Date Published:Jun 27, 2014
Substance abuse and suicide are critical public health issues affecting millions of people annually. But it is only recently that practitioners have become aware of how closely these problems are related. Nearly 90 percent of people who die by suicide have a mental health disorder, and half of those mental health disorders are substance use disorders. Moreover, adults with substance use disorders are more likely to exhibit suicidal thoughts, plans, and attempts than the rest of the U.S. population, and these rates are even higher for adults with co-occurring mental illness and substance use disorders—with almost one third of all adults reporting suicidal thoughts.
Growing awareness of these connections has motivated many states and communities to begin looking for ways to better align their substance abuse and suicide prevention efforts, with some states—like the State of Michigan—dedicating Federal funds to create integrated approaches to addressing these problems. But effective collaboration—particularly across disciplines—takes planning and preparation. Practitioners need to recognize the benefits of collaboration—to understand how stepping outside their comfort zones will and can save lives. They need to see where and how prevention priorities intersect. And they need the knowledge and skills to work effectively “across the aisle”.
To support effective collaboration, SAMHSA’s Center for the Application for Prevention Technologies (CAPT) partnered with SAMHSA’s Suicide Prevention Resource Center (SPRC) to deliver a series of webinars designed to help prevention practitioners better understand the connections between substance abuse and suicide. The series was delivered to Michigan Department of Community Health staff, state coordinating agencies responsible for overseeing the substance abuse prevention efforts of multiple counties, and practitioners from communities receiving Partnerships for Success II and Block grant funding. It will be adapted for a national webcast sponsored by SAMHSA this Fall.
Part I: The Connection between Suicide and Substance Abuse
The first webinar, facilitated by Laurie Davidson, SPRC Manager of Provider Services, focused on the intersection of substance use and suicide. Davidson explained that substance use can increase the likelihood of suicide in two ways: directly, by increasing the likelihood that an individual will die by suicide, and indirectly, because a history of substance use often contributes to suicidal behavior. She explained that among substances that are abused, alcohol use has the strongest association with suicide. And she presented data showing that when alcohol consumption rates decline—due, for example, to changes in policy—so too do suicide rates.
“When I saw the relationship between alcohol use and suicide, I got really excited about the prevention possibilities,” said Davidson. “There are decades of research documenting how states and communities can reduce alcohol use and its consequences. Really good, really effective alcohol prevention is suicide prevention.”
Co-presenter and CAPT Epidemiologist Maria Valenti also described risk and protective factors shared by substance abuse and suicide (i.e., that influence both outcomes), such as dating violence among adolescent girls, a risk factor that increases the likelihood of suicide and substance use, and positive self-esteem, a protective factor that lowers the likelihood of both substance use and suicide.
“Identifying shared factors is important for a number of reasons,” explained Valenti. “It provides a more holistic understanding of the constellation of factors that influence any one outcome. And it can spark collaboration because joint prevention efforts that target these factors can do ‘double duty’ by influencing both substance abuse and suicide.”
Part II: Suicide-Prepared Communities: Partnerships, Strategies, and Resources
During the second webinar, practitioners from three communities described strategies they used to forge successful cross-sector partnerships. Whereas the first webinar focused on the “what”, this event focused on the “how.”
Strategy #1: Start small! Faced with limited resources, prevention programs are often reluctant to engage in new initiatives that may fall outside of their regular responsibilities—even when the long-term benefits are clear. This was the case for members of the substance abuse and suicide prevention coalitions in Van Buren County, Michigan. “We were both concerned about prescription drug abuse and we wanted to work together,” explained Becky Fatzinger, a Van Buren suicide prevention professional, “but we were afraid to bite off more than we could chew.”
Mindful of this concern, the two coalitions decided to start small. Together, they designed, developed, and disseminated a flyer on safe disposal practices that included both suicide and prescription drug prevention messages. The flyers went out to pharmacies throughout the county, who then attached them to more than 25,000 filled prescriptions. “Small doesn’t mean small thinking,” explained CAPT T/TA Specialist Tehout Selameab, “There are a lot of small-scale projects that are low cost and low time commitment that can really catapult your work forward.”
Strategy #2. Learn how the ’other side’ operates. Even when goals overlap, practitioners working across sectors often approach their work in different ways, rely on different prevention frameworks, and use different terminology. “This can really distance potential partners, hindering communication and diminishing cooperation,” explained Selameab.
So when South Dakota’s Northern State University Counseling Center decided to coordinate its substance abuse and mental health services with the college’s athletic department and resident life staff, they knew the first thing they needed to do was get everyone on the same page. “Our mantra became ‘train, train, train,’” explained Deb Thorstenson, Director of Counseling, Health, and Wellness at the university. “We provided initial trainings as well as lots of follow-up. These trainings offered staff from across disciplines a common language to work from and a shared understanding of prevention strategies.”
Strategy #3. Use data to show that substance abuse and suicide prevention is everyone’s problem. “People are busy,” explained Selameab. “They have competing priorities. People working in schools, or on a police force, don’t necessarily see these problems as directly related to their work. But that’s where data can help.”
To emphasize this point, representatives from Enfield, Connecticut’s substance abuse coalition and suicide steering committee described their efforts to raise community awareness of these problems. “We collaborated to gather community data, including student surveys, Department of Children and Families open cases, and police data,” said Jean Haughey, Director of Youth Services. “We used these data to demonstrate the connection between children’s behavioral health and wellbeing, and with negative community outcomes such as drop-out and crime. And our efforts worked!” The town now champions universal screening for mental health issues and substance use in schools and at pediatric practices.
“I think more and more we are recognizing that these problems have many common denominators—that they percolate from the same place,” said Selameab, summing up the series. “We’re seeing it at the local level, and we’re seeing it at the national level, as well.”
For more information on the Michigan events and upcoming webcast, please contact Kim LaGesse, T/TA Coordinator for the CAPT Central Resource Team, at firstname.lastname@example.org.
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