HOPES - WI Suicide Prevention Strategy Resources and References

Suicide and Suicide Prevention Internet Resources

Web Resources [updates have been made to the original list due to the ever-changing nature of the World Wide Web]

References

Appendix A - Risk and Protective Factors

Appendix B - Development of the Plan

Appendix C - Glossary

Evaluation Information

Georgia Suicide Prevention Plan
http://www.sprc.org/stateinformation/statepages/georgia.asp

Evaluation Handbook from the W. K. Kellogg Foundation for Community-Based Projects
http://www.wkkf.org/pubs/Pub770.pdf

Primer on Evaluation from the U.S. Department of Justice
http://www.ojp.usdoj.gov/BJA/evaluation/index.html

The Public Health Approach to Evaluation
http://www.cdc.gov/eval

University of Kansas Community Programs Evaluation
http://ctb.ku.edu/tools/en/section_1007.htm

National and International Organizations Working for Suicide Prevention

American Association of Suicidology
http://www.suicidology.org

American Foundation for Suicide Prevention
http://www.afsp.org

Faith in Action (the Robert Wood Johnson Foundation)
http://www.faithinaction.org

Georgia Suicide Prevention Plan

The Link: National Resource Center for Suicide Prevention and Aftercare
http://www.thelink.org

National Organization of People of Color Against Suicide
http://www.nopcas.com/

Suicide Awareness Voices of Education
http://www.save.org/

Suicide Prevention Advocacy Network USA
http://www.spanusa.org/

Centre for Suicide Prevention - Canada
http://www.suicideinfo.ca

Suicide Prevention Efforts in Norway
http://www.med.uio.no/ipsy/ssff/

Suicide Prevention Research Center
http://www.sprc.org/index.asp

World Health Organization Suicide Prevention Efforts
http://www.who.int/mental_health/prevention/
suicide/suicideprevent/en/

Youth Suicide Prevention in Australia
http://www.health.gov.au/hsdd/mentalhe/
resources/life/framework.htm

National Strategy for Suicide Prevention

Comprehensive National Strategy for Suicide Prevention Web Site
http://www.mentalhealth.org/suicideprevention

Suicide Prevention Advocacy Network, USA
http://www.spanusa.org

Surgeon General's Web site: Call to Action
http://www.mentalhealth.org/suicideprevention/
calltoaction.asp

State Suicide Prevention Efforts

Wisconsin Suicide Prevention Strategy
http://www.dhfs.state.wi.us/dph_emsip/
InjuryPrevention/SuicidePrevention.htm
http://www.HOPES-wi.org/Strategy

State Planning for Suicide Prevention
http://www.wwu.edu/~hayden/spsp

State Resources for Child Injury and Violence Prevention
http://www.edc.org/HHD/csn/IPResources/resources.htm

Suicide Prevention Resources by State
http://www.edc.org/HHD/csn/Suicide0.pdf

Suicide Data

Centers for Disease Control and Prevention National Center for Injury Prevention and Control Data
http://www.cdc.gov/ncipc/osp/data.htm

Costs of Completed and Medically Treated Suicide
http://www.edc.org/HHD/csn/sucost.pdf

Maternal and Child Health Bureau Block Grant Data
http://www.mchb.hrsa.gov/data/

Web Based Injury Statistics Query and Reporting System (WISQARS)
http://www.cdc.gov/ncipc/wisqars

Suicide and Suicide Prevention Information

Center for Mental Health Services Suicide the Five W's: Depression and Mood Disorders

Crisis Management in Schools Following a Suicide
http://www.ed.gov/databases/ERIC_Digests/
ed315700.html

Evangelical Lutheran Church in America. A Message on Suicide Prevention
http://www.elca.org/dcs/suicide_prevention.html

National Institute on Mental Health Frequently Asked Questions about Suicide
http://www.nimh.nih.gov/research/suicidefaq.cfm

National Institute of Mental Health Selected Bibliography on Suicide Research--1999
http://www.nimh.nih.gov/research/suibib99.cfm

National Institute Mental Health Suicide Fact Sheets
http://www.nimh.nih.gov/research/suifact.htm

Providing Immediate Support for Survivors of Suicide
http://www.ed.gov/databases/ERIC_Digests/
ed315708.html

Role of Maternal and Child Health Bureau in Youth Suicide Prevention
http://www.edc.org/HHD/csn/Suicidef.pdf

World Health Organization, United Nations. (WHO/UN2000). Preventing Suicide in six groups.

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References

ADAMHA -Alcohol, Drug Abuse, and Mental Health Administration (1989). Report of It the Secretary's Task Force on Youth Suicide: Volumes 1-4. DHHS Pub. No. ADM 89-1624. Washington, DC: U.S. Government Printing Office.

Anderson, MA., Powell, K.E., Davidson, S.C. Suicide in Georgia: 2000. Georgia

Department of Human Resources, Division of Public Health, Epidemiology Section, June 2000. Publication number DPH00 .34H.

Atwood, K., Colditz, G.A., Kawachi, I. (1997). From Public Health Science to Prevention Policy: Placing Science in its Social and Political Contexts. American Journal of Public Health 87:1603-1605.

CDC National Mortality Statistics. Available at http://www.cdc.gov/ncipc/osp/data.htm

Commonwealth Department of Health and Aged Care. Promotion, Prevention and Early Intervention for Mental Health--A Monograph. Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, Canberra, Australia, 2000.

Durkheim, E. Suicide: A Study in Sociology. Translated by J.A. Spaulding & G. Simpson. New York: Free Press, (1987/1951).

Goodman, R.M., Speers, M.A., McLeroy, K., Fawcett, S., Kegler, M., Parker, E., Smith, S., Sterling, T. and Wallerstein, N. An Initial Attempt to Identify and Define the Dimensions of Community Capacity to Provide a Basis for Measurement. Health Education and Behavior, vol.25 (3), 1998.

Jamison, K.R. Night Falls Fast--Understanding Suicide. Alfred A. Knopf, New York, 1999.

McCraig, L.F., Strussman, B.J. National Hospital Ambulatory Care Survey: 1996. In: CDC. Emergency Department Summary: Advance Data from Vital and Health Statistics, no. 293. Hyattsville, Maryland: National Center for Health Statistics, 1997.

MMWR-Morbidity and Mortality Weekly Report. Vol.43 No. RR-6, Apri1 22, 1994.

National Strategy for Suicide Prevention: Goals and Objectives for Action. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, 2001.

Ramsey, R. United Nations Impact on the United States National Suicide Prevention Strategy. Paper presented at the 34th conference of the American Association of Suicidology, Atlanta, GA, 2001.

Raphael, B. Promoting the Mental Health and Wellbeing of Children and Young People. Discussion Paper: Key Principles and Directions. National Mental Health Working Group, Department of Health and Aged Care, Canberra, Australia, 2000.

Shneidman, E.S. and Farberow, N.L. The LA SPC: A Demonstration of Public Health Feasibilities. American Journal of Public Health 55:21-26.

Silverman, M.M., Davidson L., Potter L., Eds. Background Papers from the National Suicide Prevention Conference October 1998 Reno, Nevada. Suicide and Life-Threatening Behavior, 31 Supplement, Spring 2001.

Suicide in Georgia:2000, Georgia Department of Human Resources, Division of Public Health. Atlanta, 2001.

United Nations World Health Organization. Prevention of Suicide: Guidelines for the formation and implementation of national strategies. ST /ESA/245 .Geneva: World Health Organization, 1996.

U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. Washington, DC: U.S. Government Printing Office, November, 2000.

U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

U.S. Public Health Service, The Surgeon General's Call to Action to Prevent Suicide. Washington, DC, 1999.

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Appendix A: Risk and Protective Factors for Suicide

The base for suicide prevention comes from identifying suicide risk factors, suicide protective factors, and their interactions. Suicide risk factors are things that increase the potential for a person's suicide or suicidal behavior. A person's age, gender, or ethnicity can increase the impact of certain risk factors or combinations of risk factors for them. Understanding risk factors can help counteract the myth that suicide is a random act or results from stress alone. Suicide protective factors are things that reduce the potential for a person's suicide or suicidal behavior. Protective factors include attitudes and behaviors.

Some risk factors cannot be changed, such as a previous suicide attempt, but even these may have a purpose as reminders of the heightened risk of suicide when the individual is ill or encountering adversity. To prevent suicide, enhancing resilience and protective factors is as important as reducing risk. Unfortunately, resilience against suicide is not permanent. This means that activities to support and maintain protection against suicide need to be repeated and ongoing.

The following Risk Factors and Protective Factors for Suicide are identified in the National Strategy for Suicide Prevention: Goals and Objectives for Action.

Risk Factors for Suicide

Biological, Psychological and Social Risk Factors

Previous suicide attempt
Mental disorders, particularly mood disorders such as depression and bipolar disorder, anxiety disorders, schizophrenia, and certain personality disorder diagnoses
Alcohol and substance abuse disorders
Family history of suicide
History of trauma or abuse
Hopelessness
Impulsive and/or aggressive tendencies
Some major physical illnesses
Environmental Risk Factors
Job or financial loss
Relational or social loss
Easy access to lethal means
Local clusters of suicide that have a contagious influence

Socio-cultural Risk Factors

Lack of social support and sense of isolation
Stigma associated with help-seeking behavior
Barriers to obtaining access to health care, especially mental health and substance abuse treatment
Certain cultural and religious beliefs, for instance the belief that suicide is a noble resolution of a personal dilemma
Exposure to the influence of others who have died by suicide, including media exposure

Protective Factors in Preventing Suicide

Effective clinical care for mental, physical, and substance use disorders
Easy access to a variety of clinical interventions and support for help-seeking
Restricted access to highly lethal methods of suicide
Strong connections to family and community support
Support through ongoing medical and mental health care relationships
Learned skills in problem solving, conflict resolution, and nonviolent handling of disputes
Cultural and religious beliefs that discourage suicide and support self-preservation

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Appendix B: Development of the Wisconsin Suicide Prevention Strategy

Only recently has knowledge become available to help us approach suicide as a preventable problem with realistic opportunities to save many lives. The Wisconsin Suicide Prevention Strategy is framed upon these advances in science and public health. It is connected with national efforts to develop strategies for suicide prevention that can be carried out by public and private partners in communities across the country.

There has been international interest in suicide prevention for many years. In 1993, the United Nations/World Health Organization, in collaboration with a Canadian partnership led hosted an international conference in Calgary, Canada. The results of that meeting were documented in a publication called Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies (United Nations 1996). The UN Guidelines were developed as a way to facilitate the development of national strategies for the prevention of suicidal behaviors within the socio-economic and cultural context of any interested country (Ramsey 2001).

SPAN USA was founded by Elsie and Jerry Weyrauch in January, 1996, to create and implement a national suicide prevention strategy based on the UN Guidelines. SPAN USA members include suicide survivors (persons close to someone who completed suicide), suicide attempters, persons providing support for survivors and advocates of suicide prevention. SPAN USA' s efforts to mobilize political action for suicide prevention generated United States Congressional resolutions recognizing suicide as a national problem and suicide prevention as a national priority. As part of a 1998 National Suicide Prevention Conference in Reno, Nevada, SPAN USA and the Centers for Disease Control and Prevention commissioned briefing papers to summarize the evidence base for suicide prevention strategies among at-risk populations and to make recommendations for public health action (Silverman, Davidson, and Potter, 2001). Conference participants included researchers, health, mental health and substance abuse clinicians, policy makers, suicide survivors, consumers of mental health services, and community activists and leaders. Five delegates represented Wisconsin.

Following the work of the Reno Conference, Surgeon General David Satcher issued his Call to Action to Prevent Suicide in July, 1999, emphasizing suicide as a serious public health problem (USPHS, 1999). The Surgeon General's Call introduced a blueprint for addressing suicide prevention through Awareness, Intervention, and Methodology (AIM). AIM describes 15 broad recommendations containing goal statements, general objectives and recommendations for implementation that are consistent with a public health approach to suicide prevention. The recommendations were selected according to their scientific evidence, feasibility and degree of community support.

The recommendations of the SPAN USA Reno meeting, the Call to Action and subsequent critical examination by scientific, clinical and government leaders, other professionals and the general public resulted in a comprehensive plan outlining national goals and objectives that would stimulate the development of defined activities for local, state and federal partners. SPAN USA has worked to build its own state plan, the Georgia Plan, in concert with the National Strategy while incorporating specific state needs and interests.

In 2000, a Wisconsin work group was formed through an informal collaborative partnership to address the need for a Wisconsin state strategy. Following participation in a teleconference call with the Surgeon General and ten other states that have suicide prevention plans, this Wisconsin work group adapted goals and objectives from the National Strategy and from the Georgia Plan for the Wisconsin Strategy.

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Appendix C: Glossary of Terms Used in the Wisconsin Strategy

Assessment - The ongoing process of information gathering, examination, and evaluation to a) determine risk, b) identify contributing factors which may be modified, c) diagnose, if applicable, d) choose optimal interventions or treatments, and e) track the impact of interventions or treatments.

Attempters - See suicide attempt.

Community capacity - The characteristics of communities that affect their ability to identify , mobilize, and address social and health problems and the cultivation and use of transferable knowledge, skills, systems and resources that affect community and individual level changes consistent with population health-related goals and objectives. (Goodman et. al., 1998)

Connectedness - A person's sense of belonging with others. A sense of connectedness can be with family, school, workplace, and community.

Effectiveness - Effectiveness studies test the real world impact of interventions that have been shown to be efficacious under controlled conditions. These studies are needed to determine whether results from studies carried out under very controlled situations may be generalized to other settings.

Efficacy - Efficacy studies are used to develop and refine interventions under experimental conditions. These settings are usually controlled to represent ideal conditions.

Epidemiology - The study of statistics and trends in health as applied to the whole community or population.

Evidence-based programs - Those programs that have some research showing that the program was associated with the intended beneficial outcome(s).

Follow-back study - A study carried out after a death to provide information from persons or from existing records that will add to the information sources used by the coroner or medical examiner in determining the cause of death. Example: the collection of the same categories of information about persons who had died by suicide and persons who had died from heart disease in order to compare the two groups and help understand their risk and protective factors.

Gatekeeper training - Training for community members who have face-to-face contact with many others as part of their usual routine. Training usually includes recognition of persons at risk of suicide and information on how to refer for treatment or supporting services, as appropriate.

Interventions - Actions or programs that can reduce the effect of risk factors and/or increase protective factors. An example of an intervention would be providing effective treatment for depressive illness.

Mental Health Screening - Surveys done by health care professionals, schools, and others to identify people who have a mental illness and to refer them to mental health professionals.

Outcome - A measurable change that can be attributed to an intervention or a program.

Outreach programs - Programs with staff that go into communities to deliver services or recruit participants.

Population - based interventions -Interventions targeting populations or communities rather than individuals.

Primary care - The care system that provides the first point of contact for those in the community seeking general assistance; for example, family practitioners or pediatric nurse clinicians.

Program evaluation - The process used to measure the outcomes of a program or service.

Providers - Professionals who offer health, mental health, treatment, or social services.

Protective factors - Those characteristics and circumstances that reduce the likelihood of suicide or suicidal behaviors.

Resilience - Capacities within a person that promote positive outcomes, such as mental health and well-being, and provide protection from factors that might otherwise place that person at risk for adverse health outcomes.

Risk factors - Those characteristics and circumstances that make it more likely for suicide or suicidal behaviors to occur.

Stakeholders - The groups and individuals that care about or are affected by suicide prevention decisions and policies.

Substance use disorders - Disorders in which drugs, including alcohol, are used to such an extent that social and occupational functioning is impaired and control or abstinence becomes impossible.

Suicide attempt - (Also Attempters) Nonfatal behavior that is intended to end one's own life, and which may produce self-injury.

Suicidal behavior - Suicidal behavior includes a range of activities related to suicide and self-harm, including suicidal thinking, self-harming behaviors without thoughts of death, and suicide attempts.

Suicide - Intentional, self-inflicted death.

Suicide attempt survivors - Individuals who have previously attempted suicide.

Suicide survivors - Family members, significant others, or acquaintances who have experienced the loss of a loved one due to suicide. In other publications this term may be used to refer to suicide attempt survivors.

Surveillance - The regular monitoring of health conditions in the population through the systematic collection, evaluation, and reporting of measurable information. Surveillance can be used to understand trends.

EDITOR'S NOTE: Many entries in this Glossary quote or adapt usage from National Strategy for Suicide Prevention: Goals and Objectives for Action; Mental Health: The Surgeon General’s Report; and the Wisconsin Blue Ribbon Commission on Mental Health Final Report.

Suicide and Suicide Prevention Internet Resources

Web Resources [updates have been made to the original list due to the ever-changing nature of the World Wide Web]

References

Appendix A - Risk and Protective Factors

Appendix B - Development of the Plan

Appendix C - Glossary

Evaluation Information

National and International Organizations Working for Suicide Prevention

National Strategy for Suicide Prevention

State Suicide Prevention Efforts

Suicide Data

Suicide and Suicide Prevention Information

References

Appendix A: Risk and Protective Factors for Suicide

Risk Factors for Suicide

Biological, Psychological and Social Risk Factors

Previous suicide attempt

Mental disorders, particularly mood disorders such as depression and bipolar disorder, anxiety disorders, schizophrenia, and certain personality disorder diagnoses

Alcohol and substance abuse disorders

Family history of suicide

History of trauma or abuse

Hopelessness

Impulsive and/or aggressive tendencies

Some major physical illnesses

Environmental Risk Factors

Job or financial loss

Relational or social loss

Easy access to lethal means

Local clusters of suicide that have a contagious influence

Socio-cultural Risk Factors

Lack of social support and sense of isolation

Stigma associated with help-seeking behavior

Barriers to obtaining access to health care, especially mental health and substance abuse treatment

Certain cultural and religious beliefs, for instance the belief that suicide is a noble resolution of a personal dilemma

Exposure to the influence of others who have died by suicide, including media exposure

Protective Factors in Preventing Suicide

Effective clinical care for mental, physical, and substance use disorders

Easy access to a variety of clinical interventions and support for help-seeking

Restricted access to highly lethal methods of suicide

Strong connections to family and community support

Support through ongoing medical and mental health care relationships

Learned skills in problem solving, conflict resolution, and nonviolent handling of disputes

Cultural and religious beliefs that discourage suicide and support self-preservation

Appendix B: Development of the Wisconsin Suicide Prevention Strategy

Appendix C: Glossary of Terms Used in the Wisconsin Strategy

Assessment - The ongoing process of information gathering, examination, and evaluation to a) determine risk, b) identify contributing factors which may be modified, c) diagnose, if applicable, d) choose optimal interventions or treatments, and e) track the impact of interventions or treatments.

Attempters - See suicide attempt.

Connectedness - A person's sense of belonging with others. A sense of connectedness can be with family, school, workplace, and community.

Effectiveness - Effectiveness studies test the real world impact of interventions that have been shown to be efficacious under controlled conditions. These studies are needed to determine whether results from studies carried out under very controlled situations may be generalized to other settings.

Efficacy - Efficacy studies are used to develop and refine interventions under experimental conditions. These settings are usually controlled to represent ideal conditions.

Epidemiology - The study of statistics and trends in health as applied to the whole community or population.

Evidence-based programs - Those programs that have some research showing that the program was associated with the intended beneficial outcome(s).

Gatekeeper training - Training for community members who have face-to-face contact with many others as part of their usual routine. Training usually includes recognition of persons at risk of suicide and information on how to refer for treatment or supporting services, as appropriate.

Interventions - Actions or programs that can reduce the effect of risk factors and/or increase protective factors. An example of an intervention would be providing effective treatment for depressive illness.

Mental Health Screening - Surveys done by health care professionals, schools, and others to identify people who have a mental illness and to refer them to mental health professionals.

Outcome - A measurable change that can be attributed to an intervention or a program.

Outreach programs - Programs with staff that go into communities to deliver services or recruit participants.

Population - based interventions -Interventions targeting populations or communities rather than individuals.

Primary care - The care system that provides the first point of contact for those in the community seeking general assistance; for example, family practitioners or pediatric nurse clinicians.

Program evaluation - The process used to measure the outcomes of a program or service.

Providers - Professionals who offer health, mental health, treatment, or social services.

Protective factors - Those characteristics and circumstances that reduce the likelihood of suicide or suicidal behaviors.

Resilience - Capacities within a person that promote positive outcomes, such as mental health and well-being, and provide protection from factors that might otherwise place that person at risk for adverse health outcomes.

Risk factors - Those characteristics and circumstances that make it more likely for suicide or suicidal behaviors to occur.

Stakeholders - The groups and individuals that care about or are affected by suicide prevention decisions and policies.

Substance use disorders - Disorders in which drugs, including alcohol, are used to such an extent that social and occupational functioning is impaired and control or abstinence becomes impossible.

Suicide attempt - (Also Attempters) Nonfatal behavior that is intended to end one's own life, and which may produce self-injury.

Suicidal behavior - Suicidal behavior includes a range of activities related to suicide and self-harm, including suicidal thinking, self-harming behaviors without thoughts of death, and suicide attempts.

Suicide - Intentional, self-inflicted death.

Suicide attempt survivors - Individuals who have previously attempted suicide.

Suicide survivors - Family members, significant others, or acquaintances who have experienced the loss of a loved one due to suicide. In other publications this term may be used to refer to suicide attempt survivors.

Surveillance - The regular monitoring of health conditions in the population through the systematic collection, evaluation, and reporting of measurable information. Surveillance can be used to understand trends.

EDITOR'S NOTE: Many entries in this Glossary quote or adapt usage from National Strategy for Suicide Prevention: Goals and Objectives for Action; Mental Health: The Surgeon General’s Report; and the Wisconsin Blue Ribbon Commission on Mental Health Final Report.

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