Assessing and Managing Suicide Risk

1. Assessing and Managing Suicide Risk ATAP WEBINAR May 20, 2011

2. Nebraska Youth Suicide Prevention Initiative • Background • Began in 2009 with the receipt of the Garret Lee Smith grant through SAMHSA • Nebraska Suicide Prevention Coalition • Evidence based programming • Question Persuade Refer - Gatekeepers • Assessing and Managing Suicide Risk - Clinicians

3. Acknowledgement • The Suicide Prevention Resource Center is a funded project of SAMHSA), U.S. Department of Health and Human Services (HHS). • Promoting a mental health workforce that is better qualified to practice culturally competent mental health care based on evidence-based practices is one of the commitments of SAMHSA and a key to fully implementing the National Strategy for Suicide Prevention.

4. Nebraska Data • Suicide is the third leading cause of death in young people between the ages of 15 and 24. • Every 16 minutes a suicide occurs in the U.S. • An average of one young person (ages 15-24) dies every 2.08 hours. • No less than six other people are intimately affected by those losses. • Children who have lost a loved one to suicide are more likely to die by suicide themselves.

6. Suicide death rates by age and gender, Nebraska residents, 2004-2008 (n=881) 30 25.7 24 25 21.3 19.8 19.5 19.1 20 17.4 17.1 Males 15 Deaths per 100,000 population Females 10 7.1 6.9 4.2 3.7 3.3 3.3 5 1.6 2.3 0.9 * 0 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age group Source: NHHSS Vital Statistics 2004-2008

7. What does “Evidence-Based” mean? • Evidence-based = • Has demonstrated a causal linkbetween program and outcome through rigorous evaluation methodology • Achieves desired outcome • Accurate to say “effective” • Current research and expertise  • Help create an “evidence-base” for our work

9. Strategic Planning Process

10. Which of these suicide prevention practices are going on in your local area? Select all that apply. N = 152

11. Understanding Risk Factors Community Individual Society Relationship

12. What is the greatest precipitating factor among youth suicide? Among all 18-24 year olds who died by suicide: • Almost 50% were due to intimate partner problems • Other reasons included: • legal/criminal (20%), • financial (12%), • relationship problem with friend or family (13%) • Important to attend to youth who have had a recent life event (relationship problem), who are depressed, and a tendency towards impulsiveness, especially within 2 weeks of life event [Source: Harvard NVISS Pilot 2001]

13. What do we know about impulsiveness of youth suicide? Among all 18-24 year olds who died by suicide: • 1 in 5 occurred on the same day as an acute life crisis • 1 in 4 occurred within 2 weeks • Approx. 46% occurred either on the same day or within 2 weeks of a life crisis • Important because impulsiveness of suicide • Crucial to provide immediate help • Develop means for students in crisis to cope, provide safe haven, ensure support system in place [Source: Harvard NVISS Pilot 2001]

14. Suicide is an outcome that requires several things to go wrong all at once Immediate Triggers Proximal Factors Predisposing Factors Biological Factors Familial Risk Major Psychiatric Syndromes Public Humiliation Shame Hopelessness Substance Use/Abuse Access To Weapons Serotonergic Function Intoxication Impulsiveness Aggressiveness Severe Defeat Personality Profile Neurochemical Regulators Abuse Syndromes Negative Expectancy Major Loss Demographics Severe Chronic Pain Severe Medical/ Neurological Illness Worsening Prognosis Pathophysiology

15. Clinical Chain in Suicide Prevention • Detecting potential risk • Assessing risk • Managing suicidality • Safety planning • Crisis support planning • Patient tracking • MH Treatment

16. Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals • Do Professionals Really Need More Training? • Behavioral health professionals have a crucial role in preventing suicides. • A number of studies report that a substantial proportion of people who died by suicide had either been in treatment or had some recent contact with a mental health professional. • Many previously diagnosed with a psychiatric illness at the time of death • Additionally, hundreds of thousands of people show up in hospital emergency departments each year for treatment after a suicide attempt.

17. Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals • Clients' suicidal behaviors are a reality for mental health therapists and the source of significant distress for them. • Mental health professionals are "not adequately trained to provide proper assessment, treatment, and management of suicidal patients."² • Professionals have been calling for increased formal training in this area for decades.

18. Curriculum Development • In 2004, SPRC contracted with the American Association of Suicidology (AAS) to validate the need for competency-based curricula • collect available curricular materials, • develop curricula modules in the areas of assessment and management. • develop a one-day curriculum

19. Core Competencies • Competencies encompass clusters of knowledge, skills, abilities, and attitudes or perceptions required for people to be successful in their work. • In this case, core competencies refer to the clinical evaluation, formulation of risk, treatment planning, and management of individuals at risk for suicide to protect their lives and promote their well-being.

20. Core Competencies • The following set of core competencies, based on current empirical evidence and expert opinion, provides a common framework for learning about and gaining skill in working with individuals at risk for suicide. They are not intended to be construed or to serve as a standard of care.

21. Core Competencies • Twenty-four competencies and their sub-competencies fall into seven broad categories • Core competencies related to specific treatment interventions have not been developed.

22. Core Competencies • Literature review • Collection of core competencies and rubrics for measuring core competencies from related fields • Collection of instructional materials • Creation of a Task Force to review the collected information; develop training, recommend reference material and instructional strategies; • Pilot testing the curriculum and making necessary revisions

23. Learning Objectives • Become familiar with core competencies that enable mental health therapists to assess and work more effectively with individuals at risk for suicide • Define terms related to suicidality • Become familiar with suicide-related statistics • Identify major risk and protective factors • Understand the phenomenology of suicide

24. Increase knowledge in the following core competencies: • Manage one's own reactions to suicide • Reconcile the difference (and potential conflict) between the clinician's goal to prevent suicide and the client's goal to eliminate psychological pain via suicidal behavior • Maintain a collaborative, non-adversarial stance • Elicit suicide ideation, behavior, and plans • Make a clinical judgment of the risk that a client will attempt or complete suicide in the short and long term

25. Increase knowledge in the following core competencies • Collaboratively develop an emergency plan • Develop a written treatment and services plan that addresses the client's immediate, acute, and continuing suicide ideation and risk for suicide behavior • Develop policies and procedures for following clients closely, including taking reasonable steps to be proactive • Follow principles of crisis management

26. Experience a shift in perspective in working with individuals at risk for suicide. • Expect participants to experience changes in perceptions of working with suicidal clients. • For example, increased willingness, confidence, or clarity in working with individuals at risk for suicide. • Identify changes to make in practice specific to the assessment and management of individuals at risk for suicide.

27. Core Competencies • Attitudes and Approach • Manage one's own reactions to suicide • Reconcile the goal to prevent suicide and the goal to eliminate psychological pain via suicidal behavior • Maintaining non-adversarial stance • Realistically assess one's ability care for a suicidal client

28. Core Competencies • Understanding Suicide • Identify basic terms related to suicide • Become familiar with suicide-related data • Describe the phenomenology of suicide • Understanding of risk and protective factors

29. QUESTIONS???