Suicide Prevention at the Rhode Island Department of Health

In this interview, Jeffrey Hill—Violence and Injury Prevention Coordinator at the Rhode Island Department of Health—discusses how RIDOH’s suicide prevention work has evolved, key accomplishments, important collaborations, and future plans for this work.

Could you start by telling us a bit about current suicide prevention efforts through the RI Department of Health and what has changed over the last few years?

The program was initially funded in 2008 and we began by focusing on training. From the data, we saw that young people were dying by suicide while not in school, so we wanted to make sure that students were getting connected to support services while they were there. The program aimed to identify and screen at risk kids at schools, and then if necessary, refer these students to Kids’ Link to help triage them away from the emergency room. Since 2015, we have screened over 500 school-aged kids through our Suicide Prevention Initiative or SPI. Our initial goal of SPI was to engage 42 schools, but we have now been able to engage over 70 schools throughout Rhode Island. We are also now working with school crisis teams to more effectively connect kids with care.

Though we did not think we were going to be funded for this year, we recently found out that we did receive funding, and we are now focusing on getting everything coordinated as we start the new grant. However in July, when we received word that we were not going to be receiving funding, our state partners were prepared to help keep our initiatives moving forward. The leadership and staff at BHDDH and DCYF are the unsung heroes as they have recognized the value in the work that we are doing, and they helped to fund some of this work. For instance, BHDDH and DCYF helped to maintain the Kids’ Link RI hotline. BHDDH added the National Suicide Prevention Lifeline (1800-273-8255) contact to its BH Link service, and this was very important as we were at risk of losing certain funding streams had we not been able to maintain a certain call percentage. We also received some funding from our Maternal and Child Health program at the Rhode Island Department of Health to help sustain training around screening in schools. I think these things speak to the importance of partnerships between state agencies. We recently received a new CDC grant in November to conduct Syndromic Surveillance of Nonfatal Suicide Related Outcomes in emergency departments. This has allowed us to monitor for suicide attempts in real time among all ages. These data will help us to better understand suicide related trends and be more proactive with regards to prevention efforts. Additionally, we are working with two different groups on Zero Suicide initiatives.

Can you tell us about some of the key successes that have occurred in RI in terms of suicide prevention?

One of the main successes has been the enormous decrease in suicide rates for the state. Since 2016, Rhode Island has gone from having the 16th lowest suicide rate in the country to the lowest, and this has been the case for two years in a row. This is an enormous testament to the hard work that people on the ground are doing. Another key success has been the continuity of effective training, screening, and referral within the schools we work with. All of the people doing this work are using the Columbia Suicide Severity Rating Scale—a standardized screening tool—and I think that having a universal screening tool has helped to improve communication as everyone is able to speak the same language. Additionally, our training, screening, and referral program has enabled us to measure risk when it is actually happening rather than two to eight hours later in the emergency department. We think it is likely that if we send people to the emergency department less frequently, they will be more likely to say something when they feel they need to go to an emergency department.

Using three years of suicide fatality data, we have been able to identify times at which suicide risk is highest for teens. Using this data, we hoped to reduce deaths during the months that posed the highest risk for teens, and we have been able to do that. As we move further upstream with our prevention efforts, we hope to prevent the spikes that we see in the attempt data by working proactively to reduce anxiety, stress, depression, or other factors that may be contributing to increased attempts among that age group.

Based on the data you have collected, which populations are you primarily focusing on reaching? Are there any populations that are more challenging to reach, and if so, how do you aim to reach these groups?

We are universally targeting middle and high school students and we were recently doing some ancillary work with college age students through CCRI. Our goal in working with CCRI is to connect them with a local mental health center so that students have a place to go for counseling and referrals. People who are between the ages of 18-24 who are not in college are the most challenging population to reach. Within this group, 19-year-old men are particularly challenging to reach and they frequently struggle with issues related to relationships. Relationships and loss of relationships are an area of focus that we need to address within our suicide prevention efforts. I think we need to do more in terms of creating programs to address these issues and to help people think ‘what’s next?’ rather than ‘this is it’ when dealing with relationship loss.

Can you tell us about the work that the RI Department of Health is doing with regards to suicide prevention among veterans?

We have done a lot of work focusing on the service population, and specifically, on young veterans. Currently, we are working to support a new Governor’s Challenge to Prevent Suicide Among Service Members, Veterans and Families, and we have been working with the Rhode Island National Guard, Providence VA, and Warwick Vet Center for quite some time. There are a lot of national headlines around veteran suicide, and we often hear the quote ‘22 a day’, reminding us that 22 veterans die by suicide each day in the United States. However, only four to six of those veterans are usually connected to VA healthcare. Our goal is to figure out how to connect these veterans to care if they are not accessing care through the VA. Some veterans may not qualify for VA benefits, but veterans can still access some VA services even if they do not qualify for benefits. For instance, the VA has a walk-in mental health clinic that veterans can access regardless of whether or not they receive benefits. We are also working with the Vets Center in Warwick to find ways that they can support veterans and their families in order to decrease suicide risk.

In addition, we work closely with the National Guard. Rhode Island’s Air National Guard are some of the most employed units in the country and there are many stressors that go along with that such as time away from family and readjustment. Through our work, we aim to identify stressors, support people in dealing with these stressors, and find ways to help service people connect to the care that is available to them. For many service people, stigma around accessing care and negative cultural perceptions of behavioral health issues pose barriers to accessing behavioral health supports. For instance, if someone has high security clearance and is dealing with substance use issues, they are not likely to go to the VA for care as they might worry that someone could find out about their substance use and they could lose their job. Thus, it is very important for us to think about places outside of the VA that service people can go to within their communities to access behavioral health services.

We sat down with you in 2015 to learn more about the RI Youth Suicide Prevention Project. What have been some of the most important successes of this project? Can you tell us about how this project has evolved since we last spoke with you?

During this next phase, we will be partnering with the mental health clinic at the Kent County courthouse to do more work around supporting youth within the juvenile justice system. We will also be working with Friendsway to fund a grief support group for youth. Families can be at higher risk of suicide if someone in that family has died by suicide. Though there are some grief support groups for adults, this will be the first grief support group in Rhode Island for kids. Both of these endeavors will be new and important areas of focus for us.

Can you tell us about how the RI Department of Health’s suicide prevention work fits into the larger behavioral health system in Rhode Island? Who are some of your organizational partners and how do you collaborate with them?

Again, the success of this work is truly a testament to our community partners. We would not be able to do this work without the help of the amazing staff at Rhode Island Student Assistance Services and Bradley Hospital. On the research side of things, we collaborate with the Consortium for Research Innovation in Suicide Prevention at Brown University, and there is currently a lot of suicide prevention research happening in Rhode Island. We are also very fortunate to work with and be supported by the Rhode Island chapter of the American Foundation for Suicide Prevention as well as the South County Healthy Bodies, Healthy Minds Health Equity Zone and the Bristol Health Equity Zone, both of which are very active in terms of suicide prevention. In addition, we are working to build a broad range of partnerships with community mental health centers, hospitals, and community members so that we can better support effective responses on the ground.

All of our partners are extremely important and we value opportunities to connect with community partners and learn about what they are doing. Substance use treatment and support, behavioral health care, physical activity, and social connectedness are all so important with regards to the work that we do, so collaborating with partners that offer services around these protective factors is imperative for us.

How do you envision the RI Department of Health’s suicide prevention work evolving?

I don’t know where we will be in five years, but my goal is for people to feel more connected and know where to go to get the resources they need. Furthermore, I hope that people will continue to learn to feel comfortable enough to say something when something is amiss. It is crucial that people feel like they have someone to talk to and that they feel valued, so even just having regular conversations is essential to supporting continued decreases in Rhode Island’s suicide rate. Rhode Island has done well, but we can always do more.

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