Mandatory Suicide Prevention Course for nurses #

A six-hour suicide preven­tion course is required of all actively licensed nurses in Washington state. To meet this need, the Washington State Nurses Associ­a­tion and the Univer­sity of Washington will be co-sponsoring an accred­ited Suicide Preven­tion course at the next Washington State Nurses Conven­tion, 2019 at Tulalip Confer­ence Center on May 3, 2019.

With behav­ioral health issues (mental health and substance use disor­ders) and suicide promi­nently positioned in the local and national news headlines nearly daily, we are called to action as nurses but often feel overwhelmed and disori­ented by the depth and breadth of the problem. Under­standing the preva­lence and perva­sive­ness of behav­ioral health issues and who can be afflicted is often the first step in defining a strategic approach.

Nearly 45 million people in the U.S. (4.2 percent of the popula­tion) suffer from mental illness and at least 10 million of these people suffer from serious mental illness. It is reported that in 2016 less than half (43.1 percent) of those suffering received mental health treat­ment and nearly 45,000 lost their lives to suicide — far more than the 19,362 who were victims of homicide in this country (The National Insti­tute of Mental Health, 2018a, 2018b).

Suicide rates have steadily climbed, by 28 percent, since 1999, with Washington state carrying a relatively high suicide rate at 12.58 – 14.23 deaths per 100,000 compared with other states that are as low as 6.19 – 11.40 per 100,000. Women are more likely to seek help than men, and men are four times more likely to take their own lives than women (Regge, 2017).

Why do so many people need to unnec­es­sarily suffer and die from these treat­able diseases, and how do we get them the services they need? Stigma is at the helm of this problem and can be a barrier to seeking help. This stigma can also contribute to alien­ation from others who don’t under­stand the disease or how to help (Mayo Clinic Staff, 2018). Despite Washington’s robust mental health parity law (Washington State Legis­la­ture, 2010), strug­gles continue with health insurers who can create barriers to basic services and treat­ment for mental health disor­ders. Educa­tion and increased individual and public dialogue are key to contin­uing to diminish and hopefully, one day, erase societal stigma, allowing people to obtain the help they need so more lives can be saved.

There are many examples in health care, such as cardio­vas­cular disease (heart disease) and acute myocar­dial infarc­tion (heart attack), that illus­trate the benefit of immediacy in response by the commu­nity and health care profes­sionals. This facil­i­tates the successful delivery of appro­priate and timely care, and quality outcomes. However, this atten­tion and immediacy of care – and alloca­tion of resources – isn’t always avail­able with behav­ioral health issues because of the associ­ated stigma and failure to identify the presence of illness, and due to the signif­i­cant challenges in access to care and avail­ability of resources. Access is defined and measured by geographic proximity and time it takes to get to help, ability to secure a health care provider who is quali­fied to diagnose and treat the condi­tion, existence of adequate funding (usually insur­ance coverage) and access to a residen­tial (inpatient) facility when needed.

Both inpatient and outpa­tient behav­ioral health care are often insuf­fi­ciently reimbursed. This finan­cial caveat is a crucial consid­er­a­tion in designing successful pathways for accessing behav­ioral health services (National Council for Behav­ioral Health, 2017). Too often, the very people who are suffering from these disabling diseases are those who have signif­i­cant barriers to care due to finan­cial constraints and limited social resources. Until behav­ioral health care is appro­pri­ately valued in our health care system, these problems will persist.

As of 2014, Washington state has an average of 9.1 inpatient psychi­atric beds per 100,000 people, which ranks Washington 46 out of 50 states in capacity for inpatient beds (Burley & Scott, 2015).

There are efforts to increase mental health resources including a new 120 bed behav­ioral health hospital in Tacoma Washington sched­uled for comple­tion in 2018 (Becker, 2017). Though this is a step in the right direc­tion, much of the work ideally will be focused on primary preven­tion of acute episodes through secure access to outpa­tient treat­ment over the continuum, long before an inpatient bed is necessary.

Resources for outpa­tient treat­ment of behav­ioral health issues pose challenges. There is a paucity of avail­able psychi­a­trists to see people suffering from severe mental illness (Center for Health­care Workforce Studies & Univer­sity of Washington, 2016). This number of practi­tioners with exper­tise in psychi­atry can be doubled when psychi­atric nurse practi­tioners are added; they are also specif­i­cally trained to diagnose and treat mental health disease. However, even these numbers remain inade­quate to address the need. In reality, behav­ioral health issues should be predom­i­nantly diagnosed and managed by front-line health care profes­sionals — nurses, primary care providers, including, nurse practi­tioners and other allied members of behav­ioral health teams, in order to prevent delay of much needed care and yield better outcomes.

We all play a critical role in early identi­fi­ca­tion of behav­ioral health issues, opening access to treat­ment, facil­i­tating ongoing care and suicide preven­tion. It is essen­tial that anyone who is suffering with behav­ioral health issues or caring for someone challenged by them, under­stand that they can confi­dently reach out to a nurse, their local primary care provider or nurse practi­tioner for screening, evalu­a­tion and treat­ment for this spectrum of disor­ders. Aware­ness of the resources for you, someone you know, or a patient you are encoun­tering and how to refer someone can save a life. In addition to prompt referral to a health care profes­sional for a face-to-face visit, the following repre­sent some Washington state and national resources.

Resources #

National Suicide Preven­tion Lifeline at 1 – 800-273-TALK (8255) is a confi­den­tial service avail­able to anyone 24 hours a day, 7 days a week. http://​www​.suicide​pre​ven​tion​life​line​.org

Crisis Clinic at KING COUNTY 2 – 1‑1: DIAL 2 – 1‑1, 1 – 800-621‑4636 offers telephone-based crisis inter­ven­tion and infor­ma­tion and refer­rals to commu­nity services for youth and adults in Seattle-King County, WA. https://​crisisclinic​.org/

Teen Link at 1 – 866-833‑6546 is a teen-answered help line. https://​866teen​link​.org/

Washington Recovery Help Line at 1 – 866-789‑1511 is a statewide service offering emotional support and linkage to substance abuse, problem gambling and mental health services to anyone in Washington state. https://​www​.warecov​ery​helpline​.org/

Washington Warm Line at 1- 877 – 500-WARM (9276) is a peer-answered help line for people living with mental health challenges. https://​crisisclinic​.org/​f​i​n​d​-​h​e​l​p​/​w​a​s​h​i​n​g​t​o​n​-​warm-line/

Crisis Text Line is a free, 24/7 support for those in crisis. Text HOME to 741741 from anywhere in the U.S. to text with a trained Crisis Counselor. Crisis Text Line trains volun­teers to support people in crisis. www​.crisis​textline​.org

Substance Abuse and Mental Health Services Admin­is­tra­tion — SAMHSA’s National Helpline at 1 – 800-662-HELP (4357) is a free, confi­den­tial, 24/7, 365-day-a-year treat­ment referral and infor­ma­tion service (in English and Spanish) for individ­uals and families facing mental and/​or substance use disor­ders. https://​www​.samhsa​.gov/​f​i​n​d​-​h​e​l​p​/​n​a​t​i​o​n​a​l-helpline

References #

Burley, M., & Scott, A. (2015). Inpatient psychi­atric capacity and utiliza­tion in Washington State

(Document Number 15 – 01-4102). Olympia: Washington State Insti­tute for Public Policy. Retrieved from http://​www​.wsipp​.wa​.gov/​R​e​p​o​r​t​F​i​l​e​/​1​5​8​5​/​W​s​i​p​p​_​I​n​p​a​t​i​e​n​t​-​P​s​y​c​h​i​a​t​r​i​c​-​C​a​p​acity-and-


Center for Health­care Workforce Studies, & Univer­sity of Washington. (2016). Washington states physi­cian workforce in 2016. Retrieved from http://​depts​.washington​.edu/​f​a​m​m​e​d​/​c​h​w​s​/​w​p​-​c​o​n​t​e​n​t​/​u​p​l​o​a​d​s​/​s​i​t​e​s​/​5​/​2​0​1​5​/​0​9​/​w​a​s​h​i​n​g​t​o​n​-​s​t​a​t​e​s​-​p​h​y​s​i​c​i​a​n​-​w​o​r​k​f​o​r​c​e​-​i​n-2016.pdf

Mayo Clinic Staff. (2018). Mental Illness: Overcoming the stigma of mental illness. Retrieved from https://​www​.mayoclinic​.org/​d​i​s​e​a​s​e​s​-​c​o​n​d​i​t​i​o​n​s​/​m​e​n​t​a​l​-​i​l​l​n​e​s​s​/​i​n​-​d​e​p​t​h​/​m​e​n​t​a​l​-​h​e​a​l​t​h​/​a​r​t-20046477

National Council for Behav­ioral Health. (2017). The psychi­atric shortage: Causes and solutions. Retrieved from https://​www​.thenation​al​council​.org/​w​p​-​c​o​n​t​e​n​t​/​u​p​l​o​a​d​s​/​2​0​1​7​/​0​3​/​P​s​y​c​h​i​a​t​r​i​c​-​S​h​o​r​t​a​g​e​_​N​a​t​i​o​n​a​l​-​C​o​uncil-.pdf

The National Insti­tute of Mental Health. (2018a). Trans­forming the under­standing and treat­ment of mental illnesses. Suicide. Retrieved from https://​www​.nimh​.nih​.gov/​h​e​a​l​t​h​/​s​t​a​t​i​s​t​i​c​s​/​s​u​i​cide.shtml

The National Insti­tute of Mental Health. (2018b). Trans­forming the under­standing and treat­ment of mental illnesses. Mental Illness. Retrieved from https://​www​.nimh​.nih​.gov/​h​e​a​l​t​h​/​s​t​a​t​i​s​t​i​c​s​/​m​e​n​t​a​l​-​i​l​l​ness.shtml

Regge, A. (2017). Becker’s Hospital Review. CHI Franciscan, Multi­Care joint venture breakds ground on $45M behav­ioral health hospital. Retrieved from https://​www​.becker​shos​pi​tal​re​view​.com/​f​a​c​i​l​i​t​i​e​s​-​m​a​n​a​g​e​m​e​n​t​/​c​h​i​-​f​r​a​n​c​i​s​c​a​n​-​m​u​l​t​i​c​a​r​e​-​j​o​i​n​t​-​v​e​n​t​u​r​e​-​b​r​e​a​k​s​-​g​r​o​u​n​d​-​o​n​-​4​5​m​-​b​e​h​a​v​i​o​r​a​l​-​h​e​a​l​t​h​-​h​o​s​pital.html

Washington State Legis­la­ture. (2010). RCW 48.20.580, Mental health services — Defin­i­tion — Coverage required, when. Retrieved from http://​apps​.leg​.wa​.gov/​R​C​W​/​d​e​f​a​u​l​t​.​a​s​p​x​?​c​i​t​e​=48.20.580