Preventing Suicide Deaths in Tompkins: What’s Next?

The Suicide Prevention Center of New York conducted a two-hour workshop on June 29 that outlined a six-step strategic planning model to help Tompkins County identify suicide risk factors in the community and appropriate mitigation tools for addressing them.

WATCH: Suicide Prevention Workshop for Tompkins County

The workshop was conducted via Zoom by Garra Lloyd-Lester, director of the center’s Community and Coalition Initiatives, for the 19-member strategic planning work group of the Tompkins County Suicide Prevention Coalition.

“The goal of this workshop is to provide a framework, a structure, that you all might consider to then utilize going forward to develop your county’s strategic plan for suicide prevention,” said Lloyd-Lester.

He cited reports of at least 54 suicide deaths in Tompkins County from 2017 to 2021; 87 percent of those who died by suicide were white and 20 percent were in the 20-29 age bracket. Suicide is the 10th leading cause of death in the United States, and the second leading cause of death for Americans aged 10-34.

The Tompkins County Suicide Prevention Coalition was formed in 2017 to intensify suicide prevention efforts in the community; as of April 2021, the coalition listed 215 members including 73 agencies and community organizations.

READ: Click here for more information about suicide prevention in Tompkins County

Lloyd-Lester said that Step 1 in strategic planning involves compiling data to achieve the clearest possible understanding of a community’s suicide deaths—who is dying, and by what means.

“We want to talk about who in our community is dying by suicide, who in our community might be experiencing suicidal thoughts that haven’t necessarily led to actions, or experiencing suicidal thoughts that led to attempts that didn’t result in the individual dying,” said Lloyd-Lester.

“We want to be thinking about other characteristics that we might be able to gather: age, gender, race, ethnicity, and other characteristics that might help us begin to understand in our community who is dying by, or making attempts toward, suicide.”

Lloyd-Lester added that it is equally important to understand how people are making attempts or completing suicide. “Is there one or more that tends to be the more prevalent method in our community?” he asked. “Understanding how people are dying in our community and making attempts can really help to begin to explore possible interventions and strategies.”

READ: Click here for more information about the Suicide Prevention Center of New York

Step 2 recommends that the coalition consider two or three long-term goals, aimed at addressing the trends indicated by the data; the goals might focus on a demographic group reporting a higher suicide rate, or particular methods that appear to be prevalent in the community’s suicide deaths.

In Step 3, the coalition is advised to identify the key risk factors and protective factors or lack thereof in the community. Risk factors include mental health conditions, availability of lethal means such as firearms or drugs; protective factors include availability of mental health resources, social connectedness, and coping skills.

“We have to be thinking about ‘why’,” said Lloyd-Lester. “Are there any unique risk factors in the community that contribute to suicidal behaviors? It is not just enough to know the commonly understood risk factors. We need to drill down and say, ‘In our community, are there any unique risk factors that we can begin to address?’”

Lloyd-Lester said that Step 4 involves selecting practical, evidence-based interventions for decreasing a community’s risk factors and increasing protective factors. He cited examples such as packaging prescription drugs in lesser quantities to reduce their potential as a lethal means for suicide; or promoting problem-solving skills among young people as an increased protective factor. He recommended that the coalition take an inventory of suicide prevention efforts already underway that could be built upon, such as adoption of the Zero Suicide Model for healthcare providers and gatekeeper training for identifying at-risk individuals.

In Step 5, the coalition is advised to develop a plan to evaluate its efforts to prevent suicide deaths; Lloyd-Lester said an evaluation helps to track and measure progress and to show partners, stakeholders, policymakers, funders, and the community the value of suicide prevention efforts.

Finally, Lloyd-Lester said that Step 6 is the creation of an action plan to implement the suicide prevention interventions identified in Step 4. He said an action plan usually includes a list of tasks and who is responsible for them, and a timeline for implementation.

“I find that if I don’t have a timeline in place the ball can keep getting kicked down the road,” he said. “So I would suggest at least coming up with a rough timeline of when we hope to have the data presented, when we hope to have the long-term goals presented, and ultimately when we hope to have a final plan to present to the full coalition.”

Lloyd-Lester cautioned that a number of speed bumps can hinder the success of a strategic plan: unrealistic goals; lack of focus, resources, or full member commitment; developing and creating a plan for the sake of having a plan but just putting it on the shelf.

INTERESTED? To join or support the Tompkins County Suicide Prevention Coalition, contact coalition convener Sally Manning at SallyMCSS@racker.org

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

ReEntry Theatre Explores Mental Health and Criminal Justice

Delia Divided is a new play by Judy Tate exploring mental health in the criminal justice system and beyond and written with the collaboration of formerly incarcerated individuals in the Civic Ensemble‘s ReEntry Theatre Program.

Members of the ReEntry Theatre Program

Gabriella da Silva Carr will direct a staged reading of the play by the ReEntry Theatre members via Zoom on June 12 and June 13. There will be a post-reading dialogue with audience members. Click here for the Civic Ensemble Ticket Office (Delia Divided tickets on pay-what-you-can basis). The Sophie Fund is a co-sponsor of the event.

The ReEntry Theatre Program creates original theater that highlights and investigates the complexity of real human stories. It is a supportive, creative community for people who have experienced incarceration or court involvement, and aims to raise awareness about and shift the narrative around the realities of the criminal justice system and the people involved. This program is led by a Leadership Council of nine formerly incarcerated individuals who recruit, mentor, and participate alongside new participants.

Judy Tate is Producing Artistic Director of The American Slavery Project, a theatrical response to revisionism in this country’s dialogue about enslavement and its aftermath. She is also the Founding Artistic Director of the Stargate Theater at the Manhattan Theater Club in New York. She is a four-time Emmy Award winning writer and Writer’s Guild of America award recipient.

The ReEntry Theatre Program is an ongoing weekly program. Participation is free and everyone who has experienced incarceration in jails, prisons, or drug rehabilitation programs is welcome to attend. Participants work with theater professionals from Civic Ensemble to grow theater skills, develop scenes and plays based on the ideas each individual brings, and build community. No theater experience necessary. Email info@civicensemble.org or call/text 607-241-0195 to receive the link to join.

For Mental Health, Ithaca’s MindWell Offers Evidence-Based Care

Mental health services in Tompkins County have been stretched to the limit for years. Demand for crisis support at local mental health clinics, as well as calls to Ithaca’s crisis hotline, spiked after the Covid-19 pandemic disrupted normal life in 2020. The number of people seeking non-crisis counseling in the county has also increased steadily since then.

MindWell Center Co-Founders Sarah Markowitz and Aaron Rakow

Into this breach last October stepped a new service provider promising cutting-edge approaches to mental health care: Mindwell Center LLP, located in the South Hill Business Campus.

MindWell is the brainchild of Aaron Rakow, a clinical psychiatry professor at Georgetown University who returned to his native Ithaca with a mission to upgrade the availability of services and standard of care in rural upstate New York. In short order, Rakow and co-founder Sarah Markowitz have hired 25 therapists and are adding another one-to-two a month; they plan to open a second clinic with 10 clinicians in September in Albany. MindWell is currently supporting 350 patients and counting.

“Across our society, we have more demand for mental health services than we have providers able to support that demand,” Rakow said. “In particular, within a category of the mental health field that we refer to as evidence-based care, or psychological intervention that is based on science, to be as effective as possible in treating a host of mental health challenges amongst individuals, there are even fewer practitioners that practice in that space. My hope is that through opening MindWell Center we will be able to address some of those needs.”

The Tompkins County Chamber of Commerce honored MindWell at its 2021 Annual Meeting and Celebration on May 20 with its Distinguished Business of the Year Award. Announcing the award, the Chamber said: “In response to a specific and substantial community need—access to effective, quality mental health care, and removing stigma regarding mental health concerns—MindWell founders Aaron Rakow and Sarah Markowitz have introduced a new model of treatment to our community and expanded their staff and services considerably in a short period of time.”

MindWell strives to provide the highest quality evidence-based mental health care to children, families, and adults for a spectrum of mental health conditions, including depression, anxiety, eating disorders, sleep disorders, substance use disorders, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Attention-Deficit/Hyperactivity Disorder (ADHD).

Besides supporting individual patients, MindWell is ramping up population-level initiatives—for example, it offers contracted services for companies where clinicians implement programs fostering healthy workplaces through leadership training, wellness seminars, stress reduction classes, support groups, and individualized care for employees. MindWell is offering similar services to schools in the region, both K-12 and colleges. Rakow believes that the Ithaca community is aware of the need to address the “mental health pandemic” many experts believe accompanied the Covid crisis.

Rakow said that another key part of MindWell’s mission is to support the training and retention of high-quality evidence-based clinicians in upstate New York. To that end, MindWell has formed partnerships with the University at Albany and Binghamton University to provide training through externships for graduate programs in clinical psychology.

WATCH: Promotional video about the MindWell Center

Evidence-Based Care (EBC) is an evolving standard of care involving a variety of treatments endorsed by leading mental health associations. According to experts, it emphasizes integrating the best available research with clinical expertise in the context of a patient’s culture, individual characteristics, and personal preferences. Nonetheless, as a 2013 New York Times article pointed out, “surprisingly few patients actually get these kinds of evidence-based treatments” despite numerous trials demonstrating their effectiveness.

MindWell clinicians are trained to provide Cognitive Behavioral Therapy (CBT) and Measurement-Based Care (MBC) to carry out its evidence-based approach. According to the American Psychological Association, CBT encourages patients to recognize distortions in their thinking that are creating problems, and learn problem-solving skills to cope with difficult situations.

Any good therapist will utilize treatment elements such as reflective listening, validation, and empathy. As Rakow describes it, evidence-based treatment adds a roadmap for the client and the therapist to most efficiently decrease the symptoms of disorders through specific strategies and techniques that have been proven through science. In treating a patient with depression, Rakow explained, the therapist will assess the factors behind the patient’s negative thinking patterns. Then the treatment will focus on teaching coping skills that can change the patient’s cognitive narrative.

“The client gets a workbook to help their guidance and help their process at home,” said Rakow. “The clinician has a workbook to help guide the sessions. That is an evidence-based intervention in practice.”

Furthermore, MBC bases clinical care on data collected from patients throughout their treatment; experts say that MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes.

“We are looking at every single session for the individual on how they are improving, if they are improving,” Rakow explained. “And if they are not, what can we be doing differently on an interventional level?”

To use an example, Rakow said that a clinician treating anxiety will have patients fill out screen tests during every therapy session to measure increases or decreases in symptoms. “So they can say, ‘It looks like you’ve had a difficult week. We’re seeing your anxiety go up. Let’s see how we can calibrate the treatment effectively to bring that level back down. Because we know you have that potential.’ If we are not practicing measurement-based care, we’re not practicing evidence-based care. Those two things must always go together,” Rakow said.

Some team members at MindWell are equipped to prescribe medications. That said, Rakow points out that many of the most evidence-based strategies involve the combination of psychotherapy and medication management, as opposed to a treatment regimen that involves medication management alone. Thus, MindWell’s team of multidisciplinary providers collaborate closely on cases to ensure that the treatments are optimally calibrated to each patient’s individual needs.

Population-level initiatives provide easier access to mental health treatment, Rakow explained. “There are far too many barriers to accessing high quality mental health care in our country,” Rakow said. “We will partner with hospitals, with school systems, with institutions of higher education, with businesses big and large, to provide integrated mental health solutions for their employees, for their pupils, for their staff, for their patients, to make the process of accessing mental health care that much easier.”

Rakow said that businesses are receptive to upstream mental health support for their employees, especially amid the Covid-19 pandemic, in part because they realize that decreased wellness can impact productivity and profits. He said that MindWell services for K-12 schools can focus on administrators, teachers, and staff as well as students and their parents.

School-integrated support helps parents avoid what can be a difficult challenge in navigating mental health services for their children on their own, Rakow said. “If you are a mom or dad, and your child needs mental health care, you have to locate a provider, wait for that provider to have an opening, take time off to drive across town and take that child to that appointment, wait while the child is seen, and follow up with the clinician,” Rakow said. “That could take weeks or months to treat, in the best-case circumstances.”

MindWell’s model for higher education similarly supports faculty and staff members while seeking to relieve the increasing burden on student counseling services.

“College student mental health is right now an extremely high need for our field,” said Rakow. “The institutions of higher ed in our region are taking this issue extremely seriously and have put an incredible amount of thought and commitment and resources towards it. But our need in our society from a mental health perspective continues to grow and the demand for it continues to increase. We need to really think innovatively about how we can provide support and access points for undergraduate and graduate populations of learners in our community to be able to effectively meet that demand.”

UPDATE: MindWell is working with regional insurance carriers to become in-network as soon as possible to increase access to its care model. In the meantime, MindWell offers a generous sliding scale for clients in need. MindWell also offers what it calls courtesy billing whereby the MindWell team submits the claim on the behalf of the client so they can focus on their care rather than dealing with paperwork.

Kid in College? Read This to Know the Mental Health Risks

A letter of acceptance to college, which usually arrives in March or April before high school graduation, is a wonderful milestone for young people and their parents. Thus begins an exciting and sweet passage: commencement festivities, packing for life on a college campus, some goodbyes and hugs, moving into a dorm, making new friends, and beginning a promising academic journey into adulthood.

After more than a year of Covid-19 pandemic restrictions, the smiles will be wide when students arrive this fall for what is expected to be normal in-person classes at Cornell University, Ithaca College, and Tompkins Cortland Community College.

It is very easy to overlook—or even be clueless about—what for some students will become a dark side of leaving the family nest: anxiety, depression, sexual assault and hazing violence, misuse of alcohol and drugs, academic struggles, relationship problems, and more.

At Cornell, the proportion of undergraduates who reported that they were unable to function academically (missing classes, unable to study or complete homework) for at least a week in the past year due to depression, stress, or anxiety increased from 33 percent in 2015 to 42 percent in 2019. Many reports indicate that college students are struggling even more with their mental health during the pandemic.

College orientation materials usually provide some notice about the risks and the resources for staying safe and healthy, but they may have minimal impact amid the excitement of transitioning to college.

So, a word of advice for college students, particularly for incoming first-years:

Educate yourself about the mental health challenges that you may face, and learn about the ways that you can address those challenges if and when they arise.

The same advice goes for parents. Know what your college kid is getting into.

To help, Forefront Suicide Prevention, a center at the University of Washington, recently produced A Guide for Parents and Families: Supporting Your College Student Through Mental Health Challenges.

DOWNLOAD: A Guide for Parents and Families: Supporting Your College Student Through Mental Health Challenges

This essential booklet was written by Forefront’s Marny Lombard, who has gained a profound understanding of the challenges that college students may experience. Lombard’s son Sam struggled for many years with depression and died by suicide in 2013. He was 22 years old and a college senior majoring in architecture. Lombard wrote the Guide to provide parents and families with the knowledge that she needed but did not find.

“Mental health problems among young adults are more common than many families realize,” the Guide says. “In fact, one in three college students experiences a mental health issue, most commonly anxiety or depression. Major life changes such as adjusting to college life and experiencing added academic stress can set the stage for the onset of mental health issues.”

According to the Guide, parents and family members sometimes struggle to understand their student’s mental health concerns—or even to recognize that their student is in distress. Learning that their student is having suicidal thoughts can create extreme stress for the family.

Forefront’s Guide provides authoritative resources and recommended reading to help parents and families of students who are struggling with their mental health. It can help them to stay in touch with their students and know when and how to seek help if needed.

The Guide asks parents to gradually change the tenor of their conversations with their students, listening more and speaking less. Using compassion, setting aside judgment.

Guide sections include: “Ways to Keep Conversation Flowing”; “Ask about how things work at your college”; Finding the Right Therapist,” “What To Do When Your Student is Struggling”; “About Medications”; and “If Your Student Is Thinking About Suicide.”

“Suicidal urges, in particular, should always be taken seriously and never dismissed as a ploy to gain attention,” the Guide says, noting that “asking someone whether they are thinking about suicide will not plant the idea in their mind.” The Guide provides valuable information about engaging with a suicidal student and helping them get professional help. Suicide is preventable. “The vast majority of young people who consider suicide will move through this difficult time,” the Guide says. “Many will begin to learn how to manage their mental health.

Finally, the Guide advises parents to check in regularly about their students’ stress levels and warns against delaying treatment when the need is clear. It cites data showing that 75 percent of the time the onset of mental illness occurs by the age of 24.

“The longer the delay between the onset of mental illness and the start of treatment, the more difficult it can to successfully treat these issues,” the Guide says. “The good news is that you can learn how to support them and help them manage the underlying stressors.”

For more more resources, click here for the Student Mental Health page on The Sophie Fund Website

The Advocacy Center Steps Up

Kristi Taylor sits at her computer and logs on to Zoom. The education director at the Advocacy Center of Tompkins County smiles about the technical difficulties using the software. She holds up the soft blanket that covers her lap, just one of the little rituals that get her through long video conferences in a changing work environment.

Kristi Taylor, education director at the Advocacy Center of Tompkins County

Putting in endless hours online hasn’t been the only change in Taylor’s routine at the Advocacy Center, an Ithaca nonprofit organization that supports victims of domestic violence. While the Covid-19 pandemic brought a suspected spike in cases of domestic violence, stay-at-home guidelines made it more difficult for victims to reach out for help. In March 2020, the Advocacy Center’s hotline went cold.

“We weren’t able to connect with survivors, and we weren’t hearing from people,” Taylor explained. “And that was really, really concerning for us, because what that told us is that people were trapped with their abusive partners.”

The center moved swiftly to address the new conditions, finding solutions in technology and social media as the center’s work went remote almost entirely (a notable exception being the center’s 24/7 shelter for abuse victims). First, the center significantly increased its use of Instagram to spread awareness and combat any impression that its activities had ceased. It launched an Instagram campaign with the hashtag #wearestillhere. Staff members posted pictures of themselves holding posters with the hashtag message, putting the center’s contact information in the caption. The center also added podcasts and blog posts to its education outreach mix.

By the summer, pandemic restrictions began to ease somewhat and the Advocacy Center’s hotline began buzzing again. The center upgraded its technology to handle multiple hotline calls simultaneously, and introduced a hybrid virtual platform for training additional hotline volunteers to manage the influx.

The Advocacy Center also moved its in-person support groups for domestic violence survivors online, the Survivor Empowerment group and Knowledge is Power group. The groups utilize secure video conferencing software during meetings to give a face-to-face connection while also protecting attendees’ privacy. Group numbers fluctuate due to the center’s “drop-in” policy, but usually seven to 10 people attend the once-a-week meetings lasting an hour or more.

Between July and October, hotline calls increased 55 percent over the same period in 2019. That aligns with a study published in December in the American Journal of Emergency Medicine, which indicates that cases of domestic abuse have significantly risen since the start of the pandemic in early 2020.

Pandemic conditions from stay-at-home orders to work-from-home practices meant that abuse victims became more isolated from their support systems, and as a result, more deeply trapped in their abusive relationships. “One of the most powerful tools that abusers have is creating isolation,” said Taylor.

Between July and October, the Advocacy Center provided support to 34 percent more domestic abuse survivors compared to the same period in 2019. Compared to the previous year, in 2020 the center also supported 44 percent more children and teens who had been sexually abused.

The Advocacy Center was founded in 1977 as the Task Force for Battered Women. At the time, its purpose was to provide women who had suffered from domestic abuse and their children a safe place to live. The organization also helps victims of sexual assault and rape, victims of child sexual abuse, family members of survivors, and people of any age and gender who have experienced domestic and sexual violence.

—By Margaret Kent

Margaret Kent, an intern at The Sophie Fund, is a senior at Ithaca College majoring in Communication Management and Design with a concentration in Corporate Communication and a minor in Writing.