Attention Tompkins County mental health professionals! If you missed the 2021 Suicide Prevention Summit on July 24-25, there’s an easy way to catch up with all ten 1-hour sessions presented by some of the field’s leading experts.
Here’s how: Register retroactively for the Summit at https://www.mentalhealthacademy.net/suicideprevention. Upon registration, you will receive an email with instructions to access on-demand video recordings and PDFs of all the presentations. Note: the portal will be available until the end of September 2021. See details of the Summit below.
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.
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.”
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
U.S. Surgeon General Jerome Adams on January 19 issued a “Call to Action” report to implement the 2012 National Strategy for Suicide Prevention, a detailed roadmap for preventing suicide in a comprehensive and coordinated way. “Much remains to be done,” the report warned. “Suicide prevention continues to lack the breadth and depth of the coordinated response needed to truly make a difference in reducing suicide.”
The report noted a new urgency behind suicide prevention efforts: the COVID-19 pandemic has now created conditions that may further suicide risk, such as increased social isolation, economic stress, and reduced access to community and religious support. “Problems resulting from the pandemic—including physical illness, loss of loved ones, anxiety, depression, job loss, eviction, and increased poverty—could all contribute to suicide risk,” Adams said.
The report said that in 2019 more than 47,000 Americans died by suicide, and that the national suicide rate increased 32 percent—from 10.5 to 13.9 per 100,000 people—in the 20-year period from 1999 to 2019. The report notes that for every person who dies by suicide, thousands more experience suicidal thoughts or attempt suicide—in a 2019 survey, 1.4 million U.S. adults reported attempting suicide in the past year and 3.5 million adults reported making a suicide plan.
“Although research has identified many strategies that can be effective in preventing suicide, these evidence-informed approaches have not yet been brought to scale,” the report said. Indeed, it added, an assessment of progress toward implementation of the National Strategy showed that few efforts have been comprehensive or strong enough to have a measurable impact on reducing suicidal behavior.
The report highlights the Zero Suicide Model as one of the key instruments for saving lives. In 2018, the Tompkins County Suicide Prevention Coalition and the Tompkins County Legislature endorsed the model, which incorporates recommendations for “a gold standard of care for people with suicide risk.” The model stresses the need to include suicide prevention as a core component of all health care services, rather than limit it to services provided by mental health specialists, and to improve professional and clinical training and practice for preventing suicides.
The report calls for increased use of a key component of the Zero Suicide Model: a suicide safe care pathway, to ensure that patients at risk for suicide are identified and provided with continuing care tailored to their needs.
“All patients are screened on past and present suicidal behavior, and positive screens are followed by a full assessment. Individuals identified as being at increased risk are entered into a suicide safe care pathway, thus ensuring that they are provided with the attention and support they need to stay safe and recover.
“Components include periodic assessments of suicidality and ongoing follow-up, including contacting patients who fail to show up for an appointment or withdraw from care. The inclusion of family members and other identified support persons in pathway implementation may help support patient engagement.
“Implementation of a suicide safe care pathway requires that protocols and systems be in place to collect and analyze data to track services, ensure patient safety, and assess treatment outcomes. The system should collect data on process measures, such as screening rates, safety planning, and services provided; care outcomes; suicide attempts and deaths; and any other relevant factors, such as sociodemographic characteristics, clinical history, and referrals to other sources of care.
The report noted that in response to the need for a minimum standard of care for individuals at risk for suicide, the National Action Alliance for Suicide Prevention in 2018 developed Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe. It identifies individual recommended practices—such as screening and assessment for suicide risk, collaborative safety planning, treatment of suicidality, and the use of caring contacts—that can be adopted in outpatient mental health and substance misuse settings, emergency departments, and primary care.
The surgeon general’s Call to Action states that while that all 13 goals and 60 objectives of the 2012 National Strategy remain relevant, it is time to focus on six key actions in order to reverse the current upward trend in suicide deaths in the United States.
The Call to Action identifies four strategic directions: Healthy and Empowered Individuals, Families, and Communities; Clinical and Community Preventive Services; Treatment and Support Services; and Surveillance, Research, and Evaluation.
Within those directions, the Call to Action identifies six main actions to pursue:
Activate a broad-based public health response to suicide
Address upstream factors that impact suicide
Ensure lethal means safety
Support adoption of evidence-based care for suicide risk
Enhance crisis care and care transitions
Improve the quality, timeliness, and use of suicide-related data
Action 1. Activate a Broad-Based Public Health Response to Suicide: Inspire and empower everyone to play a role in suicide prevention.
1.1 Broaden perceptions of suicide, who is affected, and the many factors that can affect suicide risk.
1.2 Empower every individual and organization to play a role in suicide prevention.
1.3 Engage people with lived experience in all aspects of suicide prevention.
1.4 Use effective communications to engage diverse sectors in suicide prevention.
Action 1: Priorities for Action
State government and public health entities should implement the Suicide Prevention Resource Center’s Recommendations for State Suicide Prevention Infrastructure to support comprehensive (i.e., multi- component) suicide prevention in communities.
Prevention leaders from the public and private sectors, at all levels (national, state, tribal, and local), should align and evaluate their efforts consistent with the Centers for Disease Control and Prevention (CDC) resource Preventing Suicide: A Technical Package of Policy, Programs, and Practices, to expand the adoption of suicide prevention strategies that are based on the best available evidence.
Federal agencies and state, tribal, local, and county governments and coalitions should strengthen their prevention efforts by developing strategic suicide prevention plans based on available public health data. Mechanisms for the prompt sharing of innovations and best practices should be developed and supported.
State and local suicide prevention coalitions and health systems should actively reach out to organizations serving populations at high risk for suicide; these systems should also reach out to individuals with lived experience in order to learn from them and engage them in designing prevention efforts.
The public and private sectors should invest in patient-centered research and include people with lived experience in research design and implementation.
Federal agencies, mental health and suicide prevention non-governmental organizations, and others conducting communication efforts should ensure that suicide prevention communications campaigns (1) are strategic, (2) include clear aims for behavior changes that support broader suicide prevention efforts, and (3) measure their impact.
The federal government (Congress) should expand and sustain support for states, territories, communities, and tribes to implement comprehensive suicide prevention initiatives similar to the Comprehensive Suicide Prevention Program, funded by CDC, and the Garrett Lee Smith youth suicide prevention grants, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), which have been shown to reduce suicide in participating counties, particularly in rural areas. Funding targeting substance use disorder should be broad enough in scope to allow for interventions that address suicide prevention and related workforce and infrastructure needs.
Action 2. Address Upstream Factors that Impact Suicide: Focus on ways to prevent everyone from suicide.
2.1 Promote and enhance social connectedness and opportunities to contribute.
2.2 Strengthen economic supports.
2.3 Engage and support high-risk and underserved groups.
2.4 Dedicate resources to the development, implementation, and evaluation of interventions aimed at preventing suicidal behaviors.
Action 2: Priorities for Action
Private companies and workplaces should leverage their health care benefits purchasing power to enhance employee mental health (e.g., invest in benefits and programs to prevent and treat behavioral health problems) and work to shape worksite values and culture to promote mental health by providing access to crisis support, support to employees following a suicide, and ongoing mental health wellness programming.
Suicide prevention leads in federal, state, tribal, and local public health and behavioral health agencies should partner with their counterparts in labor and workforce, housing, health care, and other public assistance agencies to collaborate on strengthening economic supports for families and communities.
Foundations and other philanthropic organizations that support early intervention programs— particularly those targeting (1) social determinants of health (e.g., reducing poverty and exposure to trauma, improving access to good education and health care, improving health equity) and/or (2) enhanced social interactions (e.g., improved parenting skills) and problem-solving and coping skills— should ensure that these programs include outcomes related to suicide (e.g., ideation, plans, attempts) and evaluation of those programs for suicide-related outcomes.
Federal government and private sector research funders should support the analysis of existing data sets of longitudinal studies to determine the impact of various interventions (e.g., home visitation, preschool programs, substance misuse, child trauma) on suicidal ideation, plans, and attempts, and on deaths by suicide. This could include such projects as the CDC’s efforts to assess and prevent adverse childhood experiences and examine their effect on suicide-related problems, and National Institutes of Health (NIH) initiatives that focus on aggregating prevention trial data sets to better understand the long-term and cross-over effects of prevention interventions on mental health outcomes, including suicide risk,88 and to address suicide research gaps.
Action 3. Ensure Lethal Means Safety: Keep people safe while they are in crisis.
3.1 Empower communities to implement proven approaches.
3.2 Increase the use of lethal means safety counseling
3.3 Dedicate resources to the development, implementation, and evaluation of interventions aimed at addressing the role of lethal means safety in suicide and suicide prevention.
Action 3: Priorities for Action
The federal government and private sector entities can support efforts to ensure that updated information on lethal means safety policies, programs, and practices (e.g., ERPOs, firearm owner and retailer education, bridge barriers, medication packaging, carbon monoxide shut-off sensors in vehicles) is incorporated into existing national clearinghouses and resource centers so that local municipalities, states, and tribes can adopt and evaluate them for their prevention benefits.
States, communities, and tribes should collaborate with the private sector to increase awareness of and take action to reduce access to firearms and other lethal means of suicide, including opioids and other medications, alcohol and other substances or poisons, and community locations (e.g., railways, bridges, parking garages) where suicidal behaviors have occurred. This urgent multi-sector effort is key to saving lives by reducing access to lethal means for individuals in crisis.
Health systems and payers should leverage their existing training and resources and collaborate on a national initiative to train general and specialty health care providers and care teams on safety planning and lethal means counseling.
SAMHSA and the VA should coordinate to ensure that lethal means safety assessment and counseling are incorporated into the assessment and intervention procedures of the National Suicide Prevention Lifeline and Veterans Crisis Line call centers, particularly in preparation for the national launch of 988.
The federal government can prioritize and fund research and program evaluation analyzing community and clinical lethal means safety interventions (e.g., ERPOs, firearm owner and retailer education, bridge barriers, medication packaging, carbon monoxide shut-off sensors in vehicles) at the population level.
State and federal governments should collaborate with the private sector on a synchronized public health communication campaign addressing lethal means safety in the context of suicide prevention, which should then be evaluated to determine prevention benefits and inform future communication efforts.
Action 4. Support Adoption of Evidence-Based Care for Suicide Risk: Ensure safe and effective care for all.
4.1 Increase clinical training in evidence-based care for suicide risk.
4.2 Improve suicide risk identification in health care settings.
4.3 Conduct safety planning with all patients who screen positive for suicide risk.
4.4 Increase the use of suicide safe care pathways in health care systems for individuals at risk.
4.5 Increase the use of caring contacts in diverse settings.
State behavioral health licensing boards should add continuing education requirements for suicide prevention in order for clinicians to maintain licensure or certification.
Payers from the public and private sectors should incentivize the delivery of evidence-based care via existing levers in contracting and reimbursement.
Federal and state policymakers and commercial payers and health systems should take specific steps to improve outcomes for individuals with mental health and substance misuse conditions in primary care by using effective methods (e.g., CoCM) to integrate mental health and substance misuse treatment into primary care.
To enhance workflows for suicide safe care, health systems should collaborate with EHR vendors to develop options for integrating screening, suicide safe care pathways, and safety planning into their EHR systems.
Action 5. Enhance Crisis Care and Care Transitions: Ensure that crisis services are available to anyone, anywhere, at any time.
5.1 Increase the development and use of statewide or regional crisis service hubs.
5.2 Increase the use of mobile crisis teams.
5.3 Increase the use of crisis receiving and stabilization facilities.
5.4 Ensure safe care transitions for patients at risk.
5.5 Ensure adequate crisis infrastructure to support implementation of the national 988 number.
Action 5: Priorities for Action
The federal government and the private sector should address gaps, opportunities, and resource needs to achieve standardization among crisis centers in interventional approaches and quality assurance in preparation for the launch of 988.
The federal government, states, and the private sector should work together to optimize system design, system operations, and system financing for 988 as the hub of an enhanced, coordinated crisis system, and enhance coordination between Lifeline 988 centers and 911 centers to reduce overreliance on 911 services and ED boarding (the practice of keeping admitted patients on stretchers in hallways due to crowding).
The federal government should fund the necessary infrastructure to support crisis care (e.g., Congressional support for the 5 percent SAMHSA Mental Health Block Grant set-aside; core services identified in SAMHSA’s National Guidelines for Behavioral Health Crisis Care) and should provide technical assistance to states looking to evolve crisis systems of care.
The federal government and foundations should support research to identify effective models of mental health crisis response (e.g., coordinated efforts among mental health specialists, peers, and law enforcement) to improve short- and long-term effects on communities of color and other marginalized populations.
The federal government and private sector payers should support the use of follow-up phone calls or texts within 24 hours of discharge from psychiatric hospitalization or emergency room discharge to check in with the patient, provide support, and maintain contact until the person’s first outpatient appointment.
The federal government should establish universally recognized coding for behavioral health crisis services, and public and private sector partners should collaborate with payers and health systems to increase adoption of the new coding.
The federal government should support the development of an essential benefits designation that will encourage health care insurers to provide reimbursement for crisis services, thus reducing the financial burden on state and local governments to pay for those services, delivered within a structure that supports the justice system and ED diversion.
Action 6. Improve the Quality, Timeliness, and Use of Suicide-Related Data: Know who is impacted and how to best respond.
6.1 Increase access to near real-time data related to suicide.
6.2 Improve the quality of data on causes of death.
6.3 Expand the accessibility and use of existing federal data systems that include data on suicide attempts and ideation.
6.4 Improve coordination and sharing of suicide-related data across the federal, state, and local levels.
6.5 Use multiple data sources to identify groups at risk and to inform action.
Action 6: Priorities for Action
The federal government should support near real-time collection of data on deaths by suicide and nonfatal suicide attempts in a group of sentinel states to develop the framework for a national early warning system for suicidal behavior in the U.S. The system would create a central database that links multiple data sources and would build state and local capacity to translate data trends into prevention efforts in a timely manner. In addition, the federal government should expand ED SNSRO to monitor nonfatal suicide-related outcomes, track spikes and potential clusters in suicide attempts, and identify patterns, all of which can then inform prevention activities.
The public and private sectors should collaborate on a near real-time suicide dashboard that pulls data from existing national, state, tribal, and community databases to make data on deaths by suicide and suicide attempts timelier and more accessible, thus linking the dashboard to prevention actions on the ground.
The federal government should implement Recommendation 1.8 of the Interagency Serious Mental Illness Coordinating Committee, which calls on public and private health care systems to routinely link mortality data for serious mental illness (SMI) and serious emotional disturbance (SED) populations, and supports the standardization of similar data gathering across state and local systems for SMI and SED populations within the justice system.
Professional organizations connected to coroners and medical examiners at the state and national levels should release guidance on and support wide-scale implementation of coding sexual orientation and gender identity in death investigations.
The federal government should implement the PREVENTS Executive Order recommendation for the U.S. Department of Health and Human Services and the VA to propose legislative changes that mandate a standardized process for uniform ED data reporting across the United States specific to the external cause of injury (e.g., suicide attempt).
Health care systems should work with public sector agencies to support the linkage of mortality data with health record, social, geographic, education, and criminal justice data systems to strengthen data quality and increase accountability for patient outcomes across key systems.
State suicide prevention coordinators and community suicide prevention leaders should routinely monitor available data to identify trends and evaluate their own efforts.
The Sophie Fund is dedicated to preventing suicide in the greater Ithaca community. Our nonprofit organization is named for Sophie Hack MacLeod, a Cornell University student who died by suicide in Ithaca in March 2016. Working with partners, we work to promote mental health awareness and advocate for specific best practices such as the Zero Suicide Model in the Ithaca community as well as on the local college campuses.
In 2017, The Sophie Fund led the adoption of the Watershed Declaration in which 18 community mental health stakeholders pledged to intensify efforts toward saving lives and bringing hope to those struggling with suicide thoughts or affected by suicide loss. The Sophie Fund is a founding member of the Tompkins County Suicide Prevention Coalition. In 2018, the Tompkins County Legislature called on local healthcare and behavioral healthcare providers to follow the Zero Suicide Model’s systematic clinical approach to preventing suicide.
“While there is much still to be done, we truly thank Governor Cuomo for his commitment to preventing suicide in our state and for taking concrete actions in order to do so,” said Scott MacLeod, a co-founder of The Sophie Fund. “The governor understands the importance of addressing this challenge at the community level and with results-oriented strategies.”
In his annual State of the State Book accompanying an address to the legislature on Tuesday, Cuomo called on New York State agencies to partner with communities in five critical areas of suicide prevention: innovative public health approaches; healthcare systems; cultural competence in prevention programming; comprehensive crisis care; and surveillance data. Under the proposal, communities that demonstrably strengthen suicide prevention infrastructure will receive a New York State designation.
MacLeod noted that recent progress in Tompkins County’s suicide prevention efforts stemmed in part from the vital support provided by the state Suicide Prevention Office and affiliated Suicide Prevention Center of New York. In July 2018, the Tompkins County Legislature unanimously passed a resolution to support the Zero Suicide Model, a pillar of the state’s comprehensive suicide prevention policy. The resolution called on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.
The legislative act came a month after the newly formed Tompkins County Suicide Prevention Coalition voted overwhelmingly to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative.
“The state Suicide Prevention Office and Suicide Prevention Center of New York have been essential partners in the formation of the Tompkins County Suicide Prevention Coalition and in assisting local stakeholders with significantly expanding suicide prevention efforts,” said MacLeod. “We welcome the opportunity under Governor Cuomo’s proposal to expand our partnership with the state.”
Cuomo’s proposal builds on the work of the New York State Suicide Prevention Task Force formed at his direction in 2017. Cuomo charged the task force with identifying gaps in programs, services, and policies while simultaneously making recommendations to facilitate greater access, awareness, collaboration, and support of effective suicide prevention activities.
“Suicide is an enormous public health problem. Suicide is the 10th leading cause of death in the United States. According to the Centers for Disease Control, from 1999 to 2016, suicide rates in New York State rose by nearly 30 percent, while other leading causes of death such as cancer, heart disease, and motor vehicle accidents all decreased. Each year nearly 1,700 New Yorkers die by suicide.”
In 2016, the state Suicide Prevention Office released “1,700 Too Many: New York State’s Suicide Prevention Plan 2016–17.” It focused on three main areas for battling the rising suicide rate: prevention in Health and Behavioral Healthcare Settings (Zero Suicide Model); Prevention in Competent, Caring Communities Across the Lifespan; and Suicide Surveillance and Data-Informed Suicide Prevention.