Suicide Prevention in Nebraska David Miers Ph D

Suicide Prevention in Nebraska David Miers, Ph. D, LIPC Counseling and Program Development Manager, Mental Health Services Bryan Medical Center Board Member, Nebraska State Suicide Prevention Coalition Co-Founder Lincoln Lancaster LOSS Team

Objectives for Today • History of Suicide Prevention in Nebraska • Nebraska State Suicide Prevention Coalition • Local Coalitions-Example • Data and 5 Year GLS Grant • Local and State Partnerships – Mini-Grants Kim Foundation – LOSS Team Pilot and Growth Main Goal is for You to Walk Away with Resources Available in Nebraska and for You to Know How to Get Involved in Suicide Prevention

Surgeon General’s Call to Action to Prevent Suicide 1999 • Surgeon General David Satcher, MD-July 1999 Meeting-NE representation • August 1999 Regional Office in KC Held Multi-State Meeting • Nebraska State Suicide Prevention Coalition was formed

What is the NSSPC? The Nebraska State Suicide Prevention Coalition (NSSPC) is a voluntary non-profit group made up of committed and passionate people representing public and private agencies, suicide survivors and Nebraskans interested in suicide prevention. NSSPC is recognized by the State Department of Health and Human Services as the primary group responsible for coordinating Nebraska’s suicide prevention efforts. NSSPC relies on the generosity of private foundations, grants, and in-kind donations to continue the work of preventing suicide in Nebraska.

Nebraska State Suicide Prevention Coalition (NSSPC) -Started in 1999 and began meeting at Bryan Medical Center West -2018 NSSPC officially became 501© 3 – Continues to meet at Bryan West. -NSSPC has partnered with UNL and State of NE on 2 Federal Garrett Lee Smith Grants-Most recent 5 year, 3. 5 million dollar grant - QPR Training Statewide -Clinician Training (AMSR) Statewide -Suicide Prevention Awareness -Means Restriction-Gun Locks-(Example of gun locks available in the E. D. ) -LB 923 -NSSPC helped write legislation and grant has helped fund the required training for school staff first 5 years. (Legislation requires all school personnel receive 1 hour of suicide prevention training per year. ) -NSSPC worked with Kim Foundation on grant and offered mini-grants statewide for suicide prevention efforts to be implemented statewide. -Local Outreach to Suicide Survivors (LOSS) Teams Statewide -Goal to have LOSS Team that originated in Lincoln (with Bryan MHS Support) to be available in each of the 6 Behavioral Health Regions

Lincoln Lancaster Youth Suicide Prevention Coalition • Formed in 2014 – Bryan Mental Health on Leadership group as well as trauma team involvement. • www. hopelnk. org developed as citywide campaign – mural in Haymarket • Bryan Medical Center Mental Health on Lincoln Public School Committee for school assessment. LPS implemented the Suicide Behavior Risk Questionnaire. Revised (SBQ-R) in the 2017 -2018 school year to all elementary, middle, and high schools after a successful pilot. We assisted in training LPS personnel in 2018 and they continued in 2018/2019. Goal to have standardized screening citywide for schools so common language for community providers and hospitals. Has worked very well! – Youth are being screened and referred to help.

Local Outreach to Suicide Survivors (LOSS) -Started in Lincoln, NE as Pilot July 1999 -Public Private Partnerships-Local Grant Video produced to help educate about purpose of LOSS - https: //youtu. be/t 8 cu. M 0 ar. UME

Lincoln Lancaster Youth Suicide Prevention Coalition – Means Restriction • Public Service Announcement Development: – https: //www. youtube. com/watch? v=Jk. QExw 2 K 6 r 8 – Work done by local coalition with local gun shops and ranges on prevention • April 2018 Lincoln Police and the Local Coalition held the most successful Gun Amnesty Day in History of Lincoln. – Citizens were able to drop off firearms and ammunition with no questions asked. This resulted in: • 76 rifles and handguns, • More than 70 thousand rounds of ammunition in various calibers • Grant funding allowed 42 lock boxes and 46 trigger locks to be distributed.

Lincoln Lancaster Youth Suicide Prevention Coalition • Signage developed at Bryan Medical Center for our garages and shared and adopted citywide. Mayor approved in all city owned garages. Since then UNL and others have also utilized or expressed interest. Several stories of signage saving lives. – Omaha has since moved forward on similar project

Mini-Grants • The Kim Foundation has been instrumental in the history of the Nebraska State Suicide Prevention Coalition – Grants awarded to the State Suicide Prevention Coalition by the Kim Foundation • Grants utilized by Coalition to offer mini-grants to communities statewide to promote awareness, education, and information to individuals in need – Many successful projects – This concept was carried over to one of the focuses of our first Garrett Lee Smith federal grant –To provide minigrants based on past success

Youth Suicide Prevention in Nebraska March 2019 Data Sources: Nebraska Department of Health and Human Services Vital Records & Web-based Injury Statistics Query and Reporting System – Nebraska & US Completed Suicides – 10 -24 Year Olds – 2004 -2017

GLS Suicide Prevention Grant Funding Administered by the State of Nebraska Distributed to Six Behavioral Health Regions throughout Nebraska

Goal #1 Prevent Youth Suicides in Nebraska • Assessing and Managing Suicide Risk (AMSR) 598 clinicians 2014 -2019 • Collaborative Assessment & Management of Suicidality (CAMS) 177 clinicians 2014 -2019 • Question, Persuade, Respond (QPR) 25, 856 individuals 2014 -2019 • Building a Suicide Safe School Community 23, 745 educators 2018 - 2019 • State Suicide Coalition • Means Restriction (gun locks, medication lock boxes, awareness)

Goal #2: Standardize Screening Protocols for Youth in Child Serving Systems • Kognito At-Risk Suicide Training 50, 162 educators 2014 -2019 • Suicide Safe Schools 38, 798 educators 2014 -2019 • Professional Partner Screening Over 700 youth screened 2014 -2019 • Behavioral Health Regions, Community-Specific Prevention Strategies

Goal #3: Communities Implement Culturally Appropriate Suicide Prevention Strategies • Suicide Prevention Resources and Outreach Brochures, bracelets with Lifeline phone number, websites, billboards, public service announcements • LOSS Teams in 9 Communities Lincoln/Lancaster | Metro--Omaha Columbus-Columbus | Norfolk-Norfolk Four Corners—York/Seward Kearney--Central Ne LOSS team Mc. Cook--Southwest Ne LOSS team Chadron---Chadron/Northwest NE Beatrice--Beatrice/Fairbury • Speakers, Conferences, Events Out of the Darkness Walks, Living Well Workshops, Public Showing of Films and Documentaries (The S Word, The Mind Inside, The Ripple Effect)

Vital Records Suicide Data

Nebraska & US Suicide Rates by Year (10 -24 year olds) 14. 00 Suicide Rates per 100, 000 13. 00 12. 00 11. 00 10. 00 9. 00 8. 00 7. 00 6. 00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 US 7. 26 7. 04 6. 90 6. 75 7. 04 7. 21 7. 57 7. 91 8. 01 8. 14 8. 54 9. 16 9. 60 10. 57 Nebraska 9. 13 7. 60 11. 73 8. 78 9. 37 7. 33 6. 83 7. 04 9. 84 7. 70 10. 1512. 5812. 2413. 22

Nebraska & US Suicide Rates - 5 Year Running Averages (10 -24 year olds) 12. 00 Suicide Rates per 100, 000 11. 00 10. 00 9. 00 8. 00 7. 00 6. 00 2004 - 2005 - 2006 - 2007 - 2008 - 2009 - 2010 - 2011 - 2012 - 20132008 2009 2010 2011 2012 2013 2014 2015 2016 2017 US 7. 00 6. 99 7. 09 7. 30 7. 55 7. 77 8. 03 8. 35 8. 69 9. 20 Nebraska 9. 32 8. 97 8. 82 7. 87 8. 08 7. 75 8. 32 9. 49 9. 95 10. 98

Regional Differences

NE Regional Rate Differences (10 -24 Year Olds) District Public Health Solution West Central Sarpy Cass Four Corners Loup Basin East Central Southwest Nebraska Southeast Lancaster State Total Panhandle Public Three River Public Central South Heartland Elkhorn Logan Valley North Central District Douglas County Two River Northeast Nebraska Public 2011 -2016 20. 23 13. 74 13. 63 12. 73 12. 63 12. 48 11. 71 11. 45 9. 97 9. 91 9. 74 8. 88 8. 75 8. 74 8. 68 8. 42 7. 90 7. 82 6. 70

2011 – 2016 Average Suicide Rates by Nebraska Public Health District Suicides per 100, 000

Regional Trends

Regional Differences

Regional Differences

Regional Differences

Regional Differences

10 -24 Year Old Suicide Rate Metro vs. Non-Metro, 5 Year Averages 14 12 Suicide Rate per 100, 000 10 8 6 4 2 0 2005 -09 2006 -10 2007 -11 2008 -12 2009 -13 2010 -14 2011 -15 2012 -16 2013 -17 NE Rate - Metro 8. 41 7. 77 6. 80 7. 08 6. 79 7. 50 9. 11 10. 02 10. 44 NE Rate Non-metro 9. 97 10. 73 9. 88 9. 98 9. 56 9. 86 10. 12 11. 46 12. 66 US Rate - Metro 6. 56 6. 66 6. 86 7. 08 7. 29 7. 57 7. 87 8. 20 8. 70 US Rate - Non-metro 9. 45 9. 64 9. 90 10. 30 10. 63 10. 85 11. 31 11. 70 12. 30

10 -24 Year Old Suicide Rate by Race 5 Year Averages 14 Suicide Rate per 100, 000 12 10 8 6 4 2 0 2005 -09 US -White 7. 51 US -Nonwhite 5. 27 NE -White 8. 96 NE -Nonwhite 8. 94 2006 -10 7. 61 5. 39 8. 86 8. 32 2007 -11 7. 87 5. 46 7. 90 7. 64 2008 -12 8. 15 5. 63 7. 99 8. 78 2009 -13 8. 41 5. 73 7. 82 7. 15 2010 -14 8. 71 5. 90 8. 37 7. 86 2011 -15 9. 05 6. 18 9. 48 9. 36 2012 -16 9. 35 6. 65 10. 35 11. 56 2013 -17 9. 87 7. 15 11. 11 11. 61

10 -24 Year Old Suicide Rates Gender 5 Year Averages 20 18 Suicide Rate per 100, 000 16 14 12 10 8 6 4 2 0 2005 -09 NE rate Male 14. 46 NE rate Female 3. 07 US rate Male 11. 26 US rate Female 2. 49 2006 -10 13. 74 3. 62 11. 39 2. 57 2007 -11 12. 21 3. 31 11. 67 2. 71 2008 -12 12. 52 3. 42 11. 97 2. 91 2009 -13 12. 29 2. 98 12. 22 3. 10 2010 -14 13. 01 3. 38 12. 58 3. 27 2011 -15 15. 00 3. 65 12. 97 3. 51 2012 -16 16. 28 4. 46 13. 40 3. 75 2013 -17 17. 34 4. 73 14. 18 3. 98

10 -14 Year Old Suicide Rates 5 Year Averages 2. 50 Suicide Rate per 100, 000 2. 00 1. 50 1. 00 0. 50 0. 00 2005 -09 2006 -10 2007 -11 2008 -12 2009 -13 2010 -14 2011 -15 2012 -16 2013 -17 NE 10 -14 Rate 2. 25 1. 62 1. 14 1. 29 1. 28 1. 74 1. 73 1. 57 1. 69 US 10 -14 Rate 1. 09 1. 16 1. 28 1. 45 1. 61 1. 75 1. 90 2. 10

20 -24 yr old Suicide Rates 5 Year Averages 20 Suicide Rates per 100, 000 18 16 14 12 10 8 6 4 2 0 2005 -09 2006 -10 2007 -11 2008 -12 2009 -13 2010 -14 2011 -15 2012 -16 2013 -17 NE 20 -24 Rate 12. 40 14. 14 13. 51 14. 12 13. 45 13. 25 15. 36 17. 04 17. 35 US 20 -24 Rate 12. 58 12. 82 13. 04 13. 25 13. 45 13. 77 14. 06 14. 56 15. 23

10 -24 yr old Suicide by Firearm Rates 5 Year Averages 6 Suicide Rates by 100, 000 5 4 3 2 1 0 2005 -09 2006 -10 2007 -11 2008 -12 2009 -13 2010 -14 2011 -15 2012 -16 2013 -17 Unites States 3. 18 3. 20 3. 26 3. 37 3. 45 3. 57 3. 71 3. 90 4. 16 Nebraska 4. 58 4. 09 3. 80 3. 60 3. 48 3. 56 4. 29 4. 66 5. 18

Youth Suicide Prevention Boys Town Lifeline Data

2011 – 2016 Average Suicide Rates & 2011 - 2018 Lifeline Calls by Nebraska Public Health District Suicides per 100, 000

Youth Suicide Prevention Geo. Maps

2015 - 2019 Number of School Staff Trained in Question, Persuade, Respond (QPR) by Educational Service Unit

2015 - 2019 Number of Non-School Staff Trained in Question, Persuade, Respond (QPR) by City and Behavioral Health Region

2015 - 2019 Number of QPR Trainees (School and Non-School) by County

2015 - 2019 Number of QPR Trainees (School and Non-School) by Behavioral Health Region

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Suicide Rates-Nebraska and USA Suicide Rates in Nebraska and The United States 16 14 12 10 8 6 4 2 0 1990 Nebraska 13. 9 United States 12. 4 1991 12 12. 2 1992 11. 7 12 1993 10. 6 12. 1 1994 11. 6 12 1995 11. 4 11. 9 1996 11. 4 11. 6 1997 10. 6 11. 4 1998 12. 3 11. 3 1999 10. 6 10. 7 2006 11. 4 11. 1 2009 9. 5 12 2010 10. 6 12. 4 2012 12. 5 12. 9 2013 11. 8 13 2014 13. 3 13. 4 2015 11. 8 13. 8 2016 12. 9 13. 9 2017 14. 3 14. 5

Suicide Prevention for Staff • QPR and Mental Health First Aid are offered by each region throughout their area of the state

http: //region 1 bhs. net/ www. region 4 bhs. org/ www. regionsix. com www. r 2 hs. com/ www. region 3. net www. region 5 systems. net

Suicide Prevention Resources

http: //www. sprc. org/sites/ default/files/Final%20 Nati onal%20 Suicide%20 Preve ntion%20 Toolkit%202. 15. 1 8%20 FINAL. pdf

Materials – The Nebraska State Suicide Prevention Coalition has developed some materials that can be downloaded – www. youthsuicideprevention. Nebraska. edu

Other Resources • Many resources in toolkit-links to resources – www. afsp. org – www. sprc. org – www. suicidology. org • www. samhsa. gov - Pocket cards and publications

Thank you! Any Questions? Contact Information: Dr. Dave Miers, Ph. D, LIPC Counseling and Program Development Manager Mental Health Services, Bryan Medical Center Dave. Miers@Bryanhealth. org National Suicide Helpline-1 -800 -273 -8255