Suicide Prevention

Signs, Symptoms, and Solutions

There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest -- comes afterward. These are games; one must first answer.

ALBERT CAMUS An Absurd Reasoning French author, journalist & philosopher (1913-1960)

Mick Jagger, nominated for a Golden Globe for his music in "Hotel Rwanda" arrives with L'Wren Scott for the 62nd Annual Golden Globe Awards on Sunday, Jan. 16, 2005, in Beverly Hills, Calif.

(KEVORK DJANSEZIAN/AP) ANDREW RYAN The Globe and Mail Published Friday, Mar. 28 2014, 10:07 AM EDT at

http://www.theglobeandmail.com/life/celebrity-news/the-a-list/lwren-scott-leaves-9-million-estate-to-mick-jagger-and-nothing-to-her-siblings/article17716501/ Accessed March 28, 2014.

49-year-old L’Wren Scott was found dead in her Manhattan apartment on March 17. The New York City medical examiner determined that “she killed herself by hanging.”

“According to public records, Scott’s personal estate was worth approximately $9 million” ANDREW RYAN The Globe and Mail Published Friday, Mar. 28 2014, 10:07 AM EDT at http://www.theglobeandmail.com/life/celebrity-news/the-a-list/lwren-scott-leaves-9-million-estate-to-mick-jagger-and-nothing-to-her-siblings/article17716501/

Accessed March 28, 2014.

Beautiful and elite, this celebrity fashion designer’s world crashed

The day after Scott’s death, Jagger wrote on his website, “I am still struggling to understand how my lover and best friend could end her life in this tragic way. We spent many years together and had made a great life for ourselves. She had great presence and her talent was much admired, not least by me ... I will never forget her."

www.mickjagger.com Accessed April 4, 2014

We ask …

How can this happen? How can someone make a decision against

life? Stunned loved ones wonder what they

missed, what they could’ve done, left behind to feel guilt, shame, bewilderment.

American individualism? Or are communal values the priority?

Suicide

Blue collar, white collar, rich, poor, homeless Men more than women (women make more

attempts) Caucasian and Native Americans (more than

African-Americans and Asians) Firearms most commonly used, followed by

hangings

Suicide affects our community Causes and reflects immeasurable pain, suffering,

and loss to individuals, families, and communities nationwide.

For every suicide more than 30 others attempt suicide annually

Each attempt and death affects countless other individuals.

Family members, friends, coworkers, and others suffer the long-lasting consequences of suicidal behaviors.

SAMSHA 2012 National Strategy Overview at http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/overview.pdf. Accessed April 4, 2014.

Cultural and Historical Aspects

Honor/shame Some religious and cultural traditions sanction suicide

(Islamic sects, Hindu widows, Japanese disgrace, Chinese political corruption) Use of insecticides

Western Judeo-Christian culture Common Era church leaders concerned by high rates of

suicide related to martyrdom. St Augustine’s City of God proscription

Romans initially accepted suicide but later outlawed all manners of

reducing the population

England and colonial United States England and colonial U.S.

King Edgar proclaims goods of a person who dies by suicide are forfeited.

Henry de Bracton (13th century jurist) declares suicide a crime

17th century suicides considered criminal even if there was evidence of mental illness

This history provides the backdrop for our modern perspectives of suicide

IOM,2002. Reducing Suicide pp 24-5.

Yet over the last millennium the associations still very similar Serious mental illness

Depression, Schizophrenia, Bipolar Disorder, Personality DO

Alcohol and substance abuse Medical co-morbidities

Head trauma, neurological d/o, HIV, cancer Childhood loss Loss of a loved one Fear of humiliation Economic dislocation Insecurity

IOM, 2002. Reducing Suicide p 21

Emotional and Economic costs in U.S. Suicide outnumbers homicides by 2:1 now

>38,000 per year; >1 person every 15 minutes Suicide outnumbers death from AIDS Suicide outnumbers deaths from war Lost productivity; $11 billion to 25 billion The loss in terms of emotional, spiritual life is

beyond calculation Contagion

Stigma makes it worse

Suicidal behaviors are often met with silence and shame

Families of suicide victims often experience the same

The stigma of suicide can be a formidable barrier to providing care and support to individuals in crisis and to those who have lost a loved one to suicide.

SAMSHA 2012 at

Suicide is a serious public health problem 1958 U.S. Public Health Service first suicide

prevention center 1966 Center for Suicide Studies (NIMH) 1980s CDC task force; youth violence 1990s World Health Organization concern 1996 Prevention of Suicide: Guidelines for the

Formulation and Implementation of National Strategies by the UN and WHO

1998 Private/public partnerships respond Federal commitment Healthy People 2010 to reduce

rate to 6/100,000 (1/2 current)

The 1999 Surgeon Generals Call to Action David Satcher MD Reduce the suicide rate to 6 by 2010 Begin educational efforts for suicide

prevention, target mental illness while program being developed

Followed by the 2001 National Strategy for Suicide Prevention published by U.S. DHHS and Public Health Service.

The Public Health Approach

Public health model Define the problem--surveillance Identify causes--risk and protective factor

research Develop and test interventions Implement intervention Evaluate effectiveness

Effectiveness is difficult to measure; no control, no placebo group, may take decades

National Strategy for Suicide Prevention “The National Strategy provides a framework that

helps communities to devise their own broad-based empowering strategies for reducing suicides. It employs the public health approach, which has helped the nation effectively address problems as diverse as tuberculosis, heart disease, and unintentional injury.”

http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/index.html

http://www.samhsa.gov/nssp http://www.actionallianceforsuicideprevention.org/NSSP

The Assumption

The approach assumes that raising general public awareness about the extent to which suicide is a problem, and about the ways in which it can be prevented, can reduce suicide and suicidal behaviors.

The Second Wave is now here

The initial 2001 publication was by the National Institute of Mental Health (NIMH)

The 2012 National Strategy is a joint effort by the Office of the U.S. Surgeon General and the National Action Alliance for Suicide Prevention (Action Alliance), intended to guide prevention activities the next 10 years.

Important achievements the past 10 years Garrett Lee Smith Memorial Act Creation of the National Suicide Prevention

Lifeline (1-800-273-TALK/8255) Partnership with the Veterans Crisis Line Establishment of the Suicide Prevention

Resource Center (SPRC) Clinician trainings, community members,

collaboration between public and private sectors.

Activity in the field of suicide prevention has grown dramatically since the National Strategy was issued in 2001 Government agencies at all levels Schools Nonprofit organizations Businesses

A Plethora of Organizations are involved!

Department of Health and Human Services

Centers for Disease Control National Institutes of Health

and NIMH Department of Defense Dept of Veterans Affairs

A Big push the last 10 years

American Foundation for Suicide Prevention

Suicide Awareness Voices of Education

American Association of Suicidology

Social Media is a piece of this cooperation

Public/Private organizations are involved now Action for Alliance

>200 National Leaders Private organizations and entities

Facebook Universities of Chicago, Rochester, Calgary Entertainment Industries Council Mental Health Association of San Francisco National Organization of People Against Suicide Samaritans USA Suicide Awareness Voices of Education Jason Foundation Jed Foundation Henry Ford used in Sedg Co

School-Based Prevention Programs http://www.afsp.org/

SOS Signs of Suicide® Prevention Program (SOS)

http://www.mentalhealthscreening.org/programs/youth-prevention-programs/sos/ The SOS High School Program is the only school-

based suicide prevention program listed on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices that addresses suicide risk and depression, while reducing suicide attempts. In a randomized control study, the SOS program showed a reduction in self-reported suicide attempts by 40% (BMC Public Health, July 2007).

USD 259 Yellow Ribbon

Evaluation of pre/post program surveys Improvement in knowledge and confidence in

engagement in help seeking behaviors May be especially useful for middle school

boys No harm

International Drive

International Association for Suicide Prevention

http://www.iasp.info/index.php

http://www.who.int/en/

Spin off policies and programs Access to weapons; Firearms, packaging meds Mental Health programs

APA’s Vision for Mental Health System The President’s New Freedom Commission

The Interim Report of the President’s New Freedom Committee On Mental Health caution the nation about the impending mental health catastrophe if the attitude of denial and neglect continues unchanged

APA Suicide Treatment Guidelines Population based studies/Centers/Youth resiliency

The 2012 National Strategy for Suicide Prevention is a joint effort The Office of the Surgeon General The National Action Alliance for Suicide Prevention

(Action Alliance, NAASP) 4 strategic directions/13 goals/60 objectives

Creating supportive environments and promoting healthy empowered families and communities

Enhancing clinical and community preventive services Promoting available and timely treatment and support

services Improve suicide prevention surveillance collection,

research, and evaluation SAMHSA 2012 NSSP Overview

National Strategy for Suicide Prevention A Awareness of the problem and risks

Now under Healthy and Empowered Individual, Families, and Communities

I Intervention to solve the problem Spread against 3 strategic directions

M Methodology to monitor the populations at risk

Expanded to include surveillance and program evaluation

Our Duck Pond

State of Kansas Suicide Prevention Task Force asked Sedgwick County members to start a local task force

The Suicide Prevention Task Force became a Coalition in 2009

A recent local addition of the American Foundation for Suicide Prevention

Key gatekeepers

Teachers and school staff School health personnel Clergy Police officers Correctional personnel Supervisors in occupational settings Natural community helpers

Hospice and nursing home volunteers Primary health providers Mental healthcare and substance abuse treatment

providers Emergency healthcare personnel.

2001, DHHS. NSSP p78

I. Define the Problem

Surveillance of suicide attempts is fraught with concerns about nomenclature, accuracy in reporting, lack of systematic or mandatory reporting Educated and not so educated guesses. KS

counties Definitions lacking-population differences

Assisted suicide is a “separate issue”-should not be included in the rate

Various agencies utilize different data Death certificates Coroner reports Data may be gathered by county of residence

or by site of death Field reporters obtain the personal data and

interview the families

Suicides are tracked by using a Rate No. of suicides per 100,000 persons Overlaps other injury data (ODs, MVAs) The Rate:

Is influenced by economic, spiritual, political factors

An indicator of a country’s health, hope, stability, and culture.

10th on the list of U.S. Health Indicators

Comparing Suicide Rates

Nine of the 10 highest suicide rates

worldwide are in Europe. The average suicide rate in Europe is 13.9 Rates as high as 30.7 in Lithuania (41.9 in 2001;

males at 73.8), 21.5 in Hungary (43 in 1999), and 18.5 in Finland and 18.4 in Slovenia.

Russian Federation rate in 1998 was 35.5.

http://www.who.int/topics/suicide/en/

2002, IOM. Reducing Suicide p 35

Who Crunches the Numbers?

National Suicide Prevention Resource Center CDC utilizes Injury and Violence Data National Violent Death Reporting System

Model: National Highway Traffic Safety Administration’s system for motor vehicle deaths

National Violent Death Reporting System (NVDRS) Harvard-designed to collect information on

homicides and suicides and firearms deaths Based on FARS and the National Violent Injury

Statistics System (NVISS) Testing at 10 sites-information from death

certificates, coroner/medical examiner reports, police Uniformed Crimes Reports, crime laboratories Expected to allay irregular quality of data available through

the coroner system Currently collects data in only 18 states

Comparisons

 Suicide Rates per 100,000  2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Sedg Co.

11.2 11.1 12.3 12.0 13.4 11.6 14.6 12.2 13.5 13.6 11.0 16.5

KS 10.8 12.7 12.8 13.6 13.2 13.8 13.6 12.5 13.6 14.1    

USA 10.7 11.0 10.9 11.1 11.0 11.2 11.3 11.8 12.0 12.4 12.3  

Despite efforts at prevention the last 15 years … The suicide rate has actually increased Despite the use of antidepressants and

improved healthcare and mental healthcare Despite the economy Despite our rich heritage and freedoms Is this an indication of whether our programs

are working or not?

Public health program concerns

Anti-smoking, cancer screening, AIDs prevention can point to success in lives saved

Suicide rate however has increased in the U.S. The risk factors for suicide have a wide distribution,

are large in number, have a high prevalence, and inherent challenges that make mounting large scale prevention programs difficult.

Societal targets (limiting access to lethal means, improving community detection and treatment) have as yet been unsuccessful in achieving a reduction

Baker SP, 2013

The Disconnect

1990s—The Decade of the Brain Suicidality has a life apart from mental illness No professional has been able to consistently

predict individuals’ suicide Mental health tools have been unproven in

terms of affecting suicidality

The association of suicide with mental illness … Is a “conundrum” 80-90% of people who commit suicide have

“depression” 95% of mentally ill do not suicide (6-15% of

depressed patients commit suicide, 7% with alcohol dependence, 4% with schizophrenia) (IOM p394)

My Friend

Middle-aged Vietnam veteran who struggled with PTSD from childhood trauma, alcohol abuse, and depression

Was hospitalized after cutting his wrists in a suicide attempt when I first met him.

Struggled with his pain for 10 more years, while in and out of treatment at VA MHC

Died of an overdose on his medications and alcohol in his 50s

People who commit suicide

Frequently do not tell others or professionals Are not identifiable on individual basis Are frequently different from those with para-

suicidal behavior and frequent attempts Are from widely varying populations (young

divorced male versus dialysis patient refusing treatment)

IOM 2002 Reducing Suicide

“The stark facts”

Jan Fawcett MD: “Suicide isn’t predictable in individuals; Preventive efforts aren’t very effective; Suicidal communications aren’t often made

by patients to physicians or counselors; Denial of suicidal intent doesn’t mean a

patient won’t do it”IOM 2002 Reducing

Suicide

II. Identify Causes

Risk factors: Acute: anxiety, panic attacks, recent alcohol Chronic factors: demographic info First year post discharge Traditional risk factors did not predict for year

one—but did for years 2-10 Protective factors:

Resiliency Social support

Theories

Social theories Charles Durkheim Freud: Anger turned inwards Aaron Beck Hopelessness

Biology

Low serotonin and impulsivity Brain serotonin bounces back very high right

after suicide attack No genetic tests are helpful as of yet

SYMPTOMS

SHORT-TERM RISK FACTORS Loss (loved one, relationship, job, pride, health) Hopelessness Anxiety Agitation and Impulsiveness Intoxication with alcohol or substances

LONG-TERM RISK FACTORS Elderly caucasian male who drinks

The 4 Rs

Relief of pain—emotional and/or physical Rejoining a lost one Reality testing loss (voices, command

hallucinations, God’s desire) Revenge

“Some people think that if we just get suicidal people into treatment we’d prevent suicide. But we’re not good at it”

More than 50% of suicides occur while patients are in active treatment

69% of patients do communicate intent to a spouse, with friends, or coworker … “so we damn well better talk to the significant others --and believe what they say”

IOM 2002 Reducing Suicide

III. Develop and Test IV. Implement Interventions

Yellow Ribbon and school-based programs Air Force Program Suicide scales: Scale for Suicide Ideation

(Beck 1979), Suicide Intent Scale (Beck 1974), Beck Depression Inventory, HAM A, Beck Hopelessness Scale

Scales often have high FN and FP rates, poor positive predictive value

SADPERSONS Scoring for Suicide RiskSADPERSONS Scoring for Suicide RiskS Sex = male 1 pointA Age > 45 or <191 pointD Depression / hopelessness 2 pointsP Prior attempts / Psychiatric illness 1 pointE Excessive Alcohol / Drugs 1 pointR Rational thinking loss 2 pointsS Separated widowed or divorced 1 pointO Organized or serious attempt 2 pointsN No social support 1 pointS Stated future intent 2 pointsScore > 9 = high risk and probable need for inpatient intervention

Score > 6 = moderate risk and need for psychiatric consultationScore < 6 = low (but not no) risk

V. Evaluate Effectiveness

The global suicide rate may not be such a good indicator of effectiveness of interventions

Breaking down populations

Preventable versus non-preventable suicide

Response may be seen in one year, may take decades

Cohort effects

Sedgwick County 2012 Suicide Rates 83 Suicide deaths in Sedgwick County Rate of 16.5 deaths per 100,000 Highest rate seen in the 12 years that we’ve

been tracking local data

Suicide Prevention Hotline316-660-7500

24 hours/ 7 Days per week

Methods

Use of firearm is consistently most common method, followed by hanging and overdose

Rate per 100,000

United States 2010

Sedgwick County 2010

Sedgwick County 2012

Firearm 6.3 6.8 8.5

Hanging/Suffocation

3.1 3.0 5.4

Overdose 2.1 2.2 2.2

Sedgwick Co. Method of Suicide 2008-2012

Health History in Sedgwick County Suicides History of mental illness was noted in

approximately 50% of suicides --Depression, bipolar disorder, substance abuse

27% have history of prior suicide thoughts or attempts

Significant medical issues noted in 40% of suicides

72% suicides in Sedgwick County had alcohol or drugs in their system

Changing times/changing trends In the 1980s and 1990s most concerns were for

young black males (injury) and older white males (suicide rate 90)

Males ages 15-25 were a high risk group, now down (element of hope?)

The recent increase in the 45-65 year old group is seen nationwide as well as locally

This group of middle aged persons may reveal mixes of substance use, medical problems, relationship ills, and job losses as stressors. It may also reflect a lack of resilience in this cohort, and a cultural outlook that promotes suicidality or hopelessness. It may be the pain treatment culture promoted in the medical community

New Waves

Pain control culture Narcotics What effect does cannabis have?

Our community is busy trying to help prevent suicide Via Christi Assessment Center Via Christi hospitals Other hospital ERs ComCare MHA Private practitioners Law enforcement EMS

Community Impact of Suicidal Ideation/ Attempts Sedgwick County 911 Dispatch calls

2,179 Suicide attempts 295 Suicide threats 816 Mental health emergencies

COMCARE Crisis Intervention Services 5,586 Crisis Assessments 61,156 phone calls

Weakness in emergency management Involves the shortage of mental health

specialists in general hospital ED Enhanced training of ED physicians may help Increasing patient access to mental healthcare Implementation of advances in clinical

medicine is often a slow process

Offson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide Prevention on Periods of High Risk. JAMA. March 19, 2014, Volume 311, Number 11. 1107-1108.

The Risky Post-hospitalization Period

The period immediately following discharge from a psychiatric hospital poses an extraordinarily high risk of suicide--especially the first week. Qin P 2005.

Roughly 1/3 (39%) of all suicides in the first year after hospital discharge have been found to occur in the first 28 days. Goldacre M 1993

¼ (24%) of all suicides occur among patients who are within 3 months of discharge from a psychiatric hospital. Appleby L, 1999

Interventions for the post-hospital discharge period Clinical interventions, programs, and policies

targeting protecting patients from suicide during the period following discharge are needed.

An observational study from the United Kingdom reported implementation of a 7-day follow-up after psychiatric hospital discharge was associated with a decline in suicide rates from 24.8 to 19.5 annually during the 3-month period following discharge. While D, 2012

U.S. and local clinical practice Improvement needed in patient transitions

from inpatient to outpatient psychiatric care. Nationally only about ½ of psychiatric

inpatients receive any outpatient mental healthcare during the first week following hospital discharge and only 2/3 receive care during the first month. NCQA DATA 2013

Problems with outpatient compliance (Lincoln et al, pending)

Addressing critical links in mental health care system will not replace other interventions Hotlines Screening programs Crisis counseling services Public education campaigns

Offson 2014

WHERE DOES THAT LEAVE US NOW?

Organizational Restructuring

Revision of the Strategy for Suicide Prevention

A Prioritized Research Agenda for Suicide Prevention by NAASP

“A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives” http://actionallianceforsuicideprevention.org/s

ites/actionallianceforsuicideprevention.org/files/Agenda.pdf

3 years in production, after observations that prioritizing research into other diseases helped to advance the science in those areas.

Developed 6 key questions

Where we are at now: 6 Key Questions Why do people become suicidal? How can we better detect/predict risk? What interventions are useful? What services are most effective? What interventions outside healthcare

settings reduce suicidality? What new research infrastructure is needed?

Levin, A. “Clinical and Research News: Suicide Experts Identify Six Questions To Guide Research in Next Decade”. Psychiatric News, Vol 49, No 6, March 21, 2014. p 13.

Our little world; Sedgwick County Educate the public so that family and friends

will pick up on the signs of risk and encourage treatment

Educate gatekeepers, seminars Evaluate the programs already in use

Yellow Ribbon school program Bookmark distribution Annual run Survivors of Suicide annual teleconference

Local prevention groups

Sedgwick County Suicide Prevention Coalition

American Foundation for Suicide Prevention National Association for the Mentally Ill Private foundations

Recommendations in SCSPC Continue efforts to collect data from a variety of

sources to assess impact of Coalition activities Increase integration efforts with primary care,

pastors and business Target high risk neighborhoods

Focus groups to identify neighborhood needs and targeted prevention efforts

Create Neighborhood Advisory Committees Community workshops to educate providers

about local resources, promote dialogue among groups

Prevention measures; what you can do For information about suicide, a Survivors of Suicide Handbook, the

Cluster Response Plan or upcoming events, go to www.sedgwickcounty.org (Living, Health and Welfare, Suicide

Prevention) American Association of Suicidology - www.suicidology.org American Foundation for Suicide Prevention - www.afsp.org Suicide Prevention Hotline - 660-7500 24 Hours/7 Days a Week

LISTEN, LISTEN, LISTEN Prevent access to firearms, monitor all medication use, and be aware of potential weapons Don't promise to keep their comments of suicide a secret

Help them get help by talking to a family doctor, counselor, or clergy or by calling the Suicide Prevention Hotline.

Go to an emergency room

Do not leave the person alone

http://www.sedgwickcounty.org/comcare/suicide_prevention.asp SUICIDE PREVENTION If you or someone you know is talking

about suicide, please call the suicide prevention hotline 24 hours a day/7 days a week.

(316) 660-7500 Crisis Intervention Services (CIS) has been

the suicide prevention service for many years in Sedgwick County. At CIS, priority is given to callers who are at risk for suicide. 

Suicide can be prevented. Some occur without warning but most do give clues. Recognize the signs and know how to respond. Observable signs of serious depression:

Pessimism Hopelessness Desperation Sleep problems Anxiety, emotional pain and inner tension Withdrawal from friends and/or family Increased alcohol and/or other drug use

Recent impulsiveness and taking unnecessary risks Threatening suicide or expressing a strong wish to die Making a plan Seeking access to pills, weapons or other means Unexpected rage or anger Stressful life events may precede suicide, such as intimate partner problems, other

relationship problems, loss of employment, housing insecurity, financial difficulties, legal trouble and/or a history of medical illness.

Although most depressed people are not suicidal, most suicidal people are depressed. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses.

Be a link, save a life. SCSPC 2012 Annual Report

We always deceive ourselves twice about the people we love — first to their advantage, then to their disadvantage.

ALBERT CAMUS, A Happy Death

Read more at http://www.notable-quotes.com/c/camus_albert.html#QlzA2QwjyPpv8crk.99

17 yo white female, distraught over the breakup with her boyfriend Secretly goes to her family’s medicine cabinet and

downs a bottle of Tylenol and Benadryl, to “escape the pain.” Is ready to die if that’s what it takes.

Gets sick to her stomach after several hours and now remorseful, discloses to her mother what she has done.

Is rushed to the ER, stomach is pumped but to no avail; her liver fails from the toxin and doctors determine the chance of a transplant is unlikely to occur within the time period that she may still survive.

The liver disease takes her life within the next few weeks.

Lock all medications up. Especially OTCs Any small deterrent in a suicide attempt may

avert completion Impulsive patients are often too distraught to

think of a plan of self harm, they simply reach for anything easy.

Getting through this anxious distress will often be met with a return of more logical thinking.

18 yo white male recently hospitalized for depression and suicidal ideations A result of a break up with his girlfriend. The two reconciled while he was in hospital, his

suicidal thinking remitted, he was treated with an antidepressant, and discharged improved to outpatient care after a safety plan was established with family

Two weeks later, while doing well, he borrowed a gun to go hunting with friends.

Three days later his girlfriend broke up with him over the phone. He used the rifle, still in his truck, to take his life. Alcohol may have been a factor.

Firearm Safety: Means Restriction Firearms in the home are a risk factor.

Never leave these at home unattended Lock them away Use the safety

Pistols in the home raise the risk 10-fold Tell family and friends about the situation Alcohol and substances increase the risk of

impulsivity of any type.

Build resilience in our children Problems come and go Relationships come and go Managing emotions can instill confidence and

security There will be failures but it is not the end of

the world

STIGMA

Is a way of deceiving ourselves, a way to pretend that these things really do not exist in the “real” or “normal” world

Denies the fact that we are all on the edge of our own insanity Unforeseen tragedies Unforeseen medical problems Medications, supplements, substances Unforeseen disasters

Bravery and Courage Required

To address the addictions our loved ones face

To address our loved ones that are “enablers” To be that freaky person that keeps the guns

locked up and the safety on, keeps the medications locked up

To acknowledge we are all one step away from the edge

Summary--Suicidality is a more complex process than other public health concerns Biological, clinical, subjective, and social

factors—more complex than other “chronic disease”

Prevention may be difficult to measure and the suicide rate may not be the best indicator of effectiveness

Evaluate education, policy and/or technological changes and implement effective interventions

My Opinion

Educate families and friends Reduce stigma for survivors Limit access to means (Firearm Safety!!!) Use caution with narcotics and substances Don’t ignore the influence of cannabis Monitor the suicide rate with an eye towards

an understanding of our society’s ills Build resilience in our children

Stop the Silence Be a Voice for Life Man stands face to face with the irrational.

He feels within him his longing for happiness and for reason. The absurd is born of this confrontation between the human need and the unreasonable silence of the world.

ALBERT CAMUS, The Myth of Sisyphus

Read more at http://www.notable-quotes.com/c/camus_albert.html#QlzA2QwjyPpv8crk.99

References Baker SP, Hu G, Wilcox HC, Baker TD. Increase in suicide by

hanging/suffocation in the US. 2000-2010. Am J Prev Med. 2013;44(2):146-149.

Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry. 2005;62(4):427-432.

Goldacre M, Seagroatt V. Hawton K. Suicide after discharge from psychiatric inpatient care. Lancet. 1993;342(8866):283-286.

Appleby L, Shaw J, Amos T, et al. Suicide within 12 months of contact with mental health services: national clinical survey. BMJ. 1999;318(7193):1235-1239.

References

While D, Bickley H, Roscoe A, et al. Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: a cross-sectional and before-and-after observational study. Lancet. 2012;379(9820):1005-1012.

National Committee on Quality Assurance. Improving quality and patient experience: the state of health care quality 2013. http://www.ncqa.org/Portals/O/Newsroom/SOHC/2013/SOHC-web%20version%20report.pdf.Accessed date

Offson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide Prevention on Periods of High Risk. JAMA. March 19, 2014, Volume 311, Number 11. 1107-1108

Sedgwick County Suicide Prevention Coalition 2012 Annual Report (Nicole Klaus PhD) at http://www.sedgwickcounty.org/

comcare/reports/Suicide_Prevention_AR.pdf. Accessed April 6, 2014 “A Prioritized Research Agenda for Suicide Prevention: An

Action Plan to Save Lives” at http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Agenda.pdf.

SAMSHA 2012 National Strategy Overview at http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/overview.pdf.

Reducing Suicide; a National Imperative. 2002 by the National Academy of Science, National Academies Press, 500 Fifth Street NW, Box 285, Washington DC, 20055 http://www.nap.edu

Others: http://www.surgeongeneral.gov/library/reports/

national-strategy-suicide-prevention/index.html http://www.samhsa.gov/nssp http://www.actionallianceforsuicideprevention.org/

NSSP

http://www.who.int/topics/suicide/en/ Offson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide

Prevention on Periods of High Risk. JAMA. March 19, 2014, Volume 311, Number 11. 1107-1108.