Event ID: 2171667
Event Started: 6/27/2013 9:39:18 AM ET
[ Please stand by for real time captions ]

Good morning. My name is Jeff Cody am the original administrator for the substance abuse and mental health services administration. I also service the chair for the region five Department of Health and human service workgroup is responsible for today's event on suicide prevention. Of like to welcome the participants here in Chicago, to individuals for joining us via webcast and site around the nation. E site are organizations that have volunteered to open their doors to community partners, to listen to today's events, discuss, and collaborate on the public health -- topic of suicide prevention. September 10, 2012, the office of the Surgeon General vice ago to -- vice Admiral Regina [ Indiscernible ] released the revised national strategy for suicide prevention. We will hear today from the top experts in the field about suicide prevention, about programs that have been successful in reducing debt from suicide. Our goal for the day will be to learn about the national -- national strategy but our second goal for the day will separately will be to take the strategy and turn it into action. It is our communities with the strategy will become action and the results of the action of our communities and the next 75 days, September 10th which is national suicide awareness day will be that we will strategically advance suicide prevention in our nation. Now without further ado, I would like to introduce the acting HHS regional director and CMS Medicaid administrator, Jackie Gardner.

Good morning, everyone, and good morning to people in the E site. I am so happy that we could do this virtually and that everyone could join us. I'm so pleased to be here with you today I want to thank Jeff and his team for all of the work that we have done -- they have done. We are so fortunate to have tier three here in region five. Even more fortunate to have Jeff at the helm. The very exciting work is going on. I am here today for several reasons. But the 1st and foremost reason and those of you who know me well know that I believe so deeply in your work and I'm truly dedicated to the field of behavioral health. My dedication on this issue goes back far too long, probably, as far back as my early years out of college and grad school when one of my very early jobs was as a substance abuse counselor at a community mental health Center. That early experience shaped my career like no other. I know firsthand importance of the work that you do each and every single day. Am honored to be with you here as you kick off a long-term strategy for combating one of our nations top public health issues, suicide. Today the message I want to relate is that there is hope, not only for the people that we serve but for the country as a whole. At know other time in this field history has there been a confluence of legislation, and partnership to make the lives of individuals with mental illness better. The mental health parity and addiction equity act in the affordable care act bring about changes that we have never seen before. The two pieces of legislation for all intents and purposes eliminates the practice of unequal health treatment of mental health and substance use disorders. Prior to the law, insurers have placed strict and oftentimes random treatment schedules that were not founded and any research or personalized to the severity of an individual's illness. Type providing parity insurance coverage for substance use and mental health disorders it is now equal to other chronic health condition such as diabetes, asthma, and hypertension. The affordable care act take this one further in that it will provide insurance coverage for millions of people who otherwise could not access private insurance either because of the treatment they thought or they were denied because of a pre-existing condition or they simply were not able to afford coverage that included mental health services. Because of the ACA insurers are no longer able to discriminate against individuals with pre-existing conditions, additionallylly they will not be able to increase premiums because of health issues such as treatment for depression. The passage of the ADA, coverage is extended through requirements that qualified health plans, Medicaid benchmark and benchmark equivalent plans and new plans in the individual and small group market. And this is all very good news and it provides a great deal of hope for people with chronic illness. But, as you know, more than anyone, there is so much work to be done and you are taking the very first step today. Not the very first step. Let's just say you have other working on this for will a while. You're taking an important step today. I raise awareness about suicide you are bringing mental illness out of the shadows and hoping to shed an important light that hopefully will encourage people to access treatment and have the knowledge they need to make sure that their treatment is appropriate and covered by insurance. Starting on October 1st, 2013, this fall, people will have the option to purchase health insurance through the marketplace. The marketplace would not only provide an open market for health insurance choice but will also provide consumers with apples to apples planned comparisons. Individuals shopping on the marketplace can also rest assured that the plan may select will provide coverage for mental health and substance use disorders and it will also provide. He. So thank you for the work that you do and we look forward to our continued partnership and SAMSHA in the office on women's health and all that share health and human service partners to bring the resources you need to do the work that you do so well. Not at this time, I have the distinguished honor to introduce to you a very special guest. The 18th Surgeon General the United states Regina Benjamin. Doctor Benjamin has been a strong prevention advocate and in 2012 as just said, released the national strategy for suicide prevention which we will be referring to throughout today. So please join me in welcoming via video, the Surgeon General of the United States. Doctor Regina Benjamin. [ Applause ]

Good morning to everyone in Chicago and those of you who are participating in site around the nation. I would like to welcome you to everyone plays a role in suicide prevention, turning strategy into action. Preventing suicide is everyone's business. Everyone hundred Americans die by suicide every day and in the past year more than 8 million Americans thought seriously about suicide. That does not include 60% of all high school students who report having seriously considered it. Suicide is a tragedy of untold proportions and those of you who are part of that tragic storyline know if anguish all too well. Let's all, we partnership with the national action alliance released a national strategy for suicide prevention. Over the next 10 years, this strategy will be our nations guide to prevent the burden of suicide and suicidal behavior. It captures the progress we've made so far. The knowledge we have acquired and the promise that is within our grasp that suicide is preventable. The national suicide prevention strategy is organized with four strategic directions and there are 13 respective goals in 16 objectives. Don't worry I'm not going to list them all for you. There are some major themes in the national suicide prevention strategy. We hope to foster dialogue, to counter the shame, prejudice, and silence, to integrate public health with behavioral health in order to ensure continuity of care. To reduce access to lethal means among individuals at risk. We want you to talk about it. Don't be afraid to ask. Are you thinking about killing or hurting yourself? And no the warning signs which you're we're going to learn today. Remember, there is a free suicide prevention lifeline which connects people with the skilled, trained professional. Just call 1800 273 talk. During today's meeting, you're going to hear specifics about suicide prevention and how you can develop action plans specific for your community or your o rganization. Working together we can dramatically reduce the risk of suicide. So please, help us turn strategy into action.

Is --[ Applause ]

It's nice to get applause even though it is for the Surgeon General. I will just pretend it is for me.

Thank you and good morning and again welcome to everyone plays a role in suicide preventing dust prevention. Extend greetings from Doctor Nancy Lee, the director of the office on women's health to both all of you here in Chicago at the live event as well as to everyone who's participating and several thousand of you who are participating across the country, either individually eight your computers where you have come together in groups in your communities to figure out how to address suicide and create action plans. In the office on women's health we address an array of issues. For women and girls across there lifespan. One of the focal areas which is particularly germane to this conversation about suicide if unaddressed trauma. We know that exposure to traumatic events is so pervasive in our culture and is a key predisposing factor to both substance abuse and mental illness. Both of which are really key factors in creating greater risk for suicide. Recognizing this we have a fire -- a variety of efforts addressing violence it, including increased awareness and encourage individuals to seek help. We are also working to help and train health and social service providers to better understand, and provide, informed care. The office of women's health also has a outstanding health state -- health site. It's women's health.gov. The are from a nominal resource, it's a reliable sites for accurate information as well as a lot of links to other resources not the least of which suicide prevention efforts. We must act on the knowledge that one size does not fit all and affect their artistic -- differences between sex and gender. I ask you to keep this in mind as you go forth and create and create your action plans to help prevent suicide. Not just me truly great pleasure to introduce our master of ceremonies, Deanna Breitenberg. Dan is the executive director of the organization suicide awareness voices of education also known and save. He is also the state suicide prevention cold lead for Minnesota, Dan served on the national strategy for suicide prevention task force and was the lead for strategic priority number one. He is the US representative to the international Association for suicide prevention and leads the international task force that created the recommendations for media reporting on suicide. Please help me welcome Deanna Breitenberg.

Thank you very much I appreciate that and I'm glad to be here. I know that we are already a little bit behind so I will keep my comments very short. Although we are behind, definitely region five is the stellar region in the nation. So we are proud of that and that should encourage any of the other regions across the country as they develop their action plans to reach our level. Let me begin by thinking Doctor [ Indiscernible ] who is lead this effort to bring us here today and I also want to repeat what we heard about Doctor Benjamin is been a great champion for us in suicide prevention as the United States Surgeon General. I want to welcome the panel is there going to be speaking of the experts that you are good to hear from and all the across the country for participating at your computers where the various echo sites. We've got some great information to share with you today. We've got some great remarkable stories that you're going to hear about today. This loosens started with a passionate group of people and it continues today with those same voices and new voices that are being added every day, sometimes out of tragedy but also of hope. And we want you to know that you are part of that and we're making progress in saving lives in this country. For some of you participating t oday, we know that you know the pain of brain illnesses, mental illnesses and the emotions that go with that. We also know that some of you know the pain and the agony of loss of someone loved to suicide. I can sure -- our thoughts are going to be with you and our hope is that we can help keep others from knowing the pain that you've lived through and experienced in your life. The vice president of my Board of Directors once said that suicide was the greatest human strategy. Not only do I agree but I also know that the greatest human strength and hope can be found right here today and all of you participating in this event. Regardless of your background whether you're a clinician, camp counselor, estate was a provincial court a provincial Court nadir, a member of the save community, we all have a role in preventing suicide. It doesn't happen alone. It doesn't happen at the nation's capital or the state's capital it in our community and our families and our businesses. One of suicide occurs, it tears apart not only the family but it rips apart the soul of our community and our nation and that's why we're here today to prevent that from being torn any deeper than it already has been. While there's much to learn about the brain and many other things that are involved in suicide prevention, printing suicide is not only possible it is all about responsibility. Finally, after we break into our workgroups into breakout into your echo sites across the country, the goal today, as you heard Doctor Cody say it simple. We want to continue this conversation about suicide and suicide prevention. In doing so we want to keep the momentum going to the reason -- the recently released national strategy engage those across the country and our community that want to do something but don't know how to do that and of course reduce the incidence of burden of suicide bio -- while also recognizing countless great efforts that take place every day across the country in saving lives in America.

With that I want to get our program underway until you that echo sites from across the country that are participating can submit questions to everyone plays a role@S AMSHA. HHS .gov. Persons and attendees can come down to the Mike to the microphone and we encourage you to submit your questions. The panelists and experts don't have to anything to do after today so feel free to submit all of your questions and I will be e-mailing you directly with those questions. We will have questions for each speaker right after they present. If you have a smart phone handy, please remember to spend -- spread the message by tweeting not everyone plays a role and don't forget to retreat our messages for all of our HS partners with collaborated for this event, the administration on children and families, community living, health resources and services administration from the substance abuse and mental health services and ministration, the office of women's health and the centers for Medicaid and Medicare services. Also, don't forget to look on her Facebook page is from a content and information to be sure to share the suicide prevention resources that are listed there for you. Notice my great pleasure to introduce our first speaker, a colleague and a good friend of mine Doctor Jerry Reed, Q-letter that's the deck as executive director of the human resource center, he is a featured panelist earlier this month at the White house conference on mental health. Doctor Reed is the cold lead on the national strategy suicide prevention resource task force with the Surgeon General he led that effort and we have a fantastic new document that I hope you all have access to and if you don't, and downloaded online it is crucial to the creation and the dissemination that the work that Doctor Reid and Doctor Benjamin led if carried out by all of you. Let's bring up Doctor Reid and have him explain to you more about that and in ending the tragedy of suicide. Ladies and gentlemen, Doctor Reid. [ Applause ]

Good morning. It's wonderful to be in Chicago after several delays here and it was nice to make it so I to make its like to do do honor to my good friend and colleague Commander Cody who extended an invitation a long time ago to join you. We have had many many meetings at here in Chicago as we went to 18 months of writing the national strategy for suicide prevention and putting it all together and even more of a reunion that just geography, several of the wonderful people who helped us to do this task are in the room today sisterly but certainly like to acknowledge my good friend Admiral Jim Galloway, Richard McKeon, SAMSHA, Mort Silverman from Chicago, my colleague Dan who sits behind me and of course Doctor Benjamin we heard in a moment ago and many, many others who helped us to this formidable task. As would like to thank my colleagues here in region five for allowing us to come home and celebrate a bit of a reunion. It's been a long journey and I'm glad we are able to talk about it a little bit today. So having said that, I am personally delighted to be year to speak to everyone plays a role in suicide prevention, turning strategy into action. That was certainly a sub theme that we held onto from day one as we wrote the national strategy was how do we really make this a living document that people everywhere across the country can do something with. Not just researchers and academic environments or our clinical staff and agencies around the country but help and everybody at every level to something in suicide prevention is my hope is that at the end of the 20 minutes that be given, we will begin the journey of kicking off 75 days to world suicide prevention Day, September 10th, 2013 with demonstrable depth that can show we are in fact doing exactly what we have in mind. Before you get into the brief charts I'm going to share with you I just want to reflect on the day that I think I got the call that said Jerry, we would like you to chair the task force Doctor Benjamin on revising the national strategy. Putting my name in the same settings with Doctor Benjamin is a little awesome to start with but it made me remember a few other ports of my life that I stopped, took was and said how did this happen? One of those bliss the day my wife told me we were expecting our first child. That's a big task, and I thought that was pretty awesome. I also remember going to graduate school in deciding to get a doctorate. I don't know what I was thinking. I was so happy when they said you are accepted but I had no idea what the next five years of my life would be about. But I did it and I braced to wonderful children or 29 and 25 and I'm happy to say that we did it and it was a much more pleasant experience than I thought it would have been. I will start by saying and they think it hope -- I think I hope it sets the tone for Chicago and all across the country, I am reminded at a meeting I was at many years ago in Ottawa Canada with her colleagues in Canada for addressing first nation issues and are colleagues here in United States were dressing American Indian issues and an elder welcomed us and during his blessing he said to us, just remember it's not by accident that you are in this room. Whether you are here physically or virtually you're here for a reason, you're here because there's something that you can do and I would ask you to hold onto that if we go through the day and as you return to your communities and workplaces and do the work that needs to be done. Our field has grown so incredibly much from the years when I have started which was back in 1996 and 97 one frankly you could've put the field in a very small world and a lot of smart people would've talked about where we needed to go to the point where we are at today will we have so many nonprofit organizations, so many researchers, every state in the nation has estate suicide prevention plan, several communities all over the country are doing the best they can to make a difference in the lives of the folks who live in their communities and I could just go on and on about our field has grown and they think it's an amazing, amazing journey and I want to start with a dedication that is in the front of the national strategy that I think we held very closely to as we wrote the strategy and I would ask all of you to remember that you do this important work. The ticket eight death that dedication reads. To those who have lost their lives by suicide. To those who struggle with soft's of suicide. To those who have made an attempt with their lives. To those who are caring for someone who struggles. To those left behind after death by suicide, to those in recovery, and to all those who work tirelessly to prevent suicide and suicide attempts in our nations, our n ation, we believe that we can and we will make a difference. And I really want to emphasize the fact that in my humble opinion, much of where we are today is because of the Kurds of those would've lost a loved one to suicide, which is to speak up and encouraged all of us to fly in formation and fight to prevent this very preventable form of desk after the halls of you who have struggled to have made an attempt to encourage her to add your voice to help us realize what needs to be done in clinical settings in communities and workplaces to make sure we do not marginalize them for that event. Learn from them and hopefully prevent the suicide and death that we all want to prevent.

Turning strategy to action. . This is the strategy. If you don't have one I strongly advise you get one from the SAMSHA clearing house because full of m any, many Mark -- remarkable directions. I want to start with a couple of pictures here. I am not going to put a lot of PowerPoint charts with text. As the picture would tell a thousand words and keep it a little more interesting. So let me just begin with the major developments that occurred -- that have occurred since 2001 that we would lead us to the conclusion it was time to revise the national strategy. First, the right-hand side you see the action alliance for suicide prevention. On September 10th, 2010, secretary [ Indiscernible ] and secretary Gates wants the partnership to help us advance suicide prevention in this nation by not relying on any one nation or any one sector that have multiple sector invoices to help us to all that was necessary for suicide prevention. When that action alliance was launched, we were given the mandate to revise the national strategy for suicide prevention and quite clearly were told please do it in 18 months, let's get it done so people can have the tools we need to up us move forward. You also see the logo for the national lifeline that was mentioned earlier so we now have a response system in this country staffed by wonderful human beings and over 150 crisis centers that all you have to do is Dial 18273 talk from anywhere in the country and you will be seamlessly connected to an asset with really great people and that Expida just a little bit when the Veterans Administration a partnership with SAMSHA could provide an option that now allowed veterans and active-duty military and those that love them if they have some in their life that struggles, all they have to do is push option one and they will be seamlessly connected and the whole reservoir of the VA medical centers to get that kind of help which is a fantastic contribution to our national district truck -- infrastructure. Social media as you can see in the middle there is making huge contributions of something that we need to embrace and our strategy to embrace and also just the increase recognition that no one best practice, no one intervention, no one person, no one event is going to change the nature of suicide in this country. It is got to be kind -- comprehensive. If you want to train gatekeepers you need to make sure the clinicians in your community are trained to receive them. If you're going to engage primary care practices and helping to screen and look for those at risk? We have to make sure there are support services outside of the primary care offices for those individuals who may have been identified you're ever going to with emergency department and asked them to really screen for suicidal risk with someone present so that once we treat the injured Jerry -- the injury, as well they have continuity of care. Access to community resources, follow-up, and a clear message that you matter to us and we want to make sure that you get well in this presentation. So all of this has really helped us understand we need a very coordinated and comprehensive approach and none of us should look at it as one best practice or one of best approach is going to solve the challenge.

This slide basically is going to talk about the strategic d irections, but I will say that as those pictures showed earlier, over the last 10 years we have learned there is a burden of suicide in the military and certainly in the veterans administration and much is been done to address that burden. We understand that if we're going to truly be effective in suicide prevention, we are going to have to enhance our surveillance and and have dinner once with a nationally that is much quicker at hand so we can see the reality of what is happening in the environment and what is the impact of that happening. The CDC is working very hard to reduce the time from when deaths occur in states to one that death date is aggregate -- aggregated so we have the time and the information to do progressive things with it. I want to go back and say that the recognition of those who have lost someone they lost by suicide in those of once we made an attempt, clearly the conversation has to be at every table. In your community I hope you have the voice of the consumer and the voice of the buried at the table so we can learn what needs to be learned as we move forward.

Let me just share with you on the strategy is organized. Doctor Benjamin stated that there is for strategic directions. And what you see here are those for strategic directions. What we tried to do as we thought about the national strategy, was building a healthy and wholesome community, building a prevention prepared community in strategic direction two, making sure that the availability and treatment and aftercare services were available for those who need those services and on the far left appear, making sure that surveillance and evaluation and research remained apart of our conversation so we can learn from what we're doing, add from the best practices and hopefully continue the momentum to get better and better at saving lives. 38,000 lives were lost in 2010, we certainly know there are many people that consider suicide from some of the data that SAMSHA puts out, we have a long we could go into strategy and these directions were intended to help us get there. Strategic direction one, the goals in this idiocy to create supportive environments that will promote the general health of the population and reduce the risk for suicidal behavior and related problems. So looking at problems that may have shared risks, and trying to make sure that all the providers no those risks, no those protection and so if someone walks into your setting or if you don't know the warning signs for suicide or someone you love is behaving very differently than they ever have before, make sure that we prepare everyone in this nation to be in the lookout for that and take steps if they see that occurring. Strategic direction two, really six to ensure that clinical community-based programs are in place and prepare to help individuals who struggle navigate their care efficiently and effectively. In short, we want to make sure that every door in the community is the right door, whether it's a social service agency, whether it's a substance abuse team and agency, whether it is a crisis line or whether it's a school setting, we want every setting to be aware of what needs to be done to make sure someone who passes through that door get the help they need. Strategic direction three, just basically speaks to let's make sure the best practices, the best interventions, the best aftercare and I cannot emphasize enough how much post convention is in making sure you address the needs of the family, community, workplace, after the death of someone in that setting so that we really can't prevent what could be a subsequent death by making sure we compassionately and knowingly we talked to that setting so that people can understand what occurred and how we move forward as a community. And lastly as I said, strategic direction for supports additional efforts and surveillance, research and evaluation to consider them to continue to make the advance is that we to make. What we did quite strategically in you'll see this when you look at the strategic direction, the strategy, after every single strategic direction, there is a page that talks about what the federal government can do, what states and tribes could do, what businesses can do, what healthcare systems can do, what universities, schools, nonprofits, and what Wesley individuals and families can do. There is a roadmap of switchboards that every strategic direction the kids tangible and concrete step that can be taken to advance the objectives and the goals in that particular strategic direction and that was done because we always say everyone has a role but we never took the time to explain what their role was to people who may not not be of conversation about suicide prevention is we are switch are very hard to do that in this national strategy.

Everyone plays a role or everyone has a piece of the puzzle. And bring today a piece of the puzzle that are bring very often when I go to speak to communities around the country about the strategy and it is significant because this puzzle piece was given to me by a mine -- I have mom who lost a 15-year-old daughter to suicide many years ago. And we will -- what we were to talk about how we -- how to we mobilized nation to respond, way before this was launched in trying to build momentum I invited her to come and share her story so that federal and senior executives from the Washington area could benefit from her story so that we could can see how important doing something really was and she said I really don't have anything to say. I'm not sure that my story would be helpful. We talked a bit and I kept trying to assure her and we talked a bit and she finally agreed to come and they said your story will matter. She was moving from one home to another and as she was cleaning up the room that belong to her daughter she found the puzzle that daughter had worked on prior to her death. She said this may be my message. Should took the puzzle pieces, imparted to Washington and she passed around the fit -- passed around the felt bag and asked each of us to have a puzzle piece and it said to me never forget why we're doing this. We're doing this to try to each to the part that we have to do to make sure that other moms don't lose there 15-year-old child and eventually get to the place we are it suicide prevention prepared nation and every door is the right door and people who struggle do so without bias, discrimination and false judgment. So that is golden I have and I would ask all of you as you think through the day to think about your piece. It may be small, it may be big, but there is something and each and every one of us can do around suicide prevention. When you look at this, those were the very things that Doctor Benjamin mentioned. We what -- these other things that guided us as we went through. Promote connectedness. It's not enough to talk about risk we have to talk about prevention. What protects people who do struggle for making tragic decisions. Strengthen continuity of care. Not enough to walk in and get treated in emergency department but you will be followed until well and that has to be part of our peer nine. Training of professionals. Many of us went to graduate school never had the common training in suicide risk assessment that we needed. The field has grown, the nation has engaged in a conversation, we have to make through -- make sure that our next generation of metal as medical health prevention's know how to assess and manage suicide risk so that when a gate keeper identifies a risk there is a clinician who knows exactly what to do so we can give that patient exactly what they need. We have to challenge ourselves to think about alternatives to approach and setting, maybe it's not always the right thing to do to admit someone to an inpatient facility. Maybe it is, maybe it isn't. We ought to be really thoughtful before we make that decision. Post Post mentioned as I mentioned, multisector and make -- engagement, doing everything we can to make sure everyone in the community to take part. If you want to understand what comprehensive means, look at page 12 and Doctor Silverman wrote a very convincing one one page this is a truly prepared community whose doing all that it can to help a person identify with depression, these are all the things that would have to happen if we were to honestly say we've done all that we know to do to make a difference. And I think it's an amazing contribution by Doctor Silverman.

I would like to close my remarks by saying what was said earlier, suicide has a ripple effect. And way back in the late 90s when we first started talking about suicide, there was not a whole lot that we knew but one thing that stuck with me it's if you throw a pebble in a pond, it ripples that suicide does not just affect the individual who died by suicide but it affects their family, their neighborhood, their place of worship, it affects their school, and effects, effects, affects. And it is not just a short term effect, it's a long-term effect. Michael this cause and I'm sure for all of you is that we understand that each and every suicide that occurs in this country, while we may not know the person who died by suicide, in my humble opinion, it truly affects our fabric of the nation and I could not be prouder to be an American involved in such a cause we are in not afraid nationally to talk about preventing suicide and engaging other federal partners, all the private sector partners, and everyone in between to do there part for suicide prevention. So let me close purchasing there is something that each of us can do as the day progresses I hope you'll think about that for ways that. As Gandhi said, be the change you want to see in the world. From wherever you set be the change that you want to see in the world and that you are uniquely positioned to contribute. So for sponsoring a training, if it's developing a protocol, if it's starting a ministry in your faith community, if it's joining a community coalition or developing a curriculum that might be used in your school based on some of those that are already on the best practices registry, I just ask you to never forget their something something to eat that each and every one of us can do so I think you very much for the opportunity to join you today cosmetic

Thank you very much Sherri for that great overview of the national strategy and how came to be. We are way behind but I do want to take a question for Jerry, a very quick question. What surprised you most during the development of the new national strategy?

Trini Levens -- [ indiscernible - low audio ] weather we had a public comment period where people could offer suggestions, we had task forces of the national alliance for suicide prevention all of whom are looking into at a different topic and every one of them took the time and the energy to give concrete suggestions and with what I thought what about much more difficult process to put together and have it make sense, you could just tell the nation was on the same page and the field had been flying in formation for long time. Based on the 13 goals that we're in their, it was very clear that the people who had responsibility for input to the goals really give this serious thought so there was not a lot of changing that needed to be done once he came to the national strategy task force. It was just a matter of wording it away that look like it was wanting one fight.

So nobody got hurt and the process?

Nobody got hurt. The unique agenda and for my opinion really helped us do what we needed to do to put a strategy together that would take us to the next 10 years.

I know a lot of us lost a lot of here in the process. Thank you again for all of your leadership in the nation in suicide prevention. Moving on it's my great pleasure to introduce Doctor Richard McKeon, some of you don't -- no Doctor McCann, he is the branch chief of the suicide prevention at SAMSHA. He's the head guy. He's a great team -- he has a great team that works with them. If the well-known expert in the field and he is going to share some of the science. He's a member of the national suicide prevention task force, authored many books on suicide prevention over the last 20 years, some of you know SAMSHA has been involved in trying to move mental-health and substance-abuse forward. They've taken on the initiative for suicide prevention and for all of you in attendance today I'm participating, we hope that you learn more about the science of that that is being led by Richard, his coworkers in SAMSHA. Bridget McCann. [ Applause ]

-- Richard we can.

Thank you for the introduction. I also want to acknowledge our administrator who is been an incredible champion for suicide prevention working to try to move the national agenda forward. My background as a clinical psychologist and I spent numerous years working in a hospital based community health center running a psychiatric emergency service and being clinical director of the mental health center. I just want to follow-up on one thing that Jerry mentioned which has to do with the ripple effect in suicide if ripple effects and suicide prevention has ripple effects. Let me just mention two stories. One sad and watch -- one much more happy. But that one has to do with the time when I was covering psychiatric emergencies for our hospital over the weekend. I got a call from the emergency room physician who said to me that there was the family and the emergency room and they were very upset and Qu├ębec, and talk with them. Because the mother in the family had taken a serious intentional overdose, should make -- made a suicide attempt and she was at the moment in intensive care and they asked about comment and talk with the family and try to help them through these difficult moments. So I did that and I came in and I talked to the family and there were a couple of daughters and a son and a husband. And while I was talking with them, the emergency room physician came into the room and said I'm sorry, your mother is gone. And I will never forget the cries of anguish from that family. I will also not forget the way in which over the next several years the daughter in that family who struggled to try to keep [ Indiscernible ] as she made a series of suicide attempts herself. It made a very vivid and palpable the tragic legacy that suicide can bring in many circumstances. The anguish is always there. The suicidal behavior does not necessarily happen every time as a consequence as a death by suicide but there our heightened risks. There are also brisket -- ripple effect to suicide prevention. I also remember a time where I got a call. From a woman whose daughter had said that she had a friend who's planning on killing himself that night. And we worked with the mother and then with the daughter and we were able to locate the boy and intervene with him and found out he had made extensive efforts to kill himself. That he had prepared and he had extremely serious intent. We hospitalized him and he was not particularly happy about being hospitalized. He was a 17-year-old and his parents were in Europe but we were so sure he was going to kill himself that we helped him. His parents arrived the next day and they were very grateful. We worked with him and I saw him as an outpatient therapist for about a year afterward get in contact with him for a year afterwards. He became an adult, he got married, became a successful businessman and he touched many, many lives in a very positive way. So both suicide and suicide prevention have ripple effects and sometimes we may not see them. I was fortunate enough to know what happened to him afterwards and know that his story had a happy ending. So the actions that all of you take can have affects both close and further down the line.

Regarding national strategy that we are talking about today. One question would be reasonable for each of you to ask yourselves. Do we have evidence that national strategies can reduce suicide r ates? My answer to that would be yes we do. We have seen evidence of implementation of national strategies and efforts and at least two different countries have documented significant reductions in suicide rates. And those were in England and in Taiwan. We have also think that organizations in the United States when they meet suicide prevention essential priority have been able to bring down suicide rates. Organizations is different if the United States Air Force and the Henry for -- Henley afford health care system have been able to show healthcare reductions.

In England they found reductions in communities that reduced and implemented the national strategy there. And when they compared to ones that did not implement it they found differences in suicide rates as well pre- and [ Indiscernible ] differences [ Indiscernible ]. Compelling evidence that the work they were doing in England was helpful and some of the things will strongly associated with reductions of this was information that we took an integrated into the US national strategy with the availability of community crisis teams and a proactive outreach. I want to emphasize that. If we wait for people at risk for suicide to show up in the office of the clinical psychologist, myself or psychiatrist, we may never reduce the suicide rates. Everyone has to play a role for to be successful. And that means people have to encourage loved ones and friends and coworkers and colleagues and other students etc. to get help and to have hope. Follow-up within seven days of inpatient discharge was associated with reductions, training of clinical staff at least every three years, having dual diagnosis policies, being aware that substance abuse is a major risk factor for suicide. Content Monday focused on following up after those would meet suicide attempt in the national effort and found that in extraordinarily 53% reduction in suicide but paying attention and providing proactive follow-up to people who attempted suicide. A major need within our country. The Air Force is an In-Stat desk is an example within the United States for suicide with able to reduce suicide. They were able to to reduce suicide about a third using a comprehensive approach. I want to emphasize that approaches need to be sustained and there solid research regarding the Air Force model and this is back in the 1990s that this was first done. And you can see in there part of what happens is that the suicide rate after going down and started to climb back up. When they looked into it, they found that adherence to implementation of the strategies involved in the Air Force's model had slipped. And when they redoubled their efforts to make sure they were in fact doing it, that the rates went down again. So very important information. It is not just a one-time effort. It must be sustained over time continually in order for it to be successful. And it can also be done in the health care system. Henry Ford system had remarkable success reducing suicides for four consecutive quarters not having any suicides and a somewhat audaciously set as their goal having zero suicides. In some ways, sometimes in mental health we are taking a bit aback by that. But if the goal is not elimination of suicide entirely, what can the Kobe? It means that we would have to accept some number of suicide this being acceptable. So let me just talk easily about the key issues.. One is that we need to integrate and coordinate suicide prevention activities across multiple sectors and settings so it cannot just be a mental-health mental health issue. We need a comprehensive lifespan approach, we know that at least from the teenage years through old-age, that suicide is a major cause of death. We know that our efforts have to be data-driven and we need to strive to continually improve. We don't have a foolproof formula that we can apply. We need to be working on what we know and we need to be learning from our experience on an ongoing basis. It needs to evolve both the public and private sectors. So that means that healthcare providers certainly need to be involved but also educators, workplaces, faith-based entities, community-based organizations, all have a role. This slide just underlines the point that substance abuse is a major issue in suicide prevention and it is corporate -- incorporated into the national strategy. 30% of also cites involve alcohol and a similar number of suicide attempts. So it is imperative that that be taken into account and that is setting that are involved in the prevention and treatment for substance abuse are involved in this important effort.

It is also vitally important that emergency rooms are part of this. And we are working actively with emergency rooms because that is the place where people are most frequently seen after suicide attempts and a lot of times they do not receive treatment afterwards. So the improving continuity of care is a major theme in the national strategy. What this says it it may be hard to read all of it, this is using Richard McKeon -- SAMSHA [ Indiscernible ] data. It looks at the different categories and to give you a sense of the multiple settings that are required for suicide prevention. The [ Indiscernible ] data would emphasize for example that there are approximately 74,000 suicide attempts per year by military veterans. So that is one area. Adult Medicaid or on chip, 270,000, full-time college -- college students and SAMSHA worked actively, 108,000. Adult probation or parole, correctional and legal setting they need to be aware of as places that offer opportunities and needs for suicide prevention. 161,000. Adult substance abuse treatment, 106,000 reported past year suicide attempts. Just to give you an idea some of some of the diversity of setting that require interventions. Jerry mentioned this. I'm not going to spend too much time on it but the important need for training. Training of gatekeepers and people working in schools and people of faith based communities but also of providers because I often tell folks that I only had one lecture on suicide prevention in my entire training as a clinical p sychologist. Problem with that was at least at one, was that I gave it. [ Laughter ] because our professor said pick a topic and so I picked suicide prevention. I talked to supervisors because I had so little -- suicidal client for suicidal patients. It gives you a sense that something that got better but more work needs to be done. You need to recognize the warning signs that we now have evidence -based practice and behavior therapy that are shown in randomized control trials the ability to reduce repeated suicide attempts. Regarding the issue of the behavioral health workforce specifically, this is kind of a busy slide. Let me just tell you what it means. . What you see there are courageous folks in behavioral health systems around the country who are really working to try to make suicide prevention a core priority in their system. What they did was they asked their workforce did they feel like they had the skills to work with suicidal people? Did they have the training to work with suicidal people? Did they feel they have the support to work with suicidal patients and people? What they found was very significant number said no. The good thing what they also have data which was when people cut training that the numbers improved significantly. That people felt better and felt more confident in being able to do that. So this is important work. One of the goals in the national strategy is making suicide prevention is a core component of health care. What would that look like if our health care system and in particular behavioral health systems had suicide prevention is a core component. This really mirrors what the objectives of the national strategy on. If we were to make it a core component in the clinical workforce would be routinely trained in suicide risk assessment management and treatment. Accrediting and certifying bodies for standards and guidelines related to suicide prevention, continuity of care during high risk transition time such as discharge from inpatient units and intimate -- including proactive outreach, it death by suicide and nonfatal suicide events would be routinely monitored and reviewed to help guide suicide prevention efforts. That there be continuous quality improvement efforts focused on suicide prevention. Those of the some of the examples but I also want to point out that there are significant steps forward that major systems have taken. For example the joint commission has launched a national patient safety goal focusing on suicide prevention and that was about five or six years ago. Very important step for them to take. And the Veterans Administration has made suicide prevention a major priority across their healthcare systems. Every VA medical center has a suicide prevention coordinator and everyone who is identified at high risk with the what is called entity -- received an enhanced care package of services which have shown to be able to reduce repeated suicide events. Just a couple of other points and then I'll close. One of the other areas that we incorporated the national strategy and one of the voices that have historically been silent in the suicide prevention has been the voice of suicide -- people who've struggled with suicide IDA -- suicidal ideation. For them to tell us what they feel they need and what they feel would've helped them we are now doing much more that work. This is a port from Eduardo Vega was part of our task force to revise the national strategy. That with this integrated in the national strategy it needs to be integrated in our efforts moving forward. And faith-based areas also important because there are people that may never come to see a clinical psych out just psychologist such as myself that maybe they will talk to. And maybe they will talk to their minister or priest or rabbi or Pastor and we need to take these things into consideration and make sure that those options are available for people as well.

Jerry mentioned the national suicide prevention lifeline is a resource why won't review that. I will mention that on the lifeline website there is also now a crisis chat feature that can be utilized so that people can access care that way in addition to the telephone. And I just want to let you know that there are a lot of resources out there that can be utilized in various settings and that these are all available from SAMSHA it typically for free and you are welcome to contact us and we will get them to you. For schools, a toolkit for high schools in preventing suicide exists and we were together with the Department of Education around disseminating this but if you work in a school-based setting, this is a wonderful encapsulation a school-based approaches to suicide prevention. In tribal community, this is a resource community this is a resource that does live to see the great day that Don's. This also brings together resources and information about suicide prevention and tribal [ Indiscernible ] and it should take that one of our speakers today have [ Indiscernible ] some of her work is actually in both of these toolkits. In primary care practices, this is the toolkit by the SP RC for Wirral primary care practices, it can be applied and not Wirral primary care practices as well. It has the treatment improvement protocol for dressing suicidal thoughts and behaviors and suicidal thoughts and behaviors. This is also available in bulk and for free, these are cards that can walk a provider through doing a suicidal risk assessment. I won't go over it in detail just so you are or where it exists free in it's very current adware happy happy to get it to you and finally, the warning signs have been mentioned, these are cards that have the national suicide prevention lifeline number on the outside and the warning signs for suicide on the inside. Again we would be happy to get these to anyone who needs them so with that, I will stop. Thank you. [ Applause ]

Thank you very much, Richard. We are going to keep moving along here and we will save questions for you for a little bit later but that's great for people developing there action plans. Next I went to bring up our next speaker, we have an individual here who is been gracious enough to share his own personal story for us. Pat [ Indiscernible ] represents a group that has the highest rate in incidence of suicide in men in the Middle Ages, then it tireless advocate for mental consumers for more than [ Indiscernible ] years diagnosed in 1973 suffering through many years of mental illness and hospitalization in suicide attempt, he appeared to share his personal story with us today. Thank you very much. Come on up.

Thank you. I am Pat [ Indiscernible ]. I'm one of those people who came to an and a hospital and thought damn I can't even do that right. I felt that deep soul crushing despair, that invisible gut wrenching agony of wanting to die a feeling such great pain that I don't think I ever thought of death and dying, all I ever thought it was no more pain. I just wanted to stop hurting. Sort of like Churchill and his black dog. I want to talk to you about three K things that help. I was on a path of self-destruction and I want to tell you about the three things that I believe helped to divert me from that path William James, I was a philosophy major, one of those strange. Dollars, said I take it that no man is educated was never dallied with the thought of suicide. I believe that. I believe that those thoughts, those feelings are normal. But we have to figure out how to get past them, Susan, not let that be so strong that they take us a way. William James also said be not afraid of life, believe that life is worth living and your belief will help create the fat for interview psychology majors around, that is cognitive therapy in a nutshell, it is considered the best treatment for suicidal behavior and it came from William James, a man who dabbled himself and fought with thoughts of suicide. So he is appear. The first thing that helped divert me from that path, I lay on my couch, literally unable to get up and engage with life the depression was deep. I was fighting those demons that I knew nothing but despair and I literally could not get off the couch. A friend came over and he physically picked me up and dragged me out of the house at that we are going to go in kitchen life. I cannot -- go and engage in life. He said I cannot in good conscience let you do this. He took me to automobile races and the sites and the sounds and the smells and the outdoor sun on my body, my senses were so overwhelmed that I could not have my thoughts turned inward onto that despair. I got a break from all of that depth of agony that was going on inside. I had to be focused outside with all of that overwhelming stuff bombarding my senses. It was not the care but it was a step in the right direction. Finding a break. Knowing that there is a light at the end of the tunnel and it is not an oncoming train. Lincoln, too, had friends. Lincoln had friends who took his knife and stole away from him. Lincoln was at one point so afraid to pick up the knife because he thought he would hurt himself and try to end his life if he had a knife. The second thing that helped me with a had a therapist who taught me the difference between feelings and actions. I don't know where I got it? But I talked to a lot of people who got this weird notion that it seems like we have to be somehow congruent in our feelings and our actions. I grew up thinking that if I am angry I have to act angry. If I am sad, I have to act sad. If I'm happy, I have to act happy otherwise I am being fully and not real. So of course, if I have a suicidal feeling, oh crap, now I have to go home and take an overdose. What's with that? If I was going to be honest is a human being I thought that my thoughts and my feelings had to somehow peek congruent. So I would go into therapy. I used to tell the therapist's I'm feeling suicidal and those poor therapist just couldn't seem to handle it, they would panic and lock me up. Finally, I got a therapist who said wait a minute. Okay now if you think you are going to go out and hurt yourself I have certain legal obligations that I have to try and stop that. But, welcome to the human race, you are having a feeling. If you think you won't go out and hurt yourself, that we can think just sit and talk about this feelings. And I was like really? I didn't know that you could actually do that. I thought if I was feeling suicidal I had to go back suicidal. Here's she was telling me you can have a feeling and you don't have to act that way. I was blown away. With that and we talked about the feeling and I felt better. And I realized that I could have a loaded gun -- gun and if -- and if I have that much control over my body I don't have to pull the trigger. I can do something else. I can talk about it. I can find help for it. Feelings. Amazing things and they come and they go and if you don't do one -- if you don't like the when you're having now hang on for a while you get another one later. Really, I don't know where it came from but a lot of people are sort of stuck in their proof. The third thing that helped me was service to others. Get out of yourself. Pay it forward. The appear. The trauma sensitive and invite discussion. Not what's wrong with you, tell me what happened to you and tell me what's going on with you. Be that support to somebody else like but the guy that dragged me off the couch. Be that to someone else. I found that giving to others as a way of turning their focus that I have a word -- out word instead of focusing in word on all of that hurt that was going on. It wasn't the care but it was a step because if I can turn it out word and help somebody else for a little while but that focus out there it gave me a break from that hurt that I was feeling inside and those little breaks at up it's like a vacation to have that little break to not have to have that feeling and that pressure all the time. I can talk so much more but I want to tell you go to a comedy club with some friends. Have a good belly laugh, it's not a care but I contend that you cannot hold onto those suicidal feeling so you're having a belly laugh. I just think it's possible. Lay on the floor. With some puppies or kittens. Honest to God, if you can feel that emotional hurt while puppies are licking your face you are hurting more than I can ever imagine. Play with the baby. I don't know how we can hold a newborn baby and not feel hope. I think it's part of the human condition. And know that these things that I offer today, the agony, the hurt, the pain, but despair, you can make it through. I have not given you any cures or any answers, I don't have any. Certainly not for anybody else, I struggled to find my own. It is true. One day at a time and if not that, one hour at a time, and if not t hat, one minute at a time, and if not that, one moment at a time. Keep breathing, keep hope because there is somebody who cares about you and there's other people that you need to care about. Thank you.

[ Applause ]

PADD, that was really amazing. Thank you. Urge in your strength and your advocacy for so many and for all of those incredible tips that you gave to all of us we have a question here that I wanted to post to, out of all the things that you talked about that helped you the most, when you sit here today and hear all the things that the federal partners and State partners are doing, what would you want them to know? You talked about what would help the person that is really hurting, what would you want the rest of us to note to develop these action plans.

Let somebody know that your hurting. My friend could not have dragged me off the couch if I had not let him in the door. Let somebody know and let them be in that door and to partner with you in finding a way out of that hole.

What about the federal people that are here. What would you tell them? They are doing the right things. Richard said engaging those of us who've been in the depths of despair and asking us what worked and what helped. I engaging those would've been there and then on that path, we can more readily articulate those things that have helped to divert us from that path of self-destruction and that's why the peer support is so important. Somebody who is been through it can offer so much to help another person down the road. That service to others is very important. Thank you, again. Thank you very much. [ Applause ]

Our panel is good to switch and we're going to move up to another group of people, high risk groups, we all know that suicide affect many people throughout our country and the tragedy of suicide is not specific to one group. There are certain populations that are at high risk and those needs must be addressed for those populations. Today we are talking about three of those populations and this is in know way exhaustive. Instead it's a selection of high risk groups and in particular have expertise and can share with us things help things move forward. We have chaplain Heinz, Doctor Therese [ Indiscernible ], professor of native American studies at Stanford University, and national strategy task force member Abby [ Indiscernible ], the executive member [ Indiscernible ] among lesbian gay bisexual transgender and questioning youth. Please welcome them as they join the stage. [ Applause ]

We know we are going to start with you in the statistics regarding veterans and active military populations has been staggering and has been played out a lot in the media. We would like you to invite you to come up here and share with us what you know about that, what you work is that today and what you are doing to prevent suicide among that population. Chaplain Heinz.

Good morning. I would first like to mention that the population that we service the Army National Guard -- card into this piece in terms of the action plan what we do and in the lonely National Guard for members in terms of prevention [ Indiscernible ]. Partners in care just a brief, is a partnership between faith based communities and the National Guard and with this initiative our goal is to reach out to faith-based communities, develop a memorandum of understanding, a collaborative network within and to be able to serve military members as the need arises. Should say that at the forefront that we have a diversity of faith populations among our service members of the National Guard and so partners in care is not limited to one particular faith group. . What this is about is servicemembers we all live in specific communities will active-duty components, will they stay in an active installation, for national guardsmen such as myself I live in the Beverly Oaklawn Washington Heights community in Illinois and those around me provide the level of support and collaboration and community connections that I need. In addition to that I belong to faith based community or congregation in church and my experience is very common to other servicemembers and those faith-based communities that we reach out to when servicemen might have needs for the National Guard, our goal is to prevent suicide as mentioned before as seen in the media there is so many concerns about ideation and suicide completion. Our goal is to look at the human experience, that it perspective of servicemember such as their lifestyle, their income, financial issues that servicemembers are dealing with, partnering with some of the congregations to assist servicemembers and their time of need. What we have learned through our own internal research and investigation, servicemembers present to us issues of finances, family issues, certain pathologies and dysfunction that might exist and what that was but an a you will -- we had a servicemember who was incarcerated and we had a chaplain who was the program manager reach out to him and visit with him that servicemember actually wanted religious materials to assist him through his journey. Being a servicemember and then having the issue being incarcerated in an institution cannot -- kind of the dual perspective that was mentioned earlier that most people who have ideations, some of their issues that they [ Indiscernible ]. This particular servicemember we could not bring materials to him so we reached out to one of our faith-based partners of care who then contacted chaplain within that community so that the servicemen could get that [ Indiscernible ] that he wanted. Other examples of faith-based communities we had a servicemember was about to be evicted and effect his wife was nine months pregnant. Also he did not have employment and with that level of heightened stress, expecting a child, but to lose your home, unemployed, statistically we know that sometimes these issues lend themselves to ideations and sometimes attempts for servicemembers. Extended and reached out to one of our partners in care, they were able to assist that servicemember with finding a home, that particular faith based community also have a job. In which they were able to assist search -- the servicemember and that family effect is doing quite well. That was one of her partners in community and floss Mark, I'm s orry, Hanover Park. What we think about action plans in terms of prevention and suicide prevention in terms of partners in care, our goal is to partner with this these faith-based communities so they can be a research -- resource and our reach to servicemembers and in the communities in which they live. The Illinois National Guard has over 10,000 servicemembers and there are only about 22 chaplains that serve those servicemembers. We see the necessity of having our faith partners as a resource for outreach to assist us in meeting the needs of the service members across the state. I will and my presentation there because there may be some question at this point or -- a plus Mac -- [ Applause ]

Thank you very much chaplain Oluwatoyin Hines. We will keep moving on with our panel and if we have time for questions at the end, [ Indiscernible ], a wide Friday of University and American Indian and Alaska native settings. Professor has worked with a number of different ethnic minorities to survive [ Indiscernible ] so often typical and also neglected among children and adolescents. The professor will come up and share with us her information.

Thank you, Dan and thank you all for being here. It is really very exciting that so many people care about this topic at this time. If Dan mentioned, I cheered native American studies for 10 years that Stanford and I worked a lot in the area of native American mental health in particular the eight -- particularly the area of social science. And when Doctor Reid was talking about this wonderful event in your life and milestones, and I really think that having the invitation to develop a suicide prevention curriculum from the leaders of the global [ Indiscernible ] has certainly been a very important experience in my life. When I was at Stanford in the late '80s, we had a committee that was called the Sunni Stanford committee and it was a group of faculty members and leaders of the Zuni Pueblo will work together and the faculty members were there to respond to the request of the Zuni. It wasn't people looking to have sites sex with her studies it was people being responsive to the request of Zuni. As it turned out, one of the meetings, I set edited or next to the superintendent of schools and he asked me, if you want you know about suicide prevention? And I said I worked on a crisis line when it's working on my doctorate and I just read an article on cultural and cognitive considerations of [ Indiscernible ] with Dolores Bigfoot and that's about what I now know and he said we have a problem and we've been trying to decide within our community for a year now and a number of meetings whether or not to ask anyone from the outside to help us and we're not solving it on her own and so we are interested if you might be interested in working together. So of course, I ended up on my way to Sunni was able to get some support from the school of education and the Zuni tribe and over. Of three years we developed and evaluated a curricula -- and curriculum of the Zuni life skilled and later it was adapted for a number of different tribes and it had an ethnic [ Indiscernible ]. I like to tell that story because I think it very important and I think we have the images at times of victimization of native people and I'm going to talk about that a little bit in this presentation.

Here what we had is really a very interesting -- community organizational effort that made a big difference and it was not a major grant. It was supported by a little bit of money from the school of education at Stanford, that money from the Kaiser foundation, and then almost equally those entities and the Zuni tribe and so as we worked a lot for three years we collaborated anything that probably is the reason it was so developed and successful. So the paragraph that you see was published in the American psychologist a number of years ago it's an article and culture and suicide and the barge you they were beset different cultural groups, Native American, African American, Latino/Hispanic, Asian-American, Pacific islanders and Anglo. And I just want to point out that the tallest bars are of males and females are Native Americans. But we have great things happening we have great challenges as well. Over the years with his work I've tried to come up with what I thought was a theoretical orientation. I very much try to approach this incident this is a school-based and learning -based approach and they look a lot social learning theory but really this is sort of morphed -- this has morphed into a cognitive behavioral intervention and what you you'll see on this image to the left our number of risk factors. You could have any number but I selected these because in developing this model this comes from the research that now does exist on risk factors with Native Americans and native American adolescents. And so I am sort of clustered the risk factors into ecological factors, social factors, and of course individual factors that we think of many times. And I will go over it a little bit more because fortunately in this invitation, I've been invited to be able to talk about the importance of cultural and suicide prevention so I feel happy to be able to do that. I will see if this works or not. According to this idea, there is an array of risk factors that someone could be vulnerable to and a stressful event happened if people have options about the way they can respond. One might be avoidant coping and another might be approach coping. I chose this dichotomy avoidant and approach coaching because of the work over the years that's what I see and hear a lot about native communities is sort of this opting out, removing oneself from the situation, doing a lot of self isolation, perhaps drinking and not engage with other people and that eventually attempting -- attempting or taking one's life. I want to work at developing approach coping and so we have this option approach coping and if you ask what might be the active ingredients if there was any way to really determine in this kind of an intervention I would say that what we do continuously is emphasized positive thinking and effective problem solving. So it is very much cognitive and that respective of course we are building skills and we believe it would eventually believed to instead of suicide something like resilient adaptation. Handling the opportunities that come before us.

I just want to point out this is a culturally based intervention but it also is based on psychological theory and what we believe works well until the American Indian life skills of the social cognitive approach and I will go into it in a little more detail but when you do something like that I think we know in literature and we look at just the field and beginning results now and that it analyses about how important it is to culturally tailor something, we know they were going to do that we have to think what are the unique risk factors for that particular group so I just want to mention a few here. That I would say are very critical with Native Americans. And you can be involved and [ Indiscernible ] and not hear about historical trauma. This is a theme that prevailed in the field and I also think that the picture is worth a thousand words. This is an image of native children at Carlisle Indian school which is one of the first boarding schools in Pennsylvania. Imagine children being forcibly removed from their homes in order to go the school, the assimilation gold was it's too difficult to change the adults when people we're moved to reservation so therefore let's take the children away, killed the Indians and save the m an. What that research will tell us is that we do know that for native youth almost one out of five have daily or more thoughts about the tribes loss of land. There are many other light test items in this historical trauma scale but this is an example. In the other thing is and you ask about middle school aged children, if you ask about the parents historical trauma, they don't think about it as often. I think this point to the developmental issues that at this point in time people are becoming. Stupid politically. Another culture ration stress, many groups struggle with change and has been the mantra for native communities for long long time but we do have a few studies now that .2 the Association between pressure to acculturate and suicidal behavior and we know now that when people engage in enculturation which is the opposite being more knowledgeable about one's culture, that it certainly helps improve and certainly bolsters resilience and helps motivation for school and the number of other things. But definitely the [ Indiscernible ] Association. Again this is something that is important the work that I do because many SAMSHA project have funded what we call [ Indiscernible ] which is a gathering of Native Americans and of course the first thing that they would do it emphasized and help raise awareness about the historical trauma that people have gone through so that they can heal and move on. And so then that becomes so the backdrop of the beginning of our work and of course you mentioned over and over again the important role of substance abuse and then this is the last one that I think is really unique to American -- Native American population of those lists that is community violence. We now know that native Americans are victims to a lot of interpersonal violence, often on the part of non- native people. This is the fact from some work with Don [ Indiscernible ] when he worked with the village and he is showing the rate of suicide among those that were sexually abused by a teacher versus those in that area that were not affected. So anyway I think about these things, I think these are unique to the Native American population that should be factored into that the kind of work that we do --

Really we are teaching coping skills. I mentioned culture skills and you mentioned what is culture about that. What is culture about it is that we did engage the consumers and the development of all the scenarios the very realistic to reservation and life and what we trying to do and doing this of course is we want engagement and I say real resistance and just went to pick up the latest one that standardized on mainstream US population, rather than it's native specifics of people seemed to like this. The other thing this -- with all the work that's been done with suicide prevention I have people that are in the training that have up into gatekeeper trainings, they work with strength of suicide, they work with many so they really have those toolkit of interventions and they know more what to do. So just in terms of the effectiveness, we have seen that it reduces hopelessness, it increases his efficacy and to manage anger and behavioral videotape will role-play we see that [ Indiscernible ] problem-solving skills and this is the chart we see significant reductions in suicide, this is the work of Phil may [ Indiscernible ] and a comprehensive approach with the improve surveillance and worked with natural helpers and behavioral health etc. but they really improved everything and ours. The little part of it. This is an independent study that was done in northern New Mexico the Navajo nation and this is just 10 sessions from the curriculum. If not a treatment versus control group design, if the pre- post only but we did see some really nice benefits there. So, if think you closing what I would like to say is that I am fortunate to have been able to been invited to this training and a number of SAMSHA funded projects. I think it has improved my life a lot. I know in terms of families, my daughter is the one that keeps encouraging me because she worked in a psychiatric hospital South Dakota with many people from all over the state of South Dakota and actually used it with her patients and she said you know you really need to market this more and get the hell out a lot more. The other thing I would say is it's exciting to work with communities when they're developing their own. We have used this in East Palo Alto which is a community of largely immigrant population, some 01, Latino, and African Americans. No Americans but we did is we just change the context to East Palo Alto to an immigrant population. So it's exciting work in a very thankful to have the support to be an -- to have been able to do would have been able to do. Thank you. [ Applause ]

Thank you very much, Professor. It's really critically important information from the various cultural groups that can take this and modify the program and the excellent work that you've done. Moving all along I went to bring up [ Indiscernible ], Abby your population has very unique things that are taking place in terms of their need for social supports and we would like you to come and talk a little bit about what you know about that. Thank you.

Thank you very much, thank you for having me and what an exciting time to be here to talk about the work that the Trevor Project is doing. As many of you might have heard yesterday, the Supreme Court made a monumental ruling on marriage equality so that marriage equality is now of reality again in California and striking down of Thomas, it's such a powerful statement for those in that LG BT community and it was really great and as I was listening to the speakers today, I think it's really important to recognize the importancemportance of the national strategy on suicide prevention. I think if you had asked many people in the gay rights movement 20 or 30 years ago would marriage be a reality in their lifetime I think many people would've said no. And in a very short period of time, it is a reality and it goes to show the importance of people working together , of keeping their eye on the target and what they wanted to and not taking no for an answer. I think it's inspiring that we are here today because we really can make a dent in suicide prevention and it is really an honor to be here.

As we talk about suicide prevention for LG BT Q-letter youth and you know we are talking about is having an opportunity for a brighter future and yesterday's message says a lot to youth and it gives them a chance to think that yes there is going to be a happily ever after but for our -- young people of any age the future is so far away and what's really important is that there are still role models for young people and especially for gay, lesbian, transgendered youth for them to see that there are people like them that are achieving in sports and music and religion and it's just a very important thing and our young people really need that. At the Trevor Project, let me they did we get to the right side? I want you to understand the universe for our LG BT Q-letter youth. Suicide is the second leading cause of death for young people as young as 10 and that it's really something that we all know we all want to change but what we don't know we don't know the actual number of how many LG BT youth complete suicide but we certainly know that they have many attempts and we don't know the number because I'm death certificates, sexual orientation is not listed and we don't know quite yet how to get that information. But we will work on that but we do know that suicide is something that young people in the LG BT community to attempt quite often and as you can see for young people LG BT young people are three to four times more risk for suicide. If you come from the rejecting family, your eight times more risk for suicide and for transgender use, 25% have attempted suicide and even more have considered it. So we have a lot of work to do at the Trevor Project. The CDT recently recognized LGBT youth as a priority population and so that means that special work is being done. What you need to think about what we think about LGBT youth and their risks, so 40% of the homeless population of youth say that they are lesbian, gay, bisexual, transgender, 40% of homeless youth and probably the LGBT population is about 10% of the general population so young people being kicked out of their homes really put so many young people at risk. We also know that eight out of 10 LGBT youth experience bullying or harassment at school. That is almost every kid that identifies as gay, lesbian, bisexual, transgender, they get bullied or harassed at school and we know for every incidents of bullying, if potentially increase the sum of self harm by 2.5%. So it every incidents. LGBT put -- LG -- algae BT people are really at risk. That's where the Trevor organization comes in. We are the only national organization working on crisis intervention for suicide for gay, lesbian, bisexual, transgender and questioning youth we do a number of services help our crisis in interventions services start with our lifeline, it's a 247 lifeline for young people can cause and talk to a trained volunteer counselor and talk about their fears and talk about what they're going through. And though we are an organization that focuses on LGBT youth, we have 14% of our calls also confirmed you swipe densified as straight. They need to want to talk to anything they feel feel they can certainly say that they can say whatever they need to say to any of our concerts. We also have Trevor chat, we have instant messaging five days a week, hope to be at seven days a week of August and that it's a very important way for young people, we focus our work on young people 13 to 24 and any people who deal with young people you know they are always connected to technology for being able to chat with young people is really important and that we are piloting Trevor text so young people can reach out to us via their phones because they are always texting each other. I don't think young people talk to each other anymore. Along with their crisis intervention, we know that we have to do prevention because actually we would like our fault is never to ring, we would like people never to be chatting with us. That's where prevention comes in. We have a couple of ways of doing prevention. We have our Trevor education program and we're so excited. The cornerstone of her Trevor education program, our lifeguard workshop was just admitted into best the best practice registry for suicide prevention, it was the first LGBT focused curriculum and it's a great resource we have that we are making a DVD of that the sin that workshop will be available to classrooms all across this country. We also have the largest social networking site, Trevor space for LGBT to -- Q-letter so there are many parts in this country for people feel they are the only gay person in their community. The only person like this and they can come unto Trevor space and they can now talk to over 61,000 young people so that they feel like their friends and they are supportive and it's really wonderful and family have asked Trevor and ask Trevor R-letter's that people right to Trevor we have trained folks who answer them and all the questions and answers are posted on our our website with an amazing resource for people to have. But even with all of our services and think their going on on in the country, there is so much of that has to be done that you can see from this map, there are still many states were you can't even talk about gays and lesbians and bisexuals and transgender us because it's not just something that school curriculums would allow. And that's why we actually need all of you to be working on this important issue because every community have young people who are gay, lesbian, bisexual, transgender where they are just questioning who they are and you need to make it okay for them. You need to know that each one of us whether we are in individual or organization, we need to make it okay that young people know that they can ask us for help. And I would like to ask now we have a video that we've just done, it's a new public service campaign that we are going to be doing starting in August, making it okay to ask for help. Can we play that video?

I was feeling so alone. I was going through a really difficult time. I don't think they would u nderstand. It was tough at first but I did it and I'm glad I asked for help. I asked my teacher, I asked my dad. You can do this. Whatever it is asked for help. If you're thinking about suicide or need support call the Trevor lifeline. Thing counselors are there to help 247.

I was feeling so alone, I was going through a really difficult time. I was feeling so alone.

Asked for help, it is our newest campaign we really want to normalize for young person that it is okay to ask for help and we will have that public service announcements across the country, will have billboards, serial, we are debuting it at different pride filled night -- pride celebrations this month and this is something you can do in your community. Not only can you play our video but you can come up with ways to make sure that young people no they can ask for help and they can ask anyone for help as we know from the national strategy just talking to one person can make all the difference for someone who is feeling sad and depressed and thinking about suicide. We also have another --

Let me tell you about this other thing that we have [ Laughter ] -- I have a really great slide but I just can't so to. If called talk to me. Talk to me as a campaign that we also do encouraging people to talk to each other, there it is. Thank you very much. Goss, I'm good. Bathmat. You don't have to be trained to summon to talk to. You just have to be open to that. And this is something we've been doing every September so as you think about what you want to do toward September 10th and suicide prevention Day we actually use September as suicide prevention month and we do a number of activities and talk to me as important. You can have people go to our website and join talk to me and the kids different things to do in your community about engaging people and again about normalizing for young people that it is okay to ask for help. It is okay to talk to me. So just to summarize as you think about what you can be doing, LGBT Q-letter young people face prejudice, fear, hate, and it's only because of who they are. We have to take away these negative factors and let people be whoever they are and signed and accept t hem. At the Trevor Project that's what we do all the time. When we know we when we accept people for who they are it's a big step in letting them accept who they are. And to make sure that we offer these different strategies I think that together we really can make it a brighter future for LGBT -- LGBT to use. Thank you so much for having us here today. [ Applause ]

Thank you. Incredible presentations from our panel. I've been told that we are getting questions everywhere from Alaska to Florida from kids in high school from states all of the country and there trying to sort through all of them and we're going to work to respond to all of them, not today. But I want to take any of the question to the two panelists and give a one hundred fifty-second response to the chaplains and Teresa. Both came from one of the actual site. What would you say and 15 seconds for places that don't have mental health professionals, behavior health professional, where would you turn to for help her there's there is always a crisis line, [ indiscernible - low audio ] to assist individuals and there are also peer relationships [ Indiscernible - low audio ].

We encourage people because some communities at work and it may be a [ Indiscernible ] situation to really identify who are the trusted adult within their network of friends, the people they respect they feel would be confidential and they want to go to the we really have to prepare for that.

We do training for those trusted. My dad anything?

I think that it's just important that people know that if they are not a mental health professional, they should talk to somebody, somebody know that they need help.

That's right and I really think it does sum up a lot of messages you here today that we are all in this here together. This is a unified effort that takes everybody to save peoples lives. I want to thank the pelican and appreciate the time and bring up. And you can thank them. [ Applause ]

For those of us here in Chicago we are going to be taking a break and then going into our action steps. We ask you to do that on your echo site as well. You can continue to submit questions and we will be responding to those in due time. I can't stress this enough -- enough that the tools you heard about today in your professional experience, use those to create the plant that are going to help save lives across the country. We are not going to be collecting them but we ask that you use them and they don't have to be neat clean, they just have to be something that gives you a goal and something to reach work and strive for. We care that you provide yourself or your organization with a clear action plan and useful tools that are available to you that you heard about earlier today. Now is the time. There's never been a better time to plan for suicide prevention. Every moment counts in saving people's lives. . It's been a pleasure being here today and working with all the experts that spoke first about the panel members, I want to bring up Doctor Cody he will) -- he will close for us.

Today we have learned how suicide is one of the top public health issues in our country. Our nature is no stranger to public health achievements. The 20th century alone, we've made significant improvements in areas such as vaccination rates, motor vehicle safety, controlled infectious disease, and infant mortality. These public health topics and their success share two factors. A public health approach and community action. However, sometimes topics like suicide, mental illness and addiction, and social problems as opposed to public health issues. The communities and governments, the response for social problem as opposed to health needs of our community. Responding to social problem as opposed to public health issue sponsors individual blame and misunderstanding. It leads to discrimination, prejudice, and social exclusion. We end up focusing on the symptoms and not the root public health issue. The national strategy provides that the public health framework for suicide prevention. It is based on facts, science and data, it has a common message. It focuses on the health of our communities and is committed to the health of everyone. In turn the strategy calls for us to engage everybody, the general public, elected officials, schools, parents, houses of worship, health professionals, researchers, individuals would've been directly affected by suicide and their families, the national strategy provided -- provides us with a key component of the three Duke -- reduce that -- suicide, [ Indiscernible ] the other necessary factor will be community action and when community -- when communities take action we will see results. Fostering a national dialogue and building public support for suicide prevention will be the result of the individuals in this room take action. Promoting changes in systems and policies and environment that will support suicide prevention will be the result when participants on a webcast take action. Addressing the needs of vulnerable groups to eliminate health disparities will be the results when R-letter echo site take action. Transferring knowledge so that families and individuals know the signs of suicide, mental illness and addiction, and what to do about them, where to go for help for themselves and their families will be the result but communities take action. We have the necessary components to reduce suicide in this country. We have the strategy, the programs and the tools. But it will ultimately be the action of the community that turns the strategy into something meaningful. Over the next 75 days and beyond so that by national suicide awareness Day on September 10th we will have strategically advanced suicide prevention in our communities. A behalf of HHS region five workgroup members would like to thank everybody in person, and webcast, for participating in today's events. I would like to think our presenters and we urge everyone to complete your action plans and take the next step forwards we have an impact on our country and suicide prevention. Thank you again for your time. [ Applause ]

So between now and the next 15 minutes, we will have individuals in the Hall with help direct you in terms of where the rooms are for the breakout sessions, look forward to next power and action plan. [ Event concluded ]