Center of Excellence for Suicide Prevention

1. Center of Excellence for Suicide Prevention Canandaigua VA Medical Center Canandaigua, NY Wilfred R. Pigeon, PhD Director 27 September 2017

2. COE for Suicide Prevention We take a public health approach to suicide prevention Work supported by VA ORD, DoD, and VA OMHSP List of collaborators and references available upon request

3. COE for Suicide Prevention • Using a public health approach to suicide prevention, our portfolio includes: • Suicide Surveillance • Pharmaco-epidemiology • Education and Training • Health Communication Research and Evaluation • Interventions Research

4. COE for Suicide Prevention • Using a public health approach to suicide prevention, our portfolio includes: • Suicide Surveillance • Pharmaco-epidemiology • Education and Training • Health Communication Research and Evaluation • Interventions Research • Suicide Data Repository (SDR) • Suicide Prevention Application Network (SPAN) • Behavioral Health Autopsy Program (BHAP)

5. COE for Suicide Prevention • Using a public health approach to suicide prevention, our portfolio includes: • Suicide Surveillance • Pharmaco-epidemiology • Education and Training • Health Communication Research and Evaluation • Interventions Research Partner withVA Pharmacy Benefit Management Group and other partners to improve medication safety for VHA users to reduce risk for adverse effects related to suicidal ideation and behaviors.

6. COE for Suicide Prevention • Ongoing support and training resources to VA Suicide Prevention Coordinators in the field. • A portfolio of suicide prevention trainings for VHA employees, clinicians, and staff. • Using a public health approach to suicide prevention, our portfolio includes: • Suicide Surveillance • Pharmaco-epidemiology • Education and Training • Health Communication Research and Evaluation • Interventions Research

7. Education & Training: A Learning Systems Approach to Suicide Prevention

8. COE for Suicide Prevention • Using a public health approach to suicide prevention, our portfolio includes: • Suicide Surveillance • Pharmaco-epidemiology • Education and Training • Health Communication Research and Evaluation • Interventions Research Evaluates the effects of public communication campaigns designed to increase awareness and use of VA resources, and promote help seeking behaviors among Veterans.

9. Shifting the Paradigm: The use of public health communication to promote suicide prevention

10. COE for Suicide Prevention • Using a public health approach to suicide prevention, our portfolio includes: • Suicide Surveillance • Pharmaco-epidemiology • Education and Training • Health Communication Research and Evaluation • Interventions Research • Interventions designed to: • cut across VHA clinical care settings • engage Veterans outside of VA • address risk factors associated with suicide

11. Intervention Development & TestingInterventions Aimed at: • Life & Care Transitions • From inpatient psychiatry to outpatient care • From VA nursing facilities back to home or community • From military service to Veteran status • Treatment Settings outside of Specialty Mental Health • e.g., primary care settings • Enhancing Engagement in Mental Health Care • e.g., 1 session phone intervention doubled rate of engaging in care • Common Conditions associated with Suicide • e.g., depression, chronic pain, sleep disturbance

12. Why Target Sleep Disturbance as a Suicide Prevention Strategy ? • Sleep Disturbances Represent a Gateway to: - Relieving a health problem that impacts function - Improving co-occurring medical & psychiatric conditions - Preventing negative health consequences - Decreasing resistance to mental health care ? Altering the trajectory of those on a path to suicide ?

13. Why Consider Treating Insomnia as a Suicide Prevention Strategy ? • Insomniaisassociated with suicidal thoughts, suicide attempts & suicide. • Insomniais strongly associated with depression & PTSD, which are themselves potent risk factors for eventual suicide. • Insomnia is highly prevalent among primary care patients, a setting that is most often the last treatment venue visited by suicide decedents .

14. Addressing Insomnia to have a Broad Reach on Suicide Prevention - Treat insomnia with behavioral approaches - Do so in the presence of depression - Demonstrate we can deliver treatment in a manner consistent with primary care milieu Can we do so with patients endorsing Suicidal Ideation, while retaining effects on insomnia and depression ?

15. Treating insomnia in patients endorsing Suicidal Ideation, while retaining effects on insomnia and depression? Pilot Randomized Clinical Trial Control Condition Consisted of Treatment-As-Usual for Depression, PTSD and/or suicidal ideation. Brief Behavioral Insomnia Treatment Two, 30-minute face- to-face sessions + Two 20-minute phone contacts

16. A brief insomnia intervention delivered in VA primary care reduced the severity of symptoms 50-60% for: Insomnia Suicidal Thoughts Depression Compared to 1-25% for Treatment as Usual

17. Suicide is a Multi-Factorial Problem Requiring [a] Multi-Pronged Solution(s)

18. Center of Excellence for Suicide PreventionCanandaigua VA Medical Center, Canandaigua NY Wilfred R. Pigeon, PhD, Executive Director Stephanie Gamble, PhD , Education Director Brady Stevens, MS, Director of Informatics Deborah King, PhD, Fellowship Director Lisa Lochner, Administrative Officer Contact Information Wil Pigeon (585) 393-7918 wilfred.pigeon2@va.gov