By Adem Lewis / in , , /

Operator: Good day everyone and welcome to
the Suicide and Substance Use in Young People Conference Call. Today’s call is being recorded. At this time, I’ll turn the presentation
over to David Wilson. Please go ahead. David Wilson: Good afternoon, everyone. My name is David Wilson, I am the National
Prevention Week Coordinator. I work for the Center for Substance Abuse
Prevention, which is under the Substance Abuse and Mental Health Services Administration. I am acting as your moderator today, and I
am so very, very pleased to know that we have got a full, full slate of participants for
this webinar. Last I checked, we had over 1,000 registrations
for this webinar. So, what that says to me is that this topic
is very relevant and top-of-mind to a lot of people. And I just want to say to everybody who’s
participating: you’ve come to the right place for all of the questions that I already
see as a part of this chat pod[?]. So, I’m going to give a little introduction
of National Prevention Week, an overview of why we’re here. And then I’m going to shut up and turn it
over to the three dynamic speakers that we have, that is going to lead the majority of
this discussion today. Again, my name is David Wilson. Like I said before, I’m the Coordinator
of National Prevention Week. Let me go over today’s agenda, before we
get into the meat. Like I said, I want to do a quick, brief overview
of National Prevention Week and then we are going to focus this discussion on Suicide
and Substance Use: Challenges and Opportunities. And we’re going to take this perspective
from a prevention, treatment and a recovery perspective. And we will have not only the speakers representing
our agency under those three focuses, but we also have one of our National Prevention
Week partners from the Jed Foundation. And then after that, we are going to have
a rich Q&A discussion, which I already see from the Chat pod, that we are going to have
some lively discussions. And then, we’re going to end with some next
steps, not only on this topic, but next steps for things that are forthcoming for National
Prevention Week. So, what is National Prevention Week? National Prevention Week is in its fifth year,
it’s a national, annual health observance dedicated to increasing public awareness of,
and action around, substance use and mental health issues. I always like – as I’m talking about National
Prevention Week – I like to put out what the three main goals of National Prevention
Week are. And the first one is the one that is most
relevant to me, and I think it’s most relevant to all of you who are joining us on the phone;
it is to involve communities in raising awareness of behavioural health issues and the implementation
of prevention strategies around those issues. So, basically what that means to me is the
communities are showing us, through National Prevention Week, what prevention looks like
around a particular topic. The second goal is we want to foster partnerships
and collaborations with our federal agencies and national Organizations dedicated to these
topics that we’re talking about for National Prevention Week. So as we talk about a topic like suicide,
we know that SAMHSA isn’t the only game in town around that issue; that there are
other partners that talk about these issues and have a wealth of knowledge and tools and
resources to bring to bear. And so, we want to partner and expand the
reach and the knowledge of a particular issue. So, that’s our second goal. And then third, we’d like to promote and
disseminate quality behavioural health resources in publications, of which this webinar is
one example of us trying to demonstrate – I’m sorry – to disseminate information around
a behavioural health issue. So those are the three basic goals of National
Prevention Week, which always leads me to my next question, or the next question that
I usually get from individuals is: Why should I get involved? Why should I care about National Prevention
Week? Well, one, you will be a part of the national
dialogue around substance use prevention and intervention. It also gives you an opportunity, if you work
for a community Organization or one of the many, many grantees that SAMSA funds or many
of our federal agency funds, you can take that opportunity to raise awareness around
these issues, and also raise awareness around the types of services that your community
Organization may provide. You can introduce your organization to new
audiences and potential partners around some of these issues, and lastly – and most importantly
– you can make a difference in your community. So, I’ve talked a little bit what it is,
why you should get involved. This year’s theme for National Prevention
Week is “Making Each Day Count”, which to me means that everybody has a role in prevention;
whether you’re an individual, whether you’re a community organizer, whether you’re in
law enforcement, whether you’re a physician, everybody has a role and a stake in prevention. I talked a little about some of the issues
that we cover under National Prevention Week. I just want to give you a quick breakdown
of the themes that we’re covering for this year’s National Prevention Week. So, we cover the Prevention of Youth Tobacco
Use, the Prevention of Underage Drinking & Alcohol Misuse, the Prevention of Prescription and
Opioid Drug Misuse, the Prevention of Illicit Drug Use & Youth Marijuana Use, the Prevention
of Suicide and, lastly, we wouldn’t be the Substance Abuse and Mental Health Services
Administration if we didn’t talk about the promotion of mental health and wellness. The last thing that I want to say about our
National Prevention Week is that if you see on your screen, we have tools and resources
that support all of these behavioural health issues. And we invite you to go to www.samhsa.govPreventionWeek,
and that’s where you will see all of the tools, materials, the strategies, even the
community successes around these issues that will further raise awareness around this issue
and put these issues on the national map. I’m going to shut up now, and get to the
meat of the webinar by introducing one of our three excellent panellists for today’s
discussion. Our first speaker up is someone that is not
only an expert in the field, but someone that I am proud to call a colleague of mine within
SAMHSA, Dr Richard McKeon. I’m going to read a short bio before Dr
McKeon speaks. Dr McKeon received his PhD in Clinical Psychology
from the University of Arizona, and has a Masters of Public Health and Health Administration
from Columbia University. He has spent most of his career working in
community mental health, including 11 years as the Director of a psychiatric emergency
service, and four years as an associate administrator and clinical director of a hospital-based
community mental health Center in New Jersey. He is currently the Chief for the Suicide
Prevention Branch in the Center for Mental Health Services of SAMHSA, where he oversees
all branch suicide prevention activities, including our Garret Lee Smith’s state and
Tribal Youth Suicide Prevention grant programmes. I think I could go on and on and on talking
about Dr McKeon’s accomplishments, but I’m sure you will see and you will hear just the
wealth of experience that he brings to bare. So without any further ado, Dr Richard McKeon. Richard McKeon: Thank you very much, David. I’m very glad to be here with everyone to
talk about this extremely important topic. And, you know, there are a number of reasons
why this topic is particularly important now. Suicide has been increasing in the United
States across almost all age groups. And given the magnitude of the relationship
between suicide and substance use, it’s imperative that this issue be addressed, and
that we work to prevent deaths and injuries from this. There are a number of different aspects to
this. One is the frequent presence of substance
use when someone dies by suicide or makes a suicide attempt. Another is the high prevalence of suicidality
among those in substance misuse treatment. It is also important to be aware that many
overdose deaths are suicides. And I did see a question that came in about
how do we know the difference. And sometimes we don’t. Sometimes it’s unclear whether an overdose
death was intentional – and therefore a suicide – or unintentional, and would then
be classified as accidental death, as an accidental overdose. It’s thought that the official suicide statistics
are likely an undercount for these reasons because only a minority of suicides, for example,
will leave a suicide note or otherwise clear indication of what was on their mind at the
time that they took the action that they did. So, we have more data than we’ve had before
regarding the issue of substance use and suicide. The Centers for Disease Control, the CDC,
has a system called the National Violent Death Reporting System, which is now able to track
on the issues much more systematically for violent deaths, in terms of the presence of
drugs or alcohol. The System has now expanded to 42 states;
the data that has been analysed to date comes from the first 17 states that were part of
this System. And from that, the estimate is about 22% of
suicides involve alcohol intoxication. So that’s more than one in five of all deaths
by suicide, based on this information, would involve alcohol intoxication. And that number would go up if you include
any alcohol use, not only alcohol intoxication. It goes up when there’s measurable blood
alcohol levels present, even if it doesn’t rise to the level of the legal limit for intoxication. Some studies have shown that between 30% and
40% of suicide attempts involve alcohol intoxication. And alcohol is the substance that has been
most frequently studied in terms of its relationship to suicide. But we also have additional information coming
from the National Violent Death Reporting System around other drugs, so opiates, including
heroin and prescription painkillers, were present in 20% of the US suicide deaths in
these 17 states, marijuana in 10%, cocaine 4%, amphetamines 3%. So substance misuse is second only to mood
disorders, in terms of its association with suicide. We tend to associate suicide with depression,
and frequently people who make a suicide attempt or die by suicide are clinically depressed. But substance misuse is second only to those
mood disorders in terms of its association with suicide, and comorbidity increases the
risk even further. So if somebody, for example, has a major depressive
episode and they’re drinking or they’re using drugs, it will increase the risk. There are other areas that have shown us the
important interconnections between suicide and substance use; for example, the fact that
suicide mortality can be impacted by changes in alcohol-control policy. So for example, when states increase their
drinking age from age 18 to 21, that was associated with decreased mortality from suicide, estimated
at about 600 lives annually. Also, depending on how you analyse patterns
of alcohol consumption, you see different patterns of increased risk. So there’s an association between suicide
and binge drinking, as well as what per capita consumption, binge drinking being more associated
with short-term risk; per capita consumption with long-term risk. So the National Institute of Mental Health,
along with the National Action Alliance for Suicide Prevention, has put together a research
prioritisation document for the areas that if we intervened in, we could have the most
impact in reducing suicide and suicide attempt. They use SAMHSA’s NSDUH data – the National
Survey on Drug Use and Health – to estimate that about 2 million adults were treated each
year in facilities for substance abuse. And of those, about 17% or 395,000 reported
suicidal thoughts, and 5% or just over 100,000 attempted suicide in the past year. And therefore, they estimated that if an intervention
to reduce suicide risk was able to be introduced to all these individuals, and it had 50% effectiveness,
that it could prevent 53 attempts at suicide per year. We also know that there have been increases
in Emergency Department visits for drug-related suicide attempts by both men and women and
that every year, more than 650,000 people receive treatment in emergency rooms following
suicide attempts. And many of those are drug-related. The Emergency Departments are a particularly
challenging place in terms of these issues, because people who are suicidal but also misusing
substances, may receive fragmented care in the Emergency Department. As I said, I worked in a medical emergency
room running a psychiatric emergency service for a long time. Medical staff frequently see suicide as a
mental health issue, they want Mental Health to take charge. Mental Health typically wants the patient
medically cleared, meaning they want the blood alcohol level to drop below the legal limit
for intoxication before an evaluation takes place. Inpatient Psychiatry may see the person as
a substance misuser who needs detox and rehabilitation, but the Detox Unit may see the person as needing
Mental Health because of them being suicidal. So, there are numerous complexities. Now we know – and again alcohol is the area
that’s been focussed on most intensively – we know that there are different kinds
of mechanisms that are likely involved in terms of the relationship between alcohol
use and suicide; that the risk for attempts might be increased by increase in dysphoria
and intensity of suicidal ideation when somebody’s drinking. And some studies have shown this in the 24
hours before a suicide attempt. There’s research by Courtney Bagge at the
University of Mississippi Medical Center. Then it can be also be due to what is called
is alcohol myopia, a cognitive construction or tunnel vision, where once a person is locking
in on the idea of suicide while they’ve been drinking, that the have a difficult time
thinking of anything else. And then alcohol of course, can lead to disinhibition. And so inhibiting a response – a desire
to harm oneself or kill oneself, a decrease in that inhibition can lead to actually acting
on the ideation. We do know that many, many more people think
about suicide than act on it, thankfully. And alcohol, by reducing that inhibition,
can make it more likely the person will act on it. And so the acute transition from thinking
about suicide to acting on suicide is a hugely important issue. Compounding this is the fact that, like for
mental illness, people with substance use disorders are often not getting treatment. In these data – they’re a few years old
now – so that’s only 18.3% of those with substance use disorders are receiving treatment;
mental illness a little bit better at 37.9%. But you can see the comparison with medical
diagnoses like diabetes, heart disease and hypertension, where a much greater percentage
of people are receiving care for their problems. But one of the things that SAMHSA has – along
with many of our partners – has been really focussing on, is how to make suicide prevention
a core component of healthcare, in mental health settings, in emergency rooms, in substance
abuse treatment settings and then in primary care settings. There are a number of pieces to this that
are really important. One is around screening and risk assessment. And in the substance abuse field, the expert
is already frequently used. So connecting expert to suicide screening
and risk assessment is an important area for additional work. It’s also quite important that the clinical
workforce is routinely trained. Many training programmes, unfortunately, in
mental health, psychology, social work, counselling, etc., do not routinely train in suicide risk
assessment. So, suicide risk needs to be a competency
of the workforce. Another competency is being able to collaboratively
safety-plan with people who are at risk or having thoughts about suicide, to work together
to try to find a way to help keep the person safe. There are also some specialty treatments that
have been developed that have shown effectiveness for people who experience both problems with
substance use and with suicidality. For example, there is a form of dialectical
behaviour therapy which has, in multiple randomised control trials, shown reductions in suicide
attempts called DBTs. And this was created by Dr Marsha Linehan. Anthony Spirito up in Rhode Island has been
involved with a treatment for adolescents with substance use and suicidality. The issue of continuity of care during high-risk
transition times is also really important. When people leave emergency rooms after an
overdose, whether it’s intentional or not – intentional, this is a time of high risk. And our systems of care do not typically do
a good job of maintaining contact with people during these high-risk times. And we think that healthcare systems need
to be routinely monitoring and reviewing suicide deaths to help guide quality improvement. The link between suicide and substance abuse
can be seen in the Adverse Childhood Experiences Scale, where with increased trauma, there’s
also increased use for drug and alcohol abuse and for suicidal ideation and attempts. In Utah, a major study of the juvenile justice
system showed that 63% of youth who died by suicide had contact with the juvenile justice
system. But a little more than half of them who had
contact with Juvenile Justice, had a referral for substance possession use or misuse. So again, you can see the significant overlap
between substance use and suicide. And then there are common risk factors for
premature death and that’s what this slide – so that these common risk factors can
lead to differing tragic outcomes, including suicide, accidental overdoses or other poisonings,
and motor vehicle accidents. It’s likely – and in addition to motor
vehicle accidents driving under the influence, and so forth. Probably some single vehicle accidents may
in fact be suicides. One resource that has been created by the
Center for Substance Abuse Treatment, called the TIP 50: Addressing Suicidal Thoughts and
Behaviours in Substance Abuse Treatment. And the information on how to access that,
as well as a training video around it, is on the slide. And I think that most people that have used
it, have reported that it has been very helpful. So this is my contact information, and you
can find information about SAMHSA’s Suicide Prevention Grants on the SAMHSA website. There’s also lots of information about suicide
on the Suicide Prevention Resource Center website at, which is a National
Technical Assistance Center for Suicide Prevention that SAMHSA funds. So with that, I appreciate having the chance
to talk with you. I’d be glad to answer questions later, and
I’ll turn it back to David to introduce our next speaker. David Wilson: And thank you so very much,
Dr McKeon. I was – I learned a lot myself, and I was
thinking that with the wealth of information that you brought just in your slides alone,
you could have conducted this whole webinar just by yourself. But luckily we also have two other speakers. Our second speaker, her name is Audra Stock,
and she is the Division Director for the Division of Services, Improvement, and our sister Center,
the Center for Substance Abuse Treatment. She is responsible for managing a comprehensive
grant portfolio focussed on improving access to care, promoting high quality treatment
and recovery services for individuals, youth and families. She too, like Dr McKeon, brings a wealth of
experience and just through her slide presentation alone, you’re going to see how much knowledge
she brings to bear. So without any further ado, Audra Stock. Audra Stock: Thank you so much for that nice
introduction, and thank you all for your interest today in this important topic. So I’m going to jump right in. As mentioned a moment ago, I am with the Center
for Substance Abuse Treatment, so I tend to focus in that area and want to share with
you our vision, and how you can help us achieve this vision because you’re a big part of
that. So basically, what we’re trying to accomplish
across this nation is ensuring that everyone who has a substance use disorder, including
those with complex, co-occurring condition, are identified and connected to appropriate
and quality care. And that everyone who has a substance use
disorder has equal access to high quality treatment, and that they’re able to pursue
their uniquely individual path to recovery and good health. And I think we all share that today and that’s
why we’re here talking about this. I’m going to try and Organize my presentation
into these four areas: sharing some data and science, talking about the importance of access
and quality from across prevention to treatment and recovery, a little bit about the continuum
and how we can create that continuum and leverage that continuum to create better outcomes for
our youth and our families, and then of course your important role in making that happen. So starting with the data and the science,
those of you who are prevention leaders, you know how important the data is. It helps tell the story and helps us get closer
to accomplishing our goal. I think we know that there’s a high cost
in this country related to untreated substance use disorders. We estimate about over $4 billion annually
related to crime, healthcare issues and lost productivity. Many who should be receiving treatments or
accessing treatments, they don’t consider their youth problematic, and they don’t
feel treatment is necessary. And complicating this further, those who are
interested in treatments maybe aren’t aware of how to get treatment or who to get care. On the other hand, we’ve made some great
strides in changing the landscape of addiction and how we care for individuals who have an
addition. The Mental Health Parity and Addiction Act,
the 21st Century Cures Act, and the Comprehensive Addiction Recovery Act are all great efforts
at the legislative level to increase access, and show that we now understand that addiction
is a disease that can be prevented and treated successfully. I also want to bring your attention to – if
you haven’t already looked at this – this link to the Surgeon General’s Report. This came out a few months ago, and it focusses
entirely on addiction, both prevention, treatment, recovery – uses public health, behavioural
health and science to really help keep shifting the needle forward in making progress here. So if you do nothing else after you hear me
speak, please go to the Surgeon General’s Report and use that in your efforts to work
in your prevention worlds. This next slide – a little bit more about
the data – demonstrates how adolescence is really a high-risk period for the root
of addiction to take place. This shows a past month alcohol use – binge
alcohol use and marijuana use by age. I bring this to your attention because, as
concerned as we are about the opioid and heroin crises in this country, we still have a significant
problem with alcohol and marijuana. We also still recognise that in addition to
these problem substances, a lot of the individuals who use substances, regardless of the age
or stage of their [inaudible] life, often don’t want to stop using. In fact, that’s the top reason for not receiving
treatment, is somebody’s not ready to stop using. The second most common reason is someone – they
don’t access care or they can’t afford care. In the adult population, they’re worried
about it having a negative effect on their job, and then additionally not knowing where
to go for care. So I really want to focus your attention on
that top reason for not receiving treatment, and that’s not being ready to stop using. It’s an important factor to consider, especially
in your role as an individual in the community, and as your role in someone trying to develop
a good prevention, comprehensive effort. I’ll come back to that in a moment. So, although I shared some good news about
the 21st Century Cures Act and CARA and some other great policy level work, and also realising
that across the country, we’re accepting that addiction is a disease, we still have
issues with access to care. So, we’re pouring money into the system,
and we have all this science and data, yet we have no data to indicate that we’ve had
an increase in access to care. This is why I’m asking you to help us be
that change agent, and to think in terms of what you can do when working with young people
and families, or just other community members, and how to break down those barriers and connect
individuals to care, whether it’s you’re developing a comprehensive continuum – which
I’ll talk about in a moment – or you, as an individual, being that spark for someone
to begin to begin to change. I encourage you to think about prevention,
treatment and recovery from that comprehensive, kind of public and behavioural health approach. And when you’re developing a local plan,
that you’re able to think in terms of those integrated risk and protective factors, like
suicide and substance use, and that you’re able to – as you’re an individual leading
those efforts, connecting with those other entities that are interested in those efforts,
like the healthcare professionals, the education system. They are able to set the tone that there is
no wrong door to connect to care, and that we’ll treat anyone who has either a substance
use or mental disorder with the same level of compassion and care as any other chronic
disease. And this is where we get to the power of language. Your role is as important in what you say
and as is what you do. We have so many studies now that show that
our language influences thoughts and our perceptions and, ultimately, our response and our behaviours. So if we just pause here for a minute and
think in terms of when we call somebody an addict, or we say that addiction is a chronically
relapsing disease, we’re kind of setting the tone that there’s not a lot of hope
there. When we think about addiction as a chronic
illness, like other chronic illnesses – say cancer, or cardiac disease, or even asthma
– we don’t call ourselves ‘Cancer’, we don’t call ourselves ‘Heart Attack’,
I don’t call myself ‘Allergies’ this time of year. I say I’m somebody who happens to have allergies,
or I’m working with someone who happens to have, you know, a cardiac risk factor. We need to have that same approach as with
our language when we approach addiction. Again, the Surgeon General’s Report provides
some great language and tips on how to shift that language. Here’s a great visual to show you how we
can approach substance use, misuse and disorder, and with a corresponding prevention, early
intervention, treatment and recovery continuum of care – something we can follow up with
later. But it ties to this map, this is something
I want to pause on. I think a lot of you in the prevention world
have seen this ‘protractor,’ which is a great way to guide your planning efforts
and to ensure that you’re linking and connecting the dots across all those populations of risk
and services. And so since we’re talking about suicide
and substance misuse today, I provided you some examples here and some ideas that you
can maybe do in our community to have a comprehensive approach. You could look at doing a combined social
media campaign around the risk of overdose and suicide; you can work with individuals
who we would call ‘gatekeepers’ or ‘access points’, who may come across young adults
or adolescents who are at higher risk, and help train them on effective suicide prevention
and effective substance misuse screening. I encourage you to reach out and connect with
your local behavioural health providers, those individuals who actually provide the treatment
and care for individuals who have a substance use disorder, and understand what their system
looks like. Understand that perhaps once you’re able
to engage someone in care, especially an adolescent, transition-aged youth, or a family, that first
session at the Behavioural Health Center may involve an hour and a half of paperwork, and
not feel helpful at all. But how do you get them to go back and engage
in care? And how do you invite that treatment provider
back to the table to help them have a visible, accessible presence to demystify what the
behavioural health system looks like? This is again just providing some integrated
prevention strategy concepts, and emphasising the importance of thinking in terms of a universal
population, looking at who your gatekeepers might be, and then really integrating, connecting
and formalising the continuum with other systems. Another concept I hope you’ll walk away
with today and learn more about is that treatment really does work. It’s not so much art and hope anymore; we
have a lot of science to tell us to what works. And I have listed the critical elements in
a treatment programme that have been shown to help individuals achieve recovery when
struggling with a substance use disorder. And so in the past, we used to say that recovery
was possible and that, again, addiction’s a chronically relapsing disease. But we know enough now to say that actually,
when you’re able to engage someone in care and keep them in care for a period of time,
that we can expect recovery. And we know for effectively treating the substance
use disorder, we’re reducing the risk for suicide. And instead of saying that we should be expecting
a relapse, we should be saying that relapse may happen, but it’s not expected. So, say you’ve developed your wonderful
system of continuum and your system of care from prevention to treatment to recovery,
but still you have individuals in your life, adolescents, families, who maybe aren’t
aware of their use issues, aren’t ready to change, and feel like there’s too many
barriers to get into care. Here’s where I might provide just a few
slides to think in terms of motivational and reviewing in stages of change, and keeping
in mind that us, as human beings, we’re all the same in some ways. And for us to be motivated to change, whether
it’s reducing our chocolate intake, or saving more money, or actually engaging in working
towards reducing our substance use, it starts with motivation. And we have to have certain things in place
for that motivation to go into action. And that’s the willingness to change, the
readiness to change, feeling that it’s important enough to change and that we feel like we
have the ability to change. And that you as an individual, a caring individual,
prevention leader and somebody in your community working with youth and families, keeping in
mind that most of us change in the context of a relationship, and how we’re interacting
over time; in fact, 80% of us do. 10% are motivated to change based on the information
we receive, and then there’s about 10% of us who, no matter what, are kind of digging
our heels in the ground and not ready. You think about that; 80% of us are motivated
by how we interact with somebody over time. Think about those gatekeepers again, and those
service points: physicians, teachers, probation officers, prevention and coalition leaders
– you all have that chance to be in that 80% and to have a positive influence on somebody,
engaging in care. If you are partnering with a behavioural health
provider who says they specialise in Adolescent and Family Services, I’ve provided a list
here of evidence-based practices that we’ve used in our grant programmes and that are
used across the nation, and have a good effect. And that’s for your reference and your ability
to question and interview your behavioural health providers to see what they provide. And, finally, I just want to emphasise the
integrated approach; it works. Your role is critical in shifting the way
we perceive and respond to behavioural health needs of youth and adults. We know that the risk and protective factors
are shared, and so our response needs to be integrated. And that ultimately you as an individual,
or you as a coalition leader, could be that spark that creates a change and shows that
individuals can achieve that pathway to health and recovery. With that, I thank you for your important
work, and I’ll hand it back to David. David Wilson: And we thank you Audra, for
not only that rich, rich discussion, but I’m so glad that you left us with some solid and
concrete things to do around this issue; much appreciated. So lastly, we have our last dynamic speaker
that is not only dynamic, but he is also a new partner to National Prevention Week representing
the Jed Foundation. I wanted to say for those of you who have
been posting your questions around college students, Dr Victor is your man. So let me give a brief introduction of – of
his skills and expertise and then, we’re going to let him talk and enlighten us. So Dr Victor Schwartz has over 25 years of
experience as a psychiatrist working in college mental health. He was the Medical Director of NYU’s Counselling
Service, established the Counselling Center at Yeshiva University, where he subsequently
served as the University Dean of Students. He was an original member of the American
Psychiatric Association’s Presidential Task Force on College Mental Health, and he was
the Co-Chair of the ATA Working Group on Legal Issues in College Mental Health. And he is an APA Distinguished Life Fellow. So, Dr Schwartz comes with a wealth of information
and knowledge and skill, just like our other two speakers, and I unleash his knowledge
on all of you who are listening. Victor Schwartz: Thanks very much, David,
it’s a pleasure to be here with you as a partner for National Prevention Week. And I really want to thank SAMHSA for creating
the platform for this programme. And, you know, I have to say I learned a lot
from Richard and Audra as well, so it’s really an honour for me to be part of the
programme. What I’d like to do with you in the couple
of minutes I have is really take some of the principles that Richard and Audra talked about
and explain how we think about those, in relation to our college campuses and, now more recently,
high school settings as well. And really present a kind of framework that
might introduce a way of thinking about some of these principles in a little bit simpler
framework that I’m going to share with you. So just a few moments: the Jed Foundation
is a bit over 15 years old; started with a very specific focus on suicide prevention
in college settings. And over the 15 years, we’ve come to realise
more and more that, particularly with teens and young adults, it’s really impossible
to talk and think about suicide prevention without also being thoughtful about substance
misuse and substance abuse prevention, and the risks that so often go along with each
other. We have a number of programmes – I’ll
share a couple of the programmes online – but you can find all of our content if you go
to our website at, which again will be in the PowerPoint that’s sent
along. So as you’ve heard from everybody today,
you know, it’s clear that the overlap of suicide and substance misuse is a serious
concern. I don’t know if this point has been made
explicitly. I think Richard alluded to the fact that suicide
and accidental death are the largest cause of death among young people in the 15 to now
35-year-old age range. Accidental deaths very, very often associated
with substance use and misuse is the leading cause of death followed by suicide. And the thing that we’ve come to understand,
I think, more and more clearly is the significant overlap between the risk factors as well. That many of the things that predispose young
people to substance abuse also put them at risk for suicidal behaviours and suicide,
which leads to the notion – and I think you’ve heard a lot about this already – that
interventions that would be likely to help on one side would likely help to prevent the
other problem. So, what I’d like to present with you is
a framework that the Jed Foundation and actually the Suicide Prevention Resource Center developed
some years ago, which is a way of thinking about – initially again, it was developed
in relation to suicide prevention, but clearly has impact on substance abuse and misuse risk
as well. So, to quickly go over this, if you think
about this – and I love the fact that I can use this really spiffy pointer here – at
the top of this model, you can see that – and these two factors are highly associated, both
with suicide risk and with substance misuse risk. Young people who are deficient in basic life
skills, don’t know how to manage you know, day-to-day activities of self-care, basic
social and emotional skills that typically develop for young people as they mature. Deficits in those skills put young people
at risk. And when we work with colleges, we really
help them through their Student Services activities, through their Counselling Services, to think
about how they can develop programming that enhances these skills in young people. And we know that people who lack trusting
connections with others, with friends and family, for young people, with other adults
and with friends, are at higher risk both for substance misuse and for suicidal behaviours. And again, these are things that we work with
colleges – and I’ll tell you a little bit more about the context in which that happens
– to think about how campus communities can help to promote social connections. And you can think of these two as the most
upstream, universal interventions that really can be done outside of clinical settings,
to a large extent. Then these two next items are really two sides
of the same coin of early intervention. So what can a system do to identify who are
those people within the system who may be at risk for mental health or substance problems
or crises? And then again, what can we do to get those
people both to recognise their own difficulties and problems, and to make it more likely that
they increase – that they seek help for those problems? So, screening tools that are available, online
resources that educate young people. Screening days that campuses do are examples
of this. The next area of concern and really the clinical
focus areas – obviously as you’ve heard from both speakers – making sure that people
have adequate access to care that is there, you know, when they need it and is nimble
and flexible, is of course, you know, kind of fundamental to any mental health and substance
system. And the system also needs to focus on making
sure that there are proper processes in place to both address crises, post-vention[?]. And one other area that we kind of fold into
this and has become, I think, more and more obvious as an important concern, is the area
of continuity of care. We know that many people are lost between
an inpatient setting and an outpatient setting, and it’s urgently important to make sure
that we don’t let people fall through the cracks in our care system. And finally, environmental safety, making
sure – as Richard pointed out before – that there are policies and ways of restricting
access to substances. And we know restricting access to lethal means
of self-harm is another fundamentally important and effective way of keeping people safe. So, I’ve actually talked about the basic
ideas that are inherent in the model. And just to go back to this for one second,
the assumption is that all of this is kind of directed within a framework of strategic
planning, that it’s important to think about what your resources are, how you can prioritise,
do the things that are easiest or most urgent within your system; this I’ve covered in
my comments. So the way we try to implement this programme
with campuses is through our Jed Campus Programme where we work with schools over a number of
years to help them evaluate how they’re addressing each of these elements of the model,
help them find ways of connecting the dots and filling in gaps in their system that are
missing. We work with schools, again over a four-year
period. Many of the GLS grantees are also members
of the Jed Campus Program, so we work in concert and closely with SAMHSA around this. And it’s really an honour to be able to
work together with schools and with SAMHSA on this area. We ask for campuses, who are going to engage
in the programme, to make a commitment from the campus leadership. We then do a careful review of their activities. We’ve broken that framework that I presented
to you to about 140 action items. We review those with the school, we help them
establish a strategic plan and then provide ongoing technical assistance over the four
years that the school is in the programme. In the last year, we really try to work with
them to think about how they can sustain the steps that they’ve taken. And, you know, I would urge you to, you know,
go back over this. Look at the website where we talk about some
of the details and tactics around these things and think about how you can really put these
to practice in towns and other kinds of school settings, because the general principles – I’m
pretty sure, and we’re thinking more and more – are applicable to broader settings. We have now expanded our work into high schools. We recently released a website called Set
to Go, which again is a very upstream, preventive tool. We want young people and their families and
high school administrators to think about the value of college, make sure that they
are prepared for college by – and for adulthood – by really working on enhancing their basic
life skills, looking at how to think about social and emotional skills development. There’s content on the site about basic
mental health literacy that’s really directed towards young people, and specific information
about transitioning to college. For those of you who are working with young
people who might have health or mental health concerns, we also have transition of care
suggestions from high school to college. We found that that’s one of the major concern
areas where people do sometimes fall through the cracks and have problems. So again, I’ve told you of a little bit
about Set to Go. We want this to be helpful to young people
and their families and to school administrators. And we are planning – now that the website
is released – to develop toolkits, like we have a Transition of Care Guide, we have
a guide that helps young people to think about ‘goodness of fit’, and college choice
– thinking about social and emotional factors and campus factors, not just about branding. And you should all take a look at this site. Also, just to make you aware so that you’ll
have this, some of our other Jed Foundation resources: Half of Us is a series of public
service announcements and brief videos around mental health and substance issues, which
is a co-product with MTV and is – these are all Open Source and available to be used. And I think we – I was able to finish more
or less on time. So it was a pleasure joining you here today,
and here is my contact information. And please check out our resources. They’re there for you to use and we really
would be happy for, you know, as many people to be sending us comments and thoughts and
using our resources as possible, thanks. David Wilson: No, thank you, thank you very,
very much. I love the fact that you gave us a very hands-on
tool, that Set to Go, that’s very comprehensive. As I promised in earlier and in my introduction,
that we would have time for a rich discussion. And as witnessed by the Chat pod, we have
had a very rich discussion during the presentation. I want to encourage everybody to still continue
just sending your questions because now is the time that our three expert speakers are
going to be taking some of those questions and answering them for you. And since we last heard from Dr Schwartz,
I was wondering if Dr Schwartz would take a question and respond to it. And then I’m going to ask our other two
panellists to pick a question to answer. Victor Schwartz: It would be my pleasure. David Wilson: So, I want to start with, are
there certain types of substances that have a higher suicide rate? Victor Schwartz: Well, actually, I think this
might be better for Richard. But in his comments, he talked about the frequency
with which, you know, alcohol is found among people who’ve died by suicide, followed
closely by opiates. So, you know, these are clearly the two highest
risk substances. Very often, you know it’s not uncommon – and
I think again, Richard and Audra could probably confirm this – but in many cases, more than
one substance is found, so it’s not unusual for opioids and alcohol to be combined, or
opioids and benzodiazepines, which really ratchets up the risk dramatically. David Wilson: Thank you. I’m going to direct this one to Richard
and Audra. How can we identify markers that inform us
that the person is inclined to suicide? Richard McKeon: Well, I think that that’s
a great question. And I think that the most important thing
is really that when there’s indication that somebody is thinking about suicide, or in
particular if they take an action, if they’ve made a suicide attempt, it’s really important
to take that seriously and to not be concerned by issues such as – sometimes, you know,
people wonder whether somebody is talking about suicide to get attention. But it’s really important that any time
anybody makes any communication about suicide, that we take it seriously, and that we respond
to them. And along with that, it’s really important
to be willing to ask somebody directly if they’re thinking about suicide. And a lot of times, there’s fear that will
put the idea in someone’s head. It’s very clear that that does not happen,
you know, that someone’s not going to start thinking about suicide because we ask them
the question. So you know, if somebody seems depressed,
if they feel absolutely miserable, that really appear hopeless, dissatisfied with their life,
that being willing to ask the question is really important. Thankfully, most people who think about suicide
will not go on to kill themselves. But even so, it’s important to recognise
that thinking about suicide reflects significant misery, significant pain that needs attention,
that needs help, that needs to be responded to. So I think that that is the single most important
thing, is to take suicide-related communications seriously and to be willing to ask the question
whether somebody’s thinking about suicide. David Wilson: Thank you, Dr McKeon. Audra, did you have anything else to add to
that? And if not, I was going to roll off – Audra Stock: No, that’s the perfect answer. David Wilson: Excellent. So I think we have two more – I think we
have time enough for at least two more questions, so I’m going to try to pull two questions
that I think we’ve gotten multiple ones from. And this may be more suited for Victor. Are there any transition guides for college
students transitioning into the work field? Victor Schwartz: Yeah, so this is actually,
David, an excellent question and is something that – I think there’s been a growing
sense that a number of young people, both those who’ve had mental health concerns
and those who haven’t, are having some challenges adjusting to work-life. We, actually, it turns out, are in the process
of developing a series of guidelines for colleges to try to coordinate their career counselling
offices with their counselling and other student support areas better, in order to really get
young people ready for this work. So we’ve already done a kind of survey of
work places that bring in a lot of recent college grads. We’re surveying career offices and surveying
young people as well, to try to find out what they feel – what everyone feels is missing,
and, you know, figure out how can we develop some guidelines to help address these gaps. David Wilson: Thank you. I have a question for you, Audra. What are best the SUD screening tools primarily
for indicative[?] populations in prevention programmes? Audra Stock: That’s a great question. I would love to provide a comprehensive list
to that; if I could get their contact information, I could provide that. And it depends on whether it’s drugs or
alcohol, so let me send me send a list out. David Wilson: Okay, and I will definitely
flag that from our guests from Texas, who gives us his greetings[?]. I’m going to ask one more question which
is – and this could be for any of you – do you recommend suicide prevention programmes
for middle school aged children? Any recommended programmes. Richard McKeon: Yeah, this is Richard Mckeon. I think
that there’s a lot of work that’s been done on school suicide prevention programmes. Most of that work has focussed on high schools. And so there’s a lot of evidence regarding
effective programmes, such as Signs of Suicide, and Sources of Strength is another one. And much less work has been done around middle
school, but we do know that during middle school, there are increasing numbers of kids
thinking about suicide. So many people in the community have expressed
the need for more programmes, and a number of programmes such as Signs of Suicide, I
believe, have been adapted for middle school use. I’m not aware and I don’t know whether
Victor may be aware of anything that has shown evidence yet, you know, that’s really been
studied carefully with that population. You know, there is some work that’s been
done with much younger children using the Good Behaviour Game in first and second grades. But around middle school, there are programmes
that are out there, but I think the evidence base is not as good as for high schools. One thing that people are welcome to do is
to go to the SPRC website to look for programmes. You can look on SAMHSA’s website for EMRAP[?],
for evidence-based programmes. At the SPRC, you can also talk to one of our
prevention specialists regarding evidence-based programmes, and specifically around those
who are in middle school. Victor Schwartz: What I think – Richard,
just to follow up on that, people should recognise that you don’t necessarily, at that early
an age, need to be looking for programmes that are hyper suicide-focussed, that there
can be real value at that age in doing much broader, you know, kind of mental health,
literacy, and really kind of beginning to teach sort of good mental health practices,
stress management. I mean, a lot of the things that are typically
thought of as being social and emotional learning, I think are turning out, and over time, it
will become clearer that those have real benefits, both on the substance prevention side and
ultimately on the suicide prevention side. David Wilson: Thank you. So, unfortunately we have reached time, and
so I’m going to answer the last question, which is, yes, the slides from our wonderful
presenters will be emailed automatically to everybody who has registered for the webinar. In addition to that automatic email, you will
get a link to the recording of this programme so you can listen and watch it again if you
missed particular segments of it. I would be remiss if I didn’t mention that
there are three more webinars as a part of the National Prevention webinar series. The next one is 15th May. It’s actually a webinar on the live webcast
of the kick-off of National Prevention Week. And then the fourth webinar will be Emerging
Issues and Tobacco Use, which is on 16th May. And then our last webinar of this series will
be Opioid Addiction and Prevention, which is on 17th May. All three of these webinars have the same
webinar link and registration that you used for this webinar, so it should be easy access
for you. I want to thank our wonderful, wonderful speakers
and especially thanking them for all of the information that they provided to us. And, last but not least, I want to thank everybody
who tuned in and participated. I hope it was a rich discussion, and I hope
you walk away with knowing more about this topic than you came into the phone call with. So thank you. Have a great day. Operator: That will conclude today’s presentation. Thank you for your participation.

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