INDIANA STATE SUICIDE PREVENTION PLAN JOURNEY FROM HOPELESSNESS TO HEALTH Indiana State Suicide Prevention Plan Presented by the Indiana State Department of Health and the Indiana Family and Social Services Administration, Division of Mental Health and Addiction. Table of Contents The Personal and Public Tragedy of Suicide in Indiana .......................... 3 Teenagers and Young Adults ............................................................... 4 Child Maltreatment ............................................................................. 6 The Lesbian, Gay, Bisexual, and Transgender Population .................... 7 The Older Adult Population ................................................................. 8 Ethnic and Racial Minority Groups ...................................................... 9 The Military ....................................................................................... 11 State of Suicide Survey ......................................................................... 12 Indiana Suicide Prevention Action Areas ............................................. 13 I. Awareness ...................................................................................... 13 II. Prevention ..................................................................................... 16 III. Intervention .................................................................................. 18 IV. Postvention .................................................................................. 20 V. Evaluation ...................................................................................... 22 Legislation ............................................................................................. 24 Resources .............................................................................................. 28 References ............................................................................................ 30 Suicide Advisory Committee................................................................. 32 INDIANA STATE SUICIDE PREVENTION PLAN 1 We would like to thank the courageous individuals who shared their heart-breaking stories with us. We commend their continued efforts in suicide prevention in Indiana. Our wish, like theirs, is a state working together to prevent the tragic loss of life by suicide. For more information about suicide in Indiana, visit: www.IN.gov/isdh/20627.htm (youth mental health and suicide attempt) www.IN.gov/isdh/25194.htm (adult mental health) www.IN.gov/isdh/reports/mortality/2009/table09/tbl09_00.htm (suicide among all ages) INDIANA STATE SUICIDE PREVENTION PLAN 2 The Personal and Public Tragedy of Suicide in Indiana Burden of Suicide in the United States The facts on suicide are staggering. More Americans die from suicide every year than from homicide. In 2009, nearly 37,000 suicides oc- curred, an average of one life lost every 14.2 minutes. In 2009, suicide In 2009 in the was the 10th leading cause of death overall and 3rd for those ages 15–24 U.S., one life years. It is estimated that more than 900,000 Americans need emer- gency care annually due to a nonfatal suicide attempt. This translates was lost to to one attempt every 34 seconds and 25 attempts for every death by suicide every suicide.1 14.2 minutes.1 In addition to the emotional impact on families and friends, suicide also places an enormous financial burden on our society. The Cen- ters for Disease Control and Prevention (CDC) estimated the cost to society of $26.7 billion in combined medical and work loss costs in 2005.2 For each suicide prevented, the United States could save an average of $1,182,559 in medical expenses and lost productivity.3 Burden of Suicide in Indiana In 2009, 826 suicides occurred in Indiana, making suicide the 11th leading cause of death among Hoosiers. The majority of these deaths occurred among those ages 25–64 years (72%).4 826 Hoosiers Suicide was the 2nd leading cause of death among those ages 15–34 died by suicide years, the 3rd leading cause of death among those ages 10–14 years, and the 4th leading cause of death among those ages 35–54 years.4 in 2009, making it the 11th In 2009, Hoosiers between the ages 25–34 had the highest rate of hospi- talization (72.7 per 100,000) due to self-inflicted injury or suicide attempt, leading cause while those ages 15–24 years had the highest rate of emergency depart- 4 of death. ment visits (182.0 per 100,000).5 Suicide is a complex problem, resulting from one or more biological, psycho- logical, environmental, social and/or cultural factors. Several factors can put a person at risk for suicide. But, having these risk factors does not always mean that suicide will occur. Known risk factors include: • Previous suicide attempt(s) • Family history of suicide or • Barriers to care • History of depression or violence • Physical illness other mental illness • Financial or relationship losses • Feeling alone • Alcohol or drug abuse • Lack of social support There are also factors that help protect people from suicide. Certain protective factors, such as problem-solving and conflict resolution skills, strong family and community connections, and access to effective clinical care for mental, physical and substance abuse disorders, can help counter these risks and challenges. INDIANA STATE SUICIDE PREVENTION PLAN 3 Did you know that in Indiana: 4,5 • More than 800 people a year die by suicide-- an average of 2 Hoosiers a day. • Suicide is the 11th leading cause of death among Hoosiers of all ages; it is the 2nd leading cause of death among Hoosiers ages 15–34 years. • More Hoosiers die by suicide than homicide. • It is estimated that more than 4,000 Hoosiers will seek emergency care this year for injuries related to suicide attempt. Voices of Suicide Survivors The designation of a “suicide survivor” refers to the family and friends who are directly affected and impacted by the suicide death of their loved one. This definition does not represent all the people affected by the suicide, such as those affected by a suicide death in a school, faith community or other community setting, but refers to those who were closest to the victim.1,6 Survivors of suicide are themselves at an increased risk for suicide. Experts have estimated that each suicide intimately affects at least six other people.1 Based on this estimate, there are about 5,000 new people affected by the tragedy of suicide in Indiana each year.4 Suicide among Teenagers and Young Adults Young people with mental health problems, such as anxiety, depression, bipolar disorder, or insom- nia, are at higher risk for suicidal thoughts, as are teens experiencing major life changes, such as the divorce of parents, moving, or change in financial security. Victims of bullying are also more likely to think about suicide.7 The Youth Risk Behavior Survey (YRBS) monitors health risks and behav- iors among Indiana high school students. The results below from the 2011 YRBS show that nearly three out of ten high school students felt so depressed that they stopped doing their usual activities, and more than one out of ten actually attempted suicide.8 Depression and Suicide among E.R. Visits/Hospitalizations and Deaths from Suicide Attempts Indiana Students, Grades 9-12 Ages 15-24, Indiana, 20094,5 During the past year: 1268 Hospital Visits 29% felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing their usual activities. 978 19% seriously considered suicide. Hospital Visits 14% made a plan about how they would attempt suicide. 11% actually attempted suicide. 4% made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated medically. 29: the average annual number of suicide-related deaths among Indiana 14-18 year olds during 2004-2008. 98 Deaths 11 Deaths Source: Indiana Youth Risk Behavior Survey, Indiana State Department of Health Males Females INDIANA STATE SUICIDE PREVENTION PLAN 4 For teenagers and young adults ages 15– 24 years, suicide is the 2nd leading cause of In 2009: death.4 But deaths from youth suicide are only part of the problem. For every sui- • 109 Hoosiers ages 15–24 took their lives.4 cide death, there are about 15 emergency • More than 1,600 Hoosiers ages 15–24 department visits due to suicide attempts. visited the emergency department due Although girls are more likely to attempt 5 suicide, boys are much more likely than to self-inflicted injuries. girls to die by suicide.7 Loss of a Son “His heart, his laughter, comedy and smile are with me all the time…that precious young man that I am blessed to call SON.” –Lisa B., Noblesville “There is no way to accurately explain what it is like to have lost a loved one to a disease that so many do not recog- nize, understand, or care to acknowl- edge. There is no way to convey the hole in our hearts to individuals that cannot get past what shame it is be- cause ‘we did not outlive our children’. They are right we should not outlive our children, so let’s do something Lisa and Doug B. with son, Kurt about it rather than just say what a shame it is. Let’s talk about the fact that my son was a handsome young man, strong in his love for children and animals, hilariously funny, and artistically creative, but suffered daily with a depressive disorder. Let’s talk about the stigma linked to anything labeled as a ‘men- tal illness’ and the reluctance to admit to anyone that such a problem might exist. Let’s talk about the never ending pain that will forever reside in a father that misses his son