Victor and Mary Ojakian March 23, 2007

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Higher Education Roundtable Forum Student Depression and Suicide

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To Discuss

• Mental Health Issue – Basic Data / Information

• The Growth of the Depression Caseload: The Times They Are A Changing

• Mental Health Landscape and Recent Events

• Our Actions

• Actions: Legislative and Local

• Ending Remarks

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Mental Health Statistics and Information Overview

• Mental Disease: a health issue – 21M Americans per year suffer from a mental illness– Cases of depression exceed all major health issues combined– Estimated that 70% of affected people do not seek treatment

• US Data:– One in five children have a mental disorder– 30,000 Americans die from suicide annual– TAY (transition age youth 15 to 25) annual deaths: 3,800

• Suicide is the leading medical cause of death for this age group – 650,000 attempted suicides annually in US– 2,000 cases of attempted or completed suicides per day– From 1952 – 1995: suicides in TAYs increased three fold (300%)– Estimated annual cost for mental health care: $47B – Annual mental health direct costs: $73B (1997)

• California: – 56% of Californians report a direct or indirect impact from mental wellness issues– about 4,000 suicide deaths annually– TAY (transition age youth 15 to 25) suicide deaths: about 200 reported

• Estimate ninety percent (90%) of all suicides are caused by a mental illness

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Table 2Adolescent Suicide Mortality Rates for 15-19 Year Olds (per 100,000)

by Race and Hispanic OriginUsing CDC WISQARS Mortality Data (1991-2002)

UNITED STATES

AmericanYear Total White Black Indian/AK Hispanic Native Origin1991 11.0 11.8 6.9 22.8 7.71992 10.7 11.1 8.4 18.8 8.11993 10.8 11.4 7.9 15.7 8.91994 10.9 11.2 9.5 22.3 8.51995 10.3 10.9 8.0 12.4 8.41996 9.6 10.2 6.6 24.6 7.91997 9.3 9.8 7.0 18.4 7.21998 8.8 9.2 6.2 20.0 6.11999 8.0 8.5 5.8 19.2 5.72000 8.0 8.5 5.5 15.5 5.62001 8.0 8.6 4.3 18.0 5.22002 7.4 8.2 4.0 14.4 5.7

• Data Downloaded from WISQARS on 6/14/05.

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Mental Health Case Increase Student Depression on the Rise

• Service cases are rising faster than student enrollment – twenty-three percent (23%) to fifteen and half percent (15.5%) (UC Student Mental Health Report, September 2006)

• In 2003 the National Survey of College Counseling Center Directors reported 84% more students with serious psychological problems over the previous 5 years.

• Researchers at Kansas State University ….. found that “students experience more stress, more anxiety, and more depression than a decade ago. Some of these increases were dramatic. The number of students seen each year with depression doubled, while the number of suicidal students tripled, and the number of students seen after a sexual assault quadrupled” (Benton, Robertson, Tseng, Newton, & Benton, 2003, p. 69). (From SPRC, Promoting Mental Health and Preventing Suicide in College and University Settings, 2004, p. 7)

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Mental Health QuoteDoing Something

Increasing depression among students is taxing campus mental health services. A number of surveys conducted during the past decade suggest that the prevalence of depression among college students is growing and eclipses the rate in the general public. In addition to the emotional pressures that come with leaving home and developing new relationships, the pressure on students to succeed academically has perhaps never been so high. Moreover, as college costs continue to climb, students approaching graduation with substantial loans to be repaid face the gloomiest job market in the past decade. Although campus services can offer a crucial point of entry to diagnosis and treatment, student health services and campus counseling centers frequently have not kept pace with the increased demand for treatment that such pressures bring. Thus, thousands of students with depression go undiagnosed and untreated just as they are facing some of life's most important junctures.

Mounting Student Depression Taxing Campus Mental Health ServicesVoelker, Rebecca. JAMA [H.W. Wilson - GS]. Apr 30, 2003.Vol.289, Iss. 16;  pg. 2055

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Suicide Data: What Has Happened?

• General Data: – College students suicide deaths nationally: as many as 1,100 individuals every year (Jed

Foundation) – UC student suicide deaths (from 2000 – 2005): about 40 individuals– Santa Clara County for youth (ages 15 – 24) suicide deaths (Kidsdata) :

• For 2002: 3.7 per 100,000• For 2003: 9.5 per 100,000

– California: the non-fatal, self-inflicted injury hospital rate for ages 5 – 20 in 2003: 44.1 per 100,000 (Kidsdata)

– Santa Clara County: the non-fatal, self-inflicted injury hospital rate for ages 5 – 20 in 2003: 74.9 per 100,000 (Kidsdata)

• UC student deaths by suicide: – Since 2004, UC Davis: 4 student deaths– Since 2002, UC Santa Cruz: 3 student deaths

• Bay Area: – High school deaths by suicide recently:

• In last four years, Mt. Tamalpais High School: 4 deaths• In last four years, Mission High School: 4 deaths

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Mental Health Landscape Recent Events

• Federal Government actions:

– Garrett Lee Smith Memorial Act (2004)

– The Mental Health Parity Act of 1996 (MHPA)

– Mental Health & Addiction Equity Act (H.R. 1367) (under consideration)

– The Mental Health Parity Act of 2007 (S. 558) (under consideration)

• State of California actions: – Mental Health Services Act (MHSA - 2004)

• Mental Health Stigma & Discrimination Reduction Advisory Group Meeting (2007)

– Suicide Prevention Act (SB 1356 – 2006)• Department of Mental Health – 2007 planning process• Twelve (12) US states with youth suicide prevention plans (1995 – 2005)

– Mental Health Parity Law (AB 88 - 1999)

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Mental Health Landscape Something Is Going On

• Lucile Packard Foundation for Children’s Health Parent Poll Report (January 11, 2007) – Parent’s feeling comfortable with their children’s health:

• physical health - 78% and emotional/mental/behavioral health- 42%– Children’s stress has been the top parental concern for the last two years

• US Center for Disease Control (January 2007 press release)– After a gradual drop since 1990, youth suicide rate increased by 18% in

2003-2004

• University of California Student Mental Health Report (September 2006)– “UC students are presenting mental health issues with greater frequency

and complexity.” (Executive Summary, page 5)– “This increasing demand and declining capacity pose a threat to the

learning environment ….. “(Executive Summary, page 5)– Three tier approach:

1. Restore critical mental health services2. Implement and augment targeted interventions3. Take a comprehensive institutional approach to creating healthier learningenvironments

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The Mental Health Landscape

What We Are Doing • College and University Environment:

– Requested UC Davis mental health program improvements– Requested UC systemwide study– Looking at other California university/college systems program improvements

• High & Middle School Environments:– Foster implementation of federally mandated Wellness Policy with strong mental

health component– Encourage more racial/ethnic base information

• Support Mental Health Parity Insurance:– Testified at federal congressional hearing for the Mental Health and Addiction

Equity Act of 2007 (H.R.1367) – Encourage revisions in California mental health parity legislation

• Improve mental health awareness – California Mental Health Stigma & Discrimination Reduction Advisory Group

participation

• Support statewide suicide prevention plan– Requested information from twelve states with youth suicide prevention plans

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What Can Be Done? Actions

Legislation: Locally:

Request / support Santa Clara County health funding measure

California State: Follow suicide prevention strategic planning and stigma and

discrimination reduction planning Write/email support for Assemblyman Jim Beall’s AB 423 to

improve mental health parity legislation Help in UC Mental Health Report funding by emailing UC

president, Dr. Robert Dynes, UC Regents, and your state legislators

Nationally: Write/ email support for US House mental health parity bill (H.R.

1367) Write/ email US congressional representatives requesting

extension of Garrett Lee Smith Memorial Act

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What Can Be Done? Actions College / University actions:

Awareness programs: Target communications for documented high risk time periods:

November – December and April - June Evaluate postcard mailing per:

University of Washington study (Geisner, Neighbors, and Larimer; Journal of Consulting and Clinical Psychology, 2006, Vol. 74, No 2, pgs. 393-399)

State of Colorado: ‘Its ok to ask for help” postcard campaign Provide journalism students with training on mental health and suicide

reporting (see examples by AFSP and WHO write-ups) Have post intervention / crisis team procedures

See San Francisco Unified Schools Crisis Team write-up Provide for student support groups:

Active Minds, a student run mental health awareness, education & advocacy program (at UCLA, UC Davis, USC, St. Mary’s, Mills College, etc.) http://www.activemindsoncampus.org/

University of Michigan’s Finding Voice findingvoice@umich.edu

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What Can Be Done? Actions

College / University actions: Consider joint area proposal for Garrett Lee Smith Memorial Act funds (May

due date) Voice interest in getting MSHA funding for college program Evaluate/ Research:

Yellow Ribbon Program (youth suicide prevention) effectiveness Intervention and recognition & referral skills training effectiveness AFSP College & University Screening Project (online)

Explore linkages with local mental health organizations to leverage the services

High School: Ensure mental health emphasis in federally mandated Wellness Policy Inform students of local mental health services Raise awareness and education of parents, administrators, & teachers about

mental wellness Have post intervention /crisis team procedures

San Francisco Unified Schools Crisis Response Manualhttp://www.sfusd.k12.ca.us/health/shpd/PSA_PUBS/Pubs/CRM2001.pdf

Obtain and use Omnigraphics, Inc. health series books: Suicide Information For Teens Mental Health Information For Teens, 2nd edition

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What Can Be Done? Actions

Other : Ensure thorough reporting system Ensure emergency personnel trained in crisis intervention

team (CIT) Adopt programs like:

StigmaBusters (NAMI) Breaking the Silence (NAMI)

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Mental Health Quote

Mental health is not a reflection of one's character, morals, or personality. It is not a character flaw or personal weakness. Factors such as hormones, genetics, and environment are major determinants of mental health, and pressures from identity issues, relationship problems, isolation, or other societal, environmental, and personal stresses have profound effects on our mental health.

--from University of Michigan student mental health page

http://www.umich.edu/~mentalit/

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Ending Remarks

• Mental health rights is the next national civil rights issue – Rhode Island Congressman, Patrick Kennedy (Mental Health Parity hearing February 2007)

• “The nation must address suicide as a significant public health problem and put into place national strategies to prevent the loss of life and the suffering suicide causes.” -- David Satcher, M.D., PH.D., (Remarks at the Release of The Surgeon General's Call To Action to Prevent Suicide, 1999)

• “Suicidal people are stressed and depressed, not stupid.” – from www.doitnow.org

• “You are worth it – talk to someone today.” – from www.TeenGrowth.com

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The End

Contacting us: via the Forum Sponsors

How can you help: Provide email

address on the sign-up sheet

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Appendix

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What Are They Saying?

Mental Health Websites

Websites With Student Mental Health Information: 1. http://www.sprc.org/whatweoffer/audience/college_student.asp 2. http://www.nimh.nih.gov/publicat/students.cfm 3. http://www.campusblues.com 4. http://www.goaskalice.columbia.edu/ 5. http://www.samaritans.org/ 6. http://www.ulifeline.org 7. http://www.span-california.org/suicide-prevention-links.html 8. University of Michigan Depression Center: www.med.umich.edu/depression 9. North Carolina’s Cecil G. Sheps Center: http://www.shepscenter.unc.edu/ 10. Jed Foundation: http://www.jedfoundation.org/ 11. iEmily: http://www.iemily.com/ 12. Teen Growth: http://www.teengrowth.com/ 13. Suicide Prevention Resource Center key paper:

http://www.sprc.org/library/college_sp_whitepaper.pdf 14. Active Minds: http://www.activemindsoncampus.org/ 15. Kidsdata: http://www.kidsdata.org/

Mental Health Websites:

1. American Foundation for Suicide Prevention: www.afsp.org 2. Suicide Prevention Resource Center: http://www.sprc.org/ 3. National Institute of Mental Health: www.nimh.nih.gov 4. National Alliance for the Mentally Ill: www.nami.org and

http://www.namisantaclara.org/ 5. Depression and Bipolar Support Alliance: www.dbsalliance.org 6. U.S. Department of Health and Human Services: www.samhsa.gov/stigma 7. American Association of Suicidology: http://www.suicidology.org/index.cfm 8. Asian Americans for Community Involvement (AACI): http://www.aaci.org/ 9. Alliance for Community Care: http://www.alliance4care.org/

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What Mental Health Websites Are Saying? Promoting Mental Health and Preventing Suicide in College and University Settings http://www.sprc.org/library/college_sp_whitepaper.pdf “A randomized clinical trial of a brief, mailed intervention for symptoms of depression.” Geisner IM,

Neighbors C, Larimer ME J Consult Clin Psychol. 2006;74: 393-399. http://www.psychiatrictimes.com/Depressive-Disorders/print.jhtml?articleID=193400937&url_prefix=/Depressive-Disorders and http://uwnews.org/article.asp?articleid=25095 Mental Health Parity Act of 1996: http://mentalhealth.samhsa.gov/cmhs/ManagedCare/Parity/ParityAct96.asp Mental Health Parity Act of 1996 2007:

o S.B 558: http://thomas.loc.gov/cgi-bin/query/C?c110:./temp/~c110S92MzF o H.R. 1367: http://thomas.loc.gov/cgi-bin/query/C?c110:./temp/~c110LTKhs4

University of California Student Mental Health Committee Final Report: http://www.universityofcalifornia.edu/regents/regmeet/sept06/303attach.pdf National Survey for Counseling Center Directors 2003:

http://www.aucccd.org/NDS/2003DirectorsSurvey.pdf National Survey for Counseling Center Directors 2006: http://www.iacsinc.org/National%20Survey%20for%20Counseling%20Center%20Directors%20Results%20-%20Final.pdf University of Michigan Report of the Mental Health Work Group: http://www.umich.edu/~mhealth/imgs/mhfinalreport.pdf Garrett Lee Smith Memorial Act: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=108_cong_bills&docid=f:s2634enr.txt.pdf California Mental Health Services Act: http://www.dmh.cahwnet.gov/mhsa/docs/meeting/12-17-2004/Mental_Health_Services_Act_Full_Text.pdf California Mental Health Parity Act (AB 88) -- a Bill snapshoot by Mathematica: http://www.chcf.org/documents/policy/SnapshotMentalHealthParityLaw.pdf California Mental Health Parity Act (AB 423) by Jim Beall: http://www.leginfo.ca.gov/pub/07-08/bill/asm/ab_0401-0450/ab_423_bill_20070216_introduced.html Lucile Packard Foundation for Children’s Health Parent Poll Report (January 11, 2007) : http://www.lpfch.org/informed/facts/parentpoll.pdf US Center For Disease Control Youth Suicide Rate information: http://www.medicalnewstoday.com/medicalnews.php?newsid=62584 Media coverage:

o American Foundation for Suicide Prevention: http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=0523D365-A314-431E-A925C03E13E762B1

o World Health Organization: http://www.who.int/mental_health/media/en/426.pdf

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What We Are Trying To Do?

• Our work is focused on young adults and youth, the so called Transition Aged Youth (TAY), mental health and specifically youth suicide prevention

• Provide mental health information to young adults through venues they attend

• Encourage regional cooperation amongst mental health service providers, educational institutions, and social agencies working with young adults – create a regional fabric and social safety net

• Reduce stigma and improving resources for mental health awareness

• We have a California focused

• Our goal: save lives

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Not Our Children? Transition Age Youth (ages 15 to 24)

Characteristics

• Greater pressures than in the past: concerns about future, hopelessness, and alienation

• Advent of significant mental health issues, including uni-polar, bipolar disorder, schizophrenia, and others

• Possibility of suicide – the 2nd leading cause of TAY deaths

• Research shows prevalent characteristics, including age, grade level, racial/ethnic background, college major, and gender (4 male suicides for every female suicide)

• The literature suggest most mental diseases are treatable and suicide is preventable

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Are There Warning Signs? • General characteristic statements and hard to identify

• Check out AFSP key warning signs on their website. Some are:

– Thinking/talking about suicide– Made a plan for suicide– Unrelenting, low, irritable mood– Appetite or weight changes– Feelings and expressions of pessimism, hopelessness, anxiety and withdrawals– Sleep problems– Fatigue and low energy– Loss of feeling of pleasure in acts that are normally pleasurable– Poor concentration and memory– Worthlessness or guilt– Psychomotor agitation / retardation– Increase in alcohol and drug use– States being a failure

• Avoid the “grow out of it” syndrome

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Other Web-based Information Provide web-base information that may include the following:

Mental health for women: http://www.4collegewomen.org/

Gavilan Community College Student Health – Suicide: Webpage: http://www.gavilan.edu/health/suicide.html

Foothill Community College: Webpage: http://www.foothill.edu/vcc/psych.php

UC Davis brochures: Helping Dangerous Students: Tips for Faculty/Staff:

http://caps.ucdavis.edu/resources/brochures/CAPS_Dangerous.pdf

Responding to Distressed Students - A Guide For Staff: http://www.adelaide.edu.au/counselling_centre/staff/distressed.html

Responding to Students Expressing an Ambiguous Danger: http://caps.ucdavis.edu/emergencies/

School Crisis Response Manual, SFUSD - 6/01

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ANNUAL CRISIS MANAGEMENTPLANNING CHECKLIST

• Select your Crisis Response Team (CRT) and designate a Team Leader.

• Train/Update the CRT. (Refer to the CR Manual) Include Car 29 officers and

other law enforcement support available at your school.

• Establish liaisons for the media, parents/caregivers and community.

• Establish a working relationship with community-based organizations and

develop a list of telephone numbers and contact persons after procedures for

using them are in place. Place list in Resource Section.

• Set up telephone trees to contact staff.

• Identify space where service providers assisting in the crisis can see students for

individual and small group counseling.

School Crisis Response Manual, SFUSD- 6/01

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ANNUAL CRISIS MANAGEMENTPLANNING CHECKLIST

• Review, revise and print forms and materials that might be needed by CRT and

staff.

• Develop a plan for emergency coverage of duties for CRT members.

• Establish a code to alert staff to implement prearranged procedures, e.g. lock

down.

• Develop a collection of educational resources on crisis topics: grief, loss, death,

suicide.

• Hold a mock crisis response.

• Establish procedures for annual crisis response professional development of new

staff and update/review for all staff.