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New Suicide Prevention Initiatives in Rhode Island

Tuesday, March 20, 2012


With teen suicide on the rise in Rhode Island, as well as an overall suicide rate that leads the nation, new approaches come to the fore.

After a winter of sobering news of youth suicide increases in Rhode Island as well as the state leading the nation in percentage of residents who attempt suicide, new initiatives on behalf of teens as well as Rhode Islanders of all ages promise advancements in support as well as intervention.

Support for youth

"Untreated mental health disorders dramatically increase a youth’s risk of suicide," said Sarah C. Dinklage, LICSW, Executive Director, Rhode Island Student Assistance Services. "It is, therefore, concerning that one in five Rhode Island children has a diagnosable mental-health disorder and, yet, four out five do not receive treatment. The Youth Suicide Issue Brief sends a critical message to parents, educators, teens, and medical and mental health providers, along with state and federal government, to take action to prevent youth suicide attempts and completions in this state. The brief lists 15 recommendations for reducing the risk of youth dying by suicide, many of which are already underway."

A safety net for at-risk youth

According to Dinklage, the RI Department of Health-funded RI Youth Suicide Prevention Project (RIYSPP) is implementing evidence-based suicide prevention programming in selected public schools and community-based youth organizations. "The project provides a safety net for at-risk youth by developing early identification and referral protocols," Dinklage said, as well as training for adult and youth gatekeepers and conducting a media campaign directed to parents about youth who may be at risk and how to respond.

The purpose of the gatekeeper training program is to teach any adult in a youth’s life how to recognize the warning signs and risk factors for suicide and how to get help for a young person at risk. Gatekeeper training also teaches the following:

- How to ask the “S” question. Asking someone about the presence of suicidal thoughts and feelings demonstrates compassion and opens up a conversation that may lead to a referral for help.

- How to intervene, persuade a person to get help, and refer to the professionals in the school community and beyond.

Maintaining the Lifeline

Dinklage said that resources include the National Suicide Prevention Lifeline (1-800-273-TALK) which provides immediate over the phone crisis response and interventions, and possible referral for further evaluation. The Lifeline is answered by a locally contracted community mental health agency staffed by clinicians. "Action is critical," she said, "as most people contemplating suicide are suffering from a diagnosed or undiagnosed treated or untreated mental illness or substance abuse disorder for which treatment exists. Offering hope, as well as social and spiritual support can often avert a suicide attempt. Once a referral is made, professional assessment and treatment can begin. As with any illness, early detection and treatment results in better outcomes and fewer deaths by suicide."

New Suicide Severity Rating Scale

Earlier this month, the Providence Center became the first provider in Rhode Island to use the Columbia Suicide Severity Rating Scale (C-SSRS). The scale is being used at The Providence Center’s facilities, in the emergency rooms at Roger Williams and Fatima Hospitals where The Providence Center is located, and will be rolled out by the end of March in the agency’s community-based programs.

“This scale allows us to figure out what people who are presenting as suicidal need, and that’s not always hospitalization, said Dale K. Klatzker, President/ CEO of The Providence Center. “A lot of times it’s helping the person change their environment, giving them longer-term community support. The use of this scale can be transformative for Rhode Island because it will improve care and allow us to focus resources where they most help people.”

A way to predict suicide attempts

The C-SSRS is able to predict suicide attempts, a first among suicide screening tools, and get people who need help both the appropriate level and kind of behavioral health care services they need. The C-SSRS has been associated with decreased burden by reducing unnecessary interventions and redirecting limited resources. The scale is used world-wide, translated into 103 languages and adapted for schools, prison systems, and the homeless. The scale is used by general medical and psychiatric emergency departments, hospital systems, clergy, hospices, schools, college campuses, the US Army, National Guard, VAs, Navy and Air Force settings, frontline responders (police, fire department, EMTs), prisons, and juvenile justice systems around the world. New York City has implemented the scale across all school districts with tremendous success.

“The scale is an easy way to save lives,” said Deb O’Brien, Providence Center Vice President and Chief Operating Officer. “Our staff have been trained by Dr. Posner, the creator of the C-SSRS, and have found it easy to use and effective. By tying it to our electronic health records, it becomes that much more streamlined into every day care.”

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