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Emergent Trends in Suicide Prevention: Implications for Provider Organizations


Emergent Trends in Suicide Prevention: Implications for Provider Organizations Paul Quinnett, Ph.D. QPR Institute U of Washington School of Medicine – PowerPoint PPT presentation

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Title: Emergent Trends in Suicide Prevention: Implications for Provider Organizations

Emergent Trends in Suicide Prevention
Implications for Provider Organizations
  • Paul Quinnett, Ph.D.
  • QPR Institute
  • U of Washington School of Medicine

Surgeon General of the United States
  • Suicide is our most preventable form of death.
  • David Satcher, MD

A brief developmental history
  • Politically active survivors of the death by
    suicide of a family member
  • Congressional appeal house/senate resolutions
  • Senator Harry Reid (D Nevada)
  • Senator Gordon Smith (R Oregon)
  • 2001 first national meeting NSSP 2001
  • IOM report Reducing Suicide A National

Who are the players?
  • AAS
  • AFSP
  • SPRC
  • NIMH
  • CDC
  • National Action Alliance for Suicide Prevention
  • http//actionallianceforsuicideprevention.org

Mission of the National Alliance?
  • Championing suicide prevention as a national
  • Catalyzing efforts to implement high-priority
    objectives of the NSSP
  • Cultivating the resources needed to sustain

National Alliance Actions so far?
  • National Strategy 2012 Revision (done)
  • Research Prioritization Reduce suicide by 20 in
    five years or 50 in 10 years.
  • Clinical Care and Intervention Released a task
    force report, Suicide Care in Systems Framework,
    laying out recommendations for national leaders,
    health and behavioral health providers, and
    health plans.

NSSP 2012 revision
  • - Chaired by the Honorable John
  • McHugh, Secretary of the Army, and the Honorable
    Gordon H. Smith, President and CEO of the
    National Association of Broadcasters
  • 200 organizations participated
  • Chaired by Surgeon General Regina M. Benjamin and
    SPRC Director Jerry Reed
  • Public-private all the way..

Emerging standards
  • AFSP/SPRC Best Practices Registry
  • Role of BPR in emerging state healthcare law
  • Implications for practice from the National
    Violent Death Surveillance System (NVDRS)
  • Example
  • 41 adult suicides occur while in active care of
    a health professional (49 in Dane CO.)
  • 23 EMS professionals in CO over 4 years

Why NSSP 2012?
  • An increased understanding of the link between
    suicide and other health issues
  • New knowledge on groups at increased risk
  • Evidence of the effectiveness of suicide
    prevention interventions
  • Increased recognition of the value of
    comprehensive and coordinated prevention efforts

NSSP 2012 Selected Recommendations
  • Objective
  • Encourage health care providers and health and
    safety officials caring for individuals with
    suicide risk to routinely assess for the presence
    of, or access to, lethal means as part of their
    patient safety plans, and to educate those
    individuals and their support networks about
    actions to reduce risk.

Selected Recommendations
  • GOAL
  • Encourage the training of community and clinical
    service providers on the prevention of suicidal
    self-directed violence, including training on how
    to address the needs of those affected or
    bereaved by suicide deaths and attempts

  • Objective
  • Deliver training on suicide prevention to
    community groups that have a role in the
    prevention of suicidal self-directed violence and
    related behaviors

  • Objective
  • Develop core education and training guidelines
    for the recognition, assessment, and team-based
    management of at-risk behavior, and the delivery
    of effective clinical care for people with
    suicide risk.

  • Objective
  • Promote the adoption of core education and
    training guidelines on the prevention of suicidal
    self-directed violence and related behaviors by
    all health professions, including graduate and
    continuing education.

  • Objective
  • Develop and implement protocols and programs for
    clinicians and clinical supervisors, first
    responders, crisis staff, and others on how to
    implement effective strategies for communicating
    and collaboratively managing suicide risk.

  • GOAL 8
  • Promote suicide prevention as a core component of
    behavioral health services using systems level
    strategies that provide coordination and
    continuity of care.

  • Objective
  • Promote the adoption of zero suicides as an
    aspirational goal by health care and community
    support systems that provide services and support
    to defined patient populations.

  • GOAL
  • Develop and promote effective clinical and
    professional practices for assessing and treating
    those identified as being at risk for suicidal
    self-directed violence.

  • Objective
  • Encourage all specialty mental health and
    substance abuse treatment programs to have
    policies and procedures designed to assess
    suicide risk and intervene to promote safety and
    reduce suicidal self-directed violence among
    their patients.

Bottom line?
  • The 2001 NSSP strategy started the ball rolling
  • The suicide deaths of soldiers and veterans have
    ramped up interest and motivation
  • Professional member organizations, universities,
    and training institutions did not heed the
    recommendations of the IOM or NSSP
  • The suicide prevention community is growing and
    building political force for change

Why the emphasis on training?
  • It is strongly believed by the SP community that
    stigma and taboo have contributed to the training
    deficit in suicide prevention education at the
    professional level. And that such training could
    enhance consumer safety and prevent suicide

Old goal 6 Implement training for recognition
of at-risk behavior and delivery of effective
  • 1. Who is qualified to conduct a suicide risk
  • 2. What are these qualifications?
  • 3. When is the risk assessment done? How often?
  • 4. Where are staff trained in recognition of
    at-risk behavior?
  • 5. How is this risk assessment documented?

SRMI quiz (1,100 practicing professionals)

  • Would improved specific knowledge and skill in
    the assessment, treatment, and management of
    consumers detected to be at elevated risk of
    suicide reduce morbidity and mortality among
    behavioral health service customers?
  • Answer ???? - We shall see

Case example
  • Chart entry from PCP visit with 18-year-old
    single Hispanic female. Complains of headache
    and stomach distress. Drank some poison last
    week. (provided medicines for headache, etc.)
  • Two days later this young woman was dead of an
  • No SRA, no referral for a workup by a MHP, even
    though one was in the building

Goal 6 NSSP Targeted and Struck in Washington
  • Washington state legislature drafted and passed
    Engrossed Substitute House Bill No. 2366 An
    act relating to requiring certain health
    professionals to complete education in Suicide
    assessment, treatment, and management.
  • House vote 92 to 5
  • Senate vote 100

Back Story
  • Matt Adler dies by suicide
  • Jenn Stuber obtains providers record
  • Begins review support by U of WA School of
    Social Work
  • Champion Rep. Tina Orwall SW with experience
    with suicidal consumers
  • Review of literature undertaken/BPR review
  • Agenda inadequate training costs lives
  • Stakeholder meetings begin ownership of failure
    to train
  • A gathering of expert eaglets (AAS/AFSP support)
  • A bill is drafted
  • Atmosphere Legislative session where both sides
    wanted to get a least something passed.

Law requires
  • All licensed mental health providers to
  • Complete a training program in suicide
    assessment, treatment, and management every six
  • Clarifies that training programs in suicide
    assessment, treatment, and management must
    include the following elements Suicide
    assessment, including screening and referral,
    suicide treatment, and suicide management.

Law relied on several things
  • Availability of BPR training options (more than
  • Consensus expert opinion published paper (read
    from paper in testimony you have a copy)
  • Capacity to train an entire workforce online
    availability (cost shift to providers)

  • Allows a disciplining authority to approve
    training programs that do not include all of the
    elements if the excluded elements are
    inappropriate for the profession in question
    based on the profession's scope of practice.
  • Requires training that includes only screening
    and referral to be at least three hours in
    length. Requires all other training to be at
    least six hours in length.

Governor Signs Bill

Update June 12, 2013
  • Rules are in process
  • Implementation on schedule
  • Staff will be impacted by license, age, renewal
  • Physicians and nurses working to adopt/adapt
  • DOH evaluation on training status report out in
  • Other states all in KY
  • WA is ahead of the curve.. FOREFRONT
    organization lauched

Best treatment practices?
  • - Detection
  • - Assessment
  • - Treatment (limited)
  • - CBT DBT Lithium Clozapine - Follow Up
    (caring letters/emails) see complete list of
    NREPP programs (17 only)
  • - Management of risk over time good data on
    continuity as a best practice

  • Suicide risk continues to go undetected
  • Assessment failures account for 70 of medical
    errors associated with patient suicide
  • Lack of specific training
  • Lack of specific knowledge
  • Lack of supporting policies payments
  • Reliance on junk science, e.g., no-suicide
  • Wrong beliefs, e.g., If they really want to kill
    themselves you cant stop them.
  • CEO, Patient suicides is the cost of

Discussion questions
  • How can national policy vision be translated into
    practice settings?
  • What questions do you (providers) have about
    current research/evidence re suicide prevention?
  • What challenges/barriers do you experience in
    practice settings?

Contact information
  • Free e-book and apps
  • Office phone 509-235-8823
  • Institute phone 1-888-726-7926
  • Email pquinnett_at_mindspring.com
  • Website www.qprinstitute.com
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