SUICIDE PREVENTION EFFORTS FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS: ROLES FOR THE STATE MENTAL H

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SUICIDE PREVENTION EFFORTS FOR INDIVIDUALS WITH
SERIOUS MENTAL ILLNESSROLES FOR THE STATE
MENTAL HEALTH AUTHORITY

• Alan Q. Radke, M.D., M.P.H.
• State Medical Director
• Minnesota Department of Human Services

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ACKNOWLEGEMENT

• NASMHPD Medical Directors Council
• Suicide Prevention Resource Center
• Suicide Prevention Action Network USA
• National Suicide Prevention Lifeline
• National Mental Health Association
• Department of Veterans Affairs
• SAMHSA/CMHS

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CONSIDERATIONS

• Suicide prevention strategies for individuals
  with SMI
• Person-centered prevention approach
• SMI population heterogeneity

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SCOPE

• Understanding the characteristics dynamics of
  individuals with SMI who attempt or die by
  suicide
• Considering improvements to suicide prevention
  activities through the SMHA
• Applying person-centered approaches to suicide
  prevention
• Adopting a conceptual model for use by the SMHA
  to improve care.

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EPIDEMIOLOGY

• 32, 439 deaths by suicide in the U.S. in 2004.
• Eleventh cause of death in the U.S.
• 1 person every 16.2 minutes dies by suicide.
• 324,000 treated in ED for deliberate self-harm.
• 90,000 hospitalized following a suicide attempt.
  

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EPIDEMIOLOGYContinued

• Between 811,000 and 1.8 million suicide attempts
  per year.
• 1 out of 65 Americans is a survivor.
• Over 90 of individuals who die by suicide have a
  significant psychiatric illness.
• 25 Billion impact to the U.S. economy for deaths
  and injuries associated with suicidal behavior.

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FOCUS POPULATION

• Individuals with Serious Mental Illness.
• Recurrent Major Depression
• Schizophrenia and Other Psychotic Disorders
• Bipolar Disorder
• Borderline Personality Disorder
• 17.5 Million adults in the U.S. have SMI.

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SUICIDE RISKPERSONS WITH SMI

• People with SMI have a higher risk of suicide
  attempt and death by suicide.
• Suicide Attempts
• 30 - Major Depression
• 25 to 50 - Bipolar Disorder and
• 20 to 40 - Schizophrenia
• Deaths by Suicide
• 3 to 20 - Bipolar Disorder and
• 10 - Schizophrenia

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CONSUMER SURVIVORPERSPECTIVES

• Consumers call for
• Better training
• Enhanced treatment for shame and humiliation
• Address concerns of possible long term
  disability
• Nurturing spiritual concerns
• Creating creative, meaningful connections with
  others and
• Developing peer support groups.

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CONSUMER SURVIVORPERSPECTIVES

• Survivors call for
• Better education on available resources
• Enhanced treatment for grief
• Open communication with providers and
• Developing peer support groups.

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National Response Methods

• Surgeon Generals Call.
• DHHS National Strategy for Suicide Prevention
• NASMHPD recommendation to SMHA and position
  statement on mental health promotion and mental
  illness prevention

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Service Delivery Systems

• The National Suicide Prevention Lifeline
  (1-800-273-TALK)
• Suicide Prevention Task Forces
• Emergency Departments
• Inpatient Care
• Primary Care
• Risk Factors Management

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CONCLUSIONS AND RECOMMENDATIONS

• 1 Suicide is a serious, but preventable public
  health threat that requires high profile
  recognition at the state level, and a high
  priority on the state health agenda.

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CONCLUSIONS AND RECOMMENDATIONS

• 1.1 The Governors of each state should appoint
  a state advisory council to advance suicide
  prevention.

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Conclusions and Recommendations Continued

• 2 Persons with SMI carry a significantly
  elevated risk for suicidal behaviors. The SMHA
  has responsibility for providing mental health
  services to people with SMI, and in that
  position, is ideally positioned to lead suicide
  prevention efforts for this sub-population.
  Access to effective mental health services for
  people with SMI can prevent substantial morbidity
  and mortality associated with suicide attempts
  and deaths by suicide.

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Conclusions and Recommendations Continued

• 2.1 SMHA, working closely with other principles
  on the state suicide prevention advisory council,
  ensure suicide prevention programs and practices
  are in place for persons with SMI.

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Conclusions and Recommendations Continued

• 3 Suicidal individuals with SMI can benefit
  from a robust continuum of care that extends
  beyond the boundaries of the traditional physical
  health and mental health care systems. Crisis
  hotlines have been shown to provide effective
  services to individuals seriously contemplating
  suicide and are available to all regardless of
  geographical barriers, timely access or ability
  to pay.

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Conclusions and Recommendations Continued

• 3.1 The public mental health system should
  support and collaborate with crisis hotlines to
  ensure individuals at risk for suicide, including
  those who have made a suicide attempt, can
  readily access high quality crisis support
  services.

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Conclusions and Recommendations Continued

• 4 Poor communication and lack of information
  sharing between social service agencies, law
  enforcement, justice, education, physical health
  care providers and mental health care providers
  and others hinders suicide prevention efforts for
  persons with SMI.

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Conclusions and Recommendations Continued

• 4.1 The SMHA and the SHA should lead efforts
  improve collaboration, information sharing and
  surveillance between and among systems of care
  for all persons and promote use of standard
  terminology.

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Conclusions and Recommendations Continued

• 5 Inadequate continuity of care, especially
  after discharge from emergency departments and
  inpatient psychiatry units contributes to
  significant suicide-related morbidity and
  mortality.

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Conclusions and Recommendations Continued

• 5.1 The SMHA, in collaboration with the SHA,
  should initiate policies and practices that
  promote improved continuity of care for suicidal
  individuals following discharge from emergency
  departments and inpatient psychiatric
  hospitalizations.

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Conclusions and Recommendations Continued

• 6 Suicide risk often goes undetected, even
  though suicidal individuals frequently seek and
  receive medical care in primary care settings.
  Screening of persons with depression and
  substance abuse in primary care settings can
  identify individuals at elevated risk for suicide
  and expedite their referral for definitive
  evaluation and treatment.

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Conclusions and Recommendations Continued

• 6.1 The SMHA, in collaboration with the SHA,
  should require screening for suicide risk at all
  primary care appointments for those individuals
  who exhibit risk factors such as depression or
  substance abuse.

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Conclusions and Recommendations Continued

• 7 Individuals who have access to lethal means
  of suicide have been shown to have higher rates
  of suicide.

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Conclusions and Recommendations Continued

• 7.1 The SMHA, in collaboration with the SHA,
  should develop and implement strategies to reduce
  access to lethal means of suicide.

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Conclusions and Recommendations Continued

• 8 Members of the general public, and especially
  consumers and their families, are unaware of
  suicides toll on society and the heightened risk
  of suicide carried by many consumers. Increasing
  awareness of suicide among consumers and their
  families and reducing the social stigma, shame
  and humiliation associated with being a consumer
  are key elements of comprehensive suicide
  prevention.

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Conclusions and Recommendations Continued

• 8.1 The SMHA, in collaboration with the SHA,
  should strengthen psycho-educational programs in
  communities and for at-risk populations.
  Objectives should include eliminating stigma
  associated with mental illness, care seeking, and
  recovery from a suicide attempt.

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Conclusions and Recommendations Continued

• 9 Specific treatments for certain mental
  illnesses can significantly reduce suicidal
  behavior. Access to these treatments inadequate
  and must be improved.

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Conclusions and Recommendations Continued

• 9.1 The SMHA, in collaboration with the SHA,
  should develop and promote new models for
  providing evidence-based services over the life
  course for those who have attempted suicide,
  particularly for those who have made multiple or
  medically serious suicide attempts.

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Conclusions and Recommendations Continued

• 9.2 The SMHA should implement strategies to
  provide training of mental health services
  providers in evidence-based practices that reduce
  rates of suicidal behaviors among people with SMI.

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Conclusions and Recommendations Continued

• 10 Funding for suicide prevention, intervention
  and research is disproportionately low when
  compared to other serious health threats.
  Increased public and private funding is necessary
  to make systematic improvements to the health
  care and social service systems that serve those
  at the highest risk for suicide, persons with
  SMI.

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Conclusions and Recommendations Continued

• 10.1 NASMHPD should increase its efforts to
  advance suicide prevention through its work in
  the state and federal policy arenas.

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BOTTOM LINE

• People with SMI are a high risk population
• Fragmented, discontinuous system of care
• SMHA must be the leader
• Proactive suicide prevention

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QUESTIONS AND CONCERNS