In a previous piece, I discussed suicide risk and protective factors that may be central to prevention efforts in Hampton Roads. Up front, it is critical to understand that suicide prevention efforts hinge on community-level buy-in.
My aim in this piece is to provide research-supported ideas to contribute to fostering a conversation in Hampton Roads. No single suggestion below is an absolute. Rather, I hope that, in conjunction with recent mental health training and forum efforts put on by Work|Release and engagement with the right set of community contributors, these ideas spur discourse and action toward prevention and change. And I do so from the viewpoint that successful suicide prevention is multidisciplinary. I have had the good fortune to be trained by or work alongside psychiatrists, nurses, law enforcement, attorneys, psychologists, social workers, teachers, health educators and many others. Without a doubt, I can say that an “all hands on deck” approach would be best.
Before understanding science-backed prevention and intervention, we first need to have a clear vision of the ultimate goals. For instance, there is a difference between aiming to identify community members at individual risk and getting them to mental health care providers versus prevention of new cases. Though both are important, the former identifies people already at high risk for suicide to get to therapy or a mental health professional, whereas the latter reflects a public health-oriented prevention approach aimed at stopping people from becoming a high risk for suicide in the first place. In public health terms, helping people get to therapy is tertiary prevention where preventing new suicide ideation or attempt cases is primary prevention. Both are valuable goals, but different in their intent. Let me also add another layer we call “postvention.” This idea deals with helping in the aftermath of a crisis or health issue. The American Association of Suicidology devotes an entire website, conference and network of professionals in support of suicide survivors, be they personal attempters or loved ones who lost someone to suicide.
One reason why we need precise goals is that the necessary community players at the table to achieve these aims may or may not differ.
The way I see it, Hampton Roads can aim for any or all of the following suicide-related goals:
1. Reducing the presence of key risk factors (which may have added benefits in other areas such as health or violence prevention).
2. Enhancing key risk factors (which may also have added benefits associated with building capacity, coalitions, or community involvement).
3. Seeking to identify high-risk individuals and getting them mental health care.
4. Reducing the risk of new high-risk suicide cases.
5. Absolute elimination of suicide (as an aspirational goal).
A sampling of suicide prevention or intervention programs may include:
1. Public awareness campaigns concerning risk factors, warning signs, and regional resources.
2. Establishment of a regional crisis phone line, text connection, virtual chat room, or physical crisis center.
3. Group or family-based support programming in key settings such as schools or churches.
4. Gate keeper training for community members who may interface with those at high risk.
5. Mental health literacy education and training for health providers to share with their patients.
6. Suicide prevention competency training in the necessary skills to work with at-risk patients.
The potential success of any of these methods all require both an understanding of the unique needs of a given population and sufficient infrastructure (financial, personnel, motivation). Where a lack of information concerning a high-risk population exists, a logical starting point may be a comprehensive needs assessment. For instance, while we know much about general issues concerning homelessness, my recent conversations with the Planning Council and United Way in Norfolk suggest that recent point in time count data are very limited in scope. To fully capture the potential needs and resiliency for a particular at risk group, a well-designed evaluation of current health, housing, financial, social and other factors would be a great first step.
Another important consideration is picking where to start is avoiding redundant efforts. For instance, while data supports the potential effectiveness of lowering suicide rates at the county level when crisis hotlines are put in place, Hampton Roads already has access to the national suicide lifeline, as well as a military lifeline when contacting the VA Hospital. Careful consideration would be needed to decide whether this would be a sensible place to start relative to other options.
A variety of other options exist in order to address specific risk factors and to capitalize on identified protective factors in the region.
These might include, but certainly are not limited to:
1. Community-engaged scholar-practitioner partnerships between EVMS, ODU, Norfolk State and local mental health care, counseling and emergency medicine service providers.
2. Firearm safety training offered through gun sellers, gun ranges, or law enforcement agencies.
3. Development of educational material concerning appropriate firearm storage protocols paired with access to such professional assistance (again perhaps by engaging with firearm sellers or trainers).
4. Public awareness campaigns concerning warning signs of traumatic brain injury, depression, PTSD and other high-risk conditions among military personnel.
5. Needs assessment and outreach development to reach the aforementioned homelessness population, especially youth and members of the GLBTQ community.
6. Firearm safety counseling training for medical, mental health, law enforcement and other professionals who can share such information with patients and community members.
7. Implementation of a region-wide voluntary firearm “no sell” list coordinated between firearm sellers; individuals identified at elevated risk can voluntarily put themselves on such a list (though controversial, there seems to be some momentum for this idea in the scientific literature).
8. Focus groups consisting of local suicide survivors, law enforcement, and healthcare professionals toward the goal of generating additional insight and ideas unique to Hampton Roads.
Let me reiterate, my aim to spark conversation. These are ideas supported by general scientific literature (which I am happy to comment on further or refer key persons to as needed). Let the conversation commence.
There will be a Forum on Mental Health Care & Stigma in Norfolk on Thursday, January 26, at Work Release in the NEON District, from 6 to 7:30pm. The event is free. No reservations required. For more info or to invite your friends, here is the event on Facebook.