Suicide Prevention ppt and more detailss

Suicide Prevention

1. National Strategy for Suicide National Strategy for Suicide
Prevention: Prevention:
Goals and Objectives for ActionGoals and Objectives for Action
Retooling the VillageRetooling the Village
Colonel (Dr.) David Litts
Special Advisor to the U.S. Surgeon General

2. OverviewOverview
•The Problem
•Public Health Strategy
•Community Perspective
•Air Force Suicide Prevention Program

3. Suicide Among Leading Causes of Deaths Suicide Among Leading Causes of Deaths
by Age Group-1998by Age Group-1998

4. Suicides and suicide rates by age group-- Suicides and suicide rates by age group--
United States, 1998United States, 1998
Source: Natl. Center for Health Statistics
Rate  Number 

5. Suicide and Homicide Rates Suicide and Homicide Rates
1995-1998*1995-1998*
0
10
20
30
40
50
60
DC US
Area
R
a
t
e
/
1
0
0
,
0
0
0
SuicideHomicide
0
1
2
3
4
5
6
7
8
DC
R
a
te
R
e
la
tiv
e
to
th
e

O
v
e
r
a
ll U
S
R
a
te
SuicideHomicide
*CDC, National Center for Injury Prevention and Control

6. 0
0.5
1
1.5
2
2.5
DCNVAZUTSDMENHRIMA
State
R
a
t
e
s

R
e
l
a
t
i
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e

t
o

t
h
e

O
v
e
r
a
l
l

U
S

R
a
t
e
SuicideHomicide
Suicide and Homicide Rates
1995-1998*
*CDC, National Center for Injury Prevention and Control
(7.07)

7. Public Health ApproachPublic Health Approach
•Prevention based--no public health problem
has ever been treated out of existence
•Public Health Strategies:
–Find the noxious agent and render it harmless
–Prevent transmission of the noxious agent to the
host
–Strengthen the host to be resistant to the
noxious agent

8. Noxious Agent (Influence) for Noxious Agent (Influence) for
SuicideSuicide
•Loneliness and isolation
•Hopelessness
•Beliefs and stigmas about help-seeking
•Violence -- child abuse, sexual abuse
•Harassment & bullying
•Acceptance/tolerance of suicide
•Low value on human life
•Depression and other mental illnesses*
Society/
Culture
* Also has a significant society/cultural component

9. Lethal MeansLethal Means
•What role
•Potential for Prevention
•Impulsive/Agitation
•Potential for Prevention

10. Suicide Rates by MethodSuicide Rates by Method
0 2 4 6 8 10 12 14 16 18
Deaths/100,000
Denmark
Australia
New Zealand
Canada
Scotland
Norw ay
US
The Netherlands
Eng & Wales
Israel
FirearmPoisoningSuffocationAll Other
Source: Lois A. Fingerhut, MA, Centers for disease Control and Prevention, Unpublished

11. Suicide Rates United States, 1933-1998Suicide Rates United States, 1933-1998
Source: Natl. Center for Health Statistics
Age-adjusted to 1940 U.S. population
0
2
4
6
8
10
12
14
16
18
1
9
3
3
1
9
4
5
1
9
6
5
1
9
8
5
1
9
9
7
Year
R
a
t
e

p
e
r

1
0
0
,
0
0
0

p
o
p
u
la
t
io
n

12. CommunityCommunity
“...not just the sum of its citizens, but
rather the web of relationship between
people and institutions that hold
communities together.”
Wallack L and Dorfman L: Media advocacy: a strategy for advancing policy and
promoting health. Health Education Quarterly; 1996, 23:293-317.

13. Community CapacityCommunity Capacity
Social CapitalSocial Capital
•Extent to which community members:
–Demonstrate a sense of shared responsibility for
the general welfare of the community and its
members, and
–Evidence collective competence in confronting
situations that threaten the integrity of the
community and the safety and well-being of its
members.

14. Community TypesCommunity Types
Collective Competence
Shared
Responsibility
Low High
Low
High
Anomic
Communities
LL
Detached
Communities
LH
Intentional
Communitie
s
HL
Empowered
Communitie
s
HH

15. Prevention goes beyond Prevention goes beyond
changing individuals--changing individuals--
it changes cultural normsit changes cultural norms
--Murray Levine (1998)

16. Cultural DirectionsCultural Directions
•Interdependence -- interconnectedness
•“My brother’s keeper” -- shared
responsibility
•Knowledge and skills
•High view of human life
•Positive attitudes toward help-seeking
•Accurate understanding of mental illness

17. Cultural ApproachesCultural Approaches
Think not only about:
•Changing children
•Changing students
•Changing workers
•Changing people with
problems
Think also about:
•Changing families
•Changing schools
•Changing work settings
•Changing societal
attitudes about suicide
prevention, mental health,
stressful living patterns,
violence

18. Expected ResultsExpected Results
Drops in
•Suicide rate
•Family violence
•Truancy
•Drug abuse
•Alcohol Abuse
•Crime

19. “We are on a treadmill to nowhere if all our efforts are
directed at helping individual victims…..It is well-
known public health doctrine that no mass disorder
afflicting humankind has ever been eliminated or
brought under control by treatment of affected
individuals. Only successful efforts at primary
prevention reduce the rate of distress in the future.”
-- George Albee
Albee, G. (1996). Editorial: Primary Prevention Means a Change in Business as Usual.
J Nerv Ment Dis, 184(2).

20. U.S. Air Force Suicide U.S. Air Force Suicide
Prevention: A Community Prevention: A Community
Based Public Health ApproachBased Public Health Approach
Colonel (Dr.) David Litts
Special Advisor to the U.S. Surgeon
General for Suicide Prevention

21. The Air Force CommunityThe Air Force Community
•350,000 Service Members
•Educated, Employed, Housed, Health Care,
One Language
•Prescreened; Low Illicit Drug Use (1%);
Discharge for Mental Illness
•Clearly Identified Community Leaders
•Formal Gatekeeper Network

22. Community Prevention PartnersCommunity Prevention Partners
•Medics-Mental
Health
•Public Health
•Personnel
•Command
•Law Enforcement
•Legal
•Family Advocacy
•Child & Youth
•Chaplains
•Criminal Investigative
Svc.
•CDC
•Walter-Reed Army
Inst. Of Research

23. CommunityCommunity
CapacityCapacity
CommunityCommunity
AgenciesAgencies
InformalInformal
NetworksNetworks
Unit Unit
LeadersLeaders
CommunityCommunity
ResultsResults
Air Force Air Force
CommunityCommunity

24. Assumptions Assumptions / / ApproachApproach
•Suicides are preventable
•Tip of the iceberg
•Not a medical problem
•No proven approaches
•Partnerships key to success
•Cultural barriers to prevention
 One is too many
 Address entire iceberg
 A community problem
 Use CDC & WHO guidelines
 All partners shared stake in outcome
 Leverage sr. leaders for cultural change

25. Stress Event
(In Trouble, Loss, Humiliation)
Mood Change
(Anxiety--Dread,
Hopelessness, Anger)
Inhibition
Survival
Taboo,
Support,
Ventilation,
Faith
Facilitation
Suicide
No Taboo,
Method Avail
Recent Example
Excitation/
Impulsivity,
Solitude
*David Shaffer, M.D., Columbia U.
Suicide Model*
Vulnerability
(Mood, Impulsiveness,
Aggression, Substance Abuse
Anxiety, Sexual Abuse, Sexual
Orientation, Neuro-Chemistry)
Explanation
Case Find--Treat
Crisis Intervention,
Protection/Support
Promote/Protect
Help-Seeking--Treat
Anger Management, Conflict
Resolution, Negotiation Skills,
Parenting Skills, Financial Mgmt
Public Affairs
Guidance
Method Control
Alcohol Control
Social Support
Prevention Action

26. Data-Driven Prevention Model*Data-Driven Prevention Model*
Clear Clear
vision for vision for
PreventionPrevention
Assess Assess
Incidence/Incidence/
Prevalence, Prevalence,
Risk/Risk/
Protection & Protection &
DemographicsDemographics
PrioritizePrioritize
PopulationsPopulations
& &
Risk/Risk/
ProtectiveProtective
FactorsFactors
Assess Assess
Community Community
ReadinessReadiness
forfor
PreventionPrevention
Assess Assess
ResourcesResources
CompareCompare
Populations,Populations,
Risk/Risk/
Protection, &Protection, &
ResourcesResources
PromotePromote
ReadinessReadiness
forfor
PreventionPrevention
ImplementImplement
ProgramsPrograms
toto
Mitigate Mitigate
Risks,Risks,
EnhanceEnhance
Protection,Protection,
Monitor Monitor
Data toData to
EvaluateEvaluate
* Richard Catalano, Univ of Washington (Adapted)

27. Leading Causes of Death Leading Causes of Death
ADAF 1990 -1995ADAF 1990 -1995
Suicide
24%
Unintentional
Injuries
(Accidents)
48%
Other
4%
Homicide
4%
Disease
20%

28. Suicide Rates for USAFSuicide Rates for USAF
Suicides/100,000 - 1990-95 Suicides/100,000 - 1990-95
5
7
9
11
13
15
17
19
21
90 91 92 93 94 95

29. 0
5
10
15
20
25
7980818283848586878889909192939495
Year
0
5
10
15
20
25
7980818283848586878889909192939495
Year
Suicide Rates for Enlisted MalesSuicide Rates for Enlisted Males
1979-1995 (Per 100,000)1979-1995 (Per 100,000)
White Enlisted Males
Black Enlisted Males
Trend Lines

30. Risk FactorsRisk Factors
AF Suicides vs AF Population*AF Suicides vs AF Population*
0 10 20 30 40 50 60 70
Job Stress
Depression
Substance
Abuse
UCMJ Problems
Legal Problems
Relationship
Problems
Percent
AF Population
AF Suicides
Data from various sources, covering various timeframes between 1990 and 1995.

31. Mental Health ServicesMental Health Services
UtilizationUtilization
Received
Mental Health
Care
18%
No Mental
Health Care
82%
Suicides 1990 - 1995 with Criminal ProblemsSuicides 1990 - 1995 with Criminal Problems
(n = 92)(n = 92)

32. Protective Factors*
•Social Support
–Belonging & caring
–Leadership responsibilities
•Effective Coping Skills
•Policies & Culture that:
–Approve/encourage help
seeking behavior
–Protect those who seek help
Key Risk Factors*Key Risk Factors*

Mental Health Problems Mental Health Problems

Substance Abuse Substance Abuse

Relationship ProblemsRelationship Problems

Poor Coping SkillsPoor Coping Skills

Legal ProblemsLegal Problems

Previous AttemptsPrevious Attempts

Financial ProblemsFinancial Problems

Job/PerformanceJob/Performance

Social IsolationSocial Isolation
* * Most of these are modifiableMost of these are modifiable
Suicide FactorsSuicide Factors

33. Data-Driven Prevention Model*Data-Driven Prevention Model*
Clear Clear
vision for vision for
PreventionPrevention
Assess Assess
Incidence/Incidence/
Prevalence, Prevalence,
Risk/Risk/
Protection & Protection &
DemographicsDemographics
PrioritizePrioritize
PopulationsPopulations
& &
Risk/Risk/
ProtectiveProtective
FactorsFactors
Assess Assess
Community Community
ReadinessReadiness
forfor
PreventionPrevention
Assess Assess
ResourcesResources
CompareCompare
Populations,Populations,
Risk/Risk/
Protection, &Protection, &
ResourcesResources
PromotePromote
ReadinessReadiness
forfor
PreventionPrevention
ImplementImplement
ProgramsPrograms
toto
Mitigate Mitigate
Risks,Risks,
EnhanceEnhance
Protection,Protection,
Monitor Monitor
Data toData to
EvaluateEvaluate
* Richard Catalano, Univ of Washington (Adapted)

34. ActionsActions
•Community Leader Messages
–Social Support
–Help-seeking Behavior

35. ““Since relationship problems are a factor in over half of our Since relationship problems are a factor in over half of our
suicides, be vigilant for risk signs and respond with help to suicides, be vigilant for risk signs and respond with help to
fellow airmen having problems. Encourage your troops to get fellow airmen having problems. Encourage your troops to get
whatever assistance they need…we need to continually whatever assistance they need…we need to continually
communicate that we value peoplecommunicate that we value people who demonstrate good who demonstrate good
judgement by seeking help when they need it.” judgement by seeking help when they need it.”
General Michael E. RyanGeneral Michael E. Ryan
Air Force Chief of Staff, 19 Jul 99Air Force Chief of Staff, 19 Jul 99.
““Please go the extra mile to foster a sense of belonging. Make Please go the extra mile to foster a sense of belonging. Make
sure your people feel they are a member of the team at unit sure your people feel they are a member of the team at unit
functions and other small gatherings. It has been repeatedly functions and other small gatherings. It has been repeatedly
demonstrated that demonstrated that social connectionssocial connections save lives…Let’s ensure save lives…Let’s ensure
we take care of our own--our Air Force family.”we take care of our own--our Air Force family.”
General Michael RyanGeneral Michael Ryan
Air Force Chief of Staff, 1998Air Force Chief of Staff, 1998

36. ActionsActions
•Community Leader Messages
–Social Support
–Help-seeking Behavior
•Policy
–Increased confidentiality in mental health
–Handoff to commanders
•Education
–Career Development Courses
–Annual Risk Awareness & Prevention Training

37. 0
50000
100000
150000
200000
250000
300000
350000
400000
450000
TOTAL MILITARY TOTAL CIVILIAN TOTAL
M
e
m
b
e
r
s




EDUCATED
ASSIGNED
82%
42%
77%
Annual Training Rates - 1998Annual Training Rates - 1998

38. ActionsActions
•Mental Health Screening
–Entry to USAF & Annually Thereafter
•Unit Behavioral Health Surveys
•Surveillance Database--All Self Injuries
•Postvention
•Re-engineering Human Services
–Primary Prevention Roles for Mental Health Providers
–Integrated Delivery of Community Services

39. Community Preventive ServicesCommunity Preventive Services
Pre-1996Pre-1996
Family
Support
Family
Advocacy
HAWC
Mental
Health
Child and
Youth
Chaplains
Unique
Mission
Prevention
Mission
Unique
Mission
Prevention
Mission
Unique
Mission
Prevention
Mission
Unique
Mission
Prevention
Mission
Unique
Mission
Prevention
Mission
Unique
Mission
Prevention
Mission
Customer Customer

40. Seamless, Integrated Delivery System
for Preventive Services
Family
Support
Family
Advocacy
HAWC
Mental
Health
Child and
Youth
Chaplains
Unique
Mission
Unique
Mission
Unique
Mission
Unique
Mission
Unique
Mission
Unique
Mission
Community Preventive ServicesCommunity Preventive Services
Post-1996Post-1996

41. PrinciplesPrinciples
•Gatekeeper Training
–Buddy Care, Supervisor, Community, Medical
•Community Suicide Prevention Education
•Screening Programs
•Support and Protection for Responsible Help-
seekers
•Resiliency Building - Community Agencies
•Access to Mental Health Care

42. Data-Driven Prevention Model*Data-Driven Prevention Model*
Clear Clear
vision for vision for
PreventionPrevention
Assess Assess
Incidence/Incidence/
Prevalence, Prevalence,
Risk/Risk/
Protection & Protection &
DemographicsDemographics
PrioritizePrioritize
PopulationsPopulations
& &
Risk/Risk/
ProtectiveProtective
FactorsFactors
Assess Assess
Community Community
ReadinessReadiness
forfor
PreventionPrevention
Assess Assess
ResourcesResources
CompareCompare
Populations,Populations,
Risk/Risk/
Protection, &Protection, &
ResourcesResources
PromotePromote
ReadinessReadiness
forfor
PreventionPrevention
ImplementImplement
ProgramsPrograms
toto
Mitigate Mitigate
Risks,Risks,
EnhanceEnhance
Protection,Protection,
Monitor Monitor
Data toData to
EvaluateEvaluate
* Richard Catalano, Univ of Washington (Adapted)

43. Annual ADAF Count and Rate Annual ADAF Count and Rate
of Suicides: 1980-1999of Suicides: 1980-1999
*Significant negative linear trend in suicide rate from 1994 to 1998 (p < .002)

44. Necessary ConditionsNecessary Conditions
Prevention
•Knowledge base
•Political will
•Social strategy

45. Where Do We Go From HereWhere Do We Go From Here
•Evaluate
•Improve
•Evaluate
•Improve

46. Take HomeTake Home
•Leadership, Vision
•Consolidate Political Will
•Community as an organizing principle for
Social Strategy
–Limitations of single sector approach

47. “Still, the effort seems unhurried.
Every seventeen minutes in
America someone commits
suicide. Where is the public
concern and outrage?”
Kay Redfield Jamison, Ph.D., Professor of Psychiatry, The
Johns Hopkins School of Medicine

48. Comments? Comments?
Questions?Questions?
[email protected]@osophs.dhhs.gov