On November 15, ACHD hosted their monthlyinstallment in the Educational Webinar Series, Emergency Preparedness.  The webinar featured speaker Kim Baldwin, Senior Consultant with Wipfli/HFS, who reviewed national emergency preparedness requirements to ensure adequate planning for both natural and man made disasters. 

If you were unable to participate in the November 15th webinar but would like to access a recording of the series, click here.  To access a copy of the slide deck, click here. 

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Suicide is a public health matter requiring proactive prevention, so denial or avoidance are not solutions, only action is. A recent Center for Disease Control (CDC) study -- Increase in Suicide in the United States, 1999-2014 - states the extent suicides impact our society. It indicates USA suicide rates are significantly increasing for most age groups, including 10-14 year olds. Similarly, California is experiencing an increase in suicides.

But, we should understand that suicide is more than deaths. Focusing on just suicide deaths ignores the range of suicidal behaviors, being inconsistent with treating other public health matters. Suicide deaths constitute about three percent (3%) of suicidal behaviors. In 2014 over nine millions USA residents had suicidal thoughts (ideation), just under three million individuals planned a suicide, and just over one million attempted suicide. By comparison about forty three thousand people died by suicide. To recognize and help suicidal individuals, addressing the spectrum of suicidal incidents and behaviors long before an individual is in critical condition is needed.  

Californians are aware of suicidal behaviors and are willing to help and support struggling individuals.  One study -- California Statewide Awareness of Suicide - 2012 (part three of California Situational Overview for Suicide Prevention) -- showed a majority of Californians (51.2%) have had their lives affected by suicide. These Californians understood to take talk about suicide seriously and  express concerns when they perceive someone maybe suicidal. Many Californians stated their willingness to discuss suicide with a loved one and believe suicide is preventable. When individuals have some awareness of suicide warning signs, they are more likely to:

Still, some are adverse to understanding and discussing suicide prevention. Communication is critical especially with one group, those who lost a loved one (often called suicide loss survivors). Not only do the survivors need assistance after a suicide, but often help is needed weeks or months after the death. Besides this "lag effect", different events or situations can precipitate anguish in these survivors. Understanding these prolong effects are important in care for an individual coping with a suicide loss.  

How can people who working in healthcare services assist and are there tools and resource that can be utilized?

 

The primary care setting is critical to suicide prevention. Studies show that individuals who died by suicide recently visited their primary care provider. Seventy-six percent (76%) of those who died by suicide visited a primary care provider in the prior month and about ninety percent (90%) during the year. Primary care providers must be active participants in suicide prevention.  

A few documents/posters could be useful. These readily available and free tools include an emergency room poster -- Is Your Patient Suicidal? by the Emergency Nurses Association. Hospital emergency rooms have used this poster to identify warning signs and ask questions if a patient is suspected of being suicidal. Another tool, Suicide Risk: A Guide for ED Evaluation and Triage , similarly shows warning signs and questions while providing interventions and discharge procedures to use depending on the level of suicidal risk a patient exhibits.

There are screening tools to identify individuals at-risk. For depression diagnosis there is the free screening tool  The MacArthur Initiative on depression and Primary Care. For suicidal patients more specific diagnostics could be used, including A sk Suicide-Screening Questions (ASQ) Emergency Department Suicide Screening Tool Accurately Predicts At Risk Youth and A ssessment and Interventions With Potentially Suicidal Patients. There is also always PHQ 9.

Readily accessible online toolkits and resources should be studied and utilize. Most are free. The one most recognized is the Suicide Prevention Toolkit for Rural Primary Care from the Suicide Prevention Resource Center (SPRC). This toolkit provides information for clinician and patient education, patient management, patient billing and resources and policies. The American Psychiatric Association's guidelines ASSESSING AND TREATING SUICIDAL BEHAVIORS A Quick Reference Guide explains assessing, treating, documenting, and managing a suicidal patient. Also, the Zero Suicide Model is used for Collaborative Safety Planning to Reduce Risk in Suicidal Patients: A Key Component of the Zero Suicide Model to explain brief interventions before going into in-depth safety planning. This safety planning explanation includes a six step process to assist clinicians. 

For an extensive list of suicide prevention trainings and websites for clinicians and health providers view the August 31 2017 webinar or access the SPRC. Do a search for primary care or clinician trainings.  

Let me end with this thought. Recently my wife and I were at a meeting with parents who had lost children to suicide. Some of these parents had children die by suicide in the last 6 to 8 weeks. To say many were distraught would not adequately describe the situation. The personal impact is profound. If you are like me, you understand we are not doing enough to prevent suicide and we should enhance our understanding and awareness of suicide warning signs and available resources and double our efforts. The time to do more was yesterday and we do not need any more dark tomorrows. 

Thank you.