Priority Health Topic: Suicide Prevention


Objective #25: Reduce the suicide mortality rate per 100,000 population

Target: 25 per 100,000

Strategy 1: Coordinate prevention efforts to ensure that Alaskans have access to a comprehensive suicide prevention system.

The State of Alaska Suicide prevention plan was developed through input from stakeholders and is aligned with the National Strategy for Suicide Prevention and the Alaska Native National Suicide Prevention Strategic Plan (2011-2015). State of Alaska Suicide Prevention Plan: Recasting the Net, Promoting Wellness to Prevent Suicide in Alaska 2018-2022

Sources:
https://theactionalliance.org/our-strategy/national-strategy-suicide-prevention https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf
http://dhss.alaska.gov/SuicidePrevention/Documents/pdfs/Recasting-the-Net-Promoting-Wellness-to-Prevention-Suicide-2018-2022.pdf www.meansmatter.org
http://www.pc-cares.org/
http://www.sprc.org/
http://www.dhss.alaska.gov/Commissioner/Documents/MentalHealth/StrengtheningSystem-CompPlan_2020-24.pdf

Action Step 1

ActionProvide training in evidence-based suicide prevention, intervention and postvention models.
• Postvention education and planning increases the capacity of a community to respond effectively to a suicide death in order to prevent additional suicides and promote healing for survivors of suicide loss. – Developed by NAMI New Hampshire, the Connect Suicide Postvention program
• Update the Alaska Postvention Guide; Preparing to Heal
MeasureNumber of reported evidence based suicide prevention, intervention and postvention trainings delivered annually
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services, Division of Behavioral Health
• State of Alaska Department of Education and Early Development
• Alaska Training Cooperative, Statewide Suicide Prevention Council
• Alaska Native Tribal Health Consortium
• Other community organizations

Action Step 2

ActionProvide public education on mental health and suicide through statewide collaboration and coordination with emergency responders, law enforcement, emergency room staff, direct service professionals, criminal justice staff, schools, and Tribal providers.
Measure• Number of Youth and Adult Mental Health First Aid participants trained annually.
• Number of Crisis Intervention Team (CIT) trainings for law enforcement.
• eLearning classroom lessons for students “Navigating Transitions: Promoting Wellness to Prevent Suicide Grades 5-12
• Number of Suicide Awareness, Prevention & Postvention Training delivered in eLearning format to educators
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services, Division of Behavioral Health & Division of Public Health
• State of Alaska Department of Education and Early Development
• Alaska Native Tribal Health Consortium
• Alaska Training Cooperative, Statewide Suicide Prevention Council
• State of Alaska Department of Corrections
• UAA Center for Human Development
• Other community organizations.

Action Step 3

ActionProvide safe and effective messaging for suicide prevention that supports positive messaging, community conversations and media efforts to change social norms and perceptions about mental illness, addiction, depression and suicide, and promote seeking treatment and recovery. Messaging will be consistent with Suicide Prevention Resource Center guidelines.
Measure• Number of social media posts by DHSS – DBH will report
• Number of media organizations educated on safe messaging guidelines
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health & Division of Public Health
• Statewide Suicide Prevention Council
• Alaska Mental Health Trust Authority
• Department of Education and Early Development

Action Step 4

ActionRaise awareness and educate Alaskans about safe storage and temporarily limiting access to lethal means of suicide during a crisis.
Measure• Number of health care and behavioral health care organizations that were provided information about counseling on access to lethal means.
• # of “access to lethal means” educational materials distributed (brochures, gun locks, information cards)
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Statewide Suicide Prevention Council
• Alaska Mental Health Trust Authority

Action Step 5

ActionDevelop a statewide work group dedicated to engaging state and regional organizations such as gun shops, law enforcement, veterans, military, and health care and behavioral health care, to identify practical and relevant strategies and measures to reduce access to lethal means during times of crisis.
MeasureTask force is developed.
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Statewide Suicide Prevention Council
• Alaska Mental Health Trust Authority
• Alaska Native Tribal Health Consortium

Action Step 6

ActionIncrease utilization of Alaska’s Careline, the statewide suicide prevention and someone to talk to line.
MeasureNumber of calls received annually.
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health

Strategy 2: Evidence based treatment and recovery services are available for people at risk of suicide.

Identifying people at risk of suicide and the continued provision of treatment and support for these individuals can positively impact suicide and its associated risk factors. Preventing Suicide: A Technical Package of Policy, Programs and Practices (2017) https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf
In February 2016, the Joint Commission, the accrediting organization for health care programs in hospitals throughout the United States, issued a Sentinel Event Alert recommending that all medical patients in all medical settings (inpatient hospital units, outpatient practices, emergency departments) be screened for suicide risk. Using valid suicide risk screening tools that have been tested in the medical setting and with youth, will help clinicians accurately detect who is at risk and who needs further intervention.

“The Zero Suicide framework is a system-wide, organizational commitment to safer suicide care in health and behavioral health care systems.” https://zerosuicide.edc.org/

Action Step 1

ActionImplement universal screening for suicide risk in all primary, hospital (especially emergency department care), behavioral health, and crisis response settings.
Measure• Increase the number of primary care, hospital, behavioral health and emergency room departments universally screening for suicide risk
• A measurement needs to be developed to track this
Timeframe2023-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Alaska Native Tribal Health Consortium
• Tribal Health Organizations
• Alaska Mental Health Trust Authority
• Healthcare organizations in the community

Action Step 2

ActionCommunity health providers offer appropriate services to Alaskans in crisis when they need them and as close to home as possible.
MeasureIncrease in the number of providers implementing new waivered services available through 1115 waiver for SUD/MH, regionally and statewide. – 2021-2030
Timeframe2021-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Alaska Native Tribal Health Consortium
• Tribal Health Organizations
• Alaska Mental Health Trust Authority
• Healthcare organizations in the community

Strategy 3: Quality data and research is available and used for planning, implementation, and evaluation of suicide prevention efforts.

National Strategy for Suicide Prevention
Web link: https://theactionalliance.org/our-strategy/national-strategy-suicide-prevention

Action Step 1

ActionCoordinate statewide suicide data and develop a suicide data surveillance system that identifies trends in Alaska that will help support a coordinated, targeted and more immediate response.
MeasureThe development of a collaborative data base including data from partners listed below.
Alaska Violent Death Reporting System
Alaska Trauma Registry
Alaska Hospital Discharge Data
Alaska Youth Risk Behavior Survey
Alaska Behavioral Risk Factor Surveillance System
Alaska Health Analytics and Vital Records
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services Division of Behavioral Health & Division of Public Health
• Alaska Mental Health Trust Authority

Strategy 4: Create supportive environments to promote resilient, healthy, and empowered individuals, families, schools, and communities.

Alaska has many groups working on mitigating ACEs, trauma prevention, and community resilience & wellness. For more information on this and other resources, and updates on what is happening around the state, visit the “Overcoming ACEs in Alaska” website, www.dhss.alaska.gov/abada/ace-ak.

The Centers for Disease Control and Prevention hosts the website for the Adverse Childhood Experiences study.
http://www.cdc.gov/violenceprevention/acestudy/index.html

Dube, S.R., Anda, R.F., Felitti, V.J., Chapman, D., Williamson, D.F., Giles, W.H. (2001) Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: Findings from Adverse Childhood Experiences Study JAMA 2001;286:3089–3096

Vulnerable populations tend to experience suicidal behavior at higher than average rates. Such vulnerable populations include: low socioeconomic status and living with a mental health problem, people who have previously attempted suicide, Veterans and active duty military, individuals who are institutionalized, have been victims of violence, or are homeless, individuals of a sexual minority status, and members of certain racial and ethnic minority groups.
https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf

Action Step 1

ActionReduce the instances and impact of Adverse Childhood Experiences (ACEs) through community engagement and by improving social determinants of health.
• Support community education on ACEs.
• Increase access to family and peer support services that address resiliency by reducing early adversity, toxic stress, and childhood trauma, and by building protective relationship supports, cultural identity, and self-regulation skills.
• Support parenting skill development through community programs and activities, building upon local, natural supports.
• Support resiliency development efforts with training and technical assistance on practice-Informed interventions for trauma-engaged providers and communities.
• Support services and staff training that address trauma and resiliency for youth involved with the juvenile justice and child welfare systems.
• Provide technical assistance to community wellness coalitions to create and strengthen supportive environments in local communities.
Measure% of children who have experienced one or more adverse childhood experiences

Data Source: National Survey of Children’s Health https://www.childhealthdata.org/browse/survey , Alaska, Child and Family Health Measures; Family Health and Activities; Indicator 6.13: Has this child experienced one or more adverse childhood experiences (ACEs) from a list of 9 ACEs?
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health, Prevention and Early Intervention Section
• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services Division of Public Health
• Alaska Mental Health Trust Authority
• Statewide Suicide Prevention Council

Action Step 2

ActionIdentify and support targeted strategies for populations with disproportionate rates of suicide.
MeasureDecrease in rates of suicide by vulnerable population
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health, Prevention and Early Intervention Section
• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services Division of Public Health
• Alaska Mental Health Trust Authority
• Statewide Suicide Prevention Council

Strategy 5: Reduce death by suicide among youth and young adults (15-24) through targeted, culturally and age appropriate strategies to reduce the risk factors and increase the protective factors impacting adolescent depression and suicide.

The research and practices related to increasing protective factors to impact adolescent health and development are summarized in: Addressing a Crisis: Cross Sector Strategies to Prevent Adolescent Substance Use and Suicide (2019); Fostering Healthy Mental, Emotional and Behavioral Development in Children and Youth: A National Agenda (2019); Connecting the Dots: An Overview of the Links among Multiple Forms of Violence (2014); School Connectedness: Strategies for Increasing Protective Factors among Youth (2006), Shared Risk and Protective Factors Impacting Adolescent Behavior and Development (2019). Research related to risk and protective factors for suicide are summarized in Preventing Suicide: A Technical Package of Policy, Programs and Practices (2017) SPRC – protective factors.

Sources:
https://www.tfah.org/report-details/adsandadolescents/; https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf; https://safealaskans.org/our-work/tools-resources/ ;
https://www.countyhealthrankings.org/
https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage.pdf

Action Step 1

ActionReduce the risk factors impacting adolescent depression and suicide such as:
• Adverse childhood experiences (ACEs)
• Mood disorders, anxiety and depression
• Easy access to firearms
• Use of substances (alcohol and other drugs)
• Prior suicide attempts
• Exposure to Violence
• Excessive Screen Time/Social Media usage
MeasurePercent of adolescents (9-12th grade students) who report: attempted suicide in the past year(YRBS #29); use of alcohol in the past 30 days; access to and being ready to fire a gun within 4 hours (YRBS #18); having experienced forced intercourse or other sexual activities or dating, physical/sexual violence(YRBS #19-22); students who use electronics for something that is not school work for 3 or more hours per day (YRBS #83). (See YRBS for exact verbiage, frequency and time duration)
Timeframe2020-2030
Key Partners• Center for Safe Alaskans
• State of Alaska Department of Health and Social Services Division of Public Health, Section of Chronic Disease Prevention and Health Promotion and Office of Substance Misuse and Addiction Prevention,
• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services, Division of Behavioral Health
• Alaska Mental Health Trust Authority
• Alaska Suicide Prevention Council
• Alaska Mental Health Board
• Regional non-profits and Tribal organizations

Action Step 2

ActionIncrease the protective factors impacting adolescent depression and suicide such as: (See LH13 for more detail)
• Supportive adults and connections (LHI 17)
• Youth feeling valued and mattering to others (LHI 18)
• Social, emotional competence and self-regulation skills
• Attending a school with a positive climate (safe, supportive and encouraging)
• Participating in quality after-school activities and structured meaningful activities
• Sense of cultural identity and connection
Regular physical activity
MeasureMeasure: Percent of 9-12 grade students who: have 3 or more supportive adults (#93); feel like they matter to others (#96); are able to control their emotions and stay calm when needed (#98, 99); have caring teachers that give a lot of encouragement (#95); participate in out of school activities and clubs(#97).
Timeframe2020-2030
Key Partners• Center for Safe Alaskans
• State of Alaska Department of Health and Social Services Division of Public Health, Section of Chronic Disease Prevention and Health Promotion and Office of Substance Misuse and Addiction Prevention,
• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services, Division of Behavioral Health
• Alaska Mental Health Trust Authority
• Alaska Suicide Prevention Council
• Alaska Mental Health Board
• Regional non-profits and Tribal organizations
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