Emergent Trends in Suicide Prevention: Implications for Provider Organizations

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Emergent Trends in Suicide Prevention
Implications for Provider Organizations

• Paul Quinnett, Ph.D.
• QPR Institute
• U of Washington School of Medicine

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Surgeon General of the United States

• Suicide is our most preventable form of death.
• David Satcher, MD

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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
  Imperative

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Who are the players?

• AAS
• AFSP
• SPRC
• NIMH
• CDC
• SAMSHA SPRC/AFSP BPR
• National Action Alliance for Suicide Prevention
• http//actionallianceforsuicideprevention.org

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Mission of the National Alliance?

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

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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.

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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..

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Emerging standards

• AFSP/SPRC Best Practices Registry
• NREPP
• 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

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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

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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.

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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

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Continued

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

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Continued

• 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.

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Continued

• 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.

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Continued

• 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.

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Continued

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

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Continued

• 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.

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Continued

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

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Continued

• 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.

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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

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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

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Old goal 6 Implement training for recognition
of at-risk behavior and delivery of effective
treatment

• 1. Who is qualified to conduct a suicide risk
  assessment?
• 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?

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SRMI quiz (1,100 practicing professionals)

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Question

• 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

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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
  overdose
• No SRA, no referral for a workup by a MHP, even
  though one was in the building

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Goal 6 NSSP Targeted and Struck in Washington
State

• 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

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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.

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Law requires

• All licensed mental health providers to
• Complete a training program in suicide
  assessment, treatment, and management every six
  years
• 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.

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Law relied on several things

• Availability of BPR training options (more than
  one)
• 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)

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Details

• 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.

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Governor Signs Bill

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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
  July
• Other states all in KY
• WA is ahead of the curve.. FOREFRONT
  organization lauched

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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

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Challenges.

• 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
  contracts
• Wrong beliefs, e.g., If they really want to kill
  themselves you cant stop them.
• CEO, Patient suicides is the cost of
  business.

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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?

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Contact information

• Free e-book and apps
• Office phone [phone]
• Institute phone [phone]
• Email pquinnett_at_mindspring.com
• Website www.qprinstitute.com