Focus is on Prevention as Suicide Continues to Rise

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One of the measures that flew through the House (85 to 0) and then with amendments, through the Senate (32 to 0), in the regular 2018 Legislative session, was Representative Reid Falconer’s “Louisiana Suicide Prevention Act.”

An ambitious plan, Act 450 directs the Office of Behavioral Health to ensure that administrators of all healthcare facilities licensed by state and all licensed healthcare professionals have access to informational resources and technical assistance necessary for implementation of the zero suicide initiative. The initiative carried a price tag of nearly $800,000. Because of the state’s financial picture, an amendment was added requiring that implementation had to be contingent on obtaining grant money.

The authors of Act 450 note that according to the 2016 America’s Health Rankings report, the number of deaths due to suicide per one hundred thousand people in the United States rose steadily from 2012 through 2016, and Louisiana’s rate of deaths from suicide is nearly ten percent higher than the national average.

The Center for Disease Control continues to rank suicide as the 10th leading cause of death in the US. The most recent year of data (2015) placed suicide deaths at 44,193 nationwide, more than the number killed in automobile accidents, which was 37,757, or homicides, 17,793, for that same year.

Representative Falconer wrote “While suicide occurs among persons of all ages, ethnic backgrounds, and income levels, it is an especially troubling problem among youth in Louisiana, with suicide ranking as the second-leading cause of death in this state for persons between the ages of ten and twenty-four in 2014, the most recent year for which complete data are available.”

Suicide is a pronounced public health concern among military veterans nationwide and in Louisiana particularly, as Louisiana’s veteran suicide rate is over ten percent higher than that of the nation and of the southern region, write the authors. And, more than half of the people who died by suicide did not have unknown mental health condition, reports the CDC.

The rising rates of suicide has been at the front of the news for some psychologists in the field, and motivated the Louisiana Psychological Association to host suicide prevention expert Dr. April Foreman at their recent state convention.

Foreman is a licensed psychologist serving Veterans as Suicide Prevention Coordinator for Southeast Louisiana Veterans Health Care System. She also serves as Suicide Prevention Lead for Veterans Integrated Service Network 16, a region of Veterans Affairs. She is on the Executive Committee for the Board of the American Association of Suicidology.

Dr. Foreman presented “Suicide Risk Assessment,” at the Louisiana Psychological Association Convention recently, providing an overview of basics of suicide risk assessment, risk levels, and acute vs. chronic risk. She covered the use of safety planning as a follow up to risk assessment, current research innovations pertaining assessment of risk and actual prediction of suicide attempts/deaths, and possible ways this may impact clinical work in the upcoming years.

Dr. Foreman has been working toward this goal for some time. In 2014, Foreman supported Senator Ben Nevers’ effort to ensure that mental health professionals were adequately trained, SB 539. While the mandate was removed, the effort drew attention to the problem.

“This is a public health issue that is squarely in psychology’s wheelhouse,” said Foreman in a previous interview. “Only 9 to 10 percent of mental health professionals can pass a competency exam,” in this topic, said Foreman. “This is a big training deficit.”

Dr. William “Bill” Schmitz, Jr., a licensed clinical psychologist in Baton Rouge, working primarily with the nation’s veterans, and who has served as President of the American Association for Suicidology previously explained the importance. “It is the number one emergency in mental health and the most lethal situation a professional will encounter. But, no one is required to have training,” he said.

Schmitz co-authored a white paper, “Preventing Suicide through Improved Training in Suicide Risk Assessment and Care,” a report of the American Association of Suicidology Task Force, which Schmitz chaired. In the report, authors noted that training for suicide prevention is inconsistent at best. The majority of mental health professionals receive very little, if any formal training in suicide prevention. The exceptions are the psychiatrists; 94 percent have received some training. However, even in this group, only about a quarter of these receive skill development training.

“An hour of didactic training may increase knowledge,” Schmitz explained to the Times, “but it doesn’t do anything to actually change competency.”

Dr. Foreman has also looked carefully into the competency problem. “When the state of Georgia was asking these same questions in 2005,” she said, “they assessed a sample of mental health professionals, and the competency rate was 9 percent. A few hours of training raised the rate to 83 percent,” she said. “That’s a huge difference.”

The rising rates of suicide are a concern. “There are several theories regarding this trend, though a specific and definitive explanation has not emerged,” Schmitz noted. “We do know that suicide attempts, across the lifespan, tend to become more lethal,” explaining that the ratio of suicide attempts to death is 100-200 to one for adolescents and young adults, but for those over 65 the ratio is four to one.

“Coupled with this,” Schmitz said, “I would also add that help-seeking and mental health treatment remain very stigmatized among the older adult populations. There is lingering doubt and fears associated with institutionalization, asylums, and being ‘locked up’ if one divulges any thought of suicide,” he explained. “This is very disconcerting given the clear evidence that even people determined to be at high risk for suicide have been shown to respond to intensive outpatient therapy.

In a previous interview with the Times, Dr. Frank Campbell, a clinical social worker and expert from Lacombe, Louisiana, former Executive Director of the Baton Rouge Crisis Intervention Center, and also Past-President of and American Association for Suicidology, said, “It is important to accept that suicide is a very complex and paradoxical cause of death to develop clear
understandings from. It is an N of 1 and by that I mean each suicide is unique.” Dr. Campbell’s work has been featured in a documentary for the Discovery Channel.

“For me the most comprehensive micro or individual answer to any death by suicide,” he said, “is that it happens as a result of a self-defined crisis where the individual’s ability to cope with the precipitating event which brings on the crisis response––decline in coping and possible increase in maladaptive coping––was unable to keep that person safe from suicide,” Dr. Campbell said.

“Data is helpful in awareness but each death impacts the community in ways that are unique and little research has been conducted on the impact suicide has on generating additional causalities both in the short term or long term for a community.”

“The macro response would include considering the impact of social and economic changes in the past 10 years,” Campbell said, “because economic conditions have historically correlated with upward trends in suicide.”

Also, “… a growing number of citizens who are veterans of military service––mostly men––which are estimated to equal one out of each five deaths by suicide,” he said.

Dr. Schmitz pointed out that there is growing evidence supporting various approaches that help those at risk. “There are treatments that work, there are warning signs and basic skills of suicide assessment and management that should be core clinical competencies,” said Schmitz.

“Unfortunately, the majority of mental health professionals do not obtain this training in either their graduate studies or continuing education,” he said.

“Providers that are not engaging their patients in active discussions about means restriction and crisis response planning really terrify me,” he said.

Dr. Campbell said, “Managing transitions in life if not easy and when health and loneliness are isolating factors along breakdown geographically of the family and health care challenges it is a lot to manage. Generational expectations are not always shared or expressed clearly to family who might be wanting to help but just don’t know how.”

“My thought is that if we had the number of folks who die by suicide each year drowning then we would train more lifeguards to stand by those in the water.

“The river of suicide is large in this country and it is up to all of us in our communities to become trained as lifeguards. One such training that is for all care givers is the two-day ASIST (Applied Suicide Intervention Skills Training) that helps anyone help another at risk from the river to safety for now.”

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