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Addressing Pandemic Mental Health Crisis in the HIV Clinic

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Project ECHO - UNM Indian Country HIV TeleECHO Addressing Pandemic Mental Health Crisis in the HIV Clinic 8/11/21 Associate Professor Department of Psychiatry and Behavioral Sciences University of New Mexico School of Medicine Jasen Christensen, DO Version_ 08 2021 Conflict of Interest Disclosure Statement Speaker has nothing to disclose. This presentation was reviewed by UNMHSC and SCAETC faculty to ensure it meets Continuing Education guidelines. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). Under grant number U1OHA33225 (South Central AIDS Education and Training Center). It was awarded to the University of New Mexico. No percentage of this project was financed with non-governmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. Learning Objectives Identify a resource for suicide screening. Describe data supporting safety planning. Discuss recent data regarding suicide rates. Suicide Rates Have Remained Stable Studies are showing overall suicide rates to be remaining stable: Massachusetts March-May 2020 Foust J, et al. Suicide Deaths During the COVID-19 Stay-at-Home Advisory in Massachusetts, March to May 2020. JAMA, 2021;4(1) 21 Countries April-July 2020 Pirkis J, et al. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. The Lancet, July 2021;9(1):579-588. Reference 14 font Suicides Dropped in 2020 Suicide rate declined by ~ 6% from 2019 to 2020 1 2019: 47,511 2020: 44,834 Suicide experts have observed that rates tend to decrease following communal trauma: Possibly reflecting social cohesion / shared suffering 2 Ahmad F, et al. The Leading Causes of Death for the US in 2020. JAMA, March 31,2021. Moran M. Suicides Drop During Past Year of Pandemic, Study Finds. Psychiatric News. June 2021;56(6). Reporting on suicidal behavior and COVID-19 Need for caution "News reporting on suicidal behavior can influence suicide and self-harm in the general population." "Sensational media coverage of the negative effects resulting from the pandemic, especially when focused on suicidal behavior, could increase the risk of imitation and contribute to normalizing suicidal behavior as a common and acceptable way to cope with difficulties related to the crisis." Hawton K, et al. Reporting on suicidal behavior and COVID-19 - need for caution. The Lancet Psychiatry, January 2021;8(1):15-17 BH crises have increased among adolescents Mental Health-related emergency department (ED) visits among adolescents (age 12-17yo) increased by 31% in 2020 vs 2019 ED visits for suspected suicide attempts among girls Feb-March 2021 were 50.6% higher than same period 2019 ED visits for suspected suicide attempts among boys Feb-March 2021 were 3.7% higher than same period 2019 Yard et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12-25 Years Before and During the COVID-19 Pandemic - United States, January 2019-May 2021. CDC Morbidity and Mortality Weekly Report. June 18,2021 70(24);888-894. Columbia Suicide Severity Rating Scale https://cssrs.columbia.edu/wp-content/uploads/C-SSRS-Brochure-for-First-... Safety Planning Step 1: Warning signs that a crisis may be developing: 1: __________________________________ 2: __________________________________ 3: __________________________________ Step 2: Internal Coping strategies - things that can be done to take one's mind off problems without contacting another person: 1: __________________________________ 2: __________________________________ 3: __________________________________ Step 3: People and social settings that can provide distraction: 1: Name__________________________________ # _________________ 2: Name__________________________________ # _________________ 3: Place _______________________ 4: Place ______________________ Step 4: People I can contact for help: 1: Name__________________________________ # _________________ 2: Name__________________________________ # _________________ 1: Name__________________________________ # _________________ Safety Planning Step 5: Professionals or agencies I can contact for help 1: Clinician__________________________________ # _________________ 2: Clinician__________________________________ # _________________ 3: Local Urgent Care Service ______________________________________ Address ____________________________________________________ Phone _____________ 4: Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255) Step 6: Safety of the home 1: __________________________________ 2: __________________________________ The one thing that is most important to me and worth living for _____________________________________________________ Stanley B et al. Comparison of the Safety Planning Intervention With Follow-up vs. Usual Care of Suicidal Patients Treated in The Emergency Department. JAMA Psychiatry. 2018:75(9):894-900. Evidence for Safety Planning 9 Emergency Departments (5 intervention sites, 4 control sites) Cohort comparison design with 6-month FU Patients enrolled if presented to ED with suicide-related concern 1186 in intervention group, 454 in comparison group Intervention was Safety Plan + 2 telephone follow-ups to inquire about risk, review/revise the Safety Plan and support engagement Intervention cohort had 45% fewer suicidal behaviors at 6 months (p=0.03) And double the odds (OR: 2.06, p=0.001) of attending at least 1 outpatient mental health visit Stanley B et al. Comparison of the Safety Planning Intervention With Follow-up vs. Usual Care of Suicidal Patients Treated in The Emergency Department. JAMA Psychiatry. 2018:75(9):894-900. No-Harm contracts Avoid such contracts There is no evidence to support their use They create a false sense of security Psychiatric Crisis Resources SAFE-T: 5-step suicide assessment https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-F... Columbia Severity Rating Scale https://cssrs.columbia.edu/wp-content/uploads/C-SSRS-Brochure-for-First-... Stanley/Brown Patient Safety Plan https://suicidepreventionlifeline.org/wp-content/uploads/2016/08/Brown_S... Resources National Clinician Consultation Center http://nccc.ucsf.edu/ HIV Management Perinatal HIV HIV PrEP HIV PEP line HCV Management Substance Use Management Present case on ECHO http://echo.unm.edu [email protected] AETC National HIV Curriculum https://aidsetc.org/nhc AETC National Coordinating Resource Center https://targethiv.org/library/aetc-national-coordinating-resource-center-0 Additional trainings [email protected] www.scaetc.org Find additional TeleECHO sessions in your area: https://echo.unm.edu/locations-2/echo-hubs-superhubs-united-states/ https://hsc.unm.edu/echo/get-involved/join-an-echo/ IDEA Platform: Infectious Diseases Education & Assessment. https://idea.medicine.uw.edu/ AETC National HIV Curriculum: 6 core modules for self study; regularly updated; CME, CNE Hepatitis C Online Curriculum: https://www.hepatitisc.uw.edu/ Hepatitis B Online Curriculum: https://www.hepatitisb.uw.edu/ National STD Curriculum: https://www.std.uw.edu/