Addressing Suicide with Community Prevention and Clinical Intervention: New York State’s

Suicide Prevention Plan 2016-17

Jay Carruthers MDDirector, Suicide Prevention OfficeApril 18, 2017

2

LearningObjectives

1. Describe the scope of the problem around suicide in New York State

2. Identify the 3 tiers or pillars of the NYS Suicide Prevention Plan 2016-17

3. Explain specific projects and programs used by New York State to prevent suicide

3

Suicide: An Enormous Public Health Problem

Copy (Arial Regular)

Nationally: 44,193 suicide deaths in the US in 2015*. § Surpassed annual deaths by motor vehicle accidents,

homicides, and breast cancer§ 10th leading cause of death for all ages§ National suicide rate: 13.3 per 100,000

New York State in 2014: 1,700 suicide deaths (only 4 states had more) § NYS suicide rate: 8.6 per 100,000§ 2.5x the number of homicides§ >75% of NYS suicides are male§ Suffocation (37%), firearms (28%), poisoning (17%)

Consistent with national trends: § NY state suicides have increased by 32% in last decade § Rate increase from 6.26 per 100,000 in 1999 to 8.6 in 2014§ Rate for those with SMI is 5-6x that of general population

4

-40%

-30%

-20%

-10%

0%

10%

20%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

PercentChangeinAge-AdjustedDeathRatessince2003byCauseofDeath,2003-2013

Suicide Heartdisease Cancer Stroke All-cause

Suicide: An Enormous Public Health Problem

“From1999through2014,theage-adjustedsuiciderateintheUnitedStatesincreased24%,from10.5to13.0per100,000population”

NCHSDataBriefNo.241,April2016CenterforDiseaseControlandPrevention

5

NYSSuicideDeathRatebyCounty,2011-2013

2015Age-AdjustedSuicideRateRural=12.5per100,000Urban=7.5per100,000

6

SuicideDeathsandHospitalizationsandEDVisitsforSelf-InflictedInjury,byGender,Age-AdjustedRateper100,000,NYS,2012-2014

12.9

46.8 45.1

3.9

61.557.3

0

10

20

30

40

50

60

70

Deaths Hospitalizations EDVisits

Rateper100

,000

Male Female

Source:NYSDepartmentofHealthhttps://www.health.ny.gov/statistics/prevention/injury_prevention/suicide_selfinflicted.htm

Men75%morelikelytodiebysuicide

Women22-34%morelikelytomakeanattemptandbehospitalizedortreatedinED

7

SuicideDeathsandHospitalizationsandEDVisitsforSelf-InflictedInjury,byAge,Age-AdjustedRateper100,000,NYS,2012-2014

1.2 5.1 8 9.2 12.7 9.7

36.6

111.6

94.5

73.2

55.4

22.3

87.9

192.9

116

61.2

26.7

6

0

20

40

60

80

100

120

140

160

180

200

10-14 15-19 20-24 25-44 45-64 65+

Rateper100

,000

Deaths Hospitalizations EDVisits

Source:NYSDepartmentofHealthhttps://www.health.ny.gov/statistics/prevention/injury_prevention/suicide_selfinflicted.htm

YouthhavehigherratesofEDvisitsandhospitalizationsforself-inflictedinjuries.

AmongNYShighschoolstudents:• 29%feltsad/hopeless• 16%seriouslyconsidered

suicide• 10%attemptedsuicide• 4%hadasuicideattemptthat

hadtobetreatedbyamedicalprofessional(YRBS,2015)

8

Suiciderateper100,000byage,raceandgender,NYS,2013-2015

Source:CDCWISQARShttps://webappa.cdc.gov/cgi-bin/broker.exe

11.6

15.817.4

23.922.3

21.0 20.6

23.9

0

5

10

15

20

25

15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Rateper100

,000

AgeWhiteMen BlackMen AsianMen HispanicMen WhiteWomen

9

Drug,Alcohol,andSuicideMortality,ages50-54

Case&Deaton,2017

10

The New York State Suicide Prevention Plan 2016-17

4/22/17 10

11

https://www.omh.ny.gov/omhweb/resources/publications/suicde-prevention-plan.pdf

12

ZeroSuicide

CommunityInterventions

Surveillance&QIData

13

NYS Suicide Prevention Plan Strategy/Pillar 3: Better Use of Data

14

Leveraging Existing NYS Data SetsNIMRS PSYCKES/Medicaid SPARCS VitalStatistics

Other:NewYorkViolentDeathReportSystem!

15

NYS Surveillance Patterns: What We’ve Learned

• OMH (NIMRS) surveillance data suggest ~ half of all reported suicide deaths are among those that had an outpatient mental health visit within 30 prior to their death

– The highest suicide burden is among outpatient MH services, especially clinics.

– Suicides often occur within the first month of treatment. Must be ready from day 1!

• Preliminary* SPARCS and NYS vital statistics data suggest ~1:5 suicides take place within 7 days of a hospital discharge

– Improvements in transitional care are critical

15*needsfurthervalidationtesting

16

NYS Suicide Prevention Plan Strategy/Pillar 1: Zero Suicide

17

Bedrock Principles of Zero Suicide• Most suicide deaths are among people in care or recently seen in

healthcare.• Suicide prevention must become a core responsibility of health care

organizations and systems.• We have new knowledge about detecting and treating suicidality.

Very little of it is commonly used.• The gap between what we know and what we do can be fatal. We

must apply new knowledge.• Preventing suicide deaths in health care requires a systematic

clinical approach, not “the heroic efforts of crisis staff and individual clinicians.” • We have work to do.

Slide provided by Mike Hogan, PhD

18

Zero Suicide

www.zerosuicide.com

19

Seven key dimensions of the model:1. Lead–Make an explicit commitment to reduce suicide deaths2. Train–Develop a confident, competent, and caring workforce3. Identify–Identify every person at risk for suicide4. Engage–Engage clients in a Suicide Care Management Plan5. Treat–Treat suicidal thoughts and behaviors directly6. Transition–Follow patients through every care transition7. Improve–Apply data-driven quality improvement

www.zerosuicide.sprc.org

Zero Suicide Model for Suicide Prevention

WITHOUTIMPROVEDSUICIDECARE,PEOPLESLIPTHROUGHGAPS

EDC©2016.Allrightsreserved.

Ask?

ActforSafety?

TreatSuicidality?Reduce

LethalMeans?

EngagementandSupport?

THETOOLSOFZEROSUICIDEFILLTHEGAPS

EDC©2016.Allrightsreserved.

22

Zero Suicide: Early Evidence It Works

Centerstone BehavioralHealthSystem

23

Joint Commission Sentinel Event Alert 56: Detecting & Treating Suicide Ideation in All Settings

“The suggested actions in this alert cover suicide ideation detection, as well as the screening, risk assessment, safety, treatment, discharge, and follow-up care of at-risk individuals. Also included are suggested actions for educating all staff about suicide risk, keeping health care environments safe for individuals at risk for suicide, and documenting their care.”

24

Supporting Zero Suicide Implementation in NYS

25

– High Risk Suicide Care Management Plan/Pathway• Safety Plan with means restriction• Increased engagement and monitoring• Individualized plan that targets drivers

– Workforce training provided by Center for Practice Innovations at NYSPI/Columbia Univ. to support culture change

– Monthly performance metrics for CQI throughout – Project launch now:

180 mental health clinics signed up!

PSYCKES Outpatient Clinic Suicide Prevention CQI Project

Zero Suicide

Building Zero Suicide into the project architecture:– Systematic personalized screening for increased detection– Sound suicide risk assessment to guide treatment & engagement

(planning and prevention, not prediction)

26

NewYorkStateA-I-MforZeroModel• A common framework for assessing and responding to risk

mapped onto a set of best practices and tools• Common language for talking about suicide risk with patients,

family members, other medical and BH providers (eases promulgation across disciplines [MD/DO, SW, RN] within and across systems)

• Shifts mindset from prediction to prevention, facilitating immediate engagement around, and response to, risk

• Includes enhanced transitional care for those at-risk• Pilots launching in inpatient psychiatric units, EDs, and primary

care26

27

AdaptedfromPisaniCTL2015 27

28

NYS Suicide Prevention Plan Strategy/Pillar 2: Community Interventions

Developed by Mark LoMurray (1995-2004)§ Suicide prevention by adolescent Peer Leaders w/ adult mentors§ National Field Project Award – APHA (2005)

Testing/program refinement w/ U Rochester began 2006§Increases youth-adult connections, help-seeking acceptance across school populations

§First Peer Leader program to change school-wide risk-protective factors associated with reduced suicide in RCT w/ 18 schools (Wyman et al 2010, AJPH); NREPP 2012

Creating Suicide Safer School Communities: Sources of Strength

29

Attempt Ideation

Node size: local network densityShading: suicide homophily

Illustrative High School Social Network w/ Sources of Strength: Clustering of High Risk Students on Periphery

31

Thankyouforyourtime!Jay.Carruthers@omh.ny.gov

Resources & Collaborators:Suicide Prevention Center of NY (coalitions, postvention, school and gate keeper trainings)Center for Practice Innovations SP-TIE (clinical trainings)

Save the Date: Sept 18-19 NYS Suicide Prevention Conference https://nyssuicidepreventionconference.org/

31