Benedictine University
MPH 610 – D1B4
Health Policy
Developing New Policies: Policy Proposal
Suicide Prevention
Week Eight
N. De Shields
Instructor
Dr. Yasmin Dada-Jones

ABSTRACT
This policy proposal attempts to abate the increasing number of suicides in the United States, a survey from 2001 to 2009 list fatal self-injuries span world-wide demographics, male and female, age, ethnic disparity and economic disposition. From 1999 to 2007 the number of suicides in the United States increased from 10.46 to 11.26 per 100,000 people, between ages 10 to 24 it is the 3rd leading cause of death, 2nd leading cause in 24 to 35 year olds and the 10th from all age groups. Globally one in every 40 seconds, 800,000 a year, suicide is absolutely preventable, these are not accidents and 90% sought treatment for mental health prior. Thoughts and ideation are higher among young adults’ ages 18 to 25 years where the greatest attempts are made; among 18 and older 8.3 million report having suicidal thoughts, 2.2 million made plans, 1 in every 25 succeed in committing suicide. Between the ages 15 to 24 years old 100 to 200 attempts are made, 500,000 in the United States seek help in emergency rooms; an estimated 6.5 billion in non-fata, self-inflicted medical cost.
The initiative seeks to apply ecological approaches normally dedicated to specialized populations; the approach will intrinsically identify suicide victims through venues and or genres. Public suicide prevention efforts could encompass and engage participants via screening an entire social demographic and ordained community care as means to introduce interventions.

In the context of public health, suicide is on the rise in the United States and world-wide; a community’s health is diminished by the exponent death of its members. A government existence is within its ability to assure the quality of life and extend the length of the life of its population. The health of a nation is shaped by more than medical care, or by the choices that individuals make to maintain their health, such as quitting cigarette smoking or controlling diabetes. (CPHSIH, 2011) According to the CDC, emergency departments in the United States report 487,700 self-inflicted injuries, an estimated 6.5 billion in medical care and work loss alone is spent on persons attempting to take their own lives. Exceeding from the eleventh leading cause of death to the tenth, suicide has the distinction of escalating the morbidity and mortality rate by climbing the scale not by a normative curative methodology rate of another disease.
It is essential that policies are created that address some of the most critical demographics; as comorbid diseases impact the health of a human population a similar provision can be administered to persons suffering physical and mental health related illnesses in a community organizing preventative care. Public suicide prevention efforts could encompass and engage participants via screening demographics and commonly associated health risk. The act assumes branding techniques similar to advertisers but with the perspectives of making comprehensive medical interventions from a primary perspective of traditional one on one care to a social ecological model enveloping medical psychology. “If programs…are implemented at a time when adolescents are still malleable and relatively free of sexual and reproductive health problems and gender role biases, very young adolescents can be guided safely through this life stage, supported by their parents, families and communities,” (Culp-Ressler, 2014) A caveat, establishes classes dealing with health are implemented earlier into the current curriculum guidelines; students will begin learning about suicide and concepts of illnesses pre-adolescents. Studies in education are now suggesting that refocusing subject such as sex-ed, when brain chemistry has a greater malleability, is appropriate measure. Similar to how disease epidemiological events unfold the exposure to a mental disorder can best be addressed before excessive imbalances normalize and adulterate healthy brain chemistry.
People who suffer from an untreated anxiety disorder often also suffer from other psychological disorders, such as depression, and they have a greater tendency to abuse alcohol and other drugs. (APA, 2013) Unable to make rational responses to an exposure can cognitively preclude someone from rational judgments in day to day life. It is these very judgments that an act arresting these issues can circumvent chronic strains that preclude suicide. While anxiety within itself is not a disease the chronic condition introduced by stress manifest physiological strains, such as, bipolar disorder, eating disorders, headaches, and depression to name a few.
Capital of Nevada is Carson City, they have an approximate population of 55,000; approximately 2,790,136 total residents in Nevada, it has the unique distinction of having one of the highest suicide rates in the United States. Carson City’s suicide rate in 2008 was approximately 24 per 100,000, the states was approximately 16; introducing a policy on suicide prevention, Nevada growth rate as of 2013 was 35 percent, 24.1 percent being children and 13.1 being adults over 13.1 percent. Males are four times greater to death by suicide in Nevada, Native Americans and Alaskan Natives have the highest reports of suicide related in Nevada. Suicide claims are four times greater males than females, American Indians/ Alaska Natives report experiencing the highest suicide related prevalence, 2.5 times higher than the national average. Introducing the act consist with identifying ecological trends which cultivate groups, Nevada has a significant number of cultural enthusiasts. Western lifestyles and motifs that glorify Native American trade as a staple could author a community driven intervention for persons limited in community and healthcare.
Legislative changes to a geographic distribution requirement, requires 75% of the state residents supporting a new petition to the amendment of the state’s constitution as a requirement, currently residents from each of the 361 counties weighting in on the petition for voter support. Now a vote requires that 10% of the total voters are required for a petition initiative to be adapted. Current initiatives are built into the Nevada Suicide Prevention Plan that mirrors the National Strategy; Nevadans report some of the highest diagnosable mental health and substance abuse claims in the United States. Introduction of a new public health initiative would require a great deal of public awareness to account for demographic appeal. Without a challenged perspective, positive or negative, social development is a difficult achievement.
The State of New Jersey has a pursuant amendment, P.L. 2011, Chapter 166, N.J. Statue 30:9A-29 et seq, requires a statewide provision requiring the Commissioner of the Department of Children and Families (DCF) must develop and adopt a suicide prevention plan. A prepared report is to be drafted and submitted to the Governor and the Legislature within 18 months of this laws adoption. Under the allotted time, DCF and the Department of Human Services (DHS) collaborated on drafting a comprehensive analysis of current prevention methodologies the state currently used. Findings insisted that the New Jersey Suicide Prevention Network Lifeline, augmented calls at approximately 60%, rerouting callers to Lifeline centers outside of New Jersey. A concern of suicidal patients is the stigma associated in seeking help, lengthy wait times at mental health clinics are barriers impeding patients from receiving help. A number concerns through further analysis exposed that the callers requiring a greater degree of mental health care then the operators where able to reference and a culture prefixes to specific demographics, i.e, Spanish or veteran. Callers from these cultures where more often rerouted outside of New Jersey network, suggesting a degree of training be established to compensate for the lengthy exchanges which diminished the care.
The United States Senate and House of Representatives, 110th Congressional Committee Hearing, Public Law 110-110, H.R. 327 Joshua Omvig Veteran Suicide Prevention Act of 2007, is a potential public law that seeks to prevent suicide and related illnesses. Chapter 17 of title 38 U.S. code mandates a comprehensive program for the prevention of suicide among veterans to be implemented. “Law is foundational to U.S. public health practice. Laws establish and delineate the missions of public health agencies, authorize and delimit public health functions, and appropriate essential funds,” wrote Goodman and colleagues (2006, p. 29). This policy establishes the authority of Secretary of Veteran Affairs to address the public health concern by establishing a program and support. An amendment that compliments the inception of H.R. 327 Joshua Omvig Veteran Suicide Prevention Act, would offer similar constructs to various others; H.R. 327 divines a partnership between the Veteran Administration Medical centers, the Department of Health of Human Services, the National Institute of Mental Health and the Substance Abuse, the Center for Disease Control and Prevention and the Mental Health Services Administration to carry out best practices that identify potential events that veterans are exposed to and carry out intervention components as deemed necessary.
The Act incurs a rather sophisticated error from conception; the Department of Defense and the Department of Veteran Affairs are two separate federal entities. H.R. 327 Joshua Omvig Suicide Prevention Act only addresses veterans, while each are or were groups of military personnel, their distinguish for the eligibility criteria is not well conceived. A congressional review in 2008 identifies a few concerns for the Joshua Omvig Veteran Suicide Prevention Act, in which the authors identify several concerns with the acts conception. Veterans are no longer eligible active military personnel but suicides amongst military members often include veterans as reserve members. Additionally, not all military members continue to receive healthcare from the Veteran Administration. Health is often used synonymously with healthcare and it is not seen as something that is widely discussed alongside with politics (Cohen et al., 2000). A prevention method drastically diminishes suicides prevalence but prevention approaches assume many facets are interrelated to a specific demographical suicidal identity; suicide is immeasurably difficult to account for if no jurisdiction is properly identified.
Several initiatives have been enacted to compliment the prevention of suicide among veterans and military members, H.R. 5771 and S. 3808 and S.2899 requiring the V.A. Secretary and the Secretary of Defense to coordinate services.
Pennsylvania General Assembly, 2014 P.L. 779, Act 71, ACT 779 Public School Code of 1949 – Youth Suicide Awareness and Prevention and Child Exploitation Awareness Education, is a provision to current legislation amending, revising and adding terms of course studies that address youth suicide awareness and the prevention of child exploitation in public, private and parochial schools. Adopting age an appropriate awareness policy and an inclusion of professional training for staff specifically in regards of suicide prevention and exploitation are the general terms of the enactment. Adopted in 2014 the state will implement the act in schools 2015 seeking to author programming for student based education for grades six through twelve; materials educating children on suicidal ideation are not mandated nationally. A proposal focused on suicide prevention to age orientation garners specific methods and concepts of sociological subgroups. ACT 779 requires schools initiate policies which implement instructional programming, create partnerships working to reduce suicide and curriculum for kindergarteners through eighth grades.
It is very difficult to predict how this act will or will not do, many variables could convolute its implementation but Pennsylvania has a history of robust initiatives and exceeds the national strategy guidelines. It integrates aspects of an ecological approach to the various socially diminished through programs that appeal to very specific activities and thus some normally alienated groups get lots of attention. Student Assistance Program (SAP), Services for Teens at Risk (STAR) and a variety of others are interwoven with high school curriculum. A resiliency program addressing behavioral health is one of many and championed by groups like the Office of Mental Health and Substance Abuse Services (OMHSAS) speaks well of the collaboration and sophistication channeled to reducing suicidal behaviors early on in a child’s development. Very specific criteria defining the identities that those impacted by the means in which they identify themselves by.
Opposition to ACT 779 can best be described through the structures of politics, “…health is political because power is exercised over it as part of a wider economic, social and political system” (Bambra, C., Fox, D., & Scott-Samuel, A., 2005). Verbiage within the bill hindered its implementation; the bill was introduced stipulating that that school staff “shall” receive four hours of annual training, shall indicating a mandate that school pay cost. How the training costs are appropriated is controversial; after months of the bill languishing between political offices "shall" were stripped out of House Bill 1559 and changed to "mays" and language was added to require the Department of Education to study whether or not schools adopt suicide prevention policies on their own. (Gillilanad, D., 2014) Possible a public health professional skilled in policy development would have the foresight to address this concern prior to the bills submission, eliminating much of the frustration.
Interventions aimed at violence reduction underwent a similar construct change, criteria identifying violent outcomes where obtained by associating developments, to address very specific circumstances. The American Journal of Preventive Medicine published a 2005 article; recommendations to reduce violence through early childhood interventions focused specific environments and particular subgrouping. The review analyzes the effectiveness of firearms laws, early childhood home visits and therapeutic therapy has on families involved in violent events. In selecting and designing interventions to meet local objectives, decision makers should consider not only these recommendations and other evidence provided in the Community Guide, but also state and local laws and regulations; administrative structures; resource availability; and the economic, cultural, and social environments of organizations and practitioners. (AJPM, 2005) Similar rates of prevalence in claims related to suicide and violence suggest the early instructional awareness and a collaboration of public and private partners addressing mental health concerns in the auspice of special demographics can reduce the potential for loss of lives. Support from the U.S. Department of Health and Human Services (DHHS) and the Center for Disease Control and Prevention (CDC), intervene on intimate partner abuse by fostering parental life skills, integrating family social support and linking social supports to the family. The intervention uniquely uses the violence as a subset to family consisting of teenage parents, low birth weight newborns or a history of substance abuse. Evidence patterning person suffering from suicidal ideation support a healthcare policy which assess the events of person related to various subgroups of the population.

Nevada Coalition for Suicide Prevention (NCSP) has an extensive network of public and private community members, an appropriate team of donors, affiliates and bipartisan leaders are very pronounce. Identifying stakeholders in Nevada’s communities consist of surveying representatives that equating the various educational, health, and social programs; everyone in the state has a stake and role in developing its health. Members from each of the Nevadan community would assess their level and individual venue. Determining the specific membership would consist of individual communities’ assessing and present their interests needs. Specialist capable of motivating and identify the uniqueness of their related subcultures within their community; the ability to integrate personal and community agendas susceptible to suicide ideation based on their relative association, will be assigned as key members. The state’s initiative would compel local and national agencies related to the Office of Prevention, Center for Disease Control and Prevention, Department of Health and Human Services to orchestrate epidemiological models. Supporters from various backgrounds, interest and levels within their cultural venue would act to fortify their own public venue. Suicide Prevention Teams (SPT) would be prioritized into self-identified skillsets and their influence with a specific population. Target populations such as patients and providers should be involved in program evaluation to ensure that the evaluation focus meets their needs and that the evaluation is ethical. (CDC, 2008) The two greatest demographics, youth younger than 15 years and elderly men over 55 years will retain their perspective affiliations, members within their venue will be trained for aligning care. Retirement seminars could have case managers that administer assessments to distinguish elder men with highest probable cause. Youths 10 to 14 years of age should be addressed by healthcare administering their 9 to 12 year old checkups, with their consent, a portion of the time can be derived by health or social care workers establishing eligibility to suicide prevention programs. Constituents will have to engaged in their venue, willing to accept assignments and capable of maintaining an advocacy of suicide prevention.
Once SPTs are assigned formal operations to train members in advocacy and community empowerment will be administered. Because so many public health efforts are complex and because public health agencies may be several layers removed from frontline implementation, stakeholders take on particular importance in ensuring that the right evaluation questions are identified and that evaluation results will be used to make a difference. (CDC, 2008) A framework of interactive team collaborations, teambuilding and communications of individual team motives will be assessed and brainstorming from each of the teams is anticipated. Teams will be expected learn approaches from educational, health and municipal perspectives, then develop projects that are assessed by team support. The concept is to gather several types of identities within ecologies that develop mentors who flourish with inner team dynamic thinking. The SPT will create staffed events that collaborate off of one another, assessing stakeholders and community member’s needs.

PUBLIC INITATIVE REPORT (Fact Sheet)______________________________________

Suicide is the occurrence of death through injuries of self-infliction, suicide prevention through planning and organizing uniquely inspired interventions are best implemented during early ages. It is this initiatives belief that behaviors identified early on and genre driven health care can establish support groups which foster healthy behaviors. Age specific services continuously evaluating mental stressors commonly associated with an increased length of suicidal ideation are monitored by trained health care staff. Training is consisting in culturally related beliefs and activities equating social norms offered significant insights to decreasing suicide related occurrences. Step | Summary | Narrative | 1 | Organize member selection plan | Research used in determining committee members as primary and principal components.One year commitment requirements. | 2 | Promote specific community partnerships | Defines initial partnerships for various community events that offer the highest degree of incident amongst specific population. | 3 | Defined programs | Program mission and statements are evaluated and meets eligibility requirements.On-site accreditation, pre-screening personnel.Property request are based on accreditation scores. | 4 | Author policy for approval | Developed policy delivered to State House for public adoption of code enforcement. | 5 | Delegate legislative authority of Nevada Suicide Prevention Planning Committee | Board of Directors, appropriate legal and procedural structure defining non-profit or profit affiliation.Standards and review consisting of paid and non-paid public health specialist.Ethics and cadre training with local community members. | 6 | Coordinate program partnerships | Required training of safety statues.Suicide community competency integrating local hospitals, school and businesses. |

* In the United States death by self-infliction constitutes the tenth leading cause in all ages; 16 per 100,000 in the state of Nevada will die from suicide. Suicide is preventable, through resiliency programs and prevention strategies community members can prevail. * Nationwide grades between 9 and 12 reports students attempting suicide, 12.8% of students have contemplated a suicide attempt to the extent as to create a plan. Suicide is the 2nd leading causes of death amongst Nevadan youth 15 to 24 years of age, the 10th highest rate in the United States, approximately 6 per 100,000 suicidal deaths occur in Nevada. Programming established early development age will include dialogue and instructions addressing suicide. * 80% of all suicide deaths in Nevada are perpetrated by males but females contemplate death greater. Access to programs abating suicidal ideation will detail appropriate studies related to gender and sexuality. * Ranked in the top five Nevada loses Nevadans by lethal self-inflictions greater than homicide, HIV/AIDS or automobile accidents. * In just two days applied suicide prevention skills are taught, there are nearly 1,000 Nevadans trained, 8,000 are trained in awareness strategies essential to continuity of public health. * An ecological approach to Nevada suicide rate engages the rich resources of its community stakeholder, members educated in the prevention will be able to advocate their venues beliefs. * The development and promotion of mental health and substance abuse to reduce the rate of suicide attempts; public policy supports the state’s efforts to collaborate ideal, increase understanding and reduce the prevalence rate of suicides. * Managing the public policy’s agenda will require committee leaders willing to offset person gains during the interim, decision makers will be held accountable to the production of training and staffed events.

Committee members of the suicide prevention imitative will submit semi-annual reports detail each of the initiative programs. Coaching staff for training transitioning team members will assume civil engagements regularly and offer input resolving conflicting programming strategies. Civic engagement differs from social responsibility by the nature of relationship and the scope of impact on its society. Civic engagement differs as your civic identity may describe the role you are playing for a social resolution. Social responsibility describes the obligation to overall trust defined by society. It would be imperative that coaching members maintain cordial yet responsible objectivity to the various genres and venues. Semi-annual surveys depicting community perception and annual review of statistical findings due to the committee leaders will assist the initiative in defining core objectives as derived by the mission statements principle intent.
The purpose of is to evaluate the participatory results of community members, program development, accountability and transference of policy’s mission. Stakeholders include staff, community members, participants and state interest; third party evaluators as desired by state interest remain critical to maintaining validity of the results. Semi-annual data collections will take the form of scaling projected goals, surveys and interviews from auditors. A comprehensive and complete program narrative of each featured activity will be provided; programs ability to prevent suicides and capacity issues will be addressed. Framework which derives the logical steps, providing future development; maturity of the participants distinguishing their successful graduation, defining the programs intended purpose.
The scope of the program will be described in terms of its short term, intermediate and long-term objectives. The participants progression through the prescribe activity will be rated by their comprehension of suicide ideation and management of those thoughts. Budgetary constraints listing cost and resources applied during the programs development and current audit is necessary for surveillance purposes. Credible evidence gathered during the onsite visit used to evaluate the approach as prescribed: methodology selected per the participants specific influence. Measurements of performance, feasibility and culture will integrate qualities data and graduates and number of participants will include quantities means. Conclusive criteria will be summarized and disseminated to the current Public Suicide Intervention Leaders and made available to public edification.

References:
American Journal of Preventive Medicine, 2005, Recommendations to Reduce Violence Through Early Childhood Home Visitation, Therapeutic Foster Care, and Firearms Laws, Task Force on Community Preventive Services, http://www.thecommunityguide.org/violence/viol-AJPM-recs.pdf
Bambra, C., Fox, D., and Scott-Samuel, A., 2005. Towards a politics of health. Health Promotion International. 20, 2. : 187-193.
Center for Disease Control and Prevention, 2008, Introduction to Program Evaluation for Public Health Programs: Step 1 Engage Stakeholders, http://www.cdc.gov/getsmart/program-planner/Step1.pdf
Center for Disease Control and Prevention, 2012, Suicide: Facts at Glance, National Center for Injury Prevention and Control, Division of Violence Prevention, http://www.cdc.gov/violenceprevention/pdf/Suicide-DataSheet-a.pdf
Center for Disease Control and Prevention, 2014, Suicide Prevention: Youth Suicide, Injury Center: Violence Prevention, http://www.cdc.gov/violenceprevention/pub/youth_suicide.html
Cohen, J. E., Milio, N., Rozier, R. G., Ferrence, R., Ashley, M. J., & Goldstein, A. O. (2000). Political ideology and tobacco control. Tobacco Control. doi:10.1136/tc.9.3.263
Committee on Public Health Strategies to Improve Health, 2011, Law and the Public’s Health: Law as a Tool for Improving Population Health, For the Public's Health: Revitalizing Law and Policy to Meet New Challenges. Washington, DC: The National Academies Press, http://www.nap.edu/openbook.php?record_id=13093&page=57 Gilliland, D., 2014, How effective teen suicide prevention in Pennsylvannia was derailed: Analysis, PennLive.com, http://www.pennlive.com/midstate/index.ssf/2014/04/teen_suicide_mike_turzai_mike.html
Sundrararaman, R., Panangala, S., Lister, S., 2011, CRS Report for Congress: Suicide Prevention Among Veterans, Domestic Social Policy Division, DIANE Pub. http://books.google.com/books?id=TS6jSEW6QaIC&printsec=frontcover&dq=inauthor:%22Ramya+Sundararaman%22&hl=en&sa=X&ei=vI46VKCQK-bBigKskoCwDA&ved=0CCAQuwUwAA#v=onepage&q&f=false
Culp-Ressler, T., 2014, Sex Ed Classes Should Start As Early As Age 10, Researcher Recommends, Health, Think Progress.org, http://thinkprogress.org/health/2014/08/05/3467593/sex-ed-classes-earlier/
United States Senate and House of Representatives, 110th Congressional Committee Hearing, Public Law 110-110, H.R. 327 Joshua Omvig Veteran Suicide Prevention Act of 2007, http://npl.ly.gov.tw/pdf/6173.pdf
Pennsylvannia General Assembly, 2014, PUBLIC SCHOOL CODE OF 1949 – Youth Suicide Awareness and Prevention and Child Exploration Awareness, Public Law 779, 2014 ACT 71, http://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2014&sessInd=0&act=71
Blake, A., New Jersey Youth Suicide Prevention Plan 2011-2014, Department of Children and Families, http://www.nj.gov/dcf/news/reportsnewsletters/dcfreportsnewsletters/DCF_SuicidePreventionUpdate.pdf