Higher Education Roundtable Forum Student Depression and Suicide

Higher Education Roundtable Forum Student Depression and Suicide Victor and Mary Ojakian March 23, 2007 1

To Discuss • Mental Health Issue – Basic Data / Information • The Growth of the Depression Caseload: The Times They Are A Changing • Mental Health Landscape and Recent Events • Our Actions • Actions: Legislative and Local • Ending Remarks 2

Mental Health Statistics and Information Overview • Mental Disease: a health issue – 21 M Americans per year suffer from a mental illness – Cases of depression exceed all major health issues combined – Estimated that 70% of affected people do not seek treatment • US Data: – One in five children have a mental disorder – 30, 000 Americans die from suicide annual – TAY (transition age youth 15 to 25) annual deaths: 3, 800 • Suicide is the leading medical cause of death for this age group – 650, 000 attempted suicides annually in US – 2, 000 cases of attempted or completed suicides per day – From 1952 – 1995: suicides in TAYs increased three fold (300%) – Estimated annual cost for mental health care: $47 B – Annual mental health direct costs: $73 B (1997) • California: – 56% of Californians report a direct or indirect impact from mental wellness issues – about 4, 000 suicide deaths annually – TAY (transition age youth 15 to 25) suicide deaths: about 200 reported • Estimate ninety percent (90%) of all suicides are caused by a mental illness 3

Table 2 Adolescent Suicide Mortality Rates for 15 -19 Year Olds (per 100, 000) by Race and Hispanic Origin Using CDC WISQARS Mortality Data (1991 -2002) UNITED STATES Year Total White 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 11. 0 10. 7 10. 8 10. 9 10. 3 9. 6 9. 3 8. 8 8. 0 7. 4 11. 8 11. 1 11. 4 11. 2 10. 9 10. 2 9. 8 9. 2 8. 5 8. 6 8. 2 • Black 6. 9 8. 4 7. 9 9. 5 8. 0 6. 6 7. 0 6. 2 5. 8 5. 5 4. 3 4. 0 American Indian/AK Hispanic Native Origin 22. 8 7. 7 18. 8 8. 1 15. 7 8. 9 22. 3 8. 5 12. 4 8. 4 24. 6 7. 9 18. 4 7. 2 20. 0 6. 1 19. 2 5. 7 15. 5 5. 6 18. 0 5. 2 14. 4 5. 7 Data Downloaded from WISQARS on 6/14/05. 4

Mental Health Case Increase Student Depression on the Rise • Service cases are rising faster than student enrollment – twenty-three percent (23%) to fifteen and half percent (15. 5%) (UC Student Mental Health Report, September 2006) • In 2003 the National Survey of College Counseling Center Directors reported 84% more students with serious psychological problems over the previous 5 years. • Researchers at Kansas State University …. . found that “students experience more stress, more anxiety, and more depression than a decade ago. Some of these increases were dramatic. The number of students seen each year with depression doubled, while the number of suicidal students tripled, and the number of students seen after a sexual assault quadrupled” (Benton, Robertson, Tseng, Newton, & Benton, 2003, p. 69). (From SPRC, Promoting Mental Health and Preventing Suicide in College and University Settings, 2004, p. 7) 5

Mental Health Quote Doing Something Increasing depression among students is taxing campus mental health services. A number of surveys conducted during the past decade suggest that the prevalence of depression among college students is growing and eclipses the rate in the general public. In addition to the emotional pressures that come with leaving home and developing new relationships, the pressure on students to succeed academically has perhaps never been so high. Moreover, as college costs continue to climb, students approaching graduation with substantial loans to be repaid face the gloomiest job market in the past decade. Although campus services can offer a crucial point of entry to diagnosis and treatment, student health services and campus counseling centers frequently have not kept pace with the increased demand for treatment that such pressures bring. Thus, thousands of students with depression go undiagnosed and untreated just as they are facing some of life's most important junctures. Mounting Student Depression Taxing Campus Mental Health Services. Voelker, Rebecca. JAMA [H. W. Wilson - GS]. Apr 30, 2003. Vol. 289, Iss. 16; pg. 2055 6

Suicide Data: What Has Happened? • General Data: – College students suicide deaths nationally: as many as 1, 100 individuals every year (Jed Foundation) – UC student suicide deaths (from 2000 – 2005): about 40 individuals – Santa Clara County for youth (ages 15 – 24) suicide deaths (Kidsdata) : • For 2002: 3. 7 per 100, 000 • For 2003: 9. 5 per 100, 000 – California: the non-fatal, self-inflicted injury hospital rate for ages 5 – 20 in 2003: 44. 1 per 100, 000 (Kidsdata) – Santa Clara County: the non-fatal, self-inflicted injury hospital rate for ages 5 – 20 in 2003: 74. 9 per 100, 000 (Kidsdata) • UC student deaths by suicide: – Since 2004, UC Davis: 4 student deaths – Since 2002, UC Santa Cruz: 3 student deaths • Bay Area: – High school deaths by suicide recently: • In last four years, Mt. Tamalpais High School: 4 deaths • In last four years, Mission High School: 4 deaths 7

Mental Health Landscape Recent Events • Federal Government actions: – Garrett Lee Smith Memorial Act (2004) – The Mental Health Parity Act of 1996 (MHPA) – Mental Health & Addiction Equity Act (H. R. 1367) (under consideration) – The Mental Health Parity Act of 2007 (S. 558) (under consideration) • State of California actions: – Mental Health Services Act (MHSA - 2004) • Mental Health Stigma & Discrimination Reduction Advisory Group Meeting (2007) – Suicide Prevention Act (SB 1356 – 2006) • Department of Mental Health – 2007 planning process • Twelve (12) US states with youth suicide prevention plans (1995 – 2005) – Mental Health Parity Law (AB 88 - 1999) 8

Mental Health Landscape Something Is Going On • Lucile Packard Foundation for Children’s Health Parent Poll Report (January 11, 2007) – Parent’s feeling comfortable with their children’s health: • physical health - 78% and emotional/mental/behavioral health- 42% – Children’s stress has been the top parental concern for the last two years • US Center for Disease Control (January 2007 press release) – After a gradual drop since 1990, youth suicide rate increased by 18% in 2003 -2004 • University of California Student Mental Health Report (September 2006) – “UC students are presenting mental health issues with greater frequency and complexity. ” (Executive Summary, page 5) – “This increasing demand declining capacity pose a threat to the learning environment …. . “(Executive Summary, page 5) – Three tier approach: 1. Restore critical mental health services 2. Implement and augment targeted interventions 3. Take a comprehensive institutional approach to creating healthier learning environments 9

The Mental Health Landscape What We Are Doing • College and University Environment: – Requested UC Davis mental health program improvements – Requested UC systemwide study – Looking at other California university/college systems program improvements • High & Middle School Environments: – Foster implementation of federally mandated Wellness Policy with strong mental health component – Encourage more racial/ethnic base information • Support Mental Health Parity Insurance: – Testified at federal congressional hearing for the Mental Health and Addiction Equity Act of 2007 (H. R. 1367) – Encourage revisions in California mental health parity legislation • Improve mental health awareness – California Mental Health Stigma & Discrimination Reduction Advisory Group participation • Support statewide suicide prevention plan – Requested information from twelve states with youth suicide prevention plans 10

What Can Be Done? Actions ü Legislation: ü Locally: ü Request / support Santa Clara County health funding measure ü California State: ü Follow suicide prevention strategic planning and stigma and discrimination reduction planning ü Write/email support for Assemblyman Jim Beall’s AB 423 to improve mental health parity legislation ü Help in UC Mental Health Report funding by emailing UC president, Dr. Robert Dynes, UC Regents, and your state legislators ü Nationally: ü Write/ email support for US House mental health parity bill (H. R. 1367) ü Write/ email US congressional representatives requesting extension of Garrett Lee Smith Memorial Act 11

What Can Be Done? Actions ü College / University actions: ü Awareness programs: ü Target communications for documented high risk time periods: ü November – December and April - June ü Evaluate postcard mailing per: ü University of Washington study (Geisner, Neighbors, and Larimer; Journal of Consulting and Clinical Psychology, 2006, Vol. 74, No 2, pgs. 393 -399) ü State of Colorado: ‘Its ok to ask for help” postcard campaign ü Provide journalism students with training on mental health and suicide reporting (see examples by AFSP and WHO write-ups) ü Have post intervention / crisis team procedures ü See San Francisco Unified Schools Crisis Team write-up ü Provide for student support groups: ü Active Minds, a student run mental health awareness, education & advocacy program (at UCLA, UC Davis, USC, St. Mary’s, Mills College, etc. ) http: //www. activemindsoncampus. org/ ü University of Michigan’s Finding Voice findingvoice@umich. edu 12

What Can Be Done? Actions ü College / University actions: ü Consider joint area proposal for Garrett Lee Smith Memorial Act funds (May due date) ü Voice interest in getting MSHA funding for college program ü Evaluate/ Research: ü Yellow Ribbon Program (youth suicide prevention) effectiveness ü Intervention and recognition & referral skills training effectiveness ü AFSP College & University Screening Project (online) ü Explore linkages with local mental health organizations to leverage the services ü High School: ü Ensure mental health emphasis in federally mandated Wellness Policy ü Inform students of local mental health services ü Raise awareness and education of parents, administrators, & teachers about mental wellness ü Have post intervention /crisis team procedures ü San Francisco Unified Schools Crisis Response Manual http: //www. sfusd. k 12. ca. us/health/shpd/PSA_PUBS/Pubs/CRM 2001. pdf ü Obtain and use Omnigraphics, Inc. health series books: ü Suicide Information For Teens ü Mental Health Information For Teens, 2 nd edition 13

What Can Be Done? Actions ü Other : ü Ensure thorough reporting system ü Ensure emergency personnel trained in crisis intervention team (CIT) ü Adopt programs like: ü Stigma. Busters (NAMI) ü Breaking the Silence (NAMI) 14

Mental Health Quote Mental health is not a reflection of one's character, morals, or personality. It is not a character flaw or personal weakness. Factors such as hormones, genetics, and environment are major determinants of mental health, and pressures from identity issues, relationship problems, isolation, or other societal, environmental, and personal stresses have profound effects on our mental health. --from University of Michigan student mental health page http: //www. umich. edu/~mentalit/ 15

Ending Remarks • Mental health rights is the next national civil rights issue – Rhode Island Congressman, Patrick Kennedy (Mental Health Parity hearing February 2007) • “The nation must address suicide as a significant public health problem and put into place national strategies to prevent the loss of life and the suffering suicide causes. ” -- David Satcher, M. D. , PH. D. , (Remarks at the Release of The Surgeon General's Call To Action to Prevent Suicide, 1999) • “Suicidal people are stressed and depressed, not stupid. ” – from www. doitnow. org • “You are worth it – talk to someone today. ” – from www. Teen. Growth. com 16

The End Contacting us: via the Forum Sponsors How can you help: Provide email address on the sign-up sheet 17

Appendix 18

What Are They Saying? Mental Health Websites 19

What Mental Health Websites Are Saying? 20

What We Are Trying To Do? • Our work is focused on young adults and youth, the so called Transition Aged Youth (TAY), mental health and specifically youth suicide prevention • Provide mental health information to young adults through venues they attend • Encourage regional cooperation amongst mental health service providers, educational institutions, and social agencies working with young adults – create a regional fabric and social safety net • Reduce stigma and improving resources for mental health awareness • We have a California focused • Our goal: save lives 21

Not Our Children? Transition Age Youth (ages 15 to 24) Characteristics • Greater pressures than in the past: concerns about future, hopelessness, and alienation • Advent of significant mental health issues, including uni-polar, bipolar disorder, schizophrenia, and others • Possibility of suicide – the 2 nd leading cause of TAY deaths • Research shows prevalent characteristics, including age, grade level, racial/ethnic background, college major, and gender (4 male suicides for every female suicide) • The literature suggest most mental diseases are treatable and suicide is preventable 22

Are There Warning Signs? • General characteristic statements and hard to identify • Check out AFSP key warning signs on their website. Some are: – – – – • Thinking/talking about suicide Made a plan for suicide Unrelenting, low, irritable mood Appetite or weight changes Feelings and expressions of pessimism, hopelessness, anxiety and withdrawals Sleep problems Fatigue and low energy Loss of feeling of pleasure in acts that are normally pleasurable Poor concentration and memory Worthlessness or guilt Psychomotor agitation / retardation Increase in alcohol and drug use States being a failure Avoid the “grow out of it” syndrome 23

Other Web-based Information ü Provide web-base information that may include the following: ü Mental health for women: http: //www. 4 collegewomen. org/ ü Gavilan Community College Student Health – Suicide: ü Webpage: http: //www. gavilan. edu/health/suicide. html ü Foothill Community College: ü ü Webpage: http: //www. foothill. edu/vcc/psych. php UC Davis brochures: ü Helping Dangerous Students: Tips for Faculty/Staff: http: //caps. ucdavis. edu/resources/brochures/CAPS_Dangerous. p df ü Responding to Distressed Students - A Guide For Staff: http: //www. adelaide. edu. au/counselling_centre/staff/distressed. ht ml ü Responding to Students Expressing an Ambiguous Danger: http: //caps. ucdavis. edu/emergencies/ 24

ANNUAL CRISIS MANAGEMENT PLANNING CHECKLIST • Select your Crisis Response Team (CRT) and designate a Team Leader. • Train/Update the CRT. (Refer to the CR Manual) Include Car 29 officers and other law enforcement support available at your school. • Establish liaisons for the media, parents/caregivers and community. • Establish a working relationship with community-based organizations and develop a list of telephone numbers and contact persons after procedures for using them are in place. Place list in Resource Section. • Set up telephone trees to contact staff. • Identify space where service providers assisting in the crisis can see students for individual and small group counseling. School Crisis Response Manual, SFUSD - 6/01 25

ANNUAL CRISIS MANAGEMENT PLANNING CHECKLIST • Review, revise and print forms and materials that might be needed by CRT and staff. • Develop a plan for emergency coverage of duties for CRT members. • Establish a code to alert staff to implement prearranged procedures, e. g. lock down. • Develop a collection of educational resources on crisis topics: grief, loss, death, suicide. • Hold a mock crisis response. • Establish procedures for annual crisis response professional development of new staff and update/review for all staff. School Crisis Response Manual, SFUSD- 6/01 26