GETTING INVOLVED IN STATEWIDE SUICIDE PREVENTION INITIATIVES John Madigan, AFSP Vice President of Public Policy R. Keith Hotle, JD, MPA,Wyoming Department of Health Nicole Gibson, MSW, AFSP Manager of State Advocacy & Grassroots Outreach THIS SESSION WILL: Give an in-depth look at statewide suicide prevention planning/programming in one example state – Wyoming Give guidance to Field Advocates and Chapters re: getting involved in your own statewide planning/programming efforts back home Building Wyoming’s State Suicide Prevention Program R. KEITH HOTLE, J.D., MPA Chronic Disease, Substance Abuse and Suicide Prevention Unit Manager Public Health Division Wyoming Department of Health A FEW INTRODUCTORY THOUGHTS Wyoming’s geographic, demographic & cultural traits make a lethal combination If a Country we would be 9th deadliest in the world 9th largest state but least populous Frontier Isolation “Cowboy Up” mentality Politically independent w/libertarian ideals Social Stigma Access to Care Issues in most of state Wyoming Suicide Prevention Death Rates Year 2002 2003 2004 2005 2006 2007 2008 Number 106 Rate per 100,000 109 88 84 116 97 119 2009 2010 2011 2012 2013 111 130 127 132 23.06 22.85 21.20 21.65 17.29 16.34 22.19 18.14 21.79 19.83 98 Source: Wyoming Department of Health, Vital Statistics Services (2014) Wyoming Top 5 Causes of Death (2012) Cause of Death Percentage of all deaths Rank Number 1 1173 27.1% 2 919 21.2% 3 319 7.4% Alzheimer’s Disease 4 153 3.5% Suicide 5 127 2.9% 2691 62.1% Major Cardiovascular Disease Malignant Neoplasms (i.e., cancer) Chronic Lower Respiratory Disease TOTAL Source: Wyoming Department of Health, Vital Statistics Services (2012) BRIEF HISTORY OF PREVENTION IN WYOMING 2000 Substance Abuse Division Created by Gov. Geringer 2001 21st Century State Incentive Grant 2004 Strategic Prevention Framework State Incentive Grant 2005 State Suicide Prevention Program 2006 Youth Suicide Prevention Grant (1st Cohort) 2009 Youth Suicide Prevention Grant (2nd Cohort) 2010 Core Prevention Program Begins; SEOW Grant 2011 State Prevention Enhancement Grant-Building the PMO 2012 Prevention Management Organization Funded for Biennium 2014 Legislative Attempt to Dismantle PMO Framework COMMUNITY PREVENTION SYSTEM PRIOR TO JULY 1, 2012 State plans and makes funding decisions. State contracts with approximately 40 Fiscal Agents. Fiscal agents hire approximately 50 Program Managers. Program Managers organize and support local prevention coalitions in each county (roughly 30 coalitions). Local coalitions define and implement local strategies. COMMUNITY PREVENTION SYSTEM BEGINNING JULY 1, 2012 State plans and makes funding decisions State contracts with 1 Prevention Management Organization Program Managers organize and Fiscal agents hire 42 Program support local prevention Managers (38 coalitions in charged with each county SA prevention and 4 regional suicide prevention coordinators Local coalitions define and implement local strategies 2009 State Task Force & WYSPAC Merged into WySPAC Suicide in Wyoming (Nov. 2012) PRIORITY RECOMMENDATIONS 1. FIREARM SAFETY COALITION: The Governor should establish a Wyoming Firearm Safety Coalition for the purpose of adopting best practices and tools for gun shop owners and others on how to avoid selling firearms to suicidal persons and how to educate customers about methods to protect persons at high-risk of suicide from self-harm with firearms (19 votes). 2. IMPROVE PRIMARY CARE COMPETENCIES: The Wyoming Board of Medicine Wyoming Medical Society, Wyoming Association of Osteopathic Physicians and Surgeons, Wyoming Association of Psychiatric Physicians, Wyoming Association of Physicians Assistants, Wyoming Primary Care Association, Wyoming Hospital Association and other stakeholders in the medical community should collaboratively develop educational competencies and training tools for physicians and physician assistants for the diagnosis and management of depression, routine screening of clients for mental health issues and suicide, and suicide intervention (18 votes). 3. BETTER SUICIDE DEATH DATA: The Board of Coroners Standards should develop and implement uniform standards for the investigation of cases of apparent or suspected suicide and for collecting and reporting of suicide death data (16 votes). 4. EMERGENCY ROOM GUIDELINES: The Wyoming Hospital Association, Wyoming Medical Society, Wyoming Emergency Nurses Association, Wyoming Trauma Coordinators, Wyoming Office of Emergency Services and other stakeholders in the emergency medical services community should collaborate to create and implement uniform guidelines for emergency room treatment, discharge and post-discharge follow-up for suicidal patients (15 votes). 5. MENTAL HEALTH PROFESSIONAL EDUCATION: State licensing boards should require suicide-specific continuing education as a requirement for the renewal of every mental health professional’s license (14 votes). 6. MIDDLE-AGED MAN CAMPAIGN: A statewide media campaign should be implemented to reduce stigma and encourage Wyoming men between ages 20-60 to seek help for depression and suicidal thoughts; because this span of years encompasses both young adult males and middle-age males, multiple messages should be considered (14 votes). 7. STATE EMPLOYEE TRAINING: The Wyoming Departments of Family Services, Health, Workforce Services and other state agencies should develop and implement mandatory staff training on suicide risk recognition and response for all personnel who have direct contact with individuals at risk for suicide and their families (12 votes). 2013 ACTIVITIES Innovative Assessment Tool Middle Aged Man Social Marketing Campaign piloted FC BIT – implemented and moving towards NREPP Community Coalitions in 22 of 23 WY counties (doubled previous levels) School Suicide Prevention – Support and TA Trainings -- 291 trainings; 7,698 people trained Psychological Autopsy Training brought to Wyoming Community Critical Response (Postvention Services) Campbell County Comprehensive Suicide Prevention Project AMERICAN FOUNDATION FOR SUICIDE PREVENTION (AFSP) Last year the PMO collaborated with AFSP Wyoming Chapter to: Facilitate two Bipolar Education Events in May 2013, held in Sheridan and Cody. Host the Cody Out of the Darkness Walk on September 7, 2013, also in collaboration with the Park County Suicide Prevention Alliance. More than $25,000 in cash and donations were received; 182 people participated in the walk. Fund six Applied Suicide Intervention Skills Training (ASIST) workshops. Conduct International Survivors of Suicide broadcasts on November 23, 2013. The broadcasts were held in Casper, Riverton, Sheridan, Gillette and Cheyenne. The PMO: Case Study in State and Local Political Manipulation 2011 Move to Single Statewide Management Entity • Pushback from WAMHSAC Providers • Held Community Meetings • Decision to Move Forward 2012 Implementation Begins • Mandate was Community Collaboration (even when it was hard) • Persistent Problem Areas – Campbell, Natrona esp. • Significant Accomplishments in Suicide Prevention • Generational Opportunity • Governor Support • Decision to use Public Procurement Process for 2014-15 February 18-21 – Budget Session Shenanigans • • • • Tuesday - Blindsided • 2 p.m. by Monday’s (Presidents Day) floor remarks by Senator Scott • Tuesday night – transcribed and rebutted with issue brief and talking points Wednesday – The Battle Begins • 11a.m. Discovered Matching Amendments filed in Senate and House • 11 a.m.-Noon: Last minute efforts to survive second reading vote; mobilized with talking points and PMO Report Card • 1:30 p.m. – meeting with Senator Schiffer in Capitol Anteroom • 2 p.m. – afternoon sessions begin • Doors close and unable to reach any House Representative • 2:30 p.m. JAC Chairman Bebout gets talking points during session • 4 p.m. – Senate and House floor debates on budget amendments • Amendment is killed in Senate but passes House • Wednesday night is strategic planning and engagement of resources Thursday – Desperate Hours • WASCOP takes the stage [law enforcement on the attack] • other statewide grassroots efforts to reach House representatives • Amendment 17 filed • Both sides jockeying for upper hand – TV interviews • Discovery of WAMHSAC secret email [“Aha” moment] • late night discussions with House representatives Friday – The Drama Plays Out • last minute outreach and education efforts • distribution of talking points and supporting materials on House floor • early morning discussions with House representatives vote; 43-14 win SUICIDE PREVENTION INITIATIVES 2014-15 • Strategic Communication Plan & Regional Roundtables • August 2014 Stakeholder Summit • Middle Aged Man Social Marketing Campaign replicated • FC BIT – implemented as part of Berman Legacy Project • Community Coalitions – build capacity • School Suicide Prevention – Support and TA • Community Trainings – Goal is 5% of Total Population (@ 27,000) • Psychological Autopsy Project Initiation • Community Critical Response (Postvention Services/CIT) • Online State Employee Training • Campbell County Comprehensive Suicide Prevention Project o Move from Planning to Implementation TYING IT ALL TOGETHER… Getting involved in your OWN state’s suicide prevention efforts is important, and doable, for Field Advocates and Chapters! TYING IT ALL TOGETHER… Your state may be very similar to, or very different from, our Wyoming example in terms of: Strengths Challenges Structures Players FIELD ADVOCATES AND CHAPTERS CAN: Read and familiarize yourself with your state’s statewide plan/strategy Web links provided in the “Statewide Initiatives and Projects” handout Contact the Public Policy Office to find out who your state’s players are Act as a liaison between other players and AFSP FIELD ADVOCATES AND CHAPTERS CAN: Attend local/statewide coalition meetings to learn what is going on Get the OK from the Public Policy Office and your Field Staff to wear your “AFSP” hat at those meetings Where there is no organized statewide or local activity, AFSP can be the driving force for bringing the players to the table QUESTIONS? OTHER IDEAS? For those who have been involved in statewide programming/planning, what did you learn/what advice do you have for your fellow Field Advocates/Chapter volunteers? What questions do you have for us/Keith? Thank you!