GOOD AFTERNOON. THANK YOU FOR JOINING US FOR
OUR NOVEMBER OHSRP EDUCATION
SERIES SESSION TITLED
"DETECTING AND MANAGING SUICIDE
RISK IN THE MEDICAL SETTING:
TURNING RESEARCH INTO PRACTICE".
OUR SPEAKER TODAY IS DR. LISA
HOROWITZ WHO IS A CLINICAL
PSYCHOLOGIST AND SENIOR
ASSOCIATE SCIENTIST AT THE NIH
NATIONAL INSTITUTE OF MENTAL
HEALTH.
DR. HOROWITZ RECEIVED HER
DOCTORATE IN CLINICAL
PSYCHOLOGY FROM GEORGE
WASHINGTON UNIVERSITY, SHE
COMPLETED PEDIATRIC RESEARCH
FELLOWSHIP AT HARVARD MEDICAL
SCHOOL AND OBTAINED A MASTERS
IN PUBLIC HEALTH AT THE HARVARD
SCHOOL OF PUBLIC HEALTH.
THE MAJOR FOCUS OF DR.
HOROWITZ'S RESEARCH HAS BEEN IN
THE AREA OF SUICIDE PREVENTION
IN HEALTHCARE SETTINGS,
INNOVATING TOOLS FOR CLINICIANS
SUCH AS THE SUICIDE SCREENING
QUESTIONS, ALSO KNOWN AS THE
ASQ TOOL.
ALSO ONE OF THE CO-AUTHORS OF
THE BEFORE YOU PRINT FOR YOUTH
SUICIDE PREVENTION, RELEASED BY
THE AMERICAN ACADEMY OF
PEDIATRICS IN MARCH OF 2022.
DR. HOROWITZ IS COLLABORATING
WITH HOSPITALS AND OUTPATIENT
CLINICS BOTH NATIONALLY AND
GLOBALLY, ASSISTING WITH
IMPLEMENTATION OF SUICIDE RISK
SCREENING AND MANAGEMENT OF
BOTH ADULT AND PEDIATRIC
PATIENTS WITH SCREEN POSITIVE
USING THE ASQ TOOLKIT.
THIS WILL BE ARCHIVED IN THE
PAST EVENT SECTION OF THE NIH
VIDEOCAST SITE.
SLIDES WILL ALSO BE POSTED ON
THE OHSRP WEBSITE APPROXIMATELY
1-2 WEEKS AFTER THE SESSION IN
THE PRESENTATION ARCHIVES
SCIENCE FICTION OF THE OHSRP
EDUCATION AND TRAINING WEB PAGE.
THROUGHOUT THIS SESSION WE
ENCOURAGE VIEWERS TO SUBMIT
QUESTIONS BY CLICKING ON THE
LIVE FEEDBACK LINK AND DR.
HOROWITZ WILL ADDRESS THESE
DURING OUR Q&A SESSION AFTER
THE PRESENTATION.
THANK YOU R FOR JOINING US DR.
HOROWITZ AND GO AHEAD AND GET
STARTED.
>> Lisa Horowitz: THANK YOU,
IT'S SUCH A PRIVILEGE TO BE
HERE TALKING WITH YOU ALL.
THANK YOU, PEG FOR INVITING ME.
I WANT TO MAKE SURE MY SLIDES
ARE OKAY.
>> Peg Sanders: YOU NEED TO GO
INTO FULL SCREEN.
OKAY, PERFECT.
>> Lisa Horowitz: SO TODAY WE
ARE TALKING ABOUT SOMETHING SO
IMPORTANT IT'S THE PUBLIC
HEALTH PROBLEM OF SUICIDE AND,
IF I WERE THERE IN PERSON, I
WOULD ASK FOR A SHOW OF HANDS
OF WHO HAS BEEN TOUCHED BY
SUICIDE, EITHER PERSONALLY OR
PROFESSIONALLY?
AND INEVITABLY ALMOST EVERY
HAND IN THE AUDIENCE GOES UP
WHEN I ASK THAT.
EVEN THOUGH SUICIDE IS A
RELATIVELY RARE EVENT, THE
RIPPLE EFFECTS ARE REALLY
ENDLESS.
BEFORE I START, I WANT TO SEND
MY CONDOLENCES TO ANYONE WHO
HAS LOST SOMEONE TO SUICIDE.
I ALWAYS LIKE TO START MY TALKS
WITH MY TAKE-HOME SLIDE.
AND IT'S GOING TO BE THAT
SUICIDE IS A MAJOR PUBLIC
HEALTH, AND NOT ONLY NATIONALLY
BUT GLOBALLY PUBLIC HEALTH
PROBLEM.
AND THERE ARE SIGNIFICANT
DISPARITIES IN THE RATES.
AND I'M GOING TO TALK A LOT
ABOUT HOW YOU START DIFFICULT
CONVERSATIONS ABOUT SUICIDE
RISK AND IT STARTS WITH, IN
HEALTHCARE SETTINGS IT STARTS
WITH SUICIDE RISK SCREENING
TOOL.
THAT'S A STRUCTURED WAY FOR
PROFESSIONAL HEALTHCARE
PROVIDERS TO DETECT SUICIDE
RISK.
BUT WE ARE ALSO GOING TO TALK
ABOUT HOW YOU CAN START THESE
CONVERSATIONS WITH FAMILY,
FRIENDS, CO-WORKERS.
BECAUSE THESE CONVERSATIONS CAN
REALLY HELP SAVE LIVES.
I ALSO WANT TO TALK ABOUT OUR
RESEARCH FROM OUR LAB AT
SUICIDE PREVENTION IN THE
MEDICAL SETTING AND HOW WE KEEP
TURNING THE RESEARCH INTO
REASONABLE AND PRACTICAL
GUIDELINES.
THE WAY WE DO THAT IS BY USING
A CLINICAL PATHWAY.
YOU WILL HEAR ME TALK ABOUT
THIS A LOT.
BUT IT STARTS WITH A BRIEF
SCREENING TOOL.
THE SCREENING TOOL IS FURTHER
TRIAGED WITH A SUICIDE SAFETY
ASSESSMENT AND THAT ASSESSMENT
REALLY HELPS THE CLINICIAN TO
DETERMINE DISPOSITION, WHAT
SHOULD HAPPEN NEXT FOR THE
PATIENT TO KEEP THEM SAFE?
LET'S JUST VIEW A LITTLE BIT OF
THE BACKGROUND.
SUICIDE IS THE 11th LEADING
CAUSE OF DEATH FOR ALL AGES IN
THE UNITED STATES.
IT IS ALSO THE THIRD REASON WHY
YOUNG PEOPLE DIE.
WHEN I SAY YOUNG PEOPLE, I'M
TALKING ABOUT 10-24.
NOW YOUNG PEOPLE AREN'T
SUPPOSED TO DIE.
THEY ARE SUPPOSED TO GROW UP
AND LIVE LONG HEALTHY LIVES BUT
IF YOU LOOK AT THE NUMBER OF
YOUTH DEATHS FROM 2022, YOU
WILL SEE THAT ALMOST 20%, THAT
IS A STUNNINGLY HIGH NUMBER,
20% OF THESE DEATHS WERE FROM
SOMETHING THAT'S POTENTIALLY
PREVENTABLE, SUICIDE.
I SAY POTENTIALLY PREVENTABLE
BECAUSE ALL SUICIDES CANNOT BE
PREVINTED.
-PREVENTED BUT THERE'S SO MUCH
WE CAN DO TO TRY TO PREVENT
THEM.
IF YOU LOOK AT THE GRAPH,
THAT'S THE SUICIDE RATE IN OUR
COUNTRY OVER TIME.
AND AS YOU CAN SEE IT KEEPS
CREEPING UP.
THIS IS A GRAPH OF SUICIDE
RATES BY RACE AND ETHNICITY.
THE OUT ALLIANCE OUTLIER
AMERICAN INDIANS AND ALASKA
NATIVES.
WE HAVE SEEN INCREASE IN BLACK
YOUTH SUICIDE, ASIAN YOUTH
SUICIDE, HISPANIC YOUTH SUICIDE.
THERE ARE SIGNIFICANT
DISPARITIES, THEY DON'T STEM
FROM THE POPULATIONS
THEMSELVES, THEY MORE REFLECT A
LACK OF ACCESS TO HEALTHCARE.
OR THERE'S, YOU KNOW, MORE
SYSTEMIC PROBLEMS LIKE RACISM.
NOW, THERE ARE MANY
UNDERSERVED, UNDER STUDIED
POPULATIONS THAT ARE AT HIGHER
RISK FOR SUICIDE, THAT'S NOT
JUST BY RACE AND ETHNICITY BUT
ALSO LGBTQ+ INDIVIDUALS,
INDIVIDUALS WITH
NEURODEVELOPMENTAL DISORDERS
LIKE AUTISM.
CHILDREN IN THE CHILD WELFARE
SYSTEM ARE FIVE TIMES THE RISK
OF DYING BY SUICIDE.
ANYONE IN DETENTION CENTERS AND
RURAL AREAS.
ALL OF THESE POPULATIONS ARE AT
HIGHER RISK FOR SUICIDE.
WE BELIEVE UNIVERSAL SUICIDE
RISK SCREENING IN MEDICAL
SETTINGS CAN HELP PROMOTE
HEALTH EQUITY.
IT'S SCREENING EVERYBODY AND
EVERYBODY HAS A CHANCE TO GET
LIFE-SAVING MENTAL HEALTHCARE.
SUICIDE, I GAVE YOU THE
STATISTICS FOR DEATH.
IT'S STILL A RELATIVELY RARE
EVENT.
WHAT'S MORE COMMON ARE SUICIDAL
BEHAVIORS AND IDEATIONS.
ABOUT 1.6 MILLION ADULTS
ATTEMPTED SUICIDE AND 13.2
MILLION ADULTS HAD SERIOUS
THOUGHTS OF SUICIDE.
THIS IS YOUR AVERAGE HIGH
SCHOOL STUDENT, THE CDC GOES
AROUND HIGH SCHOOLS AROUND THE
COUNTRY, 9.5% HIGH SCHOOL
STUDENTS REPORTED ATTEMPTING
SUICIDE IN THE LAST YEAR AND
20.4% OF HIGH SCHOOL STUDENTS
REPORTED THAT THEY SERIOUSLY
CONSIDERED KILLING THEMSELVES.
THESE ARE STAGGERING NUMBERS.
THEY HAVE BEEN FOR A WHILE.
PEOPLE SAY WHAT HAPPENED DURING
THE PANDEMIC, I CAN TELL YOU
THAT EXACERBATED AN ALREADY
VERY SERIOUS PUBLIC HEALTH
PROBLEM.
I WAS FORTUNATE ENOUGH TO BE
PART OF THIS STUDY LED BY
JEFFREY BRIDGE FROM NATIONWIDE
CHILDREN'S.
WHAT WE SAW IS DURING THE FIRST
YEAR OF COVID, THE NUMBER OF
SUICIDE DEATHS HAD INCREASED
WAY PAST WHAT WAS EXPECTED.
THERE WERE 212 EXCESS DEATHS.
YOU COULD SEE IT WASN'T, YOU
COULD SEE THOSE DISPARITIES,
MORE MALES, AGE GROUPS 5-12
YEAR OLDS, INCREASED SUICIDE.
LIKE I MENTIONED AMERICAN
INDIANS AND BLACK YOUTH HAD
HIGHER RATES AND MORE SUICIDE
DEATHS FROM FIREARMS.
SO MUCH SO THAT IN 2021, THE
SURGEON GENERAL ISSUED AN
ADVISORY AND DECLARED A YOUTH
MENTAL HEALTH CRISIS IN THIS
COUNTRY.
AND THEN THE AMERICAN ACADEMY
OF PEDIATRICS, THE AAP AND
AMERICAN ACADEMY OF CHILDREN'S
HOSPITAL ASSOCIATION ALSO
DECLARED A MENTAL HEALTH
EMERGENCY.
THE COUNTRY IS PAYING ATTENTION
TO THIS FROM A PUBLIC HEALTH
PERSPECTIVE.
AND LET ME JUST GO OVER SOME OF
THE RISK FACTORS FOR SUICIDE.
I'M NOT GOING TO GO THROUGH ALL
OF THEM.
BUT I HIGHLIGHTED THE STRONGEST
RISK FACTORS PREVIOUS ATTEMPT
IS THE MOST POTENT RISK FACTOR.
WE HAVE A SAYING IN PSYCHOLOGY
IS BEST PREDICTOR OF FUTURE
BEHAVIOR IS PAST BEHAVIOR.
THIS IS ABSOLUTELY TRUE FOR
SUICIDE.
ANYONE WHO HAS TRIED TO KILL
THEMSELVES IN THE PAST IS MORE
LIKELY TO TRY AGAIN IN THE
FUTURE OR HAVING A MENTAL
ILLNESS THAT PUTS SOMEONE AT
GREAT RISK FOR SUICIDE.
I HIGHLIGHTED THIS ONE AT THE
BOTTOM, MEDICAL ILLNESS,
BECAUSE THAT'S A RISK FACTOR
THAT'S OFTEN OVERLOOKED.
BUT ONE THAT MY RESEARCH TEAM
HAS FOCUSED ON.
MANY OF THE BULLET POINTS
AREN'T GOING TO DIE BY SUICIDE,
THEY ARE SIMPLY RISK FACTORS.
IF YOU WERE A TRIAGE NURSE IN
AN EMERGENCY DEPARTMENT AND
SOMEONE CAME IN WITH RISK
FACTORS FOR HEART ATTACK.
IF THEY CAME IN WITH WARNING
SIGNS, LIKE THEY WERE CLUTCHING
THEIR CHEST IN PAIN AND
SWEATING PROFUSELY, MIGHT THINK
THEY ARE HAVING A HEART ATTACK.
THE SAME THING IS TRUE FOR
SUICIDE, THERE'S RISK FACTORS
BUT MORE IMPORTANT TO PAY
ATTENTION TO ARE THE WARNING
SIGNS.
LET'S GO THROUGH SOME OF THEM.
THE FIRST ONE SEEMS SO OBVIOUS,
TALKING ABOUT WANTING TO DIE OR
KILL ONE SELF.
HOWEVER WE OFTEN DON'T TAKE
TALK OF SUICIDE SERIOUSLY.
SO PEOPLE WHO DIE BY SUICIDE
SOMETIMES TELL OTHER PEOPLE AND
THEY STILL DON'T GET HELP.
SO IT'S REALLY IMPORTANT TO PAY
ATTENTION.
OR IF SOMEONE IS TALKING ABOUT
FIREARM WHERE THEY DIDN'T
COLLECT FIREARMS BEFORE, OR
FEELING HOPELESS, TRAPPED OR
LIKE YOU ARE A BURDEN.
INCREASED OR EXCESSIVE USE OF
ALCOHOL OR DRUGS.
OR SIGNS OF DEPRESSION,
SLEEPING TOO LITTLE OR TOO
MUCH, BEING ISOLATED, SEVERE
MOOD SWINGS.
THESE ARE ALL WARNING SIGNS
SOMEONE MIGHT BE AT IMMINENT
RISK FOR SUICIDE.
I HAVE JUST LAID SOME VERY
SOBERING STATISTICS ON YOU.
GIVING YOU THE RISK FACTORS AND
WARNING SIGNS.
IT SEEMS, THIS IS A VERY HEAVY
TOPIC.
BUT THIS IS NOT A DEPRESSING
TALK, NOT AT ALL.
WE USE THESE STATISTICS TO
CONTINUE TO BE A CALL TO ACTION.
BECAUSE THERE IS SO MUCH WE CAN
DO ABOUT REDUCING SUICIDE.
SO THAT'S WHAT THIS TALK IS
GOING TO BE.
IT HAPPENS TO BE A REALLY GOOD
TIME TO BE TALKING ABOUT MENTAL
HEALTH ISSUES LIKE SUICIDE.
WE HAVE A SURGEON GENERAL WHO
ISSUED AN ADVISORY IN 2023 ON
LONELINESS AND ISOLATION.
AND THE IMPORTANCE OF SOCIAL
CONNECTEDNESS AND COMMUNITY.
THIS IS VERY WELL SUPPORTED.
AND THE MEDIA, WE HAVE
CELEBRITIES NOW COMING OULT
WITH TALKING ABOUT THEIR MENTAL
HEALTH CONCERNS, TALKING ABOUT
DEPRESSION, TALKING ABOUT
SUICIDE RISK.
SO THIS IS A GOOD TIME TO HAVE
THESE CONVERSATIONS.
THESE VERY DIFFICULT BUT VERY
CRITICAL CONVERSATIONS.
SO I'M FORTUNATE ENOUGH TO BE
PART OF A RESEARCH TEAM THAT
ASKS WITH KE SAVE LIVES BY
SCREENING FOR SUICIDE RISK IN
THE MEDICAL SETTING.
I'M HOPING TO CONVINCE YOU THAT
THE ANSWER TO THIS IS "YES".
WHY DID WE PICK THE MEDICAL
SETTING?
IF YOU LOOK AT DEATH REGISTRY
STUDIES, THE MAJORITY OF PEOPLE
WHO HAVE DIED BY SUICIDE, AND
THIS IS BOTH ADULTS AND YOUTH
HAVE VISITED A HEALTHCARE
PROVIDER, NOT JUST MONTHS BUT
WEEKS BEFORE THEY DIED.
SO THEY ARE PASSING RIGHT
THROUGH OUR HEALTHCARE SYSTEM.
HOWEVER, THEY DON'T USUALLY SAY
THINGS TO THEIR DOCTOR OR THEIR
NURSES LIKE, I'M THINKING OF
KILLING MYSELF, RIGHT?
THEY PRESENT WITH SOMATOIC
MEDICAL COMPLAINTS.
IF SOMEONE DOESN'T ASK THEM
DIRECTLY, ARE YOU THINKING OF
KILLING YOURSELF, THEY MOST
LIKELY WON'T TALK ABOUT THEIR
SUICIDAL THOUGHTS, SO THE
MAJORITY OF SUICIDE ATTEMPTERS
GO UNRECOGNIZED BECAUSE THE
MAJORITY OF MEDICAL SETTINGS DO
NOT SCREEN FOR SUICIDE RISK.
THEY DO NOT INITIATE THESE
REALLY CRITICAL CONVERSATIONS.
STARTING DIFFICULT
CONVERSATIONS.
AND THIS IS WHY UNIVERSAL
SUICIDE RISK SCREENING IS SO
IMPORTANT.
I SHOULD DEFINE UNIVERSAL.
THERE ARE TWO WAYS TO DO
SCREENING, YOU CAN DO TARGETED
OR UNIVERSAL.
TARGETED MEANS, FOR EXAMPLE, IN
MANY HOSPITALS PEOPLE WHO
PRESENT WITH BEHAVIORAL HEALTH
OR MENTAL HEALTH COMPLAINTS,
GET SCREENED FOR SUICIDE RISK
BUT PEOPLE WITH MEDICAL
COMPLAINTS DO NOT, RIGHT?
THAT'S TRICKY, BECAUSE WHO
DOESN'T HAVE MENTAL HEALTH
CONCERNS AMONG US.
YOU DON'T KNOW THAT.
THAT'S WHY UNIVERSAL SCREENING
MEANS YOU SCREEN EVERYONE.
YOU DON'T JUST TARGET PEOPLE
PRESENTING WITH BEHAVIORAL
HEALTH CHIEF COMPLAINTS.
WHY IS UNIVERSAL SCREENING SO
IMPORTANT?
JUST A FEW WEEKS AGO THERE WAS
A JAMA OPEN STUDY, SHOWING THAT
THE MAJORITY OF YOUNG PEOPLE
THIS IS 10-24 WHO DIED BY
SUICIDE, THESE WERE ACTUAL
DEATHS, 60% OF THEM HAD NO
PREVIOUSLY DOCUMENTED MENTAL
HEALTH DIAGNOSIS.
SO THIS PERSON WOULDN'T PRESENT
WITH THE BEHAVIORAL HEALTH
CHIEF COMPLAINT YET THEY TOOK
THEIR OWN LIFE.
SO THIS IS WHY UNIVERSAL
SCREENING IS SO IMPORTANT.
I WAS FORTUNATE ENOUGH TO BE
PART OF THIS STUDY.
WE LOOKED AT SUICIDE RATES FOR
PRE-TEENS, KIDS UNDER THE AGE
OF 12.
WHAT WE SAW IS FROM 2008-2022,
EVERY SINGLE YEAR THE RATE ROSE
BY 8% FOR 8-12-YEAR-OLDS.
AND THERE WERE SIGNIFICANT
INCREASES.
THERE USED TO BE MORE MALE
DEATHS THAN FEMALE DEATHS, NOW
THE FEMALES, THERE'S EQUAL MALE
AND FEMALE DEATHS FOR PRE-TEENS.
AMERICAN INDIANS, AGAIN, THEY
HAVE HIGHER RATES.
ASIAN PACIFIC ISLANDERS,
HISPANIC PRE-TEENS AND YOUNG
PEOPLE WHO DIED BY FIREARM.
AND THESE WERE TWO STUDIES.
OKAY, SO WHAT STOPS PEOPLE FROM
TALKING ABOUT SUICIDE?
IF WE WERE ALL TOGETHER IN AN
AUDITORIUM I WOULD ASK FOR A
BRAVE SOUL TO RAISE THEIR HAND
AND SAY WHAT DO YOU THINK THE
MOST COMMON CONCERN IS, WHY
DON'T PEOPLE TALK ABOUT SUICIDE?
SO PEOPLE WORRY IF YOU ASK
PEOPLE ABOUT SUICIDE YOU ARE
GOING TO PUT THE IDEA INTO
THEIR HEAD.
BUT THIS IS ACTUALLY THE
OPPOSITE IS TRUE.
IT'S NOT HARMFUL TO ASK SOMEONE
ABOUT SUICIDE.
IT'S THE OPPOSITE.
YOU COULD SAVE THEIR LIFE BY
ASKING.
YOU DON'T HAVE TO TAKE MY WORD
FOR IT BECAUSE THERE'S AT LEAST
FOUR RESEARCH STUDIES THAT SHOW
IT IS NOT HARMFUL TO ASK
SOMEONE ABOUT SUICIDE RISK.
OKAY, SO.
I'VE JUST WANTED TO SHOW YOU,
SO THIS IS A TREE IN FRONT OF
THE NIH CLINICAL CENTER,
BETHESDA.
IT'S IN MEMORY OF DANIEL ROBERT
MORENO, THIS IS A PATIENT WHO
DIED BY SUICIDE IN THE CLINICAL
SETTING.
IN 2005, IN THE MIDDLE OF THE
DAY, VERY PUBLIC.
IT WAS DEVASTATING.
THIS WAS NOT ONLY DEVASTATING
TO THIS PATIENT AND THEIR
FAMILY BUT TO EVERYBODY IN THE
CLINICAL CENTER.
AND THE GREATER NIH COMMUNITY.
BUT I PUT THIS UP BECAUSE OF
THIS PEOPLE GOT VERY INTERESTED
IN SUICIDE RISK.
AND IT WAS JUST KIND OF A
COINCIDENCE THAT I MOVED HERE
TO NIH AND I HAD STUDIED
SUICIDE RISK SCREENING IN THE
MEDICAL SETTING UP IN
MASSACHUSETTS.
AND I HAD COME RIGHT AFTER THIS
SUICIDE.
BUT I PUT THIS UP BECAUSE SINCE
2005, WE HAD THAT SUICIDE IN
THE CLINICAL CENTER.
NOW IN 2024, THERE ARE PEOPLE
BEING SCREENED IN ETHIOPIA AND
NEPAL AND ALL OVER THE WORLD
FOR SUICIDE RISK.
IT STARTED WITH THIS TRAGEDY
BUT IT WAS ABLE TO BE TURNED
INTO SOME HOPE AND ACTION.
SO IT STARTED WITH, I WAS
HAVING LUNCH WITH DR. MARYLAND
PAO,THE CLINICAL DIRECTOR OF
NIMH.
I HAD COME FROM CHILDREN'S
HOSPITAL WHERE I CAME UP WITH A
SUICIDE RISK SCREENING TOOL FOR
PEDIATRIC PATIENTS WITH
PSYCHIATRIC CHIEF COMPLAINTS.
SHE SAID TO ME SHE HAD JUST
COME FROM BEING HEAD OF
PSYCHIATRY IN THE EMERGENCY
DEPARTMENT AT CHILDREN'S
NATIONAL.
SHE SAID CAN WE USE YOUR TOOL
ON ALL COMERS TO THE EMERGENCY
DEPARTMENT, I CALL THIS THE PAO
FACTOR.
SHE KIND OF SET LET'S DO THIS
STUDY.
SO WE DID THIS STUDY.
I'M GOING TO TELL YOU ABOUT IT
IN A MINUTE.
BUT I JUST WANTED TO TELL YOU
WHAT'S GOING ON WITH THE JOINT
COMMISSION AND HOSPITAL.
THE JOINT COMMISSION IS THIS
ACCREDITATION BODY THAT
ACCREDITS MOST OF THE HOSPITALS
IN THIS COUNTRY.
SO HOSPITAL-BASED SUICIDES ARE
RARE BUT VERY DEVASTATING
EVENTS.
YOU MAY BE SURPRISED TO HEAR
IT'S ONE OF THE TOP FIVE
REPORTED SENTINEL EVENT, THAT'S
WHEN IT HAPPENS SUDDENLY.
A QUARTER OF THEM ARE HAPPENING
IN NON-BEHAVIORAL HEALTH UNITS,
LIKE THE EMERGENCY DEPARTMENT,
ICU, CANCER UNITS, MED-SURGE
UNITS, OUTPATIENT CLINICS.
I JUST WANTED TO SHOW YOU FROM
THE SUICIDE THAT WE HAD AT THE
CLINICAL CENTER, THAT HAPPENED
IN 2005, A TEAM HERE LED BY DON
ROSEN STAOEN AT THAT TIME WENT
TO THE JOINT COMMISSION AND WE
BELIEVE BECAUSE OF THIS
PROCESS, THE JOINT COMMISSION
ACTUALLY ISSUED A NATIONAL
PATIENT SAFETY GOAL THAT ALL
HOSPITALS IN THE COUNTRY SHOULD
SCREEN BEHAVIORAL HEALTH
PATIENTS FOR SUICIDE RISK.
AND IN 2008, WE LAUNCHED THE
FIRST SUICIDE-RISK SCREENING
TOOL STUDY WE DO IN THE
EMERGENCY DEPARTMENT THAT I
WILL TELL YOU ABOUT.
AND THEN IN 2010, THE JOINT
COMMISSION WAS LOOKING AT THEIR
DATA AND SEEING THAT MORE AND
MORE NON-BEHAVIORAL HEALTH
UNITS WERE EXPERIENCING SUICIDE.
THEY BROUGHT IN THEIR ALERT.
AND IN 2012, THE ASK WAS
PUBLISHED.
AND IN 2016, THE JOINT
COMMISSION BROADENED IT EVEN
MORE AND RECOMMENDED ALL
MEDICAL PATIENTS BE SCREENED
FOR SUICIDE RISK.
AND IT HAS BEEN SINCE UPDATED
AND NOW THE ASK IS VALIDATED IN
NOT ONLY YOUTH BUT IN ADULTS AS
WELL.
SO WE WERE READY.
SO LET'S TALK ABOUT THIS
SCREENING.
STARTING THESE CONVERSATIONS IN
HEALTHCARE SETTINGS.
WE ARE USED TO SCREENING.
EVERYONE WHO GOES TO A MEDICAL
APPOINTMENT GETS SCREENED FOR
BLOOD PRESSURE.
THAT'S THE NIH CLINICAL CENTER
TOP RIGHT WHERE WE SCREENED FOR
COVID IN 2020 AND SCREENED AT
AIRPORTS AND SOME KIDS EVEN GET
SCREENED BEFORE THEY GO ON A
ROLLER COASTER.
SO PEOPLE ARE USED TO SCREENING.
I WANT TO TELL YOU THE
DIFFERENCE BETWEEN SCREENING
AND ASSESSMENT.
SCREENING IS A RAPID WAY TO
IDENTIFY SOMEONE WHO NEEDS
FURTHER EVALUATION.
AN ASSESSMENT IS MORE
COMPREHENSIVE EVALUATION, IT
CONFIRMS RISK AND ALL THOSE IN
FAVOUR -- GUIDES NEXT STEPS.
OUR TEAM ASKS WHAT ARE THESE
VALID QUESTIONS THAT
NURSES/PHYSICIANS CAN USE TO
SCREEN MEDICAL PATIENTS WITHOUT
OVER BURDENING THEIR PRACTICE?
WE LAUNCHED THIS STUDY IN THREE
PEDIATRIC EMERGENCY
DEPARTMENTS, BOSTON CHILDREN'S,
CHILDREN'S NATIONAL AND
NATIONWIDE CHILDREN'S.
WE INFUSED THE SAMPLE WITH
PSYCHIATRIC PATIENTS.
AT THAT TIME WE DIDN'T KNOW IF
KIDS WOULD BE TALKING ABOUT
SUICIDE RISK, SO WE WANTED TO
MAKE SURE THERE WERE KIDS WITH
SUICIDAL THOUGHTS IN THE SAMPLE.
IN BRIEF TERMS WE TOOK A BUNCH
OF CANDIDATE ITEMS AND TAKE A
GOLD STANDARD ASSESSMENT LIKE
THE SUICIDAL IDEATION
QUESTIONNAIRE AND THEN WE
STATISTICALLY MODEL THE 17
CANDIDATE ITEMS TO SEE WHAT IS
THE FEWEST NUMBER OF ITEMS THAT
CAN CAPTURE THE SAME PATIENTS
AS THE GOLD STANDARD.
AND SO PEOPLE OFTEN STOP ME AND
SAY, WELL IF YOU HAVE A GOLD
STANDARD WHY ARE YOU MAKING A
NEW TOOL.
WE HAD TO DO A VERY BRIEF
SCREENING TOOL THAT WOULD
CAPTURE THE SAME KIDS.
AND SO, WE HAD SEVERAL
DIFFERENT MODELS AND WE PICKED
ONE THAT REALLY LIMITED
MISCLASSIFYING PATIENTS AND
MISSING PATIENTS.
WHAT WE CAME UP WITH IS A TOOL
THAT HAD VERY STRONG
SENSITIVITY, TRUE/POSITIVE RATE.
VERY GOOD SPECIFICITY WHICH IS
THE TRUE-NEGATIVE RATE, LIMITS
FALSE POSITIVE AND VERY GOOD
NEGATIVE PREDICTIVE VALUE,
MEANING WHEN THE TOOL SAYS
SOMEBODY IS A NEGATIVE, THERE
WAS A 99.7% OF THEM, THE GOLD
STANDARD ALSO SAID THEY WERE
NEGATIVE.
WE WERE REALLY HAPPY ABOUT THE
HIGH SPECIFICITY BECAUSE WHAT
WE DIDN'T WANT TO DO IS OVER
BURDEN MEDICAL SYSTEM WITH
FALSE POSITIVES.
IN THE PAST FEW WEEKS HAVE YOU
WISHED YOU WERE DEAD.
IN THE PAST FEW WEEKS HAVE YOU
THOUGHT YOU OR YOUR FAMILY
WOULD BE BETTER OFF DEAD.
HAVE YOU BEEN HAVING THOUGHTS
ABOUT KILLING YOURSELF?
HAVE YOU EVER TRIED TO KILL
YOURSELF?
WE KNOW FROM BIG DATASETS, I
WILL PICK ONE STUDY ON MY MIND
FROM PARKLAND HOSPITAL IN
DALLAS, TEXAS, THINK HAD 90,000
ASKS.
WE KNOW THAT MAYBE 97% OF
PATIENTS ARE GOING TO SCREEN
LIKE THIS.
IT WILL BE 20 SECONDS AND
YOU'RE DONE.
THEY ARE NEGATIVE.
THIS IS WHAT MAKES UNIVERSAL
SUICIDE RISK SCREENING FEASIBLE
IN THE MEDICAL SETTING.
BECAUSE MOST PATIENTS AREN'T
GOING TO BE POSITIVE.
NOW IF YOU DO SCREEN POSITIVE,
THERE'S TWO WAYS, ACUTE AND
NON-ACUTE.
IF YOU SAY YES TO ANY
COMBINATION, YOU ARE GIVEN THAT
FIFTH QUESTION, YOU SAY NO,
THAT'S A NON-ACUTE POSITIVE.
IN THE SAME STUDY, 99.5% OF THE
POSITIVES WERE NON-ACUTE.
WHICH MEANT IT WAS GREAT THAT
YOU PICKED SOMETHING UP BECAUSE
NOW YOU CAN HELP THE PATIENT
BUT IT WAS NOT AN EMERGENCY.
WE ARE GOING TO TALK A LOT MORE
ABOUT THIS, THIS IS NOT A TRIP
TO THE EMERGENCY ROOM.
THIS IS NOT A ONE-TO-ONE.
HOWEVER, YOU DO HAVE TO BE
READY IF SOMEONE SAYS YES TO
FIVE, THAT IS AN ACUTE POSITIVE
AND THAT IS AN EMERGENCY.
AND THAT IS FULL ON SAFETY
PRECAUTIONS, BUT THAT HAPPENS
AT A 0.5% OF THE TIME.
IT'S NOT THE MOST COMMON
RESPONSE.
IT'S A HIGHER RESPONSE IN
BEHAVIORAL HEALTH PATIENTS.
BUT IT'S STILL NOT THE MAJORITY.
SO THE ASK WAS VALIDATED
THROUGH RESEARCH IN INPATIENT
MEDICAL SURGICAL UNIT,
OUTPATIENT PRIMARY CARE,
SPECIALTY CLINICS AND IN ADULT
MEDICAL PATIENTS.
SO THIS IS ONE OF THOSE TOOLS
THAT USUALLY TOOLS GO FROM THE
ADULT WORLD TO THE PEDIATRIC
WORLD.
THIS IS A TOOL THAT WENT FROM
THE PEDIATRIC WORLD TO AT DULT
WORLD.
THE PLACES IN BLACK WE HAVE
ONGOING RESEARCH.
I'M SO EXCITED ABOUT OUR INDIAN
HEALTH SERVICE PARTNERSHIP
BECAUSE OF THE DATA I SHOWED
YOU THAT AMERICAN INDIANS HAVE
THE HIGHEST RATE.
THEY HAVE SELECTED ASQ TOOL.
WE ARE TESTING THE ASQ IN
PEOPLE WITH NEURODEVELOPMENTAL
DISORDERS LIKE AUTISM.
IT HAS BEEN TRANSLATED IN OVER
23 LANGUAGES AND COMES WITH A
TOOLKIT.
THE PLACES IN GREEN ARE PLACES
THAT ACTUALLY VALIDATED THE ASQ
THROUGH RESEARCH.
ALSO BECAUSE OF THE RISE IN
BLACK YOUTH SUICIDE, WE WENT
BACK AND REANALYZED TO COMPARE
BLACK YOUTH AND WHITE YOUTH
WITH VALIDITY ASQ AND WE SAW
AMONG BLACK YOUTH IT HAD STRONG
PSYCHO METRIC PROPERTIES.
THE ASQ WASN'T DEVELOPED TO BE
PREDICTIVE OF SUICIDE ALABI
HAIFOR BUT THERE ARE SEVERAL
STUDIES THAT THAT SHOW IT HAS
SOME PREDICTIVE HAVE A LIT ID
FOR POST EMERGENCY DEPARTMENT
DISCHARGE.
SUICIDAL BEHAVIOR.
THE WAY YOU CAN MAKE IT
FEASIBLE AND NOT OVER BURDEN IS
MAKE IT PART OF THE CLINICAL
PATHWAY.
WE HAVE IT FOR ASTHMA AND
DIABETES.
WE NEED CLINICAL PATHWAYS FOR
TREATING MENTAL HEALTH PROBLEMS
AS WELL.
SO THIS PATHWAY, THE BARE BONES
OF IT IS A BRIEF SCREEN,
FOLLOWED BY A BRIEF SUICIDE
SAFETY ASSESSMENT THAT FURTHER
TRIAGES THE SCREEN.
AND THAT HELPS YOU DETERMINE
WHAT HAPPENS NEXT WITH THE
PATIENT.
DO THEY NEED A FULL MENTAL
HEALTH EVALUATION, OR CAN THEY
TAKE AN OUTPATIENT REFERRAL.
OR NO FURTHER ACTION AT THIS
TIME?
WHAT I'VE SEEN FROM CONSULTING
TO HOSPITALS AROUND THE COUNTRY
IS THAT THERE ARE A HUNDRED
DIFFERENT WAYS TO DO THESE
THREE STEPS BUT THESE THREE
STEPS ARE THE IMPORTANT STEPS.
WHAT REALLY MAKES IT FEASIBLE,
IT'S ALL IN THE NUANCE.
SO EVERY PLACE IS GOING TO DO
THIS A LITTLE BIT DIFFERENT AND
THROUGH A QUALITY IMPROVEMENT
PROCESS, AN ITERATIVE PROCESS,
THEY CAN KEEP STUDYING HOW THIS
CLINICAL PATHWAY WORKS AND KEEP
TWEAKING IT UNTIL IT GETS TO
THE PLACE WHERE IT'S REALLY
WORKING EFFICIENTLY.
OKAY, SO LET'S TALK ABOUT THE
FIRST LEVEL IS A BRIEF SCREEN.
AND SO, WHAT WE TELL PEOPLE IS
TRAIN EVERYONE IN YOUR OFFICE
ABOUT SUICIDE RISK.
AND THEN ANYONE WHO IS TRAINED
TO SCREEN CAN SCREEN.
I MEAN, THE ASQ WAS CREATED FOR
A NURSE, MEDICAL TECHNICIAN OR
MEDICAL ASSISTANT.
BUT IT CAN ALSO BE USED BY
PHYSICIANS AND OTHER PEOPLE WHO
ARE TRAINED.
AND THEN THEY DECIDE, ARE THEY
GOING TO DO IT SELF-REPORT OR
IS SOMEONE GOING TO DO IT VERB
BALLY.
-- VERBALLY.
THEY SET THE FREQUENCY, HOW
OFTEN ARE WE GOING TO SCREEN.
THESE ARE DECISIONS MADE AT THE
LOCAL LEVEL.
ARE THEY GOING TO START AT 10,
WHAT WE RECOMMEND OR ARE THEY
GOING TO START AT 12.
SO THAT HAS TO DO WITH STARTING
THE DIFFICULT CONVERSATIONS
THROUGH SCREENING IN A
HEALTHCARE SETTING.
BUT WHAT HAPPENS WHEN A PATIENT
SCREENS POSITIVE?
RIGHT?
HERE IS WHAT SHOULD NOT HAPPEN.
THIS IS SO IMPORTANT.
YOU CANNOT TREAT EVERY PERSON
WHO HAS A THOUGHT ABOUT SUICIDE
LIKE THEY ARE AN EMERGENCY.
BECAUSE OTHERWISE THEY END UP
IN THE EMERGENCY DEPARTMENT IN
A PAPER GOWN, THEY ARE GIVEN A
VERY COSTLY ONE-TO-ONE SITTER,
THEY ARE THERE FOR HOURS, THEIR
BELONGINGS LIKE THEIR PHONES
ARE TAKEN AWAY, AND THIS PERSON
MAY FEEL PUNISHED.
YOU MIGHT BE, IF YOU ARE A
PROVIDER, THIS PROVIDER MIGHT
BE THE FIRST PERSON TO ASK THEM
ABOUT SUICIDE RISK AND THEY
OPENED UP AND NOW THEY FEEL
SORRY THAT THEY TOLD ANYONE AND
MAYBE THEY WILL NEVER TELL
ANYONE AGAIN.
SO WE CANNOT HAVE THIS HAPPEN.
SO THAT'S WHERE THESE CLINICAL
PATHWAYS COME IN.
THEY COME IN TO AVOID THESE
KIND OF UNNECESSARY
INTERVENTIONS.
I CAN'T TELL YOU HOW MANY
HOSPITALS I WENT IN WHERE
SOMEONE JUST MAYBE HAD A
PASSIVE THOUGHT OF SUICIDE AND
THEY ENDED UP LIKE THIS.
THAT'S NOT OKAY.
THAT'S NOT A COMPASSIONATE WAY.
NOW, WHEN SOMEONE IS AT ACUTE
RISK THERE'S A VERY
COMPASSIONATE WAY TO KEEP THEM
IS A, SOMETIMES THEY DO NEED A
1:1 SITTER AND PUT IN A ROOM
WHERE THEY ARE SAFE.
BUT THERE'S A COMPASSIONATE WAY
TO EXPLAIN YOU ARE TRYING TO
KEEP THEM SAFE AND HAVE THEM BE
PART OF THAT PROCESS AS WELL.
TWO WAYS TO SCREEN POSITIVE,
ACUTE AND NON-ACUTE.
I'M NOT GOING TO GO THROUGH ALL
THESE DETAILS BUT THE
ACUTE-POSITIVE IS THE EMERGENCY.
AND THERE'S A WHOLE LIST OF
THINGS THIS PATIENT CANNOT
LEAVE THE HOSPITAL UNTIL THEY
HAVE THE FURTHER SAFETY
EVALUATION.
AND THEN MORE COMMONLY, THE
POSITIVES ARE NON-ACUTE, A YES,
1-4, NO TO #5.
RISK IS DETECTED BUT NOT
IMMINENT.
WE WORKED WITH THE JOINT
COMMISSION TO GET THEM TO
AGREE, WHILE THE PERSON IS
ASKED TO STAY FOR THE FOLLOW-UP
SUICIDE SAFETY ASSESSMENT, IF
THEY DECIDE TO LEAVE, THEY CAN
LEAVE.
JUST LIKE IF SOMEONE HAS A SKY
ROCKETING BLOOD PRESSURE AND
HOSPITAL SAYS WE WANT YOU TO
WAIT FOR A CARDIOLOGY CONSULT
AND THEY MAKE THE DECISION NOT
TO WAIT, THEY ARE ALLOWED TO
WAIT.
SECURITY DOES NOT ASCEND ON
THEM.
THEY SIGN OUT AGAINST MEDICAL
ADVICE.
WE WANTED PARITY, THEY WANT
THIS TO BE THE SAME FOR PEOPLE
AT RISK OF SUICIDE.
YOU DON'T HAVE TO READ THESE
BUT I SHOW YOU, THAT INVERTED
TRIANGLE, THIS IS FLESHED OUT
IN AN OUTPATIENT CLINIC FOR
ADULTS.
BUT IT COMES DOWN TO THOSE
THREE STEPS I TOLD YOU ABOUT.
AND THIS IS ONE OF THE
OUTPATIENT YOUTH FLESHED OUT
PATHWAY, BUT IT COMES DOWN TO
THOSE THREE STEPS.
SO EACH PLACE FLESHES OUT THEIR
OWN PATHWAY AND THROUGH THIS
ITERATIVE QI PROCESS KEEPS
GETTING BETTER UNTIL IT'S
EFFICIENT.
BUT IT ALL COMES DOWN TO THESE
THREE STEPS.
WHAT IS THE MIDDLE ROLE?
IS THE ROLE OF THE CLINICIAN,
RIGHT?
THIS IS USUALLY, AND IDEALLY A
MENTAL HEALTH CLINICIAN WHO
FURTHER TRIAGES THE SCREEN.
BUT IT COULD BE A NURSE
PRACTITIONER OR NURSE ASSISTANT
OR PHYSICIAN.
SOME CASES LIKE WITH OUR WORK
WITH THE INDIAN HEALTH, WE
TRAINED THE PHARMACISTS TO DO
THE BRIEF SUICIDE SAFETY
ASSESSMENT.
NOW, IDEALLY AT THE CLINICAL
CENTER AT NIH, WE USE THE ASQ
AND SCREEN OUR PATIENTS AND
SOCIAL WORK DOES THIS BRIEF
SUICIDE SAFETY ASSESSMENT.
WE ARE LUCKY THAT WE HAVE
SOCIAL WORKERS.
BUT PLACES THAT DON'T, WE HAVE
TO MAKE IT, IT'S NOT IDEAL BUT
WE HAVE TO MAKE IT GOOD ENOUGH.
IT DOESN'T HAVE TO BE PERFECT.
WE ARE TRYING TO GET PEOPLE
HELP.
THAT'S AN IMPORTANT THING.
THERE'S TWO SAFETY ASSESSMENTS,
EITHER THE COLUMBIA SUICIDE
SAFETY SCALE, AND WE CAME UP
WITH THE OTHER.
WE HAVE THREE FOR ADULTS, THREE
FOR YOUTH AND FOR THE DIFFERENT
VENUES.
BUT THE PURPOSE, WHATEVER TOOL
YOU USE, THE PURPOSE IS TO
COME, HELP DECIDE WHICH ONE OF
THESE THREE PLANS ARE YOU GO TO
MAKE FOR THE PATIENT?
ARE THEY IN IMMINENT RISK?
ARE THEY AT LOW RISK AND NO
FURTHER ACTION IS NEEDED?
OR THE HARDER CATEGORY IS THE
ONE IN YELLOW.
IT'S NOT AN EMERGENCY BUT THE
PATIENT DOES REQUIRE FURTHER
MENTAL HEALTH EVALUATION.
OKAY, SO I'M GOING TO JUST SHOW
YOU SOME OF HOW WE MAKE THIS AN
ITERATIVE PROCESS AND KEEP
REVISING THIS PATHWAY THROUGH
RESEARCH.
I'M GOING TO TELL YOU ABOUT
SUICIDE RISK VERSUS DEPRESSION
SCREENING, VERSUS SUICIDE
SCREENING.
WHEN THE JOINT COMMISSION CAME
OUT AND SAID IT'S IMPORTANT YOU
SCREEN FOR SUICIDE RISK.
THEY SAID WE ARE SCREENING FOR
DEPRESSION, DEPRESSION/SUICIDE
RISK THEY ARE KIND OF THE SAME,
RIGHT?
WE DON'T THINK SO.
THERE'S A COMMONLY USED
DEPRESSION SCREEN, THE PHQ-9.
EACH OF THE NINE ITEMS ASSESS
DIFFERENT DSM FOR DEPRESSION.
IT HAS A NINTH ITEM CONSIDERED
THE SUICIDE RISK ITEM, HOW
OFTEN HAVE YOU BEEN BOTHERED BY
THE FOLLOWING SYMPTOMS DURING
THE PAST TWO WEEKS, THOUGHTS
THAT YOU WOULD BE BETTER OFF
DEAD OR OF HURTING YOURSELF IN
SOME WAY.
THERE'S THREE THINGS ACTUALLY
WRONG WITH THIS QUESTION.
ONE IS, IT HAS AN "OR".
SO YOU NEVER KNOW WHICH SIDE OF
THE QUESTION THE PATIENT IS
RESPONDING TO, SO IT BOTH OVER
AND UNDER DETECTS FOR SUICIDE
RISK.
SECOND IT SAYS HURTING, IT
DOESN'T SAY KILLING.
WE KNOW PEOPLE, ESPECIALLY
YOUNG PEOPLE THINK OF HURTING
THEMSELVES AND KILLING
THEMSELVES AS TWO DIFFERENT
THINGS.
THE THIRD THING, IT SAYS
"BOTHERED", YOU HAVE TO BE
BOTHERED.
IT HAS TO BE DYSTONIC, INSTEAD
OF SYNTONIC.
THIS HAS PROBLEMS BUT WE WANTED
TO LOOK INTO IT.
THERE'S ACTUALLY 13 STUDIES
SHOWING THE PHQ-9 WHILE GOOD
FOR DEPRESSION SCREENING MAY
NOT BE SUFFICIENT FOR
IDENTIFYING PATIENTS AT RISK
FOR SUICIDE.
WE HAD OVER 700 INPATIENT
ADULTS AND 116 SCREENED
POSITIVE FOR SUICIDE RISK AND
175 SCORED POSITIVE ON THE
PHQ-9.
HAD YOU ONLY SCREENED WITH PHQ
YOU WOULD HAVE MISSED A THIRD
OF THE ADULTS AT RISK FOR
SUICIDE, HAD YOU ONLY USED #9
YOU WOULD HAVE MISSED 63,
TWO-THIRDS OF PATIENTS AT RISK
FOR SUICIDE.
SO THE BOTTOM LINE, THIS IS BY
ALL MEANS SCREEN FOR DEPRESSION.
BUT IF YOU ARE GOING TO SCREEN
FOR SUICIDE RISK, USE A
SUICIDE-SPECIFIC SCREENING TOOL.
SOME DO SEQUENTIALLY, THEY DO
THE PHQ-2, IF THAT IS POSITIVE,
THEN THE PHQ-9, THEN THE
SUICIDE RISK ASSESSMENT.
WHY MAKE THEM JUMP THROUGH THE
HOOPS.
WE STUCK THE ASK ON THE BOTTOM
OF THE PHQ-2.
BECAUSE MANY SAID THEY WANT ONE
TOOL.
WE ALSO SAW THE MOST COMMON
PRESENTATION OF A POSITIVE ASQ
LOOKS LIKE THIS.
OF A POSITIVE, THE MOST COMMON
PRESENTATION LOOKS LIKE THIS.
A SOLE YES TO, "HAVE YOU EVER
TRIED TO KILL YOURSELF?
".
THERE'S GOOD NEWS AND BAD NEWS,
THERE'S A LOT OF PEOPLE WHO TRY
TO KILL THEMSELVES.
THE GOOD NEWS FOR THE SCREENER,
THIS MAY NOT BE YOUR BUSINESS
OF THE DAY.
SOMEONE MIGHT COME INTO THE
EMERGENCY DEPARTMENT WITH A
BROKEN ANKLE AND THEY SCREEN
LIKE THIS.
AND MAYBE THEY ARE 60 YEARS OLD
AND THEY HAD SOME THOUGHTS
ABOUT SUICIDE OR TRIED TO KILL
THEMSELVES WHEN THEY WERE 20.
SO THAT PERSON SHOULDN'T GO
THROUGH THE PATHWAY AND USE UP
THE RESOURCES, IF THEY DON'T
NEED IT.
SO THE OTHER THING THAT HAPPENS
IS THIS PERSON IS ALWAYS GOING
TO BE POSITIVE.
IF THEY SEE YOU IN APRIL AND
THEY COME BACK TO THE CLINIC IN
NOVEMBER, THEY ARE STILL GOING
TO LOOK LIKE THIS, IF THEY ARE
ANSWERING HONESTLY.
WE ADDED A SIXTH QUESTION, THE
NEXT TIME THEY COME IN WE SAY,
IF THEY LOOK EXACTLY LIKE THIS
AND THERE ARE NO OTHER CONCERNS
WE SAY "SINCE LAST VISIT HAVE
YOU TRIED TO KILL YOURSELF", IF
THAT IS NO, AND EVERYTHING ELSE
IS NO, THEY MOVE OUT THE
PATHWAY.
WE ALSO DO RESEARCH HOW LONG
AGO IN THE PAST IS AN ATTEMPT
CONSIDERED SAFE ENOUGH.
SO WE LOOKED AT
PUBLICLY-AVAILABLE DATABASE,
FUNDED BY NIMH, I BELIEVE A $9
MILLION GRANT, 13 EMERGENCY
DEPARTMENTS, THE EDSTARS
DATABASE.
WHAT WE FOUND IS YOUTH GREATER
THAN A YEAR AGO WERE SAFER,
LESS LIKELY TO REATTEMPT
SUICIDE THAN THE YOUNG PEOPLE
WHO HAD THE SUICIDE ATTEMPT
WITHIN THREE MONTHS.
THAT AGAIN, HELPED US WITH OUR
PATHWAY.
MAYBE IF THE SUICIDE ATTEMPT IS
MORE THAN A YEAR AGO, WE CAN
CONSIDER THEM A BIT SAFER.
OKAY.
SO NOW, THIS IS WHAT
PEDIATRICIANS NEED TO SCREEN
FOR.
I DON'T EXPECT YOU TO READ THIS.
BUT THESE ARE ALL THE THINGS ON
THE LEFT.
ON THE RIGHT IS BY PERIOD OF
CHILD.
THAT'S A LOT.
IN FEBRUARY 2022, THE BEST
THING TO EVER HAPPEN TO SUICIDE
PREVENTION FOR YOUNG PEOPLE IS
AAP RECOMMENDED SUICIDE RISK
SCREENING ALONGSIDE DEPRESSION
SCREENING FOR 12 AND ABOVE.
THAT MEANS PEDIATRICIANS ARE
SCREENING FOR SUICIDE RISK.
A BUNCH OF US AT NIH JOINED THE
AAP AND AMERICAN FOUNDATION FOR
SUICIDE PREVENTION AND PUT
TOGETHER A BLUEPRINT FOR
SUICIDE PREVENTION, LOOK AT
AAP.ORG/SUICIDEPREVENTION.
REALLY GOOD WEBSITE THAT HELPS
PRACTITIONERS EMBED SUICIDE
RISK IN THEIR PRACTICE.
WE HEARD IT'S TOO HARD TO
SCREEN BECAUSE WE DON'T HAVE
ACCESS TO MENTAL HEALTHCARE.
I HAVE THIS KID, THIS KID IS AT
RISK FOR SUICIDE, I HAVE NO
RESOURCES TO GIVE THEM.
PEOPLE THINKING OF SUICIDE ARE
THINKING ABOUT IT WHETHER YOU
SCREEN IT OR NOT.
SO LET'S GIVE YOU THREE THINGS
YOU CAN DO RIGHT AWAY THAT
WOULD MAKE A DIFFERENCE.
SAFETY PLANNING.
SAFETY COUNSELING AND PROVIDING
988.
SAFETY PLANNING IS A WAY TO
HELP SOMEONE WHEN THEY ARE NOT
IN A SUICIDAL STATE TO THINK IF
IT WAS 2:00 IN THE MORNING AND
THEY WANTED TO KILL THEMSELF,
WHAT WOULD THEY DO.
AND MAKING SURE THERE'S NO
DANGEROUS MEDICATIONS OR
UNSECURED FIREARMS.
WE TALK ABOUT EVERYONE HAVING
988 IN THEIR PHONES.
THIS IS 24/7 HOTLINE, ALSO A
CRISIS TEXT LINE THAT'S
MONITORED BY PEOPLE THAT ARE
TRAINED TO HELP PEOPLE AT RISK
FOR SUICIDE AND ANYONE CAN CALL.
WE LEARNED FROM OUR RESEARCH
HOW IMPORTANT IT IS TO BE
CULTURALLY RESPONSIVE.
SOME EXAMPLES,WITH THE TRIBE
THEY FELT IF THEY USED THE WORD
DEATH, IT WOULD BRING DEATH.
SO WE CHANGED SOME OF THE WORDS.
STUDIES GLOBALLY, IN PAKISTAN,
FOR EXAMPLE, THE WORD WISH IN
URDU MEANS SOMETHING LIKE A
BIRTHDAY WISH.
WE ASKED HAVE YOU WISHED YOU
WERE DEAD AND THAT SOUNDED
CRAZY.
IT'S IMPORTANT THAT OUR TOOLS
ARE SENSITIVE AND RESPONSIVE TO
THE CULTURES WE ARE USING THEM
IN.
SO THE ASQ RESEARCH STARTED IN
THREE STATES BEING USED AROUND
THE COUNTRY.
WE HAVE VALIDATED IT IN THESE
PLACES IN THE WORLD.
HOPEFULLY ONGOING.
THESE ARE SOME EXAMPLES OF
HOSPITALS USING THE ASQ,
INCLUDING THE NIH CLINICAL
CENTER.
OKAY, SO NOW I'M SHIFTING TO
STARTING THESE CONVERSATIONS
ABOUT SUICIDE WITH YOUR FAMILY,
FRIENDS AND COLLEAGUES AT WORK,
RIGHT?
SO PEOPLE OFTEN SAY, HOW DO WE
START THESE DIFFICULT
SITUATIONS?
AND SHOULD I USE A SCREENING
TOOL TO START THESE DIFFICULT
CONVERSATIONS?
THE ANSWER IS ABSOLUTELY NOT.
YOU DON'T WANT TO START
SCREENING YOUR FAMILY MEMBERS,
FRIENDS, COLLEAGUES AT WORK.
THAT'S BECAUSE YOU HAVE THE
LUXURY OF HAVING A RELATIONSHIP.
THESE SCREENING TOOLS ARE
STRUCTURED FOR HEALTHCARE
PROVIDERS IN TALKING ABOUT
SUICIDE RISK.
BUT IF YOU HAVE SOMEONE THAT
YOU KNOW, YOU CAN USE SOME OF
THE LANGUAGE FROM THE SCREENING
TOOL, BUT YOU DON'T WANT TO
PULL OUT A SCREENING TOOL AND
SCREEN THEM, YOU WANT TO TALK
TO THEM.
HERE ARE SOME WAYS YOU CAN
BRING UP, YOU CAN ENGAGE
SOMEONE IF YOU ARE CONCERNED.
YOU CAN SAY SOMETHING LIKE, I
NOTICE YOU HAVE NOT BEEN
YOURSELF LATELY, IS THERE
SOMETHING BOTHERING YOU?
OR I'M SORRY YOU ARE FEELING SO
BAD.
IF YOU KNOW THEM, YOU CAN SAY I
KNOW YOU FEEL AWFUL RIGHT NOW,
I PROMISE YOU, YOU WILL NOT
ALWAYS FEEL THIS WAY.
OR SIMPLY SAY, LET'S GET YOU
SOME HELP.
THESE ARE ALL WAYS TO ENGAGE
SOMEBODY.
AND WHAT DOES SOMEONE AT RISK
FOR SUICIDE WANT FROM YOU.
I WILL ASK YOU TONIGHT.
WHEN YOU GO AND BRUSH YOUR
TEETH AND LOOKING IN THE
MIRROR, PICTURE YOURSELF ASKING
THEM IF THEY WERE THINKING OF
KILLING THEMSELVES, THINK ABOUT
WHAT YOU WOULD DO WITH ANY
NON-NO ANSWER.
WHAT WILL YOU SAY BACK?
THE FIRST THING IS TO NOT PANIC.
YOUR JOB IS NOT TO FIX THIS OR
CONVINCE THEM THEY DON'T WANT
TO KILL THEMSELVES.
YOUR JOB IS TO BE PRESENT,
LISTEN, EXPRESS EMPATHY.
LISTENING TO SOMEONE TALK ABOUT
THEIR PAIN IS A GIFT.
AND IF YOU KNOW THIS PERSON,
YOU CAN PROVIDE HOPE, RIGHT?
YOU CAN SAY I KNOW YOU HAVE
BEEN THROUGH A LOT, AND I KNOW
HOW RESILIENT YOU ARE, YOU CAN
CONNECT THEM WITH A MENTAL
HEALTH PROVIDER AS SOON AS
POSSIBLE.
EVERYONE SHOULD HAVE A TRUSTED
ADULT.
WE TELL PARENTS MAKE SURE YOUR
KID HAVE A TRUSTED ADULT.
OFTEN TIMES IT'S NOT THE PARENT.
IT'S BECAUSE KIDS KEEP THESE
THINGS TO THEMSELVES AND THEY
NEED SOMEONE ELSE THEY CAN TALK
TO SOMETIMES. SOMETIMES IT'S A
COACH, OR NEIGHBOR, OR UNCLE OR
AUNT.
AND THEN ANYONE AT RISK SHOULD
HAVE A SAFETY PLAN.
A LETHAL MEANS, SAFETY CHECK,
LIKE MAKING SURE THEY DON'T
HAVE LETHAL MEANS AND EVERYBODY
SHOULD HAVE THE 988 NUMBER.
AND THEN WHAT'S REALLY
IMPORTANT, THIS IS SUPER
IMPORTANT, I'M HEARING THIS
MORE AND MORE, YOU HAVE TO TAKE
CARE OF YOURSELF AND YOUR OWN
WELL-BEING.
I TELL PEOPLE WHEN WE TRAIN
NURSES AND PHYSICIANS AND
MEDICAL TECHNICIANS TO SCREEN
FOR SUICIDE RISK, SOMETIMES
SCREENING TRIGGERS THOUGHTS --
IT DOESN'T PUT THOUGHTS IN
THEIR HEAD BUT SOMETIMES IT
TRIGGERS THEM FROM THEIR OWN
PROBLEMS THEY ARE HAVING IN
THEIR LIFE.
SO HOW DO WE TAKE CARE OF
OURSELVES?
HERE AT THE NIH WE HAVE EAP,
EMPLOYEE ASSISTANT PROGRAM.
YOU CAN GET FREE COUNSELING
THERE, THEY ARE AVAILABLE AND
THEY ARE REALLY GOOD HERE.
SO I ENCOURAGE ANYONE WHO NEEDS
HELP TO GO TO EAP.
ALSO, WE HAVE HAD AT THE NIH
CLINICAL CENTER WE HAVE HAD
SOME STAFF SUICIDES LAST YEAR.
AND THE CEO, DR. GILMAN WAS
VERY SUPPORTIVE OF PEOPLE
GETTING HELP.
HE USED TO SAY SEEKING HELP IS
A SIGN OF STRENGTH, NOT
WEAKNESS.
HE WANTED US TO DO SUICIDE
PREVENTION TOWN HALLS FOR STAFF.
I WILL TELL YOU THAT THE NEXT
ONE IS ON DECEMBER 10th AT THE
NIH CLINICAL CENTER BETWEEN
1:30-3:00.
I ENCOURAGE YOU ALL TO SHOW UP
AT OUR SUICIDE PREVENTION TOWN
HALL SO WE CAN HAVE THESE
DIFFICULT CONVERSATIONS.
SO JUST TO SUMMARIZE, THERE WAS
A SUICIDE AT THE CLINICAL
CENTER IN 2005.
AND THE JOINT COMMISSION
IMPLEMENTED NATIONAL PATIENT
SAFETY GOAL IN 2007.
AND WE LAUNCHED OUR STUDY, OUR
FIRST ASQ STUDY IN 2008.
WE PUBLISHED OUR FIRST PAPER IN
2012.
THE JOINT COMMISSION BROADENED
THEIR RECOMMENDATIONS.
WE CREATED SUICIDE RISK
CLINICAL PATHWAYS THAT WERE
PUBLISHED.
ESTABLISHED A PARTNERSHIP WITH
IHS.
LAUNCHED THE TESTING THE ASQ IN
PEOPLE WITH NEURODEVELOPMENTAL
DISORDERS.
PUBLISHED STUDIES ON THE
PREDICTIVE HAVE -- VALIDITY
OF THE ASQ.
NOW WE HAVE TELEHEALTH PATHWAYS
DURING COVID.
HOW DO YOU ADMINISTER SUICIDE
RISK SCREENING TOOL OVER THE
TELEPHONE?
HELPING THEM GET THERE IN 2022,
RECOMMENDED PEDIATRICIAN SCREEN
ALL PEDIATRICIAN PATIENTS FOR
SUICIDE RISK.
WE CREATED THE BLUEPRINT FOR
YOUTH SUICIDE PREVENTION.
WE VALIDATED THE ASQ IN BLACK
YOUTH AND FORMER NIH DIRECTOR
FRANCIS CULLEN HIGHLIGHTED THE
ASQ AS A MAJOR ADVANCE IN
MENTAL HEALTH RESEARCH IN THE
IRP IN 2023.
WE ARE CURRENTLY NOT ONLY
VALIDATING THE ASQ NATIONALLY
BUT GLOBALLY AS WELL.
SO FOR ALL OUR WORK AND ALL OUR
RESEARCH WE ACKNOWLEDGE, I WANT
TO ACKNOWLEDGE THE
CONTRIBUTIONS OF NIMH STAFF,
TRAINEES, EXTRAMURAL SUICIDE
PREVENTION COMMUNITY AND
PATIENTS AND THEIR FAMILIES AND
OF COURSE, OHSRP FOR ALL YOU DO
MAKING SURE WE HAVE SAFE
PROTOCOLS AND WE ARE ABLE TO DO
OUR RESEARCH.
SO I WILL PUT UP A BIGGER THANK
YOU SLIDE AND I WILL END IT
THERE AND OPEN IT UP TO
QUESTIONS.
>> Peg Sanders: THANK YOU.
FOR THOSE OF YOU WHO DO HAVE
QUESTIONS PLEASE GO AHEAD AND
SUBMIT THEM BY CLICKING ON THE
BOX BELOW THE VIDEO TITLED LIVE
FEEDBACK LINK.
WE HAVE A COUPLE QUESTIONS HERE.
AT THE BEGINNING YOU SHOWED A
LIFE LINE PHONE NUMBER.
IS THAT ONLY AVAILABLE IN
ENGLISH OR AVAILABLE IN OTHER
LANGUAGES, SPANISH, MANDARIN?
>> Lisa Horowitz: LIFE LINE IS
AVAILABLE IN SPANISH.
ACTUALLY, THAT'S A GREAT -- I
DON'T THINK IT'S AVAILABLE IN
OTHER LANGUAGES.
I HAVE MY TWO RESEARCH
ASSISTANTS, TESIA, AND
[INDISCERNIBLE], CAN YOU LOOK
THAT UP AND PUT IT IN THE CHAT,
PLEASE.
I KNOW IT'S AVAILABLE IN
SPANISH, FOR SURE.
>> Peg Sanders: NEXT QUESTION,
YOU TALKED ABOUT THE ASQ IN
CHILDREN AND THEN ADULTS.
WHAT ARE THE DIFFERENCES
BETWEEN SCREENING ADULTS VERSUS
CHILDREN?
>> Lisa Horowitz: THAT'S A
GREAT QUESTION.
WHENEVER YOU WORK WITH CHILDREN
YOU ARE REALLY WORKING WITH A
FAMILY, RIGHT?
CHILDREN USUALLY SHOW UP WITH
PARENTS OR GUARDIANS.
ONE OF THE BIGGEST LIFE
STRESSORS THERE ARE IS LOSING A
CHILD.
BUT HAVING A CHILD THAT WANTS
TO TAKE THEIR OWN LIFE IS
INCREDIBLY STRESSFUL FOR
PARENTS.
SO IT'S REALLY IMPORTANT YOU
HAVE A WAY TO BRING THE PARENT
IN, IN A NON-DEFENSIVE, A WAY
TO PUT THEM NOT ON THE
DEFENSIVE.
FOR EXAMPLE, IF A PROVIDER SAYS
SOMETHING LIKE OH YOUR CHILD IS
SAYING THEY ARE HAVING SUICIDAL
THOUGHTS, DID YOU KNOW ABOUT
THIS, EVEN IF THEY SAY THAT IN
THE NICEST POSSIBLE WAY, YOU
MAY NOT KNOW ABOUT THIS.
WE TRAIN THEM TO SAY IS THIS
SOMETHING YOUR CHILD SHARED
WITH YOU.
THEY CAN SAY, NO, THEY NEVER
TOLD ME ABOUT THAT, I DIDN'T
KNOW.
YOU CAN NORMALIZE THAT, MANY
PARENTS DON'T KNOW.
NOT BECAUSE YOU ARE A BAD
PARENT BUT KIDS KEEP THESE
THINGS TO THEMSELVES.
THERE'S WAYS TO WORK WITH
PARENTS.
ALSO WHEN YOU SCREEN A CHILD,
IF THEY ARE UNDER 18, WE ARE
ALL MANDATED REPORTERS TO TELL
THE PARENTS.
SO ONE WAY TO DO THAT WITH THE
CHILD IS, YOU KNOW, YOU MIGHT
SAY TO THE CHILD, NOW I'M GOING
TO TALK WITH YOUR PARENT ABOUT
THIS, THEY MIGHT SAY NO, I
DON'T WANT YOU TO TELL MY
PARENT.
IN ORDER TO GIVE THEM SOME
AGENCY, YOU SAY SOMETHING LIKE,
WELL I WANT TO KEEP YOU SAFE,
HOW ABOUT IF YOU DECIDE IF YOU
WANT TO BE IN THE SAME ROOM
WHEN I TELL YOUR PARENT OR WANT
ME TO TELL THEM ALONE, SO THAT
GIVES THE CHILD SOME AGENCY,
SOME CHOICE, SO IT'S NOT JUST
I'M TELLING YOUR PARENT, YOU
DID THIS, IT'S MORE
COMPASSIONATE.
>> Peg Sanders: THERE WAS A
RESPONSE ABOUT THE OTHER
LANGUAGES.
IT SAYS WHEN CALLING 988 PRESS
2 TO SPEAK WITH A TRAINED
SPANISH SPEAKING CRISIS
COUNSELOR.
WHEN ASKED TO TYPE, YOU WILL BE
ASKED.
FOR OTHERS WHO SPEAK EITHER
LANGUAGES CALL 988 AND YOU WILL
BE PROVIDED TRANSLATION MORE
THAN 240 ADDITIONAL LANGUAGES
THROUGH LANGUAGE LINES, THROUGH
VOICE CALLING ONLY.
>> Lisa Horowitz: THANK YOU, SO
I GOT EDUCATED ABOUT IT TOO,
APPRECIATE THAT.
>> >> Peg Sanders: SHOULD WE
SCREEN EMPLOYEES IS A QUESTION.
>> Lisa Horowitz: IF EMPLOYEES
SHOW UP AT OMS, I THINK IF IT'S
A HEALTHCARE CENTER THEY CAN BE
SCREENED BUT WE DON'T WANT TO
BE MANAGERS SCREENING OUR
EMPLOYEES.
THAT GOES BACK TO WHAT I WAS
SAYING AT THE END.
IT'S IMPORTANT TO HAVE A
CONVERSATION CERTAINLY TALK
WITH PEOPLE IF YOU ARE WORRIED
ABOUT THEM, BUT WE DON'T WANT
TO BE GIVING THEM SCREENING
TOOLS BECAUSE THAT'S REALLY
MEANT FOR HEALTHCARE PROVIDERS
TO DO.
WE CAN HAVE CONVERSATIONS WITH
OUR EMPLOYEES.
>> Peg Sanders: WHAT IF SOMEONE
DOESN'T WANT HELP?
>> Lisa Horowitz: THAT'S A
REALLY GOOD QUESTION.
SO SOMETIMES THAT HAPPENS.
I THINK PEOPLE HAVING THOUGHTS
IN THE SUICIDAL STATE ARE IN A
STATE OF UNBEARABLE SUFFERING.
OFTEN TIMES THEY WANT SOMEBODY
TO HELP AND WANT SOMEONE TO
CARE ABOUT THEM.
HOWEVER, THERE ARE PEOPLE THAT
DON'T WANT THAT.
AND THAT'S REALLY HARD WHEN YOU
CARE ABOUT SOMEONE AND THEY
REJECT HELP.
THAT'S HARD FOR ANYTHING.
BUT THIS ONE MAKES PEOPLE WORRY.
SO YOU CAN DO YOUR BEST TO
CONVINCE THEM THAT THEY SHOULD
GET HELP.
BUT IT'S ALSO OKAY TO LET IT BE
AND FOLLOW-UP WITH THEM.
MAYBE YOU FOLLOW-UP IN A FEW
DAYS, YOU KNOW, I WAS THINKING
MORE ABOUT OUR CONVERSATION.
IS THERE SOMEONE I CAN CONNECT
YOU WITH THAT CAN HELP.
OR I WANT TO MAKE SURE YOU HAVE
THE LIFELINE IN YOUR PHONE SO
YOU CAN CALL FOR HELP IF YOU
EVER CHANGE YOUR MIND.
IT'S TRICKY.
IT'S VERY TRICKY.
IT'S ALSO OKAY TO DECLARE THIS
IS AWKWARD, RIGHT?
IT IS NEVER COMFORTABLE TO HAVE
A CONVERSATION WITH SOMEONE
ABOUT THEM TAKING THEIR OWN
LIFE.
THAT SHOULD NEVER EVEN BE
COMFORTABLE.
EVEN SOMEONE TRAINED TO ASSESS
PEOPLE FOR SUICIDE RISK, IT'S
HARD EVERY SINGLE TIME, EVERY
SINGLE PATIENT I ASSESS AND
SEND HOME, I WALK AWAY AND I
JUST THINK, OH I HOPE I MADE
THAT RIGHT DECISION TO SEND
THEM HOME.
SO THIS IS HARD.
AND IT'S OKAY TO SAY TO YOUR
FRIEND, COLLEAGUE, YOUR FAMILY
MEMBER, THIS IS REALLY AWKWARD
TO SAY, BUT, YOU KNOW, I WANT,
I JUST NOTICED YOU'RE NOT
ACTING LIKE YOURSELF LATELY,
I'M WORRIED ABOUT YOU.
THERE'S ACTUALLY A WEBSITE
CALLED SEIZE THE AWKWARD.
IT HAS A LITTLE VIDEO CLIP OF
PEOPLE TRYING TO HAVE A VERY
AWKWARD START TO THIS
CONVERSATION.
AND I ENCOURAGE YOU ALL TO GO
TO SEIZE THE AWKWARD.
IT MIGHT BE SEIZETHEAWKWARD.ORG.
THANK YOU.
>> Peg Sanders: THIS IS NOT
COMING ACROSS ON THE VIDEOCAST.
SEIZE THE AWKWARD, TALK WITH A
FRIEND ABOUT MENTAL HEALTH.
YOU ARE RIGHT,
SEIZETHEAWKWARD.ORG.
WHAT IF PATIENT SCREENS
POSITIVE OVER THE PHONE AND
EITHER YOU OR THE PATIENT
INSIDE THE CLINICAL CENTER, IT
SEEMS LIKE A LOT OF RESOURCES
REFER TO CALLING A SOCIAL
WORKER FOR AN INPATIENT OR
OUTPATIENT OFFICE.
>> Lisa Horowitz: YEAH, THAT
HAPPENS, WE HAVE A PROTOCOL FOR
WHAT HAPPENS WHEN PEOPLE CALL.
IT'S AVAILABLE ONLINE.
IT'S CALLED THE RED BOOK,
BECAUSE IT'S ACTUALLY A RED
BINDER WE KEEP IN OUR OFFICE,
BUT IT'S ONLINE NOW ON THE
WEBSITE.
IT WALKS YOU THROUGH, IT'S
REALLY IMPORTANT TO GET THEIR
NAME AND THEIR ADDRESS.
AND IS THERE ANYONE ELSE IN THE
HOUSE YOU WOULD ALLOW US TO
TALK TO.
I WANT TO KEEP YOU SAFE.
AND IF ALL ELSE FAILS AND YOU
ARE REALLY WORRIED YOU CAN CALL
9-1-1 AND TRY TO FIGURE OUT IN
THEIR AREA HOW TO DO A
WELL-CHECK.
YOU KNOW, BUT THAT DEFINITELY
HAPPENS.
AND IT'S IMPORTANT THAT, ONE,
THE PERSON WHO ANSWERS THE
PHONE ISN'T LEFT ALONE WITH
THAT.
BECAUSE THAT'S HARD.
ESPECIALLY ON A COLD CALL, YOU
KNOW.
EVERYONE SHOULD BE TRAINED.
HERE IS WHAT YOU DO.
HERE IS HOW YOU ALERT ANOTHER
PERSON IN YOUR OFFICE WHILE YOU
KEEP THEM ON THE PHONE AND THEN
YOU JUST HAVE TO DO THE BEST
YOU CAN DO.
THAT'S A REALLY HARD ONE, YEAH.
>> Peg Sanders: I THINK THIS
NEXT QUESTION SORT OF GETS AT
THE ACUTE INTERVENTION.
>> Lisa Horowitz: UNFORTUNATELY
THAT'S WHEN YOU HAVE TO CALL
9-1-1 BECAUSE YOU WANT TO DO
EVERYTHING YOU CAN TO KEEP THEM
SAFE.
IF YOU REALLY DO THINK SOMEONE
IS GOING TO KILL THEMSELVES IN
THAT MINUTE, THEN IT'S NOT THE
MOST, THE POLICE WILL SHOW UP
AND DO A WELL-CHECK AT
SOMEONE'S HOUSE.
SOMETIMES THAT'S NECESSARY.
SOMETIMES THAT PERSON GETS VERY
MAD AT YOU THAT YOU DID THAT.
THIS HAPPENED ACTUALLY IN MY
OWN FAMILY WITH A COUSIN WHO WE
HAD TO SEND THE POLICE TO HER
HOUSE AND SHE WAS VERY ANGRY,
DIDN'T TALK TO US FOR A WHILE.
BUT, WHAT WE SAID TO HER, WE
ARE SORRY YOU ARE MAD, BUT WE
DIDN'T WANT TO SEE ANYTHING BAD
HAPPEN TO YOU AND WE CARE ABOUT
YOUR SAFETY.
SO THAT'S AN UNFORTUNATE
CIRCUMSTANCE.
BUT IF YOU DO WORRY LIKE THAT,
YOU SHOULD DO THAT.
>> Peg Sanders: OKAY.
IN RESPONSE TO WHAT SOMEBODY
ASKED, THIS PARTICULAR SESSION,
THE VIDEOCAST WILL BE AVAILABLE
TO ANYBODY WHO WANTS IT.
SO WHEN YOU GO TO THE ARCHIVES
ON THE NIH VIDEOCAST, THIS IS
NOT LIMITED TO NIH OR HHS ONLY.
ON THE VIDEOCAST WITHIN A FEW
DAYS YOU CAN CERTAINLY PROVIDE
THAT LINK TO OTHERS AS WELL.
>> Lisa Horowitz: GREAT.
>> Peg Sanders: I THINK WE HIT
OUR TIME HERE AT 4:00.
THANK YOU, DR. HOROWITZ, THIS
HAS BEEN ENLIGHTENING, NOT JUST
A PROFESSIONAL STANDPOINT BUT
AS YOU SAID AT THE BEGINNING,
SO MANY OF US HAVE HAD AT LEAST
TANGENTIAL EXPERIENCES.
THIS HAS BEEN HELPFUL ON SO
MANY LEVELS.
THANK YOU.
>> Lisa Horowitz: THANK YOU.
>> Peg Sanders: BYE-BYE.