Central Arizona Programmatic Suicide Deterrent System Project

1. Central Arizona Programmatic Suicide Deterrent System Project Dr. Laura Nelson, ADHS Medical Director & DBHS Deputy Director Don Erickson, ADHS Bureau Chief Adult and Children System of Care

2. “Suicide represents a worst case failure in mental health care. We must work to make it a ‘never event’ in our programs and systems of care.” - Dr. Mike Hogan President’s New Freedom Commission on Mental Health

3. “Over the decades, individual [mental health] clinicians have made heroic efforts to save lives… but systems of care have done very little.” - Dr. Richard McKeon SAMHSA Bureau Chief for Suicide Prevention

4. Pyramid of Suicidal Behaviors (US): More Common Than Thought Source: * National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2009). Web-based Injury Statistics Query and Reporting System (WISQARS). Available from: www.cdc.gov/injury/wisqars/index.html. **Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

5. “Serious Public Health Problem”: More Common in West Region #1 #8 #4 11 1 #3 #5 15 #9 #6 13 Wash., D.C. 14 12 #9 #6 #2 Rates per 100,000 population 0.0 to 8.11 8.12 to 10.95 10.96 to 13.99 14.00 to 21.54 Source: Centers for Disease Control and Prevention (CDC) vital statistics

6. Suicide by Age, Race & Gender: Who is Highest Risk? Source: National Center for Health Statistics. Note: Non-Hispanic Ethnicity

9. Suicide Attempts: • Female>>male • Rates peak in adolescence • Concern: Latina youth and LGBT • Suicide Deaths: • Male : female = 4:1 • Elderly white males -- highest rate • Working aged males – 60% of all

10. Group A • Group B

11. Arizona’s New Paradigm: Suicide Care & Intervention

12. Arizona’s System of Care Framework • High Reliability – Aviation goal zero commercial crashes • Don’t train only the pilots; instead, all procedures & systems target success • Health Systems – Eliminate: • Wrong-site, patient surgery • Inpatient falls • Medication Errors • Crossing the Quality Chasm

13. I. Core Values & Beliefs • Current science: Suicide is preventable • Those who die by suicide have intense ambivalence • Caring saves lives • Last decade: • Increased research on effective interventions • Development of standardized risk assessments & standards • Systems successes

14. II. Systems Management • Robust Performance Improvement • Workforce Development • Standardized Clinical Care • Screening & Assessment • Stratification of Risk • Regimen of Key Interventions • Access to Care • Means Restriction • Follow-up • Transparent Reporting & Feedback Loops, Commitment to Improvement

15. III. Evidence Based Clinical Care • “Productive Interactions” – Therapeutic relationships based on engagement and collaboration • Treat suicide risk directly (not just underlying diagnosis) • Evidence based care • Involuntary hospitalization is minimized, considered a safety measure and possible sign of community care defects

16. Accountability for Results: Lives Saved • Timely public reporting of suicide deaths • Measure & Report • Feedback Loop

17. All-staff Suicide Intervention Training (ASIST) • Attempt Survivor Peer Support Groups • Standardized Screen, Assess, Stratify and Intervene • Family Engagement • Review Past 100 Deaths • Member Awareness, Outreach & Follow-up

18. Evidence based program Best practice review: HFHS, Harvard & Suicide Care in Systems Framework Competitive RFP, selection process, awards, implementation Developed a family engagement training with NAMI More than 2,400 staff trained Working with peer run organizations to increase participation. Incorporated into new employee orientation Screening tools developed – adult, adolescent & child Continued training of new staff at all sites Finalizing Family Welcome Packet with Community Resources Participation, venue, frequency Assessment categories -high, medium and low risk Detailed interventions and support strategies Suicide Prevention and Intervention Model Validation • Examples • Social Support History • Family Supports • Suicide History • Length of Care • Family History of Suicide • Substance Use • Willing to Accept Help • Medication/TX Adherence • Hospitalization/Crisis Use • Co-morbid conditions • Recent Stressors Working collaboratively with providers and stakeholders to identify potential risk factors & predictive characteristics Case Analysis of 100 suicide cases (2009-2011)

19. Suicide Care Is Everyone’s Business

23. Saving Lives Saving Money: Case Examples

24. Reduction in Suicide Death Rates

25. National Action Alliance (2010): Zero Suicide in Healthcare Initiative

26. Task Force Report Arizona Authors: A national task force was convened to develop the framework and 14 of 29 authors were from Arizona and the Programmatic Suicide Deterrent System Project Suicide Care in Systems Framework

27. Replication in Other States: Arizona’s Workforce Survey

29. Thank you! Questions or Comments?