GETTING INVOLVED IN STATEWIDE SUICIDE

PREVENTION INITIATIVES

John Madigan, AFSP Vice President of Public PolicyR. Keith Hotle, JD, MPA, Wyoming Department of HealthNicole 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 ManagerPublic 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

Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Number 106 109 88 84 116 97 119 111 130 127 132 98

Rate per 100,000

21.20 21.65 17.29 16.34 22.19 18.14 21.79 19.83 23.06 22.85

Source: Wyoming Department of Health, Vital Statistics Services (2014)

Wyoming Suicide Prevention Death Rates

Cause of Death Rank NumberPercentage of all

deaths

Major Cardiovascular Disease 1 1173 27.1%

Malignant Neoplasms (i.e., cancer)

2 919 21.2%

Chronic Lower Respiratory Disease

3 319 7.4%

Alzheimer’s Disease 4 153 3.5%

Suicide 5 127 2.9%

TOTAL   2691 62.1%

Source: Wyoming Department of Health, Vital Statistics Services (2012)

Wyoming Top 5 Causes of Death (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 SYSTEMPRIOR 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 SYSTEMBEGINNING JULY 1, 2012

State plans and makes funding decisions

State contracts with 1 Prevention Management Organization

Fiscal agents hire 42 Program Managers (38 charged with SA prevention and 4 regional suicide prevention coordinators

Program Managers organize and support local prevention coalitions in each county

Local coalitions define and implement local strategies

2009 State Task Force & WYSPAC Merged into WySPAC

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 ACTIVITIESInnovative 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

• 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

SUICIDE PREVENTION INITIATIVES 2014-15

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!