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2 Patterns of Risk and the Prevention Landscape
Pages 9-28

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From page 9...
... • Critical windows exist for suicide risk, such as the week after discharge from a psychiatric admission or emergency depart ment presentation for suicidal ideation or attempt, the first weeks after starting an antidepressant, and during significant life transitions. (Moutier)
From page 10...
... , and among young people ages 10 through 34 it is the second leading cause, observed Holly Wilcox, associate professor in the Johns Hopkins Bloomberg School of Public Health's Department of Mental Health and the Johns Hopkins University School of Medicine's Department of Psychiatry, in her overview of patterns of risk and the prevention landscape at the workshop. Beginning in adolescence, which is also an important developmental stage for the onset of mental illness, suicide becomes more common in males than in females (see Figure 2-2)
From page 11...
... SOURCES: Presented by Holly Wilcox on September 11, 2018, at the Workshop on Improving Care to Prevent Suicide Among People with Serious 11 Mental Illness. From Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System data.
From page 12...
... SOURCES: Presented by Holly Wilcox on September 11, 2018, at the Workshop on Improving Care to Prevent Suicide Among People with Serious Mental Illness. Data from National Vital Statistics System, National Center for Health Statistics, CDC.
From page 13...
... the National Violent Death Reporting System to examine demographic and descriptive characteristics and contributing circumstances to suicide among people with and without known mental health conditions, found that suicide rates had increased by 30 percent or more since 1999 in more than half the 27 states examined. Stone et al.
From page 14...
... . A whole population study from Sweden that studied risk for suicide after hospitalization for suicide attempts found that the risk and timing of suicide was particularly strong for people with unipolar and bipolar depression and schizophrenia, particularly among males (Tidemalm et al., 2008)
From page 15...
... Those that implemented seven to nine components had significantly lower suicide rates than those implementing fewer components. Particularly effective approaches were 24-hour crisis teams that were able to intervene in crises, managing patients with dual diagnoses, and multi­ isciplinary reviews after suicides that shared information with d families.
From page 16...
... PERCEPTIONS AND AWARENESS OF SUICIDE PREVENTION Public perceptions around mental health and suicide prevention have been undergoing dramatic changes, said Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, who also presented an overview of suicide prevention programs and policies during the workshop's first panel. First, the science informing mental health, psychology, psychiatry, neuroscience, and suicide has been growing rapidly in recent decades, and the results of that science are being disseminated and promoted much more actively.
From page 17...
... States have been calling for the enforcement of the federal law requiring parity for mental health benefits, and 13 federal laws have passed over the last decade involving suicide prevention. As an example of how education of community and family members is occurring, Moutier briefly described the American Foundation for Suicide Prevention's Talk Saves Lives program, which has been delivered to tens of thousands of people in all 50 states.
From page 18...
... Examples of educational materials available from the American Foundation for Suicide Prevention include "After a Suicide Attempt," "Firearms and Suicide Prevention," and "After a Suicide." This education effort, Moutier said, shows that everyone has a role to play in suicide prevention and culminates in the message that people should bring those who are at risk for suicide to a health care provider, "just as we want people to come to health care settings at the earliest indication that they might have diabetes or any other kind of health problem." Just as for other health problems, health care systems need to know what to do and deliver care for people at the earliest stages of deterioration in mental health or increase in suicide risk. TREATMENT AS A PART OF SUICIDE PREVENTION Moutier described several innovations in clinical treatments that are related to suicide prevention.
From page 19...
... (2015) customized CBT for a group of army soldiers who were either postsuicide attempt or had suicidal ideation with intent.
From page 20...
... She emphasized the need both to optimally manage primary psychiatric conditions, whether with medications or other approaches, and to incorporate considerations specific to suicide in treatment planning. A robust literature shows that lithium, compared with other mood stabilizers and other medications, and for both bipolar and unipolar mood disorders, reduces the risk of suicide attempts and death by suicide between 60 and 80 percent (Baldessarini et al., 2003, 2006)
From page 21...
... of a recommended standard care for people with suicide risk has helped meet this need. Other gaps described by Moutier include the need to achieve universal mental health literacy so that people know what to do well upstream of suicide risk becoming apparent, implementation science to measure the effect of clinical treatments and community-based programs, inclusion rather than exclusion of people at risk for suicide in clinical trials, better surveillance and health systems to capture data about suicide-related events and deaths, clinician training in prevention, integrated mental health care and screening in primary care, the ability to bill for services such as lethal means counseling or peer-to-peer and telemedicine services, and enforcement of mental health parity.
From page 22...
... SOURCES: Presented by Christine Moutier on September 11, 2018, at the Workshop on Improving Care to Prevent Suicide Among People with Serious Mental Illness. From American Foundation for Suicide Prevention.
From page 23...
... He also noted that the ED-SAFE study had a phase in which it did universal screening but did not enhance care for the people identified, which revealed that screening by itself did not change the subsequent suicide risk outcomes. Screening needs to be followed by safety planning and follow-up contact after discharge to be effective, he said.
From page 24...
... "These are all things that hopefully will be sorted out as we move more toward implementing that model in communities." Beeber from the American Psychiatric Nurses Association added that she is on the congressionally mandated Interdepartmental Serious Mental Illness Coordinating Committee, which has been examining the issue of Medicare coverage for peer support, and that the issue has come up and will continue to be pursued. In response to a question about digital health technologies, Moutier said that advances in this area require truly interdisciplinary science.
From page 25...
... One option, she said, is to use social media data for targeted interventions, which is "an area of great promise for the future." With regard to integrated data systems, Moutier noted that the Zero Suicide program is building a system that is integrated in such a way as to pay attention to all the data points that indicate suicide risk. Then people are trained to respond to that information and to make sure that patients do not fall through the cracks.
From page 26...
... 2005. Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial.
From page 27...
... 2006. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder.
From page 28...
... 2014. Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments.


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