STATE OF MARYLAND - Suicide Prevention Resource Center

1 STATEOF MARYLANDDHMHM arylandDepartmentof ,Maryland21228 MartinO'Malley,Governor- AnthonyG. Brown,Lt. Governor- JoshuaM. Sharfstein, ,SecretaryBrianM. Hepburn, ,ExecutiveDirectorSeptember28,2012 MarylandCommissiononSuicidePreventionSpr ingGroveHospitalCenter55 WadeAvenue, ,MD21228 TheHonorableMartinO'Malley,Governor100 StateCircleAnnapolis,MD21401 DearGovernorO'Malley:OnbehalfoftheMaryla ndCommissiononSuicidePrevention,J ampleasedtosubmittheCommission's2012two- yearplantostrengthenandcoordinateMarylan d'sservicesintheareasofsuicideprevention ,intervention,andpost-vention(postsuicid e).I ~BrianHepburn, : 'TIYfor Disabled- MarylandRelayService1-800-735-2258 SuicidePreventionTwo-YearPlanto theGovernorBrianHepburn, ,ChairmanSeptember2012 EXECUTIVESUMMARYS uicideis a seriouspublichealthproblemthatcausesimme asurablepain,suffering,andlosstoindividu als,families, surprisedto learnthatsuicidewasoneof the top 10 causesof deathin the UnitedStatesin onlythe tipof the Suicide ,morethan30 ,friends,coworkers,andothersin the communityall sufferthe long-lastingconsequencesof suicidalbehaviors(p.)

2 10).- HealthandHumanServices(HHS)Officeof theSurgeonGeneralandNationalActionAllian cefor ,DC:HHS, ,2009,GovernorMartinO' ,establishingtheGovernor'sCommissionon SuicidePrevention(theCommission).Overthe courseof threeyears,21 Commissionersbroughttheirprofessionalexp ertiseandpersonalexperienceswithsuicidea ndits consequencesto bearin theCommissionis alignedwithnationalsuicidepreventioneffo rts,especiallyintheState'shistoricandcon tinuingemphasison 'sPlan(thePlan)alsoputsfortha strengthenedfocuson preventingsuicidenotonlywithhighriskgrou pslikeveterans,lesbian,gay,bisexual,tran sgenderandquestioningindividuals,andpers onswhoareunemployedbutalsoat criticalhigh-riskperiods,suchas ,basedon thePublicHealthModel,thePlan'sthreeovera rchinggoalsandeightrelatedstrategiesoper ateat threelevels: Universal:preventioneffortsapplicableto all membersof a population; Selected:morefocusededucationandskill-bu ildingapplicableto selectedsub-groupswhoareat-riskfora preventableoccurrence.

3 And Indicated:focusedinterventionsprovidingi ntenseeducationandskilldevelopmentrelate dto specificrisksof an ' 'sawarenessof Suicide ,its riskfactors,andits placeas a bestpracticetrainingopportunitiesforprof essionals; ; ,effective,andaccessiblecommunity-baseds ervicesandprograms; thosewhohaveattemptedsuicideor othersaffectedbysuicideattemptor orderto achievetheseGoals,theCommissionerspropos ethefollowingeightstrategies,rankedin orderof eachstrategyaredescribedin baselinelistingof existingservicesandsupportsacrossprevent ion,interventionandpost-vention(attempte rsandsurvivors); suicidepreventionhotlines; ,planfor andimplementEvidence-basedandPromisingPr acticesto addressunmetneedsacrossprevention,interv entionandpost-vention as wellas professionalandcommunitytrainingin awarenessof suicideriskandeducationin effectivesuicidepreventioncommunityeduca tioncampaigntoincreaseawarenessandknowle dgeanddecreaseriskacrosstheagespan; high-riskpopulations,suchas:a)Returningv eteransof thearmedservices;b)Personswhohavemadesui cideattemptsc) Lesbian,gay,bisexual,transgenderandquest ioningindividuals(LGBTQ);d) Personswhoareunemployed.

4 Ande) Youthandadultswhohavebeenvictimsof theMarylandStateDepartmentof Educationthattheyworkwiththelocalschools ystems'personnelto discussbestpracticesthatareconsideredpos t-ventionstrategiesrelatedto studentdeathsthataretheresultof plannedandimplementedwithstrongtiesto theimplementationof thisPlan,as wellas coordinationandleadershipin all Statesuicidepreventionefforts, theGovernor'sSuicidePreventionCommission by extendingtheCommission'sauthorityto assistandadvisetheMentalHygieneAdministr ationin theimplementationof theserecommendations;to identifyemergingissuesin suicidepreventionandintervention;andto focusattentionandrecommendactionon definingthreeprimarygoals,eachemphasizin gthesciencebaseof suicideprevention,aswellas theculturalcompetence,effectivenessandac cessiblenatureof all outreach,services,andsupports,theCommiss ionhasset thefuturedirectionof MARYLAND ' 'sworkprovidesclearprioritiesandachievab lestrategiesfor theorganization,delivery,andfundingof Statesuicideprevention,interventionandpo st-vention( Suicide )servicesfor yearsto providetheirfinalrecommendationsin set forthin , 2009,GovernorMartinO'Malleyissuedan ExecutiveOrder( )establishingtheGovernor'sCommissionon SuicidePrevention,referencedas "theCommission"forthepurposesof two-yearplanto strengthenandcoordinateMaryland'sservice sin theareasof suicideprevention,intervention,andpost-v ention(postsuicide).

5 TheGovernorappointedtwentyone(21)Commiss ionersanddesignateda listof theappointedCommissionersis providedin Appendix3 as wellas an to theCommissionwasconvenedon May17,2010undertheleadershipoftheSecreta ryof theDepartmentof HealthandMentalHygiene(DHMH)andChairedby HenryWestrayas theSecretary' thedirectionof theGovernor,theCommissionwasco-chairedby RosemaryKingJohnston,ExecutiveDirector,G overnor'sOfficeforChildren(GOC), ,ExecutiveDirector,MentalHygieneAdminist ration,Departmentof HealthandMentalHygiene(DHMH),andstaffedb y theDepartmentof June,2012, theCommission' :GOALSANDOBJECTIVESFORACTIONIn September,2012,nearthecompletionof theCommission'sthreeyearterm,theNational StrategyforSuicidePreventionTaskForce,le dby SurgeonGeneralReginaM. Benjamin,MD,MBAreleasedthe2012 an updatedcallto actionbuildingon thefirstNationalStrategyforSuicidePreven tionissuedin 'sCommissionon SuicidePreventionformulatedandcompletedi ts recommendationsbeforethe2012 NationalStrategyforSuicidePreventionwasp ublished,it willbe citedthroughoutthisreportas illustrationof andexpansionon theCommission' 'sgoalsandobjectivesfallwithinfourstrate gicdirectionswithwhichtheMarylandCommiss ion'srecommendationsarein sync.

6 /Createsupportiveenvironmentsthatpromote healthyandempoweredindividuals,familiesa ndcommunities;./Enhanceclinicalandcommun itypreventiveservices;./Promotetheavaila bilityof timelytreatmentandsupportservices; ,research, informandshapethefurtherdevelopmentofMar yland'ssuicidepreventioneffortsas theCommissioncontinuesits workto adviseandassistin theimplementationof its theNationalStrategyforSuicidePrevention: GoalsandObjectivesfor Actioncanbe 'SWORKS uicidepreventionis not exclusivelya is a healthissuethatmustbeaddressedat manylevelsby differentgroupsworkingtogetherin a , STATE ,tribal,andlocalgovernments;health caresystems,insurers,andclinicians;busin esses;educationalinstitutions;community- basedorganizations;andfamilymembers,frie nds,andothers-allhavea roleto playin suicideprevention( ).In early2011,theCommissionbeganits formulationof GoalsandStrategiesby reviewinga"crosswalk"or ComparativeSummaryof twodocuments, MARYLAND 'sPlanforYouthSuici dePrevention(2008)andtheMentalHygieneAdm inistration'sPositionPaperon SuicidePreventionfortheAdultandOlderAdul tPopulations(2009).

7 In thisComparativeSummary,theconcernsandrec ommendationsof thesetwoeffortswereconsideredandsynthesi zed, thedocuments,it an importantpublichealthconcernthatis theYouthSuicidePreventionPlanas acomparativestructure, theComparativeSummaryis includedin guidetheremainderof thePublicHealthModel,thesethreeoverarchi ngGoalsandeightrelatedstrategiesoperatea t threelevels: Universal:preventioneffortsapplicableto all membersof a population; Selected:morefocusededucationandskill-bu ildingapplicableto selectedsub-groupswhoareat-riskfora preventableoccurrence;and Indicated:focusedinterventionsprovidingi ntenseeducationandskilldevelopmentrelate dto specificrisksof an 'sawarenessof Suicide ,its riskfactors,andunderstandthatsuicideis bestpracticetrainingopportunitiesforprof essionals; ; ,effective,andaccessiblecommunity-baseds ervicesandprograms; thosewhohaveattemptedsuicideor othersaffectedby suicideattemptor "advancethescienceof suicideprevention"wasseenas a valuethatcouldbe embeddedineachof developGoal2 wouldfocuson thepreventionof andeffectiveinterventionin wouldmaintainits focuson ,eachof thethreeGoalswould6emphasizetheculturall ycompetent,effective,andaccessiblenature of outreach,services, ".

8 Suicideis a incorporatemultipleapproachesat importanceof wellness,resiliency,andprotectivefactors ;effectivesuicideresponseandintervention programsaddressrisk factors,mentalhealthandsubstanceabuseser vices,andcrisisresponseforthosewhoare strugglingwithsuicidalbehaviors;andeffec tivesupportprogramsarerequiredfor thosewhohavebeentouchedby suicideor suicidalbehavior"( ).Describedbelowaretheeightstrategiesrec ommendedby theCommissionin orderof thestrategiesproposed,three(3) areconsideredimmediatelyachievablewithei therredirectionof existingstaffandfundingor at no additionalcostandfive(5) haveelementsofbothimmediateimplementatio nas wellas longtermcommitmentsof staffandfundingof oneyearor rankorder,a descriptionof #1 ImmediateImplementationEstablisha baselinelistingof existingservicesandsupportsacrossprevent ion,interventionandpost-vention(attempte rsandsurvivors).Beforeproposingnewor expandedservicesandsupports,a comprehensivebaselineof existingresourcesacrossagenciesandorgani zations,stateandlocaljurisdictionsneedst o be centrallyassembledandmadeavailableto thisprocessinclude:~ Usethecurrentresourcelist for youthpost-ventionservices(andotherexisti ngresourcelistsas completedto date)as a foundationuponwhichto buildacomprehensivelist.

9 ~Useexistingresourceslistedon Networkof Care.~ EmployCommissionwebsiteas wellas linkageson MHA,MSDEandVeteransAffair'swebsitesto bothcollectanddisseminateinformation.~No teservicesandsupportsthataddresstheneeds of specialpopulationssuchasveteransandtheir families;lesbian,gay,bisexual,transgende randquestioningindividuals;victimsof bullying;unemployedindividuals; #2 ImmediateandLong-term(1 Year)ImplementationEnhancethe useandcapacityof themostimmediatelyachievableof theproposedstrategies,stepsto beginimplementationof enhanceduseandcapacityof suicidepreventionhotlineswereundertakenb y a taskforceled by MHAstaffin thespringandsummerof their7recommendationscanbe foundin Appendix6. A summaryof theiractionsteprecommendationsareas follows:~RenametheMarylandYouthCrisisHot lineas informMarylandresidentsof theavailabilityofthisresourcein timesof crisisforall Marylandresidentsacrossthelifespan.~Whil etheMarylandCrisisHotlineis availableto all Marylandresidents,it isrecommendedthattheVeteranHotlineremain themainresourceforveteransto accessin timeof crisisbecauseof ,all MarylandCrisisHotlinestaffareandwillcont inueto be trainedto assistveteransshouldtheycallthathotline.

10 ~Increasefundingto theMarylandCrisisHotlinein orderto supportincreasedusageas aresultof usedto fund:oHiringandmaintainingqualifiedstaff oInvestmentin resourcesandtechnologiesto meetthechangingneedsof thoseincrisisoOutreachservicesby Hotlinestaffto hospitalsin an effortto divertpersonsincrisisTheprocessandproduc tof thesuicidepreventionhotlineworkgroupserv esas a modelof theCommission'svisionof howstaff-supportedimplementationworkacro ssall #3 ImmediateandLong-term(2 year)ImplementationIdentify,planforandim plementEvidence-basedandPromisingPractic esto addressunmetneedsacrossprevention,interv entionandpost-ventionas wellas professionalandcommunitytrainingin awarenessof suicideriskandeducationin an effortto infusescience-basedpracticeacrossall suicideprevention,interventionandpost-ve ntionservicesandsupports,especiallyin advancingeffectivecommunityeducationando utreach,theCommissionrecommendsthattheco ntinuationof existingeffortsor theinitiationof newservicesandsupportsbe basedon thisprocessinclude.