APNA 29th Annual Conference Session 3025: October 30, 2015 Suicide - - PDF document

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APNA 29th Annual Conference Session 3025: October 30, 2015 Suicide - - PDF document

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APNA 29th Annual Conference Session 3025: October 30, 2015 Suicide Prevention in Primary Care: How Zero Suicide can Help! Gail R. Stern RN, MSN, PMHCNS BC Lehigh Valley Health Network Administrator of Psychiatry APNA Annual Conference

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 1

Suicide Prevention in Primary Care: How Zero Suicide can Help!

Gail R. Stern RN, MSN, PMHCNS‐BC

Lehigh Valley Health Network‐Administrator of Psychiatry APNA Annual Conference – Orlando FL October, 2015

Disclosures

  • I have no conflicts of interest or

disclosures to make regarding this presentation Participant Objectives

  • 1. Identify current beliefs and cultures that impact
  • ur care of the individual with suicidal ideation and

behaviors

  • 2. Name 2 evidence based suicide assessment

tools/methods

  • 3. State 2 ways to partner with Primary Care in

Suicide Prevention

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 2

Action Alliance for Suicide Prevention

  • 2001 National Strategies for Suicide Prevention (NSSP) published

Prevention‐The National Action Alliance for Suicide Prevention is the public‐ private partnership advancing the NSSP

  • 2006 The Moving Forward report identifies Key National priorities of NSSP
  • 2010 The Action Alliance launched (Charting the Future of Suicide

Prevention is published and Executive Committee and six task forces established

  • 2011‐2012 The Action Alliance establishes new task forces
  • 2013‐2014 With the release of a Zero Suicide toolkit, prioritized research

agenda, and set of comprehensive juvenile justice resources, the Action Alliance continues to provide national leadership and catalyze change for suicide prevention.

What is the Zero Suicide ?

  • Zero Suicide is a commitment to suicide prevention in health

and behavioral health care systems, and also a specific set of tools and strategies.

  • It is a concept and a practice.
  • Its core propositions are that suicide deaths for people under

care are preventable.

  • The bold goal of zero suicides among persons receiving care is

an aspirational challenge that health systems should accept!

http://zerosuicide.actionallianceforsuicideprevention.org/sites/zerosuicide.actionallianc eforsuicideprevention.org/files/WhatisZeroSuicide.pdf

Creating Zero Suicide Culture

  • Beliefs about suicide
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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 3

Creating Zero Suicide Culture

  • Treatment of Mental Illness
  • Leadership
  • Commitment

What are the Numbers?

  • Overall, suicide is the 10th leading cause of death for all Americans, the 2nd

leading cause of death for adults ages 25‐34, and the 3rd leading cause of death for youth ages 15‐24.

  • Pennsylvania suicide rate is 11.06 per 100,000 lower than the national

average of 11.29 per 100,000

http://www.worldlifeexpectancy.com/usa/pennsylvania‐suicide

  • Do you know your local rates of suicide?
  • Track your organization number of suicides?
  • Set goals

Healthcare is not Suicide Safe!

  • 45 % of people who died by suicide had contact with primary care providers

in the month before death. Among older adults, kit’s 78%

  • 19% of people who died by suicide had contact with mental health services

in the month before death

  • South Carolina: 10% of people who died by suicide were seen in an

emergency department in the two months before death.

The primary care providers role in preventing suicide (August 24,2015) integration.samsha.gov

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 4

Developing a competent workforce Patient Centered‐‐Patient Driven: The Priority in Cross Training

  • Relationship building
  • Patient driven ‐ shared decision making
  • Patient centered shared care plans
  • Whole person perspective
  • Whole life perspective
  • Wellness oriented
  • Recovery based Care

Comprehensive Vital Signs

  • Temperature
  • Pulse
  • Respirations
  • Blood pressure
  • Body Mass Index
  • PHQ‐9 (CSSRS‐as needed)
  • GAD‐7
  • Audit
  • Trauma Screen (THS, PC‐PTSD)
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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 5

Identifying and Assessing Suicide Level

  • Universal screening for suicide risk should be routine in all

Primary Care, Hospital Care (especially emergency department care), Behavioral Health Care, and Crisis Response settings (e.g., help lines, mobile teams, first responders, crisis chat services).

  • Any person who screens positive for possible suicide risk should

be formally assessed for suicidal ideation, plans, availability of means, presence of acute risk factors (including history of suicide attempts), and level of risk.

Screening Tools Better or Worse

  • PHQ 2 and PhQ9
  • Columbia C‐SSRS screening
  • CAMS
  • ASSIST
  • Becks Suicide Inventory

Ongoing Monitor of symptoms

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 6

Ensuring everyone has a pathway to care Using Effective Evidence Based Care

  • Standardized risk stratification,
  • Targeted evidence‐based clinical interventions,
  • Accessibility, follow‐up and engagement
  • Education of patients, families and health care
  • Integrated care
  • CBT
  • DBT

Using Evidence Based Care

Means Reduction

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 7

Evidence Based Care

  • Safety Planning

People with Lived Experience

  • Peer counselors can inform treatment team
  • Can intervene directly with people with suicidal ideation
  • Perform as an integral part of the Team
  • Can perform community outreach activities

Continuing Contact after Care

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 8

How is Primary Care key? Team Care

  • Screening
  • EHR
  • Collaboration/ Shared care
  • Alerts (suicide risk banner)
  • Ongoing monitoring
  • Continuing contact!
  • Patient Portals
  • BH Integration
  • Whole health
  • Wellness

Data driven Quality Improvement Case Examples

  • Samantha’s story
  • Ms. T story
  • Mr. A story
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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 9

Samantha is a 17 year old girl who presented to her primary care provider for a wart

  • removal. The practice had just

initiated depression and suicide

  • screening. Samantha screened

positive for suicidal ideation.

http://zerosuicide.actionallianceforsuicideprevention.org/creating‐zero‐suicide‐ culture

  • Ms. T is a 73 year old African American woman. She is

a retired teacher with chronic back pain, HTN, and a history of multiple hospitalizations for CAD. She is depressed, has stopped going to church, misses her PCP appointments and takes her HTN medications “on my own terms.”

Suicide Risk?

  • Mr. A is a 54 year old Caucasian man. He presents in

crisis having recently lost his engineering job, health insurance and car. He is fearful that he will loose his home as well. Mr. A has a BMI over 30; DM poorly controlled with Metformin (HbA1C >10) and has been hypertensive for 6 years.

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 10

“Everything is horrible and it’s always going to be this way.”

DEPRESSION SCREENING AND MANAGEMENT IN PRIMARY CARE Susan D. Wiley, MD Vice Chairman, Department of Psychiatry Associate Professor, Morsani School of Medicine Suzanne L. Widmer, DO Family Medicine Physician Family Medicine Leadership Team

Depression & Suicide Screening in Primary Care

  • Kathleen Straubinger, BSN, RN
  • Gail R. Stern, MSN, PMHCNS-BC

“Suicide doesn’t end the chances of life getting

worse, it eliminates the possibility of it ever getting any better.” – Unknown

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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 11

“If you are looking for a sign not to kill yourself, this is it.” – Unknown Questions?

Internet resources

  • http://zerosuicide.actionallianceforsuicideprevention.org/
  • http://www.cssrs.columbia.edu/
  • http://www.sprc.org/
  • http://www.suicidepreventionlifeline.org/
  • https://www.afsp.org/
  • https://www.integration.samhsa.gov
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APNA 29th Annual Conference Session 3025: October 30, 2015 Stern 12

Written resources

  • Brown, G et al, Cognitive Therapy for prevention of Suicide Attempts, A

Randomized Controlled Trial, JAMA, August, 3,2005: vol 294, No.5: 563‐570

  • Jobes,D., Overholser, J., Rudd, M., & Joiner, T., Ethical and Competent Care of

Suicidal Patients: Contemporary Challenges, New Developments, and Considerations for Clinical Practice, Professional Psychology: Research and Practice, 2008, Vol. No. 4, 405‐413.

  • Jobes, D, The Collaborative Assessment and Management of Suicidality (CAMS):

An Evolving Evidence Based Clinical Approach to Suicidal Risk, Suicide and Life‐ Threatening Behavior 42(6) December, 2012, 640‐652.

  • Luxton, D., June, J., & Comtois, K, Can Postdischarge Follow‐up Contacts Prevent

Suicide and Suicidal Behavior?, Crisis 2013: Vol.34(1);32‐41

  • Covington,D., Hogan,M. et al (National Action Alliance: Clinical Care &

Intervention Task Force) Suicide Care in Systems Framework, 2011.