Tennessee Department of Mental Health and Substance Abuse Services

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes Tennessee Lives Count-Connect (Connect) to reduce suicidal ideation, suicide attempts, and deaths among youth and young adults ages 10-24 by developing and implementing statewide suicide prevention and early intervention strategies, risk screening/assessment, and enhanced follow-up for 6,250 unduplicated (Year 1: 1,000; Years 2-5: 1,250/year).

The focus area is the State of Tennessee, comprising urban and rural populations with multiple socioeconomic disparities (e.g., high poverty, unemployment) that contribute to high risk for suicidal ideation/behaviors among youth/young adults. Tennessee?s suicide rate for the focus population (8.83) exceeds the national rate (7.57) and 111 young Tennesseans died by suicide in 2010. Among the focus population, 20% experience serious psychological distress; 8% of adolescents ages 12-17 and 11% of 18-25 year olds have had a major depressive episode; and 7% of adolescents, 4% of 18-20 year olds, and 16% of 21-25 year olds have been admitted for substance abuse treatment ? all risk factors closely associated with youth suicide. Risk factors are exacerbated among subpopulations (children in state custody, juvenile justice involvement, veterans, and LGBTQ2S youth), with 50% having mental health and/or substance use disorders. Locally, suicide prevention, intervention, and follow-up resources are sparse and disjointed, and accessibility creates key service gaps for youth/young adults and their families.

TDMHSAS will partner with Tennessee Suicide Prevention Network and Centerstone of Tennessee to provide suicide prevention and postvention trainings for gatekeepers (schools, law enforcement, foster care, etc.) and training for primary/behavioral health professionals, screening/assessment, early intervention, follow-up, outreach/education, and linkages to treatment services, using the evidence-based Applied Suicide Intervention Skills Training (ASIST) and Columbia Suicide Severity Rating Scale (C-SSRS) models. Connect will also strengthen public/private collaborations and support higher learning institutions to train students in recognizing early signs of suicide and referring individuals needing help. Outcomes will include reduction in suicidal ideation and suicide attempts by 30% and suicide deaths by 10%. A Youth Advisory Council comprising stakeholders and focus population members will support Connect goals/objectives: (1) increasing the number of people in youth-serving organizations trained to identify/refer youth at risk of suicide, (2) increasing the number of clinical services providers/first responders trained to assess, manage, and treat risk for suicide, (3) improving continuity of care and follow-up for youth discharged from emergency/ psychiatric units, (4) increasing risk identification, referral, and behavioral health services utilization, and (5) increasing the promotion and utilization of the National Suicide Prevention Lifeline. Evaluation will report as required on participant outcomes and on progress and performance regarding infrastructure development.

The New York State Office of Mental Health’s Implementation of the National Strategy for Suicide Prevention (NSSP)

This project advances the National Strategy for Suicide Prevention by forming state and local coalitions that engage each organization’s leadership to commit to a “zero suicide” goal by implementing changes in their Core Values & Attitudes, by improving their systems management, and by adopting evidence-based practices. 2) to reduce suicides attempts and deaths by developing rapid follow up using the Assess, Intervene, Monitor (AIM) model and by implementing care transitions protocols that include Peer Bridgers and incorporate efforts to reduce access to lethal means. 3) to elevate suicide identification, intervention and treatment skills among staff and communality organizations persons ages 25-64, including agencies in primary care, mental health, substance abuse, justice, corrections, labor, veterans’ affairs; and emergency response teams, including the National Guard.

State of Maine Department of Health & Human Services/Maine Center for Disease Control

The 2012 National Strategy for Suicide Prevention (NSSP) identifies the need to promote suicide prevention as an essential element of health care services, and the importance of implementing effective practices for assessing and treating individuals at risk of suicide. In support of national efforts to reduce suicide deaths among adults, the Maine Center for Disease Control and Prevention Maine Suicide Prevention Program (MSPP) will implement the Communities of Care (CoC) Project, with the goals of increasing access to suicide-safer care for individuals served by primary care and behavioral health services; implementing comprehensive systems change to support suicide screening, assessment, treatment, and follow-up within major community mental health agencies; and developing shared discharge protocols between hospitals, emergency rooms, and regional crisis service providers to ensure rapid follow-up and transition of care for individuals after a suicide attempt or suicidal crisis. Specifically, the MSPP CoC Project will focus efforts in three areas:

• Goal 1: Increase the number of providers within Maine’s Behavioral Health Homes who use evidence-based practices to assess, treat, and manage suicide risk among patients and clients.

• Goal 2: Increase the number of behavioral health systems that implement evidence-based protocols and clinical pathways, using the Zero Suicide framework (Zero Suicide Practice Transformation), for suicide risk screening, intervention, treatment, and follow-up.

• Goal 3: Increase the number of hospitals, emergency rooms, and inpatient behavioral health programs that have developed shared protocols with regional crisis service providers that include procedures for rapid follow-up and care connections for individuals following a suicide attempt or suicidal crisis (Strengthening Supports).

To increase health and behavioral health providers’ skills in evidence-based suicide screening and treatment, MSPP CoC Project staff will partner with the Sweetser Training Institute to create a web-based training portal that provides access to best-practice educational resources in suicide prevention. The MSPP will expand upon these trainings by partnering with two additional major community mental health providers to implement the Zero Suicide model, a quality improvement process that focuses on creating organizational systems and policies to support screening, intervention, treatment, and ongoing follow-up for all clients at risk of suicide. The CoC Project will increase community supports for individuals at high risk by engaging hospitals, emergency rooms, and local crisis service programs to ensure rapid follow-up and supported care transitions for individuals following a suicide attempt or suicidal crisis. The Maine Suicide Prevention Program has a long history of engaging with community partners to provide innovative suicide-prevention interventions across many sectors. The MSPP takes a data-driven approach to implementing high-quality services. As part of the Communities of Care Project, the MSPP will train over 650 health and behavioral health providers in evidence-based suicide prevention practices, and support high-quality suicide-safer care and community follow-up for over 3500 Maine adults. The MSPP believes that these efforts will have a positive impact on the well-being of our communities by reducing Maine’s rate of suicide deaths and suicide attempts.

Massachusetts Department of Mental Health

The goals of the Massachusetts Adult Suicide Prevention Program (MASSP) are to:

1) create two Community Systems of Care (CSOC) integrating health, behavioral health, and suicide crisis services for the goal of Zero Suicide,
2) pilot an Engagement and Follow-up (E&F) intervention for adults transitioning after a suicide attempt,
3) promote statewide access to resources and treatment for high risk groups, and
4) institute an Adult Suicide Fatality Review Team process.

The purpose of the MASPP is to reduce the rate of suicide attempts and completions among adults. Two communities will form CSOCs, led by a Zero Suicide Learning Collaborative. The first CSOC will serve adults at high risk of suicide on Cape Cod and the Islands, a region with the state’s highest rate of suicide, largest veteran population, and a significant elderly population. A second CSOC will be created in another community with high risk groups. In addition to fostering Zero Suicide standards of organizational and clinical practice within healthcare organizations, the CSOCs will link medical, behavioral health, suicide crisis, and community organizations to integrate care and coordinate transitions for at risk adults. Improved linkages should guide patients to the most appropriate services, better coordinate care, and support at risk adults during transitions, particularly those following discharge after a suicide attempt. A comprehensive training program targeted to the suicide prevention roles staff play in different CSOC organizations will enhance their skills and confidence, improving the quality of care they provide, and resulting in more effective prevention, early intervention, and follow-up care. CSOCs will each pilot an Adult Suicide Fatality Review Team, which will identify factors contributing to suicide deaths to inform system improvement. In future years, these models will be implemented statewide, community by community. Statewide activities focus on improving identification of suicide risk among high risk groups by promoting awareness of the innovative MassMen website tailored to working age men, training gatekeepers working with unemployed adults, and increasing screening and referral by perinatal care providers serving new mothers.

Measurable impacts include:

• Increase in identification, referral, and treatment of at-risk adults
• Reduced rates of suicide deaths
• Reduced rates of suicide attempts
• Greater voice for adults with lived experience in strategic planning

The number of people served over this three year grant is projected to be 320,874, or an annual average of 106,958.

Florida – University of Central Florida

The Florida Implementation of the National Strategy for Suicide Prevention (FINS) Project is a partnership of the state suicide prevention infrastructure, the Inter-Agency Dissemination and Collaborative Network, which consists of the Florida Statewide Office of Suicide Prevention (SOSP), the University of Central Florida (UCF) and the University of South Florida (USF) with the Florida Hospital. Utilizing a sustainable mentorship model, FINS will adopt and integrate the National Strategy for Suicide Prevention (NSSP) to ensure that health and behavioral health settings and adult serving systems (crisis centers, VA centers, correctional facilities, housing and employment centers, grass root organizations, faith-based, and other social services) are adequately prepared to identify, engage, and treat at-risk adults with culturally competent evidence-based/best-practice (EB/BP) suicide prevention, treatment, safety planning, and care coordination services. The goals/measurable objectives are to:

(a) Transform health and behavioral health system infrastructure through the development of ZS advisory committees, suicide prevention policies and procedures, and the integration of EB/BP measures and mechanisms to monitor suicide care;
(b) Enhance the collaboration of local and state-level partnerships to promote ZS and NSPL utilization;
(c) Develop workforce training capacity to utilize EB/BP suicide prevention strategies;
(d) Enhance care coordination strategies to increase the number of referrals and sustainable treatment, recovery and support linkages for at-risk adults; and,
(e) Improve the coordination, sharing, and tracking of suicide-related indicators (suicide ideation, attempts, deaths, service utilization) via regional and state-level data surveillance systems.

Over 3 years, the project will prevent adult suicide morbidity and mortality rates by:

(1) Assisting partnering systems to adopt EB/BP screening, suicide risk assessment, safety planning, and care coordination tools via ZS workshops [155 agency administrators/directors trained];
(2) Conducting EB adult gatekeeper skills training to non-clinical staff [QPR, 1,500 gatekeepers];
(3) Training clinical and medical staff in EB/BP strategies to increase capacity to conduct suicide risk assessments, safety plans, and care coordination services [QPRT (230 trained), LINC (150trained), LINC to Life Safety Planning/CALM (430 trained)];
(4) Providing EB clinical training to treat suicidal clients [DBT, 50 trained];
(5) Promoting the ZS initiative and FINS project via participation in community events/meetings and dissemination of suicide prevention materials, including NSPL materials [144 community events/meetings; 7,200 promotional materials, 3,600 NSPL materials]; and,
(6) Providing long-term care coordination services to high risk adults to ensure rapid follow-up, smooth care transitions, and sustained engagement in services [1,620 adult clients].

Quality assurance and overall program direction will be conducted by UCF and evaluation efforts will be conducted by USF. The FINS Project will pilot the model in central Florida in order to guide future suicide prevention initiatives which are planned throughout Florida.