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File 1 of 1 from The Intersection of HIV and Mental Health: Addressing Anxiety, Depression and Suicide Prevention

Introduction to Zero Suicide

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Department of Health and Human Services Helping people. It's who we are and what we do. IN PARTNERSHIP WITH 2 Nevada's office of suicide prevention NOSP state plan Nevada's Office of Suicide Prevention NOSP State Plan Introduction to Zero Suicide Quick Refresher Gatekeeper: Overview training in Suicide Prevention 3 Disclaimer The views and opinions expressed in this presentation are not necessarily those of the Pacific AIDS Education and Training Centers (PAETC), the Regents of the University of California or its San Francisco campus (UCSF or collectively, University) nor of our funder the Health Resources and Services Administration (HRSA).Neither PAETC, University, HRSA, nor any of their officers, board members, agents, employees, students or volunteers make any warranty, express or implied, including the warranties of merchantability and fitness for a particular purpose; nor assume any legal liability or responsibility for the accuracy, completeness or usefulness of information [apparatus, product] or process assessed or described; nor represent that its use would not infringe privately owned rights. paetc.org 4 Disclosures All presenters of this continuing medical education activity have indicated that neither they nor their spouse/legally recognized domestic partner has any financial relationships with commercial interests related to the content of this activity. 5 Objectives NOSP "New Normal" Zero Suicide Nevada's Approach Terminology / Change in terminology Data Facts What to look for Risk Factors Warning Signs/ Invitations Show you care Ask about suicide What to do - Get help Community Resources and Trainings Postvention Q and A 5 Emotional highs and lows 6 NOSP State Plan Goals 2021-2025 Goals: Increase Suicide Surveillance Data, Research and Evaluation Inspire and Empower Every Person to Play a Role in Prevention Address Upstream Factors that Impact Suicide Support Adoption of Evidence-Based and Best Practices for Safer-Suicide-Care 7 NOSP Goals 2021-2025 (cont) Enhance Crisis Care Suicide Prevention and Early Detection Ensure Lethal Means Statewide Adoption of a Suicide Postvention Programs 988 July 16th, 2022 National Mental Health 3-digit number Sustainability / Legislation Project Aware DOE 8 ZERO SUICIDE 9 Zero Suicide Initiative Suicide prevention is a core responsibility of HEALTH Apply new knowledge about suicide & focuses on treating it directly A systematic clinical approach in health systems, not "the heroic efforts of crisis staff and individual clinicians." Shift from fragmented suicide care toward a holistic and comprehensive approach to patient safety and quality improvement within healthcare systems. Zero Suicide | Crisis Now Model | OPENBeds | CSSNV Bringing community partners together community team effort System-wide approaches have worked to prevent suicide: United States Air Force Depression Care (18 Months zero suicides) (et al., 2009) 10 Zero suicide Where is Nevada? LEADERSHIP / IMPROVE ZS Coordinator continuously meeting and greeting key leaders throughout our state ZS Workforce Survey continuously launching via SurveyMonkey platform;with new providers throughout the state (north, south, rural and frontier) Data is provided to individual partners: break down department and job classification; data can be provided by county and city if needed (survey is filled out correctly and enough responses are received). The data confirms Nevada's workforce is untrained in suicide prevention Champion Leadership Teams for Zero Suicide Learning Series.Must complete registration tasks Working towards 2nd Zero Suicide Learning Series Sessions.. Project Coordinator working on a statewide ZS website/toolkit: State resources, assessment tools/instructions, information, and more Completed Summer 2021|Zero Suicide Nevada Website Adapt Zero Suicide | Crisis Now Model 12 Teams. Battle Mountain Dignity NNAMHS Pershing Rural Clinics Saint Mary's South Lyon Medical Southern Nevada Public Health Tahoe-Forest UMC Humboldt General 13 Where we are Going Series Sessions / CASAT implementing Zero Suicide into health and behavioral health systems Alliance for Suicide Prevention, Suicide Prevention Resource Center, EDC Nevada's OSP Strategic Plan 2021- 2025 VA has adopted new BDR Appling for grant and Preparing for Second Statewide trainings Supports from Joint Supports "Crisis Now Working on Zero Watch our statistics go searching for funding Zero Suicide Learning and support for Commission, Action Model" Suicide legislation: down 14 Questions. This Photo by Unknown Author is licensed under CC BY 15 Pieces of the Puzzle All need to be educated Willing to talk more openly about suicide Common Language for identifying Understand your role In prevention 16 National 2019 Numbers Lost: 47,511 lives | 130.2 lives per day Males: 37,256 | 102.1 per day Females: 10,255 | 28.1 Per day Lost: 23,941 firearms | 50.4% Lost: 6,125 Poisoning | 12.9% Lost: 506 drowning | 0.2% Lost: 13,563 suffocation/hanging | 28.5% Lost: 921 to cutting/Piercing | 1.9% 10th leading cause of death overall 2nd leading cause of death for 15 24-year old's WISQARS 2020/AAS2020 https://www.suicidology.org State 2019 Numbers 7th in the nation Lost: 657 Lives Lost: 367 Firearms Lost: 144 | 65+ older | 1st in the nation 1st leading cause of death for 11-19 years of age 2nd leading cause of death for 20-49 years of age WISQARS 2020 18 Scope of Suicide Among College Students Estimated to be 2nd leading cause of death 1100 suicides per year, 75% male 1.5%report suicide attempt in past year 10% report suicidal ideation in past year 50% of college students report suicidal ideation at some point in life <20% of college students who die by suicide received campus-based services Suicide rates higher among seniors and grad students Suicide in our HIV population?? Lack of research; thus data Treatments Working General Population rates What are you seeing daily? Help us understand? 20 Gender, and culture disparities Dis Gender Disparities Suicide among males is 4x's higher than among females. Male deaths represent 79% of all US suicides. Firearms are the most used method of suicide among males. Females are more likely than males to have suicidal thoughts. Females experience depression at roughly 2x's the rate of men. Females attempt suicide 3x's as often as males. Poisoning is the most common method of suicide for females. Suicide rates among the elderly are highest for those who are divorced or widowed. (CDC, SMH) 22 Sexual Orientation and Gender Identity (SOGI) Lesbian, gay, and bisexual kids are 3x more likely than straight kids to attempt suicide at some point in their lives. Medically serious attempts at suicide are 4x more likely among LGBTQ youth than other young people. African American, Latino, Native American, and Asian American people who are lesbian, gay, or bisexual attempt suicide at especially high rates. 41% of trans adults said they had attempted suicide, in one study. The same study found that 61% of trans people who were victims of physical assault had attempted suicide. Lesbian, gay, and bisexual young people who come from families that reject or do not accept them are over 8x more likely to attempt suicide than those whose families accept them. Each time an LGBTQ person is a victim of physical or verbal harassment or abuse, they become 2.5x more likely to hurt themselves. 23 Not Just Statistics.. 24 Suicide Touches Everyone 135 People Effected for Every Death and Effects Linger Across Generations Because of the Silence that Often Follows 25 Facts You Need to Know About Suicide There is strong evidence that sexual orientation and Gender identity impact Youth of increased risk for suicide. Any concerned, caring friend can be a "gatekeeper" and may very well make the difference between life and death. Not every death is preventable. Used with permission from the Maine Resource Book for Gatekeepers 26 It's biggest cause: a heritable, treatable medical illness called depression It's Biggest Cause: a Heritable, Treatable Medical Illness Called Depression Depression is a treatable medical illness caused by changes in brain chemistry 27 Pyramid 28 Changing OUR Talk 29 Prevention/Intervention Steps KNOW WHAT TO LOOK FOR KNOW WHAT TO DO KNOW HOW TO HELP 30 What to Look For RECOGNIZING RISK FACTORS Risk factors are identified as stressful life events, situations, and/or conditions that may increase the likelihood that one will attempt or complete suicide Source:US Public Health Services, The Surgeon General's Call to Action to Prevent Suicide, Department of Health and Human Services, 1999 32 Risk Factors for Suicide 33 Key Risk Factors By Age OLDER ADULTS: DEATH OF A LOVED ONE, PHYSICAL ILLNESS, UNCONTROLLABLE PAIN, FEAR OF BURDENING FAMILY MEMBERS, SOCIAL ISOLATION, MAJOR CHANGES IN SOCIAL ROLES MIDDLE AGE: RELATIONSHIP PROBLEMS, LEGAL PROBLEMS, FINANCIAL HARDSHIP, SUBSTANCE ABUSE AND JOB STRESS YOUTH: CONTAGION, SUBSTANCE ABUSE, IMPULSIVE AGGRESSIVE PERSONALITY DISORDERS, STRESSFUL LIFE EVENTS, FAMILY FACTORS 34 Invitations / Warning SIGNS 35 RECOGNIZING Invitations / WARNING SIGNS Invitations / Warning signs are changes in a person's behavior, feelings, and beliefs about oneself for a period of two weeks or longer that are considered to be maladaptive or out-of-character for the individual Source: American Association of Suicidology 2006 Get the facts and take action. 36 Identifying Verbal Clues Direct: "I wish I were dead!" "I'm going to end it all." "I'm going to kill myself." Indirect: "Who cares if I'm dead anyway?" "I won't be around much longer." "I don't want to be a burden." 37 Invitations / Warning Signs for Elderly Patients Stockpiling medications Buying a gun Giving away possessions Taking sudden interest in religion Failing to care for themselves Withdrawing Failure to thrive, even after appropriate medical treatment Scheduling medical appointment for vague symptoms Source: Suicide Prevention Resource Center website www.sprc.org 38 Invitations / Warning Signs for Adolescents Volatile mood swings Evidence of unhealthy relationship Sudden deterioration in personal appearance Self-harm Fixation with death or violence Eating disorders Gender identity issues Depression Bullying Source: Suicide Prevention Resource Center website www.sprc.org 39 Protective Factors Coping Strategies Support: available & accessible Positive school experiences/Part of a close school community Safe environment at school (especially for lesbian, gay, bisexual, and transgender youth) A respect for all cultures Restricted access to firearms: guns locked or unloaded, ammunition stored or locked Receiving effective mental health care 40 Protective Factors Self-Esteem Sense of connectedness to family/ school / community Personal Control Sense of purpose / meaning to life Resilience: ongoing or continuing sense of hope in the face of adversity 41 What To Do SHOW YOU CARE ASK ABOUT SUICIDE 3. GET HELP Adapted with permission from the Washington Youth Suicide Prevention Program http://www.yspp.org 42 First Preventative Step What To Do SECOND Prevention Step. ASK ABOUT SUICIDE! Be direct But Non-Confrontational 45 What to do Ask The Question Share your concern with what you have recognized Don't be afraid to ask whether the person is considering suicide Do not try to argue someone out of suicide. Avoid pleading and preaching 46 What To Do 47 Adapted with permission from the Washington Youth Suicide Prevention Program http://www.yspp.org Community resources 48 911 Finding People Where They Live with the C-SSRS Mobile App: With Individualized Community Crisis Information Now available on the app store! (Search "Columbia protocol") 50 University of Nevada, Reno Counseling Services Make an appointment Scheduling an initial consultation In order to best serve our students, Counseling Services operates on a same-day scheduling basis. Please contact our office at (775) 784- 4648 to schedule a same-day initial consultation. Urgent Care appointments If students have urgent psychological concerns, they have an opportunity to meet with a clinician during our Urgent Care hours. The hours for this service vary. Please contact Counseling Services at (775) 784-4648 for information. Due to the nature of this service, students may experience a wait time to see a counselor. Nevada healthcare warmline Feeling anxious, stressed, or overwhelmed by COVID-19?? Work in health care in Nevada? Want someone to talk to, help with stress, or find a community resource? Call the Nevada HealthCARES Warmline! FREE, confidential support line for Nevada's healthcare workers Calls are anonymous Monday-Friday from 8:00 am to 8:00 pm We're here to listen at 1-833-434-0385 A collaboration between: Nevada Department of Health and Human Services and the UNLV School of Medicine Contact Sara Hunt at [email protected] NEVADA HEALTHCARE WARMLINE 52 NAMI Western Nevada WARMLine The Warmline is a stigma-free, non-crisis, phone service you can call or text at 775-241-4212 to speak one-on-one with a NAMI WNV CARES operator. The Warmline is staffed by trained peers in recovery, who provide support to peers by telephone. NAMI WNV is working with NOSP on a referral CARING CONTACTS Program 53 Mobile Crisis Units Rural (702) 486-7865 Reno (775) 688-1670 RURAL CLINICS IMMEDIATE MENTAL HEALTH CARE TEAM 1 (877) 283-2437 54 State Resources for Seniors NV CAN 211: https://www.nevada211.org/ Care Connections: https://nevadaadrc.com/ HELLO Project: https://hellostartsnow.org/ Nevada Senior Resources: https://www.seniorresource.com/nevada.htm Senior Bridges: https://www.nnmc.com/services/senior-bridges- behavioral-health Washoe County Senior services: https://www.washoecounty.us/seniorsrv/ Nevada Senior Guide: https://www.washoecounty.us/seniorsrv/ New to Reno: https://www.washoecounty.us/seniorsrv mhealth TOOLS: TSWF_T2_v4 (defeet.org) 55 Suicide Prevention Resources American Foundation for Suicide Prevention (AFSP) www.afsp.org American Association of Suicidology (AAS) www.suicidology.org Suicide Prevention Resource Center (SPRC) www.sprc.org Suicide Prevention Action Network (SPAN USA) www.spanusa.org Nevada State Suicide Prevention web site www.suicideprevention.nv.gov Surviving Suicide (survivor support) web site www.survivingsuicide.com Nevada Coalition for Suicide Prevention www.nvsuicideprevention.org Nevada Intervention Connection https://ncsp.academy.reliaslearning.com/suicide-prevention-training- ncsp.aspx ZERO Suicide Website Homepage | Zero Suicide (edc.org) 56 Office of Suicide Prevention Training Opportunities Suicide Prevention Training: Introduction (15 30 minutes) Suicide Prevention 101 (1 - 1 hours) Gatekeeper (2 hours) ASIST: (Applied Suicide Intervention Skills Training) two day workshop SafeTALK: (Suicide Alertness) 2 - 4 hours Youth Mental Health First Aid (8 hours) Other Options provided through the OSP CAMS Online (various) TMCC and CASAT online trainings (various) Zero Suicide Website CALM Counseling on Access to Lethal Means This Photo by Unknown Author is licensed under CC BY-SA-NC 57 Remember in Summary Suicide thinking is irrational Tunnel vision Almost all are ambivalent Suicidal behavior is an act of communication There is no typical suicide victim There are no absolute reasons for suicide There are no all-inclusive predictive lists of warning signs or a definitive method for determining if someone is or is not suicidal Suicide is always multi-dimensional Most people don't want to die they want to end their pain 58 POSTVENTION - The provision of crisis intervention, support and assistance for two groups of people.For those who have lost a loved one to suicide and those who have experienced their own suicide attempt. Support the survivor bereavement experience Support the healing/recovery process after an attempt Encourage safe and effective public messaging and media reporting of suicide Prevent further suicides / become educated and trained POSTVENTION IS PREVENTION! 59 Suicide loss survivor Suicide Loss Survivor Anyone whose life has been impacted by a suicide death Family, friends, co-workers, classmates, therapists, physicians, nurses etc.. who are left behind to pick up the pieces after the shattering experience of a suicide death A suicide survivor not only suffers the grief and trauma of losing a loved one to suicide, but are also themselves at higher risk for suicide and emotional problems 60 Suicide Grief 61 What you see, what you don't see 62 STAGES OF GRIEF 63 SUICIDE LOSS 64 Some Common Loss Survivor Responses Struggle to make sense of it Unanswered questions ANGER Guilt over failed responsibilities Isolation caused by self- imposed shame Blame Shock, disbelief, fear, awkwardness Stigma Difficulty accepting the death was by suicide Feelings of rejection and abandonment Often "hyper vigilant"- afraid of another loss or death PTSD Suicide isn't something we feel we can talk about Judgement 65 Secondary losses 66 Helping loss survivors Helping LossSurvivors Listen without judging Accept the intensity of the individual's grief Communicate with compassion not clich Provide information on suicide and grief Be there Have patience Let them know they're not alone Offer assistance, and expect that your help may be refused Be sensitive to difficult times Listen as often as needed 67 Attempt Survivor Anyone whose life has been impacted by a crisis followed by an attempt to end their life by suicide. "I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide." Kay Redfield Jamison An Unquiet Mind, 1995 68 Attempt Data In 2018, 10.7 million people in the U.S. seriously considered suicide 3.3 million made a suicide plan 1.4 million made a suicide attempt Data from the National Survey on Drug Use and Health (2018) In 2018 17.2% of students surveyed seriously considered suicide 13.6 % made a suicide plan 7.4% made a suicide attempt Youth Risk Behavior Surveillance System (2017) 69 How to help attempt survivors All activities designed to help attempt survivors, or anyone who has been suicidal, should be consistent with one or more of the following Core Values: Foster hope and help people find meaning and purpose in life Preserve dignity and counter stigma, shame, and discrimination Connect people to peer supports Promote community connectedness Engage and support family and friends Respect and support cultural, ethnic, and/or spiritual beliefs and traditions Promote choice and collaboration in care Provide timely access to care and support Check-in on those you love 70 Graphic 71 Survivor of suicide loss support groups Survivor of Suicide Loss Support Groups Reno Crisis Support Services of Nevada Phone: (775) 784-8085 Douglas County/South Lake Tahoe Suicide Prevention Network Phone: (775) 783-1510 Elko Survivors of Suicide Loss of Northeastern Nevada Phone: (775) 397-1911 Winnemucca Survivors of Suicide Phone: (775) 623-9003 Las Vegas Arms of Support (800) 649-0925 Canyon Ridge Christian Church Phone: (702) 656-7141 Military & Veteran Survivors of Loved Ones to Suicide Phone: (702) 738-9247 Henderson Surviving Suicide Loss Phone: (702) 501-5984. Barbara Greenspun Women's Care Phone: (702) 501-5984 72 Conclusion Preventing suicide is like the many fragments of a puzzle We need to work together until the pieces of the puzzle come together "We cannot change the past, but together we can shape a different future." Dr. David Satcher, Former US Surgeon General 73 Questions? This Photo by Unknown Author is licensed under CC BY-ND 74 Nevada's Office of Suicide Prevention Nevada's office of suicide prevention Suicide Prevention Coordinator Misty Vaughan Allen, MA 4600 Kietzke Lane, B-114 Reno, NV 89502 Phone: (775)684-2236, Email: [email protected] Suicide Prevention Training and Outreach Facilitator Janett Massolo 4600 Kietzke Lane, B-114 Reno, NV 89502 Phone: (775)684-2238, Email: [email protected] Suicide Prevention Office Manager Angela Friedman 4600 Kietzke Lane, B-114 Reno, NV 89502 Phone: (775)684-2237, Email: [email protected] Zero Suicide, Project Coordinator (OSP/CASAT) Cherylyn Wood 4600 Kietzke Lane, B-114 Reno, NV 89502 Phone: (775)684-2242, Email: [email protected] Suicide Prevention Training and Outreach Facilitator Richard Egan 3811 W. Charleston Ave. # 210 Las Vegas, NV 89102 Phone: (702)486-8225, Email: [email protected] 75 References: Zero Suicide https://zerosuicide.sprc.org/ Henry Ford Institute https://www.henryford.com/services/behavioral- health/zero-suicide Google Images Texas Zero Sucide Arizona https://magellanhealthinsights.com/category/suicide- prevention/ ZEST https://sites.utexas.edu/zest/ NYC Zero Suicide https://www.omh.ny.gov/omhweb/dqm/bqi/suicideasaneverevent.pdf 76