Public health

FROM: XXXX

SUBJECT: Office of Suicide Prevention

DATE: XXXX

Proposed Intervention

The Michigan Association for Suicide Prevention has recommended the creation of an Office of Suicide Prevention (OSP) within the Michigan Department of Community Health (MDCH) to improve the leadership of suicide prevention efforts within Michigan.

Background

The National Research Council and the Institute of Medicine report that about 61% of the total deaths due to gun violence between 2000 and 2010 were suicides and the national suicide rate in general is rising.1, 2 According to the Harvard School of Public Health, “more people in this country kill themselves with guns than with all other intentional means combined…” including poison and hanging.3 In general, suicide is the 3rd largest killer of youth aged 18-24 and the suicide rate among youth has tripled since the 1950s.4 Not to mention, the suicide rate for men and women 35-64 rose nearly 30% between 1999 and 2010.5

Specifically in Michigan, suicide is the 10th leading cause of death6 and the leading cause of injury death in Michigan.7 The leading method of suicide for males is firearm.7 In addition, rural communities, which would include a large portion of Michigan especially the Upper Peninsula, are at a higher risk for suicide.8 According to the evaluation of the Suicide Prevention Plan for Michigan: the suicide rate in Michigan per 100,000 has been increasing since 2005, and the MDCH states that firearms were used in the majority of suicides.9 Considering these facts, the MDCH still has a limited capacity and role to specifically address or coordinate prevention strategies across the state. The current website’s “Suicide Prevention” program only includes the National Lifeline number.10

Alternatives and counter arguments

· Leave suicide prevention to local authorities. Local authorities are indeed best prepared to handle regional idiosyncrasies, however, local authorities often face patchwork, “hodge-podge” access to resources to create effective prevention programs and may not utilize evidence-based strategies in the absence of a state-level leader.

· Children simply need to learn how to respect guns to prevent the majority of suicide. Research has demonstrated that firearm safety programs are ineffective at preventing young children from playing with guns when available in the home, “casting doubt on the potential effectiveness of skills-based gun safety programs.”11

Politics

Direct gun control legislation could improve suicide numbers but is unfavorable. On the political heals of national legislation like the Mental Health Parity and Addition Equity Act of 2008, the Office of Suicide Prevention will function primarily as a means of addressing the public and mental health aspects of gun violence, rather than attempting to tread issues that Michigan’s largely conservative House will not receive favorably. As an outspoken supporter of the 2nd Amendment and the rights of legal gun owners, moves like this are party-favorable steps towards limiting suicide through the misuse of legal firearms to cause self-inflicted harm.12

Recommendation

Pursuant with your previous statements regarding the holistic nature of preventing gun violence13, your administration should establish the Office of Suicide Prevention within the MDCH to significantly improve mental health and suicide prevention infrastructure in the State of Michigan.

The OSP should be modeled off similar programs, such as the OSP established in Colorado in 2000.14 The Colorado office offers a variety of examples of how the office would be able to support local capacity for appropriate prevention in schools and communities within the cultural and political context of the specific state. The Michigan OSP will enhance current initiatives across the state such as those recommended by the Suicide Prevention Plan for Michigan. The Colorado office has demonstrated some level of success since 2000 by substantially increasing: the number of calls to the state help line by almost 14,000 calls per year, the amount of materials disseminated (and used) in local communities and hospitals, and the number of hospital personnel, school officials, and others trained to recognize suicide risk through grant funded programs.15

The responsibilities and functions of the OSP would be:

· Act as a leader to “effectively and efficiently coordinate the implementation effort” of the Suicide Prevention Plan for Michigan at the state level, reducing disparities in efforts across different state regions.16

· Seek and streamline additional funds for suicide prevention programs and provide grants to local authorities and coalitions that can more effectively address assessed community needs, gaps, and limitations than state level programs

· Emphasize evaluation prevention programs across the state by improving county participation in the main objectives of the Suicide Prevention Plan for Michigan and requiring evaluation and impact assessment for OSP funded projects

· Support the use of evidence-based prevention programs within the State of Michigan from the National Suicide Prevention Resource Center’s national registry

· Provide technical assistance, materials, and data to local professionals and coalitions

· Operate and promote its own state-wide mental health and suicide awareness projects, such as promoting 1.800.273.TALK

· Evaluation of the OSP’s effectiveness should be done no less than every 8 years, allowing time for the long-term effects of prevention to materialize

· Although the OSP would require an initial investment, if properly executed the OSP could save the state and residents money. Not including emergency department, outpatient, or mental health costs, “The lifetime cost of medical care for persons dying by suicide and those being hospitalized following a suicide attempt in 2009 is an estimated $51 million,” and about $410 million in work-loss costs in a year.8, 9

Conclusion

Let alone mitigating the emotional cost of suicide on communities, there are clear public health, cost, and coordination advantages to establishing an official state office dedicated to preventing suicide over other alternatives. A state-level leader could significantly improve the current patchwork system of local organizations dedicated to suicide prevention, especially when others means to directly reduce the largest, and most lethal, source of self-harm is politically difficult.

References