Report on Suicide and Suicide Prevention in Texas

1 Report on Suicide and Suicide Prevention in Texas As Required by House Bill 3980, 86th Legislature, Regular Session, 2019 Health and Human Services Commission May 2020 2 Table of Contents Executive Summary .. 4 1. Introduction .. 6 2. Background .. 8 3. Suicide Data in Texas .. 9 Mortality Data .. 9 Hospitalization Data .. 30 Poison Control Center Data .. 41 Emergency Department Outpatient Data .. 46 Behavioral Risk Factor Surveillance System .. 50 Youth Risk Behavior Survey .. 57 4. Suicide Related Statutes .. 65 5. Policies .. 66 Department of Family and Protective Services .. 66 Health and Human Services Commission .. 68 Texas Commission on Jail Standards .. 68 Texas Department of Criminal Justice .. 69 Texas Juvenile Justice Department .. 76 Texas Military Department.

2 77 Texas Tech University Health Sciences Center .. 78 Texas Veteran Commission .. 78 6. Programs .. 79 Department of State Health Services .. 79 Texas Commission on Jail Standards .. 84 Texas Veterans Commission .. 89 Texas Juvenile Justice Department .. 90 Texas Department of Criminal Justice .. 94 Health and Human Services Commission .. 119 Appendix A. Data Tables .. A-1 A-1 Hospitalizations .. A-28 Poison Control Center .. A-34 Outpatient Emergency Department Hospitalizations .. A-38 Behavioral Risk Factor Surveillance System (BRFSS) .. A-40 Youth Risk Behavior Survey (YRBS) .. A-42 Appendix B. Texas Statutes .. B-1 Texas Civil Practice & Remedies Code .. B-1 Texas Code of Criminal Procedure .. B-1 3 Texas Education Code .. B-1 Texas Family Code.

3 B-4 Texas Government Code .. B-4 Texas Health & Safety Code .. B-5 Texas Human Resources B-7 Texas Occupations Code .. B-7 Texas Penal Code .. B-7 Texas Property Code .. B-8 Designations from 86th Legislative Session .. B-8 Appendix C. List of Acronyms .. C-1 Appendix D. Endnotes .. D-1 4 Executive Summary The Report on Suicide and Suicide Prevention in Texas is submitted in compliance with House Bill ( ) 3980, 86th Legislature, Regular Session, 2019. The bill requires a summary Report on the prevalence of Suicide in Texas as well as state policies and programs adopted across state systems and agencies to prevent suicides. The Health and Human Services Commission (HHSC) oversees Suicide Prevention in Texas with collaboration from other state agencies.

4 The primary goal is to prevent all Suicide deaths and connect individuals with appropriate behavioral health services at the right time and place. As a first step toward achieving this goal, it is critical to understand prevalence rates of Suicide -related events, including suicidal thoughts, Suicide attempts, and deaths caused by Suicide . Since the year 2000: Texas has seen an overall increase in Suicide mortality with the death rate rising 36 percent; Individuals ages 55-64 saw the greatest increase of any age group with a 61 percent increase in deaths by Suicide ; The rate of Suicide mortality in women has increased by 50 percent; The rate of high school males who have attempted Suicide has more than doubled; and The veteran Suicide death rate rose 32 percent between 2005 and 2017.

5 Due to the way data are collected on the Texas death certificate, Suicide rates for active military members could not be calculated. With Texas large size and varied geography, it is important to analyze death by Suicide prevalence rates with respect to location, showing since the year 2000: Public Health Region 2 (area west of Dallas-Fort Worth) experienced the largest increase in the Suicide death rate with an increase of 62 percent; Public Health Region 5 (lower East Texas ) experienced the lowest increase in the Suicide death rate with an increase of three percent; The Suicide mortality rate in non-metro areas is about 30-45 percent higher than the rate in metro areas; and The Suicide mortality rate is increasing faster in non-metro areas than in metro areas.

6 5 For a comprehensive understanding of Suicide Prevention work in Texas , it is vital to recognize the existing state statutes, agency rules, and policies relating to Suicide Prevention , intervention, and postvention. The Texas Education Code, Texas Family Code, Texas Health and Safety Code, Texas Civil Practice and Remedies Code, Texas Occupations Code, Texas Human Resources Code, Texas Penal Code, Texas Code of Criminal Procedure, Texas Government Code, and Texas Property Code all contain guidance relating to Suicide Prevention that affects the work of school personnel, mental health professionals, individuals working in the criminal and juvenile justice systems, and child welfare employees, among many others. These state statutes are included in this Report , along with state agency initiatives since 2000 addressing Suicide and Suicide Prevention .

7 As required by legislation, the Texas Suicide Prevention Council was consulted and worked with HHSC on the development of this Report . Per 3980, 86th Legislature, Regular Session, 2019, this summary Report on the status of Suicide Prevention in Texas will inform the subsequent legislative Report to be completed by the Statewide Behavioral Health Coordinating Council (SBHCC) on Suicide in this state. The legislative Report will identify opportunities and make recommendations for state agencies regarding improving data collection for Suicide -related events, using data to inform decisions and policy development relating to Suicide Prevention , and decreasing Suicide in Texas . 6 1. Introduction As 3980 states, Suicide is a public health crisis affecting residents of all ages in every region of the state.

8 Developing a shared understanding of Suicide in Texas will help determine the appropriate state and regional efforts necessary to decrease state Suicide rates and address the disparities in state laws, policies, programs, and efforts currently being used to address Suicide . 3980 requires HHSC to write a Report gathering available data on Suicide , Suicide attempts, and suicidal thoughts beginning in the year 2000 to the present, as available for each dataset. The Report must emphasize individuals in the highest categories of risk of death by Suicide , specifically addressing the following characteristics: the age of the individual; the gender of the individual; and the individual s veteran status. The data must be disaggregated by county and recognized categories of risk, where available.

9 The bill also calls for the summary Report to contain all Texas policies and programs adopted across state systems to prevent suicides, as well as all state statutes addressing the topic. This summary Report addresses the call for action in 3980 by cataloging available data, state laws, and an inventory of state policies and programs from 2000 to the present. Highlighted in the Report are data related to deaths by Suicide in Texas including Suicide mortality data, as is available as of January 1, 2020. Available years of data varies by source. The Centers for Disease Control and Prevention (CDC) had 2017 data available, while the Department of State Health Services (DSHS) had only finalized 2016 data. The Veteran s Administration only had data available back to 2004, instead of 2000, as required by 3980.

10 , through 2017. The Report also includes Suicide attempt data, referenced as Suicide morbidity data. One way to capture Suicide morbidity data is by examining hospital discharges reported in Texas , specifically looking at hospitalizations due to Suicide attempt. Hospital Discharge data was available to 2018. Since Hospital Discharge data does not capture all Suicide attempts, emergency department visits for Suicide attempt and calls to the poison control network for suspected Suicide are also examined in this Report . Emergency Department data was available to 2018 as was Poison Control Network data. Emergency Department data collection only began in 2016, while Poison Control Network data began in 2004. The data section of the Report includes data from the Behavioral Risk Factor Surveillance System and the Youth Risk Behavior Surveillance System including 7 Suicide attempt and suicidal thoughts among the adult population and high school students in Texas , respectively.