On June 14, 2017

Conference explores changing research, approaches to preventing suicide

By Evan Johnson

KILLINGTON—Over 250 people packed the ballroom at the Killington Grand Hotel last week to hear testimony from national experts and to exchange ideas and strategize on ways combat Vermont’s high suicide rate.

“We spent a lot of time creating awareness of factors that put people at risk,” said JoEllen Tarallo, executive director of the Vermont Suicide Prevention Center, which hosted the event. “The emphasis now is trying to work with and engage mental health systems so they can be as responsive as they can. One of the concerns is that 50 percent of the people that go on to die by suicide have actually seen a mental health provider or medical provider in the previous 30 days. That’s astounding.”

For the professionals gathered in the ballrooms, the day included lectures and TED-style talks on

the latest research and workshops on how to put new theories into practice.

“All of these people are beginning to look at their part of the system and how they link with the systems that their patient will go to once their work is done,” Tarallo said.

The most recent data, presented by Thomas Delaney, a professor and research associate with the Vermont Child Health Improvement Program at the University of Vermont, was chilling. According to the most recent data from the Vermont Department of Health, in 2014, there were 114 suicide deaths among Vermont residents and 1,509 hospitalizations and emergency department visits. Despite a consistent ranking as one of the healthiest states in the union, Vermont currently has one of the highest suicide rates in the country with 16.8 per 100,000 people, statistically higher than that for the United States’ rate of 13 per 100,000 people. From 2005 to 2015, the U.S. suicide rate increased by 19 percent while Vermont increased by 36 percent during that same period.

According to the Center for Disease Control and Prevention, suicide is the second leading cause of death for college-age youth and ages 12 to 18, and four out of five teens who attempt suicide have given clear warning signs. In Vermont, young people have shown increasing trends in suicide ideation and attempts in recent years that are higher than national rates.

Delaney said Vermont’s high suicide rate correlates with high rates of binge drinking and substance abuse, firearm ownership and easy purchase of firearms, an aging population and a status as the second most rural in the Northeastern United States.

“We’re looking at a perfect storm of these factors,” he said.

Changing perspectives

David Klonsky, an associate professor of psychology at the University of British Columbia, who delivered a keynote address at the symposium, said while rates of suicide in the United States are not decreasing, the ability of professionals to predict which individuals are at risk of attempting suicide hasn’t improved either. Klonsky said for every death by suicide, there are 20 attempts and for every attempt, 2.5 individuals have suicidal thoughts, often referred to as “ideation.”

“The scope of the problem is large enough when we focus on death, but it’s even larger than that,” he said.

In the past five years, researchers have begun to rethink how suicide is studied and perceived in communities. Suicide used to be explained by single factors including social isolation, hopelessness or desire to escape unbearable pain. In presenting recent research, Klonsky said there are separate explanations for who develops suicidal thoughts versus who progresses to making an attempt on their own life. Klonsky presented a “three-step theory of suicide,” which claimed that suicidal thoughts occur when feelings of pain and hopelessness outweigh any sense of connection to people, purpose or a sense of meaning, and that suicidal ideation progresses to action when there is the capacity to make an attempt.  Klonsky said the theory gave four clear targets for intervention:

“If we want to reduce suicide risk we can reduce pain, increase hope for the future, improve connection or we can reduce the capacity to make the attempt,” he said.

Another keynote speaker, Richard McKeon, chief of the suicide prevention branch of the Substance Abuse and Mental Health Services Administration shared some of the newest “best practices” in comprehensive suicide prevention.

In 2012, the U.S. Surgeon General and the National Action Alliance for Suicide Prevention created the National Strategy for Suicide Prevention (NSSP), a document that outlines four strategic directions, 13 goals and 60 objectives that are meant to work together to lower suicide in the nation over the next decade. A 2015 review of the NSSP found that while many states are using the NSSP to update their own plan; McKeon said the absence of state, tribal and community infrastructure hampers successful suicide prevention efforts. Efforts to integrate and coordinate suicide prevention efforts across sectors are not standard practice.

“There needs to be coordination and there needs to be partnership because no one agency or group can have that significant of an impact on suicide,” he said. “In Vermont it can’t be one agency, it must be everyone working together in a coordinated way,” he said.

KcKeon pointed to efforts in Taiwan, Europe and tribal communities in the United States that used close screening and proactive outreach to survivors to reduce suicide rates.  The goal, he said, was to create a system that reached people as early as possible.

“Ultimately we need to have a comprehensive suicide prevention effort that looks at upstream suicide prevention as well as provides a comprehensive safety net,” he said.

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