
Background
› Began in 2009 with the receipt of the Garret
Lee Smith grant through SAMHSA
› Nebraska Suicide Prevention Coalition
 Evidence based programming
 Question Persuade Refer - Gatekeepers
 Assessing and Managing Suicide Risk - Clinicians
The Suicide Prevention Resource Center is a
funded project of SAMHSA), U.S.
Department of Health and Human Services
(HHS).
 Promoting a mental health workforce that is
better qualified to practice culturally
competent mental health care based on
evidence-based practices is one of the
commitments of SAMHSA and a key to fully
implementing the National Strategy for
Suicide Prevention.


Suicide is the third leading cause of death in
young people between the ages of 15 and 24.

Every 16 minutes a suicide occurs in the U.S.

An average of one young person (ages 15-24) dies
every 2.08 hours.

No less than six other people are intimately
affected by those losses.

Children who have lost a loved one to suicide are
more likely to die by suicide themselves.
Suicide Rates, Children Ages 10-17
US and Nebraska, 1997-2007
16
Rate (deaths per 100,000 children 10-17)
14
12
10
8
6
4
2
0
1997
1998
1999
2000
Nebraska rates are three year averages; 2006 & 2007 values are
provisional. The 95% conf idence intervals around each point are also
show n. Nebraska rates are signif icantly higher than US rates f or
1999, and 2002-2005 (conf idence intervals do not overlap).
Source: Centers f or Disease Control and Prevention.
2001
2002
2003
2004
Nebraska (3-year averages)
2005
2006
2007
US (annual rates)
Suicide death rates by age and gender, Nebraska
residents, 2004-2008 (n=881)
Deaths per 100,000 population
30
25.7
24
25
21.3
19.5
20
19.1
19.8
17.4
17.1
Males
15
Females
10
5
7.1
1.6
0.9
3.7
6.9
4.2
3.3
2.3
3.3
*
0
5-14
15-24 25-34 35-44 45-54 55-64 65-74 75-84
Age group
Source: NHHSS Vital Statistics 2004-2008
85+

Evidence-based =
› Has demonstrated a causal link between program
and outcome through rigorous evaluation
methodology
› Achieves desired outcome
› Accurate to say “effective”

Current research and expertise 
› Help create an “evidence-base” for our work
7.
Implement,
evaluate, &
improve
interventions
1. Describe
the
problem &
its context
2. Identify
priority
problems &
long-range
goals
3. Consult
the
science;
identify
strategies
6. Create
an action
plan
5. Develop
an
evaluation
plan
4. Select or
develop
interventions
Means restriction practices (formal
programs designed to keep guns, pills or…
12
21
Suicide Screening practices in your jail
25
Training about suicide for volunteers
Outreach or services specifically for
suicide survivors
33
Peer Services or Mentoring (matching
people with another community member)
35
Training about suicide for health care
workers
38
Faith-Based activities, such as church-led
groups or efforts aimed at preventing…
40
Training about suicide for law
enforcement and first responders
41
Training about suicide for teachers and
schools
62
Suicide or Depression Screening practices
for adults
63
Training about suicide for behavioral
health (counselors, therapists, etc)
67
Suicide or Depression Screening practices
for youth
77
0
20
40
60
80
Society
Community
Relationship
Individual
Among all 18-24 year olds who died by suicide:
 Almost 50% were due to intimate partner problems
 Other reasons included:
› legal/criminal (20%),
› financial (12%),
› relationship problem with friend or family (13%)

Important to attend to youth who have had a recent
life event (relationship problem), who are depressed,
and a tendency towards impulsiveness, especially
within 2 weeks of life event
[Source: Harvard NVISS Pilot 2001]
Among all 18-24 year olds who died by suicide:


1 in 5 occurred on the same day as an acute life
crisis
1 in 4 occurred within 2 weeks

Approx. 46% occurred either on the same day or
within 2 weeks of a life crisis

Important because impulsiveness of suicide
› Crucial to provide immediate help
› Develop means for students in crisis to cope, provide safe
haven, ensure support system in place
[Source: Harvard NVISS Pilot 2001]
Suicide is an outcome that requires
several things to go wrong all at once
Biological
Factors
Familial
Risk
Predisposing
Factors
Major Psychiatric
Syndromes
Proximal
Factors
Immediate
Triggers
Hopelessness
Public Humiliation
Shame
Intoxication
Access To
Weapons
Serotonergic
Function
Substance
Use/Abuse
Neurochemical
Regulators
Personality
Profile
Impulsiveness
Aggressiveness
Severe
Defeat
Demographics
Abuse
Syndromes
Negative
Expectancy
Major
Loss
Severe Medical/
Neurological Illness
Severe
Chronic Pain
Worsening
Prognosis
Pathophysiology

Detecting potential risk

Assessing risk

Managing suicidality
 Safety planning
 Crisis support planning
 Patient tracking

MH Treatment

Do Professionals Really Need More Training?
› Behavioral health professionals have a crucial
role in preventing suicides.
› A number of studies report that a substantial
proportion of people who died by suicide had
either been in treatment or had some recent
contact with a mental health professional.
› Many previously diagnosed with a psychiatric
illness at the time of death
› Additionally, hundreds of thousands of people
show up in hospital emergency departments
each year for treatment after a suicide attempt.
Clients' suicidal behaviors are a reality for
mental health therapists and the source
of significant distress for them.
 Mental health professionals are "not
adequately trained to provide proper
assessment, treatment, and
management of suicidal patients."²
 Professionals have been calling for
increased formal training in this area for
decades.


In 2004, SPRC contracted with the
American Association of Suicidology
(AAS) to validate the need for
competency-based curricula
› collect available curricular materials,
› develop curricula modules in the areas of
assessment and management.
› develop a one-day curriculum
Competencies encompass clusters of
knowledge, skills, abilities, and attitudes
or perceptions required for people to be
successful in their work.
 In this case, core competencies refer to
the clinical evaluation, formulation of risk,
treatment planning, and management
of individuals at risk for suicide to protect
their lives and promote their well-being.


The following set of core competencies,
based on current empirical evidence
and expert opinion, provides a common
framework for learning about and
gaining skill in working with individuals at
risk for suicide. They are not intended to
be construed or to serve as a standard
of care.
Twenty-four competencies and their subcompetencies fall into seven broad
categories
 Core competencies related to specific
treatment interventions have not been
developed.

Literature review
 Collection of core competencies and
rubrics for measuring core competencies
from related fields
 Collection of instructional materials
 Creation of a Task Force to review the
collected information; develop training,
recommend reference material and
instructional strategies;
 Pilot testing the curriculum and making
necessary revisions






Become familiar with core competencies
that enable mental health therapists to
assess and work more effectively with
individuals at risk for suicide
Define terms related to suicidality
Become familiar with suicide-related
statistics
Identify major risk and protective factors
Understand the phenomenology of suicide
› Manage one's own reactions to suicide
› Reconcile the difference (and potential
conflict) between the clinician's goal to
prevent suicide and the client's goal to
eliminate psychological pain via suicidal
behavior
› Maintain a collaborative, non-adversarial
stance
› Elicit suicide ideation, behavior, and plans
› Make a clinical judgment of the risk that a
client will attempt or complete suicide in the
short and long term
› Collaboratively develop an emergency
plan
› Develop a written treatment and services
plan that addresses the client's
immediate, acute, and continuing
suicide ideation and risk for suicide
behavior
› Develop policies and procedures for
following clients closely, including taking
reasonable steps to be proactive
› Follow principles of crisis management
› Expect participants to experience
changes in perceptions of working with
suicidal clients.
 For example, increased willingness,
confidence, or clarity in working with
individuals at risk for suicide.
› Identify changes to make in practice specific to
the assessment and management of individuals
at risk for suicide.

Attitudes and Approach
› Manage one's own reactions to suicide
› Reconcile the goal to prevent suicide and the
goal to eliminate psychological pain via suicidal
behavior
› Maintaining non-adversarial stance
› Realistically assess one's ability care for a
suicidal client

Understanding Suicide
› Identify basic terms related to suicide
› Become familiar with suicide-related data
› Describe the phenomenology of suicide
› Understanding of risk and protective factors