Arizona Makes Suicide Prevention a Priority

E-newsletter Issue #102 | October 11, 2012

Shortly after completing a national exam that would certify him as a master counselor in 1995, David Covington took a phone call from a distressed middle-aged man.

“He was calling me to basically tell the world goodbye,” said Covington, of Magellan Health Services, which contracts with the Arizona Department of Health to serve as the regional behavioral health authority for Maricopa County. “He had a shotgun and was going to shoot himself.”

Covington had just completed a four-year degree in community agency counseling at the University of Memphis. “I did not receive five minutes of preparedness for this situation,” he said.

Not much has changed over the past 17 years. People training as counselors across the country don’t get much in the way of training on how to handle suicidal individuals.

That’s why Arizona’s Division of Health Services developed the Central Arizona Programmatic Suicide Deterrent System Project, a 2012 Western region winner of The Council of State Governments’ Innovations Award.

The effort began in 2009 when the Arizona Department of Behavioral Health committed to making suicide prevention a priority in the state.

A study showed the rates of suicide among those who are seriously mentally ill—those individuals who are directly in the state’s care—is six to 10 times higher than the general population, said Don Erickson, bureau chief in the Adult and Children System of Care in the Division of Behavioral Health.

“We’re at times stunned by that realization. While we were concerned and sensitive, we hadn’t made it an absolute priority,” Erickson said. “As odd as it sounds, to make suicide prevention a priority is a novel thing in our industry; it’s generally a secondary or tertiary priority.”

Arizona put together a large group of people both inside and outside the mental health community that compared notes and conducted research, developing the Driving Suicides to Zero Initiative. The group found that practitioners, family members, friends and other natural supports for individuals were inhibited to talk about suicide. Erickson’s department surveyed hundreds of its staff in Maricopa County, home to Phoenix.

“We discovered what, in fact, was at the heart of it—they felt they weren’t trained,” Erickson said. “They felt the only way to address a suicide was to get somebody into a hospital setting.”

Data show, however, that’s not the case.

“What’s effective is talking to someone about how they’re really feeling and giving them the opportunity to be able to share that with you, to be able to demonstrate to them that you’re really listening, that you’re present, that you’re really caring,” Erickson said. “They’re very, very basic things that, frankly, don’t require an advanced degree, let alone an M.D.”

So the Department of Behavioral Health developed a training program to enlighten staff about the basics of engaging people who are feeling suicidal, Erickson said.

“Part of the appeal and beauty of this program is that it’s remarkably simple in many respects,” he said.

Most counselors were not comfortable talking with suicidal individuals because of the enormity of the problem. “The stakes never get higher than this,” Erickson said. “It’s a true, clear-cut life and death situation.”

The training is aimed at making counselors feel more comfortable talking with suicidal individuals. After such a conversation, the whole clinical team sends a card to the individual reminding him or her that help is available.

“It turns out that’s a surprisingly effective intervention, to have that personal contact through a phone call or post card,” Erickson said. “There’s a part of the project that is, on the surface, very simple in terms of what’s required, but is remarkably effective.”

A survey of counselors found that 98 percent of those who completed the counseling felt like they had supports, training and skills to work with suicidal individuals, said Covington.

“If individuals are scared of the word suicide, they are going to frequently ferry people down a path, put them into a current that has a life of its own and leads toward involuntary hospitalization or even incarceration, in ways that are not directly related to their clinical need,” said Covington.

That can lead to significant costs to the state for services that may not be warranted.

The state has seen a dramatic reduction in suicide attempts and hospitalization among the population it serves since it began the program in 2009, Erickson said. Arizona officials are working with other states in an effort to replicate the program.

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