Suicide in Dane County: Scope of the Problem Charles R. Vear, MPH - - PowerPoint PPT Presentation

Division of Public Health

Suicide in Dane County: Scope of the Problem

Charles R. Vear, MPH Wisconsin Department of Health Services Hannah Flanagan, LMFT Journey Mental Health Center September 26–27, 2019

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Presentation Overview

1. 1.

Wiscons nsin n and Dane ne County unty suicide data ta

• Suicide by demographics
• Suicide by methods
• Toxicology of suicide decedents
• Risk factors

2. 2.

Jour urne ney Ment ntal Health h Cente nter

• Current interventions
• Suicide risk assessments
• Strategies and approaches to improving comfort discussing

suicide risk with patients

3. 3.

Questi tions

Analytic Notes

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Analytic Notes

• Data

ata in th this r s report w was o as obtai btained f from m death ath c certificate tes, c coroner an and medic ical l examin miner r reports ts, and l law e enforceme ment r t reports ts.

• Vital records: includes only Wisconsin residents
• Wisconsin Violent Death Reporting Systems: includes only

Wisconsin residents who died by suicide in Wisconsin

• All a

All age-ad adju juste ted r rate ates u s use se U U.S. stan standard p population in 2000 f 2000 for ag age- ad adju just stme ment.

Wisconsin and Dane County Suicide Data

Demographics

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Wisconsin residents died by by su suicide in 2018 2018 (5 (5% d % dec ecrease from 2017)

886 886

Suicide in 2018

Dane county residents died by by su suicide in 2018 2018 (6% i increa ease e from 2017)

74 74

Data S Source rce: : Vital Records death certificate data, 2018.

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Suicide rate among Dane residents increased by 35%, 2000–2017.

10. 10.9 15. 15.3 10. 10.4 14. 14.0 8. 8.9 12. 12.3 0.0 5.0 10.0 15.0 20.0 2000 2017 Ag Age-ad adjust sted su suicide r rate ate p per 100, 100,00 000 Ye Year Wisconsin U.S. Dane N= 588 588 N= 918 918 N= 47, 47,16 168 N= 29, 29,31 312 N= 38 38 N= 70 70

Data S Source rce: : Vital Records death certificate data, 2000-2017. Mortality data from the National Vital Statistics System (NVSS), 2000-2017.

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Dane had a significantly lower rate of suicide when compared with the state, 2013–2017.

Significantly higher rate Higher than state rate Lower than state rate Significantly lower rate No rate calculated (<10 suicides) Ag Age-adju just sted su suicide r rate ates s per 100, 100,00 000

Source ce: : Vital Records death certificate data, 2013–2017

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The majority of suicides were male, 2013–2017.

78% 78% 22% 22% Male Female Wisconsin N= 4,284

Source ce: : Vital Records death certificate data, 2013-2017

72% 72% 28% 28% Male Female Dane N= 338

10 10

Suicide rate was highest among ages 45–54, 2013–2017.

Source ce: : Vital Records death certificate data, 2013-2017

22.3 25.5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 10-14 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Ag Age-sp specific su suicide rate ate p per 100, 100,00 000 Ag Age in in years Wisconsin Dane

11 11

Suicide rate was highest among whites, 2013–2017.

15.3 14.7 5.9 5.2 13.5 6.5 4.6 5 10 15 20 White AI/AN Asian Black Ag Age-ad adjust sted su suicide r rate ate p per 100, 100,00 000 Wisconsin Dane

Source ce: : Vital Records death certificate data, 2013-2017.

Wisconsin

12 12

14.9 5.7 12.9 6.5 5 10 15 20 Non-Hispanic Hispanic Ag Age-ad adjust sted su suicide r rate ate p per 100, 100,00 000 Wisconsin Dane

Suicide rate was highest among non-Hispanics, 2013–2017.

Source ce: : Vital Records death certificate data, 2013-2017.

Wisconsin and Dane County Suicide Data

Method of Suicide

14 14

Firearm was the most commonly used method of suicide, 2013–2017.

Wisconsin Dane Wisconsin Dane

Firearm 49% Suffocation 27% Poisoning 16% Other 8%

No Note: : Other category includes drowning, motor vehicle, fire, and other. Suffocation includes hanging, strangulation, and suffocation. Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

Wisconsin Dane Firearm 42% Suffocation 30% Poisoning 18% Other 10%

15 15

Males were more likely to use firearms or suffocation and females were more likely to use poisoning as method of suicide in Dane, 2013–2017.

92% 92% 8% 8%

Firear arm

Male Female 69% 69% 31% 31%

Suffocati

• cation
• n

Male Female 34% 34% 66% 66%

Poisoni ning ng

Male Female N = 138 N = 58 N = 99

Note: : Suffocation includes hanging, strangulation, and suffocation. Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

16 16

Suffocation was the most common method of suicide for those 15 to 17. Firearm was the most common method of suicide for those 18 and

• lder in Dane, 2013–2017.

35% 38% 51% 34% 43% 70% 59% 67% 0% 20% 40% 60% 80% 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Percent nt of

• f suicid

ides Ag Age in in years Firearm Suffocation Poisoning

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

Wisconsin and Dane County Suicide Data

Toxicology

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Toxicology Definitions

Dete tected su substa bstances are those that have been detected in toxicology

• testing. This can be an indication of the victim’s state of mind during the
• incident. Detected substances can be at levels that do not cause toxicity

and may not have contributed to the cause of death. Detected substances are included for all suicide methods (for instance, poisoning, firearm, and suffocation).

19 19

Toxicology Definitions

Su Substance ces d determ rmined by by coroner/me medic ical l examin miner to contri ribute to death ath are those that reached toxic levels and impacted organ function resulting in death. Substances determined to contribute to death are

• nly included for poisoning suicides.

20 20

Alcohol and antidepressants were the 2 most commonly detected substances among suicide deaths, 2014–2017.

0% 10% 20% 30% 40% Per ercent of s

• f suicides

Wisconsin Dane

Source ce: : Wisconsin Violent Death Reporting System, 2014-2017.

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Alcohol was the most commonly detected substance among firearm suicides. Antidepressants were the most commonly detected substance among poisoning and suffocation suicides in Dane, 2014–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2014-2017.

33% 26% 34% 18% 33% 65% 8% 15% 43% 18% 15% 35% 0% 20% 40% 60% 80% Firearm Suffocation Poisoning Per ercent of

• f suicid

ides Alcohol Antidepressant Benzodiazepine Opioid

22 22

Opioids and antidepressants were the most common substances to contribute to death among poisoning suicides, 2014–2017.

38% 35% 28% 36% 53% 38% 0% 10% 20% 30% 40% 50% 60% Opioid Antidepressant Benzodiazepine Perce cent o

• f p

poisoning g suicid ides Wisconsin Dane

Source ce: : Wisconsin Violent Death Reporting System, 2014-2017.

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Substance Group Definitions

• Prescription : medication prescribed by a doctor such as oxycodone or Ambien.
• Over the counter (OTC): medications available without prescription such as

Advil or Zyrtec.

• Gas : poisons that can be inhaled such as carbon monoxide or propane.
• Legal : substances available legally such as alcohol or nicotine.
• Illegal : substances not available legally or by prescription such as heroin or

cocaine.

• Other poison: substances not intended for human consumption such as

household cleaners (not including gas).

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Prescription medications were the most common substance group determined to contribute to death among poisoning suicides, 2014–2017.

Source: Wisconsin Violent Death Reporting System, 2014-2017.

72% 23% 19% 16% 8% 3% 90% 26% 10% 29% 12% 2% 0% 20% 40% 60% 80% 100% Perce cent o

• f p

poisoning g suicid ides Wisconsin Dane

Wisconsin and Dane County Suicide Data

Risk Factors

26 26

Social Ecological Model

Indiv ivid idual: l: biological and personal history that increases the likelihood

• f becoming a victim or perpetrator
• f violence.

Relatio tionship ip: close or significant relationships that may increase the risk of experiencing violence as a victim or perpetrator. Communi nity: settings, such as schools, workplaces, and neighborhoods, in which social relationships occur and the characteristics of these associated with becoming victims or perpetrators of violence.

27 27

Individual

28 28

Less than half of those who died by suicide left a suicide note, disclosed their intent, or had a history of suicide attempts, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

42% 28% 23% 47% 30% 34% 0% 10% 20% 30% 40% 50% Left a suicide note Disclosed suicidal intent Had a history of suicide attempts Proport rtion o

• f circu

rcumstances Wisconsin Dane

29 29

Females who died by suicide were more likely to have a reported history of suicide attempts, disclosed suicide intent, or left a suicide note in Dane, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

43% 27% 25% 56% 37% 57% 0% 10% 20% 30% 40% 50% 60% Left a suicide note Disclosed suicidal intent Had a history of suicide attempts Proport rtion o

• f circu

rcumstances Male Female

30 30

The most common circumstance reported of those who died by suicide was feeling depressed, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

57% 50% 40% 51% 77% 60% 47% 60% 0% 20% 40% 60% 80% 100% Depressed mood Mental health (MH) problem Treatment for MH/Substance use (SU) History of treatment for MH/SU Proport rtion o

• f circu

rcumstances Wisconsin Dane

31 31

Females who died by suicide were more likely to have a reported mental health problem, treatment for MH/SU, and history of treatment for MH/SU, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

75% 52% 35% 52% 82% 81% 77% 80% 0% 20% 40% 60% 80% 100% Depressed mood MH problem Treatment for MH/SU History of treatment for MH/SU Proport rtion o

• f circu

rcumstances Male Female

32 32

Approximately 1 in every 4 suicide deaths had a reported alcohol or physical health problem that contributed to suicide, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

24% 16% 25% 29% 16% 25% 0% 5% 10% 15% 20% 25% 30% 35% Alcohol problem Non-alcohol substance use problem Physical health problem Proport rtion o

• f circu

rcumstances Wisconsin Dane

33 33

Depression was the most commonly reported diagnosed mental health condition among suicide deaths, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

58% 18% 12% 4% 4% 3% 58% 21% 12% 3% 3% 3% 0% 10% 20% 30% 40% 50% 60% 70% Prop

• portion of
• f men

ental hea ealth diagnos

• ses

es Wisconsin Dane

34 34

Approximately 1 in 5 suicide deaths had a reported job problem and/or financial problem, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

19% 18% 13% 6% 24% 20% 13% 9% 0% 5% 10% 15% 20% 25% 30% Job problem Financial problem Criminal legal problem Civil legal problem Proport rtion o

• f circu

rcumstances Wisconsin Dane

35 35

Males who died by suicide were more likely than females to have financial or legal problems reported in Dane, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

23% 24% 16% 11% 25% 12% 7% 3% 0% 5% 10% 15% 20% 25% 30% Job problem Financial problem Criminal legal problem Civil legal problem Proport rtion o

• f circu

rcumstances Male Female

36 36

Relationship

37 37

Approximately 1 in every 3 suicide deaths had a reported intimate partner problem, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

33% 14% 5% 28% 11% 8% 0% 5% 10% 15% 20% 25% 30% 35% Intimate partner problem Problem with family member Problem with a friend or associate Proportio ion w wit ith r rela latio ionship probl blem Wisconsin Dane

38 38

Males who died by suicide were more likely to have a intimate partner problem and females were more likely to have a family member problem reported, 2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

31% 8% 9% 21% 19% 7% 0% 5% 10% 15% 20% 25% 30% 35% Intimate partner problem Problem with family member Problem with a friend or associate Proportio ion w wit ith r rela latio ionship probl blem Male Female

39 39

Nearly 1 in every 5 suicides were reported to

• ccur recently after an argument or conflict,

2013–2017.

Source ce: : Wisconsin Violent Death Reporting System, 2013-2017.

19% 8% 3% 16% 8% 4% 0% 5% 10% 15% 20% Recent argument

• r conflict

Death of a family member or friend (excluding suicide) Recent suicide of a family member or friend Proportio ion w wit ith r rela latio ionship probl blem Wisconsin Dane

40 40

Community

41 41

Dane had a lower ratio of population to mental health providers when compared with the state, 2017.

Better than WI average of 560:1 561:1-999:1 1000:1-6622:1 Popula latio ion t to menta tal h l health lth provid ider r ratio io

Journey Mental Health

Current Interventions

43 43

Hoan Alone: Personal Stories from the Bridge

https://www.youtube.com/watch?v=xrA495uA6-Y

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Current Interventions

• We

We have recog

• gnized

ed that we have a role in reducing ng and elimin minatin ting suicid ides in our community.

• Community

ity healthca care re p provi viders rs have committe itted to the shared goal of having zero

• suicid

ide d death ths for people under the care of health and behavioral health care systems.

• Each healthcare provider in the Dane

e County y ZSI c colla llaborativ tive is working towards incorpora rating ng the same risk asse assessm ssment, colla llaborativ tive saf safety planning, and follo llow-up tools.

• We are ad

address ssing su suicide with nearly ever ery consume mer (patie tient) t) we come in contact with regardless of their initial presentation.

45 45

Is it working?

Compared to the national trend of annual increases in suicide rates, Da Dane ne County y saw a small decreas ase in su suicide r rate ate between 2016 and 2017 and although the suicide rate in 2018 was slightly higher than 2017, it was still lower er than 2016.

Journey Mental Health

Suicide Risk Assessments

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Suicide Risk Assessment: Everyone is doing it but is everyone good at it?

From a a pat patients pe perspective: Story 1

• 16 year old is brought to the emergency department (ED) following a

suicide attempt.

• She is seen by the ED Registered Nurse (RN) and the risk assessment

began with “So, you tried to kill yourself tonight, did you really want to die.”

• The RN was not looking at the patient and after the appointment the

patient thought the RN also rolled their eyes when patient shrugged her shoulders in response to the question “do you really want to die?”

• RN completed the rest of the Columbia-Suicide Severity Rating Scale

(CSSRS) questions and asked for a social worker to do a further assessment.

• 3 caring contact calls were made to the family within 72 hours of

discharge.

48 48

Suicide Risk Assessment: Everyone is doing it but is everyone good at it?

From a a pat patients pe perspective: Story 1

• What did the RN do right?
• What could have been done differently?
• How could the communication style or body language impact the

response of the patient?

49 49

Suicide Risk Assessment: Everyone is doing it but is everyone good at it?

From a a pat patients pe perspective: Story 2

• An adult female went to the ED for a physical injury to the arm.
• While meeting with the RN the RN said “I don’t know why I have to do

this, but I have to” and proceeded to ask the consumer questions on the CSSRS.

• Patient recognized the medical personnel’s discomfort when asking about

suicide risk, and was appreciative that despite the obvious discomfort the questions were still being asked.

50 50

Suicide Risk Assessment: Everyone is doing it but is everyone good at it?

From a a pat patients pe perspective: Story 2

• What did RN do right?
• What could have been done differently?
• How could the communication style or body language impact the

response of the patient?

Journey Mental Health

Strategies and approach to improving comfortability discussing suicide risk

52 52

Lets make it easier to talk about

It It can n be difficult for mental he health h providers to to ta talk about sui uicide with th their pati tients nts, so it goes witho thout ut saying ng that t it t may also be difficul ult for othe her health h care providers to talk k about ut it. So let’ t’s mak ake it eas asier to talk ab

• about. Here ar

are some way ays we can an do do that.

• Create buy-in from healthcare providers about the benefits of doing risk

assessments on every patient.

• Validate provider’s concerns about their ability to do a risk assessment.
• Leadership can provide examples of how tone, body language, and rate of

speech impact the patients perception about whether or not the person asking the questions really cares.

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Lets make it easier to talk about (cont.)

• Model and practice empathetic responses. Give providers a couple

different ways to be able to smoothly transition into a risk assessment. For example, “As a part of our mission we want to make sure that we are addressing any health issues you maybe experiencing, including mental

• health. I am going to ask you a few questions about safety and suicide
• risk. This is something that we ask all of our patients about.”
• Regularly check in with providers and offer feedback and support if they

feel like completing the risk assessment continues to be challenging.

54 54

Keep up the good work

As a community Dane County healthcare providers are taking the suicide epidemic seriously and are actively working to stop it. You are amazing. You matter. You are making a difference! Thank you and we hope you enjoy the rest of the conference.

55 55

Hoan Alone: Personal Stories from the Bridge

https://www.youtube.com/watch?v=xrA495uA6-Y

Questions?