Suicide and Psychosis

September 2016 was National Suicide Prevention month which helps promote resources and awareness around the issues of suicide prevention, how you can help others and how to talk about suicide without increasing risk of harm.  Individuals with schizophrenia and other psychoses are at heightened risk of suicide.  According to the Centers for Disease Control, "persons with schizophrenia pose a high risk for suicide.  Approximately one-third will attempt suicide and, eventually, about 1 out of 10 will take their own lives." In this month's newsletter, EIP would like to highlight the different resources available to address suicide risk and prevention.
 

Part 2: Recognizing Suicidal Ideation and Behavior in Individuals with a First Episode of Psychosis

The Substance Abuse and Mental Health Services Administration (SAMHSA) and Center for Mental Health Services (CMHS) sponsored a two-part series on recognizing and addressing suicidal ideation and behavior in individuals with first episode psychosis.

Background:  Individuals with schizophrenia and other psychoses are at heightened risk of suicide.  NIMH, in their White Paper on Coordinated Specialty Care (CSC) services for individuals experiencing a first episode of psychosis, recommends that: “… CSC staff members must understand common problems that cut across all service categories, such as difficulties in engaging the client and their family members, clients’ vulnerability for developing substance use problems, and heightened risk of suicide during the early years of treatment.”  To assist States and block grant funded first episode psychosis providers in recognizing and addressing suicidal risks in their clients, SAMHSA/CMHS sponsored two virtual sessions that address the issues of identifying and addressing suicidal ideation and behavior.

Description: Part one of this two-part series focused on the strategies and tools available to providers and public health authorities to identify and monitor suicidal ideation and behavior (part 1 Powerpoint presentation slides).  The second webinar focuses on the clinical and programmatic issues that first episode psychosis programs must address once suicidal ideation and behaviors have been identified. Experts on suicidality in schizophrenia discuss their experiences in addressing suicide risks and behaviors within a Coordinated Specialty Care program. The webinar specifically focuses on the value of continuous risk assessments for clients with first episode psychosis, the importance of safety planning, and the need for both proactive and reactive risk management.  The webinar is presented through the lens of real-world cases, and includes attention to cultural issues.  

                           Click here to view the part 2 Powerpoint presentation slides.      

    
 

Partners from Johns Hopkins and the University of Maryland will be implementing a comprehensive program working with Emergency Departments and Psychiatric Inpatient Units in an effort to improve the care for youth with suicide risk.  The program is composed of the following three components:

1) Standardized, Evidence-Based Screening: The Ask Suicide Screening Questions (ASQ) is a recently developed, non-proprietary instrument to screen for suicide risk during the Emergency Department triage phase with patients ages 10-21 years.  The ASQ demonstrated good sensitivity and specificity (Horowitz, 2012).

2) Training and Brief Interventions: Standardized training will take place in person or through webinars lead by the grant team.  Topics will include safety planning, emergency department means restriction, and emergency room interventions for adolescent females.  Further, Emergency Departments will be provided with helpful materials, including a clinical guide to assess suicide in patients and steps on navigating after a suicide attempt.  Additional outreach and technical assistance will be provided to encourage implementation of these materials.

3) Follow-up of High-risk Youth: The grant team will work with Emergency Departments and inpatient psychiatric units to develop a plan for following up with suicidal patients based on the "caring letters and texts research" (Motto & Bostrom, 2001).  The phone calls, emails and/or texts would convey care for individuals, importance of care, and availability if in need of further support or resources.

How to get involved: 1) Training can be provided to any interested EDs/inpatient units, or 2) Outpatient providers that can provide flexible care to these youth (e.g., next day appts) can partner with this program.  For more information or to get involved, contact Mary Cwik, PhD mcwik1@jhu.edu.
 

The Suicide Prevention Smart Phone App for Maryland

The Maryland Department of Health and Mental Hygiene/Grassroots Crisis Intervention has created a suicide prevention smart phone app for Maryland called "There is Hope."  The app provides fast and easy access to crisis intervention and suicide prevention support.  "There is Hope" offers next steps for someone struggling with taking their life or for those concerned about suicidal thoughts in others.

The app has lots of valuable information including safety planning, warning signs, risk factors, tips on how to talk to someone who is suicidal, information about trainings to increase suicide prevention skills, and more.  Features also include an immediate connection to crisis counselors who will deliver help and hope for preventing suicide.

"There is Hope" is currently available in the Apple Appstore and Android Google Play.  Download Now!

Introducing New Advisory Council Member: Dr. Anthony Chico

EIP is excited to welcome Dr. Anthony Chico to the Advisory Council, as our new Emergency Departments (ED) representative.  Given the importance of improving the continuum of care for the treatment of serious mental illness and suicide risk in emergency departments, EIP is looking to collaborate with those working in ED and Psychiatric Inpatient Units.  EIP looks forward to working with a leader in an Emergency Department setting who can help collaborate on educating ED regarding symptoms and signs of first episode psychosis, as well as educate discharge personnel on referral information to ensure individuals can get timely and appropriate services from our program.

Dr. Anthony Chico is a child, adolescent, and adult psychiatrist in Towson, Maryland.  In addition to his private practice, he is the medical director of emergency psychiatry at the Greater Baltimore Medical Center (GBMC).  Prior to becoming the medical director he worked 9 years as an inpatient psychiatrist at St. Joseph Medical Center in Towson, Maryland.

Dr. Chico received his undergraduate degrees in neuroscience and psychology from the University of Rochester in New York, and then attended medical school at the Lake Erie College of Osteopathic Medicine in Pennsylvania.  After a medical and surgical internship year near Philadelphia he completed both his psychiatric residency and child fellowship at the University of Maryland/ Sheppard Pratt Program. 

We are looking forward to Dr. Chico's contributions to the Advisory Council and his extensive knowledge on timely and sensitive emergency department mental health interventions.

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Peer Services for Young Adults Workgroup

The workgroup is planning on meeting monthly to focus on leveraging current opportunities for peer supports in EIP and other organizations that could benefit from peer support.  If you’re interested in joining the peer-involvement workgroup, please contact Melanie Bennett. 

Access the original peer-support for FEP guidance manual developed by Dr. Jones.

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As always, don't forget about Maryland EIP's four services to support individuals, families, and professionals who may encounter early psychosis:

1. Outreach and Education Services – To behavioral health providers, schools, primary care settings, and consumer organizations. For more information or to schedule a presentation to your organization, contact Eryn Bentley.
    
2. Clinical Services – For 12-30-year-olds who present with clinical high risk symptoms that may be predictive of future psychosis, who have early signs of psychosis, or are in the initial stages of psychoses. Services include the Strive for Wellness Clinic, the MPRC First Episode Clinic (FEC), and the Division of Community Psychiatry’s RAISE Connection Program. The Maryland Early Intervention Program Network currently provides services via two Early Intervention Teams: Johns Hopkins Early Psychosis Intervention Clinic (EPIC) & OnTrack Maryland at Family Services, Inc.
    
3. Consultation Services – To providers regarding identification and treatment for individuals that may be experiencing symptoms that may be predictive of future psychosis, who have early signs of psychosis, or are in the initial stages of psychoses.
    
4. Training and Implementation Support Services – Will establish Early Intervention Teams (EITs) throughout the state and create a learning collaborative so that EITs and others providing services to those with early psychosis can collaborate, share resources, and provide support and coordination of service delivery.

All EIP initiatives may be contacted through our toll free number (1-877-277-MEIP) or e-mail (info@MarylandEIP.com). A trained specialist is available to guide you toward the appropriate services. For more information on accessing services offered through the EIP, visit www.MarylandEIP.com.