Remarks by
A. Kathryn Power, M.Ed.
Director

Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

West Virginia Council for the Prevention of Suicide Summer Conference
"Palette of Grief": Sudden Loss of Life Due to Suicide, Depression, Illness, Natural Disasters

June 22, 2006
Charleston, WV

PowerPoint version

Slide 1 (Intro)

Good morning.

Thank you, Commissioner (John) Bianconi for your introduction… it is particularly meaningful coming from a man who is a veteran in the field of behavioral health and a strong advocate for suicide prevention.

I am frequently invited to state conferences like this one, and it’s always a good sign when the Governor starts off the event. Governor (Joe) Manchin’s remarks acknowledge the importance of the work being done in this area… and he has a strong team supporting that effort. Several of them are also here this morning.

Dave Majic, the Division Director of Children’s Mental Health Services, is known across this state as the driving force behind the State Suicide Council and his work is of great importance to West Virginia. I would also like to salute Bob Musick for his efforts as CEO of the West Virginia Council for the Prevention of Suicide. Thank you, Bob, for inviting me to speak at this conference.

It is customary to recognize the VIPs at an event like this. And so I will. Each of you—the crisis center professionals, police officers, family members, public servants, healthcare specialists, volunteers, business men and women, members of faith-based and community organizations…who have come here today to focus on the prevention of suicide—you are a Very Important Person. You are important because you understand that suicide is a public heath crisis that we must do something about…that it’s not a “tragic accident”…that it can’t be a “silent epidemic” any longer.

SLIDE 2/President Bush Quote

If you ask someone on the street about cancer… you will likely achieve an immediate agreement that it is a disease that must be cured. However, if you ask that same person about suicide—the reaction will be very different. The reality is that suicide is a public health crisis that is still greatly misunderstood and not accepted by the general public as something that we can prevent... and we must change that perception.

This morning, I would like to talk about suicide prevention from the federal perspective… and take a look at how our different roles—at the personal, local, state and national levels—are interconnected. I would like to share with you some of the things that we know about suicide…and some of the things we don’t…that continue to challenge us in our prevention goal.

SLIDE 3/Suicide Prevention—A Public Health Crisis

In one sense, death by suicide is not rare. Approximately 31,000 people die by suicide in the United States each year. That’s approximately 85 deaths by suicide every day…one person every 17 minutes. Worldwide, approximately one million people die by suicide each year…one person every 40 seconds. More people are dying by suicide than in all of the world’s armed conflicts combined. About as many people die by suicide as die in traffic accidents. Suicide is a leading cause of death.

In another sense, however, suicide is a relatively rare occurrence. Of all deaths in the United States, a little over 1% are due to suicide.

SLIDE 4/Suicide—A West Virginia Priority

We know here in West Virginia, 2,366 lives were lost to suicide between 1995-2003. According to the most recent statistics, West Virginia is ranked 8 th in terms of the overall rate of suicide in the United States.

SLIDE 5/Suicide—Gender, Ethnicity, Age”¹

We know death by suicide reflects differences in gender, ethnicity and age:

• Males are four times as likely to die by suicide than females—although females attempt suicide three times as often as males.

• Suicide is the 3rd leading cause of death among Americans between the ages of 15-24 and the second leading cause of death among those between the ages of 25-34.

• Suicide rates increase with age. Elderly people who die by suicide are often divorced or widowed and suffering from a physical illness.

1. Centers for Disease Control and Prevention (2004). Suicide Fact Sheet. Available at http://www.cdc.gov/ncipc/factsheets/suifacts.htm

SLIDE 6/Suicide & Mental Health

And we know of the definite connection between suicide and mental illness:

• Ninety percent of suicides that take place in the United States are associated with mental illness, including disorders involving the abuse of alcohol and other drugs.²

• Fifty percent of those who die by suicide have been diagnosed with major depression, and the suicide rate of people with major depression is eight times that of the general population.³

2. Goldsmith, S, Pellmar, A, Kleinman, A, Bunney, W. (editors) (2002). Reducing Suicide: A National Imperative. Washington, DC: National Academy Press.

3. Jacobs, D, Brewer, M, and Klein-Benheim, M. (1999) Suicide Assessment: An Overview and Recommended Protocol. In The Harvard Medical School Guide to Suicide Assessment and Intervention edited by D. Jacobs. San Francisco: Jossey-Bass.

SLIDE 7/ Suicide is a preventable public health problem .

Most importantly, we know that suicide is a preventable health problem. However, one of the great challenges we face is that there is not a common public awareness of this fact. I’m sure most of you in this room would agree with me and deal with this issue daily.

Thomas Joiner is a scientist, researcher and the Bright-Burton Professor of Psychology at Florida State University who is acutely aware of this fact. Thomas Joiner is also a survivor… his own father committed suicide when Dr. Joiner was a teenager. In his recent book, Why People Die By Suicide⁴, he speaks eloquently about this lack of awareness and its consequences. He tells about being at his sons’ soccer game… There were five or so full-field games going on— approximately 150 people out on the fields. Off in the distance, lightning struck, and the field administrators decided to cancel the games. There was some grumbling about this decision of course, but everyone understood the rationale—lightning can be lethal.

Dr. Joiner raises the issue… just how lethal is lightning? In other words, how many people die from lightening strikes? In fact, from 1980 to 1995, there were approximately 80 deaths per year from lightning strikes in the United States. During this same time period, there were more than 80 deaths per day from suicide. Why do people race to prevent death by lightning strike but not race in the same way to prevent death by suicide? Death by suicide is 365 times more common than death by lightning strike. We could assume that people have a bias or stigma against mental health problems… but Dr. Joiner comes to a different conclusion.

He states that it’s fairly easy to understand how and why people die when they’re struck by lightning… and prevention is even more straightforward—get out from under the weather.

However, it is not easy for people to understand how and why people die by suicide and prevention is not clear-cut at all. His point is that to make the prevention of suicide more like the prevention of lightning strikes, people need a clearer understanding of how and why people die by suicide.

The SAMHSA perspective on this national problem is simple. We must take action to address this issue…and we must do it now. The solution is, obviously, far more complex.

For more than a decade, SAMHSA has been working to help prevent the tragedy of suicide by leading national efforts to make effective mental health care and substance abuse treatment available to all Americans. In this time, SAMHSA has made a deep and ongoing commitment to elevate suicide prevention to a national priority.

4. Joiner, Thomas. Why People Die By Suicide. Harvard University Press. 2005

Slide 8 /NEW SAMHSA MATRIX

The SAMHSA matrix—a tool that keeps the Agency’s work focused on the most critical issues in behavioral health—illustrates how we are working toward this goal. When you look at the Matrix, you can see that SAMHSA’s priority program issues—on the blue axis—are linked to cross-cutting management principles—on the red axis—to help ensure that we are doing the right things…and that we are doing the right things, right. The Matrix serves as our guidepost for budget formulation, program development and resource allocation at SAMHSA.

Last month, Charles Curie, Administrator of the Substance Abuse and Mental Health Services Administration announced that the matrix would be revised to include “suicide prevention” and “workforce development” as major program priority areas.

Administrator Curie said, “When faced with the fact that the annual number of suicides in our country now outnumber homicides by three to two… urgency and immediacy of the need to take action speaks for itself.”

Suicide prevention is a priority across SAMHSA. But to take full advantage of the opportunities that exist to save lives will require coordination of resources and services across government…and between government, its private sector partners, nonprofit and community, and State organizations like the one that brings us here together today.

SAMSHA is working with multiple Federal agencies to facilitate the kind of coordination necessary to save lives. The transformation of the national mental health system of care that is underway at every level represents an unprecedented opportunity for partners across government and the private sector to collaborate to develop and implement a successful suicide prevention strategy. Suicide prevention is a mental health system transformation imperative.

I would like to spend a few minutes, sharing with you some of the exciting developments that are taking place among the Federal partners as we work together to advance the transformation agenda at the national level. I’ll briefly describe how we started and what brings us to this place.

Slide 9 /Achieving the Promise

The vision of a transformed behavioral health care system began several years ago, with the work of President Bush’s New Freedom Commission on Mental Health. In its final report to the President, Achieving the Promise: Transforming Mental Healthcare in America, the Commission reached this conclusion: our mental health system is not geared to the single most important goal of the people it serves—the goal of recovery! Achieving the Promise called for nothing short of a fundamental transformation of the mental health care delivery system in the United States.

Achieving the Promise envisioned a transformed system... a mental health system that is driven by individual and family needs...a mental health system that focuses on building resilience and is centered on recovery. It is a vision that moves the role of consumers and their families far beyond simply participating in the system...they become the reason for the system. It is a bold and powerful idea that requires a dramatic change from the status quo. It requires each of us to change the way we think about the delivery of mental health services.

In a transformed system, Americans will understand that mental health is essential to overall health, mental health care will be consumer and family driven, and disparities in mental health care will be eliminated. In a transformed system, early mental health screenings, assessments, and referrals will occur. Research will be accelerated and excellent care will be delivered. Technology will be used to access mental health care and information.

It is important to understand that transformation is both an outcome and a process. It is not just a fancy word for change. It is ultimately about newness—about new values, new attitudes, and new beliefs that are expressed in the changed behavior of people. The “people” aspect of transformation is crucial because people, just like you, are its architects. Transformation means a dramatic rethinking of what we know, what we do, and how we go about doing it.

SAMHSA is taking the lead to bring about this fundamental change at the National level. It is a time of unprecedented Federal focus on suicide prevention.

In particular, we are focusing our efforts to stem the number of youth suicides in our country.

SAMHSA has recently awarded $9.6 million for eight new grants to support national suicide prevention efforts focusing on youth suicide and early intervention programs. Later this year, SAMHSA will also be awarding 14 additional state/tribal youth suicide prevention and early intervention grants in addition to 30 more Campus Suicide Prevention grants. By the end of 2006, 36 states and tribes and 50 colleges will have received suicide prevention funding.

SLIDE 10/YOUTH SUICIDE

In 2001, more teenagers and young adults died from suicide than from cancer, heart disease, HIV, birth defects and stroke combined. This is a national tragedy…and one that hits home here in West Virginia.

Suicide is the third leading cause of death for young people ages 15 to 24. Here in West Virginia, suicide is the second leading cause of death in that age group. I commend you for developing the Helping Our Teens Thrive (HOTT) Coalition to address the seriousness of this crisis.

As disturbing as these numbers are, it is of further concern that there is a wide discrepancy between what children report and what their parents actually notice. Very few of the parents were aware of their children’s experiences.

SAMHSA’s suicide prevention funding is authorized under the “Garrett Lee Smith Memorial Act.” I don’t know that any of us here today ever met Garrett… and yet, notice how familiar this story sounds.

Garrett Lee Smith was a 22-year old, who was deeply loved by family and friends, who seemed to have everything to live for and his parents had no idea that he suffered from a mental illness.

Oregon Senator Gordon Smith and his wife, Sharon, knew that their son, Garrett, whom they adopted as an infant, suffered from learning disabilities… but they did not know that he had been suffering from serious depression since he was a young child. In his newly released book,

Remembering Garrett: One Family’s Battle With A Child’s Depression⁵ … Senator Smith describes what happened. His daughter told the Senator and his wife that Garrett had begun to abuse alcohol again… and so on their last evening together on vacation, the Smiths asked their son about his life. Senator Smith writes:

“What followed was harrowing and horrible. The dam of Garrett’s emotions suddenly broke and he began sobbing uncontrollably. He screamed out that he wished his birth mother had prevented his birth. He declared his life hopeless and valueless, his future futile. He was tired of being a burden to us and an embarrassment to himself and others. Pain and darkness so clouded his way each day, he shouted, that he dreaded the dawn, knowing it would only bring more anguish than the one before. He told us for the first time that he had experienced periods of dark depression since he was ten years old…

He told us that the suffering of his mind was so painful that ‘I think I may take my life.’

My son, I now fully realized, was mentally or emotionally ill—I didn’t know which, or the difference. Nor did I know how to help. So I exhausted my abilities of expression and experience in youth counseling with words of comfort, encouragement, and love unfeigned. I assured him that he was loved by the Lord, treasured by family and friends, and precious to his parents. I promised him there was a good and happy place for him in this world and that I would do everything in my power, that I would exhaust every avenue, to help him find it. I begged him not to hurt himself, told him that we could not live without him, that we would get help for him, so healing and hope could return. Sharon and I were desperate, but he was beyond reach, beyond reason, beyond rationality.”

Senator Smith goes on in the book to tell how he and his wife stayed with his son all night… and in the morning he seemed much better. On the flight home they discussed different career possibilities, Garrett expressed a desire to go to a culinary arts school and wondered if his father would help him open a restaurant someday. The family landed in Atlanta and made plans to meet in two weeks.

They never saw their son alive again.

5. Smith, Gordon H. Remembering GARRETT: One Family’s Battle With a Child’s Depression. Carroll & Graf Publishers: New York. 2006

SLIDE 11/SENATOR SMITH’S QUOTE

Senator Smith was asked to testify at a hearing on two bills supporting suicide prevention. He concluded with an emotional line from Norman Maclean’s poignant family story A River Runs Through It: “It is those we live with and love, and should know, who elude us… That Garrett eluded me haunts me every day, and no doubt will for the rest of my days. But this much I know—that he was a beautiful boy and that I loved him completely without completely understanding him.”

Senator Smith went on to be the driving force in getting legislation approved in the House and Senate…and personally endorsed by President Bush…that has had a dramatic impact on funding for suicide prevention.

This story is poignant and illuminates many of the issues we have come here to address today. At the heart of the story is the anguish and despair that someone with mental illness suffers. It exemplifies the barriers that can be successfully created from members of the family and closest friends, the feelings of isolation, of being a burden on the family, of worthlessness, and the common experience that the person “was getting better” that is so often reported right before a suicide.

But, when we look at Senator Smith’s story from a larger perspective… it shows how the actions of one person can greatly affect the system. Two years before the Garrett Lee Smith Act was passed in Congress, SAMHSA awarded two 3 million dollar grants for that year. By the end of this year, we will have awarded 98 grants amounting to approximately 32 million dollars for suicide prevention.

As familiar and tragic as the Garrett Lee Smith story may seem to many of you…because you hear similar stories every day…because you have survived these experiences in your own lives…there is still a great need to educate the public about suicide and its prevention. The facts of suicide…and suicide prevention…must be shared!

Collaboration and the ability to leverage assets, abilities and energy from multiple partners is a key factor in accomplishing this goal… and that provided the motivation for the Federal Agencies to join together.

Slide 12 /Federal Workgroup Members

At the Federal level, we have enlisted the aid of these 18 Federal partners to begin the exciting and challenging process of transforming our national mental health care system. This is the same level of collaboration and cooperation that you will need to foster at the State level to develop and implement a successful suicide prevention strategy.

Last July, this coalition of Federal partners completed a Federal Agenda for Action. The Action Agenda identifies the first practical steps that we can take at the Federal level to initiate this monumental change.

SLIDES 13/Federal Action Agenda

The Action Agenda responds to the Commission’s vision for mental health system transformation, and organizes its action steps around the five principles of the Executive Order that established the Commission’s responsibilities.

The first of these Principles calls on us to focus on the desired outcomes of mental health care, which are to attain each individual’s maximum level of employment, self-care, interpersonal relationships, and community participation.

Under this Principle, to the Action Agenda proposes the full launch the National Action Alliance for Suicide Prevention. SAMHSA has been building the foundation for this alliance for some months and convened a meeting of national experts to address how this alliance could function and be funded. Our intent is that this alliance, brought together to form a broad base of stakeholders in both the public and private sectors, will support the coordinated efforts and oversee implementation of the National Strategy.

Slide 14/NSSP

Only recently have the knowledge and tools become available to approach suicide as a preventable problem with realistic opportunities to save many lives. The National Strategy for Suicide Prevention (NSSP or National Strategy) creates a framework for suicide prevention for the Nation. It is designed to encourage and empower groups and individuals to work together.

The stronger and broader the support and collaboration on suicide prevention, the greater the chance for the success of this urgent public health initiative. Suicide and suicide behaviors can be reduced…as the general public gains more understanding about the extent to which suicide is a problem…about the ways that it can be prevented…and about the roles individuals and groups play in prevention efforts.

The National Strategy is comprehensive and sufficiently broad so that individuals and groups can select those objectives and activities that best correspond to their responsibilities and resources. The plan’s objectives suggest a number of roles for different groups. Sites for suicide prevention work include jails, emergency departments and the workplace. Survivors, consumers and the media need to be partners as well, and governments at the Federal, State and local levels are key in providing funding for public health and safety issues.

Suicide prevention, as detailed in the National Strategy, is a key element of transformation.

Slide 15 /Action Agenda Suicide Prevention Initiatives

There are additional areas that relate directly to suicide prevention in the Action Agenda. For example, SAMHSA will initiate a National Public Education Campaign to improve the general understanding of mental illness and emotional disturbances, and to encourage help-seeking behaviors across the age span for people in need. Suicide prevention messages that raise awareness among specific populations, such as the elderly and racial and ethnic groups, will be part of the campaign.

Other proposed action steps represent an expansion of several suicide prevention efforts already underway. For example, SAMHSA’s Indicators of Success initiative is identifying measures of progress, and sources of baseline data, for each of the National Strategy’s 68 objectives.

The Centers for Disease Control and Prevention currently is working on the National Violent Death Reporting System and conducting a multi-State survey of suicide prevention planning processes. Information collected through these efforts will add to our knowledge about suicide and suicide prevention planning efforts so that we can best allocate our resources.

The National Suicide Prevention Lifeline is a national, 24-hour, and toll-free suicide prevention service available to all those in suicidal crisis who are seeking help. People can dial the toll-free number and they are automatically routed to the closest possible provider of mental health and suicide prevention services.

The network is comprised of over 100 individual crisis centers across the country creating a nationwide coverage area. One of the many things that we’ve learned from the complexity sciences… is the power of a network.

After Katrina hit, the Vialinks Crisis Center in New Orleans was destroyed and everyone was evacuated. Other members of the National Suicide Prevention Lifeline immediately volunteered to cover the area until the resource could be restored. SAMHSA flew in volunteers from around the country who set up a temporary center first in Munroe and then Baton Rouge.

As quickly as possible the center staff returned to New Orleans and resumed services. It was a tremendous effort that proved the enormous value of the volunteer network that could respond nationally to a critical local emergency situation.

These suicide prevention resources are more vital than ever before to our communities…for example, the Lifeline call volume increased from a total of 18 calls in the 30 days before Katrina, to 350 calls in the past 30 days. Overall call volume has doubled from 4,000 in the 30 days before Katrina, to over 8,000 in the past 30 days.

SAMHSA is advancing other broad National Strategy goals through new and ongoing programs. Our Center for Addressing Discrimination and Stigma, or the ADS Center, is expanding our capability to fight stigma through national public education campaigns.

The SAMHSA-funded National Suicide Prevention Resource Center is providing prevention support, training, and informational materials to strengthen suicide prevention networks and advance the National Strategy.

These are all resources you can draw upon as you continue your work toward developing a statewide suicide prevention strategy. More people need to become aware of the extent of suicide…more communities and organizations need to become engaged in advocating for and providing the mental health care services that help prevent suicide.

The vision of the West Virginia Council for the Prevention of Suicide… that you will improve the health and wellness of West Virginians by reducing suicide and its devastating effect on individuals, families and communities…reflects your awareness of the levels of participation that are necessary to succeed.

However, as the President’s Commission noted…many of the states’ mental health care systems are fragmented and historically under funded… and require a radical change of the system at the state level as we have outlined in the Federal Action Agenda. The National Alliance on Mental Illness (NAMI) has created a state-by-state “report card” on adult mental health care systems in the public sector to help advance this change.

The report is intended as a starting point. It’s purpose is to provide a common baseline that will help the states share, learn, and build from individual lessons and innovations and will help States measure progress in future years.

The NAMI report did not focus on the individual State Mental Health Agencies but on the entire system within the state. Incidentally, the national average is “D”. Five states received grades in the “B” range- no “A’s” and eight states received “F’s”!

SLIDE 16/NAMI Report Card-WV

For each state, NAMI notes the urgent needs and recent innovations. As you can see, the formation of the West Virginia Council for the Prevention of Suicide in addition to the state’s strong involvement of families and consumers in the planning process are highlighted under this State’s recent innovations. I know that the West Virginia Council is focused on public education and has been focused on workshops to inform participants on how to recognize the early signs of depression and then where to go for assistance.

This is a good beginning…however, you can also see…and surely experience on a day-to-day basis…there is a dramatic need for mental health care transformation here in West Virginia.

SAMHSA will continue active leadership and support of National suicide prevention activities. We are depending on your continued efforts to mobilize your communities in West Virginia…and to provide the fuel that is necessary to make transformation happen here in your State.

I believe in the power of one… I believe in the Senator Gordon Smiths who can take a great personal loss and turn it into an act that benefits an entire nation… and I believe in each one of you.

Let me ask you: how many of you have had people ask you why you chose this particular field? How many times have people said to you— “Oh, isn’t this work too depressing and discouraging?”

I say, there is nothing depressing about working to prevent the suffering that millions of people go through…

There is nothing discouraging about preventing the loss of even one more life to suicide.

Slide 17 /Quote

Joan Holmes, the Executive Director of The Hunger Project said: We often think of heroes as extraordinary people with powers and abilities far beyond those of ordinary human beings. But when we really look, we discover that heroes are ordinary men and women who dare to see and meet the call of a possibility greater than themselves - people who despite their doubts and fears commit themselves to action; people who go beyond their limits in what they think is possible. Ordinary people - daring to be heroes - are the greatest expression of human potential.