Policy and Legislation

By Jerry Reed & Elly Stout

This year we celebrate Suicide Prevention Week with revitalized purpose as we welcome a new National Strategy for Suicide Prevention. For the first time since 2001, we have an updated Strategy to guide the nation, drawing on eleven years of growth and advances in our field. 

The National Strategy is a call to action to guide suicide prevention in the United States over the next ten years. It outlines four strategic directions, with 13 goals and 60 objectives that are meant to work together across all levels of government - and with various local and community programs and activities - to reduce the toll of suicide in the nation. Some of these objectives will best be advanced at the national level, while others will be most appropriately handled at state and local levels. At all levels, partners from different sectors should be involved, be they public or private.

This new National Strategy reminds us all that we all have a role to play in advancing suicide prevention efforts, and recommends specific ways we can get involved. If you are part of a state or local suicide prevention group or coalition, you may be wondering what the new strategy means for you.

As the Strategy is launched, many will consider taking steps to update their own state or local suicide prevention plans. Our hope is that you will use the revised Strategy as a guide and consider it a key resource that should be an important part of your local strategic planning efforts. At the same time, we want to caution that not every recommendation in the Strategy should be applied literally in every state and community.

The National Strategy offers a wonderful menu of options, but it’s up to state and local groups to prioritize what will work best and reach those most at risk in their communities. And the way to figure out what are the best options is simple: Start with your data. Only by looking at data on suicide risk (both quantitative and qualitative) in your community can you focus on the areas of greatest need and effectively pursue programs that reduce suicidal behaviors and save lives.

Based on local data, what groups are at highest risk for suicide in your community? What are the factors that put them at risk or may be protective? What approaches would be best to pursue? Without the data to give you answers to these questions, you really can’t know who is most at risk in your community and what strategies have the best chance of saving lives.

Go ask your state epidemiologist; see if your state has a web-based query system; look at your NVDRS data; use NSDUH, YRBSS, and WISQARS. And once you understand which groups are most at risk, or what approaches would be helpful, look to our new, improved National Strategy to find strategies that can save lives in your community.

I entered the field of suicide prevention in 1996 when, after fourteen years as a civil servant with the Department of the Army, I joined the U.S. Senate first as a fellow and then as a staffer. I attended a U.S. Senate Aging Committee hearing on mental health and the elderly with my then-boss, Senator Harry Reid (D-NV).  While preparing for the hearing I called the Nevada state aging director and asked what some of the mental health issues facing the elderly were.  To my surprise, I was told that suicide among older adults was a key concern.  I set to the task of preparing a briefing for the senator, including key information on suicide and the elderly in the background material.  On the day of the hearing, while listening to powerful testimony from Mike Wallace on his own battle with clinical depression, Senator Reid said that if Mr. Wallace could share his personal struggle with depression, he felt he should share his own personal story that his dad had taken his own life many years earlier. It was a powerful moment and, from my perspective, a significant day for suicide prevention in the public policy arena.  It was also the day that my professional interest in suicide prevention began. It was clear to me that there was little being done on the national level about this leading cause of death and I had the privilege of working for a man who was willing to bring attention to this issue.  Senator Reid’s leadership and personal story that he shared that day contributed to changes that have influenced my professional life and have influenced a nation ever since.

One concrete outcome of that hearing was Senator Reid’s request to hold a hearing on senior suicide in a subsequent U.S. Senate Aging Committee hearing.  Another outcome was that after meeting with advocates for suicide prevention, Senator Reid introduced Senate Resolution 84, which simply stated that suicide was a national problem, warranted a national solution, and called for the development of a National Strategy for Suicide Prevention.  To my amazement, Senate Resolution 84 passed unanimously the day it was introduced, and a similar resolution, House Resolution 212 introduced by Representative John Lewis (D-GA), passed several months later in the U.S. House of Representatives.  This would not have been accomplished without the involvement and investment of many professional and citizen groups, especially survivors of the suicide of a loved one. I remember how proud I was back then to see this initial policy response regarding suicide prevention by our national leaders in the U.S. Congress for an issue that, for far too long, had received little attention.

Now fast-forward sixteen years to June 20-22, 2012, when I had the pleasure of attending the annual DoD/VA Suicide Prevention Conference in Washington D.C. with over one thousand others who care deeply about suicide prevention and the impact of suicide on the men and women who serve, or have served, this nation. I witnessed three Cabinet Secretaries attend the conference and speak eloquently about suicide prevention and their commitment to do whatever it takes to make sure that the men and women who serve and protect the freedoms we all enjoy have the services they need to address their often invisible wounds of war.  First, we heard the Honorable Eric K. Shinseki, Secretary of Veterans Affairs, speak to the attendees on Wednesday. I found his remarks heartfelt and inspiring. There was no doubt in my mind that Secretary Shinseki is determined to support suicide prevention efforts in the VA.  On Friday we heard from the Honorable Kathleen Sebelius, Secretary of the Department of Health and Human Services, and the Honorable Leon E. Panetta, Secretary of Defense.  Both of them spoke of their commitment to continue to bring the resources of their departments to address the complex issue of suicide (find a copy of the speech transcripts here: Secretary Shinseki, Secretary Sebelius, and Secretary Panetta). As I write this blog this evening I can’t help but reflect on the significance of having three Cabinet Secretaries attend this conference and speak about this nation’s commitment to serving the men and women who serve this nation and to the prevention of suicide. I dare say I don’t think this has happened before, and it is an advancement and milestone well worth noting. 

I remember so vividly in 1996, when the current effort to advance public policy support for suicide prevention began, how few references could be found on suicide prevention in the Congressional Record.  This week, we witnessed three Cabinet Secretaries speaking passionately on the issue.  I can only pinch myself and reflect on how far we’ve come and what this progress represents.  I cannot say loud enough how inspired, proud and honored I am to have been a participant at this DoD/VA Suicide Prevention Conference.  I feel our field has made tremendous advances in serving those in need and we should honor the many, many pioneers who came before, and be grateful to the countless dedicated men and women who dedicate their lives to reducing the burden of suicidal behavior each and every day. While we have far to go, we have traveled far and should pause to acknowledge this progress.   

I am reminded of the health policy model put forward by Richmond and Kotelchuck in 1991. The model identifies 3 essential components for advancing public health policy: knowledge base, social strategy, and political will.  For health policy to advance, all three components were essential (see reference below).  If we look closely at where our nation is today, and certainly as reflected at the DoD/VA Suicide Prevention Conference this week, we have political will as demonstrated by the attendance and remarks of these Cabinet Secretaries.  We heard many presentations on the many new advances in treatment, programs and awareness in suicide prevention reflecting the strength and growth of our knowledge base and we spoke of specific military service strategies, and the overall directions of both DoD and VA, representing the reality that we have well-thought-out social strategies in place to guide this important work. 

What was especially reassuring to me was that there were many attendees from both the DoD/VA sectors, as well as many from the public and private sectors dedicated to advancing suicide prevention in the nation. What I heard from many is that this is not just a DoD challenge or a VA challenge, but that this is an American challenge, and it will take all of us and all of our wisdom, experience and talent to muster the will, the knowledge and the strategy to reduce the burden of suicidal behavior among our men and women who serve, our veterans, their families, and indeed, the nation at large.     

Sincerely,

Jerry Reed, Ph.D. MSW
Director, SPRC
 

Richmond, J. B., & Kotelchuck, M. (1991). Co-ordination and development of strategies and policy for public health promotion in the United States. In Holland, W. W., Detels, R., & Knox, G. (Eds.). Oxford Textbook of Public Health (pp. 441-454).Oxford, England: Oxford Medical Publications.

On March 29, 2012, Governor Christine Gregoire of Washington State signed into law the Matt Adler Suicide Assessment, Treatment & Management Act written to improve health care professionals' preparedness in the screening, assessment, and treatment of people who are suicidal. According to the website of the Matt Adler Foundation, “In February 2011, 40 year old Matt Adler, loving husband, father of two young children, and an accomplished attorney took his own life while in the midst of a battle with severe depression and an anxiety disorder. Matt was a gentle, intelligent and witty man who made an indelible impression on those he met. His death has left a gaping hole in the lives of many.”

This state law aims to strengthen the clinical capacity of providers in the state to screen, assess and treat those at risk for suicide. It will require (beginning January 1, 2014) that professionals licensed in the state of Washington, at least once every six years, complete a training program in suicide assessment, treatment, and management that is approved by the relevant disciplining authority and is at least six hours in length. The legislation instructs these authorities to consider training that is listed in the SPRC/AFSP Best Practices Registry. The providers that must comply with this new provision are: chemical dependency professionals; marriage and family therapists; mental health counselors; occupational therapy practitioners; psychologists; advanced social workers; and independent clinical social workers. 

We should applaud this significant policy achievement and as a field, work to encourage other states to consider similar legislation. Like so many of our national advancements in suicide prevention, the personal experience of those left behind after a tragic suicide death has once again turned pain to promise, grief to action, and hurt to hope. The result is an extraordinary advancement that could be precedent setting. It will, if replicated, have a lasting impact on the field of suicide prevention and the lives of many who struggle with suicidal behavior. This legislation begins to address a concern I have had for quite some time: How clinically trained and prepared are the clinicians we seek out when it comes to screening, assessing and treating those at suicidal risk?    

Very often I am asked if I can suggest a clinician skilled in suicide assessment and treatment to help someone looking for support. I sometimes struggle providing a recommendation as I have no way of knowing how much training a clinician may have received on this topic. Now, at least in Washington State commencing in 2014, this will no longer be an issue for those seeking assistance. Washington residents will have the benefit of clinical staff being required to receive such training as a condition of license renewal. This should take some of the mystery out of finding the right clinician for a person in need of clinical support. It is my hope that the power of this legislation will spread to other states and that soon the day will come when we won’t have to wonder if a clinician has been well-versed in assessment, treatment and management of patients in need. It will be the rule and the expectation, and no longer the hope or the exception. This law may also serve as a catalyst to move a bit upstream in the training process and encourage graduate programs that prepare behavioral health clinicians to include suicide assessment, management and treatment as required content in their programs.  

Our current National Strategy for Suicide Prevention (2001) called for the implementation of training for recognition of at-risk behavior and delivery of effective treatment (Goal 6) and the development and promotion of effective clinical and professional practices (Goal 7). Sadly, progress has not been as forthcoming and widespread as hoped for, as far too many clinicians are not receiving adequate training in their graduate programs and far too many still have not received continuing education to incorporate these skills into their current practice. Thankfully this is about to change, at least in the state of Washington.

Congratulations to all who led the way for this legislative achievement. To Jennifer Stuber, Matt’s wife and advocate; to Governor Gregoire for signing the bill; to Representative Tina Orwall, the prime sponsor and the other cosponsors who supported the bill; to Sue Eastgard, Peggy West and Paul Quinnett and the many advisors who added their expertise and knowledge of the suicide prevention field to ensure this legislation was crafted in ways that would lead to changes in clinical behavior; and to the many, including the professional associations representing the clinicians, who supported the bill’s passage. You have all taken a courageous and important step in the pursuit of saving lives. The field owes you a debt of gratitude and we should all hope that other states will follow suit. Your efforts are a wonderful example of advocates, legislators, clinicians, professional groups and concerned citizens coming together to make the kind of changes needed to reduce the burden of suicide and suicidal behavior. Suicide prevention really is everyone’s business, and the legislation that has been enacted makes that case loud and clear. 

Sincerely,

Jerry Reed, Ph.D. MSW

Director, SPRC