ED-SAFE: A Study in Suicide Intervention
Original study by Edwin Boudreaux, Carlos A. Camargo, Ivan Miller, & “the ED-SAFE investigators.”
As we continue to learn from home during this strange fall semester, The NAN Project brings to you a quick bit of suicide prevention science.
The ED-SAFE study, published in 2018 by the Massachusetts Department of Mental Health, echoes some truths about suicide prevention that The NAN Project brings to high school classrooms: 1) the first step in suicide prevention is detecting risk; 2) persistence is the key to supporting a person at risk; and, 3) intervention led by the person at risk is most successful.
ED-SAFE began in 2009 in response to a critical need for a suicide risk screener for patients in emergency departments. Suicide is the tenth leading cause of death in the United States, with one million people per year attempting suicide. Many individuals at risk for suicide are seen in emergency departments (“EDs”) for unrelated concerns. The ED-SAFE team argues that these are underutilized opportunities for suicide risk screening, and that to prevent suicide, ED-based screening and intervention for suicide risk must be developed. ED-SAFE aimed to test an intervention in which emergency departments screen for suicide risk using a standardized test, and initiate follow-up telephone contact with individuals who screened positive.
1,376 adult ED patients were enrolled in this three-phase study, the third of which produced the most enlightening results. Phase three had testing sites implement a three-component intervention for patients who tested positive for suicide risk: first, a second screening to determine the level of risk; next, a personalized safety plan, with a guide to local outpatient mental health resources; and lastly, a series of phone calls to the patient by trained mental health advisors for a full year following the initial ED visit.
It should be noted that treatment was not assigned to the patients (beyond check-in calls), nor were they pressured to comply with a treatment they had no part in developing – it was the patients’ decision to reach out for help using the provided resources. We know that it empowers the struggling person to lead their intervention, and that they are more likely to stick with a treatment they initiated.
Results of ED-SAFE’s phase 3 showed that universal suicide risk screening within emergency departments almost doubled suicide risk detection. We know that identifying a person at risk for suicide is the first step in preventing suicide. The NAN Project teaches “signs of suicide” in our classroom presentations and professional development workshops, enabling young people and the adults in their lives to recognize these signs in their loved ones. ED-SAFE also found that the multifaceted, long-term suicide prevention invervention tested in phase 3 reduced suicidal behavior in patients by thirty percent. Persistence is key when supporting someone struggling with thoughts of suicide: this communicates to them that we care. The NAN Project highlights this in our QPR suicide prevention training, in which we encourage participants to ask a struggling person “the question” – namely, are they thinking of suicide – and to be sure that they follow up later on.
The results of ED-SAFE demonstrate that a multi-component, persistent, patient-led suicide intervention is most successful. The research team predicts that their efforts will inform and accelerate the adoption of best practices for suicide prevention across diverse health settings, which would save countless patient lives.
The official Psychiatry Issue Brief on The ED-SAFE study can be found here.
As we work to become better supports to ourselves and the people in our lives, let us keep these findings in mind. And remember that there is help, and there is hope!
A Different Kind of Summer with The NAN Project
While COVID may have slowed down many industries and left folks physically isolated, The NAN Project and our Peer Mentors kept hard at work and socially connected all summer! One of our major initiatives during the typically slower, sunny months of school vacation was our 2020 Senior Peer Mentor Training! The goal of these 8 weeks of workshops was to support our Peer Mentors, while also keeping them active and engaged, and prepping them for what was sure to be a very different school year ahead. It was also an opportunity to provide educational development to our incredible young adults by bringing in an array of outstanding guest speakers that helped us all build skills for use both at work and in our everyday lives. We invited a different guest speaker to each Wednesday of our two month training to talk about different topics related to mental health, social justice, emotional intelligence and much more!
Two of the outstanding presenters were current and former NAN Project staff – Rachely and Greta! Both covered different therapeutic methods that our Peers might find helpful in their recovery, and can also teach others about. Rachely introduced us to Wellness Recovery Action Plans (WRAP), and covered how to identify stressors, create a wellness toolbox, and develop a daily plan to maintain strong mental health. Greta educated us about Internal Family Systems Therapy (IFST), a type of therapy that looks at ourselves as different parts, and focuses on healing the wounded parts as a part of recovery. Learning about IFST helped our Peers think about their own recovery in different ways.
We also invited Jon Mattelman to present about anxiety, specifically, what it can look like in middle and high schoolers and how to support them if they are struggling. This was valuable because we work with young adults and knowing more about how they can experience anxiety will help us get them to the support they need.
Additionally, we had speakers talk about topics that were relevant to the pandemic and current events. We had Hannah, a grad student from Salem Statem, present a workshop titled “Beyond the Rectangle,” which covered what Peers can do to feel alive and happy during a virtual presentation (skills just about everybody can use these days). Thinking about self-care activities that they can do before, during, and after a virtual presentation will help our Peers approach their work in a way that feels rewarding and prioritizes their mental health. We also had Maryanne, a longtime friend from the Department of Mental Health’s YouForward in Lawrence, present a social justice training with the help of our Senior Peer Coordinator, Lizzie, and our Peer Coordinator, Shilpa. They spoke about how COVID-19 affects Black people disproportionately in what is called the Double Pandemic, what systemic racism is, and how to be a better ally to people of color. We had a really engaging group discussion with our Peers and they had many personal experiences to share.
In light of this pandemic, the importance of developing emotional intelligence and strength is important now more than ever. We brought in inspirational speaker Kurt Faustin to introduce us to the concept of emotional intelligence through a training titled “Learning the Ingredients to Become a Better You”. This covered the importance of how developing a supportive community and helpful coping skills can affect our lives positively and help us develop emotional intelligence. Our Peers really enjoyed Kurt’s enthusiasm and we look forward to having him back!
Another important piece of the training was our weekly small group work, where we created projects for Suicide Prevention Week. Each of the four groups did a wonderful job producing very unique ways of promoting mental health education and suicide prevention. Our first group focused on the importance of a trusted adult, and our Peer Mentor, Margaret, created a story about how a trusted adult impacted her life. Group two decided to examine how mental health is portrayed in the media and we will be posting their reviews on our social media in the coming week. Group Hope! created inspirational social media posts and a personal story about mental health and recovery, and our fourth group made beautiful artwork to raise awareness for suicide prevention. We are so grateful to our Peer Mentors for all of their creativity, hard work, and commitment. Make sure to keep a lookout on our social media over the next week so you can see all of their amazing content!
Watch 13 Reasons Why We Need to Talk about Suicide
13 Reasons Why We Need to Talk about Suicide is a movie project that came about in response to the Netflix series. In mid-2017, teachers in many of the schools we work in started asking us how to address this series, which many of their students were talking about. It was a double edged sword. On the one hand, it opened up the topic of suicide to a huge segment of the population where previously it had been such a taboo subject. However, after watching the series, we had a couple major issues, which I’m sure many of you had as well.
First, we felt they sensationalized and almost glorified Hannah’s suicide by giving her a voice after her death. This is an extremely unsafe portrayal which could lead a young person who may be struggling with any number of risk factors –bullying, depression, sexual assault – to think that suicide could be a viable solution to their problems, or worse, a way to be remembered or means of “getting back” at their classmates. For a kid in or near crisis, this show could be both upsetting and dangerous.
Second, the series barely touches on the mental health issues that around 90% of people who die by suicide are struggling with. The show implied that those around her were guilty of her suicide, when we know that it is the individual themselves that makes the decision to end their life. The fact that Hannah’s mental health was barely mentioned reinforced the feeling that there is little hope for a young person who may struggling with a mental health concern in conjunction with the other traumas she endured. Yet we know, mental health is treatable, and suicide is preventable. This series did not impart this message to us and we wanted to change that.
Finally, the series painted an incredibly bleak picture of the supports a young person can turn to in times of need. Guidance counselors
were unhelpful, at best. Parents didn’t understand and were reluctant to broach some difficult topics. Friends were flaky and offered bad advice. We want to show that in reality, there are many supports you can turn to if you are concerned for yourself or a peer. You’ll notice that within, or at the end of each of the 13 vignettes, there is a support listed (hotlines, coping skills, individuals), and we hope that young people will gain an understanding of the vast array of resources you can reach out to within your school or community.
More importantly, the final vignette outlines in 3 clear steps, on how to respond to a peer in crisis. If students, young people or anyone who views this takes just one thing away from this film, we hope it’s the empowerment to reach out to a friend in crisis and 1) Ask them directly, “are you ok” “are you thinking about suicide?” 2) Step back and listen and validate what they are going through, and 3) Get that person to a trusted adult or support.
So about the process of making a movie.
The vignettes were designed over the last 9 or so months with input and feedback from our amazing Peer Mentors, as well as the peer leadership teams we work with at Stoneham and Andover High Schools. A variety of different formats were used in an attempt to reflect the different ideas our peer mentors had. Some, such as one where a young man comes out as gay to his family used actors; some were silent and focused on stats; others were based on the Peer Mentors’ own lived experience. We hope the variety adds to the experience.
Finally, I’d like to thank the organizations that provide the support that allowed us to create this project, including DPH, DMH, Cummings Foundation and Eliot Community Human Services. I’d also like to thank Dan Perez for his amazing work directing, scripting and a million other things he did to prepare this work that you are about to see. There is no way we could have done this without him. Most importantly, I’d like to thank all of our Peer Mentors and Peer Leaders who acted in and helped direct, edit and pull together this movie. They are the core of The NAN Project and we wouldn’t be here without them.
We hope you find this film educational and more importantly, useful, in your work with young people. We’d love to hear your feedback and how you’d use this tool effectively when working with students. Enjoy!