New York State to build suicide prevention competency among outpatient substance use disorder treatment providers
In 2015, the US death rate increased for the first time in ten years, while all-cause mortality has been increasing among young and middle-aged Whites for the past 15 years. These increases are being driven mainly by the troubling rise in deaths due to drug overdose and suicide.
In 2014, there were 47,055 deaths due to drug overdose and 42,773 deaths due to suicide. Recent statistics from the CDC show that the rate of death by drug overdose and suicide increased by 137% and 24% over the past 15 years, respectively. In fact, the number of deaths by drug overdose and by suicide both individually exceed the number of deaths from motor vehicle accidents.
Suicide and substance use are interrelated
These two major public health problems require immediate attention both in and of themselves, but also in tandem.
Substance use is the second-most frequent risk factor for suicide. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), alcohol misuse or dependence is associated with a 10 times greater suicide risk than among the general population, and those who inject drugs are at 14 times greater risk. Alcohol intoxication is present in 22% of suicide deaths, and opioids are present in 20% of deaths. Another 30-40% of non-fatal suicide attempts involve alcohol intoxication, and 230,000 emergency department visits resulted from drug-related non-fatal attempts in 2011.
There are other similarities between substance use and suicide. First, providers lack sufficient skills to treat patients who are either misusing substances or who express suicidal thoughts or intentions. Suicide and substance use are seldom addressed in health settings as health professionals report believing it to be the responsibility of another provider. Second, the stigma surrounding deaths by drug overdose and suicide may prevent people who have lost loved ones from reaching out for help, resulting in prolonged shock, anger, guilt, isolation, and depression.
This “nexus” between substance use and suicide was recently brought front and center by SAMHSA in their new brief report Substance Use and Suicide: A Nexus Requiring a Public Health Approach. New York State–with 1,700 deaths by suicide and 1,937 deaths by drug overdose in 2014–has recognized this intersection and is commencing efforts to address it.
Collaboration to help areas of high need in New York State
The Suicide Prevention Office of the New York State Office of Mental Health (NYS OMH), in partnership with the Center for Practice Innovations (CPI) at Columbia Psychiatry’s Suicide Prevention – Training, Implementation, and Evaluation (SP-TIE) program and the New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS), is beginning a suicide safer care learning collaborative for outpatient substance use disorder treatment providers. Under the umbrella of a three-year National Strategy for Suicide Prevention (NSSP) SAMHSA grant, this learning collaborative targets adults in Erie and Monroe counties.
Erie and Monroe counties encompass two of New York’s largest upstate cities–Buffalo and Rochester–and have the largest number of suicide deaths of all upstate counties.
A first-in-the-nation approach to suicide prevention among SUD treatment providers
Building on the experience of a recently completed learning collaborative for outpatient mental health clinics in the same counties, this suicide prevention learning collaborative will be the first in the nation for substance use disorder treatment providers.
The learning collaborative tailors the Suicide Prevention Resource Center’s Zero Suicide model to outpatient substance use disorder treatment providers. Zero Suicide represents an aspirational goal and works under the foundation that suicide deaths for individuals under care within health or behavioral health systems are preventable. The approach represents a commitment to patient safety and to the safety and support of clinical staff who treat and support suicidal patients. The essential elements of the model, outlined on the Zero Suicide website, include:
Lead – Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Include survivors of suicide attempts and suicide loss in leadership and planning roles.
Train – Develop a competent, confident, and caring workforce.
Identify – Systematically identify and assess suicide risk among people receiving care.
Engage – Ensure every individual has a pathway to care that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means.
Treat – Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors.
Transition – Provide continuous contact and support, especially after acute care.
Improve – Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk.
The one-year learning collaborative, which began at the end of June, involves one clinical supervisor and one upper-level administrator from eight different organizations in Erie and Monroe counties. Interactive webinars and routine data collection are being used to identify current practices, provide a forum for overcoming barriers to optimal care, and provide technical assistance and training support in the implementation of the Zero Suicide model.
What does the learning collaborative hope to achieve?
Specifically, the learning collaborative will help promote organizational culture change, provide a wide range of staff with the tools to act as gatekeepers for the identification of suicidality among patients and connect them with appropriate care, equip specific staff with the ability to screen and/or assess patients for suicide risk and provide brief intervention using the safety planning intervention, and provide continuous support. At the end of the learning collaborative, NYS OMH plans to develop a strategy for equipping substance use disorder treatment providers statewide with the ability to deliver appropriate suicide safer care to their patients as well as to disseminate lessons learned to a nationwide substance use and suicide prevention audience.
Brett Harris, DrPH, is the Suicide Prevention Program Manager at the New York State Office of Mental Health (OMH) and co-leader of the suicide prevention learning collaborative for outpatient substance use disorder treatment providers. Prior to joining OMH, Dr. Harris developed, implemented, and evaluated alcohol and drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) projects with the New York State Office of Alcoholism and Substance Abuse Services (OASAS). As a Clinical Assistant Professor at the University at Albany School of Public Health, Dr. Harris continues to conduct research on factors which may impact adoption and implementation of SBIRT in various settings. She also co-leads a learning collaborative on SBIRT for youth, writes grants, develops materials, and provides consultation services on substance use among youth in juvenile justice settings. Dr. Harris received her Doctor and Master of Public Health from the University at Albany and her Bachelor of Science from Cornell University.