Suicide Assessment and Prevention _ ____________________________________________________________
activities [5]. In 1983, the CDC established a violence preven- tion division that alerted the public to the disturbing increase in youth suicide rates. In 1996, survivors of suicide loss mobilized to form the Sui- cide Prevention Advocacy Network USA (SPAN USA) and launched a campaign to advocate for the development of a national suicide prevention strategy [107]. In 2009, SPAN USA merged with the American Foundation for Suicide Prevention to raise awareness, fund research, and provide resources and aid to those affected by suicide [48]. The National Strategy for Suicide Prevention (NSSP) was released by the Surgeon General of the United States in 2001 and updated in 2012. The NSSP describes a series of goals and objectives designed to reduce the incidence of suicide behaviors in the United States [46]. Although activity in the field of suicide prevention has increased exponentially since publication of the NSSP, the overall rate of suicide since 2000 continues to increase [1]. SUICIDE PREVENTION THAT TARGETS AT-RISK POPULATIONS College Students Colleges and universities are increasingly challenged to identify and manage mental health and substance use problems in students. Because the risk and protective factors for suicide among young adults include substance abuse and interpersonal violence, suicide prevention may best be integrated within broader prevention efforts [5; 108; 109]. Inmates in Jails and Correctional Settings As discussed, jails and juvenile justice facilities have excep- tionally high suicide rates. The highest rates of jail suicide occur within the first 24 to 48 hours of arrest, suggesting an important role of medical assessment of substance abuse and suicide proneness at intake. Comprehensive prevention programs targeting inmate suicide include training, screening, effective communication methods, intervention, use of report- ing protocols, and mortality review [5; 110]. Elderly Persons Almost 70% of elderly patients who take their own lives see their primary care physician within a few months of their death [111; 112]. This represents an absolutely vital, yet narrow, window for accurate screening and assessment of suicide risk [2]. Unfortunately, healthcare and mental health professionals are not immune from harboring the stereotypes of the elderly often found among society in general. These can include atti- tudes that a depressive response to interpersonal loss, physical limitation, or changing societal role is an inevitable and even normal aspect of aging [111; 113; 114]. Suicidal thoughts may even be considered age-appropriate in the elderly [112]. When held by patients and family members, these erroneous beliefs
• During operational deployment conditions or other extreme situations during which hospitalization or evac- uation is not possible, “unit watch” may be considered as appropriate in lieu of a high level care setting (hospi- talization), and service department policies, procedures, and local regulations should be followed. • Because of the high risk of suicide during the period of transition, providers should pay particular attention to ensure follow-up, referral, and continuity of care during the transition of service members at risk for suicide to a new duty station or after separation from a unit or from military service.
CONSIDERATIONS FOR HEALTHCARE PROFESSIONALS
Although confidentiality is crucial when caring for any patient, this is heightened for healthcare providers who would poten- tially be seeking assessment and treatment in their workplace. All healthcare providers should be offered the opportunity for anonymous screening for depression and suicide. The healer education assessment and referral (HEAR) screening program is a sustainable suicide prevention program that uses an anony- mous method to provide screening for untreated depression or suicide [119; 121]. The American Foundation for Suicide Prevention also provides services specifically for healthcare providers, accessible at https://afsp.org/suicide-prevention- for-healthcare-professionals. SUICIDE PREVENTION Understanding the interactive relationship between risk and protective factors in suicidal behavior and how this interaction can be modified forms the basis of suicide prevention [5; 106]. The characteristics shared by effective suicide prevention pro- grams include clear identification of the intended population, definition of desired outcomes, use of interventions known to effect a particular outcome, and use of community coordi- nation and organization to achieve an objective. Prevention efforts are based on a clear plan with goals, objectives, and implementation steps [5; 45]. HISTORY OF SUICIDE PREVENTION IN THE UNITED STATES In the United States, large-scale suicide prevention efforts began in 1958. Funding from the U.S. Public Health Service established the first suicide prevention center in Los Angeles, and other crisis intervention centers replicating this model were opened across the country [5]. The risk factor approach to suicide prevention was first implemented in 1966, and the American Association of Suicidology and the American Foun- dation for Suicide Prevention were established over the next two decades. Their activities included increasing the scientific understanding of suicide as the basis for effective prevention
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