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Improving Care to Prevent Suicide Among People with Serious Mental Illness PROCEEDINGS OF A WORKSHOP Steve Olson, Rapporteur Board on Health Care Services Health and Medicine Division Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education PREPUBLICATION COPY: UNCORRECTED PROOFS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 This activity was supported by the Substance Abuse and Mental Health Services Administration (Task Order 283-12-6101). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25318 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Improving care to prevent suicide among people with serious mental illness: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25318. PREPUBLICATION COPY: UNCORRECTED PROOFS
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the studyâs statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committeeâs deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS
PLANNING COMMITTEE ON IMPROVING CARE TO PREVENT SUICIDE AMONG PEOPLE WITH SERIOUS MENTAL ILLNESS1 M. DAVID RUDD (Chair), President, University of Memphis TERESA BROCKIE, Assistant Professor, Community Public Health Nursing, School of Nursing, Johns Hopkins University M. JUSTIN COFFEY, Vice President and Chief Information Officer, The Menninger Clinic CHELSEY GODDARD, Vice President, Education Development Center, Inc. AIMEE C. JOHNSON, Program Specialist, Public Private Partnerships, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Portland VA Medical Center NADINE KASLOW, Professor, Department of Psychiatry and Behavioral Science, School of Medicine, Emory University ANDREY OSTROVSKY, Chief Executive Officer, Concerted Care Group Project Staff MARC MEISNERE, Associate Program Officer JOSEPH GOODMAN, Senior Program Assistant WENDY KEENAN, Program Officer (until July 2018) NATALIE PEROU LUBIN, Senior Program Assistant (from September 2018) SHARYL J. NASS, Director, Board on Health Care Services NATACHA BLAIN, Director, Board on Children, Youth, and Families Consultant BRIDGET B. KELLY, Principal Consultant, Burke Kelly, Inc. 1 The National Academies of Sciences, Engineering, and Medicineâs planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS v
REVIEWERS This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: GRETCHEN HAAS, University of Pittsburgh MIKE HOGAN, Hogan Health Solutions, LLC KEITH WOOD, Emory University School of Medicine Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by PATRICK DELEON, Uniformed Services University of Health Sciences. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. PREPUBLICATION COPY: UNCORRECTED PROOFS vii
CONTENTS 1 INTRODUCTION AND OVERVIEW 1 2 PATTERNS OF RISK AND THE PREVENTION LANDSCAPE 7 3 SUICIDE PREVENTION IN HEALTH CARE SYSTEMS 23 4 MILITARY SERVICE MEMBERS AND VETERANS 35 5 NATIVE AMERICANS AND ALASKA NATIVES 43 6 CONNECTING PREVENTION ALONG THE CONTINUUM OF CARE 55 7 PERSPECTIVES ON THE FUTURE ALONG THE CONTINUUM 63 8 IDEAS FROM THE BREAKOUT SESSIONS 71 9 REFLECTIONS ON THE WORKSHOP 75 APPENDIXES A WORKSHOP AGENDA 79 B BIOGRAPHICAL SKETCHES 83 PREPUBLICATION COPY: UNCORRECTED PROOFS ix