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Good morning. My name is Jeff Coady.

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I'm the regional administrator for the Substance

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Abuse and Mental Health Services Administration.

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I also serve as the chair for the Region 5 Department of Health and Human Service

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Work Group that is responsible for today's event on suicide prevention.

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I would like to welcome the participants here in Chicago, the individuals

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who are joining us via webcast, and the echo sites around the nation.

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Echo sites are organizations that have volunteered to open their

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doors to community partners, to listen to the day's event, discuss

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and collaborate on the public health topic of suicide prevention.

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On September 10th, 2012, the Office of the Surgeon General,

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Vice Admiral Dr. Regina Benjamin, in partnership with the National Action

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Alliance, released the revised National Strategy for Suicide Prevention.

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We will hear today from some of the top experts in the field about suicide prevention,

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about programs that have been successful in reducing deaths from suicide.

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Our goal for the day will be to learn about the National Strategy.

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But our second goal for the day, most importantly,

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will be to take the strategy and turn it into action.

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It is our communities where the strategy will become action.

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And the result of the acts in our communities in the next 75 days, to

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September 10th, which is National Suicide Awareness Day, will be that

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we will strategically advance suicide prevention in our nation.

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Now, without further ado,

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I'd like to introduce the acting HHS Region 5 regional director

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and CMS Medicaid Consortium administrator Jackie Garner.

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Good morning, everyone, and good morning to people in the echo sites.

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So happy that we could do this virtually, and that everyone could join us.

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I am so pleased to be with you here today, and I want to thank Jeff

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and his team for all of the work that we have done, they have done.

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We are so fortunate to have SAMHSA here in Region 5,

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and even more fortunate to have Jeff at the helm.

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Some very exciting work is going on. So I'm here today for several reasons.

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But the first and foremost reason, and those of you who know me well this, is that I

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believe so deeply in your work and am truly dedicated to the field of behavioral health.

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And my dedication on this issue goes back far too long probably, as far back as

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my early years out of college and grad school, when one of my very early jobs

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was that as a substance abuse counselor at a community mental health center.

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And that early experience shaped my career like no other.

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I know first-hand the importance of the work that you do each and every single day.

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I'm honored to be with you here, as you kick off a long-term strategy

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for combating one of our nation's top public health issues: suicide.

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Today, the message I want to relay is that there is hope, not

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only for the people we serve, but for the country as a whole.

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At no other time in this field's history has there been a confluence of legislation

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and partnerships to make the lives of individuals with mental illness better.

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The Mental Health Parity and Addictions Equity Act and the Affordable

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Care Act bring about changes that we have never seen before.

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The two pieces of legislation, for all intents and purposes, eliminates the practiced

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of unequal health treatment of mental health and substance use disorders.

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Prior to the law, insurers could place strict and oftentimes

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random treatment schedules that were not founded in any research

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or personalized to the severity of an individual's illness.

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By providing parity insurance coverage for substance use and mental health disorders is

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now equal to other chronic health conditions such as diabetes, asthma and hypertension.

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The Affordable Care Act takes this one step further, in that it will provide insurance

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coverage for millions of people who otherwise could not access private insurance either

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because of the treatment they sought or they were denied because of a preexisting condition,

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or they simply were not able to afford coverage that included mental health services.

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Because of the ACA, insurers are no longer able to

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discriminate against individuals with preexisting conditions.

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Additionally, they will not be able to increase premiums

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because of a health issue, such as treatment for depression.

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With the passage of the ACA, coverage is extended

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through requirements that qualified health plans,

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Medicaid benchmark and benchmark equivalent plans, and new plans in the

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individual and small group markets -- and this is all very good news,

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and it provides a great deal of hope for people with chronic illness.

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But as you know, more than anyone, there is still much work

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to be done, and you are taking the very first step today.

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Well, not the very first step, let's face it.

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You've all been working on this for a while. But you're taking an important step today.

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By raising awareness about suicide, you are bringing mental illness out of

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the shadows and helping to shed an important light that hopefully will

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encourage people to access treatment and have the knowledge they need to

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make sure that their treatment is appropriate and covered by insurance.

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Starting on October 1st,

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2013, this fall, people will have the option to

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purchase health insurance through the marketplace.

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The marketplace will not only provide an open market for health insurance choice,

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but will also provide consumers with apples to apples plan comparisons.

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Individuals shopping on the marketplace can also rest assured

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that the plan they select will provide coverage for mental health

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and substance use disorders, and it will also provide parity.

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So thank you for the work you do, and we look forward to our continued partnership

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with SAMHSA and the Office of Women's Health, and all of the health and human service

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partners, to bring the resources you need to do the work that you do so well.

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Now, at this time,

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I have the distinguished honor to introduce to you a very

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special guest: the 18th surgeon general of the United States,

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Regina Benjamin.

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Dr. Benjamin has been a strong prevention advocate, and, in

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2012, as Jeff said, released the National Strategy for Suicide

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Prevention, which we will be referring to throughout today.

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So, please join me in welcoming, via video, the surgeon general of the United States,

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Dr. Regina Benjamin.

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[applause] Good morning to everyone in Chicago, and those

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of you who are participating in sites around the nation.

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I would like to welcome you to "Everyone Plays a Role in Suicide Prevention: 

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Turning strategy into action." Preventing suicide is everyone's business.

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Nearly 100 Americans die by suicide every day, and in the past year

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more than 8 million Americans thought seriously about suicide.

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That does not include 16 percent of all high school

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students who report having seriously considered it.

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Suicide is a tragedy of untold proportions, and those of you who

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are part of that tragic story line know its anguish all too well.

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Last fall, we, in partnership with the National Action Alliance,

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released the National Strategy for Suicide Prevention.

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Over the next 10 years, this strategy will be our nation's

00:09:05.76,00:09:10.18
guide to prevent the burden of suicide and suicidal behavior.

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It captures the progress we've made so far, the knowledge we've acquired,

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and the promise that's within our grasp, that suicide is preventable.

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The National Suicide Prevention Strategy is organized with four strategic

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directions, and there are 13 respective goals and 60 objectives.

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But, don't worry, I'm not going to list them all for you.

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But there are some major themes in the National Suicide Prevention Strategy.

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We hope to foster dialogue, to counter the shame, prejudice and silence, to integrate

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public health with behavioral health in order to ensure continuity of care.

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To reduce access to lethal means among individuals at risk.

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We want you to talk about it. Don't be afraid to ask,

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"Are you thinking about killing or hurting yourself?" And

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know the warning signs, which you're going to learn today.

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Remember, there is a free suicide prevention lifeline which

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connects people with the skilled, trained profession.

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Just call 1-800-273-TALK.

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During today's meeting, you're going to hear specific about suicide prevention, and

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how you can develop action plans specific for your community or your organization.

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Working together, we can dramatically reduce the risk of suicide.

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So, please, help us turn strategy into action.

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It's nice to get applause, even though it was for surgeon general.

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Just pretend it was for me. [applause] Thank you. And good morning.

00:11:12.03,00:11:16.73
And, again, welcome to "Everyone Plays a Role: Turning strategy into action."

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My name is Michelle Hirsh, and I'm with the Office on Women's Health here

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in Region 5, in Chicago, and I extend greetings from Dr. Nancy Lee, the

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director of the Office on Women's Health, to both all of you who are here

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in Chicago at this live event, as well as to everyone who is participating.

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There are several thousand of you who are participating across the country,

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either individually at your computers or you've come together in groups in

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your communities to figure out how to address suicide and create action plans.

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In the Office on Women's Health, we address an array

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of issues for women and girls across the life span.

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Though one of the focal areas, which is particularly germane

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to this conversation about suicide, is unaddressed trauma.

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We know that exposure to traumatic events is so pervasive in our culture, and

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is a key predisposing factor to both substance abuse and mental illness,

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both of which are really key factors in creating greater risk for suicide.

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Recognizing this, we have a variety of efforts addressing violence and trauma, including

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increased awareness to both destigmatize as well as encourage individuals to seek help.

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And we are also working to help train health and social service providers

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to better understand trauma and provide trauma-informed care.

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The Office on Women's Health also has an outstanding website.

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It's womenshealth.gov, and I encourage all of you to take a look at that.

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There are phenomenal resources.

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It's a reliable site for accurate information, as well as lots of links

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to other resources, not the least of which suicide prevention efforts.

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We must act on the knowledge that one size does not fit all.

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And, in fact, that there are differences based on sex and gender.

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I ask you to keep this in mind as you go forth and

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create your action plans to help prevent suicide.

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Now it gives me truly great pleasure to introduce our master of ceremonies,

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Dan Ridenberg. Dan is the executive director of the organization, Suicide Awareness,

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Voices of Education, also known as SAVE.

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He's also the state suicide prevention co-lead for Minnesota.

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Dan served on the National Strategy for Suicide Prevention

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taskforce, and was the lead for strategic priority number one.

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He is the US representative to the International Association for

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Suicide Prevention, and leads the international taskforce that

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created the recommendations for media reporting on suicide.

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Please help me welcome Dan Ridenberg. Thank you very much.

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I appreciate that, and I'm glad to be here.

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I know that we're already a little bit behind, so we'll keep my comments very short.

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And although we're behind, definitely Region 5 is the stellar region in the nation,

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so we're proud of that, and that should encourage any of the other regions across

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the country, as they develop their actions plans, to reach our level.

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Let me begin by thanking Dr. Cody, who has led this effort to bring us here today.

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I also want to repeat what we heard about Dr. Benjamin, who has been a great

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champion for us in suicide prevention as the United States surgeon general.

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I want to welcome the panelists that are going to be speaking, the experts

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that you're going to hear from, and all of you across the country who

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are participating at your computers or at the various echo sites.

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We've got some great information to share with you today.

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We've got some great, remarkable stories that you're going to hear about today.

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This movement started with a passionate group of people, and it

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continues today with those same voices, and new voices that are

00:14:59.84,00:15:05.77
being added every day, sometimes out of tragedy, but also out of hope.

00:15:05.79,00:15:09.75
And we want you to know that you are part of that, and we

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are making progress and saving lives in this country.

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For some of you participating today, we know that you know the pain of

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brain illnesses, mental illnesses, and the emotions that go with that.

00:15:20.03,00:15:22.29
We also know that some of you know the pain and the

00:15:22.31,00:15:25.74
agony of loss of someone you love to suicide.

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I'm sure I can speak for all the panelists and the experts that are here today in saying

00:15:29.44,00:15:32.67
that our thoughts are going to be with you, and our hope is that we can help keep

00:15:32.69,00:15:36.90
others from knowing the pain that you've lived through and experienced in your life.

00:15:36.92,00:15:43.56
The vice president of my board of directors once said that suicide was

00:15:43.58,00:15:47.26
the greatest human tragedy, and not only do I agree with him, but I also

00:15:47.28,00:15:51.19
know that the greatest human strength and hope in suicide prevention can

00:15:51.21,00:15:55.02
be found right here today in all of you participating in this event.

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Regardless of your background, whether you're a clinician, a camp

00:15:57.83,00:16:01.26
counselor, a state suicide prevention coordinator, a member of

00:16:01.28,00:16:07.00
the faith community, we all have a role in preventing suicide.

00:16:07.02,00:16:10.34
It doesn't happen alone, it doesn't happen in

00:16:10.36,00:16:12.48
the nation's capital, or the state's capital.

00:16:12.50,00:16:17.14
It happens in our community and in our families, in our businesses.

00:16:17.16,00:16:21.97
When a suicide occurs, it tears apart not only the family,

00:16:21.99,00:16:25.99
but it rips apart the soul of our community and our nation.

00:16:26.01,00:16:28.35
And that is why we are here today, to prevent that

00:16:28.37,00:16:31.59
from being torn any deeper than it already has been.

00:16:31.61,00:16:33.66
While there is much to learn about the brain and many other

00:16:33.68,00:16:37.36
things that are involved in suicide prevention, preventing

00:16:37.38,00:16:42.99
suicide is not only possible, it is all of our responsibility.

00:16:43.01,00:16:47.20
Finally, after we break into our work groups and you break out in your echo sites

00:16:47.22,00:16:52.09
across the country, the goal of today, as you heard Dr. Cody say, is simple but

00:16:52.11,00:16:56.95
large: We want to continue this conversation about suicide and suicide prevention.

00:16:56.97,00:17:00.94
In doing so, we want to keep the momentum going of the recently

00:17:00.96,00:17:05.91
released strategy, engage those across the country in our communities

00:17:05.93,00:17:08.59
that want to do something, but that don't know how to do that.

00:17:08.61,00:17:12.20
And of course reduce the incidence and burden of suicide while

00:17:12.22,00:17:16.51
also recognizing the countless great efforts that take place

00:17:16.53,00:17:21.76
every day across the country in saving lives in America.

00:17:21.78,00:17:22.05
With that,

00:17:22.07,00:17:27.67
I want to get our program underway, and tell you that echo sites from

00:17:27.69,00:17:32.55
across the country that are participating can submit questions to

00:17:32.57,00:17:38.35
EveryonePlaysaRole@SAMHSA.hhs.gov, and in person attendees, when we

00:17:38.37,00:17:41.49
have time for questions, can come down to the front two microphones.

00:17:41.51,00:17:43.00
We don't have a lot of time for questions, but

00:17:43.02,00:17:45.60
we do really encourage you to submit them.

00:17:45.62,00:17:48.71
And I know that the panelists and the experts here don't have anything to

00:17:48.73,00:17:51.58
do after today, so please feel free to submit all of your questions, the

00:17:51.60,00:17:57.45
thousands of you, and I'll be emailing them directly with those questions.

00:17:57.47,00:18:00.68
We'll have questions for each speaker after they present.

00:18:00.70,00:18:05.00
If you have a smart phone handy, please remember to help spread the message of

00:18:05.02,00:18:09.04
today's event by tweeting out using the hashtag #EveryonePlaysARole, and don't

00:18:09.06,00:18:14.54
forget to retweet our messages on Twitter accounts of all of our HHS partners

00:18:14.56,00:18:19.00
who have collaborated for this event -- the Administration on Children and Families,

00:18:19.02,00:18:22.82
the Administration on Community Living, the Health Resources and Services

00:18:22.84,00:18:27.04
Administration, the Substance Abuse and Mental Health Services Administration,

00:18:27.06,00:18:32.04
the Office of Women's Health, and the Centers for Medicaid and Medicare Services.

00:18:32.06,00:18:36.35
Also, don't forget to look on our Facebook pages for more content and information, and

00:18:36.37,00:18:41.18
be sure to share the suicide prevention resources that are listed there for you.

00:18:41.20,00:18:44.06
Now, it is my great pleasure to introduce our first

00:18:44.08,00:18:46.31
speaker, a colleague and a good friend of mine,

00:18:46.33,00:18:47.85
Dr. Jerry Reed.

00:18:47.87,00:18:52.41
Dr. Reed is the executive director of the Suicide Prevention Resource Center.

00:18:52.43,00:18:55.69
He was a featured panelist earlier this month at

00:18:55.71,00:18:58.58
the White House Conference on Mental Health.

00:18:58.60,00:19:01.87
Dr. Reed is the co-lead on the National Strategy

00:19:01.89,00:19:04.87
for Suicide Prevention Resource Taskforce.

00:19:04.89,00:19:08.45
With the surgeon general, he led that effort, and we have a

00:19:08.47,00:19:11.48
fantastic new document that I hope you all have access to.

00:19:11.50,00:19:14.89
And if you don't, download it online.

00:19:14.91,00:19:20.35
It's crucial to the creation and the dissemination that the work

00:19:20.37,00:19:25.38
that Dr. Reed and Dr. Benjamin led is carried out by all of you.

00:19:25.40,00:19:29.13
So, let's bring up here Dr. Reed, and have him explain to us a little

00:19:29.15,00:19:33.20
bit more about that, and the ending of the tragedy of suicide.

00:19:33.22,00:19:39.87
Ladies and gentlemen, Dr. Reed. [applause] Good morning.

00:19:39.89,00:19:46.19
It's wonderful to be in Chicago after several delays yesterday getting here.

00:19:46.21,00:19:51.04
It was nice to make it, so that I could do honor to my good friend and colleague,

00:19:51.06,00:19:55.13
Commander Cody, who sent an invitation a long time ago to join you.

00:19:55.15,00:19:58.12
In many ways, it's a bit of a reunion for me, because we had many

00:19:58.14,00:20:03.08
meetings here in Chicago as we went through 18 months of writing the

00:20:03.10,00:20:06.58
National Strategy for Suicide Prevention, and putting it all together.

00:20:06.60,00:20:10.52
And even more of a reunion than just geography, several of the

00:20:10.54,00:20:13.39
wonderful people who helped do this task are in the room today.

00:20:13.41,00:20:17.78
So, I'd certainly like to acknowledge my good friend, Admiral Jim Galloway,

00:20:17.80,00:20:19.79
Richard McKeon, from SAMHSA,

00:20:19.81,00:20:24.30
Dr. Mort Silverman from Chicago, and a member of the SPRC staff, my colleague,

00:20:24.32,00:20:28.15
Dan Ridenberg, who sits behind me, and of course Dr. Benjamin, who we heard a

00:20:28.17,00:20:33.07
moment ago, and many, many others who helped us do this formidable task.

00:20:33.09,00:20:37.01
I also would like to thank my colleagues here at Region 5 for

00:20:37.03,00:20:40.57
allowing us to come home in a way, and celebrate a bit of a reunion.

00:20:40.59,00:20:45.14
It's been a long journey, and I'm glad we're able to talk about it a little bit today.

00:20:45.16,00:20:46.36
So, having said that,

00:20:46.38,00:20:52.07
I am personally delighted to be here to speak to "Everyone Plays a Role in Suicide

00:20:52.09,00:20:57.30
Prevention: Turning strategy into action," and that was certainly a sub-theme that we

00:20:57.32,00:21:04.38
held onto from Day 1, as we wrote the national strategy, was: How do we really make

00:21:04.40,00:21:08.87
this a living document that people everywhere across the country can do something with.

00:21:08.89,00:21:14.06
Not just researchers in academic environments or our clinical staff in agencies around

00:21:14.08,00:21:19.21
the country, but how can everybody at every level do something in suicide prevention?

00:21:19.23,00:21:22.86
So, my hope is that at the end of the 20 minutes that I've been given, we'll

00:21:22.88,00:21:27.69
begin the journey of kicking off 75 days to World Suicide Prevention Day,

00:21:27.71,00:21:28.64
September 10th,

00:21:28.66,00:21:33.53
2013, with demonstrable steps that can show we

00:21:33.55,00:21:37.45
are, in fact, doing exactly what we had in mind.

00:21:37.47,00:21:41.40
So, before I get into the few brief charts I'm going to share with you,

00:21:41.42,00:21:46.69
I just want to reflect on the day that I think I got the call that said,

00:21:46.71,00:21:52.23
"Jerry, we'd like for you to chair the taskforce with Dr. Benjamin on

00:21:52.25,00:21:56.76
revising the National Strategy." Well, putting my name in the same sentence

00:21:56.78,00:22:00.16
with Dr. Benjamin was a little awesome to start with, but it made me

00:22:00.18,00:22:04.13
remember a few other points in my life that I stopped, took pause, and said,

00:22:04.15,00:22:07.15
"How did this happen?" One of those was the day my

00:22:07.17,00:22:09.77
wife told me we were expecting our first child.

00:22:09.79,00:22:13.68
I said, "Now, that's a big task." Having watched my mother and father raise seven of us,

00:22:13.70,00:22:15.41
I thought that was pretty awesome.

00:22:15.43,00:22:19.44
I also remember going to graduate school and deciding I was going to get a doctorate.

00:22:19.46,00:22:22.03
I don't know what I was thinking. I was so happy when they said,

00:22:22.05,00:22:26.80
"You're accepted," but I had no idea what the next five years of my life would be about.

00:22:26.82,00:22:31.30
But I did it, and I've raised two wonderful children who are 29 and 25 and

00:22:31.32,00:22:35.06
I'm happy to say, with regards to the National Strategy, we did it, and it

00:22:35.08,00:22:38.55
was a much more pleasant experience than I thought it would have been.

00:22:38.57,00:22:42.46
But I will start by saying, and I think I hope it sets the tone for those of

00:22:42.48,00:22:46.75
us here in Chicago as well as people all across the country in echo sites,

00:22:46.77,00:22:50.02
I'm reminded at a meeting I was at many years ago in Ottawa,

00:22:50.04,00:22:54.80
Canada, with our colleagues in Canada who were addressing first nation issues, and our

00:22:54.82,00:22:58.22
colleagues here in the United States that were addressing Native American issues.

00:22:58.24,00:23:01.93
And as is so often typical, an elder welcomed us to Canada.

00:23:01.95,00:23:04.56
And as he entered the room and gave his blessing, he

00:23:04.58,00:23:08.01
said to us, and it stuck with me all these years,

00:23:08.03,00:23:11.83
"Just remember, it's not by accident that you're in this room." So whether you're

00:23:11.85,00:23:16.19
here physically or whether you're here virtually, you're here for a reason.

00:23:16.21,00:23:18.36
You're here because there is something you can do.

00:23:18.38,00:23:22.58
And I would ask you to hold onto that as we go through the day, and as you return

00:23:22.60,00:23:27.35
to your communities or to your workplaces and do the work that needs to be done.

00:23:27.37,00:23:32.48
Our field has grown so incredibly much from the years when I started, which was

00:23:32.50,00:23:38.77
back in 1996 and '97, when, frankly, you could have put the field in a very small

00:23:38.79,00:23:43.14
room, and a lot of smart people would have talked about where we needed to go,

00:23:43.16,00:23:48.44
to the point where we are at today, where we have so many nonprofit organizations,

00:23:48.46,00:23:52.91
so many researchers, every state in the nation has a state suicide prevention

00:23:52.93,00:23:57.61
plan, tribal communities all over the country are doing the best they can to

00:23:57.63,00:24:01.03
make a difference in the lives of the folks who live in their communities.

00:24:01.05,00:24:04.41
And I could just go on and on about how much our field has grown.

00:24:04.43,00:24:07.70
And I think it's an amazing, amazing journey.

00:24:07.72,00:24:12.32
And I want to start with a dedication that is in the front of the National

00:24:12.34,00:24:16.99
Strategy, that I think we held very closely to as we wrote the strategy,

00:24:17.01,00:24:20.48
and I would ask all of you to remember as you do this important work.

00:24:20.50,00:24:26.01
And the dedication reads: "To those who have lost their lives by suicide, to those who

00:24:26.03,00:24:31.24
struggle with thoughts of suicide, to those who have made an attempt on their lives,

00:24:31.26,00:24:37.22
to those caring for someone who struggles, to those left behind after a death by

00:24:37.24,00:24:43.93
suicide, to those in recovery, and to all those who worked tirelessly to prevent suicide

00:24:43.95,00:24:50.66
and suicide attempts in our nation, we believe that we can and we will make a difference."

00:24:50.68,00:24:56.04
And I really want to emphasize the fact that, in my humble opinion, much of where we

00:24:56.06,00:25:00.88
are today is because of the courage of those who have lost a loved one to suicide, who

00:25:00.90,00:25:06.04
chose to speak up, and encourage all of us to fly in formation and fly in the direction

00:25:06.06,00:25:10.90
of preventing this very preventable form of death, and to all those who have struggled

00:25:10.92,00:25:15.60
with having made an attempt, who have the courage to add their voice to this conversation,

00:25:15.62,00:25:20.45
to help us realize what needs to be done in clinical settings, in communities, in

00:25:20.47,00:25:26.85
workplaces, to make sure we don't marginalize them for that event, learn from them,

00:25:26.87,00:25:31.70
and hopefully prevent the suicide and the deaths that we all want to prevent.

00:25:31.72,00:25:36.92
So, turning strategy to action. This is the strategy. If you don't have one,

00:25:36.94,00:25:40.06
I would strongly encourage you try to get one from the SAMHSA

00:25:40.08,00:25:44.66
clearinghouse or, as Jeff said and certainly Dan, download

00:25:44.68,00:25:49.88
one, because it's full of many, many remarkable directions.

00:25:49.90,00:25:52.73
I want to just start with a couple of pictures here.

00:25:52.75,00:25:55.90
I'm not going to put a lot of PowerPoint charts with text, at the

00:25:55.92,00:25:59.61
advice of my staff, since this is such a large conversation.

00:25:59.63,00:26:01.48
I thought a picture would tell a thousand words,

00:26:01.50,00:26:03.98
and maybe keep it a little bit more interesting.

00:26:04.00,00:26:09.74
So let me just begin with some of the major developments that have occurred since 2001,

00:26:09.76,00:26:15.02
that really led us to the conclusion that it was time to revise the National Strategy.

00:26:15.04,00:26:17.13
So, first, down in the right hand side, you see

00:26:17.15,00:26:19.48
the Action Alliance for Suicide Prevention.

00:26:19.50,00:26:20.58
On September 10th,

00:26:20.60,00:26:25.36
2010, Secretary Sebelius and Secretary Gates launched the public-private

00:26:25.38,00:26:29.76
partnership to help us advance suicide prevention in this nation by not

00:26:29.78,00:26:34.24
relying on any one agency, any one sector, but on multiple sectors, and

00:26:34.26,00:26:38.90
multiple voices, to help us do all that was necessary for suicide prevention.

00:26:38.92,00:26:43.35
When that action alliance was launched, we were given the mandate to revise

00:26:43.37,00:26:48.31
the National Strategy for Suicide Prevention, and quite clearly were told,

00:26:48.33,00:26:50.01
"Please do it in 18 months.

00:26:50.03,00:26:54.30
Let's get it done so people can have the tools they need to help us move forward."

00:26:54.32,00:26:57.96
You also see the logo for the national lifeline that was mentioned earlier.

00:26:57.98,00:27:01.62
So we now have a response system in this country staffed by wonderful

00:27:01.64,00:27:06.34
human beings in over 150 crisis centers, that all you have to do is

00:27:06.36,00:27:10.08
dial 1-800-273-TALK, from any where in the country, and you will be

00:27:10.10,00:27:14.36
seamlessly connected to a helping asset, with really great people.

00:27:14.38,00:27:18.53
And that expanded just a little bit when the Veterans Administration, in partnership with

00:27:18.55,00:27:23.68
SAMHSA, could provide an option one that now allowed veterans and active-duty military

00:27:23.70,00:27:27.58
and those that love them, if they have someone in their life that struggles, all they

00:27:27.60,00:27:31.60
have to do is push option one, and they will be seamlessly connected to Canandaigua,

00:27:31.62,00:27:37.02
New York, and the whole reservoir of VA medical centers to get that kind of

00:27:37.04,00:27:41.05
help, which is a fantastic contribution to our national infrastructure.

00:27:41.07,00:27:46.12
Social media, as you can see in the middle there, is making huge contributions,

00:27:46.14,00:27:49.87
and something we need to embrace, and our strategy did embrace.

00:27:49.89,00:27:56.87
And also just the increased recognition that no one best practice, no one intervention,

00:27:56.89,00:28:05.11
no one person, no one event is going to change the nature of suicide in this country.

00:28:05.13,00:28:06.55
It's got to be comprehensive.

00:28:06.57,00:28:08.87
If you're going to train gatekeepers, then you need to make

00:28:08.89,00:28:11.26
sure the clinicians in your community are trained to receive

00:28:11.28,00:28:14.89
them once they're identified, as individuals are identified.

00:28:14.91,00:28:20.55
If you are going to engage primary care practices in helping to screen and look for

00:28:20.57,00:28:24.44
those at risk, we have to make sure there are support services available outside

00:28:24.46,00:28:28.86
the primary care offices, for those individuals who may have been identified.

00:28:28.88,00:28:32.43
If we're going to work with emergency departments and ask them to really screen

00:28:32.45,00:28:36.34
for suicidal risk when someone presents, so that once we treat the injury that

00:28:36.36,00:28:40.46
brought them to the emergency department, as well they have continuity of care,

00:28:40.48,00:28:44.89
access to community resources, follow-up, and a very clear message that,

00:28:44.91,00:28:49.53
"You matter to us, and we want to make sure that you get well from this

00:28:49.55,00:28:53.56
presentation." So all of this has really helped us understand, we made a

00:28:53.58,00:28:57.78
very coordinated and comprehensive approach, and none of us should look at

00:28:57.80,00:29:03.83
it as one best practice or one best approach is going to solve the challenge.

00:29:03.85,00:29:10.34
So, this slide basically kind of is going to talk about the strategic directions,

00:29:10.36,00:29:14.94
but I will say that, as those pictures showed earlier, over the last 10 years

00:29:14.96,00:29:18.93
we've learned that there's a burden of suicide in the military and certainly in

00:29:18.95,00:29:23.15
the Veterans Administration, and much is being done to address that burden.

00:29:23.17,00:29:27.44
We understand that if we're going to truly be effective in suicide prevention,

00:29:27.46,00:29:32.52
we're going to have to enhance our surveillance, and have data on suicide nationally

00:29:32.54,00:29:37.44
that's much quicker at hand, so we can see the reality of what's happening in the

00:29:37.46,00:29:41.35
environment and what's the impact of that happening in the rates of suicide.

00:29:41.37,00:29:46.37
And CDC is working very hard to reduce the time from when deaths occur

00:29:46.39,00:29:50.81
in states to when that death data is aggregated, so we have the kind

00:29:50.83,00:29:54.17
of information we need to do very progressive things with it.

00:29:54.19,00:29:57.11
And I just want to go back and just say that the recognition that the

00:29:57.13,00:30:00.61
voice of those who have lost one by suicide, someone they love to

00:30:00.63,00:30:04.29
suicide, and the voice of those who have made an attempt, are clearly,

00:30:04.31,00:30:08.05
I think, the conversation that has to be at every table.

00:30:08.07,00:30:10.55
So in your community coalitions around the country,

00:30:10.57,00:30:14.95
I hope you make sure you have the voice of the consumer, and the voice of the bereaved,

00:30:14.97,00:30:19.87
at the table, so we can learn what needs to be learned as we move forward.

00:30:19.89,00:30:25.62
So: Let me just share with you how the strategy is organize.

00:30:25.64,00:30:29.29
Dr. Benjamin stated that there's four strategic directions,

00:30:29.31,00:30:33.65
and what you see here are those four strategic directions.

00:30:33.67,00:30:39.47
What we tried to do as we thought about the National Strategy was building a healthy

00:30:39.49,00:30:44.92
and wholesome community, building a prevention-prepared community, in strategic

00:30:44.94,00:30:50.86
direction too, making sure that the availability of treatment and after-care services

00:30:50.88,00:30:57.13
were available for those who needed those services, and, on the far left up here,

00:30:57.15,00:31:01.34
making sure that surveillance and evaluation and research remained a part of our

00:31:01.36,00:31:06.32
conversation, so we could learn from that we're doing, add to the best practices,

00:31:06.34,00:31:11.14
and hopefully continue the momentum to get better and better and better at saving lives.

00:31:11.16,00:31:16.09
Thirty-eight thousand lives were lost in 2010.

00:31:16.11,00:31:18.55
We certainly know there are many people who consider

00:31:18.57,00:31:21.39
suicide from some of the data that SAMHSA puts out.

00:31:21.41,00:31:24.42
So we have a long way to, and this strategy and these

00:31:24.44,00:31:27.31
directions were intended to help us get there.

00:31:27.33,00:31:31.80
So, Strategic Direction 1: The goals in this area seek to create

00:31:31.82,00:31:34.68
supportive environments that will promote the general health of the

00:31:34.70,00:31:40.09
population, and reduce the risk for suicidal behavior and related problems.

00:31:40.11,00:31:45.04
So, looking at problems that may have shared risks, and trying to make sure that all the

00:31:45.06,00:31:50.82
providers know those risks, know those protections, and so if someone walks into your

00:31:50.84,00:31:55.11
setting or if you don't know the warning signs for suicide, or someone you love is

00:31:55.13,00:31:59.79
behaving very differently than they ever have before, making sure we prepare everyone

00:31:59.81,00:32:04.25
in this nation to be on the lookout for that and take steps if they see that occurring.

00:32:04.27,00:32:08.14
Strategic Direction 2 really seeks to ensure that clinical and

00:32:08.16,00:32:11.51
community-based programs are in place, and prepared to help

00:32:11.53,00:32:16.89
individuals who struggle navigate their care efficiently and effectively.

00:32:16.91,00:32:20.38
In short, we want to make sure that every door in the community is the right

00:32:20.40,00:32:24.97
door -- whether it's a social service agency, whether it's a substance abuse

00:32:24.99,00:32:30.09
treatment agency, whether it's a crisis line, or whether it's a school setting.

00:32:30.11,00:32:34.51
We want every setting to be aware of what needs to be done to make

00:32:34.53,00:32:39.20
sure someone who passed through that door gets the help they need.

00:32:39.22,00:32:43.99
Strategic Direction 3 just basically speaks to, let's make sure the best practices,

00:32:44.01,00:32:48.66
the best interventions, the best after-care, and I can't emphasize enough how

00:32:48.68,00:32:53.74
important post-vention is -- post-vention being making sure you address the needs

00:32:53.76,00:32:58.08
of a family, a community, et cetera, a workplace, after the death of someone in

00:32:58.10,00:33:03.80
that setting, so that we really can prevent what could be a subsequent death by

00:33:03.82,00:33:08.56
making sure we compassionately and knowingly reach out to that setting, so that

00:33:08.58,00:33:13.01
people can understand what occurred and how we move forward as a community.

00:33:13.03,00:33:14.16
And lastly, as I said,

00:33:14.18,00:33:18.48
Strategic Direction 4 supports additional efforts in surveillance, research and

00:33:18.50,00:33:24.82
evaluation to consider and to continue to make the advances that we need to make.

00:33:24.84,00:33:28.81
What we did quite strategically, and you'll see this when you look at the

00:33:28.83,00:33:33.97
strategy, after every single strategic direction there is a page that talks

00:33:33.99,00:33:38.44
about what the federal government can do, what states and tribes can do, what

00:33:38.46,00:33:43.11
businesses can do, what healthcare systems can do, what universities, what

00:33:43.13,00:33:47.56
schools, what nonprofits, and, lastly, what individuals and families can do.

00:33:47.58,00:33:52.31
So there is a roadmap of sorts after every strategic direction that gives

00:33:52.33,00:33:57.00
some very tangible and concrete steps that can be taken to advance the

00:33:57.02,00:34:00.62
objectives and the goals in that particular strategic direction.

00:34:00.64,00:34:02.65
And that was done because people -- We always say,

00:34:02.67,00:34:07.24
"Everyone has a role," but we never took the time to explain what that role was

00:34:07.26,00:34:11.56
to people who may not be as conversational about suicide prevention as we are.

00:34:11.58,00:34:16.30
So we tried very hard to do that in this National Strategy.

00:34:16.32,00:34:23.59
So, everyone plays a role, or everyone has a piece of the puzzle.

00:34:23.61,00:34:27.28
I bring today a piece of the puzzle that I bring very often when I

00:34:27.30,00:34:31.97
go to speak to communities around the country about the strategy.

00:34:31.99,00:34:34.75
And it's significant, because this puzzle piece was given to me by

00:34:34.77,00:34:39.51
a mom who lost a 15-year-old daughter to suicide many years ago.

00:34:39.53,00:34:43.59
And when we were trying to talk about how do we mobilize the nation to

00:34:43.61,00:34:47.05
respond -- before the Action Alliance for Suicide Prevention was launched,

00:34:47.07,00:34:50.99
way before it was launched -- trying to build momentum for this concept.

00:34:51.01,00:34:55.67
I invited her to come and share her story, so that federal and senior

00:34:55.69,00:34:59.74
executives from the Washington area could benefit from her story,

00:34:59.76,00:35:02.96
so that we could see how important doing something really was.

00:35:02.98,00:35:05.45
And she said, "I really don't have anything to say.

00:35:05.47,00:35:09.55
I'm not sure that my story would be helpful." We talked a bit, and I kept trying

00:35:09.57,00:35:13.13
to assure her -- at the time I ran an advocacy organization that tried to build

00:35:13.15,00:35:16.85
political will, called the Suicide Prevention Action Network -- and we talked a bit.

00:35:16.87,00:35:19.04
And finally she agreed to come. And I said,

00:35:19.06,00:35:22.40
"Your story will matter." And so, she was moving from one home to another,

00:35:22.42,00:35:26.08
and as she was cleaning out the room that belonged to her daughter, she

00:35:26.10,00:35:29.57
found a puzzle that her daughter had worked on prior to her death.

00:35:29.59,00:35:30.03
And she said,

00:35:30.05,00:35:33.11
"This may be my message." So, she took the puzzle pieces, put it in a

00:35:33.13,00:35:37.74
felt bag, brought it to Washington, and in front of about 75 people

00:35:37.76,00:35:42.44
passed around this felt bag and asked each of us to take a puzzle piece.

00:35:42.46,00:35:45.72
This is mine. I still have it to this day. And it just said to me,

00:35:45.74,00:35:50.32
"Never forget why we're doing this." We're doing this to try to each do the part

00:35:50.34,00:35:54.84
that we have to do, to make sure that other moms don't lose their 15-year-old child.

00:35:54.86,00:35:58.39
And eventually get to the place we are, a suicide-prevention

00:35:58.41,00:36:01.87
prepared nation, and every door is the right door, and people who

00:36:01.89,00:36:06.17
struggle do so without bias, discrimination and false judgment.

00:36:06.19,00:36:07.95
So that's the goal that I have.

00:36:07.97,00:36:11.84
So, I would ask all of you, as you think through the day, to think about your piece.

00:36:11.86,00:36:14.36
It may be small, it may be big.

00:36:14.38,00:36:16.44
But there is something each and every one of us

00:36:16.46,00:36:19.71
in this room can do around suicide prevention.

00:36:19.73,00:36:23.95
So, when you look at this, those were the very things Dr. Benjamin mentioned.

00:36:23.97,00:36:28.82
These are the things that guided us as we went through: Promote connectedness.

00:36:28.84,00:36:33.34
It's not just enough to talk about risk. We have to talk about protection.

00:36:33.36,00:36:37.90
What protects people who do struggle from making tragic decisions.

00:36:37.92,00:36:41.81
Strength and continuity of care, so it's not enough just to walk in and get

00:36:41.83,00:36:45.67
treated at the emergency department, but you'll be followed until well.

00:36:45.69,00:36:49.91
And that' got to be part of our paradigm. Training the professionals.

00:36:49.93,00:36:53.32
Many of us who went through graduate school never had the

00:36:53.34,00:36:56.25
kind of training in suicide risk assessment that we needed.

00:36:56.27,00:37:00.07
The field has grown. The nation is engaged in a conversation.

00:37:00.09,00:37:03.30
We have to make sure that our next generation of mental health

00:37:03.32,00:37:06.61
professionals know how to assess and manage suicide risk.

00:37:06.63,00:37:09.72
So when a gatekeeper identifies a patient, or when a school

00:37:09.74,00:37:12.93
identifies someone at risk, there's a clinician who knows exactly

00:37:12.95,00:37:16.94
what to do, so we can give that patient exactly what they need.

00:37:16.96,00:37:21.63
We have to challenge ourselves to think about alternatives to approach and setting.

00:37:21.65,00:37:23.82
You know, maybe it's not always the right thing to

00:37:23.84,00:37:27.81
do to admit someone to an in-patient facility.

00:37:27.83,00:37:29.01
Maybe it is, maybe it isn't.

00:37:29.03,00:37:33.00
But we ought to be really thoughtful before we make that decision.

00:37:33.02,00:37:37.05
Post-vention, as I mentioned, multi-sectoral engagement, doing everything

00:37:37.07,00:37:40.54
we can to make sure that everybody in the community plays a part.

00:37:40.56,00:37:43.50
And if you want to understand what comprehensive means,

00:37:43.52,00:37:47.22
I would encourage you to look at page 12 of the National Strategy, where Dr.

00:37:47.24,00:37:52.31
Silverman, who is with us today, wrote a very convincing one page that said a

00:37:52.33,00:37:57.31
truly prepared community, who's doing all that it can to help a person identified

00:37:57.33,00:38:00.57
with depression, these are all the things that would have to happen if we were

00:38:00.59,00:38:04.72
to honestly say we've done all that we know to do, to make a difference.

00:38:04.74,00:38:08.37
And I think it's an amazing contribution, Dr. Silverman.

00:38:08.39,00:38:12.71
So, I'd like to kind of close my remarks by saying

00:38:12.73,00:38:17.14
what was said earlier: Suicide has a ripple effect.

00:38:17.16,00:38:20.84
And way back in the late '90s, when we first started talking

00:38:20.86,00:38:24.46
about suicide, there wasn't a whole lot that we knew.

00:38:24.48,00:38:29.88
But one thing that stuck with me is if you throw a pebble in a pond, it ripples.

00:38:29.90,00:38:34.14
And that suicide doesn't just affect the individual who died by

00:38:34.16,00:38:38.60
suicide, but it affects their family, it affects their neighborhood,

00:38:38.62,00:38:44.37
it affects their school, it affects, affects, affects.

00:38:44.39,00:38:49.10
And it's not just a short-term effect, it's a long-term effect.

00:38:49.12,00:38:54.40
So, my goal in this cause, and I'm sure the goal of all of you, is that we

00:38:54.42,00:38:58.53
understand that each and every suicide that occurs in this country, while we

00:38:58.55,00:39:03.56
may not know the person who died by suicide, it, in my humble opinion, truly

00:39:03.58,00:39:08.44
affects our fabric as a nation, and I couldn't be prouder to be an American

00:39:08.46,00:39:12.26
involved in such a cause, where we're not afraid nationally to talk about

00:39:12.28,00:39:16.49
preventing suicide and engaging all the federal partners, all the private

00:39:16.51,00:39:21.60
sector partners, and everyone in between, to do their part for suicide prevention.

00:39:21.62,00:39:25.60
So let me close by just saying there is something that each of us can do.

00:39:25.62,00:39:29.35
As the day progresses, I hope you'll think about that from where you sit.

00:39:29.37,00:39:30.47
As Gandhi said,

00:39:30.49,00:39:35.89
"Be the change you want to see in the world." From wherever you sit, be the change that

00:39:35.91,00:39:40.30
you want to see in the world, and that you are uniquely positioned to contribute.

00:39:40.32,00:39:44.62
So, if it's sponsoring a training, if it's developing a protocol, if it's

00:39:44.64,00:39:48.33
starting a ministry in your faith community, if it's joining a community

00:39:48.35,00:39:52.74
coalition or developing a curriculum that might be used in your school

00:39:52.76,00:39:56.29
based on some of those that are already on the best practices registry,

00:39:56.31,00:39:59.55
I just ask you to never forget there is something

00:39:59.57,00:40:01.73
truly that each and every one of us can do.

00:40:01.75,00:40:05.59
So I thank you very much for the opportunity to join you today.

00:40:05.61,00:40:12.50
[applause] Thank you very much. Thank you very much,

00:40:12.52,00:40:21.49
Jerry, for that great overview of the National Strategy and how it came to be.

00:40:21.51,00:40:28.69
We're way behind, but I do want to take a question for Jerry, a very quick question.

00:40:28.71,00:40:35.78
What surprised you most during the development of the new National Strategy?

00:40:35.80,00:40:40.25
After I got over the shock of being asked to write the National Strategy,

00:40:40.27,00:40:44.37
I think for me it was how much collegiality there was.

00:40:44.39,00:40:48.66
We had a public comment period for 90 days that people could offer

00:40:48.68,00:40:51.93
their suggestions about what should be in the National Strategy.

00:40:51.95,00:40:56.58
We had 14 taskforces of the Action Alliance for Suicide Prevention, all of whom

00:40:56.60,00:41:00.42
were looking at a different topic and every one of them took the time and the

00:41:00.44,00:41:04.79
energy to give concrete suggestions, and with what I thought would have been

00:41:04.81,00:41:09.16
a much more difficult process, to pull it together and have it make sense.

00:41:09.18,00:41:13.18
You could just tell the nation was on the same page, and the field had been

00:41:13.20,00:41:20.27
flying in formation for a long time, so based on the 13 goals that were in

00:41:20.29,00:41:24.55
there, it was very clear that the people who had responsibility for input

00:41:24.57,00:41:28.33
to the goals really gave this serious thought, so there wasn't a lot of

00:41:28.35,00:41:32.23
changing that needed to be done once it came to the National Strategy taskforce.

00:41:32.25,00:41:34.26
It was just a matter of writing it in a way

00:41:34.28,00:41:37.06
that looked like it was one team, one fight.

00:41:37.08,00:41:39.42
So, nobody got hurt in the process? Nobody got hurt.

00:41:39.44,00:41:43.59
The people didn't carry agendas that were uniquely theirs. Everyone rose above,

00:41:43.61,00:41:47.07
I think, that unique agenda, for my opinion, and really helped

00:41:47.09,00:41:49.87
us do what needed to be done to put a strategy together that,

00:41:49.89,00:41:52.93
as Dr. Benjamin said, would take us through the next 10 years.

00:41:52.95,00:41:54.04
Well, that's great, Jerry. I mean,

00:41:54.06,00:41:55.68
I noticed a lot of us lost a lot of hair in the

00:41:55.70,00:41:58.10
process, but -- I lost a lot of hair in the process.

00:41:58.12,00:42:02.22
Thank you again for all of your leadership in the nation in suicide prevention.

00:42:02.24,00:42:06.88
Now, moving on, it's my great pleasure to introduce Dr. Richard McKeon.

00:42:06.90,00:42:08.07
Some of you know Dr. McKeon.

00:42:08.09,00:42:14.19
He is the branch chief of the suicide prevention branch at SAMHSA, so he's the head guy.

00:42:14.21,00:42:18.60
He's the one who makes it all happen. He has a great team that works with him.

00:42:18.62,00:42:21.93
He's a well-known expert in the field, and today he's going to be sharing

00:42:21.95,00:42:24.88
some information about the science of suicide prevention with us.

00:42:24.90,00:42:29.35
He was a member of the National Strategy for Suicide Prevention Taskforce.

00:42:29.37,00:42:33.70
He's authored many articles and books on the topic of suicide prevention.

00:42:33.72,00:42:35.91
And over the last 20 years, as some of you know,

00:42:35.93,00:42:38.04
SAMHSA has been integrally involved in trying to

00:42:38.06,00:42:41.55
move mental health and substance abuse forward.

00:42:41.57,00:42:45.80
They've taken on the initiative of suicide prevention, and for all of those of

00:42:45.82,00:42:49.56
you in attendance today and participating, we hope that you learn more about

00:42:49.58,00:42:54.08
the science of that, that's being led by Richard, his coworkers, and SAMHSA.

00:42:54.10,00:43:12.32
So, Richard McKeon. [applause] Thank you, Dan, for that kind introduction.

00:43:12.34,00:43:16.01
And I also want to acknowledge our administrator,

00:43:16.03,00:43:19.51
Pamela Hyde, who has just been an incredible champion for suicide

00:43:19.53,00:43:24.23
prevention, working to try to move the national agenda forward.

00:43:24.25,00:43:29.17
My background is as a clinical psychologist, and I spent numerous years working

00:43:29.19,00:43:34.21
in a hospital-based community mental health center, running a psychiatric

00:43:34.23,00:43:39.06
emergency service, and being clinical director of the mental health center.

00:43:39.08,00:43:42.75
But I just want to follow up on one thing that Jerry

00:43:42.77,00:43:46.33
mentioned, which has to do with the ripple effects.

00:43:46.35,00:43:51.69
And suicide has ripple effects, and suicide prevention has ripple effects.

00:43:51.71,00:43:58.41
And let me just mention two stories -- one sad and one much more happy.

00:43:58.43,00:44:03.00
The sad one has to do with a time when I was covering

00:44:03.02,00:44:09.78
psychiatric emergencies for our hospital over the weekend.

00:44:09.80,00:44:15.64
And I got a call from the emergency room physician, who said to me that there was a family

00:44:15.66,00:44:21.00
in the emergency room, and they were very upset, and could I come and talk with them?

00:44:21.02,00:44:28.20
Because the mother in the family had taken a serious intentional overdose.

00:44:28.22,00:44:34.38
She had made a suicide attempt. And she was at the moment in intensive care.

00:44:34.40,00:44:37.92
And they asked if I would come in and talk with the family

00:44:37.94,00:44:40.68
and try to help them through these difficult moments.

00:44:40.70,00:44:44.32
So I did that, and I came in, and talked to the family.

00:44:44.34,00:44:49.90
There were a couple of daughters and a son, and a husband.

00:44:49.92,00:44:55.58
And while I was talking with them, the emergency

00:44:55.60,00:44:57.32
room physician came into the room and said,

00:44:57.34,00:45:02.11
"I'm sorry, your mother is gone." And I will never

00:45:02.13,00:45:06.84
forget the cries of anguish from that family.

00:45:06.86,00:45:11.41
I will also not forget the way in which over the next several

00:45:11.43,00:45:15.83
years the daughter in that family, we struggled to try to

00:45:15.85,00:45:22.26
keep alive as she made a series of suicide attempts herself.

00:45:22.28,00:45:28.58
It made very vivid and palpable the tragic legacy that suicide

00:45:28.60,00:45:35.75
can bring in many circumstances -- the anguish is always there.

00:45:35.77,00:45:42.08
The suicidal behavior doesn't necessarily happen every time as a

00:45:42.10,00:45:47.16
consequence of a death by suicide, but there are heightened risks.

00:45:47.18,00:45:49.80
But there are also ripple effects to suicide prevention.

00:45:49.82,00:45:56.07
I also remember a time where I got a phone call from a woman whose daughter had

00:45:56.09,00:46:02.18
said that she had a friend who was planning on killing himself that night.

00:46:02.20,00:46:08.45
And we worked with the mother and then with the daughter, and we were able to

00:46:08.47,00:46:17.29
locate the boy, and intervene with him and found out he had made extensive efforts

00:46:17.31,00:46:25.41
to kill himself, that he had prepared, and he had extremely serious intent.

00:46:25.43,00:46:35.39
We hospitalized him, and he was not particularly happy about being

00:46:35.41,00:46:38.49
hospitalized -- he was a 17-year-old and his parents were actually

00:46:38.51,00:46:42.76
in Europe, so we couldn't find someone to give parental consent.

00:46:42.78,00:46:46.61
But we were so sure he was going to kill himself that we held him.

00:46:46.63,00:46:50.42
His parents arrived the next day. They were very grateful. We worked with him.

00:46:50.44,00:46:53.12
I saw him as an outpatient therapist for about a year

00:46:53.14,00:46:56.45
afterwards, and kept in contact with him afterwards.

00:46:56.47,00:47:02.68
He became an adult, he got married, he became a successful

00:47:02.70,00:47:09.27
businessman, and he touched many, many lives in a very positive way.

00:47:09.29,00:47:13.82
So, both suicide and suicide prevention have ripple effects.

00:47:13.84,00:47:16.29
And sometimes we may not see them.

00:47:16.31,00:47:18.69
I was fortunate enough to know what happened to him

00:47:18.71,00:47:22.34
afterwards, and know that his story had a happy ending.

00:47:22.36,00:47:28.81
So, the actions that all of you take can have

00:47:28.83,00:47:36.55
effects both close and further down the line.

00:47:36.57,00:47:41.07
So, regarding national strategies, which we're talking about today, one

00:47:41.09,00:47:45.82
question would be very reasonable for each of you to ask yourselves, is,

00:47:45.84,00:47:50.70
do we have evidence that national strategies can reduce suicide rates?

00:47:50.72,00:47:53.55
And my answer to that would be yes, we do.

00:47:53.57,00:47:58.22
We have seen evidence that implementation of national strategies

00:47:58.24,00:48:01.50
and national efforts in at least two different countries have

00:48:01.52,00:48:06.95
documented reductions, significant reductions, in suicide rates.

00:48:06.97,00:48:12.98
And those were in England and in Taiwan.

00:48:13.00,00:48:17.89
We've also seen that organizations in the United States, when they made suicide

00:48:17.91,00:48:23.06
prevention a central priority, have been able to bring down suicide rates.

00:48:23.08,00:48:26.75
Organizations as different as the United States Air Force and the

00:48:26.77,00:48:34.05
Henry Ford Healthcare System have been able to show reductions.

00:48:34.07,00:48:39.10
In England, they found reductions in communities that

00:48:39.12,00:48:44.32
reduced, that implemented the national strategy there.

00:48:44.34,00:48:48.17
And when they compared them to ones that did not implement it, they

00:48:48.19,00:48:52.74
found differences in the suicide rates, as well as pre- and post-

00:48:52.76,00:48:55.80
differences from before where they implemented the strategy.

00:48:55.82,00:49:00.71
So, compelling evidence that the work that they were doing in England was helpful.

00:49:00.73,00:49:05.36
And some of the things most strongly associated with reductions -- and this

00:49:05.38,00:49:08.80
was information that we took and integrated into the US National Strategy

00:49:08.82,00:49:13.90
-- were the availability of community crisis teams and proactive outreach.

00:49:13.92,00:49:15.56
I want to emphasize that.

00:49:15.58,00:49:20.07
If we wait for people at risk for suicide to show up in the offices of clinical

00:49:20.09,00:49:25.41
psychologists, myself, or a psychiatrist, we may never reduce the suicide rate.

00:49:25.43,00:49:32.21
Everyone has to play a role for it to be successful, and that means that

00:49:32.23,00:49:36.70
people have to encourage loved ones and friends and coworkers and

00:49:36.72,00:49:43.46
colleagues, and other students, et cetera, to get help, and to have hope.

00:49:43.48,00:49:49.41
A follow-up within seven days of in-patient discharge was associated with reductions.

00:49:49.43,00:49:53.00
Training of clinical staff at least every three years.

00:49:53.02,00:49:55.47
Having dual diagnosis policies, being aware that

00:49:55.49,00:49:59.73
substance abuse is a major risk factor for suicide.

00:49:59.75,00:50:03.71
In Taiwan, the focused on following up after those who had made suicide

00:50:03.73,00:50:08.15
attempts in a national effort, and found an extraordinary 63 percent

00:50:08.17,00:50:14.76
reductions in suicide, by paying attention and providing proactive follow-up

00:50:14.78,00:50:24.07
to people who had attempted suicide -- a major need within our country.

00:50:24.09,00:50:27.28
Now, the Air Force is an example within the United

00:50:27.30,00:50:30.34
States of where suicide was able to be reduced.

00:50:30.36,00:50:36.86
They were able to reduce suicides by about a third using a comprehensive approach.

00:50:36.88,00:50:40.32
And I want to emphasize that approaches need to be

00:50:40.34,00:50:43.40
comprehensive, but they also need to be sustained.

00:50:43.42,00:50:48.03
And there's very solid research regarding the Air Force model,

00:50:48.05,00:50:52.77
and this is back in the 1990s that this was first done.

00:50:52.79,00:50:54.46
And you can see in there part of what happened is that the

00:50:54.48,00:50:59.87
suicide rate, after going down, started to climb back up.

00:50:59.89,00:51:05.36
When they looked into it, they found that adherence to implementation

00:51:05.38,00:51:10.12
of the strategies involved in the Air Force's model had slipped.

00:51:10.14,00:51:12.44
And when they redoubled their efforts to make sure that they

00:51:12.46,00:51:16.85
were, in fact, doing it, that the rates went down again.

00:51:16.87,00:51:18.65
So very important information.

00:51:18.67,00:51:23.07
Suicide prevention is not a one-time effort, and it must be

00:51:23.09,00:51:28.44
sustained over time continually in order to be successful.

00:51:28.46,00:51:30.96
And it could also be done in a healthcare system.

00:51:30.98,00:51:38.87
The Henry Ford system had remarkable success reducing suicides,

00:51:38.89,00:51:45.44
for four consecutive quarters not having any suicides, and they

00:51:45.46,00:51:49.49
somewhat audaciously set as their goal having zero suicides.

00:51:49.51,00:51:56.07
And in some ways, sometimes in mental health you can be taken aback a bit by that.

00:51:56.09,00:52:01.50
But if the goal is not elimination of suicides entirely, what can the goal be?

00:52:01.52,00:52:08.07
It means that we would have to accept some number of suicides as being acceptable.

00:52:08.09,00:52:12.30
So let me just talk briefly about some key issues.

00:52:12.32,00:52:15.37
One is that we need to integrate and coordinate suicide

00:52:15.39,00:52:19.00
prevention activities across multiple sectors and settings.

00:52:19.02,00:52:25.31
So, it can't just be a mental health issue. We need a comprehensive lifespan approach.

00:52:25.33,00:52:29.04
We know that, at least from the teenage years through

00:52:29.06,00:52:36.40
old age, that suicide is a major cause of death.

00:52:36.42,00:52:39.76
We know our efforts have to be data-driven, and

00:52:39.78,00:52:42.10
we need to strive to continually improve.

00:52:42.12,00:52:45.16
We don't have a foolproof formula that we can apply.

00:52:45.18,00:52:49.98
We need to be working on what we know has shown promise, and we

00:52:50.00,00:52:54.01
need to be learning from our experience on an ongoing basis.

00:52:54.03,00:52:57.89
It needs to involve both the public and the private sectors.

00:52:57.91,00:53:02.46
So, that means that healthcare providers certainly need to be involved.

00:53:02.48,00:53:07.35
But also educators, workplaces, faith-based entities,

00:53:07.37,00:53:13.71
community-based organizations all have a role.

00:53:13.73,00:53:16.58
This is why I just underline the point, again, that

00:53:16.60,00:53:19.78
substance abuse is a major issue in suicide prevention.

00:53:19.80,00:53:22.28
It was incorporated into the National Strategy.

00:53:22.30,00:53:27.14
About 30 percent of all suicides involve alcohol,

00:53:27.16,00:53:30.49
and about a similar number of suicide attempts.

00:53:30.51,00:53:36.87
So it is imperative that that be taken into account, and that

00:53:36.89,00:53:40.19
settings that are involved in the prevention and treatment

00:53:40.21,00:53:45.96
for substance abuse are involved in this important effort.

00:53:45.98,00:53:51.67
It's also vitally important that emergency rooms are part of this.

00:53:51.69,00:53:57.30
And we are working actively with emergency rooms, because that is the

00:53:57.32,00:54:00.91
place where people are most frequently seen after suicide attempts.

00:54:00.93,00:54:05.84
And a lot of times they do not receive treatment afterwards.

00:54:05.86,00:54:14.74
So, the improving continuity of care is a major theme in the National Strategy.

00:54:14.76,00:54:19.11
What this says, and it may be hard to read all of it, this is using SAMHSA's NISTA

00:54:19.13,00:54:24.47
(?) data, and it's just looking at different groups, and showing the numbers.

00:54:24.49,00:54:28.36
We have past year suicidal ideation and attempts in different categories.

00:54:28.38,00:54:30.23
So, just to give you a sense of the multiple

00:54:30.25,00:54:33.58
settings that are required for suicide prevention.

00:54:33.60,00:54:40.98
The NISTA (?) data would emphasize, for example, that there are

00:54:41.00,00:54:45.35
approximately 74,000 suicide attempts per year by military veterans.

00:54:45.37,00:54:52.64
So, that's one area. Adults on Medicaid or on CHIP,

00:54:52.66,00:54:59.40
270,000. Fulltime college students, and SAMHSA works actively with colleges on suicide

00:54:59.42,00:55:03.04
prevention as well as through organizations such as the Judd (?) Foundation,

00:55:03.06,00:55:10.39
108,000. Adults on probation or parole, so correctional and legal settings we need to be

00:55:10.41,00:55:17.18
aware of as places that offer opportunities and needs for suicide prevention -- 161,000.

00:55:17.20,00:55:23.83
And adults in substance abuse treatment, 106,000 reported a past year suicide attempt.

00:55:23.85,00:55:25.05
So just to give you an idea of some of the

00:55:25.07,00:55:30.68
diversity of settings that require intervention.

00:55:30.70,00:55:32.63
Jerry mentioned this,

00:55:32.65,00:55:35.01
I'm not going to spend too much time on it, but the

00:55:35.03,00:55:37.92
important need for training -- training of various sorts.

00:55:37.94,00:55:45.00
Training of gatekeepers, of people working in schools, and people of faith-based

00:55:45.02,00:55:52.87
communities, but also of providers, because I often tell folks that I only had one

00:55:52.89,00:55:57.82
lecture on suicide prevention in my entire training as a clinical psychologist.

00:55:57.84,00:56:01.50
The problem with that was -- at least I got one --

00:56:01.52,00:56:03.88
well, the problem with that was that I gave it.

00:56:03.90,00:56:08.57
[laughter] Because our professor in our psychopathology class said,

00:56:08.59,00:56:12.38
"Everybody pick a topic and present to the class," and I picked suicide prevention.

00:56:12.40,00:56:13.37
So that was it.

00:56:13.39,00:56:17.82
I talked to supervisors, because I had suicidal clients and suicidal patients.

00:56:17.84,00:56:18.76
But it gives you a sense.

00:56:18.78,00:56:22.00
Some things have gotten better, but more work needs to be done.

00:56:22.02,00:56:25.94
The need to recognize the warning signs, and we now have evidence-based practices,

00:56:25.96,00:56:30.74
things like dialectical behavior therapy, and cognitive behavior therapy, that have

00:56:30.76,00:56:37.72
shown in randomized controlled trials the ability to reduce repeated suicide attempts.

00:56:37.74,00:56:41.13
Now, regarding the issue of the behavioral health workforce specifically.

00:56:41.15,00:56:44.46
This is kind of a busy slide. Let me just tell you what it means.

00:56:44.48,00:56:48.34
What you see there are courageous folks in behavioral health

00:56:48.36,00:56:51.38
systems around the country, who are really working to try to

00:56:51.40,00:56:54.93
make suicide prevention a core priority in their systems.

00:56:54.95,00:56:58.78
And what they did was they asked their workforce, did they

00:56:58.80,00:57:03.33
feel like they had the skills to work with suicidal people?

00:57:03.35,00:57:06.73
Did they have the training to work with suicidal people?

00:57:06.75,00:57:11.50
Did they feel they had the support to work with suicidal people?

00:57:11.52,00:57:16.55
And what they found was, very significant numbers said no.

00:57:16.57,00:57:20.53
Now, the good thing was they also have data, which was when people got

00:57:20.55,00:57:25.88
training, that the numbers improved significantly, that people at

00:57:25.90,00:57:29.62
least felt better and felt more competent in being able to do that.

00:57:29.64,00:57:32.38
So, this is important work.

00:57:32.40,00:57:36.08
Now, one of the goals in the National Strategy is making

00:57:36.10,00:57:39.46
suicide prevention as a core component of healthcare.

00:57:39.48,00:57:43.33
Now, what would that look like, if our healthcare system, and particularly our

00:57:43.35,00:57:47.17
behavioral healthcare systems, had suicide prevention as a core component?

00:57:47.19,00:57:51.24
And this really mirrors what the objectives in the National Strategy are.

00:57:51.26,00:57:55.57
Well, if we were to make it a core component, and the clinical workforce would

00:57:55.59,00:58:00.17
be routinely trained in suicide risk assessment, management and treatment.

00:58:00.19,00:58:02.44
Accrediting and certification bodies that would have

00:58:02.46,00:58:05.91
standards and guidelines related to suicide prevention.

00:58:05.93,00:58:10.56
Continuity of care during high-risk transition times such as discharge from in-patient

00:58:10.58,00:58:15.71
units and emergency department would be assured, including proactive outreach.

00:58:15.73,00:58:20.06
Deaths by suicide and nonfatal suicide attempts would be routinely monitored

00:58:20.08,00:58:24.83
and reviewed to help guide suicide prevention efforts, that there be

00:58:24.85,00:58:29.38
continuous quality improvement efforts focused on suicide prevention.

00:58:29.40,00:58:31.23
So those would be some of the examples.

00:58:31.25,00:58:33.95
But I also want to point out that there are significant

00:58:33.97,00:58:36.38
steps forward that major systems have taken.

00:58:36.40,00:58:42.99
For example, the Joint Commission has launched a National Patient Safety Goal,

00:58:43.01,00:58:48.16
focusing on suicide prevention, and that was about five or six years ago.

00:58:48.18,00:58:50.84
Very important step for them to take.

00:58:50.86,00:58:55.16
And the Veterans Administration has made suicide prevention

00:58:55.18,00:58:57.78
a major priority across their healthcare systems.

00:58:57.80,00:59:04.61
Every VA medical center now has a suicide prevention coordinator, and everyone who

00:59:04.63,00:59:09.66
is identified at high-risk receive what's called an enhanced care package of

00:59:09.68,00:59:16.03
services that they've shown to have been able to reduce repeated suicide attempts.

00:59:16.05,00:59:18.57
Just a couple of other points, and then I'll close.

00:59:18.59,00:59:21.42
One of the other areas that we incorporated in the National Strategy, and

00:59:21.44,00:59:25.31
one of the voices that historically has been silent in the field of suicide

00:59:25.33,00:59:29.97
prevention, has been the voice of survivors of suicide attempts, or people

00:59:29.99,00:59:34.76
who have struggled with suicidal ideation themselves, for them to tell us

00:59:34.78,00:59:38.85
what they feel they need and what they feel would have helped them.

00:59:38.87,00:59:41.41
And we are now doing much more of that work.

00:59:41.43,00:59:45.70
This is a quote from Eduardo Vega, who was part of

00:59:45.72,00:59:49.44
our taskforce to revise the National Strategy.

00:59:49.46,00:59:54.08
And so, a very important voice in that, that is integrated in the National Strategy

00:59:54.10,00:59:59.79
and needs to be continued to be integrated in our efforts moving forward.

00:59:59.81,01:00:05.20
And the faith-based area is also important, because there are people who

01:00:05.22,01:00:09.14
may never come to see a clinical psychologist such as myself, but maybe

01:00:09.16,01:00:13.50
they will talk to a peer and maybe they will talk to their minister or

01:00:13.52,01:00:18.98
priest or rabbi or pastor, and we need to take these things into consideration

01:00:19.00,01:00:23.70
and make sure that those options are available for people as well.

01:00:23.72,01:00:26.96
Jerry mentioned the National Suicide Prevention

01:00:26.98,01:00:31.01
Lifeline as a resource, so I won't review that.

01:00:31.03,01:00:33.79
I will mention that on the Lifeline website, there is also

01:00:33.81,01:00:37.70
now a crisis chat feature that can be utilized, so that

01:00:37.72,01:00:42.07
people can access care that way in addition to the telephone.

01:00:42.09,01:00:44.65
And then I just want to let you know that there are a lot of resources

01:00:44.67,01:00:49.23
out there that can be utilized in various settings, and that these

01:00:49.25,01:00:53.38
are all available from SAMHSA and typically for free and in bulk.

01:00:53.40,01:00:55.67
You're welcome to contact us and we'll get them to you.

01:00:55.69,01:01:01.71
For schools, preventing suicide, a tool kit for high schools exists, and we

01:01:01.73,01:01:05.91
worked together with the Department of Education around disseminating this.

01:01:05.93,01:01:11.01
But if you work in a school-based setting, this is a wonderful

01:01:11.03,01:01:17.45
encapsulation of school-based approaches to suicide prevention.

01:01:17.47,01:01:21.20
In tribal communities, this is a resource called "To Live to See

01:01:21.22,01:01:27.59
the Great Day of the Dawns." And so, this also brings together

01:01:27.61,01:01:32.36
resources and information about suicide prevention in tribal areas.

01:01:32.38,01:01:35.23
And I should say that one of our speakers today,

01:01:35.25,01:01:44.35
Teri [1:01:35] has some of her work is actually in both of these tool kits.

01:01:44.37,01:01:46.26
In primary care practices.

01:01:46.28,01:01:52.50
This is a tool kit by the SPRC for rural primary care practices, but

01:01:52.52,01:02:00.84
much can be applied in nonrural primary care practices, as well.

01:02:00.86,01:02:02.53
SAMHSA has what's called a TIP-50,

01:02:02.55,01:02:05.83
Treatment Improvement Protocol for Addressing Suicidal

01:02:05.85,01:02:11.97
Thoughts and Behaviors in Substance Abuse Treatment.

01:02:11.99,01:02:18.25
Again, this is also available in bulk and free from SAMHSA, called "the safety cards."

01:02:18.27,01:02:27.18
These are cards that can walk a provider through doing a suicide risk assessment.

01:02:27.20,01:02:31.35
And we'll go over it in detail just so you're aware that it exists, it's for free.

01:02:31.37,01:02:34.49
It's very good and we're happy to get it to you.

01:02:34.51,01:02:39.42
And then, finally, warning signs have been mentioned.

01:02:39.44,01:02:43.39
These are cards that have the National Suicide Prevention Lifeline

01:02:43.41,01:02:51.06
number on the outside, and the warning signs for suicide on the inside.

01:02:51.08,01:02:56.51
Again, we would be happy to get these to anyone who needs them. And so, with that,

01:02:56.53,01:03:04.24
I will stop. Thank you. [applause] Thank you very much,

01:03:04.26,01:03:07.47
Richard. We're going to keep moving along here, and

01:03:07.49,01:03:08.89
we'll save questions for you for a little bit later.

01:03:08.91,01:03:12.20
But that's great for people developing their action plans.

01:03:12.22,01:03:14.27
Next I'm going to bring up our next speaker.

01:03:14.29,01:03:18.48
We have an individual here who has been gracious enough to come and share

01:03:18.50,01:03:24.22
his own personal story for us: Pat Risser (?) represents a group that has

01:03:24.24,01:03:28.13
the highest rate and incidence of suicide -- men in the middle ages.

01:03:28.15,01:03:32.96
He's been a tireless advocate for mental health consumers for more than 25 years.

01:03:32.98,01:03:38.95
Diagnosed in 1973, suffering through many years of mental illness and hospitalizations

01:03:38.97,01:03:42.66
and suicide attempts, he's here to share his personal story with us today.

01:03:42.68,01:03:51.25
Thank you very much, Pat, come on up. [applause] Thank you.

01:03:51.27,01:03:58.97
I'm Pat Risser, and I'm one of those people who came to in a hospital and thought,

01:03:58.99,01:04:05.97
"Damn, I can't even do that right." I felt that deep, soul-crushing

01:04:05.99,01:04:13.73
despair, that invisible, gut-wrenching agony of wanting to die -- a

01:04:13.75,01:04:20.31
feeling such great pain that I don't think I ever thought of death as dying.

01:04:20.33,01:04:27.19
All I ever thought of it was, no more pain. I just wanted to stop hurting.

01:04:27.21,01:04:31.15
Sort of like Churchill and his black dog.

01:04:31.17,01:04:35.86
I want to talk to you about three things that helped.

01:04:35.88,01:04:39.14
I was on a path of self-destruction, and I want to tell you about the

01:04:39.16,01:04:45.69
three things that I believe helped to divert me from that path.

01:04:45.71,01:04:52.66
William James -- I was a philosophy major, one of those strange folks in college -- said,

01:04:52.68,01:04:54.29
William James said,

01:04:54.31,01:04:57.95
"I take it that no man is educated who has never

01:04:57.97,01:05:02.96
dallied with the thought of suicide." I believe that.

01:05:02.98,01:05:09.26
I believe that those thoughts, those feelings, are normal.

01:05:09.28,01:05:12.71
But we have to figure out how to get past them, through

01:05:12.73,01:05:18.03
them, not let them be so strong that they take us away.

01:05:18.05,01:05:20.28
William James also said,

01:05:20.30,01:05:26.20
"Be not afraid of life, believe that life is worth willing, and

01:05:26.22,01:05:33.70
your belief will help create the fact." For any of you psychology

01:05:33.72,01:05:37.64
majors around, that is cognitive therapy in a nutshell.

01:05:37.66,01:05:42.24
It's considered the best treatment for suicidal behavior, and it came from

01:05:42.26,01:05:49.43
William James, a man who dabbled himself and fought with thoughts of suicide.

01:05:49.45,01:05:57.74
So, he was a peer. The first thing that helped to divert me from that path,

01:05:57.76,01:06:09.35
I lay on my couch, literally unable to get up and engage with life.

01:06:09.37,01:06:11.98
The depression was deep.

01:06:12.00,01:06:14.70
I was fighting those demons that I knew nothing but

01:06:14.72,01:06:20.71
despair, and I literally could not get off the couch.

01:06:20.73,01:06:24.95
And a friend came over, and he physically picked

01:06:24.97,01:06:28.70
me up and dragged me out of the house, and said,

01:06:28.72,01:06:32.64
"We are going to go engage life." He said,

01:06:32.66,01:06:36.29
"I cannot in good conscience sit by and watch

01:06:36.31,01:06:46.48
you do this." He took me to automobile races.

01:06:46.50,01:07:02.15
And the sights, the sounds, the smells, the outdoor sun on my body, my senses were

01:07:02.17,01:07:11.32
so overwhelmed that I couldn't have my thoughts turned inward onto that despair.

01:07:11.34,01:07:18.26
I got a break from all of that depth of agony that was going on inside.

01:07:18.28,01:07:26.62
I had to be focused outside with all of that overwhelming stuff bombarding my senses.

01:07:26.64,01:07:32.96
It wasn't the cure, but it was a step in the right direction -- finding a break, knowing

01:07:32.98,01:07:39.00
that there is a light at the end of the tunnel, and it's not an oncoming train.

01:07:39.02,01:07:41.65
Lincoln, too, had friends,

01:07:41.67,01:07:47.87
Lincoln had friends who took his knives and pistols away from him.

01:07:47.89,01:07:52.12
Lincoln was at one point so afraid to pick up a knife, because he thought

01:07:52.14,01:07:59.68
he would hurt himself, try to end his life, if he had a knife.

01:07:59.70,01:08:04.02
The second thing that helped me was I had a therapist who

01:08:04.04,01:08:10.23
taught me the difference between feelings and actions.

01:08:10.25,01:08:15.34
I don't know where I got it, but I've talked to a lot of people who got this weird

01:08:15.36,01:08:25.18
notion that seems like we have to be somehow congruent in our feelings and our actions.

01:08:25.20,01:08:32.29
I grew up thinking that if I'm angry, I had to act angry; and if I'm sad,

01:08:32.31,01:08:37.30
I had to act sad; and if I'm happy, I had to act happy; otherwise,

01:08:37.32,01:08:45.21
I'm being phony and not real. So, of course, if I have the suicidal feeling,

01:08:45.23,01:08:50.61
"Oh, crap, now I've got to go home and take an overdose." What's with that?

01:08:50.63,01:08:56.70
I mean, if I was going to be honest as a human being,

01:08:56.72,01:09:01.91
I thought that my thoughts and my feelings had to somehow be congruent.

01:09:01.93,01:09:06.07
So I'd go into therapy. I used to tell those therapists,

01:09:06.09,01:09:09.41
"Oh, I'm feeling suicidal," and those poor therapists, they just

01:09:09.43,01:09:14.99
couldn't seem to handle it -- they'd panic and lock me up.

01:09:15.01,01:09:20.65
Finally, I got a therapist who said, "Wait a minute.

01:09:20.67,01:09:24.64
Okay, now, if you think you're going to go out and hurt yourself,

01:09:24.66,01:09:28.11
I've got certain legal obligations and I've got to try and stop that.

01:09:28.13,01:09:32.79
But welcome to the human race: You're having a feeling.

01:09:32.81,01:09:37.49
Now, if you think you won't go out and hurt yourself, well,

01:09:37.51,01:09:41.08
then we can sit and talk about this feeling." And I was, like,

01:09:41.10,01:09:51.71
"Whoa, really?" I didn't know that you could actually do that.

01:09:51.73,01:09:55.79
I thought if I was feeling suicidal, I had to go act suicidal.

01:09:55.81,01:09:58.56
Here she was telling me: "No, you can have a feeling,

01:09:58.58,01:10:04.75
and you don't have to act that way." I was blown away.

01:10:04.77,01:10:10.98
We sat and we talked about the feeling, and I felt better.

01:10:11.00,01:10:13.06
And I realized I could have a loaded gun,

01:10:13.08,01:10:17.30
I could put it to my head, but if I've got that much

01:10:17.32,01:10:24.45
control over my body I don't have to pull the trigger.

01:10:24.47,01:10:35.84
I can do something else. I can talk about it. I can find help for it. Wow, feelings.

01:10:35.86,01:10:37.64
Amazing things.

01:10:37.66,01:10:40.59
And they come and they go, and if you don't like the one you're

01:10:40.61,01:10:44.92
having now, hang on a while, you'll get another later, you know?

01:10:44.94,01:10:48.31
Feelings are -- But, really,

01:10:48.33,01:10:54.87
I don't know where it came from, but a lot of people are sort of stuck in that groove.

01:10:54.89,01:11:03.15
The third thing that helped me was service to others. Get out of yourself.

01:11:03.17,01:11:10.15
Pay it forward. Be a peer. Be [1:11:07] sensitive and invite discussion -- not,

01:11:10.17,01:11:13.57
"What's wrong with you?" "Tell me what happened to you.

01:11:13.59,01:11:17.39
Tell me what's going on with you." Be that support to

01:11:17.41,01:11:21.22
somebody else, like the guy who dragged me off the couch.

01:11:21.24,01:11:24.47
Be that to someone else.

01:11:24.49,01:11:37.75
I found that giving to others is a way of turning that focus -- that I have

01:11:37.77,01:11:45.85
outward instead of focusing inward on all of that hurt that was going on.

01:11:45.87,01:11:51.81
It wasn't the cure, again, but it was a step, because if I could turn it

01:11:51.83,01:11:56.27
outward and help somebody else for a little while, and put that focus

01:11:56.29,01:12:02.30
out there, it gave me a break from that hurt that I was feeing inside.

01:12:02.32,01:12:07.18
And those little breaks add up.

01:12:07.20,01:12:15.08
It's like a vacation, to have that little break, to not

01:12:15.10,01:12:23.20
have to have that feeling and that pressure all the time.

01:12:23.22,01:12:32.42
I could talk so much more, but I want to tell you: Go to a

01:12:32.44,01:12:37.19
comedy club with some friends, have a few good belly laughs.

01:12:37.21,01:12:39.17
It's not the cure.

01:12:39.19,01:12:42.28
But I contend you cannot hold onto those suicidal

01:12:42.30,01:12:44.40
feelings while you're having a belly laugh.

01:12:44.42,01:12:54.74
I don't think it's possible. Lay on the floor with some puppies or kittens.

01:12:54.76,01:12:58.90
Honest to God, if you can feel that emotional hurt while puppies are

01:12:58.92,01:13:06.16
licking your face, you're hurting more than I could ever imagine.

01:13:06.18,01:13:16.80
Play with a baby. I don't know how we can hold a newborn baby and not feel hope.

01:13:16.82,01:13:20.16
I think it's part of the human condition.

01:13:20.18,01:13:27.36
And know that these things that I offer today, the agony,

01:13:27.38,01:13:33.16
the hurt, the pain, the despair, you can make it through.

01:13:33.18,01:13:36.53
I haven't given you any cures, any answers.

01:13:36.55,01:13:41.67
I don't have any, certainly not for anybody else. I struggle to find my own.

01:13:41.69,01:13:47.63
But it's true: One day at a time; and if not that, one

01:13:47.65,01:13:52.06
hour at a time; and if not that, one minute at a time.

01:13:52.08,01:14:00.08
And if not that, one moment at a time. Keep breathing, keep hope.

01:14:00.10,01:14:04.12
Because there's somebody who cares about you, and

01:14:04.14,01:14:08.33
there's other people that you need to care about.

01:14:08.35,01:14:21.81
Thank you. [applause] Wow, Pat, that was really amazing.

01:14:21.83,01:14:27.23
Thank you for your courage and your strength, and your advocacy for

01:14:27.25,01:14:32.92
so many, and for all of those incredible tips you gave to all of us.

01:14:32.94,01:14:37.60
We have a question here that I wanted to pose to you.

01:14:37.62,01:14:41.81
Out of all the things that you talked about, that helped you the most,

01:14:41.83,01:14:44.93
when you sit here today and say all the things that federal partners are

01:14:44.95,01:14:48.54
doing and the state partners are doing, what would you want them to know?

01:14:48.56,01:14:51.03
You talked about what would help the person who is really hurting.

01:14:51.05,01:14:53.67
What would you want the rest of us in the room to know,

01:14:53.69,01:14:55.95
that are going to develop all these action plans?

01:14:55.97,01:14:59.02
Let someone know that you're hurting.

01:14:59.04,01:15:03.68
Let somebody -- My friend couldn't have dragged

01:15:03.70,01:15:08.03
me off the couch if I hadn't let him in the door.

01:15:08.05,01:15:13.34
Let somebody know and let somebody in that door, and to

01:15:13.36,01:15:18.35
partner with you in finding a way out of that hole.

01:15:18.37,01:15:20.68
And what about the federal people that are here, the people

01:15:20.70,01:15:22.91
that work for the government -- what would you tell them?

01:15:22.93,01:15:25.64
Oh. They're doing the right things.

01:15:25.66,01:15:29.84
Richard said, engaging those of us who have been in that

01:15:29.86,01:15:34.90
depth of despair, and asking us what worked, what helped.

01:15:34.92,01:15:38.98
By engaging those people who have been there and been on that

01:15:39.00,01:15:44.33
path, we can more readily articulate those things that have

01:15:44.35,01:15:48.89
helped to divert us from that path of self-destruction.

01:15:48.91,01:15:55.87
And that's why the peer support is so important -- somebody who has been

01:15:55.89,01:16:00.89
through it can offer so much to help another person down the road.

01:16:00.91,01:16:05.40
I mean, that service to others is very important. Thank you again.

01:16:05.42,01:16:06.95
Thank you very much. Thank you.

01:16:06.97,01:16:09.43
Alright, we are going to keep moving along with our agenda.

01:16:09.45,01:16:12.03
Yes, you can clap, if you'd like to clap for him.

01:16:12.05,01:16:17.19
[applause] Our panel is going to switch up here, and now we're going to move on

01:16:17.21,01:16:21.31
to another group of people -- the High Risk Groups and Promising Practices panel.

01:16:21.33,01:16:23.27
I'd like to invite them to come on up here.

01:16:23.29,01:16:26.85
We all know that suicide affects many people throughout our country,

01:16:26.87,01:16:30.43
and that the tragedy of suicide isn't specific to just one group.

01:16:30.45,01:16:33.27
However, it's imperative that we recognize there are certain populations that

01:16:33.29,01:16:38.04
are at higher risk, and those needs must be addressed for those populations.

01:16:38.06,01:16:40.55
Today we're talking about just three of those particular

01:16:40.57,01:16:44.37
populations, and this is in no way exhaustive.

01:16:44.39,01:16:47.79
Instead, it's a selection of high-risk groups in particular who have

01:16:47.81,01:16:50.81
expertise here, that can share with us some things to help us move

01:16:50.83,01:16:53.88
that forward and for you to think about in your action plans.

01:16:53.90,01:16:57.84
Today we have with us Chaplain Hines of the Illinois Army National Guard,

01:16:57.86,01:17:01.07
Dr. Teresa LaFromboise is professor of Native American studies and

01:17:01.09,01:17:05.60
developmental and psychological sciences at Stanford University, and

01:17:05.62,01:17:09.88
National Strategy Taskforce member Abby Lan, the executive director of

01:17:09.90,01:17:13.55
the Trevor Project, the leading national organization focusing on suicide

01:17:13.57,01:17:18.49
prevention among lesbian, gay, bisexual, transgender and questioning youth.

01:17:18.51,01:17:21.14
Please welcome them as they've joined the stage.

01:17:21.16,01:17:28.93
[applause] Chaplain Hines, we know we're going to start with you, and as we know

01:17:28.95,01:17:32.59
the statistics regarding suicide among the veteran and active duty military

01:17:32.61,01:17:37.86
populations, it's been staggering and it's been played out a lot in the media.

01:17:37.88,01:17:40.57
We'd like to invite you to come up here and share with us what you

01:17:40.59,01:17:43.66
know about that, what your work has been to date, and what you're

01:17:43.68,01:17:50.03
doing to prevent suicide among that population -- Chaplain Hines.

01:17:50.05,01:17:55.06
[applause] Well, good morning.

01:17:55.08,01:17:58.60
I'd first like to mention that the population which I service is the Illinois Army

01:17:58.62,01:18:04.37
National Guard, and so this piece in terms of the action plan or what we do in the

01:18:04.39,01:18:11.49
Illinois National Guard for our members in terms of [1:18:07] specific to that population.

01:18:11.51,01:18:16.65
Partners in Care, just in brief, is a partnership between faith-based communities

01:18:16.67,01:18:24.71
and the National Guard, and with this initiative our goal is to reach out to

01:18:24.73,01:18:28.58
faith-based communities, develop a memorandum of understanding, a collaborative

01:18:28.60,01:18:37.09
network with them, to be able to serve military members as the need, as the need arises.

01:18:37.11,01:18:42.96
I should state at the forefront that while we have a diversity of

01:18:42.98,01:18:45.97
faith populations among our service members in the National Guard,

01:18:45.99,01:18:49.98
and so Partners in Care is not limited to one particular faith group.

01:18:50.00,01:18:54.79
What this is about is situating, service members, we all live in

01:18:54.81,01:18:58.85
specific communities while active duty components, while they may

01:18:58.87,01:19:02.86
stay in an active installation, for National Guardsmen such as myself,

01:19:02.88,01:19:06.95
I live in the Beverly-Oakland-Washington Heights Community, in Illinois.

01:19:06.97,01:19:11.39
So, those around me provide the level of support and

01:19:11.41,01:19:14.21
collaboration and community connections that I need.

01:19:14.23,01:19:19.95
And in addition to that, I belong to a faith-based community or congregation and church.

01:19:19.97,01:19:23.63
And my experience is very common to other service members.

01:19:23.65,01:19:27.06
And it's those faith-based communities that we reach

01:19:27.08,01:19:30.21
out to when service members might have needs.

01:19:30.23,01:19:39.23
For the National Guard, our goal is to prevent suicide. As mentioned before,

01:19:39.25,01:19:42.59
I've seen in the media there are so many concerns

01:19:42.61,01:19:47.21
about ideation and suicide completions.

01:19:47.23,01:19:51.97
Our goal is to look at the human experience, that perspective of

01:19:51.99,01:19:56.35
service members such as their lifestyle, their income, financial

01:19:56.37,01:20:01.37
issues that service members are dealing with, partnering with some

01:20:01.39,01:20:04.44
of the congregations to assist service members in their time of need.

01:20:04.46,01:20:09.82
What we have learned through our own internal research and investigation,

01:20:09.84,01:20:16.46
service members present to us issues of finances, family issues, certain

01:20:16.48,01:20:20.65
pathologies and dysfunctions that might exist, and what that looks like

01:20:20.67,01:20:24.65
is that we contact some of our partners, and they assist us.

01:20:24.67,01:20:28.44
Let me give you some practical examples of what that might look like.

01:20:28.46,01:20:35.91
We had a service member who was incarcerated, and while we had a chaplain who is the

01:20:35.93,01:20:40.45
program manager for Partners in Care to reach out to him and visit with him, that

01:20:40.47,01:20:45.48
service member actually wanted some religious material to assist him through his journey.

01:20:45.50,01:20:50.72
Being a prior service member, or still a service member, and then having

01:20:50.74,01:20:55.92
the issue being incarcerated in an institution kind of, that's the dual

01:20:55.94,01:21:01.18
perspective that some of the prisoners mentioned earlier what most people

01:21:01.20,01:21:07.46
who have ideations, some of their issues that they extend from.

01:21:07.48,01:21:11.62
This particular service member, we couldn't bring materials to him, so we reached out

01:21:11.64,01:21:16.30
to one of our faith-based partners in care, who was able to contact a chaplain within

01:21:16.32,01:21:20.91
that community, so that the service member could get the materials that they wanted.

01:21:20.93,01:21:24.88
Other examples about how faith-based communities have assisted

01:21:24.90,01:21:28.75
Illinois Guard service members, we had a service member who was

01:21:28.77,01:21:33.05
about to be evicted, and, in fact, his wife was nine months pregnant.

01:21:33.07,01:21:36.63
Also, the service member did not have employment.

01:21:36.65,01:21:40.15
And with that level of heightened stress, expecting a child, about to lose

01:21:40.17,01:21:46.65
your home, unemployed, statistically we know that sometimes these issues

01:21:46.67,01:21:52.96
lend themselves to ideations and sometimes attempts for service members.

01:21:52.98,01:21:57.16
We reached out to one of our Partners in Care.

01:21:57.18,01:22:01.70
They were able to assist that service member with finding a home.

01:22:01.72,01:22:07.23
That particular faith-based community also had a job fair in which they were able to

01:22:07.25,01:22:12.32
assist the service member, and a family, and that family, in fact, is doing quite well.

01:22:12.34,01:22:17.27
That was one of our partners [1:22:16], I'm sorry, in Hanover Park.

01:22:17.29,01:22:23.38
So, when we think about action plans in terms of prevention and with

01:22:23.40,01:22:27.83
suicide prevention, in terms of Partners in Care, our goal is to partner

01:22:27.85,01:22:32.11
with these faith-based communities, so that they can be a resource and

01:22:32.13,01:22:36.40
outreach to service members in the communities in which they live.

01:22:36.42,01:22:40.04
The Illinois National Guard has over 10,000 service members, and there

01:22:40.06,01:22:43.88
are only about 22 chaplains that serve all of those service members.

01:22:43.90,01:22:51.06
And so, we see the necessity of having our faith partners as a resource for outreach

01:22:51.08,01:22:56.16
to assist us in meeting the needs of the service members across the state.

01:22:56.18,01:22:59.63
And I'll end my presentation there, because there may be

01:22:59.65,01:23:05.78
some questions at this point, or I'll just -- Okay.

01:23:05.80,01:23:18.72
[applause] Thank you very much, Chaplain Hines.

01:23:18.74,01:23:20.53
We're going to keep moving on with our panel, and then if we

01:23:20.55,01:23:23.79
have time for questions at the end, we'll come back to that.

01:23:23.81,01:23:26.78
Prof. LaFromboise is a counseling psychologist with clinical and

01:23:26.80,01:23:31.43
teaching expertise in a wide variety of university and American Indian,

01:23:31.45,01:23:32.80
Alaska Native settings.

01:23:32.82,01:23:38.19
The professor has worked with a number of different ethnic minorities to survive

01:23:38.21,01:23:42.87
acculturation process, cultural adjustment, discrimination, major life transitions and

01:23:42.89,01:23:49.37
other stresses that are often typical and also neglected among children and adolescents.

01:23:49.39,01:23:52.22
The professor is going to come up and share with us her information.

01:23:52.24,01:24:06.64
Thank you very much. [applause] Okay, thank you, Dan. And thank you all for being here.

01:24:06.66,01:24:11.29
It's really very exciting that so many people care about this topic at this time.

01:24:11.31,01:24:13.55
As Dan mentioned,

01:24:13.57,01:24:20.39
I'm chair of Native American studies for 10 years at Stanford, and I've worked a lot

01:24:20.41,01:24:26.57
in the area of Native American mental health and particularly in the area of suicide.

01:24:26.59,01:24:31.91
So, and when Dr. Reed was talking about these

01:24:31.93,01:24:34.96
wonderful events in your life, and milestones,

01:24:34.98,01:24:35.15
I mean,

01:24:35.17,01:24:39.45
I really think that having the invitation to develop a suicide

01:24:39.47,01:24:45.22
prevention curriculum from the leaders of the Pueblo of Zuni has

01:24:45.24,01:24:51.26
certainly been a very, very important experience in my life.

01:24:51.28,01:24:56.29
When I was at Stanford in the late '80s., we had a committee.

01:24:56.31,01:24:59.62
It was called the Zuni-Stanford Committee.

01:24:59.64,01:25:07.15
It was a group of faculty members and leaders of the Zuni Pueblo who worked together,

01:25:07.17,01:25:11.92
and basically the faculty members were there to respond to the requests of Zuni.

01:25:11.94,01:25:15.91
So it wasn't people looking to have sites for their studies.

01:25:15.93,01:25:19.47
It was people being responsible to the requests of Zuni.

01:25:19.49,01:25:22.40
As it turned out, in one of the meetings,

01:25:22.42,01:25:28.40
I sat at a dinner next to the superintendent of schools, and he asked me, he said,

01:25:28.42,01:25:32.05
"What do you know about suicide prevention?" I said, "Well, you know,

01:25:32.07,01:25:35.58
I worked on a crisis line when I was working on my doctorate, and I

01:25:35.60,01:25:38.92
had just written an article on cultural and cognitive considerations

01:25:38.94,01:25:42.36
of Indian youth suicide, with Dolores Bigfoot." And I said,

01:25:42.38,01:25:45.91
"That's about what I know." And he said,

01:25:45.93,01:25:49.88
"Well, we have a problem, and we've been trying to decide within

01:25:49.90,01:25:53.33
our community for a year now, in a number of meetings, whether

01:25:53.35,01:25:56.71
or not to ask anyone from the outside to help us." And he said,

01:25:56.73,01:26:02.06
"We're not solving it on our own, and so we are interested, if you might be interested,

01:26:02.08,01:26:08.76
in working together." And so, of course I ended up on my way to Zuni, and I was

01:26:08.78,01:26:14.75
able to get some support from the School of Education and the Zuni Tribe, and over

01:26:14.77,01:26:19.74
a period of three years we developed and evaluated a curriculum that's called "Zuni

01:26:19.76,01:26:26.07
Life Skills," and then later it was adapted for a number of different tribes, and

01:26:26.09,01:26:31.96
we have sort of an ethnic [1:26:28] American Indian Life Skills Curriculum.

01:26:31.98,01:26:35.83
But I like to tell that story because I think it's very important.

01:26:35.85,01:26:41.04
I think we have sort of these images at times of victimization of native

01:26:41.06,01:26:44.52
people, and I'm going to talk about that a little bit in this presentation.

01:26:44.54,01:26:49.34
But here what we have is really a very interesting community organizational

01:26:49.36,01:26:53.70
effort that made a big difference, and it was not a major grant.

01:26:53.72,01:26:56.41
It was supported by a little bit of money from the School of

01:26:56.43,01:27:00.24
Education at Stanford, then some money from the Henry Kaiser

01:27:00.26,01:27:05.52
Foundation, and then almost equally those entities and the Zuni Tribe.

01:27:05.54,01:27:10.29
So, as we worked along for three years, we collaborated, and I think

01:27:10.31,01:27:13.91
that probably is the reason it was so developed and successful.

01:27:13.93,01:27:16.85
So, the bar graph that you see was published in

01:27:16.87,01:27:18.87
The American Psychologist a number of years ago.

01:27:18.89,01:27:23.14
It was an article on culture and youth suicide, and the bars you

01:27:23.16,01:27:29.13
see represent different cultural groups -- Native American,

01:27:29.15,01:27:34.55
African-American, Latino-Hispanic, Asian-American, Pacific Islanders, and Anglos.

01:27:34.57,01:27:38.30
And just want to point out that the tallest bars

01:27:38.32,01:27:41.29
among males and females are Native Americans.

01:27:41.31,01:27:45.26
So, while we have great things happening, we have great challenges, as well.

01:27:45.28,01:27:49.89
Over the years with this work I've tried to come up

01:27:49.91,01:27:52.69
with what I thought was a theoretical orientation.

01:27:52.71,01:27:58.49
I very much try to approach this, since this is a school-based and sort of

01:27:58.51,01:28:03.15
a learning-based approach, look a lot at social learning theory, but,

01:28:03.17,01:28:09.45
really, this has sort of morphed into a cognitive behavioral intervention.

01:28:09.47,01:28:15.55
And what you'll see on this image, to the left are a number of risk-factors.

01:28:15.57,01:28:17.58
And you could have any number.

01:28:17.60,01:28:23.19
But I've selected these because in developing this model this comes from the

01:28:23.21,01:28:27.38
research that now does exist on risk factors with Native American adolescents.

01:28:27.40,01:28:28.69
And so,

01:28:28.71,01:28:37.22
I have sort of clustered the risk factors into ecological factors, social

01:28:37.24,01:28:40.73
factors, and then of course individual factors that we think of many times.

01:28:40.75,01:28:47.03
And I'll go over it a little bit more, because, fortunately, in this invitation,

01:28:47.05,01:28:50.72
I've been invited to be able to talk about the importance of culture

01:28:50.74,01:28:54.82
and suicide prevention, so I feel happy to be able to do that.

01:28:54.84,01:28:58.20
So, let's see if this works or not -- alright.

01:28:58.22,01:29:02.34
So, according to this idea, there's an array of risk factors that

01:29:02.36,01:29:05.93
someone could be vulnerable to, and a stressful event happens,

01:29:05.95,01:29:09.06
and people have options about the way that they can respond.

01:29:09.08,01:29:13.32
One might be avoidant coping and another would be approach coping.

01:29:13.34,01:29:16.42
The reason I chose this dichotomy -- avoidant and approach

01:29:16.44,01:29:19.25
coping -- is because in the work over the years, that seems

01:29:19.27,01:29:23.83
to be what I see and hear a lot about, in Native communities.

01:29:23.85,01:29:29.09
This is sort of just like opting out, removing oneself from the situation,

01:29:29.11,01:29:36.09
doing a lot of self-isolation, perhaps drinking and not engaging with

01:29:36.11,01:29:40.06
other people, and then eventually attempting or taking one's life.

01:29:40.08,01:29:45.04
And so, I want to work at developing approach coping.

01:29:45.06,01:29:51.13
And so, we have this option, approach coping, and if you ask what might be active

01:29:51.15,01:29:55.33
ingredients, if there was any way to really determine in this kind of an intervention,

01:29:55.35,01:30:00.42
I would say that what we do continuously is emphasize

01:30:00.44,01:30:03.37
positive thinking and effective problem-solving.

01:30:03.39,01:30:06.56
So it's very much cognitive in that respect.

01:30:06.58,01:30:09.41
And of course we're building skills, and we believe that it would

01:30:09.43,01:30:12.85
eventually lead to, instead of suicide, something like resilient

01:30:12.87,01:30:18.94
adaptation -- just handling the opportunities that come before us.

01:30:18.96,01:30:25.53
Now, I just want to point out, this is a culturally-based intervention, but

01:30:25.55,01:30:31.27
it also is based on psychological theory, and what we believe works well.

01:30:31.29,01:30:34.73
And so, the American Indian Life Skills is this social, cognitive

01:30:34.75,01:30:37.44
approach, and I'll go into it in a little bit more detail.

01:30:37.46,01:30:40.06
But when you do something like that,

01:30:40.08,01:30:45.27
I think we know in the literature, if we look at just the field and some beginning

01:30:45.29,01:30:50.59
results now coming out from meta-analyses about how important is it to culturally

01:30:50.61,01:30:54.61
tailor something, we know that if we were going to do that, we have to think,

01:30:54.63,01:30:59.07
"Well, what are the unique risk factors for that particular cultural group?" So I just

01:30:59.09,01:31:06.66
want to mention a few here that I would say are very critical with Native Americans.

01:31:06.68,01:31:09.26
And you can't be involved in American Indian mental health

01:31:09.28,01:31:13.32
research or services and not hear about historical trauma.

01:31:13.34,01:31:17.15
This is a theme that prevails in the field.

01:31:17.17,01:31:21.06
And I also think that a picture is worth a thousand words.

01:31:21.08,01:31:26.26
And so, this is an image of Native children at Carlyle Indian School,

01:31:26.28,01:31:30.23
which was one of the first boarding schools in Pennsylvania.

01:31:30.25,01:31:34.87
So, imagine children being forcibly removed from their homes in order to

01:31:34.89,01:31:40.42
go to school, the assimilation goal was, it was too difficult to change

01:31:40.44,01:31:45.10
the adults when people were moved to reservations, and so, therefore,

01:31:45.12,01:31:49.78
"Let's take the children away" -- kill the Indian, save the man kind of thing.

01:31:49.80,01:31:51.97
Now, how does that affect people today?

01:31:51.99,01:31:58.49
Well, Les Wittbeck's (?) research will tell us that we do know that for Native youth

01:31:58.51,01:32:06.13
that almost one out of five have daily or more thoughts about the tribe's loss of land.

01:32:06.15,01:32:10.97
There are many other items in this historical trauma scale, but this is a good example.

01:32:10.99,01:32:13.80
And the other thing is, though, is if you ask about, and this

01:32:13.82,01:32:17.47
is middle school aged children, if you ask about the parents'

01:32:17.49,01:32:20.80
historical trauma, they don't think about it as often.

01:32:20.82,01:32:24.86
So, I think this points to the developmental issues that at this

01:32:24.88,01:32:28.84
point in time people are becoming very astute politically.

01:32:28.86,01:32:30.89
Another: acculturation stress.

01:32:30.91,01:32:35.43
Well, many groups struggle with change, and of course that's

01:32:35.45,01:32:39.65
been the mantra for Native communities for a long, long time.

01:32:39.67,01:32:45.89
But we do have, you know, a few studies now that point to the association between

01:32:45.91,01:32:51.84
pressure to acculturate and suicidal behavior, and we know now increasingly more that

01:32:51.86,01:32:57.29
when people can engage in enculturation (?), which is the opposite, being more

01:32:57.31,01:33:03.86
knowledgeable about one's culture, that it works, you know, it certainly helps improve,

01:33:03.88,01:33:10.39
certainly bolsters resilience, it helps motivation for school and a number of other things.

01:33:10.41,01:33:12.66
But definitely we see an association.

01:33:12.68,01:33:16.33
Again, this is something that is important in the work that I do, because

01:33:16.35,01:33:21.03
many SAMHSA funded projects have funded what we call GONA, which is a

01:33:21.05,01:33:25.60
gathering of Native Americans, and of course the first thing that they

01:33:25.62,01:33:30.04
would do is emphasize and help raise awareness about the historical trauma

01:33:30.06,01:33:33.88
that people have gone through, and so that they can heal and move on.

01:33:33.90,01:33:39.49
And so then we, that becomes sort of the backdrop, the beginning of our work.

01:33:39.51,01:33:41.68
And of course you've mentioned over and over

01:33:41.70,01:33:45.93
again the important role of substance abuse.

01:33:45.95,01:33:48.93
And this is the last one that I think is really unique to Native

01:33:48.95,01:33:53.75
American population, of those lists, and that is, community violence.

01:33:53.77,01:33:59.00
We now know that Native Americans are victims to a lot of

01:33:59.02,01:34:03.10
interpersonal violence, often on the part of non-Native people.

01:34:03.12,01:34:07.66
And this is a fact from some work of Don Michenbaum (?) many years ago, when he worked

01:34:07.68,01:34:17.23
with an Inuit village, and he is showing the rate of suicide among those that were

01:34:17.25,01:34:24.89
sexually abused by a teacher versus those in that area, who were not affected.

01:34:24.91,01:34:28.86
So, community violence. So, anyway, I think about these things.

01:34:28.88,01:34:31.70
I think these are unique to Native American population,

01:34:31.72,01:34:34.82
that should be factored into the kind of work that we do.

01:34:34.84,01:34:36.94
So, we have this curriculum.

01:34:36.96,01:34:41.25
Under test conditions, it was offered three days a week for a semester,

01:34:41.27,01:34:47.19
so for a full school year, but now we have it down to a semester.

01:34:47.21,01:34:51.76
And, really, we're teaching coping skills, as I mentioned, approach coping skills.

01:34:51.78,01:34:54.38
So you could say, well, that's cultural about that?

01:34:54.40,01:34:59.39
Well, what's cultural about it is that we did engage the consumers in the

01:34:59.41,01:35:04.68
development of all of the scenarios, so it's very realistic to reservation life.

01:35:04.70,01:35:09.26
And what we're trying to do, in doing this, of course is we want engagement,

01:35:09.28,01:35:13.73
and I see a real resistance to just wanting to pick up the latest one that's

01:35:13.75,01:35:18.69
standardized on mainstream US populations rather than that's Native-specific.

01:35:18.71,01:35:20.25
So, people seem to like this.

01:35:20.27,01:35:23.75
The other thing is, is with all the work that's been done in suicide prevention,

01:35:23.77,01:35:27.04
now you have people that are in the trainings that have been through gatekeeper

01:35:27.06,01:35:32.54
training, they've been through, they work with [1:35:31] of suicide.

01:35:32.56,01:35:33.19
They work with many.

01:35:33.21,01:35:40.44
So they really have this tool kit of interventions, and they know more what to do.

01:35:40.46,01:35:42.89
So, just in terms of the effectiveness, we've seen that it reduces

01:35:42.91,01:35:47.60
hopelessness, it increases efficacy, self-efficacy to manage anger.

01:35:47.62,01:35:51.15
In a behavioral video taped role play study we see that it

01:35:51.17,01:35:54.40
improves suicide intervention skills, problem solving skills.

01:35:54.42,01:35:57.95
And this is a chart where you see significant reductions in suicide.

01:35:57.97,01:36:02.34
This is the work of Phil May, when the American Indian Life Skills was used

01:36:02.36,01:36:07.28
in a comprehensive approach where they improved surveillance, and worked

01:36:07.30,01:36:13.41
with natural helpers, and basically the behavioral health, et cetera, but

01:36:13.43,01:36:17.06
they really improved everything, and ours was just a little part of it.

01:36:17.08,01:36:22.25
And then this is an independent study that was done in northern New Mexico

01:36:22.27,01:36:26.51
with the Navajo Nation, and this is just 10 sessions from the curriculum.

01:36:26.53,01:36:29.90
It's not a treatment versus control group design.

01:36:29.92,01:36:35.39
It's pre-post only, but we did see some really nice benefits there.

01:36:35.41,01:36:42.92
So, I think, in closing, what I would like to say is that I am fortunate to have

01:36:42.94,01:36:48.61
been able to be invited to do this training in a number of SAMHSA funded projects.

01:36:48.63,01:36:50.85
I think it has improved my life a lot.

01:36:50.87,01:36:55.42
I know in terms of families, my daughter is the one that keeps encouraging me, because

01:36:55.44,01:37:01.05
she worked in a psychiatric hospital in South Dakota with many people from all over

01:37:01.07,01:37:05.84
the state of South Dakota, and actually used it with her own, with her patients.

01:37:05.86,01:37:06.22
And she said,

01:37:06.24,01:37:10.37
"You know, you really need to market this more and get it out a

01:37:10.39,01:37:14.92
lot more." And the other thing I would say is that, it's exciting

01:37:14.94,01:37:17.44
to work with communities when they're developing their own.

01:37:17.46,01:37:20.07
We have used this in east Palo Alto, which is a

01:37:20.09,01:37:23.50
community of largely immigrant populations,

01:37:23.52,01:37:29.50
Samoan, Tongan, Latino and African-Americans -- no Native Americans.

01:37:29.52,01:37:32.18
But what we did is we just changed the context

01:37:32.20,01:37:34.97
to East Palo Alto, to an immigrant population.

01:37:34.99,01:37:37.55
So it's exciting, it's exciting work, and I'm just very thankful to

01:37:37.57,01:37:40.33
have had the support to be able to do what I've been able to do.

01:37:40.35,01:37:47.84
Thank you. [applause] Thank you very much,

01:37:47.86,01:37:52.56
Professor, that's really critically important information for all the various cultural

01:37:52.58,01:37:56.34
groups that can take this and modify the program, and the excellent work you've done.

01:37:56.36,01:37:59.03
Moving right along, we want to bring up Abby Lan,

01:37:59.05,01:38:01.62
the executive director of the Trevor Project.

01:38:01.64,01:38:07.59
Abby, your population has very unique things that are taking place in

01:38:07.61,01:38:10.96
terms of their needs for social supports, and we'd like you to come

01:38:10.98,01:38:17.13
and tell us a little bit about what you know about that, thank you.

01:38:17.15,01:38:20.04
[applause] Thank you very much.

01:38:20.06,01:38:24.69
Thank you for having me, and what an exciting time, actually, to

01:38:24.71,01:38:29.00
be here to talk about the work that the Trevor Project is doing.

01:38:29.02,01:38:34.81
As many of you might have heard yesterday, the Supreme Court made a monumental

01:38:34.83,01:38:41.82
ruling on marriage equality, so that marriage equality is now a reality again

01:38:41.84,01:38:47.41
in California, and the striking down of DOMA is such, just really such a

01:38:47.43,01:38:52.66
powerful statement for those in the LGBT community, and it was really great.

01:38:52.68,01:38:56.46
And as I was listening to the speakers today,

01:38:56.48,01:39:00.31
I think it's really important to recognize the importance

01:39:00.33,01:39:03.38
of the National Strategy on Suicide Prevention.

01:39:03.40,01:39:07.73
I think if you had asked many people in the gay rights movement 20,

01:39:07.75,01:39:12.05
30 years ago, would marriage be a reality in their lifetime,

01:39:12.07,01:39:14.27
I think many people would have said no.

01:39:14.29,01:39:19.24
And in a very short period of time, it is a reality, and it goes to show the

01:39:19.26,01:39:24.11
importance of people working together, of keeping their eye on the target

01:39:24.13,01:39:28.05
and what they want to do, and, candidly, not taking no for an answer.

01:39:28.07,01:39:33.06
So, I think it's inspiring that we're here today, because we really can

01:39:33.08,01:39:38.97
make a dent in suicide prevention, and it's really an honor to be here.

01:39:38.99,01:39:44.31
So, as we talk about suicide prevention for LGBTQ youth, and we're

01:39:44.33,01:39:48.70
talking about youth having an opportunity for a brighter future.

01:39:48.72,01:39:52.33
And yesterday's message says a lot to youth, it gives them a chance

01:39:52.35,01:39:55.96
to think that, yes, there is going to be a happily ever after.

01:39:55.98,01:40:01.88
But for young people of any age, the future is so far away, and what's really

01:40:01.90,01:40:05.77
important is that there are still role models for young people, and especially

01:40:05.79,01:40:10.96
for gay, lesbian, bisexual, transgender youth, for them to see that there are

01:40:10.98,01:40:16.04
people, people like them, that are achieving in sports and music and religion.

01:40:16.06,01:40:20.77
It's just a very important thing, and our young people really need that.

01:40:20.79,01:40:25.37
At the Trevor Project -- let me see, did we get to the right slide -- I

01:40:25.39,01:40:31.65
want you to understand kind of the university for our LGBTQ youth.

01:40:31.67,01:40:37.58
Suicide is the second-leading cause of death for young people, as young as 10,

01:40:37.60,01:40:42.79
and that is really something that we all know and we all want to change.

01:40:42.81,01:40:50.73
But what we don't know is that, we don't know the actual number of how many LGBT

01:40:50.75,01:40:56.07
youth complete suicide, but we certainly know that they have many attempts.

01:40:56.09,01:41:01.39
And we don't know the number, because on death certificates sexual orientation

01:41:01.41,01:41:06.80
is not listed, and we don't know quite yet how to get that information.

01:41:06.82,01:41:08.31
But we'll work on that.

01:41:08.33,01:41:11.94
But we do know that suicide is something that young

01:41:11.96,01:41:17.28
people in the LGBT community do attempt quite often.

01:41:17.30,01:41:20.92
And as you can see, for young people,

01:41:20.94,01:41:26.91
LGBT young people are three to four times more at risk for suicide.

01:41:26.93,01:41:31.77
If you come from a rejecting family, you're eight times more at risk for suicide.

01:41:31.79,01:41:35.73
And for transgender youth,

01:41:35.75,01:41:41.05
25 percent have attempted suicide, and even more have considered it.

01:41:41.07,01:41:45.48
So we have a lot of work to do at the Trevor Project.

01:41:45.50,01:41:55.04
The CDC recently recognized LGBT youth as a priority population,

01:41:55.06,01:41:59.05
and so that means that special work is being done.

01:41:59.07,01:42:04.42
What you need to think about when we think about LGBT youth and their risks -- So,

01:42:04.44,01:42:10.03
40 percent of the homeless population of youth say

01:42:10.05,01:42:14.20
that they are lesbian, gay, bisexual, or transgender.

01:42:14.22,01:42:16.53
Forty percent of homeless youth.

01:42:16.55,01:42:22.75
And, really, probably the LGBT population is about 10 percent of the general population.

01:42:22.77,01:42:27.53
So, the fears that people have, young people being kicked out

01:42:27.55,01:42:31.46
of their homes, really puts so many young people at risk.

01:42:31.48,01:42:35.97
We also know that eight out of 10 LGBT youth

01:42:35.99,01:42:39.86
experience bullying or harassment at school.

01:42:39.88,01:42:44.79
That's almost every kid who identifies as gay, lesbian, bisexual,

01:42:44.81,01:42:48.26
transgender, they get bullied and harassed at school.

01:42:48.28,01:42:53.38
And we know that for every incident of bullying, it potentially

01:42:53.40,01:42:56.40
increases someone's self-harm by about 2.5 percent.

01:42:56.42,01:43:02.93
So, that's every incident. So, LGBT people are really at risk for suicide.

01:43:02.95,01:43:05.28
But that's when an organization like the Trevor Project

01:43:05.30,01:43:08.72
comes in, and organizations in different communities.

01:43:08.74,01:43:12.93
We are the only national organization working on crisis intervention

01:43:12.95,01:43:17.05
for suicide, for gay, lesbian, bisexual and transgender and

01:43:17.07,01:43:21.05
questioning youth, and we do a number of services to help.

01:43:21.07,01:43:24.74
Our crisis intervention services start with our lifeline.

01:43:24.76,01:43:30.38
It's a 24/7 lifeline, so young people can call us and talk to a trained volunteer

01:43:30.40,01:43:36.02
counselor, and talk about their fears and talk about what they are going through.

01:43:36.04,01:43:42.57
And though we are an organization that focuses on LGBT youth, we have about

01:43:42.59,01:43:47.25
14 percent of our calls also come from youth who identify as straight.

01:43:47.27,01:43:50.03
They need someone to talk to, and I think they feel that they can

01:43:50.05,01:43:53.50
certainly say whatever they need to say to any of our counselors.

01:43:53.52,01:43:56.13
We also have Trevor Chat. It's our instant messaging.

01:43:56.15,01:44:01.57
We do that five days a week, almost, hope to be at seven days a week by August, and

01:44:01.59,01:44:05.87
that is a very important way for young people, we focus our work on young people,

01:44:05.89,01:44:08.98
13 to 24, and for any of you who deal with young people

01:44:09.00,01:44:12.29
you know they're always connected to technology.

01:44:12.31,01:44:15.60
So, being able to chat with young people is rally important.

01:44:15.62,01:44:19.71
And then we are piloting Trevor Text, so young people can reach out

01:44:19.73,01:44:23.88
to us via their phones, because they're always texting each other.

01:44:23.90,01:44:27.35
I don't think young people talk to each other anymore.

01:44:27.37,01:44:32.29
Along with our crisis intervention, we know that we have to do prevention,

01:44:32.31,01:44:35.42
because actually we'd like our phones never to ring, we'd like no one

01:44:35.44,01:44:38.54
to ever be chatting with us, and that's where the prevention part comes

01:44:38.56,01:44:42.14
in, that's what we've been talking about some this morning.

01:44:42.16,01:44:45.37
We have a couple of ways of doing prevention.

01:44:45.39,01:44:49.90
We have our Trevor Education programs, and we are so excited: the

01:44:49.92,01:44:54.50
cornerstone of our Trevor Education program, our Lifeguard Workshop,

01:44:54.52,01:44:59.50
was just admitted into the best practice registry for suicide prevention.

01:44:59.52,01:45:03.74
It was the first LGBT focused curriculum, which is really great.

01:45:03.76,01:45:08.47
And that's a great resource, and we have that, and we are making a DVD of that,

01:45:08.49,01:45:13.72
so soon that workshop will be available to classrooms all across this country.

01:45:13.74,01:45:17.21
We also have the largest social networking site,

01:45:17.23,01:45:22.65
Trevor Space, for LGBTQ, and their straight allies, to talk with each other.

01:45:22.67,01:45:26.73
Because there are many parts in this country where people feel they're the only

01:45:26.75,01:45:31.43
gay people in their community, the only person like this, and they can come onto

01:45:31.45,01:45:36.55
Trevor Space and they can talk to, now, over 61,000 young people, so that they

01:45:36.57,01:45:40.22
feel like they have friends and their supported, and it's really wonderful.

01:45:40.24,01:45:41.62
And then we have Ask Trevor.

01:45:41.64,01:45:43.71
And Ask Trevor are letters that people write to

01:45:43.73,01:45:47.03
Trevor, and we have trained folks who answer those.

01:45:47.05,01:45:49.41
And all the questions and answers are posted on our

01:45:49.43,01:45:54.64
website, so it's an amazing resource for people to have.

01:45:54.66,01:45:57.53
But even with all of our services and things that are going on

01:45:57.55,01:46:01.32
in the country, there's still so much that has to be done.

01:46:01.34,01:46:04.40
As you can see from this map, there are still many states where you

01:46:04.42,01:46:09.99
can't even talk about gays and lesbians and bisexuals and transgenders,

01:46:10.01,01:46:13.72
because it's just not something that school curriculums will allow.

01:46:13.74,01:46:19.28
And that's why we actually need all of you to be working on this important issue,

01:46:19.30,01:46:27.23
because every community has young people who are gay, lesbian, bisexual, transgender,

01:46:27.25,01:46:31.62
or they're just questioning who they are, and you need to make it okay for them.

01:46:31.64,01:46:37.87
You need to know that each one of us, whether we're an individual or an organization,

01:46:37.89,01:46:42.38
we need to make it okay that young people know they can ask us for help.

01:46:42.40,01:46:46.87
And I'd like to ask now, we have a video that we've just done, it's a new

01:46:46.89,01:46:52.07
public service campaign that we are going to be doing starting in August,

01:46:52.09,01:47:45.74
"Making it OK to Ask for Help." So, can we play that video? Thank you very much.

01:47:45.76,01:47:50.85
So, "Ask for Help." It is our newest campaign, because we really want

01:47:50.87,01:47:54.44
to normalize for a young person that it is okay to ask for help, and

01:47:54.46,01:47:58.02
we will have that public service announcement across the country.

01:47:58.04,01:48:00.67
We will have billboards, we will have materials.

01:48:00.69,01:48:05.96
We're debuting it at 25 different pride celebrations this month.

01:48:05.98,01:48:07.44
And it's really, really important.

01:48:07.46,01:48:10.37
And this is something you can do in your communities -- not only can you

01:48:10.39,01:48:14.43
play our video, but you can come up with ways to make sure that young

01:48:14.45,01:48:18.69
people know they can ask for help, and they can ask anyone for help.

01:48:18.71,01:48:24.09
As we know from the National Strategy, just talking to one person can make all the

01:48:24.11,01:48:29.50
difference for someone who is feeling sad and depressed, and thinking about suicide.

01:48:29.52,01:48:36.48
We also have another -- I hope this gets to it -- Well, I don't know.

01:48:36.50,01:48:38.84
So, let me tell you about this other thing that we have.

01:48:38.86,01:48:42.71
Well, I have a really great slide, but I just can't show it to you.

01:48:42.73,01:48:46.16
But it's called "Talk to Me," and "Talk to Me" is a campaign

01:48:46.18,01:48:50.03
that we also, again, encouraging people to talk to each other.

01:48:50.05,01:48:55.54
You don't have to be trained -- Oh, there it is, thank you very much. Gosh, I'm good.

01:48:55.56,01:49:00.85
You don't have to be trained to be someone to talk to. You just have to be open to that.

01:49:00.87,01:49:04.16
And this is something that we've been doing every September.

01:49:04.18,01:49:07.57
So as you think about what you want to do towards September

01:49:07.59,01:49:11.66
10th and Suicide Prevention Day, we actually use September

01:49:11.68,01:49:15.33
as suicide prevention month, and we do a number of activities.

01:49:15.35,01:49:17.02
And "Talk to Me" is important.

01:49:17.04,01:49:21.22
You can have people go to our website, and join "Talk to

01:49:21.24,01:49:23.75
Me," and it gives different things to do in your community.

01:49:23.77,01:49:28.04
It's about engaging people and, again, about normalizing for young

01:49:28.06,01:49:33.45
people that it is okay to ask for help, it is okay to "Talk to Me."

01:49:33.47,01:49:38.85
So, just to summarize, as you think about what you can be doing,

01:49:38.87,01:49:43.40
LGBTQ young people, they face prejudice, they face fear,

01:49:43.42,01:49:48.02
they face hate, and it's only because of who they are.

01:49:48.04,01:49:50.90
And we've got to take away these negative factors.

01:49:50.92,01:49:55.12
We have to let people just be whoever they are, and shine and accept them.

01:49:55.14,01:49:58.85
And at the Trevor Project, that's what we do all the time.

01:49:58.87,01:50:03.09
We know when we accept people for who they are, it is

01:50:03.11,01:50:06.40
a big step in letting them accept for who they are.

01:50:06.42,01:50:10.70
And then to make sure that we offer these different strategies,

01:50:10.72,01:50:16.70
I think that, together, we really can make it a brighter future for LGTBQ

01:50:16.72,01:50:21.59
youth and really let them have that happily-ever-after that we all want.

01:50:21.61,01:50:24.73
So, thank you so much for having us here today.

01:50:24.75,01:50:34.70
[applause] Wow, thank you, and incredible presentations from our panel.

01:50:34.72,01:50:38.64
I've been told that we're getting questions from everywhere, from

01:50:38.66,01:50:42.56
Alaska down to Florida, from kids in high schools and from states

01:50:42.58,01:50:45.62
all over the country, and they're trying to sort through all of them.

01:50:45.64,01:50:49.50
And we're going to work to respond to all of them, not today.

01:50:49.52,01:50:53.82
But I want to take and just ask one question to the two panelists,

01:50:53.84,01:50:58.12
and give a 15-second response, to the chaplain and to Teresa.

01:50:58.14,01:50:59.78
And this came from one of the echo sites.

01:50:59.80,01:51:05.49
What would you say, in 15 seconds, for places that don't have mental health

01:51:05.51,01:51:09.87
professionals, behavioral healthcare professionals that have access to them?

01:51:09.89,01:51:14.39
Where would you say to turn for help?

01:51:14.41,01:51:18.58
There's always crisis lines and help lines that are out there

01:51:18.60,01:51:24.42
to assist individuals who are in need, and there are also the

01:51:24.44,01:51:31.24
peer relationships that are out there, that can assist.

01:51:31.26,01:51:36.30
We encourage people, because some of the communities I work in, it may be that kind of

01:51:36.32,01:51:43.10
situation, to really identify who are the trusted adults within their network of friends,

01:51:43.12,01:51:48.05
people that they respect, they feel would be confidential, and that they want to go to.

01:51:48.07,01:51:50.16
So we really have them prepare for that.

01:51:50.18,01:51:53.60
So, more training for those trusted adults when they go to them.

01:51:53.62,01:51:56.82
Abby, you want to add anything?

01:51:56.84,01:52:02.89
I think that it's just important that people know that if there's not a mental health

01:52:02.91,01:52:07.14
professional, they should talk to somebody and let someone know that they need help.

01:52:07.16,01:52:09.74
That's great, and I think that that really does sum up a lot of the

01:52:09.76,01:52:12.09
messages that you heard today, that we're all in this together.

01:52:12.11,01:52:17.55
This is a unified effort that takes everybody to save people's lives.

01:52:17.57,01:52:19.51
So I want to thank the panel again.

01:52:19.53,01:52:22.78
I appreciate their time and being up here, you can thank them.

01:52:22.80,01:52:30.11
[applause] So, what's going to be happening next?

01:52:30.13,01:52:32.49
For those of us here in Chicago, we're going to be

01:52:32.51,01:52:34.62
taking a break and then going into our action steps.

01:52:34.64,01:52:37.58
We ask that you do that on your echo sites, as well.

01:52:37.60,01:52:44.13
You can continue to submit questions and we will be responding to those in due time.

01:52:44.15,01:52:47.18
I can't stress this enough, that the tools that you learned about and

01:52:47.20,01:52:52.02
heard about today in your professional experience, use those to create

01:52:52.04,01:52:55.50
the plans that are going to help save lives across the country.

01:52:55.52,01:52:58.20
While we're not going to be collecting them, we ask that you use them,

01:52:58.22,01:53:01.96
and they don't have to be neat or clean, they just have to be something

01:53:01.98,01:53:05.50
that gives you a goal, something to reach for and strive for.

01:53:05.52,01:53:09.69
What we care about is that you provide yourself or your organization with a clear action

01:53:09.71,01:53:14.66
plan and useful tools that are available to you, as you heard about earlier today.

01:53:14.68,01:53:20.92
Now is the time. There's never been a better time to plan for suicide prevention.

01:53:20.94,01:53:24.62
Every moment counts in saving people's lives.

01:53:24.64,01:53:27.20
It's been a pleasure being here today, working with all the

01:53:27.22,01:53:29.85
experts that spoke first, and all the panelist members.

01:53:29.87,01:53:37.88
I want to bring up Dr. Cody, who is going to close for us.

01:53:37.90,01:53:45.21
[applause] Today we have learned how suicide is one

01:53:45.23,01:53:48.28
of the top public health issues in our country.

01:53:48.30,01:53:51.71
But our nation is no stranger to public health achievements.

01:53:51.73,01:53:57.19
In the 20th century alone, we made significant improvements in areas such as vaccination

01:53:57.21,01:54:02.64
rates, motor vehicle safety, control of infectious disease, and infant mortality.

01:54:02.66,01:54:07.19
These public health topics and their success share two

01:54:07.21,01:54:13.28
factors: a public health approach and community action.

01:54:13.30,01:54:18.70
However, sometimes topics like suicide, mental illness and addictions,

01:54:18.72,01:54:24.05
they're seen as social problems as opposed to public health issues.

01:54:24.07,01:54:27.36
And the communities and governments, they respond to a social

01:54:27.38,01:54:32.11
problem as opposed to the health needs of our communities.

01:54:32.13,01:54:35.40
Responding to a social problem as opposed to a public health

01:54:35.42,01:54:41.99
issue fosters individual blame and misunderstanding.

01:54:42.01,01:54:46.33
It leads to discrimination, prejudice, and social exclusion.

01:54:46.35,01:54:52.11
We end up focusing on the symptoms and not the root public health issue.

01:54:52.13,01:54:58.23
The National Strategy provides us a public health framework for suicide prevention.

01:54:58.25,01:55:03.57
It is based on facts, science and data, and has a common message.

01:55:03.59,01:55:06.46
It focuses on the health of our communities, and

01:55:06.48,01:55:09.46
it is committed to the health of everyone.

01:55:09.48,01:55:13.20
In turn, the strategy calls for us to engage everybody.

01:55:13.22,01:55:18.19
The general public, elected officials, schools, parents, houses

01:55:18.21,01:55:22.71
of worship, health professionals, researchers, individuals who

01:55:22.73,01:55:27.06
have been directly affected by suicide in their families.

01:55:27.08,01:55:30.06
The National Strategy provides us with one of the key components

01:55:30.08,01:55:35.30
that is necessary to decrease suicides: a public health approach.

01:55:35.32,01:55:39.51
But the other necessary factor to achieve success

01:55:39.53,01:55:43.21
in suicide prevention will be community action.

01:55:43.23,01:55:48.45
And when communities take action, we will see results.

01:55:48.47,01:55:52.16
Fostering a national dialogue and building public support for suicide

01:55:52.18,01:55:58.93
prevention will be the result when the individuals in this room take action.

01:55:58.95,01:56:03.82
Promoting changes in systems and policies and environments that will support suicide

01:56:03.84,01:56:11.22
prevention will be the result of participants on our webcast take action.

01:56:11.24,01:56:14.02
Addressing the needs of vulnerable groups to eliminate health

01:56:14.04,01:56:20.86
disparities will be the result when our echo sites take action.

01:56:20.88,01:56:26.41
Transferring knowledge so that families and individuals know the signs of suicide,

01:56:26.43,01:56:31.36
mental illness and addiction, know what to do about them, where to go for help for

01:56:31.38,01:56:39.18
themselves and their families, will be the result when communities take action.

01:56:39.20,01:56:43.23
We have the necessary components to reduce suicides in this country.

01:56:43.25,01:56:46.85
We have the strategy, the programs and the tools.

01:56:46.87,01:56:50.47
But it will ultimately be the action of the community that turns the

01:56:50.49,01:56:55.74
strategy into something meaningful over the next 75 days and beyond,

01:56:55.76,01:56:59.60
so that by National Suicide Awareness Day on September 10th, we will

01:56:59.62,01:57:05.49
have strategically advanced suicide prevention in our communities.

01:57:05.51,01:57:08.51
On behalf of the HHS Region 5 Work Group members,

01:57:08.53,01:57:12.17
I would like to thank everybody in person, on the webcast

01:57:12.19,01:57:14.95
and at the echo sites, for participating in today's event.

01:57:14.97,01:57:18.74
I would like to thank our presenters, and we urge everyone to

01:57:18.76,01:57:22.27
complete your action plans and take those next steps forward,

01:57:22.29,01:57:26.12
so that we'll have an impact in our country on suicide prevention.

01:57:26.14,01:57:44.04
Thank you again for your time. [applause]