suicide) • Process stressors • Time to detox/withdraw from substances • Involve significant others (informal and formal supports) • Augmenting Protection • Instill hope; connect to their coping strategies • Support: people/phone numbers • Supervision • Develop social connectedness • Future orientation and planning • Crisis planning (identify warning signs) This Photo by Unknown Author is licensed under CC BY-NC

8. Example: juvenile detention facility • Data • 2012-2015, 10 suicide attempts • 2016, 7 suicide attempts • 2017, 13 suicide attempts • January-August 2018: 8 suicide attempts • August 2018-present: 0 attempts • Physical environment changes • Removed all access points for potential self harm • Plexiglass over bars • Removal of bunk beds • Other safety proofing measures • Staffing changes • Full time therapist • Additional hourly staff (3 FT & 2 PT)

9. Example: juvenile detention facility • State Policy Considerations • Returning 17 year-olds to the Juvenile Justice System • The suicide rate of juveniles in adult jails is 7.7 times higher than that of juvenile detention centers (Justice Policy Institute) • Wisconsin Juvenile Corrections Reform • Intent was that youth in corrections would be served in smaller and more up-to-date regional facilities closer to their home communities • Modifications to current legislation may need to be made for this model to be viable outside of the Southeastern part of the state • Data • 2012-2015, 10 suicide attempts • 2016, 7 suicide attempts • 2017, 13 suicide attempts • January-August 2018: 8 suicide attempts • August 2018-present: 0 attempts • Physical environment changes • Removed all access points for potential self harm • Plexiglass over bars • Removal of bunk beds • Other safety proofing measures • Staffing changes • Full time therapist • Additional hourly staff (3 FT & 2 PT)

10. Crisis Resolution Options Psychiatric Inpatient Adults & Kids CARE Center Adults Youth Stabilization Kids Next Day Appointment Adults & Kids Community Adults & Kids

11. If not hospitalized, then what? • Crisis Stabilization Options • CARE Center for Adults • WRAC, FCC Youth Home and Treatment Foster Homes for kids • On-site stabilization, especially for kids • Safety Planning: helping locate a safe place to stay with support • Follow up • Outreach phone call • Next day therapy appointment • Access to crisis prescribing appointment • Short term therapy and/or case management • Crisis plan development • Connection to community resources and providers

12. Alternatives to hospitalization: residential crisis centers

13. Text Hopeline: 741741

14. Financial Responsibility • Billable service: on-site assessment • Non-billable services: telephone support & consultation • Most types of medical assistance covers crisis costs • Most private insurances do NOT • Sliding fee scale is available

15. Comprehensive Community Services • A longer term community based program for individuals of all ages who need ongoing services for a mental illness, substance use disorder, or a dual diagnosis beyond occasional outpatient care, but less than the intensive care provided in an inpatient setting. (DHS)

16. Who is Eligible for CCS? • Anyone with a Mental Health and/or Substance Use Diagnosis • Functionally Impaired in Home, School, Work, Community Setting • Require more supports than outpatient counseling, but less than inpatient treatment • Medicaid (MA) Eligible*

17. What Services Can CCS Provide? CCS Service Array Individual Skills Development & Enhancement Employment Skills Training Individual/Family Psychoeducation Wellness Management/Recovery Support Services Substance Abuse Treatment • Screening & Assessment • Service Planning • Service Facilitation • Diagnostic Evaluation • Medication Management • Physical Health Monitoring • Peer Support • Psychotherapy

18. CCS and WRAPAROUND APPROCH Child Protection CCS Family Family Court CLIENT Economic Support School Staff Therapist Neighbors Doctor Justice Department Dentist Community Friends Service Vendors Psychiatrist Spiritual Community Substance Use Counselor

19. recommendations • Increase incentives to create alternatives to hospitalization • Require private insurance reimbursement for Crisis Services to increase access • Most do not fund indicating it is an out of network service or there is no code for residential crisis services • Fully fund crisis services through Medicaid • Reduce burden on county budgets • Increase ability to expand services • Increase access to health insurance to increase access to services • Explore issues related to fire arms as that is the #1 means for suicide • Return 17 year olds to the Youth Justice System • Ensure the intent of the new Wisconsin juvenile corrections model is fulfilled (keeping kids regional and close to their home communities in up-to-date facilities) even if it means legislative modifications to Act 185