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El Paso County Suicide Prevention Call to Action 17 January 2020

The El Paso County Suicide Prevention Call to Action is part of the Colorado National Collaborative, a comprehensive approach to suicide prevention in El Paso County, Colorado

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El Paso County Suicide Prevention Call to Action 17 January 2020

  1. 1. Suicide Prevention A Call To Action
  2. 2. WELCOME • Venue Orientation • Event Format • Memorial Banner
  3. 3. Access to Care Lethal Means Safety Postvention El Paso County Suicide Prevention Task Force 1. Define The Problem 2. Identify Risk and Protective Factors 3. Develop and Implement Strategies 4. Ensure Widest Dissemination Connectedness Education and Awareness Economic Stability Colorado National Collaborative El Paso County Suicide Prevention Task Force El Paso County Suicide Prevention Workgroups 5. Evaluate and Refine Young Adult Working Adult Older AdultYouth First Responder Military LGBTQ+ Disabled El Paso County Suicide Prevention Task Force
  4. 4. DEFINING THE PROBLEM: El Paso County Suicide Statistics What is the information on suicide: Nationally State-Wide Locally (City / County)
  5. 5. 11.6 11.7 12.1 12.3 12.5 12.5 12.9 13.2 13.4 14.0 0.0 5.0 10.0 15.0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 AVERAGE U.S. SUICIDE RATES 2008-2017 17.4 21.4 17.2 16.6 22.7 22.7 22.0 24.1 27.0 22.4 0.0 10.0 20.0 30.0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 AVERAGE EL PASO COUNTY SUICIDE RATES 16.5 18.5 16.6 17.4 19.5 18.5 19.7 19.4 20.4 20.3 0.0 10.0 20.0 30.0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 AVERAGE COLORADO SUICIDE RATES DEFINING THE PROBLEM: National – State – Local Suicide Rates
  6. 6. El Paso County Suicide Rate Ages 20-24 El Paso County Suicide Rate Ages 10-19 El Paso County Suicide Rate Ages 25-55 El Paso County Suicide Rate Ages 65+ High: Low: 2018: 2015 (19.5) 2011 (3.2) 9.8 High: Low: 2018: 2014 (35.8) 2011 (15.8) 25.6 High: Low: 2018: 2016 (35.4) 2006 (14.7) 29.9 High: Low: 2018: 2015 (31.3) 2005 (13.6) 19.7 DEFINING THE PROBLEM: El Paso County Suicide Statistics
  7. 7. Colorado-National Collaborative • Sarah Brummett, Colorado Office of Suicide Prevention
  8. 8. Colorado-National Collaborative Sarah Brummett, MA JD Director, Colorado Office of Suicide Prevention Overview El Paso County Suicide Prevention Conference January 17, 2020
  9. 9. Colorado-National Collaborative is a partnership of local, state and national scientists and public health professionals working with health and social service agencies, nonprofit organizations, government agencies, businesses, academic organizations and Colorado residents to identify, promote and implement successful state- and community-based strategies for suicide prevention in Colorado.
  10. 10. National Beginnings1
  11. 11. Beginning Theory: Coordinated and full-scale comprehensive prevention efforts are necessary to demonstrate a measurable reduction in rates and numbers at the state level. Goal: Develop, implement, and evaluate a comprehensive strategy that can be replicated nationwide. Assessment Capacity Building Planning Implementatio Evaluation Step 1: select the state.
  12. 12. Identifying the Starting Point: State Readiness 14 Factors Evidence Significant Burden • High enough burden to demonstrate effectiveness of successful intervention Political Will • Senior political support (e.g. governor & state legislature) • Recently passed legislation in support of suicide prevention Key Infrastructure • Senior Executive & State Infrastructure • Suicide Prevention Commission • Support across federal, county, & community behavioral health centers Firearm Laws • Preferred state with less restricted rural/urban firearm ownership laws Agreement on Approach • Respect for both Upstream & Downstream Approaches (Public Health & Mental Health)
  13. 13. Evaluation Intervention Packages / Programs • Process and outcome designs to measure baseline and impact of all intervention strategies, programs, and/or policies Action Research / Systems Level • Tracking and measuring the process • Ensuring that successes can be accounted for and replicated in additional communities • National partners – Ensure that strategy can be replicated in other states Constant Evolution • Iterative Design
  14. 14. State Conversations2
  15. 15. State Partners National Partners • Colorado Department of Public Health and Environment/ Office of Suicide Prevention • Suicide Prevention Commission • Rocky Mountain Mental Illness Research, Education and Clinical Center at the Denver Veterans Administration Center • Governor’s Office • CO Behavioral Healthcare Council • University of CO Depression Center • University of CO Hospital • Colorado Governor’s Challenge ● Injury Control Research Center for Suicide Prevention ● Education Development Center (Suicide Prevention Resource Center) ● American Foundation for Suicide Prevention ● Centers for Disease Control and Prevention ● Substance Abuse and Mental Health Services Administration ● National Action Alliance
  16. 16. Refining the Scope: An interactive data dashboard
  17. 17. County Prioritization3
  18. 18. Pilot Counties El Paso La Plata Larimer Mesa Montezuma Pueblo
  19. 19. County Conversations4
  20. 20. El Paso County • Strong Community Collaborations • Public/Private partnerships • Success with youth suicide prevention efforts • Grantees working across health systems, school districts, community mental health, nonprofits • Engaged Veteran community • Supportive firearm community • Robust data sources • Readiness!
  21. 21. County Partners Include: • Local Public Health Departments • Community Mental Health Centers • Local Coalitions and non-profits • Hospitals • Schools/Districts • Law Enforcement/Fire/EMS • Family Resource Centers • Faith Community leaders • Veteran-serving organizations • Local government agencies • And more!
  22. 22. Selection of Key Strategies5
  23. 23. Selecting Common Strategies and Priorities: - Data-driven - Across the continuum: prevention, intervention, postvention - Evidence-based, where possible - Common strategies across all 6 communities so that it can be evaluated - Aligned with national recommendations from CDC and National Action Alliance - Lens of health equity and inclusivity (race, ethnicity, urban/rural, LGBTQ+) - Infrastructure and capacity critical ($$$)
  24. 24. Older Adults 65+ Youth (0-18) LGBTQ+ Community VeteransWorking-Age Adults (25-64) Populations of Focus Young Adults (19-24)
  25. 25. Reduce Suicide Burden by 20% by 2024 Increase Key Protective Factors Reduce Key Risk Factors Providing Education and Awareness Improving Connectedness Suicide Safer Care Increasing Lethal Means Safety Strengthening Postvention Efforts Increasing Economic Stability Identify partners/support groups to fill gaps in coalition work Share information on best practice, resources, and tools Provide coordination across CNC counties Gather and share data to improve prioritization and monitoring State&National PartnerEfforts Community Strategies OutcomesPriority Provide Technical Support and Sustainability Planning Build state/local political will Provide expectations and toolkits around equity Secure funding Strategic Funding and Staffing Infrastructure Strategic Partnerships Engaged Data Shared Learning and Support Local, State, and National Leadership Responsive Planning
  26. 26. Next Up: Action Planning6
  27. 27. More questions? Sarah Brummett THANKS!
  28. 28. Call to Action
  29. 29. Chief Christopher Heberer Chief Christopher Heberer is a native of Canon City, Colorado. He received a Bachelor of Arts degree in Criminal Justice from Gonzaga University, Spokane, Washington and received his Master of Arts degree from Webster’s University in Security and Organizational Management in 2005. During his 20 year career in the Army serving as a Military Police officer, Chief Heberer commanded at all levels to include platoon, company and battalion. He served as the 759th Military Police Battalion Commander and as the Ft. Carson Director of Emergency Services. Chief Heberer commanded over 1,100 personnel and was responsible for directing and the implementation of all Police, Fire and 911 emergency dispatch services supporting a military and civilian community of over 26,000 personnel on Ft. Carson. Chief Heberer deployed three times throughout his career to include transforming the Mosul Police Force, Iraq in 2009 and serving as the Joint Expeditionary Forensic Director in 2011, supporting all US Forces in Iraq. Chief Heberer held a variety teaching and staff positions during his time in the Army and is a graduate of the Army’s Command and General Staff School, US Army Airborne, Jump Master and Air Assault schools. Chief Heberer was granted the distinction of Law Enforcement Executive Certification through CACP in 2015. Chief Heberer is also a Board Member for Status: Code 4, Inc.
  30. 30. Connectedness  David Galvan, Education for a Lifetime  Heather Pelser, Regional Youth Suicide Prevention Coordinator for El Paso County
  31. 31. Thomas Joiner: Why People Die by Suicide (2005)  Thwarted Belongingness (Feeling Alone)  Fear of Burdensomeness  Ability for Lethality
  32. 32. Education & Awareness  Morgan Lavender, UCCS  Lori Jarvis-Steinwert, National Alliance on Mental Illness
  33. 33. How common are mental illnesses? • Mental illnesses are among the most common health conditions in the United States. • More than 1 in 5 Americans will experience a mental illness in a given year. • 50% will be diagnosed with a mental illness or disorder at some point in their lifetime. • 1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness. • 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Source: Center for Disease Control and Prevention, Mental Health Basics,
  34. 34. Why peer support? “Peer support offers a level of acceptance, understanding and validation not found in many other professional relationships.” SAMSHA, Value of Peers, 2017
  35. 35. Innovative Peer Support • Below the Surface: Pomoted Colorado Crisis Services’ texting services to youth and teens in El Paso County • Text line usage among 11- to 19-year-olds in ZIP codes near the campaign’s first two pilot schools tripled from May 2017 to May 2018. • Once the campaign was introduced in Academy School District 20, the increase was even more dramatic: In the first five months following introduction of the campaign text conversations tripled. • Campaign adopted statewide by the Colorado Office of Behavioral Health
  36. 36. Education & Awareness Outline of Topics Population Barriers Programs Moving Forward
  37. 37. Suicide is the leading cause of death in those aged 10-24 years old Colorado Health Institute, 2018
  38. 38. College Counseling Centers across the nation cannot keep up with the demand of students' needs Lipson, 2019 Funding Space Personnel
  39. 39. "I feel lighter, more relieved now knowing that I’m not alone in struggling sometimes. It’s comforting to remember that if everything isn’t okay in this moment, things can get better and I can make that happen, especially with the support from people I love." Practicing Happiness Participant Image via @properfilms
  40. 40. Economic Stability • Joel Siebersma, Springs Rescue Mission • Beth Roalstad, Homeward Pikes Peak
  42. 42. Access to Safer Suicide Care  Jamie Falasca and Erin Milliken, AspenPointe  Andrea Wood, UC Health
  43. 43. The Walk-In Center offers a confidential, safe place to de-escalate from crises and receive early intervention care in order to stabilize and prevent the need for higher levels of care. Available 24 hours a day, 7 days a week. Call 844-493-TALK (8255) Text “TALK” to 38255 Stop by 115 S. Parkside Dr. Colorado Springs, CO 80910 For more information or to schedule an appointment, please call our Contact Center at (719) 572-6100.
  44. 44. Can Suicide Be A Never Event?
  45. 45. Core Components • Leadership commitment • Standardized screening and risk assessment • Suicide care management plan • Workforce development and training • Effective, evidence-based treatment • Follow-up during care transitions • Ongoing quality improvement and data collection
  46. 46. Lethal Means Safety  Dr. Erik Wallace, University of Colorado School of Medicine  Sgt. Eric Frederic, Colorado Springs Police Department
  47. 47. Lethal Means Safety El Paso County Suicide Prevention Task Force Meeting Erik Wallace, MD, FACP University of Colorado School of Medicine Sgt. Eric Frederic Colorado Springs Police Department January 17, 2020
  48. 48. Suicide Case Fatality Rates*, US (2007-2014) *proportion of all suicidal acts that are fatal in a given population • 3,657,886 suicide attempts requiring treatment in ED or hospitalization • Does not include non-fatal attempts that did not require an ED/hospital visit • 309,377 suicide deaths • 1 in 12 (8.5%) attempts are fatal • Case Fatality Rate • 3.3% females vs. 14.7% males • 3.4% ages 15-24y vs. 35.4% ages >65y Conner A et al. Ann Intern Med. 2019;171(12):885-895.
  49. 49. Methods Used for Suicide, US (2007-2014) 59%21% 5% 5% 4% 6% Suicidal Acts,% (3,657,866) Drug Poisoning Cutting/Piercing Non-Drug Poisoning Firearm Hanging Other 13% 2% 1% 51% 25% 8% Suicide Deaths,% (309,377) Drug Poisoning Cutting/Piercing Non-Drug Poisoning Firearm Hanging Other Conner A et al. Ann Intern Med. 2019;171(12):885-895.
  50. 50. Case Fatality Rate*, % (2007-2014) *proportion of all suicidal acts that are fatal in a given population 89.6 56.4 52.7 30.5 27.9 26.8 1.9 1.1 0.7 1.7 0 10 20 30 40 50 60 70 80 90 100 Conner A et al. Ann Intern Med. 2019;171(12):885-895.
  51. 51. Age-Adjusted Death Rate*, #deaths/100,000 Firearm Suicides 6.1 9 10.4 6.9 10.1 12.7 US COLORADO EL PASO COUNTY 2001-2017 2017 US and Colorado data obtained from El Paso County data obtained from *Age-Adjusted Death Rate = #deaths/100,000 population using correction factor for standard year 2000
  52. 52. Deaths by Suicide, El Paso County (2018) 53% 47% Firearm vs. Non-Firearm (152 total) Firearm - 80 Non-Firearm - 72 51% 24% 13% 6% 6% Non-Firearm (72) Hanging - 37 Drug Poisoning - 17 CO Poisoning - 9 Suffocation - 4 Trauma - 4 El Paso County Coroner’s Office
  53. 53. Deaths by Suicide, El Paso County (2018) Firearm • Avg. Age – 44.6y • Active military 26.6y (N=10) • Non-active military 47.2y (n=70) • 85% male • 86% white/non-Hispanic • 39% with alcohol • 25% above 80 mg/dl (avg. 186 mg/dl) Non-Firearm • Avg. Age – 42.8y • Hanging - 37.4y (n=37) • 67% male • Drug poisoning – 48y (n=17) • 47% male • CO Poisoning – 48y (n=9) • 67% male • 34% with alcohol El Paso County Coroner’s Office
  54. 54. Deaths by Firearm Suicide, EPC (2018) • 96% owned the firearm that was used • 65% found at home/outside home • 65% found by family/friend/colleague • 58% with h/o suicidal ideations/attempt • 53% with h/o depression/bipolar/PTSD • 55% with education more than HS diploma • 90% had identified risk factor other than mental health • Physical health (pain, cancer) • Relationship stress • Financial/employment stress • Military exposure/discipline • Suicide of friend/family • h/o sexual abuse • Criminal past • Substance abuse El Paso County Coroner’s Office
  55. 55. “People bent on suicide will find many ways to do away with themselves – pills, hanging, drowning, cutting arteries, jumping from any bridge or building. Wouldn’t it be much better to spend the money on mental health care for many people…?” • Displacement • Assumption that people would simply switch to another method of suicide…blocking one option isn’t going to make a difference • Coupling • Suicide is coupled to a particular context...specific circumstances and conditions Gladwell M. Talking to Strangers. 2019
  56. 56. Suicide using gas ovens, England • In England, gas used for ovens contained carbon monoxide • Gas converted from 1960-1977 • Gas suicides declined from >2400/year to zero • Overall suicide rate declined from 120/million to 75/million (37.5% reduction) Gladwell M. Talking to Strangers. 2019
  57. 57. How do we reduce suicides? • Suicide is an impulsive decision • 90% of people who survive suicide attempts don’t go on to kill themselves • Case Fatality Rate: 90% Firearms, <2% overdose • Reducing access to lethal means (i.e. firearms) to those who are at risk of attempting suicide is the most effective way to reduce the number of people who complete suicide
  58. 58. What if in 2018…? • If the 80 people in EPC who completed suicide by firearm did not have access to a firearm when in crisis, and… • If we assume there would have been a 37.5% reduction in suicides among this group, then… • There could have been 30 fewer suicide deaths (80x.375=30), then… • Total suicide deaths reduced from 152 to 122, which is… • A 20% reduction in total suicides in EPC • Goal of Colorado National Collaborative: Reduce suicides by 20% by 2024
  59. 59. What can I do to prevent suicide? • Identify risk factors and warning signs of suicide • Assess for and limit access to lethal means • Medications – lock boxes • Alcohol – limit access • Firearms 1. Triple-safe storage (unloaded, locked, inaccessible to children) 2. Give firearms and gun lock keys to a trusted family member or friend 3. Create a firearms directive 4. Consider off-site storage options 5. Extreme Risk Protection Order (ERPO)
  60. 60. Lethal Means Assessment Questions • Are any guns in the home stored in a way that they are safe from being misused? • Are there weapons in the home that concern you? • Do you think your child knows how to get access to a firearm? • Do you know if there are unlocked firearms in the homes where your child plays with friends? • Are you concerned that a household member might be unsafe around firearms? • Are you concerned that you might one day become unsafe around firearms? 68
  61. 61. Firearms Directive 70Betz ME et al. Ann Intern Med. 2018;169(1):47-49.
  62. 62. Gun Storage Map
  63. 63. Gun Storage Options in EPC • High Tech Custom Rifles Inc. • Oasis Custom Firearms • Springs Armory • JT Tactical Firearms And Gunsmithing • Paradise Sales/Firearms • GT Products LLC • Harless Precision LLC
  64. 64. Colorado Firearm Transfer Laws • …immediate family members do not need background checks done to transfer firearms between one another. The firearm should not be transferred to any family member who is prohibited from purchasing and/or possessing firearm. • Immediate family is defined as spouses, parents, children, siblings, grandparents, grandchildren, nieces, nephews, first cousins, aunts, and uncles (in-laws do not apply). (CRS 18-12-112)
  65. 65. Extreme Risk Protection Order (ERPO) • Civil restraining order prohibiting the named individual from controlling, owning, purchasing, possessing, or otherwise having custody of firearms. • This should only be considered as a last resort when you are concerned about the safety of a loved one who has access to firearms. • A request for an ERPO can only be initiated through the court system. • For more information, visit the Colorado Judicial Branch website at, or visit any Court Clerk’s office in Colorado
  66. 66. What can I do to prevent suicide? • Identify risk factors and warning signs of suicide • Assess for and limit access to lethal means • Medications – lock boxes • Alcohol – limit access • Firearms 1. Triple-safe storage (unloaded, locked, inaccessible to children) 2. Give firearms and gun lock keys to a trusted family member or friend 3. Create a firearms directive 4. Consider off-site storage options 5. Extreme Risk Protection Order (ERPO)
  67. 67. Postvention  Betty and Kevin Van Thournout, Heartbeat  Cassandra Walton, Pikes Peak Suicide Prevention Partnership
  68. 68. POSTVENTION What You Need to Know Presented by: Heartbeat Survivors After Suicide Pikes Peak Suicide Prevention Partnership
  69. 69. The Personal Side of Postvention: “Our New Normal”
  70. 70. Ryan was born on June 6th, 1968 Ryan ended his life July 10, 2014
  71. 71. The day of our son’s suicide.  Notified by Ryan’s Friend- immediate need to get to Betty & Kirsten  Shock/Horror/Disbelief/Denial – Ryan’s friend gave me the coroner’s number. Are you sure it’s Ryan? Are you sure about the cause of death?  Person’s bereaved by suicide grieve the loss, but also the cause of death and all that suicide means, and they are impacted by the perception of suicide by most of society.  We had no idea how to navigate the situation and no one to ask.
  72. 72. Suicide Bereaved People Have Needs and Tasks Emotional Needs  Tell their story- reviewing history, testing reality  Express their feelings – ventilating the pain, validating loss  Making meaning & Purpose – investing grief energy into positive action  Transforming the Relationship- physical presence into loving memory Real World Tasks  Employment  Routine Bills and Chores  Be a Spouse/Parent  Coordinate funeral services  Deal with previously scheduled engagements
  73. 73. The lack of formal postvention.  Our family could have been positively impacted by receiving structured communication and receiving resources to help us in the aftermath of our son’s death. Luckily, we were able to find support from a local survivor support group. We are happy to understand the current efforts to ensure that postvention responses are standardized so that families like ours can be surrounded by all of the support they need.
  74. 74. POSTVENTION: What is it? Postvention refers to the actions and interventions conducted in the immediate aftermath of a suicide. Hypothesis: Implementing coordinated postvention response efforts will reduce suicidal thoughts and behaviors including the reduction of attempts and deaths. Postvention must be a collaborative effort between the household, the school/employer, the media, and community resources. Additionally, efforts must address the unique needs of different populations that live within our community.
  75. 75. SURVIVOR SUPPORT Immediate and on-going grief support. We will work to create a standardized way for resources to be communicated as part of the postvention response by the coroner’s office. Education/Training for Schools or Employers so that they may provide the appropriate support and accommodations. Education/Training for the media to address the most appropriate ways to report in the most compassionate and respectful manner. Research has shown us that the way a suicide is reported by the media makes a difference. Families and close friends impacted by a completed suicide have an increased risk of engaging in suicidal behaviors; this is known as “suicide contagion.” They require immediate access to support services.
  76. 76. COMMUNITY SUPPORT General Grief Support- there is a ripple effect to a loss by suicide within the community whether an individual may have been close to the person who passed or not. Mental Health Support- talk of suicide and observing community impact may be triggering to individuals struggling with mental health issues and increased support should be available. Postvention Response Protocols: Entities may require general assistance on how to address a suicide and entities directly impacted may need training/support on creating the necessary postvention response protocols.
  77. 77. OBJECTIVES OF POSTVENTION EFFORTS  Increase in coordination of survivor outreach to promote and support healing.  Increase in the perceived capacity to support survivors and the impacted community.  Increase in community/agency/organizational education and awareness of postvention terms, concepts and best practice principles and interventions.  Increased coordination of community postvention response efforts that include prevention outreach, support and services.
  78. 78. COMMUNITY RESPONSE  The Community Response to Suicide must be an intentional and collaborative effort. This image provides a very simplistic view of Suicide Prevention. Postvention falls under “healing” in this model. Once an injury occurs in any other context, we understand that if the healing process is not engaged properly additional problems can be expected. It is important to acknowledge that postvention is truly a lifesaving measure. With collaborative efforts, we can and will save lives. Image from: FNHA Suicide Prevention Toolkit
  79. 79. Priority Populations Panel  Youth: Meghan Haynes and Kelsey Leva (El Paso County Public Health)  Young Adults: Dr. Benek Altayli and Stephanie Hanenberg (UCCS)  Elderly: Magdalene Lim, PsyD (UCCS) and Jason DeaBueno (Silver Key)  Veterans: Duane France (Colorado Veterans Health and Wellness Agency)  1st Responders: Sgt. Jason Garrett (El Paso County Sheriff's Office)  LGBTQ: Dr. Alexander Wamboldt (Inside/Out Youth Services)  Disabilities: Elle Livengood and Carrie Baatz (The Independence Center)
  80. 80. Raising mental health awareness is great, but I worry about a society in which we are all trained to think that the person next to us is about to take their lives. What about trainings to promote emotional intelligence? Or policies to reduce, rather than simply cope with, stress? -Dr. Rajeev Ramchand Bob Woodruff Foundation
  81. 81. Melissa K. Hansen, MPH Project Manager A Call to Action Jan. 17, 2020
  82. 82. What’s Next?
  83. 83. Suicide Prevention A Call To Action January 17, 2020 THANK YOU