Pathways to Healing: Suicide Prevention, Intervention and Postvention in Systems Of Care

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Pathways to HealingSuicide Prevention,
Intervention and Postvention in Systems Of Care

• A plenary held at the System of Care Community
  Meeting Winter 2007 in Atlanta, GA on February 1,
  2007.

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PRESENTERS Sylvia Kay Fisher, Ph.D. Program
Director of Evaluation Child, Adolescent and
Family Branch, SAMHSA Holly Echo-Hawk Senior
Mental Health Consultant, National Indian Child
Welfare Association Mark LoMurray Project
Director, Adolescent Suicide Prevention Project,
North Dakota Tribal Rural Mentoring
Partnership Shannon CrossBear Co-Director of
Evaluation and Training, Federation of Families
for Childrens Mental Health
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• SAMHSA Initiative on Suicide
• Presidents New Freedom Commission Report
• identified suicide as a significant thrust in
  mental
• health policy
• SAMHSA incorporated the topic of suicide
• within its policy matrix
• SAMHSA hired a national expert on suicide
• prevention with the goal of developing and
• implementation a national strategy on
  addressing
• suicide issues
• Garrett Lee Smith grantee program was initiated
• (29 states and 7 tribal communities have been
• funded)

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Lifetime History of Suicide Attempt Among
Children Entering SAMHSA-Funded Systems of Care
Across the Years
14.6 of children (N28,785) entering systems of
care between 1995 and 2006 had a caregiver
reported lifetime history of suicide attempt.
Based on caregiver report at intake into
services Includes data gathered from communities
funded between 1994 and 2004 Based on available
suicide attempt data gathered between 1995 and
October 2006 The caregiver reported age range of
the children in this sample 1 to 22 years.
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Lifetime History of Suicide Attempt Among
Children Entering Systems of Care by Funding Phase
Phase I 22 Communities funded 1993-1994 Phase
II 23 Communities funded 1997-1998 Phase III
22 Communities funded 1999-2000 Phase IV 29
Communities funded 2002-2004
Based on caregiver report at intake into
services Includes data gathered from communities
funded between 1994 and 2004 Based on available
suicide attempt data gathered between 1994 and
October 2006
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Lifetime Suicide Attempts Among Children Entering
Systems of Care Communities Funded 2002 - 2004
More than half (53.5) of the suicide attempters
of the 13.1 of the total group of children have
made multiple attempts
Based on caregiver report at intake into
services Includes data gathered from communities
funded between 2002 and 2004 Based on available
number of lifetime suicide attempt data gathered
between 2002 and 2006 n2291
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Lifetime History of Suicide Attempt Agreement
Between Caregiver and Youth Report

• Caregivers and youth consistently report lifetime
  history of suicide attempt in 87.1 of cases.
• Both report no attempt history 76.0 of cases
• Both report an attempt history 5.3 of cases
• Caregivers and Youth inconsistently report
  lifetime history of suicide attempt in 12.9 of
  cases.
• Caregiver reported attempt/youth no attempt
  5.3 of cases
• Youth reported attempt/caregiver no attempt
  7.6 of cases

Based on caregiver and youth report at intake
into services Includes data gathered from
communities funded between 2002 and 2004 Includes
data for children (age 11 and older) with both
caregiver and youth reported suicide attempt data
available gathered between 2002 and 2006 N1382
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Child, Adolescent and Family Branch (CAFB)
Efforts Addressing Suicide in Systems of Care
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• Special Topic session - USF Research/Training
• Conference (upcoming proceedings publication)
• Focus group at the Training Institutes
• Ongoing efforts in the National Evaluation to
  identify trends and findings relative to
  suicide-related behavior in our children and
  families
• Suicide Meeting (e.g., family members, youth,
  national experts on suicide issues, cultural
  competence experts, etc.)
• policy statement and recommendations generated

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Child, Adolescent and Family Branch (CAFB)
Efforts Addressing Suicide in Systems of Care
2

• Suicide Logic Model
• Suicide Fact Sheet with Social Marketing team
• This plenary and a plan to include sessions in
• future grantee meetings about this issue
• Working with SAMHSA suicide and trauma
• experts about several issues, including
  family
• involvement in developing suicide prevention
• strategies
• Upcoming USF RTC sessions trauma informed
• conference in New Orleans
• This is a full-scale initiative with many prongs

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Pathways to Healing Suicide Prevention,
Intervention and Postvention in Systems of Care

• Holly Echo-Hawk
• Senior Mental Health Consultant
• National Indian Child Welfare Association

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How Do We Try To Protect Our Youth and Families?
Community Health
Family Health
Economic Health
YOUTH FAMILIES
Physical Health
Personal Health
Cultural Health
Spiritual Health
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American Indian and Alaska Native Suicide

• Devastating for our communities and our young
  people
• In general, American Indian and Alaska Native
  suicide rates much higher
• At least 3x higher than non-tribal youth
• Research indicates that 14 to 30 tribal
  adolescents attempt
• Entire communities affected by suicide patterns
  that can occur in one region within a short
  amount of time

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Indian Health Service Data

• Ten year period (1995 - 2005)
• Tribes and tribal organizations that submit data
  to Indian Health Service
• Does not include Alaska

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Tribal Suicide Ideation1995 - 2005
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Tribal Suicide Ideation by Age 1995 - 2005
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Tribal Suicide Attempts 1995 - 2005
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Tribal Suicide Completions 1995 - 2005
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Tribal Suicide Completions by Age (1995 - 2005 )
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Rich Lessons from Both Perspectives

• Tribal communities who find a pathway to address
  suicidal behavior in their community
• Communities who have less, or few, incidents with
  self-inflicted injuries or fatalities

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Some Reasons Why Youth Do Not Seek Help

• They Might Think Im Crazy Young American
  Indians Reasons for Not Seeking Help When
  Suicidal
• Freedanthal Stiffman, Journal of Adolescent
  Research, January 2007

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Study Approach

• Sample of 101 American Indian 15-21 year olds
• Thought about or attempted suicide
• Open ended questions about barriers to seeking
  formal and informal help while suicidal

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Youth Responses

• Most Common
• Internal Factors
• Embarrassment
• Lack of problem recognition
• Dont want family to find out
• Belief that no one can help
• Self reliance

• Rarely Cited
• Structural Barriers
• Lack of money
• Lack of service availability

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Sources Of Strength In Suicide
Prevention Mark LoMuray
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Suicide is the 3 cause of death for ages 10-24
years old. In many western states it is the 2
cause of death for this age group.

• Approximately 15 of 9th-12th graders have
  thoughts of suicide in any given year.

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We must promote public awareness that suicides
are preventable. We must enhance resources in
communities for suicide prevention programs and
mental and substance abuse disorder assessment
and treatment. Dr. David Satcher United
States Surgeon General July 28, 1999
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Suicide Prevention Similar to Reducing Traffic
Fatalities

• Not every traffic fatality is preventable, but
  its possible to reduce unacceptably high
  numbers.
• A mixture of strategies has led to a significant
  drop in traffic fatalities over the past 25 years
  speed limits, DUI enforcement, how roads are
  built, seat belt laws, air bags, youth licensing
  restrictions, etc.

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Teen and Young Adult Risk

Source ND Health Dept. Vital Statistics
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A Blended Approach
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ND Adolescent Suicide Prevention Project Action
Strategies
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Key Adolescent Risk Factors
Aggressive/Impulsive
Depression
Substance Abuse
Trauma
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Sources of Strength
Family Support
Access to Mental Health
Positive Friends
Access to Medical
Caring Adults
Spirituality
Positive Activities
Generosity/Leadership
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Hopeful Trends

• 47 Fatality reductions (10-19 ages) from
  2000-2004 compared to 1990s.
• 20-29 YRBS reductions
• Every region/tribal area implemented at least two
  recommended strategies
• 45,000 trained, 8000 teens, 8000 professionals,
  1500 faith-based

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Prevention is Possible
A Parents Perspective Finding the
resources within ourselves within our communities
Shannon CrossBear Federatio
n of Families for Childrens Mental Health
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Courage, Conviction, Commitment

• Shields of Safety
• Protective factors
• Partnerships
• Hope in healing

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What can you do?

• As a program director
• As a clinician
• As an advocate
• As a youth and family member

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Partners in Prevention

• Uniform safety standards
• Linkages with existing suicide prevention efforts
• Formal and informal prevention supports and
  services

• Crisis plan protocols in place for every family
• Gate keeper training for all staff and
  communities
• Full investigation, evaluation and inclusion
• Postvention services in place for staff, youth
  and families

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Contact Information

• Sylvia Kay Fisher
• Sylvia.Fisher_at_samhsa.hhs.gov
• [phone]
• Holly Echo-Hawk
• echohawk_at_pacifier.com
• [phone]

• Mark LoMurray
• outreach_at_btinet.net
• [phone]
• Shannon CrossBear
• stronght_at_boreal.org
• [phone]