Listening to the Lessons of the Golden Gate Bridge<br />Version 1.0<br />Developing a Comprehensive Suicide Deterrent Stra...
What we used to think…<br />
What we know today…<br />Ambivalence<br />
2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
1999-2009<br />’58 – LASPC Crisis Center <br />’68 – AAS Formed<br />’09 – Dr. E.Shneidman Dies<br />’76 – 1st Crisis Cent...
Surgeon General David Satcher declares suicide “serious public health problem” (1999)
SAMHSA develops national network of creden-tialed crisis centers & 1-800-SUICIDE (2002)
Garrett Lee Smith grants provide $40 million annually for youth suicide prevention for states, tribes & universities (2004)
Joshua Omvig legislation provides array of new services from Veterans Affairs (2007) </li></ul>10<br />
1999-2009<br />’58 – LASPC Crisis Center <br />’68 – AAS Formed<br />’09 – Dr. E.Shneidman Dies<br />’76 – 1st Crisis Cent...
Tad Friend’s New Yorker article “Jumpers” revisits 1978 Richard Sieden research (2003)
Thomas Joiner’s groundbreaking book Why People Die by Suicide was published (2005)
Terry Wise key note at first national gathering for survivors of suicide attempts (2005)
Documentary “The Bridge” (2006)
Columbia & Rutgers publish on crisis center effectiveness and SRAS best practice (2007)</li></ul>11<br />
Current State of Affairs<br /><ul><li>Despite Advances, Too Many Lives Lost
Arizona 7th highest in 2006 (16/100,000 versus 8/100,000 in Connecticut)
986 died by suicide in Arizona in 2007 (twice the number from homicides)
Stigma and fear still a major impact
We must talk about this difficult subject
Broad variability in confidence and skills
Some staff relieved for the “suicide” burden to be passed to inpatient care, ER, or niche staff (includes liability and em...
Feel inexperienced & lack de-escalation tools</li></ul>12<br />
14<br />FY2007<br />2 Suicides<br />FY2008<br />3 Suicides<br />FY2009<br />4 Suicides<br />FY2010<br />12 Suicides<br />P...
15<br />
“Living Healthy Working Well”®<br />Achieving Better Outcomes, Improved Life-span & Richer Quality of Life<br />Four Clini...
Site of more than 1,200 deaths by suicide.<br />17<br />
<ul><li>Highest risk population (Enrollees)
Serious mental illness & addiction
Major Depression, Bi-polar Disorders, Schizophrenia, Borderline Personality, Anorexia
Today – Specialized crisis services
Niche crisis staff or programs
Suicide prevention geared toward community at large
Tomorrow – Core business
Change the culture, provide support and equip with skills
Train entire work-force with ASIST training and infuse latest research</li></ul>18<br />
The Workforce<br />19<br />
Maricopa Workforce Survey(N=1,641)<br />20<br />
Behavioral Health Workforce Survey (10/2009)<br />21<br />
I Know Someone Who Died by Suicide<br />22<br />
Question 16 of 16.<br />23<br />
Question 13. TRAINING<br />24<br />
Question 14. SKILLS<br />25<br />
Question 15. SUPPORT<br />26<br />
Question 2. Prevalence of Suicidal Desire<br />False. <br />Over one million Americans attempt suicide each year, and over...
Question 2. Prevalence of Suicidal Desire<br />28<br />
Question 3. Youth Versus Older Risk<br />False. <br />Insufficient attention has been given to the very high suicide rates...
Question 3. Youth Versus Older Risk<br />30<br />
Question 4. SMI Versus General Population<br />Estimated to be at least 6x greater.<br />Researchers vary but most agree t...
Question 4. SMI Versus General Population<br />32<br />
Question 5. Direct Suicide Questioning<br />Elizabeth Kubler-Ross.<br />Compared our culture’s feelings about talking open...
Question 5. Direct Suicide Questioning<br />34<br />
Question 6. Is Suicide Preventable?<br />Not true.<br />Many individuals struggle with ambivalence to the last moments, a ...
Question 6. Is Suicide Preventable?<br />In 1975, Dr. David Rosen wrote an in-depth study of six people who survived jumpi...
Question 6. Is Suicide Preventable?<br />37<br />
Questions 7 & 8. Planting the Idea Myth<br />Not supported.<br />Research has refuted this idea. Suicidal thoughts are one...
Question 7. Planting the Idea Myth<br />39<br />
Question 8. Depression Linked to Suicide<br />40<br />
Question 9. Emergency Intervention<br />Do No Harm.<br />This provocative question was meant to generate dialogue around t...
Question 9. Emergency Intervention<br />42<br />
Question 10. Why People Die by Suicide<br />Not true.<br />It's often a process. Most gave some indication they were unhap...
Why People Die by Suicide, Dr. Thomas Joiner<br />Capability<br />Intent<br />Imminent Risk<br />Capability + Intent<br />...
Why People Die by Suicide, Dr. Thomas Joiner<br />Highest Suicidal Risk exists when the following three components are all...
Question 10. Why People Die by Suicide<br />46<br />
Question 11. Desire to End Psychic Pain<br />Not generally.<br />They want their pain to end – they don't necessarily want...
Question 11. Desire to End Psychic Pain<br />48<br />
Question 12. Axis II – Borderline Personality<br />Not supported. Approximately 10% end up dying from their suicidal gestu...
Question 12. Axis II – Borderline Personality<br />50<br />
The Collaboration<br />51<br />
Adaptive Change Structure (2009-2011)<br />Workgroups<br />Targets of Initiative<br />Public Sector Community Behavioral H...
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Golden Gate Bridge Suicide Project 2010 07

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  • Suicides - Golden Gate Bridge:

    Problems in society. Take advantage of the 13 emergency buttons?
    No, people need to be there for each other. Survivors of suicide attempt: remorse during takeoff. Causes of suicide: mental health problems through drugs. Drugs to compensate for psychological problems. New literature: 'The dead at Fort Point', aavaa Publishing, 2013.

    Golden Gate Bridge: Wonderful World of statics and landmarks. Also remember the California gold rush in 1848 - 54 Prospectors traveled from the 'Golden Gate' in the direction of Auburn, Grass Valley and Sacramento. Many German. Literature. 'Gold of the Sierra Nevada, publishing aavaa,, 2012.
    ----------------------------------
    Selbstmorde - Golden Gate Bridge:

    Probleme in der Gesellschaft. Profitieren Sie von der 13 Notfall-Buttons?
    Nein, die Leute müssen füreinander da sein. Überlebende Suizidversuch: Reue während Absprung. Wer die Toten sah, konnte oft mit Erfolg psychisch therapiert werden: sehr schlimme Verletzungen auch durch Meerestiere.
    Ursachen Suizid auch in anderen Ländern: psychische Probleme durch Drogen. Drogen zur Kompensation psychischer Probleme. Literatur neu: 'Die Toten am Fort Point', Verlag AAVAA, 2013.
    Golden Gate Bridge: Wunderwelt der Statik und Wahrzeichen. Gedenken auch zum Kalifornischen Goldrausch 1848 - 54. Goldsucher reisten vom 'Golden Gate' in Richtung Auburn, Grass Valley oder Sacramento. Auch viele Deutsche. Literatur.: 'Das Gold der Sierra Nevada, Verlag AAVAA, 2012.
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  • Everyone can be saved. Every death can be prevented.
  • Suicidal mind is at war…
  • Transcript of "Golden Gate Bridge Suicide Project 2010 07"

    1. 1. Listening to the Lessons of the Golden Gate Bridge<br />Version 1.0<br />Developing a Comprehensive Suicide Deterrent Strategy for those with Serious Mental Illness<br />July 2010<br />David W. Covington, LPC, MBA <br />Chief of Adult Services<br />dwcovington@magellanhealth.com<br />1<br />
    2. 2. What we used to think…<br />
    3. 3. What we know today…<br />Ambivalence<br />
    4. 4. 2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
    5. 5. 2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
    6. 6. 2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
    7. 7. 2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
    8. 8. 2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
    9. 9. 2010<br />2006<br />2005<br />2003<br />1990<br />1978<br />1975<br />
    10. 10. 1999-2009<br />’58 – LASPC Crisis Center <br />’68 – AAS Formed<br />’09 – Dr. E.Shneidman Dies<br />’76 – 1st Crisis Center Certified<br />’99 – Satcher Declaration<br /><ul><li>Important Decade (Programs & Funding):
    11. 11. Surgeon General David Satcher declares suicide “serious public health problem” (1999)
    12. 12. SAMHSA develops national network of creden-tialed crisis centers & 1-800-SUICIDE (2002)
    13. 13. Garrett Lee Smith grants provide $40 million annually for youth suicide prevention for states, tribes & universities (2004)
    14. 14. Joshua Omvig legislation provides array of new services from Veterans Affairs (2007) </li></ul>10<br />
    15. 15. 1999-2009<br />’58 – LASPC Crisis Center <br />’68 – AAS Formed<br />’09 – Dr. E.Shneidman Dies<br />’76 – 1st Crisis Center Certified<br />’99 – Satcher Declaration<br />“17 Year Gap” Research to Practice <br /><ul><li>Clinical Research & Understanding:
    16. 16. Tad Friend’s New Yorker article “Jumpers” revisits 1978 Richard Sieden research (2003)
    17. 17. Thomas Joiner’s groundbreaking book Why People Die by Suicide was published (2005)
    18. 18. Terry Wise key note at first national gathering for survivors of suicide attempts (2005)
    19. 19. Documentary “The Bridge” (2006)
    20. 20. Columbia & Rutgers publish on crisis center effectiveness and SRAS best practice (2007)</li></ul>11<br />
    21. 21. Current State of Affairs<br /><ul><li>Despite Advances, Too Many Lives Lost
    22. 22. Arizona 7th highest in 2006 (16/100,000 versus 8/100,000 in Connecticut)
    23. 23. 986 died by suicide in Arizona in 2007 (twice the number from homicides)
    24. 24. Stigma and fear still a major impact
    25. 25. We must talk about this difficult subject
    26. 26. Broad variability in confidence and skills
    27. 27. Some staff relieved for the “suicide” burden to be passed to inpatient care, ER, or niche staff (includes liability and emotional components)
    28. 28. Feel inexperienced & lack de-escalation tools</li></ul>12<br />
    29. 29.
    30. 30. 14<br />FY2007<br />2 Suicides<br />FY2008<br />3 Suicides<br />FY2009<br />4 Suicides<br />FY2010<br />12 Suicides<br />Projected<br />
    31. 31. 15<br />
    32. 32. “Living Healthy Working Well”®<br />Achieving Better Outcomes, Improved Life-span & Richer Quality of Life<br />Four Clinical Initiatives/Key Programs<br />S u i c i d e P r e v e n t i o n & I n t e r v e n t i o n<br />C l i n i c a l C a r e M g m t <br />1<br />2<br />C r i s i s P l a n n i n g<br />3<br />4<br />H e a l t h / W e l l n e s s & L i f e s p a n L o n g e v i t y <br />Six Cross-Cutting Leadership Principles<br />Note: Psychiatric inpatient care may be an important treatment of last resort when medically necessary and community supports are insufficient.<br />16<br />
    33. 33. Site of more than 1,200 deaths by suicide.<br />17<br />
    34. 34. <ul><li>Highest risk population (Enrollees)
    35. 35. Serious mental illness & addiction
    36. 36. Major Depression, Bi-polar Disorders, Schizophrenia, Borderline Personality, Anorexia
    37. 37. Today – Specialized crisis services
    38. 38. Niche crisis staff or programs
    39. 39. Suicide prevention geared toward community at large
    40. 40. Tomorrow – Core business
    41. 41. Change the culture, provide support and equip with skills
    42. 42. Train entire work-force with ASIST training and infuse latest research</li></ul>18<br />
    43. 43. The Workforce<br />19<br />
    44. 44. Maricopa Workforce Survey(N=1,641)<br />20<br />
    45. 45. Behavioral Health Workforce Survey (10/2009)<br />21<br />
    46. 46. I Know Someone Who Died by Suicide<br />22<br />
    47. 47. Question 16 of 16.<br />23<br />
    48. 48. Question 13. TRAINING<br />24<br />
    49. 49. Question 14. SKILLS<br />25<br />
    50. 50. Question 15. SUPPORT<br />26<br />
    51. 51. Question 2. Prevalence of Suicidal Desire<br />False. <br />Over one million Americans attempt suicide each year, and over eight million have serious thoughts.<br />27<br />
    52. 52. Question 2. Prevalence of Suicidal Desire<br />28<br />
    53. 53. Question 3. Youth Versus Older Risk<br />False. <br />Insufficient attention has been given to the very high suicide rates among elderly, nearly 50% higher than 10-24 group. <br />Despite lower rates, youth deaths obviously account for much higher % of total deaths, e.g., 12% versus 0.3%.<br />29<br />
    54. 54. Question 3. Youth Versus Older Risk<br />30<br />
    55. 55. Question 4. SMI Versus General Population<br />Estimated to be at least 6x greater.<br />Researchers vary but most agree that between 90% and 99% who die have a diagnosable mental disorder (top 5 below):<br />Major Depressive Disorder<br />Bipolar Spectrum Disorder<br />Schizophrenia<br />Borderline Personality Disorder<br />Anorexia Nervosa <br />31<br />
    56. 56. Question 4. SMI Versus General Population<br />32<br />
    57. 57. Question 5. Direct Suicide Questioning<br />Elizabeth Kubler-Ross.<br />Compared our culture’s feelings about talking openly about death and dying as looking directly into the sun. We tend to only glance at it because of its paralyzing glare and tendency to emotionally disable.<br />She brought sun glasses by referring to death as a normal human process and event. The American Association of Suicidology believes the same is true for those doing this work, talking about death and suicide openly helps us see the person struggling and provide vital human contact and support.<br />33<br />
    58. 58. Question 5. Direct Suicide Questioning<br />34<br />
    59. 59. Question 6. Is Suicide Preventable?<br />Not true.<br />Many individuals struggle with ambivalence to the last moments, a fight between the will to live and the desire to end their pain.<br />35<br />
    60. 60. Question 6. Is Suicide Preventable?<br />In 1975, Dr. David Rosen wrote an in-depth study of six people who survived jumping from the bridge. <br />Almost unanimously, the survivors said their "will to live had taken over" after they survived. "I was refilled with a new hope and purpose in being alive.”<br />In 1978, Dr. Richard Seiden published "Where Are They Now?," a study of 515 people who were prevented from jumping from the bridge. He found only 6 percent went on to kill themselves.<br />(San Francisco Chronicle, Nov. 2005)<br />36<br />
    61. 61. Question 6. Is Suicide Preventable?<br />37<br />
    62. 62. Questions 7 & 8. Planting the Idea Myth<br />Not supported.<br />Research has refuted this idea. Suicidal thoughts are one of the DSM symptoms of major depression. 8.3 million Americans had serious thoughts of suicide last year.<br />38<br />
    63. 63. Question 7. Planting the Idea Myth<br />39<br />
    64. 64. Question 8. Depression Linked to Suicide<br />40<br />
    65. 65. Question 9. Emergency Intervention<br />Do No Harm.<br />This provocative question was meant to generate dialogue around the importance of emergency intervention by professionals. Our interest is “our” ethics to do no harm and help save lives. <br />SAMHSA is currently producing an emergency intervention standard protocol for guidance on supporting those at imminent risk.<br />41<br />
    66. 66. Question 9. Emergency Intervention<br />42<br />
    67. 67. Question 10. Why People Die by Suicide<br />Not true.<br />It's often a process. Most gave some indication they were unhappy, depressed, or considering suicide. <br />We want to combat stigma head-on so that there is more willingness to discuss openly.<br />43<br />
    68. 68. Why People Die by Suicide, Dr. Thomas Joiner<br />Capability<br />Intent<br />Imminent Risk<br />Capability + Intent<br />44<br />
    69. 69. Why People Die by Suicide, Dr. Thomas Joiner<br />Highest Suicidal Risk exists when the following three components are all present:<br />45<br />
    70. 70. Question 10. Why People Die by Suicide<br />46<br />
    71. 71. Question 11. Desire to End Psychic Pain<br />Not generally.<br />They want their pain to end – they don't necessarily want to die. Joiner’s model suggests thwarted belongingness and perception of burdensomeness.<br />47<br />
    72. 72. Question 11. Desire to End Psychic Pain<br />48<br />
    73. 73. Question 12. Axis II – Borderline Personality<br />Not supported. Approximately 10% end up dying from their suicidal gestures. The life-time prevalence of suicide for Schizophrenia is also between 5% and 10%. <br />“Why People Die by Suicide” page 18-20<br />49<br />
    74. 74. Question 12. Axis II – Borderline Personality<br />50<br />
    75. 75. The Collaboration<br />51<br />
    76. 76. Adaptive Change Structure (2009-2011)<br />Workgroups<br />Targets of Initiative<br />Public Sector Community Behavioral Health putting suicide prevention and intervention at the core of its business.<br />52<br />
    77. 77.
    78. 78.
    79. 79.
    80. 80. 56<br />Original Founding Membership<br />
    81. 81. The Five Tenet Framework<br />57<br />
    82. 82. Maricopa Programmatic Suicide Deterrent System Project: Five Key Threads<br />
    83. 83.
    84. 84. ASIST – Applied Suicide Intervention Skills Training<br />60<br /><ul><li>SAMHSA Best Practice
    85. 85. In 2007, a SAMHSA national workgroup compared top models and selected ASIST
    86. 86. More than 700,000 trained in US alone
    87. 87. Instead of warning signs and referral focus, relationship and direct, open discussion
    88. 88. Magellan of Arizona
    89. 89. In Sept 2009 and June 2010, Magellan hosted ASIST T4T trainings for 33 provider designees
    90. 90. Challenged agencies to train all staff
    91. 91. Staff report improved confidence and skills three months after going through the training</li></li></ul><li>ASIST – Applied Suicide Intervention Skills Training<br />2,000+ Trained Staff<br />Step 1: Certified Trainers<br />Step 2: Monthly ASIST<br />Step 3: National Webinars<br />Step 4: Culture Change<br />61<br />
    92. 92. Workforce Survey Findings<br />ASIST. <br />In comparing how groups performed on the survey, we found those with ASIST training basically tied those who were clinicians. As expected, nurses and physicians are also tremendous supports. <br />62<br />
    93. 93. Comparisons for Target Answers<br />63<br />
    94. 94. Equipping Maricopa’s Work Force with ASIST - 2,000+ in 2010<br />2000<br />823<br />41%<br />The November 2009 workforce survey demonstrated that nearly 10% of the Maricopa workforce received the two-day ASIST training prior to this initiative (n=152). The data in this slide covers only additional staff newly trained in ASIST in December 2009 and calendar year 2010.<br />Updated 6/22/2010<br />
    95. 95. Self-help or peer support model<br />Safe, stigma-free zone for open dialogue and support<br />Next Steps<br />Informal solicitation<br />Identify seed funding<br />Clinical support model<br />Process framework<br />
    96. 96. <ul><li>Collaboration with NAMI parents and 1300 N. Central clinic</li></ul>Next Steps<br />Family/Friends Welcome Packet<br />Family/Friends Night Events<br />Family/Friends Support Group<br />Pilot & Training<br />
    97. 97.
    98. 98.
    99. 99. Newsroom & Resources<br />69<br />
    100. 100.
    101. 101.
    102. 102.
    103. 103. 73<br />
    104. 104. 74<br />
    105. 105. 75<br />
    106. 106. 76<br />
    107. 107. Contact Us for More Info<br />David W. Covington, LPC, MBA <br />Chief of Adult Services<br />dwcovington@magellanhealth.com<br />twitter.com/davidwcovington<br />Shawn Thiele, LCSW<br />Chief, Child and Youth Services<br />SThiele@magellanhealth.com<br />77<br />
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