Using SAMSHA’s Strategic Prevention

Framework for Suicide Prevention Planning Ky Prevention Network Annual Conference

Oct. 3, 2013

Patti M. Clark Project Coordinator

Suicide Prevention Efforts in Kentucky

Goals for Today

• Overview of the Strategic Prevention Framework

• Connection between Suicide and Substance Abuse

• Suicide Epidemiology/Statistics • Starting Your Suicide Prevention Project using

the SPF • Resources

A five-step planning process to guide

the selection, implementation and

evaluation of culturally appropriate and

sustainable prevention activities

The SPF is….

Epidemiology and the SPF

Substance-Related Consequences &

Use

Risk & Protective Factors /Causal

Factors

Strategies (Policies, Practices & Programs)

Epidemiology and the SPF

Epidemiology helps us understand: – the nature and extent of substance use – abuse, dependence – associated risk and protective factors in a

population. Data about the nature and patterns of substance use and abuse in a particular community can help focus prevention efforts.

Epidemiology and the SPF

Epidemiology also helps us understand: – The nature and extent of suicide, including suicide

ideation, suicide attempts and suicide deaths – Associated risk and protective factors in a

population against suicide

SA vs. Suicide Stats

Connection between Substance Abuse and Suicidality

• Substance use is second only to mood disorders in its association with suicide.

• Comorbidity increases the risk even further. • Alcohol is present in about 30 – 40 percent of

suicides and suicide attempts. • Both binge drinking and chronic use of alcohol are

associated with suicidal behaviors.

Connection between Substance Abuse and Suicidality

• Suicide is the leading cause of death among people with substance use disorders (SUDs).

• Compared with the general population, people treated for alcohol abuse or dependence are at about a 10x greater risk for suicide. (Wilcox, et al., 2004)

• Those who inject drugs are at about a 14x greater risk for suicide. (Wilcox, et al., 2004)

• The number of substances used seems more predictive of suicide than the types. (SAMHSA, 2008)

Shared Risk and Contributing Factors

• Family history of suicide or child abuse • History of mental (especially mood) disorders • History of or family history of addition • Impulsiveness • Feelings of isolation • Barriers to behavioral health treatment • Relational, social, work, or financial losses • Physical illness/Chronic pain • Access to lethal means • Delinquency

Shared Protective Factors

• Social support • Connectedness to community and institutions • Coping/problem solving skills • Parental involvement • Trusting relationship with counselor, physician, or other

service provider • Employment • Religious attendance and/or belief in religious teachings

against suicide

Comparing Concepts from SA to Suicide Prevention

Comparing Concepts from SA to Suicide Prevention

US. Suicide Rates by Age

Statistics from SAMHSA and SPRC

National YRBS results

Ky Suicide Rate vs. National Rates

0

2

4

6

8

10

12

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Sui

cide

Rat

e pe

r 100

,000

U.S. & Kentucky Suicide Rates for those ages 15-19

KY Age-Adj. Rate US Age-Adj. Rate

Average Kentucky Population for 15-19 year olds: 290,000. Average US Population for 15-19 year olds: 21,000,000.

Ky – US Rate Comparison

Kentucky – 2009 Overall – ranked 23rd, rate of 13.7 compared to 12.0 nationwide Youth – (15-24) – ranked 15th, with 77 deaths and a rate of 13.1, compared to national rate of 10.2 Over 65 – ranked 11th, with 108 deaths and a rate of 18.9 compared to a national rate of 14.8

Kentucky - 2010 Overall - ranked 21st, rate of 14.5 compared to 12.4 nationwide Youth – (15-24) – ranked 37th, with 58 deaths and a rate of 9.9, compared to national rate of 10.5 Over 65 – ranked 25th, with 91 deaths and a rate of 15.7 compared to a national rate of 14.9

Ky Suicide Rates & Stats of Interest

From there to …

History of Suicide Prevention Efforts – Direct interventions

(about getting help for an individual person)

– Treating mental health issues – Supporting survivors of loss

(family members, friends, coworkers)

– Improving coping skills – Reducing individual risk factors – Giving hope to those with issues

Suicide Prevention

Planning Process

… Here – a public health model

Objectives of Suicide Prevention Efforts

• Promote awareness that suicide is a public health problem that is preventable • Develop broad-based support for suicide prevention • Develop and implement strategies to reduce the stigma associated with being a

consumer of mental health, substance abuse and suicide prevention services • Develop and implement community-based suicide prevention programs • Promote efforts to reduce access to lethal means and methods of self-harm • Implement training for recognition of at-risk behavior and delivery of effective

treatment • Develop and promote effective clinical and professional practices • Increase access to and community linkages with mental health and substance

abuse services • Improve reporting and portrayals of suicidal behavior, mental illness and substance

abuse in the entertainment and news media • Promote and support research on suicide and suicide prevention • Improve and expand surveillance systems

2012 National Suicide Prevention Strategy

The full copy of the National strategy can be found at: http://store.samhsa.gov/product/National-Strategy-for-Suicide-Prevention-2012-Overview/PEP12-NSSPOVER

Prevention Continuum for Suicide

Where Do We Start?

• Needs Assessment – Readiness assessment – is your community ready

to address suicide? – What do the statistics say about suicide in your

community? • Actual death numbers • Attempts (avg of 25 attempts for each death, youth

numbers as high as 200/death) • YRBS Numbers – (felt sad or hopeless, seriously

considered, made a plan, attempted, attempt required medical attention, substance abuse numbers)

Where Do We Start?

• Needs Assessment - continued – What do the statistics say about suicide in your

community? • Specialty populations? – Military, LGBTQ, Transient,

senior citizens, white males • Students report they feel unsafe at school? • Drug and alcohol use by youth? Multiple subtances? • Drug and alcohol use by adults (DUIs, other arrest data) • Risk takers • Media reports? How do your media outlets handle

suicides?

What’s Next? Who Is At the Table?

– CMHC – FRYSC – Schools – Law enforcement – Religious

organizations – Community

organization – Businesses

– Youth – Survivors of Loss – Attempt Survivors – Community

coalitions focusing on decreasing substance abuse

– Others? Who in your community needs to be at the table?

Develop a Plan

• Go back to slide 23 – what are the objectives of a good suicide prevention plan? Which ones do you want to start with?

• Does your community have the capacity to deal with at-risk individuals? (Workforce behavioral survey and Zero Suicide Initiative)

• Do your schools have effective policies and procedures related to at risk youth?

• Community gatekeeper trainings offered on a regular basis. • Stigma issues • What is your capacity? • Recent deaths by suicide?

What Might Your Plan Look Like?

• Awareness campaign to address stigma • Comprehensive school-based plan that

addresses early identification and referral process as well as strong linkages to community resources

• Partnerships with local mental health services providers to improve services (trainings, etc. for employees

What Might Your Plan Look Like

• Integrate suicide prevention into substance abuse coalition plans (task force, subcommittee, etc.)

• Start a suicide prevention coalition • Media literacy – help media outlets

understand best way to address suicide deaths to prevent contagion

• Encourage survivors to start a SOS group

What Might Your Plan Look Like

• Encourage attempt survivors (who are deemed healthy enough by their mental health providers) to reach out to other attempt survivors in a peer support network

• Increase surveillance to improve understanding of issue in community (talk with coroner, vital statistics, etc. to increase timeliness, accuracy of reporting deaths)

What Might Your Plan Look Like?

• Evidence-based please

Implement Your Plan

• Time to put those plans in place – Be ready to evaluate your efforts from day one – Consider cultural competency – Think about sustainability from the beginning

Time to Evaluate

• Evaluation is hard. • How do we know if our plan is successful?

– Decreased deaths – Decreased attempts – Less suicide ideation – Other ideas?

Time to Begin Again

And we start all over again

Resources

• Suicide Prevention Resource Center – www.sprc.org

• American Association of Suicidology – www.suicidolgy.org

• Society for the Prevention of Teen Suicide – www.sptsusa.org

• Kentucky Department of Behavioral Health – http://dbhdid.ky.gov/dbh/sped-training.aspx

Contact Information

Patti M. Clark

Project Coordinator Suicide Prevention Efforts for Adolescents in Ky

Kentucky Department of Behavioral Health www.patti.clark@ky.gov

502-564-4456, x 4554