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The Arizona Plan is based on the goals of the U.S. Surgeon General=s National Strategy for Suicide Prevention: Goals and Objectives for Action (2001), with objectives and additional recommendations modified for Arizona. Priority areas from the ADHS planning committee process for implementation in Arizona are noted in bold.

Goal 1: Promote Awareness that Suicide is a Public Health Problem that is Preventable

Objective 1: Develop a public education campaign.

Increase education and awareness of the scope of the suicide problem in Arizona and promote cooperation and collaboration with the general public to address the problem.

Objective 2: Sponsoring a state conference and participate in national conferences on suicide and suicide prevention.

Objective 3: Organize special-issue forums.

Objective 4: Disseminate information through the internet.

Goal 2: Develop Broad-Based Support for Suicide Prevention

Objective 1: Organize a statewide interagency committee to improve coordination and to ensure implementation of the National Strategy and Arizona Priorities Plan.

Objective 2: Establish public/private partnerships dedicated to implementing the National Strategy and the Arizona Priorities for Suicide Prevention Plan.

Develop and strengthen collaborative relationships (schools, employers, clergy, legislators, government, etc.) to promote necessary policy change and expand funding and other community resources for suicide prevention.

Objective 3: Increase the number of professional, volunteer and other groups that integrate suicide prevention activities into their ongoing activities.

Objective 4: Increase the number of faith communities that adopt policies designed to prevent suicide.

Goal 3: Develop and Implement Strategies to Reduce the Stigma Associated with Being a Consumer of Mental Health, Substance Abuse and Suicide Prevention Services

Objective 1: Increase the number of suicidal persons with underlying mental disorders who receive appropriate mental health treatment.

Increase the number of persons who receive mental health and substance abuse treatment by reducing barriers to care for people who are at risk. Ensure immediate linkage to treatment for individuals who attempt suicide. Develop treatment planning guidelines and procedures for attempters and their peers/family members.

Objective 2: Transform public attitudes to view mental health and substance abuse use disorders as real illness, equal to physical illness, that respond to specific treatments and to view persons who obtain treatment as pursuing basic health care.

Create opportunities to educate and reduce stigma around mental health, substance abuse, and suicidal behavior and seeking help for problems.

Goal 4: Develop and Implement Community-Based Suicide Prevention Programs

Objective 1: Increase the proportion of counties and communities with comprehensive suicide prevention plans.

Objective 2: Increase the number of evidence-based suicide prevention programs in schools, colleges and universities, work sites, correctional institutions, aging programs, and family youth and community service programs.

Work with communities, using a risk and protective factor framework, to increase the number of evidence-based suicide prevention programs addressing general and targeted populations within Arizona=s communities.

Objective 3: Develop technical support centers to build capacity across the State to implement and evaluate suicide prevention programs.

Develop a technical support center for training para professionals and gatekeepers in suicide risk assessment, crisis intervention and addressing the needs of attempters and survivors.

Goal 5: Promote Efforts to Reduce Access to Lethal Means and Methods of Self-Harm

Objective 1: Educate health care providers and health and safety officials on the assessment of lethal means in the home and actions to reduce suicide risk.

Objective 2: Implement a public information campaign designed to reduce accessibility to lethal means.

Design one or more community-level education campaigns targeting accessibility to lethal means.

Objective 3: Improve firearm safety and establish safer methods for dispensing potentially lethal quantities of medications and seeking methods for reducing carbon monoxide poisoning from automobile exhaust systems.

Objective 4: Supporting the discovery of new technologies to prevent suicide.

Goal 6: Implement Training for Recognition of At-Risk Behavior and Delivery of Effective Treatment

Objective 1: Improve education for nurses, physician assistants, physicians, social workers, psychologists and other counselors.

Develop professional education and training for healthcare, law enforcement, emergency medical services, fire, and emergency response teams on effective intervention and management of depression and other mental health and substance use disorders. Provide physician and medical professional training in undiagnosed depression, mental health, substance use disorders, and suicide risk and responding to suicide attempters, including an understanding of psychosocial development over the life span and its relationship to the suicide attempt.

Objective 2: Provide training for clergy, teachers and other educational staff, correctional workers, and attorneys on how to identify and respond to persons at risk for suicide.

Design training for key community gatekeepers on identifying and responding to depression and other mental health and substance abuse disorders within their target populations, including management of suicide attempters and assessing risk in grieving family members. Objective 3: Provide educational programs for family members of persons at elevated risk.

Support family members of persons at elevated risk through community education addressing recognition of risk behaviors, undiagnosed depression and other mental health and substance abuse disorders.

Goal 7: Develop and Promote Effective Clinical and Professional Practices

Objective 1: Change procedures and/or policies in target settings, including hospital emergency departments, substance abuse treatment centers, specialty mental health treatment centers, and other institutions, to improve assessment of suicide risk.

Implement training in effective risk assessment and evidence-based treatment to improve identification and management of patients at risk and to improve the overall quality of mental health and substance abuse services. Develop protocols for monitoring current clients during key transitions, including changes in medication use, follow-up on discharge from hospital settings and observation during periods of family stress. Design incentives for providers to deliver evidence-based models of treatment, including culturally appropriate programming.

Objective 2: Incorporate Suicide Risk Screening in Primary Care.

Increase the proportion of physicians that conduct depression, substance abuse and suicide risk screening during routine primary care.

Objective 3: Ensure that individuals who typically provide services to suicide survivors have been trained to understand and respond appropriately to their unique needs (e.g., emergency medical technicians, firefighters, police, funeral directors).

Develop statewide medical guidelines and practice protocols for managing suicide attempts, including responding to survivors, peers and family members in the hours and days immediately following a suicide event.

Objective 4: Increase the number of persons with mood disorders who receive and maintain treatment.

Objective 5: Ensure that persons treated for trauma, sexual assault, or physical abuse in emergency departments receive mental health services.

Objective 6: Foster the education of family members and significant others of persons receiving care for the treatment of mental health and substance abuse disorders with risk of suicide.

Objective 7: Develop and/or enhance existing crisis response systems.

Enhance coordination and data-sharing across multiple crisis systems in order to improve response times and the appropriateness of emergency interventions. Improve consistency between federal, state and local policy on responding to suicide events, with a particular focus on reducing criminalization and stigma associated with court-ordered evaluation and treatment. Develop mechanisms for routine meetings and coordination between local first responder networks, including emergency medical services, fire and police, tribal agencies and ADHS contractors (e.g., Regional Behavioral Health Authorities and County Public Health Departments) to ensure locally coordinated suicide crisis response planning.

Goal 8: Improve Access to and Community Linkages with Mental Health and Substance Abuse Services

Objective 1: Require health insurance plans to cover mental health and substance abuse care on a par with coverage for physical health care.

Increase availability of mental health and substance abuse coverage and funding through parity initiatives. Reimburse innovative treatments with proven effectiveness, including formularies.

Objective 2: Implement utilization management guidelines for suicidal risk in managed care and insurance plans.

Enhance quality and utilization management guidelines to specifically address suicidal risk in managed care and insurance plans.

Objective 3: Integrate behavioral health and suicide prevention into health and social services outreach programs for at-risk populations.

Increase understanding and recognition of cultural beliefs that hinder access to care and design outreach programs to reduce suicide contagion through culturally appropriate programming.

Objective 4: Define and implement screening guidelines for schools, colleges, and correctional institutions, along with guidelines on linkages with service providers.

Develop clinically appropriate screening and assessment tools and referral protocols for community institutions to ensure routine access to primary and specialized health care. Ensure continuity during transitions between institutions and the community, including special support service referrals.

Objective 5: Implement support programs for persons who have survived the suicide of someone close.

Expand the base of specialized community services available for suicide survivors and other grieving peers and family members.

Goal 9: Improve Reporting and Portrayals of Suicidal Behavior, Mental Illness, and Substance Abuse in the Entertainment and News Media

Objective 1: Establish a public/private group designed to promote the responsible representation of suicidal behaviors and mental illness in media.

Establish media guidelines for portrayal of suicidal behavior, including a media event team to promote responsible representation of suicide.

Objective 2: Increase the number of news reports that observe recommended guidelines in the depiction of suicide and mental illness.

Objective 3: Increase the number of journalism schools that adequately address reporting of mental illness and suicide in their curricula.

Goal 10: Promote and Support Research on Suicide and Suicide Prevention

Objective 1: Develop a statewide suicide research agenda.

Perform a literature review to identify evidence-based prevention and intervention models. Conduct a cross-agency review of programs in Arizona. Identify federal initiatives in Arizona addressing clinical trials of medication effectiveness, culturally appropriate models, genetics and biological research and other preventive interventions.

Objective 2: Increase funds for suicide prevention research.

Objective 3: Evaluating preventive interventions.

Assess the level and rigor of evaluation in existing prevention and intervention programs. Develop mechanisms for promoting research to practice.

Objective 4: Establish a registry of interventions with demonstrated effectiveness for prevention of suicide or suicidal behavior.

Develop a public access registry of effective models. Design a statewide training, continuing education and certification system for practitioners.

Goal 11: Improve and Expand Surveillance Systems

Objective 1: Develop and implement standardized protocols for death scene investigations.

Improve data collection through the development of standardized protocols for investigating unsuccessful and completed attempts.

Objective 2: Increase the number of follow-back studies of suicide.

Objective 3: Increase the number of hospitals that code for external cause of injuries.

Objective 4: Increase the number of nationally representative surveys with questions on suicidal behavior.

Collect and analyze data from survey instruments with items related to suicide, such as the Youth Risk Behavior Survey.

Objective 5: Implement a violent death reporting system that includes suicide.

Create standard codes, terminology and protocols in death registries and increase the number of hospitals that code for external cause of injuries.

Objective 6: Produce an annual report on suicide.

Review data, identify gaps in services and supports and improve Management Information Systems through the development of appropriate methods to track suicide attempts and completions. Publish an annual report including current suicide surveillance data and epidemiologic analysis.

Objective 7: Support pilot projects to link and analyze information on self-destructive behavior from various, distinct data systems.

Profile at-risk persons and /populations, including American Indians, Hispanic/Latinos, the elderly, adolescents, gay/lesbian/bi-sexual persons, females and residents of rural communities. Utilize data to trend suicide events across multiple first response and reporting systems. Develop data matching protocols for linking data in multiple state, county and local databases, including hospital discharges, emergency rooms, behavioral health providers, health plans, and other service agencies.