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MCW Seminar Series
Prevention of Suicide and Other Violence
Shel Gross, MPAMental Health America of Wisconsin
April 13, 2015
Overview
• Suicide Data
• Zero Suicide: Changing the Paradigm
• Reducing Gun Violence
Data: Wisconsin Deaths, 2012
• Suicides: 734• Homicides: 185
–10th leading cause of death–2nd leading cause for those
15-24 and 25-44.
Data: Burden of Suicide
• 4th leading cause of YPLL
• 2007-2011, for self-inflicted injury:–$369 m. in inpatient cost–$22.6m. in ER costs
Data: Burden of Suicide
• Highest Suicide Rates:–Men 45-54 y/o–White–Less than a high school degree–Divorced–Veterans–Northern and Western Regions
Data: Burden of Suicide
• Ideation/Self Injury Rates among HS youth:
–Racial and ethnic minorities–LGB teens.
Data: Circumstances
Clinical Training
• Percentage of individuals who reported receiving didactic training on suicide prevention in their graduate programs:
Psychology: 50%Social Work: 25%
• And most deemed it limited or inadequate.• Few licensing bodies require CE for
suicide risk and management.
Perfect Depression Care
• Henry Ford Health Systems:
– Assigned all patients to suicide risk level
– Defined interventions for each risk level
– Trained all therapists in CBT
– Means restriction protocols
Perfect Depression Care
• About 200,000 covered lives.
• Expected suicide rate in population:– 12 per 100,000; general population– 230/100,00 expected in MH clinic pop.
• First four years– Reduced from 89 to 22 per 100,000
• Next two and a half years…
Perfect Depression Care
Suicides
HFHS is Not Alone
Air Force Suicide Prevention Initiative• Suicides dropped by 1/3 over six years.
Maricopa Suicide Deterrent System Project• 38% reduction among SMI
All three programs demonstrate the ability to dramatically reduce suicide in a
“boundaried” population.
What is Zero Suicide? Culture Shift
Over the decades, there have been many instances where individual mental health clinicians have made heroic efforts to save lives, but systems of care have done very little.
Dr. Richard McKeonSuicide Branch Chief
SAMHSA
What is Zero Suicide?Practices not a Program
Program
Set of Practices
Screening
Assessment
Workforce Training
Cont-inuity
of care
Tool Kit
Zero Suicide Tool Kit
A compilation of advice, resources, and tools from several groundbreaking initiatives and from the Clinical Care and Intervention Task Force of the National Action Alliance for Suicide Prevention.
Tool Kit
Organized into 6 Sections:
• Zero Suicide Culture• Pathway to Care• Competent Workforce• Suicide Risk Level• Evidence-based Care (EBPs)• Continuity of Contact
What Can I Do Right Now?
• Re-examine beliefs about suicide prevention– Zero Suicide Culture
• Do an organizational self-assessment– On the Zero Suicide website
• Increase clinician competency– See handout
• Start the conversation
Data: Firearm Violence
• 483—WI firearm deaths in 2012
• 72% are suicides
–Nationally, 60% of firearm deaths are suicides.
Data: Firearm Violence
• The large majority of persons with mental illness are never violent.
• Most violence towards others (95-97%) is not attributable to mental illness.
• At certain times, such as the period surrounding a psychiatric hospitalization or first episode of psychosis, small subgroups of persons with serious mental illness are at elevated risk of violence.
Expand Firearm Prohibitions
• Individuals convicted of violent misdemeanor crimes.
• Respondents to temporary domestic violence restraining orders.
• Individuals convicted of multiple DWI/DUI offenses in a five year period.
• Individuals convicted of multiple drug-related misdemeanor crimes in a five year period.
Gun Violence Restraining Orders
• Develop a mechanism to allow law enforcement officers to remove firearms when they identify someone who poses a threat to themselves or others.
• The mechanism should allow for removal without a warrant in the case of immediate threat and removal with a warrant in the case of a credible but not immediate threat to self or others.
Resources
Wisconsin Deaths, 2012, WI Dept. of Health Services. https://www.dhs.wisconsin.gov/publications/p4/p45368-12.pdf
Burden of Suicide in Wisconsin: 2007-2011; WI Dept. of Health Services, Medical College of WI, Mental Health America of WI; 2014; https://www.dhs.wisconsin.gov/publications/p0/p00648-2014.pdf
Suicide Care in Systems Framework: National Action Alliance for Suicide Prevention, Clinical Care and interevention Task Force report:
http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/taskforces/ClinicalCareInterventionReport.pdf
Resources
Preventing Suicide through Improved Training in Suicide Risk Assessment and Care: An American Association of Suicidology Task Force Addressing Serious Gaps in U.S. Mental Health Training; Schmitz, W. M., Jr., et. al., Suicide and Life Threatening Behavior, 2012
Zero Suicide Toolkit:www.zerosuicide.org/zero-suicide-tool-kit
Mental illness and reduction of gun violence and suicide: Bringing epidemiological research to policy. Swanson J, McGinty EE, Fazel S, Mays V (2014). Annals of Epidemiology, In Press. http://www.annalsofepidemiology.org/article/S1047-2797(14)00147-1/fulltext
Resources
Center for Gun Policy and Research; Johns Hopkins Bloomberg School of Public Health: http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/publications/
