Suicide Prevention

Suicide PreventionSigns, Symptoms, and SolutionsThere 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 CAMUSAn 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 RYANThe Globe and MailPublishedFriday, 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 LWren 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, Scotts personal estate was worth approximately $9 million ANDREW RYAN The Globe and Mail PublishedFriday, 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 designers world crashed The day after Scotts 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, 2014We ask How can this happen? How can someone make a decision against life? Stunned loved ones wonder what they missed, what they couldve done, left behind to feel guilt, shame, bewilderment.

American individualism?Or are communal values the priority?SuicideBlue collar, white collar, rich, poor, homelessMen 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 communityCauses and reflects immeasurable pain, suffering, and loss to individuals, families, and communities nationwide.For every suicide more than 30 others attempt suicide annuallyEach 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 AspectsHonor/shame Some religious and cultural traditions sanction suicide (Islamic sects, Hindu widows, Japanese disgrace, Chinese political corruption) Use of insecticidesWestern Judeo-Christian culture Common Era church leaders concerned by high rates of suicide related to martyrdom. St Augustines City of God proscriptionRomans initially accepted suicide but later outlawed all manners of reducing the population

England and colonial United StatesEngland 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 crime17th century suicides considered criminal even if there was evidence of mental illnessThis history provides the backdrop for our modern perspectives of suicideIOM,2002. Reducing Suicide pp 24-5.Yet over the last millennium the associations still very similarSerious mental illness Depression, Schizophrenia, Bipolar Disorder, Personality DOAlcohol and substance abuseMedical co-morbiditiesHead trauma, neurological d/o, HIV, cancerChildhood lossLoss of a loved oneFear of humiliationEconomic dislocationInsecurityIOM, 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 minutesSuicide outnumbers death from AIDSSuicide outnumbers deaths from warLost productivity; $11 billion to 25 billionThe loss in terms of emotional, spiritual life is beyond calculationContagionStigma makes it worseSuicidal behaviors are often met with silence and shameFamilies of suicide victims often experience the sameThe 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 problem1958 U.S. Public Health Service first suicide prevention center1966 Center for Suicide Studies (NIMH)1980s CDC task force; youth violence1990s World Health Organization concern1996 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 ActionDavid Satcher MD Reduce the suicide rate to 6 by 2010Begin educational efforts for suicide prevention, target mental illness while program being developedFollowed by the 2001 National Strategy for Suicide Prevention published by U.S. DHHS and Public Health Service.The Public Health ApproachPublic health model Define the problem--surveillanceIdentify causes--risk and protective factor researchDevelop and test interventionsImplement interventionEvaluate effectivenessEffectiveness is difficult to measure; no control, no placebo group, may take decades

National Strategy for Suicide PreventionThe 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/NSSPThe AssumptionThe 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 hereThe 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 yearsGarrett Lee Smith Memorial ActCreation of the National Suicide Prevention Lifeline (1-800-273-TALK/8255)Partnership with the Veterans Crisis LineEstablishment 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 2001Government agencies at all levelsSchoolsNonprofit organizationsBusinessesA Plethora of Organizations are involved!

Department of Health and Human ServicesCenters for Disease ControlNational Institutes of Health and NIMHDepartment of DefenseDept of Veterans Affairs

A Big push the last 10 yearsAmerican Foundation for Suicide PreventionSuicide Awareness Voices of EducationAmerican Association of Suicidology

Social Media is a piece of this cooperation

Public/Private organizations are involved nowAction for Alliance>200 National LeadersPrivate organizations and entitiesFacebookUniversities of Chicago, Rochester, CalgaryEntertainment Industries CouncilMental Health Association of San FranciscoNational Organization of People Against SuicideSamaritans USASuicide Awareness Voices of EducationJason FoundationJed FoundationHenry Ford used in Sedg Co

School-Based Prevention Programshttp://www.afsp.org/

SOS Signs of SuicidePrevention 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 Administrations 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 RibbonEvaluation of pre/post program surveys Improvement in knowledge and confidence in engagement in help seeking behaviorsMay be especially useful for middle school boysNo harm International Drive

International Association for Suicide Preventionhttp://www.iasp.info/index.phphttp://www.who.int/en/Spin off policies and programsAccess to weapons; Firearms, packaging meds Mental Health programs APAs Vision for Mental Health SystemThe Presidents New Freedom Commission The Interim Report of the Presidents New Freedom Committee On Mental Health caution the nation about the impending mental health catastrophe if the attitude of denial and neglect continues unchangedAPA Suicide Treatment GuidelinesPopulation based studies/Centers/Youth resiliency

The 2012 National Strategy for Suicide Prevention is a joint effortThe Office of the Surgeon GeneralThe National Action Alliance for Suicide Prevention (Action Alliance, NAASP)4 strategic directions/13 goals/60 objectivesCreating supportive environments and promoting healthy empowered families and communitiesEnhancing clinical and community preventive servicesPromoting available and timely treatment and support servicesImprove suicide prevention surveillance collection, research, and evaluation SAMHSA 2012 NSSP Overview

National Strategy for Suicide PreventionAAwareness of the problem and risksNow under Healthy and Empowered Individual, Families, and CommunitiesIIntervention to solve the problemSpread against 3 strategic directionsMMethodology to monitor the populations at riskExpanded to include surveillance and program evaluation

Our Duck PondState of Kansas Suicide Prevention Task Force asked Sedgwick County members to start a local task forceThe Suicide Prevention Task Force became a Coalition in 2009A recent local addition of the American Foundation for Suicide PreventionKey gatekeepersTeachers and school staffSchool health personnelClergyPolice officersCorrectional personnelSupervisors in occupational settingsNatural community helpersHospice and nursing home volunteersPrimary health providersMental healthcare and substance abuse treatment providersEmergency healthcare personnel.2001, DHHS. NSSP p78I. Define the ProblemSurveillance 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 countiesDefinitions lacking-population differences Assisted suicide is a separate issue-should not be included in the rate

Various agencies utilize different dataDeath certificatesCoroner reportsData may be gathered by county of residence or by site of deathField reporters obtain the personal data and interview the families Suicides are tracked by using a Rate No. of suicides per 100,000 personsOverlaps other injury data (ODs, MVAs)The Rate: Is influenced by economic, spiritual, political factors An indicator of a countrys health, hope, stability, and culture.10th on the list of U.S. Health IndicatorsComparing Suicide RatesNine 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 CenterCDC utilizes Injury and Violence DataNational Violent Death Reporting SystemModel: National Highway Traffic Safety Administrations system for motor vehicle deathsNational Violent Death Reporting System (NVDRS)Harvard-designed to collect information on homicides and suicides and firearms deathsBased 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 laboratoriesExpected to allay irregular quality of data available through the coroner systemCurrently collects data in only 18 states

ComparisonsSuicide Rates per 100,000200120022003200420052006200720082009 20102011 2012 Sedg Co.11.211.112.312.013.411.614.612.213.513.611.016.5KS10.812.712.813.613.213.813.612.513.614.1USA10.711.010.911.111.011.211.311.812.012.412.344Despite efforts at prevention the last 15 years The suicide rate has actually increasedDespite the use of antidepressants and improved healthcare and mental healthcareDespite the economyDespite our rich heritage and freedomsIs this an indication of whether our programs are working or not?

46Public health program concernsAnti-smoking, cancer screening, AIDs prevention can point to success in lives savedSuicide 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 reductionBaker SP, 2013

The Disconnect 1990sThe Decade of the Brain Suicidality has a life apart from mental illnessNo professional has been able to consistently predict individuals suicideMental health tools have been unproven in terms of affecting suicidality The association of suicide with mental illness Is a conundrum80-90% 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 FriendMiddle-aged Vietnam veteran who struggled with PTSD from childhood trauma, alcohol abuse, and depressionWas 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 MHCDied of an overdose on his medications and alcohol in his 50sPeople who commit suicideFrequently do not tell others or professionalsAre not identifiable on individual basisAre frequently different from those with para-suicidal behavior and frequent attemptsAre from widely varying populations (young divorced male versus dialysis patient refusing treatment)IOM 2002 Reducing Suicide

The stark facts Jan Fawcett MD:Suicide isnt predictable in individuals; Preventive efforts arent very effective;Suicidal communications arent often made by patients to physicians or counselors;Denial of suicidal intent doesnt mean a patient wont do itIOM 2002 Reducing Suicide

II. Identify CausesRisk factors:Acute: anxiety, panic attacks, recent alcoholChronic factors: demographic infoFirst year post dischargeTraditional risk factors did not predict for year onebut did for years 2-10Protective factors:ResiliencySocial supportTheoriesSocial theories Charles DurkheimFreud: Anger turned inwardsAaron Beck HopelessnessBiologyLow serotonin and impulsivityBrain serotonin bounces back very high right after suicide attackNo genetic tests are helpful as of yetSYMPTOMSSHORT-TERM RISK FACTORSLoss (loved one, relationship, job, pride, health)HopelessnessAnxiety Agitation and Impulsiveness Intoxication with alcohol or substancesLONG-TERM RISK FACTORSElderly caucasian male who drinks

The 4 RsRelief of painemotional and/or physicalRejoining a lost oneReality testing loss (voices, command hallucinations, Gods desire)Revenge

Some people think that if we just get suicidal people into treatment wed prevent suicide. But were not good at it More than 50% of suicides occur while patients are in active treatment69% 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 sayIOM 2002 Reducing Suicide

III. Develop and Test IV. Implement InterventionsYellow Ribbon and school-based programs Air Force ProgramSuicide 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 valueSADPERSONS Scoring for Suicide RiskSADPERSONS Scoring for Suicide RiskSSex = male1 pointAAge > 45 or 9 = high risk and probable need for inpatient interventionScore > 6 = moderate risk and need for psychiatric consultationScore < 6 = low (but not no) riskV. Evaluate EffectivenessThe global suicide rate may not be such a good indicator of effectiveness of interventionsBreaking down populationsPreventable versus non-preventable suicideResponse may be seen in one year, may take decadesCohort effects

Sedgwick County 2012 Suicide Rates83 Suicide deaths in Sedgwick CountyRate of 16.5 deaths per 100,000Highest rate seen in the 12 years that weve been tracking local dataSuicide Prevention Hotline316-660-750024 hours/ 7 Days per week64

65MethodsUse of firearm is consistently most common method, followed by hanging and overdose

Rate per 100,000United States 2010Sedgwick County 2010Sedgwick County 2012Firearm6.36.88.5Hanging/Suffocation3.13.05.4Overdose2.12.22.266

Sedgwick Co. Method of Suicide 2008-201267

Health History in Sedgwick County SuicidesHistory of mental illness was noted in approximately 50% of suicides --Depression, bipolar disorder, substance abuse27% have history of prior suicide thoughts or attemptsSignificant medical issues noted in 40% of suicides72% suicides in Sedgwick County had alcohol or drugs in their system 69Changing times/changing trendsIn 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 locallyThis 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 WavesPain control cultureNarcoticsWhat effect does cannabis have?Our community is busy trying to help prevent suicideVia Christi Assessment CenterVia Christi hospitalsOther hospital ERsComCareMHAPrivate practitionersLaw enforcementEMSCommunity Impact of Suicidal Ideation/ AttemptsSedgwick County 911 Dispatch calls 2,179 Suicide attempts 295 Suicide threats 816 Mental health emergenciesCOMCARE Crisis Intervention Services 5,586 Crisis Assessments61,156 phone callsThis is all 2012 dataSource: E-mail from Jason Scheck on 5/7/13CIT2013Summit presentation by Narciso Narvais74Weakness in emergency managementInvolves the shortage of mental health specialists in general hospital EDEnhanced training of ED physicians may helpIncreasing patient access to mental healthcareImplementation 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.

Source: Susan Bumsted, MN, RN, e-mail communication 5/7/1376The Risky Post-hospitalization PeriodThe 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 (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 periodClinical 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, 2012U.S. and local clinical practiceImprovement needed in patient transitions from inpatient to outpatient psychiatric care.Nationally only about 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 2013Problems with outpatient compliance (Lincoln et al, pending)Addressing critical links in mental health care system will not replace other interventionsHotlinesScreening programsCrisis counseling servicesPublic education campaignsOffson 2014WHERE DOES THAT LEAVE US NOW?Organizational RestructuringRevision of the Strategy for Suicide PreventionA Prioritized Research Agenda for Suicide Prevention by NAASPA Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Liveshttp://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Agenda.pdf3 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 QuestionsWhy 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 CountyEducate the public so that family and friends will pick up on the signs of risk and encourage treatmentEducate gatekeepers, seminarsEvaluate the programs already in useYellow Ribbon school programBookmark distributionAnnual runSurvivors of Suicide annual teleconferenceLocal prevention groupsSedgwick County Suicide Prevention CoalitionAmerican Foundation for Suicide PreventionNational Association for the Mentally IllPrivate foundations

Recommendations in SCSPCContinue efforts to collect data from a variety of sources to assess impact of Coalition activitiesIncrease integration efforts with primary care, pastors and businessTarget high risk neighborhoodsFocus groups to identify neighborhood needs and targeted prevention effortsCreate Neighborhood Advisory CommitteesCommunity workshops to educate providers about local resources, promote dialogue among groupsMoving beyond autopsy data to evaluate and improve our prevention efforts87Prevention measures; what you can doFor information about suicide, a Survivors of Suicide Handbook, the Cluster Response Plan or upcoming events, go towww.sedgwickcounty.org (Living, Health and Welfare, Suicide Prevention)American Association of Suicidology - www.suicidology.orgAmerican Foundation for Suicide Prevention - www.afsp.org Suicide Prevention Hotline - 660-7500 24 Hours/7 Days a Week

LISTEN, LISTEN, LISTENPrevent access to firearms, monitor all medication use, and be aware of potential weaponsDon'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.aspSUICIDE PREVENTIONIf you or someone you know is talking about suicide, pleasecallthe suicide prevention hotline24 hours a day/7 days a week.(316)660-7500Crisis 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:PessimismHopelessnessDesperationSleep problemsAnxiety, emotional pain and inner tensionWithdrawal from friends and/or familyIncreased alcohol and/or other drug useRecent impulsiveness and taking unnecessary risksThreatening suicide or expressing a strong wish to dieMaking a planSeeking access to pills, weapons or other meansUnexpected rage or angerStressful 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 ReportWe always deceive ourselves twice about the people we love first to their advantage, then to their disadvantage.ALBERT CAMUS,A Happy Death

Read more athttp://www.notable-quotes.com/c/camus_albert.html#QlzA2QwjyPpv8crk.99 17 yo white female, distraught over the breakup with her boyfriendSecretly goes to her familys medicine cabinet and downs a bottle of Tylenol and Benadryl, to escape the pain. Is ready to die if thats 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 OTCsAny small deterrent in a suicide attempt may avert completionImpulsive 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 ideationsA 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 RestrictionFirearms in the home are a risk factor.Never leave these at home unattendedLock them awayUse the safetyPistols in the home raise the risk 10-foldTell family and friends about the situationAlcohol and substances increase the risk of impulsivity of any type.Build resilience in our childrenProblems come and goRelationships come and goManaging emotions can instill confidence and securityThere will be failures but it is not the end of the worldSTIGMAIs a way of deceiving ourselves, a way to pretend that these things really do not exist in the real or normal worldDenies the fact that we are all on the edge of our own insanityUnforeseen tragediesUnforeseen medical problemsMedications, supplements, substancesUnforeseen disastersBravery and Courage Required

To address the addictions our loved ones faceTo address our loved ones that are enablersTo be that freaky person that keeps the guns locked up and the safety on, keeps the medications locked upTo 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 factorsmore complex than other chronic diseasePrevention may be difficult to measure and the suicide rate may not be the best indicator of effectivenessEvaluate education, policy and/or technological changes and implement effective interventions

My OpinionEducate families and friendsReduce stigma for survivorsLimit access to means (Firearm Safety!!!)Use caution with narcotics and substancesDont ignore the influence of cannabisMonitor the suicide rate with an eye towards an understanding of our societys illsBuild resilience in our childrenStop the Silence Be a Voice for LifeMan 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 athttp://www.notable-quotes.com/c/camus_albert.html#QlzA2QwjyPpv8crk.99 ReferencesBaker 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.ReferencesWhile 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 dateOffson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide Prevention on Periods of High Risk. JAMA. March 19, 2014, Volume 311, Number 11. 1107-1108Sedgwick County Suicide Prevention Coalition 2012 Annual Report (Nicole Klaus PhD) at http://www.sedgwickcounty.org/comcare/reports/Suicide_Prevention_AR.pdf. Accessed April 6, 2014A 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.eduOthers:http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/index.html http://www.samhsa.gov/nssp http://www.actionallianceforsuicideprevention.org/NSSPhttp://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.

Chart1261113926171583415118398354326113

GunshotHangingOverdoseOther

Sheet1GunshotHangingOverdoseOther20082611139200926171582010341511820113983520124326113To resize chart data range, drag lower right corner of range.