Mark Twain Behavioral Health Suicide Prevention Initiative
Need
The Mark Twain Behavioral Health Suicide Prevention Initiative plans to target at-risk youth,
LGBT population, foster children/parents, and suicide attempt survivors that span across all age
ranges in northeast Missouri. In 2011 Northeast Missouri experienced suicides from area youth
as young as 11 years of age. The regional data does suggest that occurrences in youth suicide
younger than the age of 11 are fairly rare. Sadly, the data remains consistent with no real noted
reduction in Missouri’s youth suicides in the 10-24 age range over the past few years. When
reviewing the Behavioral Health Profile for counties in our service area, over 13.62% of students
report struggling with psychological distress annually. Youth suicide is a tragic and unhealthy
choice that remains in the spotlight every time there is a local occurrence. On the other end of
the age spectrum, MTBH has also recently been involved in local employment assistance
interventions in the workplace when middle age adults and older adults have completed suicide,
with the ultimate goal to work with providers regarding staff coping with those untimely deaths.
Due to rising healthcare costs more and more employers are focused on overall employee
wellness efforts. Through conducting those activities it is evident that there is still a struggle to
accept completed suicide as a cause of death and those occurrences leave so many unanswered
questions for co-workers and loved ones in its mists on what they could have done to prevent the
event.
Overall Missouri experienced approximately 800 suicides annually. Statewide data suggests that
116 of those on average were youth completed suicides. The youth rates are ever so slightly
higher than the national average but fairly stable for Missouri. The middle age adult population
has actually shown an increase in completed suicide rates, which makes the need for a variety of
clinically based services on the rise. Due to recent occurrences in Northeast Missouri, there has
been a request by local media to address prevention activities specifically regarding youth
suicides. With some of the recent deaths, it becomes evident of the lack of knowledge and
acceptance that such tragic events can occur in our youngest citizens. With the recent youth
suicide this October, it was apparent that despite the diligent local efforts over the past seven or
eight years on the Missouri State Suicide Prevention Plan the community responses are still very
stressed and uncomfortable when reports are made of local youth completed suicides. There also
continues to be a question of what is appropriate media coverage. As a mental health
organization, we want to balance the need to educate the community about risk factors and how
to seek help with the sensitivity of the community’s and family’s grief of the loss of such a
young child. With the trends in the known “contagion effect,” it is important to educate the
community about the risk factors associated with suicide and encourage help seeking behavior as
a norm both before and after an event occurs.
Purpose and Description
MTBH plans to utilize existing coalitions and within those coalitions we will be developing
subcommittees to address suicide prevention efforts in the community. Two long-time
established coalitions that we plan to utilize are the System of Care team in Kirksville and the
Adair County Mental Health Board. Secondly, we plan to use the Northeast Missouri Health
Coalition in Hannibal to establish group missions and objectives on prevention efforts in the
Hannibal area. The Kirksville groups have experienced longevity of members for over ten years
and will assist in providing guidance to the MTBH clinical team on activities related to suicide
prevention efforts in Northeast Missouri. The Hannibal coalition has been established in the
past two years to address the shortage of inpatient hospitalization for the areas for their most
vulnerable citizens. The teams will develop annual goals and objectives for ongoing suicide
prevention efforts which can be implemented by the MTBH clinical team.
The program will target having a coordinator to collaborate with the local coalitions on local
needs assessments, enhancing their mission to include targeted prevention activities, and
coordination of awareness activities. The initial goal of the program is to have a kick-off event
that will raise awareness in the community about local suicide prevention efforts. Since the
Kirksville community has suffered such a loss in recent months, the MTBH team will
recommend targeting our youth population and coordinate services with Megan Meier
Foundation to invite them into our community to present on youth suicide prevention.
Subsequent grant interventions will range across universal, selected and indicated interventions
and vary from implementing gatekeeper trainings, establishing survivor support groups,
professionally driven mental health support groups and increase community development
opportunities. Initial conversations have taken place in Adair County Mental Health Board
meetings regarding reaching the LGBT population and coordinating services with the local group
on the Truman State University Campus. Overall the coalitions in our service area will be
utilized to collaborate with the community regarding identified community needs and the clinical
services and trainings will be delivered by MTBH clinical staff.
Organizational Experiences and Capacity
Mark Twain Behavioral Health (MTBH) staff has actively provided comprehensive mental
health services to the citizens and families in northeast Missouri for over 30 years. MTBH has
three offices in Kirksville, Hannibal and Macon. The organization serves the northeastern
counties including Marion, Lewis, Clark, Shelby, Macon, Adair, Scotland, Schuyler, and Knox
County. The center is an outpatient not for profit organization with over 80 employees. MTBH
is the administrative agent in the area and provides coordination for services for consumers
coming from the state hospitals and also operates a 24 hour Access Crisis Intervention Services
to assist local residents in mental health crisis evaluation, consultation and referral for
continuation of services. MTBH staff is actively involved in with local coalitions and System of
Care teams to wrap supportive services around our most vulnerable residents.
MTBH provides extensive services to adults and youth that are experiencing severe and
persistent mental health conditions through our Community Psychiatric Rehabilitation Program.
With one of the highest identified risk factor of suicide being mental disorders and substance
abuse, MTBH is an organization with extensive knowledge of both treatment interventions. We
have certified staff in both clinical mental health disciplines. Several staff members are dually
certified in substance abuse. MTBH has spent the past ten years working toward co- occurring
competence and has been striving to provide integrated care to individuals with co-occurring
disorders.
Sustainability
The organization have experienced great successes in reaching out to area youth, which is
evidenced by our growing numbers of youth being served in our Children’s Community
Psychiatric Rehabilitation Program. MTBH supervisors and staff are active members of the
System of Care and area Child and Adolescent Service System Program, which provides direct
contact with school officials, social services workers, and juvenile justice staff this allows us to
send our message to a larger student population, than students just seeking specialized mental
health services. In addition to our work with area youth, we have a thriving adult program that
also provides much needed services to the community through an integrated healthcare approach
including behavioral healthcare, treatment of co-occurring disorders, and providing coordination
of overall healthcare to promote better client outcomes.
Clinical Director, Angela Caraway MSW, LCSW, CASAC will champion this project with the
inclusion agency clinical staff in both the Kirksville and Hannibal offices. MTBH has also been
a past recipient in 2007 of the Suicide Prevention Mini Grants and the larger Suicide Prevention
Resource Center Grant. The organization is very familiar with evidence based practices in this
area. The organization is currently a recipient of the 2012 Youth Suicide Prevention Mini-Grant
through the Missouri Department of Mental Health to conduct awareness activities through
universal interventions such as Public Service Announcements (PSA’s). The efforts associated
with this larger initiative would be sustained through our partnership with the local coalitions by
establishing annual goals for local suicide prevention efforts. Through those sources we also
have the ability to conduct further needs assessments associated with behavioral health
community prevention needs in Northeast Missouri as they develop with this initiative.
After an initial start up of some of the groups, MTBH can establish a line item budget for
continuation of those groups or incorporate them into the current service planning. The
coalitions identified have access to training dollars for continuation of some professional
development training in the future. Truman State University can assist with lodging expenses for
the identified speaker for the kick-off event.