Paul Quinnett, Ph.D.
QPR Institute
U of Washington School of Medicine
Suicide is our most
preventable form of death.”
“
David Satcher, MD
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Politically active survivors of the death by
suicide of a family member
Congressional appeal – house/senate
resolutions
Senator Harry Reid (D – Nevada)
Senator Gordon Smith (R – Oregon)
2001 first national meeting – NSSP 2001
IOM report: Reducing Suicide: A National
Imperative
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AAS
AFSP
SPRC
NIMH
CDC
SAMSHA – SPRC/AFSP BPR
National Action Alliance for Suicide
Prevention
http://actionallianceforsuicideprevention.org
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Championing suicide prevention as a national
priority
Catalyzing efforts to implement high-priority
objectives of the NSSP
Cultivating the resources needed to sustain
progress
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National Strategy 2012 Revision (done)
Research Prioritization: Reduce suicide by
20% in five years or 50% in 10 years.
Clinical Care and Intervention: Released a task
force report, Suicide Care in Systems Framework,
laying out recommendations for national leaders,
health and behavioral health providers, and health
plans.
- Chaired by the Honorable John
McHugh, Secretary of the Army, and the
Honorable Gordon H. Smith, President and
CEO of the National Association of
Broadcasters
- 200 organizations participated
- Chaired by Surgeon General Regina M.
Benjamin and SPRC Director Jerry Reed
Public-private all the way……..
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Foster positive public dialogue, counter
shame, prejudice, and silence; and build
public support for suicide prevention
Address the needs of vulnerable groups, be
tailored to the cultural and situational
contexts in which they are offered, and seek
to eliminate disparities
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Be coordinated and integrated with existing
efforts addressing health and behavioral
health and ensure continuity of care
Promote changes in systems, policies, and
environments that will support and facilitate
the prevention of suicide and related
problems
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Bring together public health and behavioral
health
Promote efforts to reduce access to lethal
means among individuals with identified
suicide risks
Apply the most up-to-date knowledge base
for suicide prevention.
1. Create supportive environments that
promote healthy and empowered
individuals, families, and communities (4
goals, 16 objectives)
2. Enhance clinical and community preventive
services (3 goals, 12 objectives)
3. Promote the availability of timely treatment
and support services (3 goals, 20 objectives);
4. Improve suicide prevention surveillance
collection, research, and evaluation (3 goals,
12 objectives).
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AFSP/SPRC Best Practices Registry
NREPP
Role of BPR in emerging state healthcare law
Implications for practice from the National
Violent Death Surveillance System (NVDRS)
Example:
- 41% adult suicides occur while in active care
of a health professional (49% in Dane CO.)
- 23 EMS professionals in CO over 4 years
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An increased understanding of the link
between suicide and other health issues
New knowledge on groups at increased risk
Evidence of the effectiveness of suicide
prevention interventions
Increased recognition of the value of
comprehensive and coordinated prevention
efforts
Objective:
Encourage health care providers and health
and safety officials caring for individuals with
suicide risk to routinely assess for the
presence of, or access to, lethal means as
part of their patient safety plans, and to
educate those individuals and their support
networks about actions to reduce risk.
GOAL:
Encourage the training of community and
clinical service providers on the prevention of
suicidal self-directed violence, including
training on how to address the needs of those
affected or bereaved by suicide deaths and
attempts (postvention services)
Objective:
Deliver training on suicide prevention to
community groups that have a role in the
prevention of suicidal self-directed violence
and related behaviors
Objective:
Develop core education and training guidelines
for the recognition, assessment, and teambased management of at-risk behavior, and
the delivery of effective clinical care for
people with suicide risk.
Objective:
Promote the adoption of “zero suicides” as an
aspirational goal by health care and
community support systems that provide
services and support to defined patient
populations.
GOAL:
Develop and promote effective clinical and
professional practices for assessing and
treating those identified as being at risk for
suicidal self-directed violence.
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The 2001 NSSP strategy started the ball
rolling
The suicide deaths of soldiers and veterans
have ramped up interest and motivation
Professional member organizations,
universities, and training institutions did not
heed the recommendations of the IOM or
NSSP
The suicide prevention community is growing
and building political force for change
It is strongly believed by the SP community that
stigma and taboo have contributed to the
training deficit in suicide prevention
education at the professional level…. And
that such training could enhance consumer
safety and prevent suicide…
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Would improved specific knowledge and skill
in the “assessment, treatment, and
management” of consumers detected to be at
elevated risk of suicide reduce morbidity and
mortality among behavioral health service
customers?
Answer: ???? - We shall see…
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Chart entry from PCP visit with 18-year-old
single Hispanic female. “Complains of
headache and stomach distress. Drank some
poison last week….” (provided medicines for
headache, etc.)
Two days later this young woman was dead of
an overdose…
No SRA, no referral for a workup by a MHP,
even though one was in the building…
Washington state legislature drafted and
passed Engrossed Substitute House Bill No.
2366 – “An act relating to requiring certain
health professionals to complete education in
Suicide assessment, treatment, and
management.”
House vote: 92 to 5
Senate vote: 100%
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Matt Adler dies by suicide
Jenn Stuber obtains provider’s record
Begins review – support by U of WA School of Social
Work
Champion: Rep. Tina Orwall – SW with experience
with suicidal consumers
Review of literature undertaken/BPR review
Agenda: inadequate training costs lives
Stakeholder meetings begin – ownership of failure to
train
A gathering of expert eaglets (AAS/AFSP support)
A bill is drafted
Atmosphere: Legislative session where both sides
wanted to get a least ‘something passed.’
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All licensed mental health providers to:
Complete a training program in suicide
assessment, treatment, and management
every six years
Clarifies that training programs in suicide
assessment, treatment, and management
must include the following elements: Suicide
assessment, including screening and referral,
suicide treatment, and suicide management.
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Availability of BPR training options (more than
one)
Consensus expert opinion published paper
(read from paper in testimony – you have a
copy)
Capacity to train an entire workforce – online
availability (cost shift to providers)
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Allows a disciplining authority to approve
training programs that do not include all of
the elements if the excluded elements are
inappropriate for the profession in question
based on the profession's scope of practice.
Requires training that includes only screening
and referral to be at least three hours in
length. Requires all other training to be at
least six hours in length.
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Rules are in process
Implementation on schedule
Staff will be impacted by license, age, renewal
Physicians and nurses working to
adopt/adapt
DOH evaluation on training status report out
in July
Other states “all in” KY+
WA is ahead of the curve….. FOREFRONT
organization launched
- Detection
- Assessment
- Treatment – (limited)
- CBT – DBT – Lithium – Clozapine - Follow
Up (caring letters/emails) – see complete list
of NREPP programs (17 only)
- Management of risk over time… good data
on continuity as a best practice…
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Suicide risk continues to go undetected
Assessment failures account for 70% of
“medical errors” associated with patient suicide
Lack of specific training
Lack of specific knowledge
Lack of supporting policies & payments
Reliance on junk science, e.g., no-suicide
contracts
Wrong beliefs, e.g., If they really want to kill
themselves you can’t stop them.
CEO, “Patient suicides is the ‘cost of business.’”
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The public is being taught that suicide is
“preventable.” (SPAN USA Survey)
If so, then, “How come my brother killed
himself after seeing one of your therapists?”
SP training is needed to maintain the public’s
trust in our competence…
Millions need to be trained – few subject
matter experts, fewer trainers…
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How can national policy vision be translated
into practice settings?
What questions do you (providers) have about
current research/evidence re: suicide
prevention?
What challenges/barriers do you experience
in practice settings?
Free e-book and apps
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Office phone: 509-235-8823
Institute phone: 1-888-726-7926
Email: pquinnett@mindspring.com
Website: www.qprinstitute.com