SD17 - Suicide Prevention Across The Life Span Plan for the Commonwealth of Virginia


Executive Summary:
Introduction

In 2003, the General Assembly agreed to Senate Joint Resolution 312 requesting the Secretary of Health and Human Resources, in cooperation with the Secretaries of Education and Public Safety, to formulate a comprehensive Suicide Prevention across the Life Span Plan for the Commonwealth. The General Assembly directed the Department f Health (VDH) and the Department for the Aging (VDA) to develop the plan, with participation from the Departments of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS); Social Services; Education; Juvenile Justice; Criminal Justice Services; State Police; Corrections; and any other state agency with an interest, responsibility, or role in suicide prevention.

The Suicide Prevention across the Lifespan Plan was developed with the input of stakeholders from around the Commonwealth, through research into national and state resources, and with guidance and review by an Interagency Committee. The goals from the National Strategy for Suicide Prevention (National Strategy), developed by the United States Department of Health and Human Services in 2001, were adapted to Virginia and form the basis for the Virginia goals. One of the National Strategy’s objectives is to “increase the proportion of States with comprehensive suicide prevention plans that a) coordinate across government agencies, b) involve the private sector; and c) support plan development, implementation , and evaluation in its communities.” This plan, with emphasis on the entire lifespan, responds to this objective.

Epidemiology of Suicidal Behaviors

In 2002, there were 792 suicides in the Commonwealth, or about two suicides per day, for an age-adjusted rate of 10.8 suicides per 100,000 people. (*i) It was the eleventh leading cause of death among all Virginians and the third leading cause of death for youth. Twice as many people died from suicide in Virginia as compared to homicides. Suicides occur in all areas of Virginia. The highest rates are in rural areas, primarily in the Southwest and West Piedmont areas. Firearms are the major means chosen by those who die by suicide; suffocation (mostly by hanging) is the second most common method, followed by drugs and gases. (*a) For every suicide, there are about 25 suicide attempts; suicide attempts are three times more common in women than in men. (*b) In the U.S., about 90 percent of people who completed suicide had a mental illness, including alcohol and/or substance use disorders and some had multiple diagnoses. (*c) Therefore, in this country, the problem of suicide is inextricably linked to the issue of mental health and substance abuse.

The Institute of Medicine, in its landmark report, Reducing Suicide: A National Imperative, summarizes risk factors for suicide succinctly:

Risk factors associated with suicide include serious mental illness, alcohol and drug abuse, childhood abuse, loss of a loved one, joblessness and loss of economic security, and other cultural and societal influences. Resiliency and coping skills, on the other hand, can reduce the risk of suicide. Social support, including close relationships, is a protective factor.(*d)

and

Converging evidence across disciplines indicates that suicide is related to stress: developmental and adult trauma; cumulative stressors, including multiple morbidities; acute and chronic social and cultural stressors; and capacity to cope with stress. Suicide can be considered an expected outcome of a significant subgroup of mentally ill patients who experience accumulative life stresses, just as cardiac infarction is an expected outcome of untreated high blood cholesterol.(*e)

Effective Strategies

In the field of suicide prevention, a widely used model for grouping strategies is the Universal, Selective, and Indicated prevention model. Universal strategies are designed to reach all the members of a community or population. Selective strategies are targeted for the population groups at higher risk for becoming suicidal, for example, those with undiagnosed and untreated mental health conditions and aim at preventing the onset of suicidal behaviors. Indicated strategies are intended to prevent suicide among those most at risk for suicide and showing early signs of suicide potential, such as people who have attempted suicide.

Integrated programs combine universal, selective and indicated strategies. Program evaluations have indicated the effectiveness of this approach; there is also compelling logic to this strategy. Why increase public awareness without having adequate services and community support to help those most in need? Strengthening mental health services is valuable when coupled with actions that reduce barriers toward utilization of services.

Summary of Plan

Leadership Development and Infrastructure

Goal 1: Develop broad-based support for suicide prevention.
Objectives:
• Establish state-level oversight and leadership by assigning the Department of Mental Health, Mental Retardation and Substance Abuse Services as the lead agency.
• Identify and support strong regional and/or local coalitions.
• Identify sustainable and reliable funding for basic suicide prevention functions.
• Increase awareness of and support by state and local leaders.

Goal 2: Improve and expand surveillance systems.
Objectives:
Suicide Prevention Across the Life Span Plan for the Commonwealth

• Systematically collect, analyze and disseminate data measures and reports to constitute the Virginia Suicide Prevention Surveillance System.
• Increase the number of localities regularly conducting suicide follow-back studies.
• Promote and support national efforts to standardize data collection methods.

Goal 3: Promote and support research, including evaluation, on suicide and suicide prevention.
Objective:
• Increase applied research in Virginia on suicide prevention.

Awareness

Goal 4: Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services.
Objective:
• Increase the percentage of the population who recognize the importance of disclosing mental health symptoms to family, friends, or health care professionals and obtaining care for these problems.

Goal 5: Promote Awareness that Suicide is a Public Health Problem that is Preventable.
Objective:
• Conduct a public information campaign on the problem of suicide.

Intervention

Goal 6: Develop and implement community-based suicide prevention programs.
Objectives:
• Reduce the suicide rate in those planning districts with high male suicide rates.
• Establish effective programs aimed at population groups at high-risk for suicide.
• Integrate suicide prevention components in more community programs.

Goal 7: Promote efforts to reduce access to lethal means and methods of self-harm.
Objective:
• Reduce the rate of self-inflicted suicide firearm deaths.

Goal 8: Implement training for recognition of at-risk behavior and delivery of effective treatment.
Objectives:
• Increase the number of trained gatekeepers.
• Increase the number of education programs for family members and others in
close relationships with those at risk for suicide.

Goal 9: Develop and promote effective clinical and professional practices.
Objectives:
Suicide Prevention Across the Life Span Plan for the Commonwealth

• Increase the proportion of primary care practices with systems to assure accurate diagnosis, effective treatment, and follow-up for suicidal behaviors, depression, substance misuse, and other mental health conditions.
• Increase the proportion of specialty mental health and substance abuse treatment centers that have policies, procedures, and evaluation programs designed to assess suicide risk and intervene to reduce suicidal behaviors among their patients.
• Increase the proportion of patients with mood disorders who complete a course of treatment or continue maintenance treatment as recommended.
• Increase the proportion of patients treated for self-destructive behavior in hospital emergency departments that pursue the proposed mental health follow-up plan.
• Increase the proportion of institutional settings that apply guidelines for aftercare treatment programs for individuals exhibiting suicidal behavior.

Goal 10: Increase access to and community linkages with mental health and substance abuse services.
Objectives:
• Increase the proportion of the population with insurance coverage for mental health and substance abuse services.
• Expand local mental health services, especially in areas with high suicide rates.
• Improve integration and coordination among organizations/agencies including health, mental health, and spiritual.

Goal 11: Improve reporting and portrayals of suicidal behavior, mental illness and substance abuse in the entertainment and news media.
Objective:
• Identify and inform the media of inappropriate portrayal of or reporting on suicides, suicidal attempts, and mental illness.

Financial and Staffing Resources Envisioned for Plan Implementation

In an attempt to quantify the additional resources that would be necessary for implementation of the Suicide Prevention across the Life Span Plan for the Commonwealth, input was solicited from the members of the Interagency Committee. Committee members were asked to review the plan and estimate the amount of resources their agency would need to address the objectives that were relative to their agencies’ work. Responses were received from Virginia Department of Health’s Center for Injury and Violence Prevention and Office of the Chief Medical Examiner, Virginia Department for the Aging and Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services. In total, the preliminary estimate of the additional resources needed to implement the objectives listed in the Suicide Prevention across the Life Span Plan for the Commonwealth is $307,470 in fiscal year 2006 and $4,814,633 in fiscal year 2007.
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(*1) Age-adjusted rates are standardized to a common population age distribution, in this document, the Year 2000 U.S. population. This allows for comparison among populations in spite of differing age distributions.
(*a) All Virginia suicide data is from the Virginia Center for Health Statistics, Virginia Department of Health, Richmond, Virginia.
(*b) McIntosh, J.L. (2003). U.S.A. Suicide: 2001 Official Final Data. Retrieved June 12, 2004, from the American Association of Suicidology web site: http://www.suicidology.org/associations/1045/files/2001datapg.pdf
(*c) USPHHS, Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System: Youth Online Comprehensive Results, 1991 – 2003. Retrieved July 29, 2004, from the Centers for Disease Control and Prevention web site: http://apps.nccd.cdc.gov/yrbss/
(*e) Institute of Medicine. 2002. Reducing Suicide: A National Imperative. Washington, DC: National Academy Press, p. 424.
(*f) Institute of Medicine. 2002. Reducing Suicide: A National Imperative. Washington, DC: National Academy Press, p. 434.