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September is National Suicide Prevention Month, with World Suicide Prevention Day on September 10. To those in the healthcare community and countless mental health and substance abuse allies, suicide prevention is a year-round mission. Suicide is the 10th leading cause of death for Americans and among the top five causes of death for those ages 10 to 54.

Fortunately, numerous federal, state, and local public and private agencies are working to reduce suicide deaths and detect warning signs sooner.  We have recognized the importance of screening, early and regularly, for suicide and mood changes outside of strictly behavioral health settings with a focus on prevention. 

As agents of care, whether as administrators, clinicians, or caregivers, valuable resources exist to guide our prevention efforts.

• The Center for Integrated Health Solutions offers practical tools, trainings, and information regarding suicide prevention, and a resource compilation on suicide prevention in primary care. 
• The Suicide Prevention Resource Center (SPRC) offers a substantial compendium of resources and trainings surrounding suicide prevention. SPRC’s Zero Suicide program offers toolkits designed to help assess an organization’s readiness and ability to impact suicide, and specific training and development strategies to provide safer prevention-informed care. 
• The National Suicide Prevention Lifeline (1-800-273-TALK (8255)) is available 24/7 to provide confidential support for individuals in crisis, as well as concerned family and loved ones. The Lifeline also offers information to professionals in their efforts to help others. Lifeline report data is also available to help identify state-based call volume trends as recently as the past year, providing up-to-date information to supplement the Centers for Disease Control and Prevention’s (CDC) information. 
• Admission and discharge transitions pose a particularly heightened period of risk for patients with suicide ideation. A toolkit for comprehensive care transitions incorporating the Zero Suicide approach can be found here.  An Emergency Department Discharge Planning Checklist and Discharge Decision Support Tool are two quick reference guides available here.  
• Clinics and health centers should also consider incorporating suicide screening into Electronic Health Records (EHR) to standardize and routinize assessment. Here, Virna Little speaks about how this EHR modification has been implemented at the Institute for Family Health. 
• Mental Health First Aid is an evidence-based public education program that teaches lay-people and professionals how to recognize the signs and symptoms of depression, suicide risk, anxiety, trauma, psychosis, and substance use disorders. Through its interactive action plan, participants in the course learn how to provide comfort, de-escalate crisis, refer to professional help, and suggest self-help strategies to individuals in need. 
• Suicide Safe is a free suicide prevention app from SAMHSA for providers integrating suicide prevention into their practice. The app is based on SAMHSA’s Suicide Assessment Five-Step Evaluation (SAFE-T) card, available here. 
• The Columbia-Suicide Severity Rating Scale (C-SSRS) and the PHQ-9, both of which are available in numerous language versions, are two additional well-validated assessment tools. 
• Stories of Hope and Recovery is a free video guide featuring survivors of suicide attempts who share their stories of recovery and messages of hope. Perspectives from family members are also offered.
• Vicarious traumatization, or the effects of exposure to the traumatic experiences of other people, and direct exposure to client suicide, can be a serious occupational hazard in healthcare. The U.S. Office of Justice Programs offers a Vicarious Trauma Toolkit designed to assess and manage the effects of trauma exposure. The American Association of Suicidology also offers information for survivors of suicide attempts, clinicians who have lost patients or family members to suicide, and individuals who have lost loved ones to suicide.

Read more on Integration.SAMHSA.gov.

Give an Hour™ a national nonprofit  501 (c)(3), founded in September 2005, announces that it is opening its network to provide immediate and long term mental health support for those affected by Hurricane Harvey. Give an Hour will extend these services to those affected by Hurricane Irma should the need arise. 

As the flood waters begin to recede in Hurricane Harvey’s wake, Give an Hour is partnering with the American Red Cross to bring mental health and emotional support services to those affected. While some people will be in immediate need of intensive mental health treatment, many more people will be in need of someone who can provide emotional support and assistance. As our nation closely watches the approach of Hurricane Irma, Give an Hour stands ready to help those affected by this massive storm as well. 

“Give an Hour is proud to partner with the American Red Cross to provide this essential mental health support and we are grateful to our network of 7000 generous mental health professionals – many of whom are already stepping up during this time of need”, said Dr. Barbara Van Dahlen, Founder and President of Give an Hour. “Some Give an Hour providers may join efforts on the ground  – others in our vast network will offer phone support to the thousands who need their compassion, expertise and assistance. We all have gifts to give to those who are hurting.” Since 2005, Give an Hour has provided free and confidential mental health care to those who serve, our veterans, and their families – providing over 224,000 hours of free care valued at nearly $23M.  Give an Hour has since expanded efforts to address the mental health needs of other populations. 

Read more on BusinessInsider.com.

Last month, the University of Alaska Fairbanks announced a $4.25 million initiative to tackle youth suicide in Alaska Native communities, with a focus on resilience and solutions. But one program in the Northwest Arctic Borough School District has focused on this type of community-based prevention since its start in 2008, and it now has been showing results.

Promoting peer-to-peer mentoring, the school district’s Youth Leaders Program engages students and their communities, challenging them to come up with solutions to bullying, isolation and suicidal tendencies. In the years since the program’s start, the school district has seen a dramatic drop in student suicides. According to Michelle Woods, the program coordinator until she retired two years ago, nine students died by suicide in 2007. By 2009, it was five.

The premise of the Youth Leaders Program is simple: tap a number of student leaders in each school and give them the training to help their peers during times of distress. Anyone can be a Youth Leader — there are currently over 120 in the school district, which has around 2,000 students in grades kindergarten through 12th. Over 90 percent of the district’s students are Alaska Native, spread out among 11 villages in Northwest Alaska that range in population between 150 and 3,200.

Students also nominate two of their peers who they think are approachable if students have an issue at school or home. These students are offered positions as captains, who help teach Youth Leaders at their schools. Both captains and Youth Leaders are trained in the TALK suicide prevention program — short for “Tell Somebody,” “Ask,” “Listen and Reflect” and “Keep Them Safe.”

Read more on ADN.com.

Maintaining dignity and self-worth in the prison system isn’t easy. Arts education has helped incarcerated people emotionally deal with being in prison, and some incarcerated artists have taken to selling their work to financially supplement their families and themselves.

A disproportionate amount of the prison population is made up of people from low-income communities: A 2015 report by the nonprofit Prison Policy Initiative found that the average income of incarcerated people ages 27 to 42 prior to their incarceration was $13,320 less than that of non-incarcerated people in the same age group. This economic disparity means that prisoners and their families are often unable to post bail or hire a lawyer, and that day-to-day necessities inside prisons — shampoo, toothpaste and pads, for example — may be harder to come by.

While profits from prison art are not large, they can help to soften the blow of these expenses for those who are incarcerated and their families. The profits can also be used to create a fund for prisoners for when they are released — an essential part of starting over and reintegrating into a community. 

And prison art is hardly a means of livelihood. Making a profit is already rare for most artists, and it is even less likely for those in prison. “It’s not an easy sell,” Dennis Sobin, who was once incarcerated and is the current director of Safe Streets Arts Foundation, which sells and supports prison art, said in a phone interview. “A lot of people are attracted to prison art because of the sensationalistic aspect of it, but many more people are unattracted to it because of the same thing.”

Yet there is increasing evidence that rehabilitation is more effective than incarceration, and arts education has been shown to increase self-confidence, time management skills, emotional control and interest in pursuing other education programs — all of which help former inmates assimilate to life outside prison, decreasing recidivism rates. In Sobin’s words, when inmates become involved with the arts, “they become better and more content people in prison and they can make that adjustment on the outside.”

Read more on Mic.com.

For the 14th year in a row, Agency for Healthcare Research and Quality (AHRQ) is reporting on health care quality and disparities. The annual National Healthcare Quality and Disparities Report (QDR) is mandated by Congress to provide a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups. The report assesses the performance of our health care system and identifies areas of strengths and weaknesses, as well as disparities, for access to health care and quality of health care. Quality is described in terms of the National Quality Strategy priorities, which include patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of health care services and settings. Selected findings in each priority area are shown in this report, as are examples of large disparities, disparities worsening over time, and disparities showing improvement. The report is produced with the help of an Interagency Workgroup led by AHRQ.

The following are the key findings from the report:

• Access: While most access measures (65%) tracked in this report did not demonstrate significant improvement (2000-2014), uninsurance rates (measured as uninsured at the time of interview) decreased from 2010 to 2016.
• Quality: Quality of health care improved overall from 2000 through 2014-2015 but the pace of improvement varied by priority area:
  • Person-Centered Care: About 80% of person-centered care measures improved overall.
  • Patient Safety: Almost two-thirds of patient safety measures improved overall.
  • Healthy Living: About 60% of healthy living measures improved overall.
  • Effective Treatment: More than half of effective treatment measures improved overall.
  • Care Coordination: About half of care coordination measures improved overall.
  • Care Affordability: About 70% of care affordability measures did not change overall.
• Disparities: Overall, some disparities were getting smaller from 2000 through 2014-2015, but disparities persist, especially for poor and uninsured populations in all priority areas:
  • While 20% of measures show disparities getting smaller for Blacks and Hispanics, most disparities have not changed significantly for any racial and ethnic groups.
  • More than half of measures show that poor and low-income households have worse care than high-income households; for middle-income households, more than 40% of measures show worse care than high-income households.
  • Nearly two-thirds of measures show that uninsured people had worse care than privately insured people.

Read more and download the full report on AHRQ.gov.

What is the recipe for long-term happiness? One crucial ingredient cited by many people is closeness in their social relationships. Very happy people have strong and fulfilling relationships. But if we feel rejected by those who are closest to us – our family and friends – it can sour our attempts to master the recipe for happiness.

Bi-cultural people, who identify with two cultures simultaneously, are particularly vulnerable to this kind of rejection. A person can become bi-cultural by moving from one country to another, or if they are born and raised in one country by parents who came from elsewhere. For example, for a child born and raised in London by Russian parents, Russian will be what’s called their “heritage culture”.

Research has shown that being bi-cultural is a tremendously beneficial trait because it makes us more flexible and creative in our thinking. But bi-cultural people may experience their upbringing as the collision of multiple worlds. They sometimes face criticism for stepping outside the bounds of what’s normally acceptable in their heritage culture. This experience of rejection from one’s heritage culture is referred to as “intragroup marginalisation”. People experience this when they adapt to a new culture in ways that are deemed to be a threat to their cultural origins.

In the author’s ongoing research, they are looking at ways that people can cope and overcome experiences of rejection from their heritage culture. To understand this painful experience, other research has looked at whether personality traits, such as attachment style, can make a person more likely to feel intragroup marginalisation. Attachment style shapes how we interact with others in our relationships. A securely attached person sees themselves as worthy of love and others as trustworthy, while somebody who is insecurely attached can be anxious and sensitive to threats of rejection. They can also avoid and feel uncomfortable with closeness and intimacy.

Insecurely attached bi-cultural people tend to report greater marginalisation from their friends and family. This may be because they are sensitive to rejection and perceive themselves as failing to uphold the traditions expected of them by their heritage culture. For example, a second-generation Bangladeshi in Britain may feel ashamed at not being able to speak Bengali very well, or a Hungarian who moved to Britain may feel that their values have changed. Another key personality trait reflects how individuals perceive their sense of self in relation to others. We can see our self as being independent and unique from others, and as having a high sense of agency. Alternatively, we can see ourselves as being interdependent with others and fluid, changing based on the situation.

Research has found that people who have a more fluid sense of self are less likely to feel rejected from their heritage culture, compared to those who have an independent sense of self. This is because they are better able to reconcile both their cultural identities without experiencing conflict.

Read more on TheConversation.com.