Massachusetts Coalition for Suicide Prevention
Strategic Plan for Suicide Prevention
State agencies have endorsed this Draft. In 2005, the Massachusetts Coalition for Suicide Prevention, who drafted the 2002 Plan, began working on a new updated and "action oriented" Plan. We need your input into this process by letting us know what you're doing in your community about preventing suicide, what gaps in service exist, what programs/strategies would be most helpful, etc.
For more information or to provide comments on this draft, please contact:
info@MassPreventsSuicide.org
Preface
Suicide is one of the ten leading causes of death in the United States, resulting
in approximately 30,000 deaths per year.1 Suicide
exacts a significant toll on the lives of the citizens of Massachusetts. Our
Commonwealth loses an average of 500 lives to suicide each year.2 The
resulting suffering, trauma, and loss devastate the lives of family members,
friends and co-workers.
The Massachusetts Strategic Plan for Suicide Prevention was developed in response
to the Call to Action to Prevent Suicide issued by Surgeon General David Satcher
in July 1999.The Massachusetts Suicide Prevention Working Group, representing
numerous disciplines, worked together to develop this Plan to guide and coordinate
our statewide efforts. The Plan creates a framework for our state's strategy
to confront this serious public health issue. The goals and objectives are
reflective of the recommendations outlined in the National Strategy for Suicide
Prevention3 in a manner that makes this Plan appropriate for our state. It
represents the combined work of over 50 suicide prevention experts, advocates,
clinicians, researchers, legislators, and survivors.
The development of goals, objectives, and strategies is the first step in
formulating a plan of action to meet the challenge of preventing suicide. Massachusetts
is one of only a few states whose Plan addresses the problem across the life
span.
The Massachusetts Strategic Plan for Suicide Prevention is designed to encourage
groups and individuals to work together. Crucial to the future success of the
effort is the development of broad-based support for suicide prevention. Collaboration
across a wide spectrum of agencies, institutions and groups, from mental health
and other health care agencies to schools to faith-based organizations, is
a way to ensure that suicide prevention efforts are comprehensive.
In the implementation of this plan, the Suicide Prevention Working Group hopes
that communities will take the next steps to assess and plan for preventing
suicide at the local level. The Plan is intended to be a work in progress with
regular revisions to best address the challenge of preventing suicide in Massachusetts.
We welcome comments and suggestions that would make this Plan more effective.
Summary
The Massachusetts Strategic Plan for Suicide Prevention targets eleven goals,
and includes: the rationale for the goals, the objectives, and the suggested
strategies to implement the goals, which include some or all of these components;
policy, education, direct services, engineering/environmental, community organizing,
and resources.
The Goals of the Massachusetts Suicide Prevention Working Group Strategic
Plan for Suicide Prevention are:
- Improve and expand surveillance systems;
- Promote awareness that suicide
is a preventable public health problem;
- Develop broad-based support for
suicide prevention;
- Develop and implement strategies to reduce the stigma
associated with being a consumer of mental health, substance abuse, and
suicide prevention services;
- Develop and implement community-based suicide
prevention programs;
- Reduce access to lethal means and methods of self-harm;
- Implement professional
training programs in recognizing and treating suicidal behavior for those
who are in regular contact with persons at risk;
- Develop and promote effective
clinical practices to reduce suicide morbidity and mortality;
- Improve access
to and community linkages with mental health and substance abuse services;
- Improve reporting and portrayals of suicidal behavior, mental illness,
and substance abuse in the entertainment and news media;
- Promote and support
research on suicide and suicide prevention.
Goal # 1 Improve and expand surveillance system
Rationale
Surveillance - defining the problem - is the first step in a public health
approach to prevention. Surveillance of suicide includes information on suicide
mortality and morbidity resulting from suicidal behavior. Existing surveillance
systems provide only a partial picture of suicide and self harm in the Commonwealth.
In Massachusetts, information on suicide mortality - suicide deaths - are
obtained from Vital Statistics, coded by medical examiners on death certificates.
Lacking clear information related to intentionality, medical examiners might
code the death as substance abuse or motor vehicle-related, or as undetermined
or unintentional. Pressure from loved ones and historical stigma against suicide
may also influence how a death is coded. Therefore, nationally it is estimated
that suicide deaths are under-reported by 20-30%.
Suicidal morbidity or data on suicide attempts or ideation are harder to capture.
Self inflicted injuries that result in an admission to an acute care hospital
are available from the Massachusetts Hospital Discharge Data Set, and a sample
of those treated and released from acute care emergency departments are obtained
through the Injury Surveillance Program at the Massachusetts Department of
Public Health. However, these systems fail to capture admissions to acute care
hospitals for suicidal behavior which did not result in an injury, and do not
include information on any suicidal behavior that results in an admission to
a psychiatric hospital, to a Veteran's Administration hospital, or to a state
facility.
Questions on suicidal behavior are included in the Massachusetts Youth Risk
Behavior Survey (MYRBS) (administered by the Massachusetts Department of Education
to students in public high schools) but are not included in the Behavioral
Risk Factor Surveillance System (BRFSS), administered to Massachusetts' adults
by the Massachusetts Department of Public Health. Yet it is middle aged and
older adults who are at greatest risk for suicide4. Suicide deaths of those
under 18 are being reviewed by some county Child Fatality Review Teams, but
there is no system in place to review suicide deaths of those over 18. More
information on suicide and suicidal behavior among adults could yield important
prevention information.
It is critically important to increase surveillance of suicide mortality and
morbidity to fully define the scope of the problem and plan for prevention.
Objectives
1.1 Develop and refine a standardized protocol for death scene investigations
and implement these protocols. (Mid-term)
1.2 Implement Death Reviews/Follow Back Studies of all suicide deaths. (Long
term)
1.3 Increase the quality and quantity of data on hospitalizations for suicidal
behavior in Massachusetts. (Long term)
1.4 Increase information on suicidal behavior that may not result in a hospitalization.
(Long term)
1.5 Publish an annual report on suicide and suicidal behavior in Massachusetts,
integrating data from multiple state data management systems. (Short term)
1.6 Increase the number of state health and safety surveys that include questions
on suicidal behavior. (Mid-term)
1.7 Implement a model project that analyzes and links information related
to self-destructive behavior derived from separate systems. (Long term)
Suggested Strategies
Policy: Increase surveillance of suicide deaths and self-inflicted injuries.
Education: Develop training modules that educate acute care emergency department,
psychiatric hospital, and EMS systems staff on the importance of collecting
suicide-related data, standards of data quality, and how to collect data.
Engineering/Environmental: Develop a simple, ongoing and systematic surveillance
system for collecting information on suicide attempts and self-inflicted injuries.
Resources: Provide resources for staff surveillance, collaboration with hospitals
and EMS and information on other states' experience with surveillance.
Goal # 2 Promote awareness that suicide is a preventable public health
problem
Rationale
Most people are not aware that suicide is a leading cause of death nationally
and in Massachusetts. Promoting awareness that suicide is a major public health
issue has potential for influencing people to be more vigilant for risk factors
in themselves and among people they know.
Increased awareness should result in more people providing assistance to at-risk
persons and in more people seeking assistance when they are at risk of suicidal
behavior. Awareness among policy makers may result in efforts to modify policies
and to allocate resources towards suicide prevention efforts.
Objectives
2.1: Develop and implement a public information campaign designed to increase
public knowledge of suicide prevention. (Short term)
2.2: Establish and enhance existing meetings on suicide prevention designed
to foster collaboration with stakeholders and the general public on prevention
strategies across disciplines. (Short term)
2.3: Convene forums that reinforce the effectiveness of suicide prevention
messages.
( Short term)
2.4: Increase the number of both public and private institutions that are
involved in collaborative, complementary dissemination of suicide prevention
information on the World Wide Web. (Short term)
Suggested Strategies
Policy: Collaborate with media outlets to cover topics related to suicide
as a public health issue and to assist in educating the public about suicide
prevention. Provide information to create legislative awareness through public
policy around suicide prevention.
Community Organizing: Promote awareness of suicide as a public health issue
in communities and through community-based organizations. Increase participation
in the Suicide Prevention Working Group.
Education: Educate policy makers and the general population about suicide
as a public health issue using forums, the media, and awareness events. Participate
in public events and conferences to disseminate information about the Suicide
Prevention Working Group. Identify organizations that have information on suicide
prevention and communicate with them about web content.
Resources: The effort will mainly require in-kind human resources to organize
and deliver messages in and to appropriate mediums.
Goal # 3 Develop broad-based support for suicide prevention
Rationale
Since suicide and suicidal behavior are the result of complex, multidimensional
biological and psychosocial factors, the prevention of self-violence and suicide
will require an ecological, multidisciplinary approach. The Massachusetts Suicide
Prevention Working Group recognizes that no one agency or program alone can
reduce the incidence of suicide. It has, therefore, established a broad-based
coalition with representation from a wide spectrum of public and private agencies,
institutions, and organizations. Similar collaborative efforts will be required
at the community and regional levels in Massachusetts.
Suicide prevention strategies at the local, state, and national level will
require public/private partnerships. Without these partnerships, efforts will
be only marginal in their impact.
One goal of the National Strategy for Suicide Prevention has been the development
of collective leadership and increasing the diversity of groups working to
prevent suicide. This goal applies at the state level, and must be a key factor
at the community level.
The development of broad-based support for suicide prevention will require
ready access to information, research, best practices and program models and
literature resources. This includes the identification of multiple sites can
disseminate these resources.
Objectives
3.1 Increase participation in the Massachusetts Suicide Prevention Working
Group to include appropriate agencies, organizations, and institutions not
yet represented to help implement the Massachusetts Strategy for Suicide Prevention.
(Short-term)
3.2 Encourage agencies and organizations involved in suicide prevention to
work within a collaborative framework at the community and/or regional level.
(Short-term)
3.3 Increase the number of state, professional, voluntary, and other groups
that integrate suicide prevention activities into their ongoing programs and
activities. (Mid-term)
3.4. Increase availability of monographs, periodicals, videos, outreach posters,
information pamphlets, etc., on suicide and suicide prevention in the Massachusetts
Prevention Centers Resource Libraries. (Short term)
3.5. Develop and maintain an extensive web site on suicide, suicidal ideation
and suicide prevention. (Mid-term)
Suggested Strategies
Community Organizing: Through the Massachusetts Suicide Prevention Working
Group galvanize support for the State Plan and seek participation of key stakeholders.
Policy: Develop criteria for suicide prevention activities that encourage
the development of suicide prevention coalitions at the community and/or regional
level.
Education: Reach out to public and private agencies and organizations
to promote awareness of suicide prevention and the Massachusetts Suicide Prevention
Strategic Plan and to promote active participation in local and statewide suicide
prevention activities.
Convene a "Massachusetts Strategy for Suicide Prevention Funders Forum."
Resources: Utilize the Massachusetts Suicide Prevention Working Group, existing
organizations and materials that address suicide prevention, the Massachusetts
Prevention Centers, and other professional and advocacy organizations as resources.
Goal # 4 Develop and implement strategies to reduce the stigma associated
with being a consumer of mental health, substance abuse, and suicide prevention
services.
Rationale
Ninety percent of all suicidal behaviors are associated with some form of
mental illness and/or substance abuse disorder. An estimated 50 million Americans
experience a mental disorder in any given year and only one-fourth of them
may actually receive treatment; a significant number who do receive treatment
will be incorrectly diagnosed, receive inappropriate care and/or discontinue
treatment against medical advice.
The stigma of mental illness and substance abuse prevents many persons from
seeking assistance. Stigma has contributed to the silence and shame associated
with mental health problems and suicide. Family members of survivors of suicide
attempts often hide the behavior from friends and relatives, believing that
it reflects badly on their own relationship with the suicide attempter or that
suicidal behavior itself is shameful or sinful. Stigma has contributed to the
inadequate funding for preventative services and to low insurance reimbursements
for treatments. Stigma has been identified as the most formidable obstacle
to future progress in the arena of mental health (U.S. Dept. of Health and
Human Services, 1999).
Objectives
4.1 Increase the proportion of the public that views mental and physical health
as equal and inseparable components of overall health. (Mid-term)
4.2 Increase the proportion of the public that views mental disorders as real
physical illnesses that respond to specific treatments. (Long term)
4.3 Increase the proportion of the public that views consumers of mental health,
substance abuse, and suicide prevention services as pursuing fundamental care
and treatment for overall health. (Long term)
4.4 Increase the proportion of those exhibiting suicidal behaviors who also
have underlying disorders who receive appropriate mental health treatment.
(Long term)
Suggested Strategies
Policy: Encourage statewide professional groups and associations concerned
with mental health, health care, substance abuse, faith communities, public
safety, youth, elders, and others that focus on policy development to address
the issue of stigma associated with being a consumer of mental health and substance
abuse prevention services.
Community Organizing: Promote adequate resources and technical assistance
for new and existing community-based efforts, especially in helping to reduce
the stigma associated with mental illness and suicide.
Education: Promote education (the single most potent strategy in reducing
stigma) and efforts to increase the dissemination of educational materials
for diverse target populations.
Resources: Promote anti-stigma campaign materials and strategies, including
the Massachusetts Department of Mental Health's Anti-Stigma campaign determine
best practices and materials to replicate and integrate with Massachusetts'
anti-stigma efforts.
Goal # 5: Develop and implement community-based suicide prevention programs
Rationale
The American Association of Suicidology estimates that 9 out of every 10 suicides
are preventable. Effective suicide prevention requires a broad-based community
commitment. Although there is not any one "suicide type," there are
individuals who are at a higher risk based on particular risk factors. To help
individuals in need within communities, leaders must mobilize resources, identify
risk and protective factors, and bring focused attention to the issue of suicide.
Successful suicide prevention and intervention strategy is based on a public
health approach. Evidence-based approaches and evaluations are needed as programs
are developed. The scientific study of suicide prevention is still in its infancy,
existing evidence-based strategies must be utilized and new ones tested.
Objectives
5.1 Establish a single number linking existing Massachusetts's crisis lines.
(Mid-term)
5.2 Develop and utilize a statewide database of suicide prevention resources.
(Short term)
5.3 Define key outcomes for a suicide prevention training curriculum such
as protective and risk factors, resiliency, risky behaviors, identification
of problem, crisis intervention for those at risk of suicide or for those displaying
suicidal behavior, and post-vention. (Short term)
5.4 Conduct training in the area of suicide prevention for community agencies
and individuals from a wide variety of populations. Specific populations may
include the elderly, adolescents, young and mid-life adults, gay/lesbian/bisexual/transgender
individuals, those in the correctional or juvenile justice system or other
institutions, and immigrants. (Short term)
5.5 Conduct training for suicide prevention program staff around suicide prevention
and intervention. (Short term)
Suggested Strategies
Policy: Implement the Suicide Prevention Working Group's Massachusetts Suicide
Prevention Strategic Plan.
Community Organization: Develop Support networks for at-risk individuals and
the implement and evaluate evidence-based suicide prevention interventions
at the state and local levels.
Education: Develop training modules to be used with various target populations
that include sections for both potential helpers and those in need of services.
Direct Service: Support the identification of interventions, barriers to access
to treatment, and increase awareness of the availability of prevention services.
Resources: Increase access to and availability of community-based suicide
prevention programs including, counseling, mental health, and substance abuse
treatment services.
Goal # 6: Reduce access to lethal means and methods of self-harm
Rationale
Research indicates that some suicides and many non-lethal self-injuries are
impulsive responses to acute crises or recent losses. Studies have determined
that those who make a significant suicide attempt that does not result in a
completed suicide may not pursue more lethal means if it is not available to
them. Limiting access to lethal and non-lethal methods of self-harm may be
an effective strategy to prevent self-destructive behavior and suicide in such
cases.
According to the Massachusetts Department of Public Health, suffocation, firearms
and poisonings are the leading methods of suicide in Massachusetts. Firearms
and poisonings together made up about 50% of all methods used in Massachusetts
suicides between 1996 and 1998. Poisonings constituted 83% of self-inflicted
injury hospitalizations in Massachusetts between 1996 and 1998.5 Window guards,
bridge barriers, and safer medication packaging also have the potential to
prevent suicides and self-injuries.
Objectives
6.1 Work with the MA Department of Mental Health to increase the proportion
of primary care, mental health clinicians, and public safety officials who
routinely assess the access to lethal means in the home or institutional setting
in higher risk situations (persons with depression, persons recently arrested).
(Mid-term)
6.2 Increase the proportion of households that have been exposed to public
information designed to reduce the accessibility of lethal means in the home.
(Mid-term)
6.3 Identify locations where architectural modifications may prevent suicide.
(Mid-term)
6.4 Promote safe and secure storage of materials that could be used for self-injury,
for the purpose of promoting decreased access for persons at risk of self-harm.
(Long term)
6.5 Promote appropriate architectural and engineering standards in the design
and building of bridges, buildings, and other locations where suicide attempts
may occur. (Long term)
6.6 Establish a system that maps high incident locations of suicide deaths
or self-inflicted injuries. (Long term)
Suggested Strategies
Policy: Support the development of policies that reduce access to lethal means.
Work with pharmaceutical companies and firearm manufacturers to encourage research
and development of new technologies and appropriate barriers to access. Promote
architectural and engineering innovations that create barriers to suicide.
Community Organizing: Identify and organize community-based organizations
to assist with educating professionals, parents, caregivers, and legislators
regarding issues of reducing access to lethal means.
Education: Provide training for health, mental health, and public safety professionals
on assessing for access to lethal means among persons at risk for suicidal
behavior. Provide education to parents and caregivers regarding risks associated
with access to lethal means.
Direct Services: Encourage assessment of access to lethal means by clinicians
and other professionals who interact with potentially high-risk individuals.
Engineering/Environmental: Promote architectural and engineering design, pharmaceutical
innovations, and other technologies that may reduce the risk of self-injury.
Resources: Promote the development of resources for training, educational,
and community organizing endeavors and environmental modifications.
Goal # 7 Implement professional training programs in recognizing and treating
suicidal behavior for those who are in regular contact with persons at risk.
Rationale
There are many different settings where trained personnel can intervene with
individuals at risk for self-injury and/or suicide. It is well known that 45%
of those who die by suicide have had some contact with a mental health professional
in the year before their death. Elders are at highest risk for completed suicide.
75% of elders who complete suicide visited their primary care physician in
the month prior to their death. Trained personnel who regularly come into contact
with people at risk for suicide have been called "key gatekeepers," and
include teachers, clergy, police, physicians, nurses, therapists, to name a
few. The environments in which key gatekeepers regularly interact with suicidal
persons are varied. Massachusetts is proud of its nationally renowned school
systems, higher institutions of learning, top-rated hospitals, as well as its
diverse population. There are many places in Massachusetts where we can affect
suicide prevention by implementing training programs for key gatekeepers.
Objectives
7.1 Assess current awareness, attitudes and knowledge of Massachusetts's health
and human service professionals about suicidal behavior. (Long term)
7.2 Implement key gatekeeper suicide prevention training programs in Massachusetts
to ensure adequate recognition and treatment of suicidal behavior. (Short term)
7.3 Understand of the effect of key gatekeeper suicide prevention training
programs on suicide mortality and morbidity in Massachusetts. (Short term)
Suggested Strategies
Education: Implement training programs in the recognition and treatment of
suicidal behavior across different human services disciplines including medical
and mental health, legal services including courts and law enforcement, education
system, and religious organizations. This training program should focus mostly
on the secondary prevention of suicidal behavior, but may have an impact on
the primary prevention of suicidal behavior amongst their consumers in the
long term. It should include instruction on identification of a person at risk,
appropriate counseling and treatment, and on availability of referral services
in Massachusetts. Initially, this training program can be incorporated in primary
clinical training settings, such as nursing schools, medical and psychiatry
residency programs, social work and psychology practicuum training. A suicide
prevention education program can also be incorporated into all primary training
programs and continuing education programs of health and human service professionals.
Policy: Promote implementation of suicide prevention education in primary
training programs and in continuing education programs, and encourage all human
and health service state licensure programs have a component of suicide prevention
education.
Community Organizing: Promote collaboration between the Massachusetts Department
of Mental Health, the Massachusetts Suicide Prevention Working Group and other
coalitions that address the mental health needs of the public (including suicidal
risk) to maximize knowledge of currently available training programs for health
and human service professionals and to access resources that may have already
performed a need-based assessment of the varied disciplines being targeted
for our suicide prevention program implementation. This collaboration would
also be crucial in the program evaluation component of the plan, as collection
of the data assessing program outcomes will certainly be laborious, necessitating
a coalition of data analysts.
Resources: Encourage coalition building between different groups in Massachusetts
that address the mental health needs of the state in order to promote information
and resource sharing.
Goal # 8 Develop and promote effective clinical practices to reduce suicide
morbidity and mortality
Rationale
Nationwide, for every suicide death, there are 5 hospitalizations and 22 emergency
department visits for suicidal behavior. Massachusetts has one of the most
generous health care access programs in the country, and a relatively higher
number of hospitals per person. Therefore, our number of hospital visits for
suicidal behavior may be even higher than the country overall. The mandate
to identify individuals at risk for suicide, to engage them in effective, early
treatments, and to promote protective factors in suicide prevention is especially
urgent for Massachusetts.
Suicide and self-injury can be prevented by identifying individuals at risk
and by engaging them in early and aggressive treatments which are effective
in reducing the factors associated with suicidal behavior. Increasing the presence
of protective factors for persons at risk can also prevent self-injury.
Professionals in health and mental health care, public health, education,
and law enforcement may be involved in the identification, referral, and treatment
of persons at risk. The quality of identification, referral, and treatment
of high-risk individuals may be improved by the identification and implementation
of effective clinical practices.
Objectives
8.1 Collaborate with the MA Department of Mental Health to develop and promote
best-practice, evidence-based guidelines on the recognition of suicidal behavior
and recommended algorithms for immediate treatment, including an appropriate
referral plan. (Short term)
8.2 Distribute suicide prevention guidelines to emergency department, primary
care, mental health and substance abuse provider practices. (Mid-term)
8.3 Reinforce current guidelines regarding the diagnosis and treatment of
patients with mood disorders. (Short term)
8.4 Reinforce the treatment algorithm for post-trauma patients in emergency
departments, and recognize that they are at risk for future mental illness
and suicidal behavior. (Short term)
8.5 Include suicide prevention guidelines in standard quality improvement
initiatives. (Mid-term)
Suggested Strategies
Education: Dissemination of best-practice guidelines in the diagnosis and
treatment of suicidal behavior can occur through educational venues in various
provider settings. Emergency, primary care, mental health, and substance abuse
providers can be the primary targets of this guideline dissemination and implementation,
but certainly other professionals who care for suicidal persons should be addressed
in the future. Reinforcement of current best-practice guidelines for the treatment
of mood disorders should occur largely through provider educational seminars.
Policy: Encourage inclusion of suicide prevention strategies in nationwide
quality improvement initiatives such as the Health Plan Employer Data and Information
Set (HEDIS) that will ensure that suicide prevention becomes an important quality
measure of care.
Resources: Development of clinical guidelines is a broad venture that will
likely occur across several academic institutions and different clinical departments.
Shared resources allocated towards the goal of suicide prevention guideline
development will be a necessary part of this goal.
Community Organizing: Community leaders and advocates can play a crucial role
in the development and the dissemination of suicide prevention guidelines.
Goal # 9 Improve access to and community linkages with mental health and substance
abuse services
Rationale
Persons with untreated mental health and substance abuse problems are at high
risk for suicidal behavior. Access to mental health and substance abuse services
is critical. Barriers to access should be reduced and linkages between various
community agencies, mental health, and substance abuse treatment programs need
to be established. Services must be integrated and coordinated, especially
across different funding sources.
Parity legislation has increased access to treatment for many; however, some
insurance coverage is still insufficient and uninsured individuals may still
be without care. Scarce resources for inpatient, outpatient and detox programs,
and trained professionals, increase the potential for persons to remain untreated.
Barriers remain for many in need, including cultural or spiritual differences,
language issues, not knowing when or how to seek care, concerns about confidentiality
or discrimination, or geographic inaccessibility. Programs must become more
sensitive to issues of discrimination based on age, geography, culture, gender,
income, disability and sexual orientation. Intrinsic to many persons in need
of mental health and substance use problems is the inability to reach out for
care; it is therefore the responsibility of the community to develop screening
and outreach services. Improving access will help ensure that at-risk populations
receive the services they need, reducing the potential for resultant suicidal
risk behavior.
Objectives
9.1 Increase the number of outreach programs for at-risk populations that
incorporate mental health services/substance abuse and suicide prevention.
(Long term)
9.2 Define age-specific guidelines for mental health and substance abuse screening
and referral of at-risk populations, such as youth, adults, the elderly, individuals
in adult and juvenile corrections, gay / lesbian / bisexual youth, and school
and college students. (Mid-term)
9.3 Implement screening and referral guidelines in school districts, colleges,
senior centers, corrections, DYS facilities, and other programs, senior centers,
and other programs serving those at risk. (Mid-term)
9.4 Develop effective comprehensive support programs for suicide survivors,
including follow-up treatment, support groups, and other services. (Long-term)
9.5 Complete an inventory of resources which support suicide prevention efforts
and disseminate information to human service providers and the general public.
(Short term)
9.6 Increase the number of seamless community-based mental health and substance
abuse treatment services. (Long term)
Suggested Strategies
Policy: Address barriers to mental health and substance abuse services, including
access to insurance and parity for covering persons employed by companies that
self-insure and others not covered. For those covered by public insurance,
address gaps in covered treatment services.
Community Organizing: Increase community awareness of risk behavior and increase
availability of culturally competent and linguistically accessible outreach
services
Education: Increase awareness of particularly vulnerable populations such
as college students and the elderly; develop screening tools and appropriate
linkages with crisis intervention and treatment services.
Direct Services: Work with the MA Department of Mental Health to increase
access to an integrated network of effective, efficient, culturally competent
and linguistically accessible mental health and substance abuse services, including
suicide prevention and counseling services. Develop and implement standard
best-practices protocols for effective response to and treatment of individuals
at risk for suicide or who experience suicidal behavior.
Resources: Promote access to community-based clinics, school-based clinics,
community crisis response teams, health and mental health professionals, crisis
hotlines, and parity health insurance.
Goal # 10 Improve reporting and portrayals of suicidal behavior, mental illness,
and substance abuse in the entertainment and news media.
Rationale
Media - film, television, radio, newspapers, magazines and the internet -
have a strong influence on the opinions of policy-makers and the public, and,
therefore, are a critical partner in health promotion and prevention. In addition
to the influence of national media, Massachusetts is home to many media with
national visibility.
Media representations of suicide can influence other's suicidal behavior.
The Centers for Disease Control and Prevention has issued guidelines for reporting
of suicide. Yet, media covering a suicide does not always know these guidelines.
In addition, individual suicides may be reported, but the larger context
of the burden of suicide is rarely the subject of a story. Thus, relying on
the media, the average person does not know of the full scope of suicide as
a public health problem.
The Suicide Prevention Working Group has generated some good press placement
to promote suicide prevention and the scope of suicide. Further efforts are
needed to raise the awareness of suicide, to promote prevention of suicide,
and to engage the media as a partner in prevention.
Objectives
10.1 Create a forum to connect Massachusetts' media with suicide prevention
experts.
(Short term)
10.2 Increase utilization of recommended CDC guidelines on reporting on suicide
by the media in Massachusetts. (Short term)
10.3 Increase the proportion of Massachusetts academic journalism programs
that include in their curricula guidance on the appropriate portrayal and reporting
of mental illness, suicide, and suicidal behaviors. (Long term)
Suggested Strategies
Policy: Share the CDC media guidelines for reporting on suicide with all media
covering suicide-related news events.
Community Organizing: Establish collaborative networks with local media and
academic journalism programs.
Education: Educate media professionals on the revised media guidelines.
Resources: The revised guidelines for reporting on suicide, local media contacts,
academic programs in journalism, local experts on suicide and suicide prevention.
Goal # 11 Promote and support research on suicide and suicide prevention.
Rationale
Suicide prevention is a relatively new field, with a limited science base.
Few suicide prevention programs have been evaluated, and few resources are
available to help community-based programs evaluate their efforts.
While this requires us to proceed cautiously with our prevention efforts,
we must still proceed. There are lessons applicable to suicide prevention from
over 20 years of substance abuse prevention research, and from the growing
evidence base on preventing youth violence.
Suicide prevention efforts at the state, community, and individual program
level can be strengthened by promoting research-based strategies, using research
in program planning and development, including an evaluation component for
each program and intervention, and collecting data.
There is a need for much more training in evaluating suicide prevention. Few
community-based programs have the knowledge, skills, or resources to facilitate
evaluation.
Objectives
11.1 Promote ongoing dissemination of science-based suicide prevention models
and use of research-based strategies for suicide prevention. (Short term)
11.2 Establish and maintain a current directory of suicide prevention activities
with demonstrated effectiveness. (Mid-term)
11.3 Promote the evaluation of suicide prevention activities. (Short term)
11.4 Increase the percentage of suicide prevention programs that conduct program-specific
research, and/or participate in research and evaluation efforts of others.
(Short term)
Suggested Strategies
Policy: Encourage suicide prevention programs to include an evaluation component.
Community Organizing: Encourage all Massachusetts suicide prevention programs
to participate in the Massachusetts Suicide Prevention Working Group and share
successful models and strategies.
Education: Educate key stakeholders on evidence-based strategies for suicide
prevention. Include materials on science-based suicide prevention in the Massachusetts
Prevention Center Library system
Engineering/Environmental: Create an environment that supports participation
in research related to suicide prevention.
Resources: Existing national and state research on suicide and suicide prevention,
funding for suicide prevention.
References
- National Center for Injury Prevention and Control, Center for Disease
Control
- Vital Registry of Records and Statistics, MA Department of Public
Health
- National Strategy For Suicide Prevention: Goals and Objectives For
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