by Noah Whitaker
Noah J. Whitaker is the coordinator of the Tulare & Kings Counties Suicide Prevention Task Force, and the Community Outreach Manager for the Tulare County Health & Human Services Agency.
I’ve worked in the field of suicide prevention for nearly a decade. In that time I have seen and experienced a lot of interesting things. National Suicide Prevention Week, which falls September 10-16, 2017, is a perfect time to reflect upon some of the changes and advancements, as well as looking forward to the future.
There are a lot of areas to examine when thinking across the span of the last ten years. To help me mull through my thoughts, I’m organizing this article into the areas of Zero Suicide, Prevention & Intervention, Education, and Legislation. 
I’d like to first add that sometimes a great deal of reach can take place when a celebrity or artist utilizes their platform to reach others. The artist Logic recently released a thoughtful song called “18002738255”, the number for the National Suicide Prevention Lifeline. It is through efforts like these that we can reach more people and save lives.
You can check out the song in this video:
Zero Suicide
A major recent advancement has been the proliferation of the Zero Suicide movement through the Suicide Prevention Resource Center (SPRC). This is a systematic approach in health and behavioral health care settings utilizing a specific set of strategies and tools to drive prevention efforts. The underlying belief of this program is that it is possible to have zero suicides. It helps these systems identify strengths, gaps, processes, and develop strategies for enhancing workforce education for better detection, treatment, and support. Zero Suicide has been growing and adapting to other settings, and will likely prove to be a major milestone in suicide prevention.
Prevention & Intervention
This area is exceedingly exciting as this is where a lot of action and activity takes place. With advancements in the understanding of suicide, have come advancements in understanding strategies to prevent and intervene. There are also wonderful resources like the National Suicide Prevention Lifeline, The Trevor Project, and the Crisis Text Line. These national resources are bolstered by local call centers such as the Central Valley Suicide Prevention Hotline, which is affiliated with the National Lifeline.
This area includes programs that are school-based such as Coping and Support Training (CAST), Reconnecting Youth (RY), Signs of Suicide (SOS), Sources of Strength and many others. Programs for workplace education or recognition. There are programs focusing on older adults such as the Program to Encourage Active, Rewarding Lives (PEARLS). There has also been massive advancement in prevention efforts in the armed forces. The Marines have implemented a program called DStress Line to aid those in active duty as well as their family members. The U.S. Department of Veterans Affairs (VA) has been partnering with the National Suicide Prevention Lifeline, and has staff at each VA hospital who are specifically tasked with working with veterans who are suicidal or have attempted suicide.
There are also fair amount of locally developed programs that focus on adhering to standards and practices. We have a program to help local high school students called RESTATE, which takes the Youth Mental Health First Aid (YMHFA) training and introduces it to high school junior and senior students in art and after-school programs. We have a program for post-high school students called Depression Reduction Achieving Wellness (DRAW), that educates, screens, and provides brief therapeutic services to students. We have a Local Outreach to Suicide Survivors Team (LOSS Team), which is a team of volunteers that supports people affected by a suicide loss. A decade ago we didn’t have any of these programs. Today we have these and others.
Education
The field of study devoted to understanding suicide is called suicidology. This relatively young field in the social sciences blends sociology, psychology, psychiatry, as well as marketing, technology, and many others. Advancements in the understanding of suicide have led to advancements in training on risk, prevention, and treatment.
Basic Education—These are courses designed to introduce an attendee to the issue of suicide and suicide prevention. This level of education provides definitions, statistics, theories, and explains systems and resources. These trainings are usually not intended to teach interventions, but often will share signs and symptoms. These training opportunities are usually titled Suicide Prevention Basics, Suicide 101, or something similar. This can also take the form of community education programs such as Man Therapy®, which targets specific at-risk populations such as middle-aged white males.
Man Therapy® video- Feelings
Gatekeeper training (recognition/intervention)—This level focuses on teaching skills to recognize and take action when suicide risk is detected; this is an intervention focused training level. This level of training heavily focuses on signs and symptoms of risk, provide a strategy or approach to interacting with an at-risk individual, and steps to take to get them linked to care providers. This level does not focus upon ongoing support and treatment for at-risk individuals. Common training offerings in this area Applied Suicide Intervention Skills Training (ASIST), Question, Persuade, Refer (QPR)
Treatment (systems / tools)—This level of training is very skills intensive and most often is designed for mental/behavioral health professionals or other medical professionals. Broadly speaking, there are two layers of training. The first layer focuses on strategies to working with people who are either at-risk or have had an intentional self-inflicted injury. This is usually documentation, follow-up, linkage, and basic management of care. The second layer is specific clinical interventions. This layer focuses on approaches like Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) therapy. These approaches have been studied, evaluated, and demonstrate significant advantages when applied to individuals with suicidal thoughts and behaviors.
EMDR video:
Legislation
First, there are three pieces of legislation that helped change the landscape and provide hope for a suicide free future. There have been dozens of changes to federal, state, and local laws, regulations, or ordinances, but these three selected items have particular weight.
First, California voters passed Proposition 63, better known as the Mental Health Services Act (MHSA). This provided for new funding to provide for new mental health services, and helped to fund suicide prevention efforts in some communities. These funds support our efforts in multiple counties include Tulare and Kings, Fresno, Kern, San Diego, and others.
Second, a little known section of the Affordable Care Act mandated that medical providers that accept Medicaid must conduct routine screening for depression. This is key as among people who have had a suicide attempt, 95% had seen a medical provider in the year before their attempt, 64% in the month prior to the attempt, and 38% in the week before their attempt. This provides an opportunity to screen and intervene, and underscores the importance of medical providers being trained to recognize and respond to risk for suicide.
Finally, the California Legislature enacted AB 2246, known as Pupil Suicide Prevention Policies. This landmark legislation requires all schools that report to the California Department of Education, and have a student population between 7th-12th grade to have formally adopted policies and procedures on suicide prevention, intervention, and postvention (activities following a death), as well as requiring training. This is essential in our state as efforts to improve the mental wellbeing of our youth will yield lifelong benefits. Suicide is the second leading cause of death for adolescents. This requirement should help to more effectively protect and support our youth.
Final Thoughts
This short article only begins to scratch the surface of the incredible work that is being undertaken across the globe, nationally, in the state of California, and at the local level. Regardless of a person’s background, age, economic status, profession, or other characteristics, they can get involved in helping to save lives. You can get involved. Get involved.
If you or someone you know is at risk for suicide, please contact the National Suicide Prevention Lifeline at 1 (800) 273-8255.
If you would like to learn more about the SPTF, refer to the contact information below.
For Non-Crises Information Related to the SPTF:
Suicide Prevention Task Force
C/O Noah Whitaker
5957 S. Mooney Blvd.
Visalia, CA 93277
(559) 624-7471
Coordinator’s Email: sptf@tularehhsa[dot]org
Facebook: www.facebook.com/HOPE.SPTF
Website: www.sptf.org
Check out KRL’s Mental Health section for more mental health related articles.
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