The El Paso County Suicide Prevention Call to Action is part of the Colorado National Collaborative, a comprehensive approach to suicide prevention in El Paso County, Colorado
4. Access to Care
Lethal Means
Safety
Postvention
El Paso County Suicide Prevention Task Force
1. Define The
Problem
2. Identify Risk
and Protective
Factors
3. Develop and
Implement
Strategies
4. Ensure
Widest
Dissemination
Connectedness
Education and
Awareness
Economic Stability
Colorado
National
Collaborative
El Paso County
Suicide
Prevention Task
Force
El Paso County
Suicide
Prevention
Workgroups
5. Evaluate and
Refine
Young Adult Working Adult
Older AdultYouth
First
Responder
Military
LGBTQ+ Disabled
El Paso
County
Suicide
Prevention
Task Force
5. DEFINING THE PROBLEM:
El Paso County Suicide Statistics
What is the information on suicide:
Nationally
State-Wide
Locally (City / County)
6. 11.6 11.7 12.1 12.3 12.5 12.5 12.9 13.2 13.4 14.0
0.0
5.0
10.0
15.0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
AVERAGE U.S. SUICIDE RATES 2008-2017
17.4
21.4
17.2 16.6
22.7 22.7 22.0 24.1
27.0
22.4
0.0
10.0
20.0
30.0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
AVERAGE EL PASO COUNTY SUICIDE RATES
16.5 18.5 16.6 17.4 19.5 18.5 19.7 19.4 20.4 20.3
0.0
10.0
20.0
30.0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
AVERAGE COLORADO SUICIDE RATES
DEFINING THE PROBLEM:
National â State â Local Suicide Rates
7. El Paso County Suicide
Rate Ages 20-24
El Paso County Suicide
Rate Ages 10-19
El Paso County Suicide
Rate Ages 25-55
El Paso County Suicide
Rate Ages 65+
High:
Low:
2018:
2015 (19.5)
2011 (3.2)
9.8
High:
Low:
2018:
2014 (35.8)
2011 (15.8)
25.6
High:
Low:
2018:
2016 (35.4)
2006 (14.7)
29.9
High:
Low:
2018:
2015 (31.3)
2005 (13.6)
19.7
DEFINING THE PROBLEM:
El Paso County Suicide Statistics
11. Colorado-National Collaborative is a
partnership of local, state and national scientists and
public health professionals working with health and social
service agencies, nonprofit organizations, government
agencies, businesses, academic organizations and
Colorado residents to identify, promote and implement
successful state- and community-based strategies for
suicide prevention in Colorado.
13. Beginning
Theory: Coordinated and full-scale
comprehensive prevention efforts are
necessary to demonstrate a measurable
reduction in rates and numbers at the state
level.
Goal: Develop, implement, and evaluate a
comprehensive strategy that can be
replicated nationwide.
Assessmentď Capacity Buildingď Planningď
Implementatioď Evaluation
Step 1: select the state.
14. Identifying the Starting Point:
State Readiness
14
Factors Evidence
Significant
Burden
⢠High enough burden to demonstrate effectiveness of successful intervention
Political Will ⢠Senior political support (e.g. governor & state legislature)
⢠Recently passed legislation in support of suicide prevention
Key
Infrastructure
⢠Senior Executive & State Infrastructure
⢠Suicide Prevention Commission
⢠Support across federal, county, & community behavioral health centers
Firearm Laws ⢠Preferred state with less restricted rural/urban firearm ownership laws
Agreement on
Approach
⢠Respect for both Upstream & Downstream Approaches
(Public Health & Mental Health)
15. Evaluation
Intervention Packages / Programs
⢠Process and outcome designs to measure baseline and impact of all intervention strategies, programs,
and/or policies
Action Research / Systems Level
⢠Tracking and measuring the process
⢠Ensuring that successes can be accounted for and replicated in additional communities
⢠National partners â Ensure that strategy can be replicated in other states
Constant Evolution
⢠Iterative Design
17. State Partners National Partners
⢠Colorado Department of Public Health
and Environment/ Office of Suicide
Prevention
⢠Suicide Prevention Commission
⢠Rocky Mountain Mental Illness
Research, Education and Clinical
Center at the Denver Veterans
Administration Center
⢠Governorâs Office
⢠CO Behavioral Healthcare Council
⢠University of CO Depression Center
⢠University of CO Hospital
⢠Colorado Governorâs Challenge
â Injury Control Research Center for
Suicide Prevention
â Education Development Center (Suicide
Prevention Resource Center)
â American Foundation for Suicide
Prevention
â Centers for Disease Control and
Prevention
â Substance Abuse and Mental Health
Services Administration
â National Action Alliance
23. El Paso
County
⢠Strong Community
Collaborations
⢠Public/Private partnerships
⢠Success with youth suicide
prevention efforts
⢠Grantees working across
health systems, school
districts, community mental
health, nonprofits
⢠Engaged Veteran
community
⢠Supportive firearm
community
⢠Robust data sources
⢠Readiness!
24. County Partners Include:
⢠Local Public Health Departments
⢠Community Mental Health Centers
⢠Local Coalitions and non-profits
⢠Hospitals
⢠Schools/Districts
⢠Law Enforcement/Fire/EMS
⢠Family Resource Centers
⢠Faith Community leaders
⢠Veteran-serving organizations
⢠Local government agencies
⢠And more!
26. Selecting Common Strategies and Priorities:
- Data-driven
- Across the continuum: prevention, intervention,
postvention
- Evidence-based, where possible
- Common strategies across all 6 communities so that
it can be evaluated
- Aligned with national recommendations from CDC
and National Action Alliance
- Lens of health equity and inclusivity (race, ethnicity,
urban/rural, LGBTQ+)
- Infrastructure and capacity critical ($$$)
28. Reduce Suicide Burden by 20% by
2024
Increase Key Protective
Factors
Reduce Key Risk Factors
Providing
Education and
Awareness
Improving
Connectedness
Suicide Safer
Care
Increasing
Lethal Means
Safety
Strengthening
Postvention
Efforts
Increasing
Economic
Stability
Identify partners/support
groups to fill gaps in coalition
work
Share information on best
practice, resources, and tools
Provide coordination across
CNC counties
Gather and share data to
improve prioritization and
monitoring
State&National
PartnerEfforts
Community
Strategies
OutcomesPriority
Provide Technical Support
and Sustainability Planning Build state/local political will
Provide expectations and
toolkits around equity
Secure funding
Strategic
Funding and
Staffing
Infrastructure
Strategic
Partnerships
Engaged Data
Shared
Learning and
Support
Local, State,
and National
Leadership
Responsive
Planning
33. Chief Christopher Heberer
Chief Christopher Heberer is a native of Canon City, Colorado. He received a Bachelor of Arts degree in
Criminal Justice from Gonzaga University, Spokane, Washington and received his Master of Arts degree
from Websterâs University in Security and Organizational Management in 2005.
During his 20 year career in the Army serving as a Military Police officer, Chief Heberer commanded at
all levels to include platoon, company and battalion. He served as the 759th Military Police Battalion
Commander and as the Ft. Carson Director of Emergency Services. Chief Heberer commanded over
1,100 personnel and was responsible for directing and the implementation of all Police, Fire and 911
emergency dispatch services supporting a military and civilian community of over 26,000 personnel on
Ft. Carson. Chief Heberer deployed three times throughout his career to include transforming the
Mosul Police Force, Iraq in 2009 and serving as the Joint Expeditionary Forensic Director in 2011,
supporting all US Forces in Iraq.
Chief Heberer held a variety teaching and staff positions during his time in the Army and is a graduate
of the Armyâs Command and General Staff School, US Army Airborne, Jump Master and Air Assault
schools. Chief Heberer was granted the distinction of Law Enforcement Executive Certification through
CACP in 2015.
Chief Heberer is also a Board Member for Status: Code 4, Inc.
34. Connectedness
ď David Galvan, Education for a Lifetime
ď Heather Pelser, Regional Youth Suicide Prevention
Coordinator for El Paso County
35. Thomas Joiner: Why People Die by
Suicide (2005)
ďľ Thwarted Belongingness (Feeling Alone)
ďľ Fear of Burdensomeness
ďľ Ability for Lethality
40. How common are mental illnesses?
⢠Mental illnesses are among the most common health conditions in the United
States.
⢠More than 1 in 5 Americans will experience a mental illness in a given year.
⢠50% will be diagnosed with a mental illness or disorder at some point in their
lifetime.
⢠1 in 5 children, either currently or at some point during their life, have had a
seriously debilitating mental illness.
⢠1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar
disorder, or major depression.
Source: Center for Disease Control and Prevention, Mental Health Basics, https://www.cdc.gov/mentalhealth/learn/index.htm
41. Why peer support?
âPeer support offers a level of acceptance, understanding and
validation not found in many other professional relationships.â
SAMSHA, Value of Peers, 2017
42. Innovative Peer Support
⢠Below the Surface: Pomoted Colorado Crisis Servicesâ
texting services to youth and teens in El Paso County
⢠Text line usage among 11- to 19-year-olds in ZIP codes
near the campaignâs first two pilot schools tripled from
May 2017 to May 2018.
⢠Once the campaign was introduced in Academy School
District 20, the increase was even more dramatic: In the
first five months following introduction of the campaign
text conversations tripled.
⢠Campaign adopted statewide by the Colorado Office of
Behavioral Health
46. "I feel lighter, more relieved now knowing that
Iâm not alone in struggling sometimes. Itâs
comforting to remember that if everything isnât
okay in this moment, things can get better and I
can make that happen, especially with the
support from people I love."
Practicing Happiness Participant
Image via @properfilms
48. ECONOMIC STABILITY:
FOOD STABILITY, AFFORDABLE HOUSING,
FAMILY FRIENDLY EMPLOYMENT, QUALITY
CHILDCARE
FIRST ANNUAL EL PASO COUNTY SUICIDE PREVENTION TASK FORCE
BY: BETH HALL ROALSTAD, MSW & JOEL SIEBERSMA, MA LPC
49. Access to Safer
Suicide Care
ď Jamie Falasca and Erin Milliken, AspenPointe
ď Andrea Wood, UC Health
50. The Walk-In Center offers a confidential, safe place to de-escalate from crises and receive
early intervention care in order to stabilize and prevent the need for higher levels of care.
Available 24 hours a day, 7 days a week.
Call 844-493-TALK (8255)
Text âTALKâ to 38255
Stop by 115 S. Parkside Dr.
Colorado Springs, CO 80910
For more information or to schedule
an appointment, please call our
Contact Center at (719) 572-6100.
51. Can Suicide Be A Never
Event?
https://zerosuicide.sprc.org
52. Core Components
⢠Leadership commitment
⢠Standardized screening and risk assessment
⢠Suicide care management plan
⢠Workforce development and training
⢠Effective, evidence-based treatment
⢠Follow-up during care transitions
⢠Ongoing quality improvement and data collection
53. Lethal Means Safety
ď Dr. Erik Wallace, University of Colorado School of
Medicine
ď Sgt. Eric Frederic, Colorado Springs Police
Department
54. Lethal Means Safety
El Paso County Suicide Prevention Task Force Meeting
Erik Wallace, MD, FACP
University of Colorado School of Medicine
Sgt. Eric Frederic
Colorado Springs Police Department
January 17, 2020
55. Suicide Case Fatality Rates*, US (2007-2014)
*proportion of all suicidal acts that are fatal in a given population
⢠3,657,886 suicide attempts requiring treatment in ED or
hospitalization
⢠Does not include non-fatal attempts that did not require an ED/hospital visit
⢠309,377 suicide deaths
⢠1 in 12 (8.5%) attempts are fatal
⢠Case Fatality Rate
⢠3.3% females vs. 14.7% males
⢠3.4% ages 15-24y vs. 35.4% ages >65y
Conner A et al. Ann Intern Med. 2019;171(12):885-895.
56. Methods Used for Suicide, US (2007-2014)
59%21%
5%
5%
4%
6%
Suicidal Acts,% (3,657,866)
Drug Poisoning
Cutting/Piercing
Non-Drug
Poisoning
Firearm
Hanging
Other
13% 2%
1%
51%
25%
8%
Suicide Deaths,% (309,377)
Drug Poisoning
Cutting/Piercing
Non-Drug
Poisoning
Firearm
Hanging
Other
Conner A et al. Ann Intern Med. 2019;171(12):885-895.
57. Case Fatality Rate*, % (2007-2014)
*proportion of all suicidal acts that are fatal in a given population
89.6
56.4
52.7
30.5
27.9 26.8
1.9 1.1 0.7 1.7
0
10
20
30
40
50
60
70
80
90
100
Conner A et al. Ann Intern Med. 2019;171(12):885-895.
58. Age-Adjusted Death Rate*, #deaths/100,000
Firearm Suicides
6.1
9
10.4
6.9
10.1
12.7
US COLORADO EL PASO COUNTY
2001-2017 2017
US and Colorado data obtained from https://www.cdc.gov/injury/wisqars/fatal.html
El Paso County data obtained from https://www.colorado.gov/pacific/coepht/death-data-statistics
*Age-Adjusted Death Rate = #deaths/100,000 population using correction factor for standard year 2000
59. Deaths by Suicide, El Paso County (2018)
53%
47%
Firearm vs. Non-Firearm (152 total)
Firearm - 80
Non-Firearm - 72
51%
24%
13%
6%
6%
Non-Firearm (72)
Hanging - 37
Drug Poisoning - 17
CO Poisoning - 9
Suffocation - 4
Trauma - 4
El Paso County Coronerâs Office
60. Deaths by Suicide, El Paso County (2018)
Firearm
⢠Avg. Age â 44.6y
⢠Active military 26.6y (N=10)
⢠Non-active military 47.2y (n=70)
⢠85% male
⢠86% white/non-Hispanic
⢠39% with alcohol
⢠25% above 80 mg/dl (avg. 186
mg/dl)
Non-Firearm
⢠Avg. Age â 42.8y
⢠Hanging - 37.4y (n=37)
⢠67% male
⢠Drug poisoning â 48y (n=17)
⢠47% male
⢠CO Poisoning â 48y (n=9)
⢠67% male
⢠34% with alcohol
El Paso County Coronerâs Office
61. Deaths by Firearm Suicide, EPC (2018)
⢠96% owned the firearm that was
used
⢠65% found at home/outside home
⢠65% found by
family/friend/colleague
⢠58% with h/o suicidal
ideations/attempt
⢠53% with h/o
depression/bipolar/PTSD
⢠55% with education more than HS
diploma
⢠90% had identified risk factor other
than mental health
⢠Physical health (pain, cancer)
⢠Relationship stress
⢠Financial/employment stress
⢠Military exposure/discipline
⢠Suicide of friend/family
⢠h/o sexual abuse
⢠Criminal past
⢠Substance abuse
El Paso County Coronerâs Office
62. âPeople bent on suicide will find many ways to do away with
themselves â pills, hanging, drowning, cutting arteries, jumping from
any bridge or building. Wouldnât it be much better to spend the money
on mental health care for many peopleâŚ?â
⢠Displacement
⢠Assumption that people would simply switch to another method of
suicideâŚblocking one option isnât going to make a difference
⢠Coupling
⢠Suicide is coupled to a particular context...specific circumstances and
conditions
Gladwell M. Talking to Strangers. 2019
63. Suicide using gas ovens, England
⢠In England, gas used for ovens
contained carbon monoxide
⢠Gas converted from 1960-1977
⢠Gas suicides declined from
>2400/year to zero
⢠Overall suicide rate declined from
120/million to 75/million (37.5%
reduction)
Gladwell M. Talking to Strangers. 2019
64. How do we reduce suicides?
⢠Suicide is an impulsive decision
⢠90% of people who survive suicide attempts donât go on to kill
themselves
⢠Case Fatality Rate: 90% Firearms, <2% overdose
⢠Reducing access to lethal means (i.e. firearms) to those who are at
risk of attempting suicide is the most effective way to reduce the
number of people who complete suicide
https://www.thetrace.org/2016/09/10-facts-guns-suicide-prevention-month/
65. What if in 2018�
⢠If the 80 people in EPC who completed suicide by firearm did not
have access to a firearm when in crisis, andâŚ
⢠If we assume there would have been a 37.5% reduction in suicides
among this group, thenâŚ
⢠There could have been 30 fewer suicide deaths (80x.375=30), thenâŚ
⢠Total suicide deaths reduced from 152 to 122, which isâŚ
⢠A 20% reduction in total suicides in EPC
⢠Goal of Colorado National Collaborative:
Reduce suicides by 20% by 2024
66.
67. What can I do to prevent suicide?
⢠Identify risk factors and warning signs of
suicide
⢠Assess for and limit access to lethal
means
⢠Medications â lock boxes
⢠Alcohol â limit access
⢠Firearms
1. Triple-safe storage (unloaded, locked,
inaccessible to children)
2. Give firearms and gun lock keys to a trusted
family member or friend
3. Create a firearms directive
4. Consider off-site storage options
5. Extreme Risk Protection Order (ERPO)
68. Lethal Means Assessment Questions
⢠Are any guns in the home stored in a way that they are safe from
being misused?
⢠Are there weapons in the home that concern you?
⢠Do you think your child knows how to get access to a firearm?
⢠Do you know if there are unlocked firearms in the homes where your
child plays with friends?
⢠Are you concerned that a household member might be unsafe around
firearms?
⢠Are you concerned that you might one day become unsafe around
firearms?
68
72. Gun Storage Options in EPC
⢠High Tech Custom Rifles Inc.
⢠Oasis Custom Firearms
⢠Springs Armory
⢠JT Tactical Firearms And
Gunsmithing
⢠Paradise Sales/Firearms
⢠GT Products LLC
⢠Harless Precision LLC
https://coloradofirearmsafetycoalition.org/gun-storage-map/
73. Colorado Firearm Transfer Laws
⢠âŚimmediate family members do not need background checks done to
transfer firearms between one another. The firearm should not be
transferred to any family member who is prohibited from purchasing
and/or possessing firearm.
⢠Immediate family is defined as spouses, parents, children, siblings,
grandparents, grandchildren, nieces, nephews, first cousins, aunts, and uncles
(in-laws do not apply). (CRS 18-12-112)
74. Extreme Risk Protection Order (ERPO)
⢠Civil restraining order prohibiting the named individual from
controlling, owning, purchasing, possessing, or otherwise having
custody of firearms.
⢠This should only be considered as a last resort when you are
concerned about the safety of a loved one who has access to
firearms.
⢠A request for an ERPO can only be initiated through the court system.
⢠For more information, visit the Colorado Judicial Branch website at
https://www.courts.state.co.us, or visit any Court Clerkâs office in Colorado
75. What can I do to prevent suicide?
⢠Identify risk factors and warning signs of
suicide
⢠Assess for and limit access to lethal
means
⢠Medications â lock boxes
⢠Alcohol â limit access
⢠Firearms
1. Triple-safe storage (unloaded, locked,
inaccessible to children)
2. Give firearms and gun lock keys to a trusted
family member or friend
3. Create a firearms directive
4. Consider off-site storage options
5. Extreme Risk Protection Order (ERPO)
76. Postvention
ď Betty and Kevin Van Thournout, Heartbeat
ď Cassandra Walton, Pikes Peak Suicide Prevention
Partnership
77. POSTVENTION
What You Need
to Know
Presented by:
Heartbeat Survivors After Suicide
Pikes Peak Suicide Prevention
Partnership
79. Ryan was born on June 6th, 1968
Ryan ended his life July 10, 2014
80. The day of our sonâs suicide.
ďľ Notified by Ryanâs Friend- immediate need to get to Betty & Kirsten
ďľ Shock/Horror/Disbelief/Denial â Ryanâs friend gave me the coronerâs number.
Are you sure itâs Ryan? Are you sure about the cause of death?
ďľ Personâs bereaved by suicide grieve the loss, but also the cause of death and
all that suicide means, and they are impacted by the perception of suicide by
most of society.
ďľ We had no idea how to navigate the situation and no one to ask.
81. Suicide Bereaved People Have Needs and
Tasks
Emotional Needs
ďľ Tell their story- reviewing history,
testing reality
ďľ Express their feelings â ventilating
the pain, validating loss
ďľ Making meaning & Purpose â
investing grief energy into positive
action
ďľ Transforming the Relationship-
physical presence into loving
memory
Real World Tasks
ďľ Employment
ďľ Routine Bills and Chores
ďľ Be a Spouse/Parent
ďľ Coordinate funeral services
ďľ Deal with previously scheduled
engagements
82. The lack of formal postvention.
ďľ Our family could have been positively impacted by receiving structured
communication and receiving resources to help us in the aftermath of our
sonâs death. Luckily, we were able to find support from a local survivor
support group. We are happy to understand the current efforts to ensure that
postvention responses are standardized so that families like ours can be
surrounded by all of the support they need.
83. POSTVENTION:
What is it?
Postvention refers to the actions and interventions
conducted in the immediate aftermath of a suicide.
Hypothesis:
Implementing coordinated
postvention response efforts
will reduce suicidal thoughts
and behaviors including the
reduction of attempts and
deaths.
Postvention must be a collaborative effort between the
household, the school/employer, the media, and
community resources. Additionally, efforts must address the
unique needs of different populations that live within our
community.
84. SURVIVOR
SUPPORT
Immediate and on-going grief support. We will work to create
a standardized way for resources to be communicated as part
of the postvention response by the coronerâs office.
Education/Training for Schools or Employers so that they may
provide the appropriate support and accommodations.
Education/Training for the media to address the most
appropriate ways to report in the most compassionate and
respectful manner. Research has shown us that the way a
suicide is reported by the media makes a difference.
Families and close friends impacted by a completed suicide
have an increased risk of engaging in suicidal behaviors; this
is known as âsuicide contagion.â They require immediate
access to support services.
85. COMMUNITY
SUPPORT
General Grief Support- there is a ripple effect to a
loss by suicide within the community whether an
individual may have been close to the person who
passed or not.
Mental Health Support- talk of suicide and observing
community impact may be triggering to individuals
struggling with mental health issues and increased
support should be available.
Postvention Response Protocols: Entities may
require general assistance on how to address a
suicide and entities directly impacted may need
training/support on creating the necessary
postvention response protocols.
86. OBJECTIVES OF
POSTVENTION
EFFORTS
ďľ Increase in coordination of survivor outreach to
promote and support healing.
ďľ Increase in the perceived capacity to support
survivors and the impacted community.
ďľ Increase in community/agency/organizational
education and awareness of postvention terms,
concepts and best practice principles and
interventions.
ďľ Increased coordination of community
postvention response efforts that include
prevention outreach, support and services.
87. COMMUNITY
RESPONSE
ďľ The Community Response to Suicide
must be an intentional and collaborative
effort. This image provides a very
simplistic view of Suicide Prevention.
Postvention falls under âhealingâ in this
model. Once an injury occurs in any
other context, we understand that if the
healing process is not engaged properly
additional problems can be expected. It
is important to acknowledge that
postvention is truly a lifesaving
measure. With collaborative efforts, we
can and will save lives.
Image from: FNHA Suicide Prevention Toolkit
88. Priority Populations
Panel
ď Youth: Meghan Haynes and Kelsey Leva (El Paso County Public
Health)
ď Young Adults: Dr. Benek Altayli and Stephanie Hanenberg (UCCS)
ď Elderly: Magdalene Lim, PsyD (UCCS) and Jason DeaBueno (Silver
Key)
ď Veterans: Duane France (Colorado Veterans Health and Wellness
Agency)
ď 1st Responders: Sgt. Jason Garrett (El Paso County Sheriff's Office)
ď LGBTQ: Dr. Alexander Wamboldt (Inside/Out Youth Services)
ď Disabilities: Elle Livengood and Carrie Baatz (The Independence
Center)
89. Raising mental health awareness is great, but I worry about a society in which we
are all trained to think that the person next to us is about to take their lives. What
about trainings to promote emotional intelligence? Or policies to reduce, rather
than simply cope with, stress?
-Dr. Rajeev Ramchand
Bob Woodruff Foundation