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
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.
April is Sexual Assault Awareness Month, dedicated to raising awareness about the impacts of all forms of sexual violence on survivors and the community while also highlighting the work being done to promote healthy development and practices that work towards preventing these forms of violence from occurring. The Advocacy Center of Tompkins County is offering a variety of events in April to promote sexual assault awareness.
Roll Red Roll Film Screening Thursday April 15
Tompkins County teens are encouraged to join the Advocacy Center for a Netflix Watch Party and post-screening discussion of the film Roll Red Roll. Hosted by its student activism group, ACTion, the event will explore how social media and sports culture can influence sexual violence, as well as how students can challenge toxic social norms that perpetuate rape culture. To register for the screening, please fill out the following form: https://bit.ly/2OAGpJV
Wen-Do Women’s Self Defense Online Workshop April 19 & 20
The Advocacy Center invites college-enrolled women to participate in this four-hour self-defense program offered by the longest running women’s self-defense organization in Canada. This program will run over two sessions and includes frank discussions about violence against women and children along with verbal and physical resistance strategies. This program recognizes and celebrates our diversity, feminist principles, the empowerment of women and children while expressly rejecting victim blaming so often present in society. Follow the Advocacy Center on social media for more details and registration information.
Mighty Yoga Donation Class April 24
Join Mighty Yoga for a smoothly paced vinyasa flow experience. Donations raised through this yoga session will support survivors of sexual assault, as well as preventative education efforts led by the Advocacy Center. To sign up, please visit https://www.mightyyoga.com/livestream-schedule and select April 24 on the calendar. Then click on the “Sign Up” button next to the 1 p.m. donation class. *If you do not have an existing Mighty Yoga account, you will need to create one in order to register for the session.
Denim Day April 28
Wear jeans to raise awareness about the misconceptions that surround sexual assault! Started after an Italian Supreme Court ruling in which a rape conviction was overturned because the victim had been wearing tight jeans: the justices ruled that she must have helped her rapist remove them, thereby implying consent. For denim day materials visit www.denimdayinfo.org and follow the Advocacy Center on Facebook and Instagram for info and updates. Use #ACdenimday2021 so the Advocacy Center can follow your posts!
Clothesline Project Display DeWitt Park April 30 12-1pm
The Advocacy Center is excited to offer a socially distanced opportunity to see this powerful display in person. The project provides a space for domestic and sexual violence survivors to create and unapologetically display the “dirty laundry” that is abuse. The t-shirts, which contain powerful stories, images, and artwork, are hung on a clothesline to show that the people who experience domestic, sexual, or emotional violence aren’t just statistics but people in our communities and neighborhoods. *Social distancing and masks required
Take Back The Night! April 30
March. Rally. Speak Out. Vigil. Keep an eye out for social media posts and website updates as the Advocacy Center plans the 2021 virtual event! Participants are encouraged to join any way that feels comfortable. Marchers are encouraged to make signs, banners or wear clothes that highlight groups and organizations standing in solidarity with survivors or with messages of protest against domestic and sexual violence.
Each day throughout April, the local organizations are posting infographics on their social media platforms about safety plans, reporting procedures, hotline help, medical and mental health support, and tools to fight sexual assault.
Citing data from the Rape, Abuse & Incest National Network (RAINN), the campaign highlights that sexual violence affects hundreds of thousands of Americans each year. RAINN says that one out of every six American women, and one out of every 33 American men, has been the victim of an attempted or completed rape.
College women are at three times greater risk of assault, according to RAINN; 13 percent of all graduate and undergraduate students experience rape or sexual assault through physical force, violence, or incapacitation. The U.S. Centers for Disease Control says that sexual violence impacts health in many ways and can lead to short and long-term physical and mental health problems.
The Advocacy Center is the premier community organization providing support services for victims of domestic violence, sexual assault, rape, and child sexual abuse. Besides the social media campaign, the Advocacy Center is organizing a host of activities throughout the month. They include a screening of the film Roll Red Roll, a Wen-Do Women’s Self Defense online workshop, a yoga class fundraiser, a Clothesline Project Display in DeWitt Park, and a “Take Back the Night!” march, rally, speak out, and vigil.
“The Advocacy Center is dedicated to raising awareness about the impacts of all forms of sexual violence on survivors and the community, while also highlighting the work being done to promote healthy development and practices that work towards preventing these forms of violence from occurring,” said Advocacy Center Executive Director Heather Campbell.
IC Strike, a student organization at Ithaca College dedicated to education, action, and allyship surrounding sexual assault, is collaborating in the social media campaign because it believes in the power of education and communication.
“Our society struggles to have conversations about sex, trauma, and sexual violence,” said IC Strike Co-President Julia Siegel. “The social gag rule on sexual assault fosters ignorance and perpetuates harmful behavior and values. By equipping students with the facts and the vocabulary to discuss these issues, productive conversations can be had and stigmas can be broken.”
The social media campaign was designed by Lorelei Horrell and Margaret Kent, Ithaca College students and interns at The Sophie Fund.
“I have enjoyed getting to work with other individuals who are passionate about sexual assault awareness,” said Kent. “As a female college student, the issue of sexual assault is a common worry. I hope that our campaign can help raise awareness about this issue and at the same time, make survivors feel seen.”
Horrell agreed on the importance of supporting survivors of sexual assault.
“There’s a lot of stigma around discussing sexual assault that makes it more difficult for survivors to find information and resources,” said Horrell. “As a young woman and as a college student, fear of sexual assault is constant. Working on this campaign both validated that fear and transformed it into something more. We can be angry, and we can be afraid, but we can also learn how to protect ourselves, practice being able to support our friends, and educate ourselves on all the resources available if something does happen.”
Click any of the links to check out the campaign’s social media posts and share:
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.