Senate Bill 542 addressed posttraumatic stress among first responders. In 2008, “after averaging approximately one physician or medical student suicide annually over a decade” (Norcross et al., 2018), the University of California, San Diego, School Prevention of pregnancy-related suicide in California Although the suicide rate among California women of reproductive age tends to be low compared with statistics for the rest of the nation, and although pregnancy does not seem to be a time of heightened suicide risk in general (DPH, 2019a), the suicide of a mother is a disaster for the whole family. To prevent such suicides, it is important to acquire an understanding of the risk factors and warning signs. According to the California Pregnancy-Associated Mortality Review (CA-PAMR; DPH, 2019a), between the years 2002 and 2012, “suicide as the mechanism of death accounted for 4.3% of all deaths among California women who were pregnant within the prior year” (p. 6). In reviewing various types of data, investigators discovered that suicide was being greatly underreported among this population. The reviews also revealed that “suicide preventability is high” (p. 6). The CA-PAMR looked into the suicides of 99 women and discovered that: ● 83% died between 43 and 365 days following the end of the pregnancy (36% between 43 days and 6 months and 47% after 6 months). ● 62% had reported mental health conditions before pregnancy and 25% developed mental health conditions during or after pregnancy. ● 23% had a family history of mental health conditions. ● Substance use was a common co-occurring condition with the mental health disorders and seemed to be a precipitating factor in 29% of the suicides. ● 85% had one or more psychosocial stressors, such as interpersonal conflict with a partner, financial problems, or exposure to violence in childhood or adulthood. ● Women who died by suicide within one year of pregnancy were more likely to have been adolescents the first time they gave birth, and they were more likely to have received less- adequate prenatal care during their most recent pregnancy than women who did not die in this way. Each Mind Matters The California Mental Health Services Authority (CalMHSA) is an organization of county governments that promotes prevention and early intervention (PEI) initiatives in the areas of mental health and suicide. These initiatives, which fall under the Screening tools for youth Screening is a suicide-prevention case-finding technique that involves screening either all students or students at risk for mental illness or suicidal ideation. Screening tools focus on identifying risk factors, such as depression, drug abuse, alcohol abuse, and prior suicidal ideation or attempts. Those identified as being at increased risk are referred to a specialist for further treatment. When designing screening studies for patients with suicidal ideation, it is important to evaluate and identify the availability of sites before initiating screening. The screening technique always carries a risk of false positives and false negatives. It is paramount to follow evidence-based practice and listen to the research. Some clinicians have raised concerns about screening techniques causing iatrogenic detrimental effects, i.e., seeding the idea of suicide into the minds of the children being screened. A large randomized control trial demonstrated that screening did not create an increase in emotional distress or suicidal ideation. On the contrary, suicidal youth who had not been asked about suicidal ideation reported that they were more distressed (NIMH, 2018).
of Medicine created the Healer Assessment, Education, and Referral (HEAR) Program, wherein medical and pharmacy students, physicians, and other healthcare professionals can seek confidential online assessments and receive personalized referrals. The program has proved beneficial and cost-effective. (DPH, 2019a) In approximately 51% of cases, there was a good to strong chance that intervention could have prevented the suicide. To that end, the CA-PAMR report makes general recommendations that include: ● Obstetric care that coordinates with psychiatry and other mental health care where indicated. ● Improved screening for mental health conditions during and after pregnancy, along with screening for substance use, adverse childhood experiences, and intimate partner violence. ● Pregnancy and postpartum care and support for women who have lost or terminated pregnancies. ● Linguistically- and culturally-appropriate information and support for partners and families concerning the woman’s mental health condition. (DPH, 2019a) The report urges primary prevention that focuses on increasing public awareness about “maternal mental health risk factors, signs, symptoms, treatment, and recovery” (p. 9) and better data collection at the time of maternal suicide. The report also recommends “selective prevention,” targeting higher-risk individuals and subgroups. Social isolation, for example, should be reduced through group prenatal care, peer-led support, or home visits. Obstetricians and pediatricians should be encouraged to do mental health screenings of pregnant and postpartum women. For people with mental health risk factors, gun safety and access to lethal means also need to be explored. Work also needs to be done to foster interprofessional and interagency cooperation and to educate all concerned on the importance of keeping the mother and her baby together (DPH, 2019a). umbrella title of the Statewide PEI Project, are publicly known as Each Mind Matters: California’s Mental Health Movement (CalMHSA, n.d.). This organization offers suicide prevention resources through its Know the Signs campaign.
ADVANCED SUICIDE RISK ASSESSMENT AND INTERVENTION FOR YOUTH
Early detection of suicidal ideation is a critical prevention strategy and The National Institute of Mental Health (NIMH) developed the Ask Suicide- Screening Questions (ASQ) Toolkit for this purpose. The NIMH noted that the majority of people who die by suicide visit a healthcare provider within months before their death; this represents a tremendous opportunity to identify at-risk individuals and connect them with mental health resources. Yet, most healthcare settings do not screen for suicide risk. In February 2016, the NIMH, accrediting organization for health-care programs in hospitals throughout the United States, issued a Sentinel Event Alert recommending that all medical patients in all medical settings (inpatient hospital units, outpatient practices, emergency departments) be screened for suicide risk. Using valid suicide-risk screening tools that have been tested in the medical setting and with youth, will help clinicians accurately detect who is at risk and who needs further intervention (NIMH, 2018). As described by the NIMH: The Ask Suicide-Screening Questions (ASQ) Toolkit is a free resource for medical settings (emergency department, inpatient medical/surgical units, outpatient clinics/primary care) that can help nurses or physicians successfully identify
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