ABSTRACT

BULLETIN 03-11

STUDY OF SUICIDE PREVENTION

Nevada Revised Statutes 218.682

Members

Senator Ann O’Connell, Chairwoman

Senator Randolph J. Townsend

Senator Valerie Wiener

Senator Mark Amodei

Assemblyman David E. Humke

Assemblyman David R. Parks

Assemblywoman Sheila Leslie

Assemblywoman Debbie Smith

Staff Contacts

Research Division:

Donald O. Williams, Chief Principal Research Analyst

Kennedy, Senior Research Secretary

(775-684-6825)

Legal Division:

Jan K. Needham, Principal Deputy Legislative Counsel

(775-684-6830)

ABSTRACT

STUDY OF SUICIDE PREVENTION

The Legislative Commission, at its meeting on September 6, 2001, created an interim subcommittee, comprised of four Senators and four Assembly members, to study suicide prevention in Nevada.

The Subcommittee held a total of five meetings, including the final meeting and work session, during the course of the study. Except for a meeting held in Reno, these public hearings were conducted through simultaneous videoconferences between legislative meeting rooms at the Legislative Building in Carson City and the Grant Sawyer State Office Building in Las Vegas.

During the course of this interim study, the Subcommittee obtained extensive expert and public testimony concerning Nevada’s high rate of suicide, which is consistently the highest rate of any state in the nation, and the need for effective suicide prevention programs. It received testimony and correspondence from concerned citizens, clergy, educators, surviving family members of suicide victims, national and local suicide prevention advocates, medical researchers, licensed health care providers, law enforcement officials, emergency and fire service personnel, retired persons, and representatives from various public health and mental health agencies. Federal, state, and local officials contributed significant information and suggestions throughout the study.

At its final meeting and work session, the Subcommittee adopted 19 recommendations, including four bill draft requests (BDRs), for consideration by the 2003 Legislature. The recommendations address the following major topics:

§ Developing and Implementing a Nevada State Suicide Prevention Plan and Program;

§ Improving Local Suicide Prevention Services;

§ Enhancing Suicide Prevention Education and Training for Key Gatekeepers;

§ Addressing Suicide Prevention in Public Schools;

§ Increasing State Mental Health Services; and

§ Recognizing the Relationship of Substance Abuse and Other Co-Occurring Disorders to Suicide.

The Subcommittee’s final report contains an overview of the interim study and a discussion of each of the topics under which the Subcommittee made its recommendations.

SUMMARY OF RECOMMENDATIONS

STUDY OF SUICIDE PREVENTION

This summary presents the recommendations approved by the Legislative Commission’s Subcommittee to Study Suicide Prevention. The Subcommittee submits the following proposals for consideration by the 72^nd Session of the Nevada Legislature:

RECOMMENDATIONS FOR LEGISLATIVE MEASURES ‑

SUBCOMMITTEE BILL DRAFT REQUESTS (BDRS) FOR BILLS OR RESOLUTIONS

1. Draft and enact legislation requiring the development of a Nevada State Suicide Prevention Plan and establishing a Statewide Suicide Prevention Program within the Director’s Office of Nevada’s Department of Human Resources (DHR). The purpose of the state plan/program is to reduce the number of attempted and completed suicides in Nevada. The state plan should address the risk factors related to suicide and identify populations most at risk, and it should be distributed statewide and made available to the public not later than January 3, 2005.

The State Suicide Prevention Plan shall be modeled after existing state plans in Georgia and several other states, which incorporate goals from the United States Surgeon General’s 2001 report, National Strategy for Suicide Prevention: Goals and Objectives for Action. Nevada’s state plan should focus on the Surgeon General’s goals relating to public awareness, building community networks, and implementing suicide prevention training programs for law enforcement, health care professionals, school employees, and others who are the first contacts with individuals at risk of suicide.

The Statewide Suicide Prevention Program will include the establishment and funding of two personnel positions to develop and implement suicide prevention programs in Nevada. One position would be the Statewide Suicide Prevention Coordinator based in the Director’s Office of DHR in Carson City, and the other position would be a Suicide Prevention Trainer & Networking Facilitator based in the office of a government or nonprofit agency in Clark County. Funding for these positions may depend on a combination of government (federal, state, and local) and nongovernmental money. The Governor is urged to include this program as part of the DHR budget, and the Legislature is urged to approve a budget to support the program.

The Director of DHR shall be required to submit a copy of the state plan and a report on the program to the Governor and the Director of the Legislative Counsel Bureau (for distribution to the Legislature) on or before January 3, 2005.

Statewide Suicide Prevention Coordinator

Under the direction of the Director of DHR, the Statewide Suicide Prevention Coordinator will be responsible for developing, disseminating, and implementing a statewide suicide awareness and prevention plan and program throughout Nevada, including public education activities, gatekeeper training, and enhancement of crisis services. The Coordinator will conduct suicide prevention public awareness and media campaigns in all 17 Nevada counties, beginning first in Clark County.

Furthermore, the Coordinator will link suicide assessment and intervention trainers to schools, community centers, nursing homes, and other facilities serving persons most at risk of suicide. The position will coordinate the establishment of local advisory groups in each county to offer additional support to the program’s efforts. Working with suicide prevention advocacy groups, community coalitions, managers of existing nationally accredited/certified crisis hotlines, and staff of mental health agencies in the state, the Coordinator will identify and address the barriers that interfere with providing services to at‑risk groups, such as the elderly, Native Americans, youth, and residents of rural communities. The Coordinator will also develop and maintain a state suicide prevention Internet Web site with links to appropriate resource documents, accredited/certified suicide hotlines, licensed professionals, state and local mental health agencies, and national organizations.

The Coordinator will review current research on data collection for factors related to suicide, and develop recommendations for improved surveillance systems and uniform data collection. In addition, the position will develop and submit proposals for funding from federal government agencies and nongovernmental organizations. Finally, the Coordinator would provide oversight and technical assistance to the Suicide Prevention Trainer & Networking Facilitator based in Clark County.

Suicide Prevention Trainer & Networking Facilitator

Under the oversight of the Statewide Suicide Prevention Coordinator, the Suicide Prevention Trainer & Networking Facilitator will assist in disseminating and implementing the state suicide prevention plan and program in Clark County. This position will provide suicide prevention information and training to mental health agencies, social service agencies, churches, public health clinics, school districts, law enforcement agencies, emergency medical personnel, health care providers, and various community organizations. In addition, the position will assist in developing and carrying out public awareness and media campaigns targeting Clark County groups at risk of suicide.

The Trainer & Facilitator will assist in developing a network of community-based suicide prevention programs in Clark County, including the establishment of one or more local suicide prevention advisory groups. This position will facilitate sharing information and consensus building among multiple constituent groups in the county, including public agencies, community organizations, suicide prevention advocacy groups, mental health providers, and various representatives of the at‑risk population groups.

(BDR --288)

2. Urge, by drafting and adopting a resolution, governmental and nongovernmental agencies in Clark County to cooperate in establishing a Clark County suicide prevention program to provide effective and diverse suicide prevention programs for its communities. Funding for these programs should include a combination of government (federal, state, and local) and nongovernmental money. The proposed suicide prevention program would include the following:

§ Evidence-based programs to reduce risk factors and enhance protective factors for suicidal behavior across the life span of individuals;

§ Distribution of awareness and educational materials to reduce the stigma associated with suicide;

§ A 24-hour suicide hotline accredited or certified by a nationally recognized organization in the field of suicide prevention (and supported by a continuation and increase in the Clark County local governments’ existing funding for suicide prevention programs);

§ Service referral for at-risk individuals;

§ Development of a Clark County Resource Directory and/or Internet Web site for suicide prevention and survivor assistance;

§ Effective and accessible suicide intervention training for gatekeepers and first responders, including school district personnel;

§ Media education and guideline distribution; and

§ Suicide survivor services.

(BDR --289)

3. Urge, by drafting and adopting a resolution, that each community in Nevada form a coalition of agencies and service providers to address suicide prevention, education, response, and treatment (adapted to community resources and needs), with the goals of reducing suicides in each community and providing survivor support. (BDR --291)

4. Urge, by drafting and adopting a resolution, that the Clark County Health District: (1) plan and coordinate a public information campaign on suicide prevention; and (2) expand community injury prevention efforts and increase the corresponding financial commitment. (BDR --290)

RECOMMENDATIONS FOR POSSIBLE LEGISLATIVE actions or MEASURES TO BE CONSIDERED BY OTHER LEGISLATIVE COMMITTEES

5. Draft and send a letter to the Legislative Committee on Education recommending that it consider requesting legislation requiring all public school teachers, including elementary education teachers, to complete certain courses in suicide prevention prior to license renewal. Such legislation could require that Nevada’s Regional Training Programs for the Professional Development of Teachers and Administrators provide teachers and administrators with information and training specific to suicide issues, including identifying and intervening with pupils at high risk of suicide.

6. Draft and send a letter to the Legislative Committee on Education requesting that it consider requesting legislation for an appropriation of state funds to provide additional counseling positions in public middle schools and high schools, and state funds for counselors at the elementary school level.

7. Draft and send letters to the Legislative Committee on Health Care and its Subcommittee to Study Mental Health Issues recommending consideration of requesting that the Governor and the Legislature approve increased funding for mental health services throughout Nevada and particularly for rural mental health agencies to provide emergency response and ongoing services to suicide survivors, those who have attempted or threatened suicide, and those determined to be at high risk for suicide.

8. Draft and send letters to the Legislative Committee on Health Care and its Subcommittee to Study Mental Health Issues requesting consideration of the following recommendations from the Task Force on Emergency Room Overcrowding (also known as the Chronic Public Inebriate [CPI] Task Force) and the Southern Nevada Mental Health Coalition:

§ Allow more people in crisis to have access to treatment and allow first responders, police, fire, and paramedics, a timely return to service by: (1) creating a centralized drop-off location for triage with funding provided by state and local governments and area hospitals; (2) developing a mechanism for providing permanent, long-term funding to support CPI and mental health services such as increasing the tax on the sale of liquor; (3) considering changing NRS 433A.330, which requires the mentally ill to be transported to hospitals for medical screening or authorize paramedics to transport patients, who meet specific criteria, directly to a MHDS facility or other qualified facilities for treatment; and (4) funding mobile crisis units that can make assessments in the field and reduce the need for transporting patients to hospitals.

§ Increase services to the seriously mentally ill in southern Nevada by (1) adding sufficient crisis observation beds and adequate staff to care for the increasing number of patients who need mental health care, including those with co‑occurring disorders; (2) adding sufficient in-patient beds and staffing for treatment after patients have been assessed and stabilized at a triage facility, emergency room, or MHDS facility; (3) establishing a client data base to provide easy access to available services, track patients through various programs and prevent duplication of services; (4) providing centralized and coordinated case management and outpatient services; (5) contracting with the Program for Assertive Community Treatment to perform personalized, intensive case management; and (6) ensuring that all possible federal funding has been accessed.

§ Establish and fund a mental health court in southern Nevada.

The letters from the Subcommittee should also include a statement in support of providing funding for mental health courts in northern Nevada and throughout the state.

9. Draft and send letters to the Legislature’s Standing Committees on Judiciary recommending their consideration of requesting legislation to amend the statutes pertaining to minors and alcohol. Although current law makes it unlawful for a minor to be purchasing, consuming, or possessing an alcoholic beverage, testimony indicated that law enforcement cannot arrest minors who have already consumed, but are not at the time consuming, an alcoholic beverage. Amend the statutes with provisions similar to the Reno Municipal Code whereby it is unlawful for a person under the age of 21 to “be impaired to any degree by the use of an alcoholic beverage.” The purpose of this amendment is to require that such minors be required to undergo evaluation and possible treatment for alcohol and/or drug abuse.

10. Draft and send letters to the Legislature’s Standing Committees on Judiciary recommending their consideration of the recommendation from the Task Force on Emergency Room Overcrowding (also known as the Chronic Public Inebriate [CPI] Task Force) and the Southern Nevada Mental Health Coalition requesting legislation to expand the civil protective custody statute (NRS 458.270) to pertain to persons with substance abuse and mental illness.

STATEMENTS TO BE INCLUDED IN

THE SUBCOMMITTEE’S FINAL REPORT

11. Include a statement in the Subcommittee’s final report recommending that the Governor and the Legislature approve the necessary state funding to provide Nevada’s Division of Mental Health and Developmental Services (MHDS) with the computer equipment and related software necessary to collect and analyze data regarding suicide rates for MHDS clients and their family members.

12. Include a statement in the Subcommittee’s final report recommending that the Governor and the Legislature support state funding for the Reno Crisis Call Center to establish, in Clark County, a service similar to its existing crisis call center and suicide prevention hotline.

13. Include a statement in the Subcommittee’s final report recommending that the Board of Regents of the University and Community College System of Nevada (UCCSN), the UCCSN Chancellor, and the President of the University of Nevada, Las Vegas (UNLV) assist in providing university faculty, staff, and students to help coordinate and staff suicide prevention programs in Clark County.

One possible plan would be to coordinate educational, survivor support, and crisis line services through the Psychology Department at UNLV. A faculty member could serve in a coordinating role, responsible for overseeing the various support programs and supervising graduate students who would provide direct services. Services provided by graduate students could include educational programming for gatekeepers, at-risk groups and concerned community members, support groups for survivors, and coverage for the suicide crisis line. Additionally, graduate students could recruit volunteers from the community and from the undergraduate psychology program who would be trained to provide crisis intervention services and would assist with the crisis line work. Crisis line training and coverage would be specifically developed to meet accreditation/certification requirements with a short-term goal of obtaining crisis line accreditation/certification. This plan would provide continuity of preventative and intervention services as well as provide long-term stability in the delivery of ongoing services.

14. Include a statement in the Subcommittee’s final report recommending enhancing community gatekeepers’ education and training by requiring two hours of continuing education in suicide prevention, including identification, diagnosis, referral, and treatment, as a requirement for renewal of license for health care professionals.

15. Include a statement in the Subcommittee’s final report recommending that the DHR Health Division’s Emergency Medical Services Program develop a formalized education and training program in suicide prevention for emergency medical services (EMS) managers and personnel. Among other things, the program should raise awareness of EMS personnel at risk for suicide. In addition, the program should provide EMS personnel with a directory of suicide prevention agencies and programs to leave at scenes of trauma.

16. Include a statement in the Subcommittee’s final report recommending that Nevada school districts address adolescent suicide by adherence to a theoretical framework which incorporates three levels of intervention: (1) primary intervention – when a suicide occurs; (2) secondary intervention – treatment activity with survivors, other students, parents, school personnel, and so forth; and (3) tertiary intervention – suicide prevention activities and programs.

In addition, recommend that the school districts consider hiring additional trained professionals, including counselors, school psychologists, and social workers, to: (1) conduct assessments, implementation, follow-up, and to provide treatment (including primary, secondary, and tertiary interventions); (2) perform interventions in school settings; (3) establish relationships with parents, students, and other professionals; (4) maintain effective networks with the community; (5) address the mental health of troubled students; and (6) support the school student services staff.

17. Include a statement in the Subcommittee’s final report recognizing the importance of including substance abuse and other co-occurring disorders in a Nevada statewide suicide prevention plan. In addition, the statement should recognize that the enhancement of the delivery of co-occurring treatment and services may assist in reducing Nevada’s suicide rate.

18. Include a statement in the Subcommittee’s final report recognizing that any state suicide prevention program should address the relationship between youth suicide and the use of alcohol and drugs by minors.

19. Include a statement in the Subcommittee’s final report supporting the work of the President’s New Freedom Commission on Mental Health. Also include in the final report a summary of the Commission’s findings and recommendations regarding suicide prevention.