Thursday, March 27, 2014

A Historic Moment in Suicide Prevention: Summit on Lived Experience

Reposted with permission from the American Association of Suicidology

On March 6, 2014, a historic moment occurred in San Francisco. The first ever National Summit on Lived Experience in Suicide Prevention convened – suicide attempts survivors, suicide loss survivors and people representing mental health service systems came together to explore how we can “light the way forward.”

The meeting was hosted by the Mental Health Association of San Francisco with support from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Action Alliance for Suicide Prevention (“Action Alliance”) and the National Suicide Prevention Lifeline (NSPL). The goal of the meeting was to open up an open and honest conversation about how best to move the goals of the Action Alliance’s Suicide Attempt Survivors Task Force and Zero Suicide Initiative forward with coordination and compassion.

The meeting began with Dr. DeQuincy Lezine sharing an overview of the Suicide Attempt Survivors Task Force soon-to-be released guide for how the suicide prevention field can best incorporate the “lived expertise” of those who have survived their own suicide attempts. 

The guide underscores the importance of real-world wisdom that people gain through surviving and can share with others to guide best practices in research, treatment and prevention efforts. A main message of the document is to include attempt survivors in all areas of suicide prevention – as leaders and in critical masses. In addition to covering key policy, practice and program suggestions, Dr. Lezine described the core values of the task force:
  • Inspire Hope, find meaning and purpose
  • Preserve dignity, counter stigma, stereotypes discrimination
  • Connect people to peer supports
  • Promote community connectedness
  • Engage and support family and friends
  • Respect and support cultural spiritual beliefs and traditions
  • Promote choice and collaboration
  • Provide timely access to care and support
Next David Covington from the Zero Suicide Initiative shared the concept and practices of this high priority focus of the Action Alliance. The Zero Suicide Initiative is a “commitment to suicide prevention in health and behavioral healthcare systems aligned with a specific set of tools and strategies. It advocates for a systematic approach to improve outcomes and fill gaps to relentlessly pursue a reduction in suicide death and calls for visible, vocal and visionary leadership. Additionally, the initiative strives to develop of a competent, confident and caring workforce within behavioral health.

“We believe that suicide is preventable always, up to the last minute,” said Covington. “Let’s create a suicide deterrent system.”

Most of the conversation over the course of the day centered on how these two groups could reduce the fear each has about the other. Suicide attempt survivors expressed fear about being misunderstood, stigmatized, and punished in many forms when trying to access professional care. Mental health providers have fear about not knowing what to do, about getting sued, and about having someone “die on my watch.”

The dialogue continued through the morning and encouraged both groups to look forward and find ways to improve collaboration and understanding. Here are some moving sound bites:

·       “People need to know they can disclose suicidal thoughts and that they will get help, not get punished,” Shari Sinwelski, National Suicide Prevention Lifeline
·       “Every attempt survivor should define the support network for himself or herself.”
·       “Emergency care providers need to improve practices to preserve dignity of people in the middle of a suicide crisis.”
·       “Most clinical care work is focused on assessment of risk; we need to shift this focus to collaborative care,” David Covington
·       “The problem is clinicians don’t feel safe and they don’t know what to do,” Shari Sinwelski
·       “To start with a place of assessment creates disconnection,” Leah Harris, National Empowerment Center
·       “Stop assessing the symptoms. When we do that we are working from a deficit model rather than a strength model. Rather than creating a treatment plan create a hope plan and assess for that. Find out what brings meaning and purpose and create a plan for that,” Tom Kelly, Magellan Health Services of Arizona
·       Tom Kelly, “I haven't had a suicide attempt since 2001. Since then I became an advocate, and I developed meaning and purpose.”
·       “How do we fill the middle gap in services when people are not feeling home provides enough support but don’t need inpatient care? Peer support can fill this gap. Right now the system is insufficient – we just evaluate, medicate, vacate,” CW Tillman, Consumer Advocate
·       “Let’s build a strengths-based approach – rather than ‘what’s wrong with you’ shift to ‘what happened to you.’ Let’s provide trauma informed care. Change some primary assumptions,” Leah Harris.
·       “The concept of Zero Suicide is really transformative. I like the fact that people react so strongly to it,” Eduardo Vega, Mental Health Association of San Francisco. “We can take the outlandish out of the picture by saying our goal is that no one in this building kill themselves today. Then we can expand to ‘can we work to stop suicide in this town this week?’”
·       “The field has talked too much about the difference between suicide attempt survivors and those who die by suicide. The intrapsychic experience is the same,” Covington
·       “Over the decades, individual mental health clinicians have made heroic efforts to save lives but systems of care have done very little,” Richard McKeon, SAMHSA.
·       “People who go through training for suicide prevention get increased confidence and change culture within a system. People become less afraid and are more likely to reach out,” Becky Stoll, Centerstone
·       “Suicide prevention has not been informed by peers who have experienced the agony and decision making. They can provide support that can be magic,” Eduardo Vega.
·       “Suicide attempt survivors should not just be a token presence in the conversation of how to prevent suicide. If have 25% each of researchers, care providers, loved ones at the table, we also need 25% attempt survivors. Critical mass offers meaningful input. Like 32 degrees. Below water freezes, above water is just cold,” David Covington
·       “How do we infuse recovery oriented perspectives – a spirit of optimism – in systems of care?” Leah Harris. “How do we focus on what’s strong rather than what’s wrong?”
·       How do we reframe safety from something that is more about the clinician’s need for assurance to something that’s more about connectedness, hope and meaning?

The meeting concluded with a brainstorming session on key messages to promote the goals of these two groups and how we might best invigorate the field around these goals. The following list of ideas emerged:
·       Establish partnerships and communities of support
·       Move beyond fear to optimism
·       Introduce behavioral health professionals to people’s stories of hope and recovery and show the value, “your experience can help me help other people”
·       How do value peers in suicide prevention work? We can pay them well and identify them as leaders/professionals
·       Let’s move behavioral health systems from precontemplation to contemplation and get them to think about, “Maybe the system doesn’t work”
·       Attempting suicide didn’t destroy my life; it transformed it.
·       Sometimes when things make you angry you pay attention. Language matters.
·       Crisis is an opportunity. If in the middle of a transformative moment you are punished, it stops the process in its tracks.
·       Coercion is system failure.
·       People don’t send you flowers and cards when you are in the hospital for a psychiatric condition.
·       “Continuity of care is really about not giving up on someone,” John Draper, National Suicide Prevention Lifeline
·       “When we create system change, don’t bolt it on, bake it in. Change will only last as long as there is energy around something. When it is bolted on it won’t stick; baked in means here to stay,” David Covington
·       Board members and other leaders for behavioral health organizations can act as secret shoppers by visiting behavioral health care as undercover bosses. This experience can be eye opening.

·       Ask suicide attempt survivors, “How can we celebrate your survival?”
·       “I am not a lost cause. I am a person.”

The meeting closed with a round robin discussion of what people were taking away from the Summit. Many tears were shed as people disclosed the momentous opportunity created by the shared understanding that commenced on that day.

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