Preventing Suicide in Communities: A Public Health Approach Jerry Reed, PhD, MSW

1. Preventing Suicide in Communities: A Public Health Approach Jerry Reed, PhD, MSW Katherine Wootten, MPH Sixth World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders Washington, DC :: 17 November 2010

2. What We Will Cover Suicide as a public health problem Preventing suicide in local communities Resources for community-based suicide prevention

3. I. Suicide as a Public Health Problem Suicide places a significant burden on the health of the population. There is the presence of known risk factors that are measurable and preventable. There is public will for suicide to be addressed. Strategic Planning for Suicide Prevention Community Core Competencies course, SPRC

4. Suicide around the World Suicide (global)1 Nearly 1,000,000 deaths per year 16suicidesper 100,000 people per year 60%increase in suicide rates in last 45 years 1.8% of the total global burden of disease (1998) Suicide attempts,estimates (global)1: Up to 20 times more frequent than completed suicide Suicide ideation, estimates (United States)2: 24% of US population have considered suicide in lifetime 1: WHO http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ 2: Linehan and Laffaw, 1982

5. Suicide Rates by Country (WHO)

6. Suicide Rates by Gender and Age (WHO)

7. Impact of Suicide Suicide survivors and suicide attempt survivors Years of potential life lost Economic cost of suicidal behavior Medical expenses of emergency intervention and non-emergency treatment for suicidality Lost wages of those completing a suicide Lost productivity of the loved ones grieving a suicide Lost and/or reduced productivity of people suffering from suicidality

8. Why Suicide?Social Ecological Model

9. Public Health Approach “The complexity of causes necessarily requires a multifaceted approach to prevention that takes into account cultural context. Cultural factors play a major role in suicidal behavior.” Violence – A global public health problem. World Health Organization. 2002, p. 206. DeLeo, D. Cultural Issues in suicide and old age. Crisis. 1999, 20:53-55.

10. Public Health Approach Create Planning Team Obtain “Buy-In”

11. II. Preventing Suicide in Local Communities “…the work of suicide prevention must occur at the community level, where human relationships breathe life into public policy.”1David Satcher, MD, PhD Sixteenth Surgeon General of the US “Prevention goes beyond changing individuals – it changes cultural norms.” Murray Levine (1998) 1: USDHHS. (2001). National strategy for suicide prevention. p 2.

12. Community • Norms of communities empowered for suicide prevention: • shared responsibilityfor the general welfare of the community and its members • collective knowledge and ability to confront situations that threaten the integrity, safety, and well-being of the community • positive attitudes towards “help-seeking” behavior

13. Model for Action: Necessary Conditions for Prevention Richmond and Kotelchuck’s Health Policy Model Atwood K, Colditz GA, Kawachi I. (1997). From public health science to prevention policy: Placing science in its social and political context. American Journal of Public Health, 87(10).

14. Sequential steps: Leadership Planning group Organization Resources Strategic planning A plan Evaluation (confirming success) Achieving Success in Suicide Prevention

15. 1: Leadership, 2: Planning, and3: Organization “Problems are complex and go beyond the capacity, resources, or jurisdiction for any single person, program, organization, or sector to change or control.” Lasker R, Weiss E. 2003. Broadening participation in community problem solving: A multidisciplinary model to support collaborative practice and research. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 80(1):5.

16. 4: Resources New line item Realigning existing resources “In kind” Networking Grants/fundraising Human resources Idea people Action people Technical assistance, prevention support

17. 4: Resources “The best and most effective prevention programs are ones that are directed toward using resources which are indigenous to a particular community… external programs generally don’t work as well, as they don’t recognize the values of the culture.”Sherry Davis Molock, MDiv, PhD Preventing Suicide: The National Journal, 2(3):9. July 2003.

18. 5: Strategic Planning Many steps required before choosing programs: Assess the problem Incidence/Prevalence Demographics Risk/Protective Factors Assess community readiness, resources What’s in place already? Set priorities Populations, risk/protective factors Articulate: What specific results or changes do we hope to achieve, and how will those help reduce suicide? 18

19. 5: Strategic Planning Selection principles: Evidence-based (effective) practices Multi-layered Achieves desired outcome Cost feasibility Sustainability Political acceptability Social will Possible unintended consequences

20. 5: Strategic Planning Best Practices Registry (BPR) for Suicide Prevention A resource for information about best practices that address specific objectives of the National Strategy for Suicide Prevention. Three sections: Section I: Evidence-Based Programs Section II: Expert and Consensus Statements Section III: Adherence to Standards

21. 7: Evaluation Formative Evaluation Process Evaluation Outcome Evaluation Project Beginning Project End

22. From SPRC (www.sprc.org) Resources related to coalition building, locating and using data, strategic planning, evaluation, and more Best Practices Registry (BPR) for Suicide Prevention Online library Elsewhere Univ of Kansas Community Tool Box (http://ctb.ku.edu/en/) Prevention Institute (http://preventioninstitute.org/tools.html) International Association for Suicide Prevention (IASP) (http://www.iasp.info/) World Health Organization (WHO) http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ III. Resources

23. What We Have Covered Suicide as a public health problem Preventing suicide in local communities Resources for community-based suicide prevention

24. Thank you SPRC, www.sprc.org info@sprc.org, 00 1 + 1 877 438 7772 Jerry Reed, Director jreed@edc.org, 00 1 + 202 572 3771 Katie Wootten, Associate Project Director kwootten@edc.org, 00 1 + 202 572 3722