Other states attack suicide from the top
Part of a four-day series on suicide in Wyoming.
By JACKIE BORCHARDT – Star-Tribune staff writer
They tried donuts, sandwiches, everything they could think of to entice doctors to share suicide prevention techniques and raise awareness.
But the doctors didn’t come, even though the sessions were in their own offices, so the Natrona County Suicide Prevention Coalition gave up.
“We were trying everything to get in there,” said Jean Davies, executive director of the Wyoming Meth Project and a coalition member. “Nobody was rude, but the only people who ended up coming weren’t the people we were trying to reach.”
In the five years since, the coalition has funneled suicide prevention efforts into schools, where participants had little choice to attend. In health classes and school assemblies, coalition members have a captive audience that wants to learn.
Davies said coalition members would like to reach out to doctors again.
They’re not alone.
Other states and communities are reaching out to the medical community, hoping to make suicide a public health problem akin to smoking or not wearing seat belts.
Big effort, little results
Most states answered U.S. Surgeon General Dr. David Satcher’s call to action in 1999. Armed with strategic plans and varying sums of money to combat suicides, volunteer groups set out to attack what Satcher called “a serious public health program.”
But a decade later, suicide rates nationwide haven’t dropped. The latest figures from the Centers for Disease Control and Prevention indicate things are worse — the rate increased from 10.46 suicides per 100,000 people in 1999 to 11.26 in 2007, the last year for which figures were available.
Suicide has been addressed in small pockets and with various programs, but big change requires a change to the system, said Dr. Lloyd Sederer, medical director of the New York State Office of Mental Health.
“This is not to try to disparage any of the efforts that have gone on but to say there are other ways we should be thinking,” Sederer said.
His office and the New York State Health Department plan to incorporate suicide prevention into physician licensing requirements and insurance incentives.
People on medical plans and who seek medical care are “boundaried populations,” meaning they can be individually identified, targeted and tracked.
The idea comes from several successful efforts, the most widely known being the Henry Ford Health System in Detroit.
The Michigan HMO created the Perfect Depression Care Initiative. The suicide prevention program focuses on patients two ways: assessing signs of depression and suicidal behavior and building a comprehensive follow-up system in which physicians check on patients in person, over the phone and via email.
In the first four years of the program, the number of suicides per 100,000 patients dropped 75 percent. The program celebrated 10 consecutive quarters last year without a suicide, defying statistics and inspiring others to follow suit.
Small program support
The New York plan for a system-wide approach won’t end smaller efforts, Sederer said.
The state Office of Mental Health formed a strong network between county and community offices and research at the University of Rochester and Columbia University.
After the 1999 “call to action,” advocates lobbied the state Legislature to mandate suicide prevention efforts.
“[Legislative action] gives credence to how serious suicide is,” said Melanie Puorto, director of suicide prevention initiatives for New York state. “Otherwise, the grassroots efforts and small community groups have a hard going to make a big difference.”
The smaller groups and programs encourage moving suicide out of the realm of mental health to a place where people feel safe to talk about it.
“People are afraid to seek help because they feel people are judging them, not listening to them,” Puorto said. “You break down stigma one person at a time.”
Nebraska lowered its suicide rate through targeted efforts and partnerships with existing agencies.
The youth rate decreased and Nebraska ranked No. 41 in the nation for high suicide rate in 2007 — an improvement from No. 33 in 2006.
In 2003, the Nebraska Suicide Prevention Coalition developed its own prevention curriculum and specific training for clergy, law enforcement, schools and doctors. Training sessions were free.
“We wanted it to be like CPR but with suicide prevention,” said Dave Miers, licensed professional counselor and commission co-chair. “Everybody in the state should be trained.”
Local coalitions formed and telecommunication makes communication possible across the large state. The farm state also utilizes an existing Nebraska Rural Response Hotline, a toll-free number available to rural families in crisis.
Hospitals hand out fliers about firearm safety and how to properly dispose of medications — two major methods of suicide.
“We know that individuals who have any type of health condition are at a higher risk of suicide,” Miers said. “They may not be suicidal but are at a higher risk. Any information hospitals can have, the better.”
Grassroots efforts help, but governments have the responsibility of getting practices to change, Sederer said.
He said program-based initiatives risk losing funding with the election of a new official or a shift in priorities.
“We’re trying to get around that by saying there are basic standards that supersede all of this and they need to be encoded in the care system,” Sederer said.
For example, a doctor who didn’t take your blood pressure or told you that you don’t need a mammogram or colonoscopy would be considered giving lousy care.
“The same applies to mental health [conditions], which are more common than diabetes,” Sederer said.
In order for an agency to enact change, Sederer said it must have the following:
- a culture of innovation;
- a capacity to measure certain processes of care;
- and the ability to influence practice.
Exercising power over purse strings to reward or punish helps, too.
“Governments have responsibility in terms of getting practices to change, supporting good practice and demanding that practices that are not up to snuff do better,” Sederer said.
“Or there will be impacts on their financing.”