# Presentation: 415133

## Pathways to Healing:Suicide Prevention, Intervention and Postvention in Systems Of Care

**A plenary held at the System of Care Community Meeting Winter 2007 in Atlanta, GA on February 1, 2007.**

## PRESENTERS

***Sylvia Kay Fisher, Ph.D.***
**Program Director of Evaluation**
**Child, Adolescent and Family Branch, SAMHSA**
***Holly Echo-Hawk***
**Senior Mental Health Consultant, National Indian Child Welfare Association**
***Mark LoMurray***
**Project Director, Adolescent Suicide Prevention Project, North Dakota Tribal Rural Mentoring Partnership**
***Shannon CrossBear***
**Co-Director of Evaluation and Training, Federation of Families for Children’s Mental Health**

## SAMHSA Initiative on Suicide

** ****President’s New Freedom Commission Report **
**  ****identified suicide as a significant thrust in mental**
**  ****health policy**
** ****SAMHSA incorporated the topic of suicide**
**  ****within its policy matrix**
** ****SAMHSA hired a national expert on suicide**
**  ****prevention with the goal of developing and**
**  ****implementation a national strategy on addressing**
**  ****suicide issues**
** ****Garrett Lee Smith grantee program was initiated**
**  ****(29 states and 7 tribal communities have been**
**  ****funded)**

## Lifetime History of Suicide Attempt Among Children Entering SAMHSA-Funded Systems of Care: Across the Years

**Based on caregiver report at intake into services**
**Includes data gathered from communities funded between 1994 and 2004**
**Based on available suicide attempt data gathered between 1995 and October 2006**
**The caregiver reported age range of the children in this sample: 1 to 22 years.**

- 14.6% of children *(N=28,785)* entering systems of care between 1995 and 2006 had a caregiver reported lifetime history of suicide attempt.

## Lifetime History of Suicide Attempt Among Children Entering Systems of Care by Funding Phase

**Phase I:    22 Communities funded 1993-1994**
**Phase II:   23 Communities funded 1997-1998**
**Phase III:  22 Communities funded 1999-2000**
**Phase IV:  29 Communities funded 2002-2004**

**Based on caregiver report at intake into services**
**Includes data gathered from communities funded between 1994 and 2004**
**Based on available suicide attempt data gathered between 1994 and October 2006**

## Lifetime Suicide Attempts Among Children Entering Systems of Care Communities Funded 2002 - 2004

**More than half (53.5%) of the suicide attempters of the 13.1% of the total group of children have made multiple attempts**

**Based on caregiver report at intake into services**
**Includes data gathered from communities funded between 2002 and 2004**
**Based on available number of lifetime suicide attempt data gathered between 2002 and 2006**
***n=2291***

## Lifetime History of Suicide Attempt: Agreement Between Caregiver and Youth Report

- Caregivers and youth _consistently_ report lifetime history of suicide attempt in 87.1% of cases.
- Both report no attempt history = 76.0% of cases
- Both report an attempt history = 5.3% of cases
- Caregivers and Youth _inconsistently _report lifetime history of suicide attempt in 12.9% of cases.
- Caregiver reported attempt/youth no attempt = 5.3% of cases
- Youth reported attempt/caregiver no attempt = 7.6% of cases

**Based on caregiver and youth report at intake into services**
**Includes data gathered from communities funded between 2002 and 2004**
**Includes data for  children (age 11 and older)  with both caregiver and youth reported suicide attempt data available gathered between 2002 and 2006**
***N=1382***

## Child, Adolescent and Family Branch (CAFB) Efforts:  Addressing Suicide in Systems of Care [1]

*** ***Special Topic session - USF Research/Training
- 		Conference (upcoming proceedings 	publication)
-  Focus group at the Training Institutes
-  Ongoing efforts in the National Evaluation to identify trends and findings relative to suicide-related behavior in our children and families
-  Suicide Meeting  (e.g., family members, youth, 	national experts on suicide issues, cultural 	competence experts, etc.)
- policy statement and recommendations generated

## Child, Adolescent and Family Branch (CAFB) Efforts:  Addressing Suicide in Systems of Care [2]

- Suicide Logic Model
- Suicide Fact Sheet with Social Marketing team
- This plenary and a plan to include sessions in
- 	   future grantee meetings about this issue
- Working with SAMHSA suicide and trauma
- 	   experts about several issues, including family
- 	   involvement in developing suicide prevention
- 	   strategies
- Upcoming:  USF RTC sessions; trauma informed
- 	   conference in New Orleans
- This is a full-scale initiative with many prongs

## Pathways to Healing: Suicide Prevention, Intervention and Postvention in Systems of Care

*Holly Echo-Hawk*
*Senior Mental Health Consultant*
*National Indian Child Welfare Association*

## How Do We Try To Protect Our Youth and Families?

**YOUTH & **
**FAMILIES**

- Physical
- Health

- Economic
- Health

- Personal
- Health

- Community
- Health

- Family Health

- Cultural Health

- Spiritual Health

## American Indian and Alaska Native Suicide

- Devastating for our communities and our young people
- In general, American Indian and Alaska Native suicide rates much higher
- At least 3x higher than non-tribal youth
- Research indicates that 14% to 30% tribal adolescents attempt
- Entire communities affected by suicide patterns that can occur in one region within a short amount of time

## Indian Health Service Data

- Ten year period (1995 - 2005)
- Tribes and tribal organizations that submit data to Indian Health Service
- Does not include Alaska

## Tribal Suicide Ideation1995 - 2005 

## Tribal Suicide Ideation by Age 1995 - 2005 

## Tribal Suicide Attempts 1995 - 2005 

## Tribal Suicide Completions 1995 - 2005 

## Tribal Suicide Completions by Age  (1995 - 2005 )

## Rich Lessons  from Both Perspectives

- Tribal communities who find a pathway to address suicidal behavior in their community
- Communities who have less, or few, incidents with self-inflicted injuries or fatalities

## Some Reasons Why Youth Do Not Seek Help

*They Might Think I’m Crazy: Young American Indians’ Reasons for Not Seeking Help When Suicidal*
- Freedanthal & Stiffman, Journal of Adolescent Research, January 2007

## Study Approach

- Sample of 101 American Indian     15-21 year olds
- Thought about or attempted suicide
- Open ended questions about barriers to seeking formal and informal help while suicidal

## Youth Responses

- Most Common
-  	***Internal Factors***
- Embarrassment
- Lack of problem recognition
- Don’t want family to find out
- Belief that no one can help
- Self reliance

- Rarely Cited
- Structural Barriers
- Lack of money
- Lack of service availability

## Sources 

**Sources **
**Of **
**Strength **
**In **
**Suicide **
**Prevention**
**Mark LoMuray**

## Suicide is the #3 cause of death for ages 10-24 years old. In many western states it is the #2 cause of death for this age group. 

- Approximately 15% of 9th-12th graders have thoughts of suicide in any given year.

##  “We must promote public awareness that suicides are preventable.  We must enhance resources  in communities for suicide prevention programs and mental and substance abuse disorder assessment and treatment. 	Dr. David Satcher	United States Surgeon General	July 28, 1999

## Suicide Prevention Similar to Reducing Traffic Fatalities

- Not every traffic fatality is preventable, but it’s possible to reduce unacceptably high numbers.
- A mixture of strategies has led to a significant drop in traffic fatalities over the past 25 years – speed limits, DUI enforcement, how roads are built, seat belt laws, air bags,  youth licensing restrictions, etc.

## Teen and Young Adult Risk

**Source: ND Health Dept. – Vital Statistics**

## A Blended Approach

## ND Adolescent Suicide Prevention Project:  Action Strategies

## Key Adolescent Risk Factors

- Aggressive/Impulsive

- Depression

- Substance Abuse

- Trauma

## Sources of Strength

- Family Support

- Positive Friends

- Caring Adults

- Positive Activities

- Generosity/Leadership

- Spirituality

- Access to Medical

- Access to Mental Health

## Hopeful Trends

- 47% Fatality reductions (10-19 ages) from 2000-2004 compared to 1990’s.
- 20-29% YRBS reductions
- Every region/tribal area implemented at least two recommended strategies
- 45,000 trained, 8000 teens, 8000 professionals, 1500 faith-based

##  Prevention is Possible

-  A  Parents Perspective
*Finding the resources:*
*within ourselves*
*within our communities*

-                        Shannon CrossBear
- Federation of Families for Children’s Mental Health

## Courage, Conviction, Commitment

-  Shields of  Safety
-  Protective factors
-  Partnerships
-  Hope in healing

## What can you do?

- As a program director
- As a clinician
- As an advocate
- As a youth and family member

## Partners in Prevention

- Uniform safety standards
- Linkages with existing suicide prevention efforts
- Formal and informal  prevention supports and services

- Crisis plan protocols in place for every family
- Gate keeper training for all staff and communities
- Full investigation, evaluation and inclusion
-  Postvention services in place for staff, youth and families

## Contact Information

- Sylvia Kay Fisher
- _[Sylvia.Fisher@samhsa.hhs.gov](mailto:Sylvia.Fisher@samhsa.hhs.gov)_
- (240) 276-1923
- Holly Echo-Hawk
- _[echohawk@pacifier.com](mailto:echohawk@pacifier.com)_
- (360) 571-3203

- Mark LoMurray
- _[outreach@btinet.net](mailto:outreach@btinet.net)_
- (701) 471-7186
- Shannon CrossBear
- _[stronght@boreal.org](mailto:stronght@boreal.org)_
- (218) 475-2728